Biomedical subjects

E M Friedman

Publications and source records attributed to E M Friedman.

64 records · Page 4Linked to original sources

PubMedDate not supplied

Intracranial complications of sinusitis in children. A sequela of periapical abscess.

The cases of two children with periapical abscess in the upper incisors, sinusitis, and intracranial abscess are described. The ethmoid and maxillary sinuses were involved in both patients. Subdural empyema occurred in both, and one of the children had also cerebritis and brain abscess. Anaerobic bacteria were isolated from the infected subdural empyemas. Peptostreptococcus intermedius and microaerophilic streptococci were recovered in one patient and Fusobacterium sp in the other. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in both patients. The role of anaerobic bacteria and the therapy directed against them in periapical abscess and the sinusitis and intracranial abscess which follow are discussed.

Brain Abscess↗

PubMedDate not supplied

Carbon dioxide laser in subglottic hemangioma. An update.

Congenital subglottic hemangioma is a potentially life-threatening lesion which frequently presents before the age of 6 months. Many forms of therapy have been advocated for the treatment of this difficult lesion. The use of the carbon dioxide laser has been advocated in the past and this report represents an update in treating 31 patients from 1975 to 1983. The success rate was 94% and the complication rate was 6.5%. This form of therapy is an effective and valuable addition to those already available for this troublesome lesion.

Carbon Dioxide↗

PubMedDate not supplied

Pediatric endoscopy: a review of 616 cases.

Congenital and acquired lesions of the pediatric airway may lead to significant morbidity and mortality. A review of 616 endoscopic procedures, carried out over a 2-year period, was undertaken. Of these procedures, 270 were diagnostic and 346 were therapeutic. This paper outlines the clinical indications, the role of radiology, and the diagnoses revealed by this retrospective review. Of particular interest was the fact that 11.5% of the patients had lesions in more than one anatomic site in the upper aerodigestive tract. The complications were divided into intraoperative, immediate postoperative, and delayed. In total, there was a 1.6% complication rate.

Adolescent↗

PubMedDate not supplied

Supraglottitis and concurrent Hemophilus meningitis.

Acute epiglottitis is a true pediatric emergency. The intense inflammation of the supraglottic larynx may completely obstruct the larynx within several hours. This infection is secondary to infiltration of Hemophilus influenzae type b (HIB), and 90% to 95% of patients have positive blood cultures. During this period of generalized septicemia HIB involvement of other soft tissue sites may occur. The goal of this article is to alert otolaryngologists to the possibility of extraepiglottitic HIB involvement. In particular, HIB meningitis, concurrent with supraglottitis, will be discussed. Although the overall incidence of multiple site involvement is relatively low, it is important to be aware of the possibility, since the outcome may be significantly altered.

Acute Disease↗

PubMedDate not supplied

Benign lesions of the nose, oral cavity, and oropharynx in children: excision by carbon dioxide laser.

The carbon dioxide laser was used to treat a group of pediatric patients with benign lesions of the upper aerodigestive tract exclusive of the larynx. Prior to development of the CO2 laser, excision of these lesions by conventional means often resulted in incomplete removal, significant bleeding, and postoperative edema resulting in airway obstruction. The CO2 laser, with its unique properties of precise excision, hemostatic effect, and minimal postoperative edema, has become the instrument of choice in the removal of these lesions.

Adolescent↗

PubMedDate not supplied

Nasal and paranasal sinus surgery in children with cystic fibrosis.

Cystic fibrosis (mucoviscidosis; fibrocystic disease of the pancreas) is an inherited autosomal recessive disorder that results in generalized dysfunction of exocrine glands. Chronic pansinusitis with nasal polyposis occurs frequently in this disease. Polypectomy and sinus drainage procedures are often required in those cases refractory to medical therapy. Recurrence of nasal polyps following removal is common. Controversy exists regarding the timing and extent of surgery. The management of 40 children with cystic fibrosis who underwent nasal polypectomy, intranasal ethmoidectomy, and Caldwell-Luc procedures to treat extensive sinusitis and nasal polyposis forms the basis for this report. Follow-up data indicate that fewer recurrences and longer symptom-free intervals result when intranasal ethmoidectomy and Caldwell-Luc procedures are combined with polypectomy.

Child↗

PubMedDate not supplied

Caustic ingestions and foreign body aspirations: an overlooked form of child abuse.

Caustic ingestions and foreign body aspirations are common occurrences in the pediatric population. The high association between caustic ingestions and foreign body aspirations and family stress with social problems may result in significant morbidity and mortality. It is the purpose of this article to increase physician awareness concerning the possibility that these events may be a form of child abuse. It is hoped that by recognizing the risk of child abuse in these cases the physician can make the appropriate referrals in order to avoid serious injury to the child.

Child↗

PubMedDate not supplied

Airway management of acute supraglottitis at the Children's Hospital, Boston: 1980-1985.

A controversy has existed in recent years regarding the ideal method of establishing and maintaining an airway in the pediatric patient with acute supraglottitis. Nasotracheal intubation has been used as the sole method of airway management of acute supraglottitis at The Children's Hospital, Boston, since 1970. This paper reviews our experience with 80 children with acute supraglottitis presenting at our institution during the years 1980 to 1985.

Acute Disease↗

PubMedDate not supplied

Paranasal sinus development in chronic sinusitis, cystic fibrosis, and normal comparison population: a computerized tomography correlation study.

Chronic sinus disease in patients with and without cystic fibrosis may have an impact on the pattern of paranasal sinus pneumatization. Arrest of pneumatization has been reported in both of these conditions. To assess the development of the paranasal sinuses in relationship to chronic sinusitis and cystic fibrosis (CF), a retrospective review of coronal CT scans of the age-matched patients with no previous sinus disease, patients with chronic sinusitis, and cystic fibrosis patients was conducted. The patients' ages ranged from 4 to 17 years. The maxillary sinus volume, anteroposterior diameter, and greatest transverse diameter and height were determined using image analysis software after the coronal CT scans were scanned into Macintosh computer. The size of the maxillary sinus increased with advancing age in the control and chronic sinusitis group, but not in the patients with cystic fibrosis. The patients with cystic fibrosis had a statistically significant smaller maxillary sinus size. Approximately 50% of the patients with chronic sinusitis had anatomic anomalies, the most common being paradoxical middle turbinates. The CT scans of CF patients were characterized by uncinate process demineralization and medial displacement of the lateral nasal wall in the middle meatus, and decreased maxillary sinus pneumatization.

Adolescent↗

PubMedDate not supplied

Intracranial complications of sinusitis: a pediatric series.

Intracranial complications of sinusitis (ICS) (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and contemporary topic. The progressive pneumatization and continued development of the sinuses after birth and the late appearance of the frontal and sphenoid sinuses imply that some infections would not appear until later childhood. We reviewed the records at a large pediatric hospital between 1986 and 1995 and found 10 children with 13 ICS (cerebral abscess, 5; extra-axial empyema, 5; and meningitis, 3). Of 43 children with cerebral abscess and 16 with extra-axial abscesses treated in this period, 12% of cerebral and 63% of extra axial abscesses were due to a sinogenic source. Multiple intracranial and extracranial complications of sinusitis in a single patient were common. The average age of children with ICS was 12.2 years old. We present these 10 cases and discuss their presentation, microbiology, and clinical course. Although the majority presented with a classic picture of headache, altered mental status, and fever, a few had symptoms that were more subtle. One child had recurrent meningitis, believed to be due to skull base dehiscence after endoscopic sinus surgery (ESS). He has required multiple otolaryngologic and neurosurgical procedures in an effort to prevent further episodes of meningitis. Ultimately, nine of 10 patients survived with an average hospital stay of 27.8 days (median of 17 days). The diagnosis of ICS requires a high index of suspicion, imaging of the brain and paranasal sinuses, and aggressive intervention.

Adolescent↗