Searched for: in-biosketch:true
person:aprilm01
Polysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea
Helfaer MA; McColley SA; Pyzik PL; Tunkel DE; Nichols DG; Baroody FM; April MM; Maxwell LG; Loughlin GM
OBJECTIVES: a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea. DESIGN: Randomized, prospective study. SETTING: University hospital. PATIENTS: Children, ranging in age between 1 and 18 yrs, presented to the Pediatric Otolaryngology Clinic for adenotonsillectomy for mild obstructive sleep apnea defined as from one to 15 obstructive apnea events per hour on preoperative polysomnogram. INTERVENTIONS: Patients were assigned to receive either a narcotic- or a halothane-based anesthetic for adenotonsillectomy. A postoperative polysomnogram was performed in the pediatric intensive care unit on the first operative night. MEASUREMENTS AND MAIN RESULTS: Eighteen patients were recruited, 15 of whom met inclusion criteria: nine patients received a halothane-based anesthetic and six patients received a fentanyl-based anesthetic. When the data were analyzed by pooling both groups, the differences between pre- and postoperative sleep studies demonstrated a reduction in the number of obstructive events and less severe oxygen desaturations on the operative night. Total sleep time between the two sleep studies decreased from 371 +/- 13 to 304 +/- 14 mins. The number of obstructive apnea events/hr decreased as well. The lowest oxygen saturation measured during rapid eye movement sleep was 78 +/- 5% preoperatively and 92 +/- 1% postoperatively. CONCLUSIONS: Our data suggest that children without underlying medical conditions, neuromotor diseases, or carniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic
PMID: 8706486
ISSN: 0090-3493
CID: 27038
Obstructing laryngeal granuloma after brief endotracheal intubation in neonates [Case Report]
Kelly SM; April MM; Tunkel DE
PMID: 8758644
ISSN: 0194-5998
CID: 27040
Bilateral odontogenic keratocysts of the maxillary sinus [Case Report]
Hunter RB; Zaretsky LS; Nuovo M; April MM
PMID: 8827294
ISSN: 0196-0709
CID: 27039
The effect of intravenous dexamethasone in pediatric adenotonsillectomy
April MM; Callan ND; Nowak DM; Hausdorff MA
OBJECTIVE: To determine whether the intravenous administration of dexamethasone sodium phosphate before tonsillectomy and adenoidectomy can reduce the morbidity from, and increase the safety of, this procedure. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: A university medical center, caring for both ambulatory and hospitalized children. PATIENTS: Eighty children aged 3 to 15 years undergoing tonsillectomy and adenoidectomy for either chronic tonsillitis or adenotonsillar hypertrophy (obstructive sleep apnea and/or upper airway obstruction). INTERVENTIONS: Forty-one children received intravenous dexamethasone sodium phosphate (1 mg/kg up to 16 mg) and 39 received placebo before undergoing an electrocautery dissection tonsillectomy and adenoidectomy. MAIN OUTCOME MEASURES: Postoperative oral intake, pain, vomiting, temperature, and complications. RESULTS: Patients who received intravenous dexamethasone had significantly less trismus, vomiting, and elevations of temperature 6 hours after surgery and more oral intake (liquids and soft solids) at 24 hours. Three children, all of whom were in the placebo group, had emergency department visits for pain and dehydration. Each group had one child who had a secondary hemorrhage (no surgery needed), one child who had pneumonia, and one child who had night terrors. CONCLUSIONS: Treatment with intravenous dexamethasone before electrocautery tonsillectomy and adenoidectomy is safe, increases early postoperative oral intake, and decreases morbidity
PMID: 8630203
ISSN: 0886-4470
CID: 27041
Self-induced pneumoparotitis [Case Report]
Goguen LA; April MM; Karmody CS; Carter BL
Pneumoparotitis is a rare cause of enlargement of the parotid gland; it is often misdiagnosed and therefore incorrectly treated. We report three pediatric cases of self-induced pneumoparotitis and detail the clinical presentation, pathogenesis, radiographic findings, and treatment options. We also review the literature on the subject. In children, inflammatory swelling of the parotid gland is usually due to acute viral or bacterial infection, juvenile recurrent parotitis, or allergic, autoimmune, or systemic disease. Infrequently, swelling may result from air being forced through Stensen's duct, resulting in pneumoparotitis. This may occur as a transient or recurrent phenomenon. Recurrent parotid insufflation is not entirely benign and may predispose to sialectasias, recurrent parotitis, and even subcutaneous emphysema
PMID: 7488376
ISSN: 0886-4470
CID: 27042
Follicular variant of papillary carcinoma with hyperthyroidism [Case Report]
April MM; Heimann A; Jung LU; Gelato MC
PMID: 7478657
ISSN: 0194-5998
CID: 27043
Chronic hemoptysis: an unusual manifestation of fungal sinusitis [Case Report]
Fiero, R A; Groth, M; Hurewitz, A; April, M; Nuovo, M
A woman with chronic hemoptysis as her only complaint had extensive testing and did not respond to antibiotic therapy. Radiologic examination of the sinuses identified a mass which, on surgical exploration, was found to be the result of a fungus, Pseudallescheria boydii. Although this fungus is known to be a cause of epistaxis, this is the first instance in which it has been reported to cause hemoptysis.
PMID: 7597490
ISSN: 0038-4348
CID: 2348322
Pediatric otolaryngology: isolated cervical subcutaneous emphysema [Case Report]
Scioscia KA; April MM
Two cases of pediatric isolated cervical emphysema caused by foreign bodies are presented. This report emphasizes the need for roentgenograms, flexible nasolaryngoscopy, and situational barium swallows to identify the exact location of a tear and to determine whether the situation requires direct laryngoscopy and esophagoscopy to remove a foreign body, or an open surgical repair of a mucosal disruption. The treatment of this self-limited condition usually requires only antibiotics, fasting, intravenous fluid, and most importantly, close observation for signs of perforation
PMID: 8179109
ISSN: 0196-0709
CID: 27044
Massive cystic heterotopic brain tissue [Case Report]
April MM; Seymour BT; Duboys E; Egnor M; Braun A; Katz AE
The differential diagnosis of large cystic masses in the newborn should include heterotopic brain tissue. This lesion is attributed to early displacement of pluripotential cells and cyst formation may result from cerebrospinal fluid production by choroid plexus-like structures. Treatment consists of surgical excision
PMID: 8157424
ISSN: 0165-5876
CID: 27045
Coronal CT scan abnormalities in children with chronic sinusitis
April MM; Zinreich SJ; Baroody FM; Naclerio RM
Coronal computed tomography (CT) scans are currently the optimal study to display the normal and abnormal anatomy in children with chronic and recurrent acute sinusitis after failure of medical therapy. To assess the extent and distribution of disease as well as associated anatomic abnormalities in this pediatric population, 74 coronal CT scans of children with continued symptoms of sinusitis after failure of extensive medical therapy were reviewed retrospectively. Twelve children with cystic fibrosis showed the characteristic features of medial displacement of the lateral nasal wall in the middle meatus and uncinate process demineralization, creating the appearance of a maxillary sinus mucocele. Nine of these 12 children had increased attenuation in the maxillary sinus on soft-tissue windows. In the remaining 62 children, a significantly greater frequency of disease, when compared with that reported for adults, was seen in the maxillary, anterior ethmoid, posterior ethmoid, and frontal sinuses. Children with asthma (n = 33) had more extensive disease. Bony anatomic abnormalities were similar to those reported for adults, except for a lower incidence of septal deformity
PMID: 8361320
ISSN: 0023-852x
CID: 27046