Differential Diagnosis Of Stridor In Children

Definition of Stridor
Stridor is a harsh, high pitched respiratory sound produced by turbulent airflow that is usually inspiratory but may be biphasic; it is a sign of upper air way obstruction.

Stridor is commonly seen in sick children and is due to a number of different cause. A list of differential diagnosis of stridor is given here:

Infectious Causes

• Acute laryngotracheobronchitis
• Epiglottitis
• Pharyngitis
• Parapharyngeal abscess
• Bacterial tracheitis
• Laryngopharyngeal diptheria
• Laryngeal papillomatosis
• Extrinsic inflammatory mass compressing the trachea (e.g tuberculosis)

Non Infectious Conditions

• Foreign body aspiration
• Angioneurotic edema
• Spasmodic croup
• Ingestion of caustic or hot fluid
• Trauma, smoke inhalation
• Laryngomalacia
• Congenital subglottic stenosis
• Extrinsic mass compressing the trachea ( cystic hygroma, hemangioma, vascular malformation)
• Hypocalcemia
• Vocal cord paralysis

Paracentesis In Children

Parecentesis is defined as a procedure in which a needle or a catheter is inserted into the peritoneal cavity through the abdominal wall in order to remove the ascitic fluid. It may be for diagnostic or therapeutic reasons.

Indications

Diagnostic:

• Evaluation of new onset of ascites.
• Exclusion of Peritonitis.
• Assessment of clinical deterioration in known cirrhotic patients.

Therapeutic:

• Decompression of tense ascites in symptomatic patients ( dyspnea, abdominal discomfort, early satiety )

Contraindications
Almost all are relative contraindications.

• Coagulopathy: consider platelet transfusion for platelet count <50,000 and FFP for INR> 1.5
• Uncooperative patient: consider sedation
• Multiple surgical operations: consider surgical consultation.

Materials needed for the procedure

• Minor procedure tray,
• 18-22 gauge 1.5 inch catheter over needle assembly,
• Syring (10-30 ml for infants and small children; 20-60 ml for older children and adolescents),
• Sterile specimen containers,
• Blood culture bottles,
• Povidone-iodine solution,
• Pressure dressing,
• Sterile gloves

Introduction To Bartter Syndrome

Bartter syndrome is caused by an inborn autosomal recessive defect, in the Na-K-2Cl co transporter in the thick ascending limb of the loop of Henle, leading to NaCl and water wasting.

Clinical Symptoms
The patient presents with polyuria, polydipsia, episodes of dehydration, flattering growth and constipation. sometimes there may be maternal polyhydramnios with an affected fetus.

Pathophysiology
Since there is NaCl and water wasting the resultant ECF volume contraction causes secondary renin secretion and raised aldosterone levels, with avid Na and water reabsorption in the distal tubule and reciprocal K and H secretion into the urine. Imprtant to note is that blod pressure is normal. There is also increases renal prostaglandin E2 secretion.

The above changes produce the characteristic biochemical disturbance of hypochloraemic hpokalaemic alkalosis.

Diagnosis
Crucial to the diagnosis is the finding of inappropriately high levels of urinary Cl and Na- usually more than 20mmol/L ; urine Ca is normal or high.

A Brief Discussion Of CNS Tumors In Children

Brain Tumors in children tend to be located in the posterior fossa, in the midline, have greater differentiation and have slightly better survival figures than their counterparts in adults.

The anatomical grouping together of brain tumors masks their diverse biological differences. As a general rule brain tumors do not metastasize out of the CNS.

Treatment options for CNS tumors remains controversial but usually involves surgery and/or radiotherapy.

Clinical Features
Brian tumors are notoriously difficult to diagnose because of thier varied and often non-specific presentations. The mean time from onset of symptoms to diagnosis is usually around 5 to 6 months.

The most common presenting symptom is vomiting and headache. Other features that may be seen are changes in personality and mood, deterioration of school performance, growth failure, weight loss and seizures. Some children may present with disturbance of speech and developmental delay.

A brief discussion of different CNS tumors in children is given here:

Astrocytoma

• Most commonly occurring brain tumor.
• Range from low grade (benign) tumors, usually in the cerebellum, to high grade (malignant) tumors, usually supratentorial and in the brain stem.
• The glioblastoma multiforme tumor has a near fatal prognosis.

Legg-Calve-Perthes Disease

This is a non-inflammatory deformity of the femoral head caused by a vascular insult leading to osteonecrosis of the capital femoral epiphysis.

Incidence

• It affects more boys than girls (4:1)
• Usually presents between 4 and 8 years of age. ( can have a secondary peak between 10 and 12 years ).
• Caucasians are affected more frequently than other races.
• Occurs in approximately 5.5 of 100,000 children per year (and therefore a lifetime risk of developing the disease is about 1 per 1200 individuals)

Etiology
Although the cause is not clear it occurs in those with a delayed skeletal maturation and also there is an increased incidence with a positive family history or in children with a history of low birth weight.

Clinical Features

• Pain (may present with referred pain in the knee).
• Decreased range of motion.
• Limping gait.
• There are 4 clinical stages: Initial stage, fragmentation, healing and residual.

Neonatal Mastitis - Clinical features & Management

Neonatal mastitis is an infection of the breast tissue that occurs in full-term neonates with a peak incidence in the third week of life. Females are affected more often than males in a 2:1 distribution.

Clinical Signs and Symptoms: Clinically, it manifests as swelling, induration, erythema, warmth, and tenderness of the affected breast. The ipsilateral axillary lymph nodes may be swollen. Approximately two-thirds have palpable fluctuance. In some cases, purulent discharge may be expressed from the nipple. Fever may be present in 25% of affected patients. Other systemic symptoms (irritability, decreased appetite, and vomiting) are less common but indicate a more severe infection if present. Bacteremia is rare.

Pathology: Staphylococcus aureus is the most common pathogen, causing 75% to 85% of cases. Rarely, gram-negative organisms or group B or D Streptococcus are the cause. If treatment is delayed, mastitis may progress rapidly with involvement of subcutaneous tissues and subsequent toxicity. In the initial stages, neonatal mastitis may mimic mammary tissue hypertrophy owing to maternal passive hormonal stimulation. Minor trauma, cutaneous infections, and duct blockage may precede this infection.