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Biomedical subjects

D B Kearns

Publications and source records attributed to D B Kearns.

At least 37 records · Page 2Linked to original sources
PubMed1996

One-stage tracheal reconstruction of congenital tracheal stenosis.

Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.

Airway Obstruction↗
PubMed1996

Nager acrofacial dysostosis: management of a difficult airway.

Nager acrofacial dysostosis, first described by Nager and deReynier in 1948, is a rare syndrome characterized by mandibulofacial dysostosis with associated radial defects. The facial features include downward slanting palpebral fissures, absent eyelashes in the medial third of the lower lids, mandibular and malar hypoplasia, dysplastic ears with conductive deafness, and variable degrees of palatal clefting. Upper limb malformation is a constant feature of Nager syndrome and ranges from thumb hypoplasia to absence of the radial ray. The maxillo-mandibular hypoplasia and associated retroplaced tongue set the stage for early and significant upper airway obstruction. The craniofacial anomalies and associated trismus make emergent airway intubation challenging. We present a case of Nager syndrome with life threatening airway obstruction unresponsive to conservative management. This case and a review of the literature emphasize the importance of early tracheotomy for these patients.

Abnormalities, Multiple↗
PubMed1995

Respiratory distress in the neonate. Sequela of a congenital dacryocystocele.

Congenital dacryocystoceles presenting with intranasal extension may precipitate respiratory distress in neonates. Twenty-one children have been described as having congenital dacryocystoceles with intranasal extension, and, of these, 14 had respiratory distress. We present a series of patients with congenital dacryocystoceles who presented with ranging degrees of respiratory distress. Magnetic resonance imaging and computed tomographic scans confirmed the diagnosis. In all cases, the endonasal portion of the cyst was marsupialized endoscopically with complete resolution of symptoms. Pertinent embryology, anatomy, clinical presentation, and treatment are discussed.

Apgar Score↗
PubMed1995

Regulation of the lactose phosphotransferase system of Streptococcus bovis by glucose: independence of inducer exclusion and expulsion mechanisms.

Streptococcus bovis had a diauxic pattern of glucose and lactose utilization, and both of these sugars were transported by the sugar phosphotransferase system (PTS). Lactose catabolism was inducible, and S. bovis used the tagatose pathway to ferment lactose. Since a mutant that was deficient in glucose PTS activity transported lactose as fast as the wild-type, it appeared that S. bovis has separate enzyme IIs for glucose and lactose. The nonmetabolizable glucose analogue 2-deoxyglucose (2-DG) was a noncompetitive inhibitor of methyl beta-D-thiogalactopyranoside (TMG) transport, and cells that were provided with either glucose or 2-DG were unable to transport TMG or lactose. Because the glucose-PTS-deficient mutant could ferment glucose, but could not exclude TMG, it appeared that enzyme IIGlc rather than glucose catabolism per se was the critical feature of inducer exclusion. Cells that had accumulated TMG as TMG 6-phosphate expelled free TMG when glucose was added, but 2-DG was unable to cause TMG expulsion. The glucose-PTS-deficient mutant could still expel TMG in the presence of exogenous glucose. Membrane vesicles also exhibited glucose-dependent TMG exclusion and TMG expulsion. Membrane vesicles that were electroporated with phosphoenolpyruvate (PEP) and HPr retained TMG for more than 3 min, but vesicles that were electroporated with PEP plus HPr and fructose 1,6-diphosphate (FDP) (or glycerate 2-phosphate) lost their ability to retain TMG. Because FDP was able to trigger the ATP-dependent phosphorylation of HPr, it appeared that inducer expulsion was mediated by an FDP-activated protein kinase.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Proteins↗
PubMed1993

Neonatal otitis media. An update.

Neonatal otitis media may be an isolated infection or part of a more complex sepsis syndrome. Because early studies suggested that the microbiologic characteristics of neonatal otitis media included a high risk of gram-negative coliforms and Staphylococcus aureus, tympanocentesis was recommended routinely. Subsequent studies have supported empiric medical therapy in selected patients, reserving tympanocentesis for patients in whom medical treatment fails. Because of these conflicting recommendations, records from 37 neonates with otitis media who underwent tympanocentesis from 1986 through 1991 were studied retrospectively. Cultures in one outpatient (11%) and four inpatients (13%) yielded Escherichia coli, all of which were sensitive to amoxicillin. No cultures of S aureus were identified. Sterile cultures and pneumococcus isolates were found most frequently. No septic or intracranial complications were noted. All patients were discharged on regimens of routine antibiotics for otitis media.

Anti-Bacterial Agents↗
PubMed1993

Bilateral congenital cholesteatomas.

Congenital cholesteatoma is a rare entity. Bilateral involvement is rarer still. We present the sixth case of bilateral congenital cholesteatoma and briefly review the theories regarding the origin of congenital cholesteatoma. The lesion in the left ear was seen on physical examination, however the lesion in the right ear was detected only on a computed tomography (CT) scan, which was obtained to assess the extent of the disease on the left side. Although usually asymptomatic, these cholesteatomas can enlarge and lead to complications. Management of congenital cholesteatoma by various surgical approaches is discussed.

Child, Preschool↗
PubMed1992

Candida laryngotracheitis: a complication of combined steroid and antibiotic usage in croup.

The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

Amphotericin B↗
PubMed1992

Tongue gastric choristoma: failure to localize by technetium-99m pertechnetate scan.

Congenital rests of gastric epithelium have been reported in a variety of head and neck locations. Presenting symptoms of these lesions range from an asymptomatic cyst to one which is compromising the airway. The true diagnosis is rarely suspected prior to excision. A case of a gastric choristoma of the tongue is presented which was noted at birth as an intermittently bleeding ulcer. Complete excision of the mass was difficult to ascertain due to poor delineation of the tumor margins from the tongue musculature. A postoperative technetium-99m pertechnetate scan failed to demonstrate residual gastric mucosa. Conservative management resulted in only transient healing of the ulcer. Repeat excision demonstrated abundant residual gastric mucosa. Technetium-99m pertechnetate scanning may not be a reliable indicator of ectopic gastric mucosa in the head and neck region.

Choristoma↗
PubMed1992

Pediatric airway manifestations of gastroesophageal reflux.

Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.

Airway Obstruction↗
PubMed1991

One-stage laryngotracheoplasty.

This article documents the evolution of our approach to the repair of subglottic stenosis in infants. With increasing experience in the management of subglottic stenosis using the anterior cricoid split procedure, we extended our procedure to include older children. This then led to the use of the one-stage procedure for repair of severe and mature subglottic stenosis. We present the results of surgical repair in 13 patients. Extubation was accomplished in 12 of 13 patients using one-stage laryngotracheoplasty.

Child↗
PubMed1991

The prognostic value of endotracheal tube-air leak following tracheal surgery in children.

In an effort to determine if the endotracheal tube-leak pressure has prognostic value in relation to a successful outcome after one-stage laryngotracheal reconstruction or cricoid split surgery, a retrospective analysis was performed on 17 children who had undergone such surgery. The daily leak pressures, length of intubation, and ultimate outcome of attempts at extubation were noted. One hundred percent of patients with a leak pressure of less than 20 cm H2O on the day before extubation were successfully extubated. In contrast, the failure rate was 100% in children extubated with a leak of greater than 30 mm H2O. The difference between these two groups was statistically significant (chi 2, 13.03). Sixty percent of patients with leak pressures in the range of 21 to 30 cm H2O were successfully extubated. The endotracheal tube-leak pressure is a parameter that has prognostic value, and should be considered in determining when to extubate children who have undergone tracheal reconstructive surgery.

Airway Obstruction↗
PubMed1991

Actinomycosis in obstructive tonsillar hypertrophy and recurrent tonsillitis.

A quantitative analysis of adenoid and tonsillar specimens from 460 patients was performed. The patients underwent tonsillectomy or adenotonsillectomy for either recurrent tonsillitis or obstructive tonsillar hypertrophy. Histologic preparations revealed Actinomycetes as statistically more prevalent in the obstructive population. The presence of Actinomycetes in the adenotonsillar core of this diagnostic group may indicate an etiologic role for this organism in tonsillar and adenoidal hypertrophy.

Actinomycosis↗
PubMed1991

The open surgical approach to subglottic hemangioma.

The management of subglottic hemangioma in infants remains controversial. We report two patients in whom an open surgical approach was utilized to completely excise the subglottic hemangioma. Both children have been successfully extubated and have remained symptom-free since that time.

Child, Preschool↗
PubMed1991

Closure of the soft palate for persistent otorrhea after placement of pressure equalization tubes in cleft palate infants.

Four case reports of infants with cleft palate and intractable otorrhea following the placement of pressure equalization tubes are presented. In one patient, liquids taken orally were noted to reflux through her ears. Otorrhea was refractory to medical management in all cases and was controlled only after closure of the soft palate. Persistent otorrhea may be an indication for early closure of the soft palate in these infants.

Cleft Palate↗