OBJECTIVETo investigate the causes of severe upper respiratory tract obstruction in neonates.

METHODSForty seven cases with severe dyspnea history were reviewed and retrospective analysis performed. Clinical manifestation, direct laryngoscope, CT, X-ray barium meal examination results and the treatment process were recorded.

RESULTSAmong 47 neonates, 41 cases were congenital diseases, accounting for 87.2% (41/47). In 41 cases, 15 cases were congenital laryngeal stridor, accounting for 31.9%, involving 6 cases accompanied by the gastroesophageal reflux. Fourteen cases were congenital upper respiratory tract cyst (10 cases of lingual root cyst, 3 cases of epiglottis cyst, 1 case of laryngeal cyst), accounting for 29.8%, in which 13 cases were misdiagnosis as congenital laryngeal stridor. Others were 6 cases of acute membrane laryngotracheobronchitis, 3 cases of congenital main respiratory tract stenosis, 2 cases of congenital laryngeal webs, 2 cases of vocal cord paralysis, 3 cases of Pierre Robin syndrome, 2 cases of Cri-du-chat syndrome. Except for 3 in 47 cases whose parents refused treatment, dyspnea in other 44 cases were relieved with inhaling oxygen and drug treatment, 37 case received tracheal intubation and sputum suction, 19 cases received direct laryngoscope or self-retaining laryngoscope operation.

CONCLUSIONSCongenital disease is the main cause of severe upper respiratory tract obstruction. For the neonates suffering from severe upper respiratory obstruction, finding out the cause and prompt treatment are essential for prognosis and reducing mortality.

Airway Obstruction ; etiology ; Congenital Abnormalities ; pathology ; Female ; Humans ; Infant, Newborn ; Male ; Retrospective Studies

Airway Obstruction ; complications ; etiology ; physiopathology ; Asphyxia ; etiology ; physiopathology ; Fibroma ; complications ; pathology ; Humans ; Infant, Newborn ; Oropharyngeal Neoplasms ; complications ; pathology ; Rare Diseases

OBJECTIVETo review the clinical features and therapeutic experience in children with plastic bronchitis.

METHODSFourteen children with plastic bronchitis were reviewed retrospectively, 12 of which were under two years old. The clinical features are characterized by sudden onset, episodes of profound hypoxia and respiratory tract obstruction. SaO2 was between 0.70 and 0.80 even with mask oxygen inhalation. Eight cases were pyretic, 4 cases expectorated jel-like bronchial casts. The chest X-ray picture showed patchy consolidation or atelectasis unilaterally (10 cases) or bilaterally (2 cases). Pulmonary marking thickening and patchy shadow were observed in 2 cases. Twelve cases underwent rigid bronchoscopy and the bronchial casts were removed. Two cases underwent endotracheal intubation.

RESULTSEight cases of 12 children received therapeutic bronchoscopy were cured. Other 4 cases had second therapeutic bronchoscopy and bronchial casts were removed again in 3 cases, one died from pulmonary hemorrhage. Two cases who underwent endotracheal intubation died from the multiple organ failure (MOF). Pathologic results showed:the bronchial casts were composed mainly of mucus and fibrin, inflammatory cell infiltrate were observed in 6 cases (Type 1, inflammatory), no cellular infiltrate occurred in 8 cases (Type 2, acellular).

CONCLUSIONSPlastic bronchitis is a severe and dangerous disease. The branching plastic casts may obstruct part or the entire tracheobronchial, causing respiratory failure. Bronchoscopy and pathologic examination are essential for it's diagnosis and treatment.

Airway Obstruction ; Bronchitis ; etiology ; pathology ; surgery ; Bronchoscopy ; Child ; Child, Preschool ; Female ; Humans ; Hypoxia ; Infant ; Male ; Pulmonary Atelectasis ; Retrospective Studies

OBJECTIVETo improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson's disease (OEIPD).

METHODSFifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.

RESULTSThe mean clinical course in OEIPD patients was 6.2 +/- 3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8 +/- 3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9 +/- 1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm.

CONCLUSIONSThe clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by 'supraglottic swallowing'.

Aged ; Aged, 80 and over ; Airway Obstruction ; etiology ; Brain ; pathology ; Cause of Death ; Enteral Nutrition ; Female ; Humans ; Lung ; pathology ; Male ; Parkinson Disease ; complications ; mortality ; pathology

Orthognathic surgery has been used regularly to treat dentofacial deformities. The surgical procedures affect both the facial appearance as well as the posterior airway space (PAS). Our current literature indicates that setback procedures produce an inferior repositioning of the hyoid bone and posterior displacement of the tongue and the soft palate. These movements cause anteroposterior and lateral narrowing of the PAS. Most authors agree that these effects are permanent. The PAS changes in turn produce an adaptive posturing, with an increased craniocervical angle to open up the PAS. Even though most patients do not display snoring and obstructive sleep apnoea (OSA) post-surgery, there is certainly an increased possibility in patients with already compromised airways. Therefore, patients who are undergoing orthognathic surgery should be screened for excessive daytime somnolence, snoring, increased body mass index (BMI) and medical conditions related to OSA and sent for an overnight polysomnography (PSG) if OSA is suspected. Then the proposed treatment plan may be modified according to the risk of potential airway compromise or even to improve it. Conversely, advancement of the maxilla and mandible causes widening of the airway in both the anteroposterior and lateral dimensions. This effect would translate to better airflow and decreased airway resistance. This is supported by the evidence showing high success rates when orthognathic surgery, especially maxillomandibular advancement (MMA), is utilised to treat OSA.
Airway Obstruction ; etiology ; surgery ; Cephalometry ; Humans ; Malocclusion ; complications ; pathology ; surgery ; Malocclusion, Angle Class II ; surgery ; Malocclusion, Angle Class III ; surgery ; Mandibular Advancement ; Oral Surgical Procedures ; Osteotomy ; Treatment Outcome

OBJECTIVETo observe the therapeutic effects of Le Fort III osteotomy and midface distraction osteogenesis (DO) on the upper-airway narrow.

METHODSSince 2000, 11 cases (10 cases of Crouzon syndrome and 1 case of Apert syndrome) with severe midface deficiency were treated with Le Fort III osteotomy and midface DO. The section area of different parts of upper-airway were tested by computer assistants image measurement preoperatively and postoperatively. Some patients received sleep function monitoring.

RESULTSThe face appearance and the function of upper-airway improved significantly after Le Fort III osteotomy and Midface DO. The section area at the level of posterior nasal spine and uvula increased obviously after treatment (P < 0.05), however the section area at the level of epiglottis and separation between airway and esophagus were not obviously enlarged (P > 0.05).

CONCLUSIONSMidface DO after Le Fort III osteotomy can effectively improve the upper-airway narrow, especially the upper part from uvula.

Adolescent ; Airway Obstruction ; etiology ; surgery ; Child ; Child, Preschool ; Craniofacial Dysostosis ; complications ; surgery ; Epiglottis ; pathology ; Female ; Humans ; Male ; Nasopharynx ; pathology ; Osteotomy, Le Fort ; methods ; Palate, Soft ; pathology ; Postoperative Period ; Sleep Apnea, Obstructive ; etiology ; surgery ; Treatment Outcome

Malignant airway obstruction and hemoptysis are common in lung cancer patients. Recently, airway stent is commonly used to preserve airway in malignant airway obstruction. Hemoptysis can be managed through various methods including conservative treatment, endobronchial tamponade, bronchoscopic intervention, embolization and surgery. In our case studies, we sought to investigate the effectiveness of airway stents for re-opening the airway as well as tamponade effects in four patients with malignant airway obstruction and bleeding caused by tumors or lymph node invasions.
Aged ; Airway Obstruction/*etiology/pathology/*therapy ; Alloys ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung/*complications ; Fatal Outcome ; Fluoroscopy ; Hemoptysis/*etiology/pathology/*therapy ; Humans ; Lung Neoplasms/*complications ; Male ; Middle Aged ; *Stents

BACKGROUND: Airway responsiveness after acute inhalation of ozone is related to the concentration and duration of ozone exposure. Using barometric whole-body plethysmography and increase in enhanced pause (Penh) as an index of airway obstruction, we measured the response of BALB/c mice to acute ozone inhalation to study the time course change of pulmonary function after ozone exposure. METHODS: Penh was measured before and after exposure to filtered air or 0.12, 0.5, 1, or 2 ppm ozone for 3 hr (n=6/group). In addition, Penh was measured 24, 48 and 72 hr after ozone exposure. Bronchoalveolar lavage (BAL) and histopathologic examinations were performed. RESULTS: The increase in Penh after ozone exposure was significantly higher in the 0.12, 0.5, 1 and 2 ppm groups compared with the control group (all p< 0.01). Increases in Penh 24 hr after ozone exposure were significantly lower than those immediately after acute ozone exposure; however, increases in Penh 72 hr after ozone exposure were significantly higher than those in the control group (each p< 0.01). The proportion of neutrophils in BAL fluid was significantly higher in the group exposed to 2 ppm ozone than in the groups exposed to filtered air or 0.12 ppm ozone (both p< 0.01). CONCLUSION: These results indicate that airway obstruction is induced following ozone exposure in a concentration-dependent manner and persists for at least 72 hr.
Airway Obstruction/*etiology/*pathology ; Animals ; Animals, Newborn ; Bronchoalveolar Lavage Fluid/cytology ; Disease Models, Animal ; Female ; Mice ; Mice, Inbred BALB C ; Plethysmography, Whole Body/*methods ; Probability ; Reference Values ; Respiratory Function Tests ; Risk Assessment ; Sensitivity and Specificity ; Statistics, Nonparametric ; Sulfuric Acids/*adverse effects

Kawasaki disease is a common paediatric vasculitide. It is usually diagnosed by its classical constellation of mucocutaneous signs. Recurrent Kawasaki disease is a rare phenomenon that occurs in approximately 3% of all patients diagnosed with Kawasaki disease. Its presentation is usually similar to the first episode of Kawasaki disease, and early diagnosis with prompt treatment is key in preventing associated cardiovascular morbidities. Recurrent Kawasaki disease is not well reported, and atypical presentations have not been previously reported in medical literature. Here, we report the case of a young girl with recurrent Kawasaki disease who presented atypically with acute airway obstruction secondary to retropharyngeal phlegmon.
Acute Disease ; Airway Obstruction ; diagnosis ; etiology ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Neck ; Recurrence ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical characteristics of negative pressure pulmonary edema (NPPE).

METHODA retrospective investigation of the clinical manifestation, imageology, clinical course and outcome of 4 children with NPPE seen between June 2012 and July 2013 in a children's hospital. The causation of the airway obstruction was also explored.

RESULTAll the 4 cases were boys, the range of age was 40 days to 9 years. They had no history of respiratory and circulatory system disease. In 3 cases the disease had a sudden onset after the obstruction of airway, and in one the onset occurred 1.5 hours after removing the airway foreign body. All these cases presented with tachypnea, dyspnea, and cyanosis, none had fever. Three cases had coarse rales. Chest radiography was performed in 3 cases and CT scan was performed in 1 case, in all of them both lungs displayed diffuse ground-glass-like change and patchy consolidative infiltrates. Three cases were admitted to the ICU, duration of mechanical ventilation was less than 24 hours in 2 cases and 39 hours in one. Oxygen was given by mask to the remaining one in emergency department, whose symptoms were obviously improved in 10 hours. None was treated with diuretics, glucocorticoids or inotropic agents. Chest radiographs were taken within 24 hours of treatment in 2 cases and 24-48 hours in the other 2; almost all the pulmonary infiltrates were resolved. All the 4 cases were cured. The causes of airway obstruction were airway foreign bodies in two cases, laryngospasm in one and laryngomalacia in the other.

CONCLUSIONNPPE is a life-threatening emergency, which is manifested by rapid onset of respiratory distress rapidly (usually in several minutes, but might be hours later) after relief of the airway obstruction, with findings of pulmonary edema in chest radiograph. The symptoms resolve rapidly by oxygen therapy timely with or without mechanical ventilation. In children with airway obstruction, NPPE should be considered.

Acute Disease ; Airway Obstruction ; complications ; Child ; Child, Preschool ; Foreign Bodies ; complications ; Humans ; Infant ; Intensive Care Units ; Intubation, Intratracheal ; methods ; Laryngismus ; complications ; Larynx ; Lung ; diagnostic imaging ; pathology ; Male ; Oxygen Inhalation Therapy ; Positive-Pressure Respiration ; methods ; Pulmonary Edema ; diagnosis ; etiology ; therapy ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed