Search PubMed⌕ Search

Biomedical subjects

L W Tom

Publications and source records attributed to L W Tom.

At least 37 records · Page 2Linked to original sources
PubMed1992

Is outpatient tonsillectomy appropriate for young children?

The current literature suggests that outpatient tonsillectomy is a safe, cost-effective procedure. These reports have based their conclusions on the low rates of postoperative bleeding and dehydration. Generally, they have not examined other factors that may influence the postoperative course or identified groups of patients in whom outpatient management may not be appropriate. The literature regarding tonsillectomy in young children is conflicting. A retrospective analysis of the records of 223 children, 36 months of age and younger who had tonsillectomies, was performed. Postoperative airway complications including oxygen desaturation and airway obstruction developed in 115 patients. Seventeen (7.6%) children required postoperative care in an intensive care unit while an additional 117 (52.5%) patients received more than standard management. Preoperative apnea, an age of less than 12 months, and the presence of accompanying medical conditions were associated with a higher incidence of postoperative airway complications. It is recommended that tonsillectomy in patients under 36 months of age be planned as an inpatient procedure.

Age Factors↗
PubMed1992

Nasopharyngeal malignancies in children.

A retrospective analysis identified 29 children with nasopharyngeal malignancies who were evaluated at the Children's Hospital of Philadelphia from 1970 through 1989. Rhabdomyosarcoma (15) and carcinoma (9) were the most common tumor types, and there were distinct differences in the clinical presentations of these two malignancies. Patients with rhabdomyosarcoma were generally younger than those with carcinoma and enjoyed longer survival. Six (67%) of the children with carcinoma were black; all of the patients with rhabdomyosarcoma were white. Patients with carcinoma were also more likely to present with cervical metastases. The presentation, evaluation, and methods of treatment for pediatric nasopharyngeal malignancies are discussed.

Adolescent↗
PubMed1992

Recurrent meningitis and a congenital perilymph fistula.

In any child with recurrent meningitis, the presence of a congenital perilymph fistula must be entertained. All of the patients must have an audiologic assessment, and if a sensorineural loss is demonstrated, CT of the temporal bones should be performed. CT is excellent in identifying malformations within the temporal bones, fistulous tracts, soft tissue densities in the middle ear, and defects in the tegmen tympani. Although MRI may provide superior discrimination of the audiovestibular and facial nerves and cerebellopontine angle, presently it does not offer any distinct advantages over CT in evaluation of the inner ear. When a fistula is suspected, an exploratory tympanotomy is recommended, and any CSF leak is sealed with muscle.

Cerebrospinal Fluid Otorrhea↗
PubMed1991

Mandibular fractures in the pediatric patient.

Seventy-three patients were admitted to the Children's Hospital of Philadelphia (Pa) between January 1979 and June 1989 with a diagnosis of mandibular fracture. Data were obtained through a retrospective review of these cases. The cases were divided into three age groups that reflected the developing structure of the mandible and the maturation of the dentition. A trend toward a greater number of fractures and a predominance of males is shown with increasing age. Child abuse is a relatively frequent cause of fractures throughout all groups. Associated injuries are more common in young children, except in cases where abuse has been documented. The high osteogenic potential of the pediatric mandible allowed conservative management to be successful in 25% of younger patients and was responsible for a low complication rate overall.

Accidents, Traffic↗
PubMed1991

Radial versus circumferential incision in myringotomy and tube placement.

Pressure equalization tubes are a well-recognized treatment for persistent otitis media with effusion and recurrent acute otitis media. Ideally, the tube should remain in place until the Eustachian tube function returns. Efforts to improve the functional life expectancy of tubes have concentrated on tube design with little attention directed at modification of the surgical technique. Some authors have noted that a radial incision offers theoretical advantages over a circumferential incision. A randomized study comparing radial and circumferential incisions in myringotomy with tube placement was conducted. Two hundred and twenty-eight patients had a circumferential incision performed in one ear and a radial incision in the opposite ear. On follow-up examinations the tube position and time to extrusion were noted. Using the sign test, there was no statistical difference in extrusion rates between the two groups. This study does not support the theoretical advantages espoused in the literature.

Acute Disease↗
PubMed1991

Torticollis in children.

Torticollis is a common clinical sign that is found in a variety of disorders. Childhood torticollis differs from the adult form in that congenital types are common and many frequently encountered disorders found in adults are unusual. Pediatric torticollis related to otolaryngologic conditions is reviewed, and three illustrative cases are presented.

Child↗
PubMed1991

First branchial cleft anomalies involving the tympanic membrane and middle ear.

First branchial cleft anomalies may involve the tympanic membrane or middle ear. A complete otologic examination must be performed in any patient with a suspected first branchial cleft anomaly. A surgeon treating such a defect must be prepared to perform both the excision of the lesion and reconstructive otologic surgery.

Branchial Region↗
PubMed1990

Rhabdomyosarcoma of the head and neck in children.

Rhabdomyosarcoma is the most common soft-tissue sarcoma in infants and children, with the head and neck being the most frequent site of involvement. Treatment for this neoplasm has undergone many changes, with a much improved prognosis using a combination of surgery, radiation therapy, and chemotherapy. This retrospective analysis presents the management and outcome of 60 children (aged 3 months to 18 years) with rhabdomyosarcoma of the head and neck evaluated at the Children's Hospital of Philadelphia (Pa) between 1970 and 1987. The overall death rate for all head and neck sites decreased from 50% in 1970 to 1979 to 23% in 1980 to 1987, reflecting the improved management protocol.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

The efficacy of cefaclor vs amoxicillin on recovery after tonsillectomy in children.

Tonsillectomy and adenoidectomy continues to be one of the most commonly performed operations in the pediatric age group. The morbidity from tonsillectomy can be severe and includes throat and ear pain, fever, lethargy, and poor oral intake. A previous study at the Children's Hospital of Philadelphia (Pa) demonstrated the efficacy of amoxicillin therapy in minimizing some of these postoperative symptoms. However, some children continue to have a prolonged recovery even while receiving this antibiotic regimen. Because of these children and the high incidence of Staphylococcus found in tonsillar core tissue, a randomized, prospective study was undertaken at the Children's Hospital of Philadelphia to evaluate the efficacy of cefaclor vs amoxicillin in patients recovering from tonsillectomy. The patients received either ampicillin or cefazolin intravenously at the time of surgery and for 12 to 24 hours postoperatively. When oral intake was adequate, they received either amoxicillin or cefaclor orally for 7 additional postoperative days. Intraoperative cultures of the oropharynx and tonsillar tissue were obtained, as well as cultures of the tonsillar fossa 7 to 14 days postoperatively. The patients were evaluated for severity and duration of postoperative symptoms as well as complications. The results of this study showed no difference between the two groups of patients. We conclude that there is no justification for routine use of cefaclor over amoxicillin in the posttonsillectomy patient.

Amoxicillin↗
PubMed1990

Vocal cord paralysis in children.

Bilateral vocal cord paralysis is a common cause of stridor in infants and children. There are significant differences in this entity between children and adults with regard to etiology, diagnosis, management, and outcome. A review of 10 years' experience at Children's Hospital of Philadelphia identified 51 children seen with the diagnosis of vocal cord paralysis. These cases were evaluated with respect to etiology of paralysis, whether unilateral or bilateral, delay in diagnosis, need for tracheotomy, abnormality of voice, surgical treatment, and outcome. Guidelines for management for a child with vocal cord paralysis are presented with emphasis on flexible endoscopic evaluation and conservative management.

Child↗
PubMed1990

Branchial cleft anomalies: a five-year retrospective review.

Branchial cleft cysts, sinuses and fistulas are among the most commonly encountered congenital anomalies in pediatric otolaryngic practice. They can present difficulties in differential diagnosis and surgical management. In order to study the clinical presentation and surgical management of branchial cleft anomalies, the operative records of the Children's Hospital of Philadelphia (CHOP) were reviewed for a five year period, January 1, 1982 through December 31, 1986. All patients with a pathologically-confirmed post-operative diagnosis of a branchial cleft anomaly were included in a retrospective chart review. Their case histories were studied to determine symptoms upon presentation, presence or absence of drainage, type of lesion, site of lesion, characteristics of the lesion, accuracy of pre-operative diagnosis, recurrence and complications. A total of 71 patients, 39 males and 32 females, underwent surgical excision of a branchial cleft cyst, sinus or fistula during the study period. There were 23 branchial cleft cysts, 50 sinuses and 3 fistulas. A correct pre-operative diagnosis was established in 60 (85%) of the patients, being highest for patients with branchial cleft fistulas. Incorrect pre-operative diagnoses included thyroglossal duct cyst, cervical lymphadenitis, dermoid, dermal inclusion cyst, lymphangioma and malignant neoplasm. The clinical presentation, pre-operative evaluation, pitfalls in diagnosis, surgical management and post-operative complications are discussed and strategies for the management of branchial cleft anomalies are presented.

Branchial Region↗
PubMed1989

Laryngotracheoplasty in the management of subglottic stenosis.

Laryngotracheoplasty (LTP) has revolutionized the surgical management of subglottic stenosis in children. A 10-year review of patients at the Children's Hospital of Philadelphia yielded 27 patients who had undergone a LTP. LTP with an anterior cartilage graft was utilized in over 80% of procedures. Morbidity was minimal, and there were no deaths. In this series, 78% of patients have been successfully decannulated. LTP has reduced the time necessary for decannulation in children with chronic tracheostomies as a result of subglottic stenosis.

Adolescent↗
PubMed1989

Ototoxicity of antimycotics.

Neither otomycoses nor defects of the tympanic membrane are rare. In cases of fungal infection when the tympanic membrane is not intact, the possibility exists that antimycotic medication could enter the middle ear and diffuse into the cochlea via the round window. Five antimycotic preparations were tested for acute ototoxic potential in guinea pigs. Those containing acetic acid or propylene glycol caused appreciable elevation of brainstem response thresholds, while little or no impairment resulted from tolnaftate or clotrimazole solutions in polyethylene glycol 400.

Animals↗
PubMed1989

Approach to the pediatric neck mass.

Neck masses are frequent findings in the pediatric population and the physician caring for a child with a neck mass may be faced with a diagnostic dilemma. The etiology of pediatric cervical masses includes a variety of conditions. Unlike for the adult, there are few established guidelines for evaluation of these children. A recent review of 445 neck masses operated on at the Children's Hospital of Philadelphia noted the preoperative diagnosis to be correct in 270, or only 61%. Clinical characteristics which may aid in establishing a correct preoperative diagnosis, as well as guidelines for the evaluation of the child presenting with a neck mass will be discussed.

Biopsy↗
PubMed1989

Desmoplastic fibroma of the mandible.

Desmoplastic fibromas of the facial skeleton are the bony counterparts to the soft-tissue desmoid tumors and are almost exclusively confined to the mandible. The diagnosis should be considered whenever a rapidly increasing swelling with little functional disability is noted in the mandible. Historical, clinical, radiologic, and histologic findings must be correlated to establish the correct diagnosis. Every effort must be made to distinguish these lesions from well-differentiated fibrosarcomas. An illustrative case is presented. The treatment of desmoplastic fibromas affecting the facial skeleton should be conservative. Curettage is recommended for small tumors. Wide resections with reconstruction should be reserved for larger lesions and for those that have recurred after conservative treatment.

Female↗
PubMed1988

Microbiology of the tonsils and adenoids in a pediatric population.

To investigate the microbial flora of the tonsils and adenoids, the core tissue from the tonsils and adenoids of 50 children undergoing tonsillectomy and adenoidectomy for either recurrent infection or airway obstruction was cultured aerobically and anaerobically, and the number of bacterial colonies was quantitated. The most common organisms isolated were alpha-hemolytic streptococci, nonpathogenic Neisseria species, Haemophilus species, Staphylococcus aureus, and Corynebacterium species. No anaerobes were identified. Bacterial isolates from the tonsils and adenoids were similar in number and frequency of occurrence. Potential pathogenic bacteria (Haemophilus species, S aureus, beta-hemolytic streptococci, and Streptococcus pneumoniae) were identified in 40 patients. Seventy-three percent of these patients shared a common pathogen in tonsil and adenoid tissue. Haemophilus species were recovered in 54% of patients and S aureus in 46%. No significant difference exists between the type and number of pathogens in patients undergoing adenotonsillectomy for recurrent infection or obstruction.

Adenoidectomy↗
PubMed1988

Pediatric neck masses: guidelines for evaluation.

Neck masses are frequent findings in the pediatric population. Unlike the adult, there are few established guidelines for evaluation of these children. The etiology of cervical masses includes many conditions. Knowledge of these conditions and their clinical presentations is essential. To elucidate the clinical characteristics which may help in establishing a correct diagnosis, the charts of 445 patients with biopsies of neck masses performed at the Children's Hospital of Philadelphia were analyzed. There were 244 (55%) congenital lesions, 118 (27%) inflammatory lesions, 23 (5%) non-inflammatory benign masses, 12 (3%) benign neoplasms, and 48 (11%) malignancies. The preoperative diagnosis was correct in 270 (61%) patients. Guidelines are established for the evaluation of the child presenting with a neck mass.

Adolescent↗