Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

CRITICAL REVIEW OF TAMAKA SHAWASA (ASTHMA) CHIKITSA

Asthma is known as reactive airway disease. This hyperresponsiveness manifests itself as bronchoconstriction following exercise, on natural exposure to strong as irritant fumes such as sulphur dioxide, tobacco smoke or cold air and an intentional exposure in the laboratory to inhalations of histamine or parasympathamimetic agent such as methacholine. In Ayurveda it can be correlated with Tamaka Shwasa. Tamaka Shwasa is one of the diseases where Nidana parivarjana and samprati vighatana plays an important role. The detailed study of Nidana panchaka is helpful in better understanding of the disease and for the proper treatment. As Kapha and Vata are the pre-dominant Doshas, so the medicines and the dietetic regimen which controls the Kapha and Vata due to their Ushna guna and are Vata- anulomaka in action must be utilized in the treatment of Shwasa roga. While The patient with Kapha and Vata dominance and of strong build should be given Samshodhan therapy i.e. vaman & Virechana. Keywords: Tamaka Shwasa, Shwasa roga, Samshodhana, Asthma.

Clinal study of Pippalyadya Lau in the management of Tamaka Shwasa

Our lifestyles have been driven to another level with introduction of new gadgets and science and technological interferences in living in one way or the other. The major cause of poor health conditions are diseases, improper and unhealthy dietary habits, injury, incremented mental stress levels, lack of hygiene, unhealthy lifestyle, etc. The true meaning of being healthy is apposite balance of mental, physical and a spiritual state of a being. Shwasa Roga is classified into 5 categories in Ayurveda. Tamaka Shwasa is one of the categories of Shwasa Roga. In modern Asthma is known as reactive airway disease. This hyper responsiveness manifests itself as broncho constriction following exercise, on natural exposure to strong as irritant fumes such as sulphur dioxide, tobacco smoke, etc. The present study deals with clinical Study of Pippalyadya Lauh on Tamaka Shwasa. In this study total 60 patients of Tamaka Shvasa were registered. Patients were randomly divided under three groups. Results of study reveals that all preparations of Pippalyadi Loha has shown significant results on Tamaka Shwasa patients and Pippalyadi Loha No I and considered to be the best among three different preparations and safe for use.

Follicular Bronchiolitis: Two Cases with Varying Clinical and Radiological Presentation

Follicular bronchiolitis (FB) is a rare bronchiolar disorder associated with hyperplasia of the bronchial-associated lymphoid tissue (BALT). It is characterized by the development of lymphoid follicles with germinal centers in the walls of small airways. It falls under the category of lymphoproliferative pulmonary diseases (LPDs) and commonly occurs in relation to connective tissue disease, immunodeficiency, infections, interstitial lung disease (ILD), and inflammatory airway diseases. Computerized tomography (CT) findings include centrilobular nodules with patchy ground glass infiltrate, tree-in-bud findings, and air trapping. It can very rarely present as diffuse cystic lung disease. We present two cases of FB. The first case is associated with Human Immunodeficiency Virus (HIV) infection and asthma with diffuse cystic changes on the CT. The second case is associated with reactive airway disease and gastroesophageal reflux disease (GERD) with the classic centrilobular nodules and ground glass opacities on the CT.

Double Aortic Arch Mimics the Clinical Characteristics of Severe Reactive Airway Disease in a Pediatric Patient

Reactive airway disease is a prevalent condition that can be detected in the early infancy period. The condition might also deteriorate into asthma in some cases. If infants do not respond to the treatment of persistent wheeze and coughing, other rare causes should be investigated. The complete form of vascular ring is an extremely uncommon congenital cardiovascular abnormality. Double aortic arch constitutes the most significant portion of the complete vascular ring anomalies. Clinical manifestations of the anomaly are mainly respiratory due to the tracheal compression and mimicking the conditions of asthma. There have not been many reports about the clinical presentations of double aortic arch being remarkably similar to the same clinical manifestations of asthma in the literature. As far as we can be sure, there have not been any reported cases about severe reactive airway disease that caused a patient to have a life-threatening condition in the pediatric intensive care unit. Herein, we present a 5-month-old girl who had double aortic arch. Her anatomical aberration was diagnosed by three-dimensional computed tomography angiography of thorax, and the anomaly mimicked the clinical characteristics of life-threatening severe reactive airway disease.