3 research outputs found
Screening for undiagnosed bleeding disorders in post-tonsillectomy bleed patients: Retrospective review and systematic review of the literature
Get PDFOBJECTIVES: There is currently no standard for screening children with post-tonsillectomy bleeds (PTB) for coagulopathy disorders. This study aims to identify children with occult coagulopathy diagnosed at PTB and to identify factors associated with diagnosis. A systematic review of the literature further identified trends in this topic.
METHODS: A retrospective chart review of patients returning to the operating room for PTB at a tertiary children\u27s hospital was undertaken from 2012 to 2016. A systematic review using Medline OVID was subsequently performed.
RESULTS: Of 12,503 tonsillectomies, 311 children (52% male, mean age 8 years) required surgery for PTB (2.5% rate). Twenty-one patients (7%) had multiple episodes. Only two patients (0.6%) (both with known coagulopathy) underwent pre-tonsillectomy labs and 260 (84%) had labs at PTB. Six patients (2%) were diagnosed with a new coagulopathy, most commonly von Willebrand\u27s Disease (vWD) in five (2%). Three patients (1%) were diagnosed at first PTB and three (1%) at second PTB. Of the three diagnosed at second PTB, two had normal partial thromboplastin time (PTT). In systematic review, 1243 manuscripts were reviewed and 8 papers discussing this topic are presented.
CONCLUSION: Occult coagulopathy was rarely diagnosed at PTB, but this may be limited by inconsistent screening. PT and PTT are not sensitive tests for vWD, and normal coagulation labs may lead to delayed diagnosis. The literature reveals occult coagulopathy is rare but often diagnosed after severe or recurrent hemorrhage. In order to provide efficient care and medical management, a standardized algorithm and sensitive labs for screening PTB patients are needed
Measuring the Impact of a Delay in Care on Pediatric Otolaryngologic Surgery Completion
No full textObjective: To determine if postponement of elective pediatric otorhinolaryngology surgeries results in a change in overall healthcare utilization and if there is any commensurate impact on disease progression.
Methods: We identified patients ≤18 years of age whose surgeries were postponed at the onset of the COVID-19 pandemic-related shutdown. We then tracked patients\u27 rate of and patterns of rescheduling surgery. Surveys were also sent to caregivers to better characterize his/her decision regarding moving forward with his/her child\u27s surgery during COVID-19.
Results: A total of 1915 pediatric patients had elective surgeries canceled, of which 992 (51.8%) were rescheduled within 4 months. No difference in rates of rescheduling was identified based on race or ethnicity. Patients who were scheduled for tonsillectomies and/or adenoidectomies were 1.22 times more likely to reschedule compared to those patients with other planned procedures (CI: 1.02-1.46). A total of 95 caregivers at two hospitals completed surveys: 44 (47.4%) rescheduled their child\u27s surgery. Most caregivers who rescheduled were concerned their child\u27s disease could impact their future (n = 14, 32%).
Conclusions: Just over half of patients who had pediatric otolaryngologic surgery canceled during a period of social distancing went on to have surgery within a 4-month timeframe. This reflects the dependence of pediatric otolaryngologic surgery on environmental exposures and may represent a potential target for prevention and management of some pediatric otolaryngology diseases
Solitary Bone Plasmacytoma of the maxilla- A rare case report
Get PDFAbstract:Aims and Objectives: Plasmacytoma is a discrete, uni-focal, monoclonal neoplastic proliferation of plasma cells. It can be either solitary or multiple and skeletal or extraskeletal. Solitary bone plasmacytoma accounts for 3% of all plasma cell neoplasms with 50% of cases transforming into multiple myeloma. Since plasmacytoma is a rare lesion in the oral cavity, this case presentation is an attempt to focus on the clinical, histopathological aspects of this lesion and the spectrum of plasma cell neoplasms.Case description: We report a case of solitary bone plasmacytoma in a young patient, presenting as a painless ulcero-proliferative growth in the maxillary region. OPG showed radiolucency with respect to non-healing extracted tooth socket (16) with slight bony erosion. Microscopy revealed mature and immature plasma cells with eccentrically placed nucleus, suggestive of solitary plasmacytoma.Conclusion: The purpose of this article is to report a rare case of solitary bone plasmacytoma with emphasis on diagnostic workup. 
