Abstract

To investigate the factors associated with recurrence of differentiated thyroid cancer in children. We combined the clinical and pathological features to guide surgical treatment options, ensure efficacy, and reduce complications. A prospective analysis of clinical data of 43 cases of pediatric differentiated thyroid cancer from March 2008 to June 2014 admitted in our department, including 38 cases of papillary cancers and five cases of follicular cancer, 40 cases were Stage I and three cases were Stage II (Union for International Cancer Control [UICC] Tumor Node Metastasis classification [TNM] staging). We performed the operations according to the condition of lesions and lymph nodes. Operations included subtotal resection in 36 cases, total resection in seven cases. We applied statistical methods to investigate the risk factors of recurrence and postoperative complications. The pathologic lymph node metastasis rate was 67.44% (29/43): Area VI lymph nodes metastases in 20 cases and Area III/IV or Area II/V lymph nodes metastases in nine cases. Postoperative hypocalcemia symptoms were seen in three cases and hoarseness in three cases, for a total rate of 13.95% (6/43). Until December 2015, patients were followed up from 1.5 years to 8.7 years, with a median of 4.9 years. There were three cases of cervical lymph node recurrence, one case of local recurrence, and one case of lung metastasis, for a total recurrence rate of 11.63% (5/43), all patients survived. Log-rank test of Kaplan-Meier curves and Cox stepwise regression analysis showed that lesion number, extrathyroidal extension, and lymph nodes metastases were the risk factors for postoperative recurrence, the relative risk values were, respectively, 3.117, 2.816, and 4.628 (p = 0.041, p = 0.048, and p = 0.031, respectively) and the 95% confidence intervals (CI) were, respectively, 1.094∼8.735, 1.046∼7.932, and 1.189∼10.205. However, the lesion excision approach was not a risk factor for postoperative recurrence (p = 0.107). The logistic stepwise regression model showed that lesion excision approach was a risk factor for postoperative hypocalcemia and hoarseness, the odds ratio value was 2.537 (p = 0.037) and the 95% CI was 1.034∼6.983. Pediatric differentiated thyroid cancer has a high metastatic rate to lymph nodes and distant organs, but the total prognosis is good. Application of total resection cannot necessarily reduce the relapse rate of pediatric differentiated thyroid cancer, but it may increase the postoperative hypocalcemia and hoarseness. The authors propose strictly adhering to various operation indicators, and carrying out various operations with a full understanding of the local lesion and lymph nodes in order to reduce relapse and postoperative complications.

Abstract

Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood. Children with asthma who had recently developed RML atelectasis were included, anti-inflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chest-physiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit. Twenty-seven patients (6.8 (4.8–8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7–30) days before admission. The thickness of the atelectasis was 11.8 ± 5.8 mm, FEV1% was 75.9 ± 14.2 and Childhood Asthma Control Test scores were 11.8 ± 5.6 at the time of admission. The atelectasis had been resolved by the sixth (n = 3), fourteenth (n = 9), thirtieth (n = 10), and ninetieth days (n = 3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7 ± 1.7 vs. 11.9 ± 7.3 mm, p = 0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p = 0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis. Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.

Abstract

In chronic nasal obstructive syndrome, mucosal desiccation occurs, causing cilia to be damaged and becoming more susceptible to infection and altering pulmonary function. A bibliographic review was carried out including 28 documents, with the aim of describing the main elements of Nasal Obstructive Syndrome in pediatric patients. Nasal Obstructive Syndrome is considered worldwide one of the most frequent diseases in children and adolescents. Nasal obstruction is a symptom that is frequently presented in dentistry. It manifests as a discomfort, which manifests as a sensation of insufficient airflow through the nose. There are anatomical, physiological and neurological/iatrogenic factors that can cause nasal obstruction. Therefore, it is always pertinent to perform a detailed anamnesis and a thorough physical examination of each patient to properly diagnose the cause of their nasal obstruction, keeping in mind the premise that it is a multifactorial disease.

Abstract

High-flow nasal cannulae (HFNC) seem to improve respiratory efficiency by flooding the nasopharyngeal anatomical space with a constant high flow, and contribute to the decrease of respiratory work and CO2 washout. A literature review was performed with the aim of this article is to describe the main elements about oxygen therapy and high flow nasal cannula in pediatrics. Oxygen therapy is indicated whenever there is a deficiency in oxygen supply to the tissues. HFNC consists of providing a flow of oxygen, alone or mixed with air, above the child's inspiratory flow through a nasal cannula. The oxygenation of the child, allows to protect its biological functions and its consequent decrease in the possibility of preventing complications that usually arise from hypoxemia. Regarding the advantages and disadvantages of high flow, when surveyed on the perception of the professionals, most of them consider that the CNAF improve the patient's comfort, decrease nasal trauma and facilitate the initiation and progression of enteral feeding.

Abstract

Background: Nasal Obstructive Syndrome, is more abundant among children than is generally assumed and may be the initial symptom of a bronchial asthma attack or be the state preceding sensitization of the lower airways.Aim: To characterize SON in a sample of children aged 7 to 12 years.Methods: Observational, descriptive, cross-sectional study of 194 children who were examined in the office.Results: The prevalence of female sex was found to be 63.9% and the age group 7-9 years with 56.7%; the most prevalent dentomaxillofacial anomalies according to sex were: Bilabial incompetence with 51.5% and 48.4% antero-lower crowding. The 48.4% of the patients present Angle Class I. There are 34.5% of children treated in the specialty of Otorhinolaryngology who receive drug treatment; while 62.8% who maintain the habit of mouth breather.Conclusions: In this study it was found that female patients and the age group 7 to 9 years were the most affected. At the age of 7 to 9 years, Class I prevailed and according to sex, Class II. There was evidence of a greater number of patients receiving medication treatment during orthodontic treatment, with the age group 7 to 9 years prevailing. A greater number of patients aged 7 to 9 years maintained the habit of mouth breathing despite orthodontic treatment.