Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study ... more Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study was to compare rigid versus flexible endoscopy in esophageal FB extraction in children. In a retrospective cohort study with consecutive data, children with esophageal FB impaction who were admitted between January 2005 and December 2008 to the Stollery Children's Hospital, Edmonton, Canada, were included. Nature of the procedure for FB removal (flexible vs. rigid endoscopy), duration of the procedure, complications, and associated pathology were documented. A total of 140 children were included (81 boys; mean age, 59.8 ± 48.6 (range, 4-203) months). More than half (54%) of patients were aged 3 years or younger. Coins were the most common foreign body (77.9%). Flexible endoscopy was used in 89 patients, rigid in 49, and both in 2 patients. The mean duration of the endoscopic procedure was 10.50 ± 12.2 minutes for FE (95% confidence interval (CI), 7.94-13.08) and 16.49 ± 21.1 minutes for RE (95% CI, 13.75-22.45; p = 0.04). Biopsies were taken in 19% of patients undergoing FE and in 6% of RE (p = 0.04). Both rigid and flexible endoscopy techniques appear to be equally safe and effective in esophageal foreign body extraction. However, performing flexible endoscopy for esophageal foreign body takes a substantial shorter duration compared with rigid endoscopy. Flexible endoscopy would probably allow a better and more thorough examination and, hence, biopsying esophageal mucosa compared with rigid endoscopy.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2012
To report on airway endoscopic findings and gastrointestinal and atopic conditions in a large con... more To report on airway endoscopic findings and gastrointestinal and atopic conditions in a large consecutive series of atypical croup. Case series with chart review. Tertiary pediatric referral center. A surgical database was searched for all children who underwent full airway endoscopy to investigate atypical croup. The primary outcome measure was the prevalence of large airway lesions in patients with atypical croup undergoing endoscopy. Demographics, secondary diagnoses, and rate of positive findings were documented. Age and atopy were correlated using Spearman's correlation coefficient, and multivariate analysis identified predictors of large airway lesions. Eighty patients were identified over a period of 8 years (58 boys; mean [SD] age 4.8 [3.8] years; range, 46 days to 13.7 years). Of the 80 children, 31 had positive airway findings, with 33 large airway lesions demonstrated, including 10 subglottic stenosis, 7 laryngeal clefts, 6 subglottic hemangiomas, 4 tracheomalacia, an...
International Journal of Pediatric Otorhinolaryngology, 2014
To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/compl... more To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/complex (PRS/C) children to the otolaryngologist and to explore predictive factors of upper airway type and management. This is a retrospective cohort study conducted in a tertiary pediatric referral center. A prospective surgical database was searched for children who were diagnosed with PRS/C. Demographics, presenting complaint, secondary diagnoses, type of upper airway obstruction, secondary airway lesions, presence of cleft palate, and airway interventions were collected. Multiple linear regression analysis was performed to predict upper airway obstruction type and intervention. Seventy-seven potentially eligible patients were identified. Forty-six were included (20 females). Mean age at presentation was 20.4±36.9 months (range 1-191.25 months). Twenty-three primarily presented with respiratory failure, 14 with sleep disordered breathing, and nine with swallowing dysfunction. Children with presentations other than respiratory failure were older (p=0.004). Nineteen were syndromic. Overt cleft palate was more common in those presenting with respiratory failure (p=0.01). The type of airway obstruction encountered and use of tracheostomy were positively predicted by the primary presenting feature of respiratory failure (p<0.05) and male gender (p<0.05). A substantial number of PRS/C patients present later than the neonatal period with presentations other than respiratory failure. Both male gender and presentation with respiratory failure predicted a more severe airway obstruction type and the need for trachesotomy.
International Journal of Pediatric Otorhinolaryngology Extra, 2009
ABSTRACT Pyogenic granuloma is a polypoidal capillary hemangioma that occurs on the skin and muco... more ABSTRACT Pyogenic granuloma is a polypoidal capillary hemangioma that occurs on the skin and mucosal surface. Trauma, hormonal changes seen in pregnancy and use of the oral contraceptive pill have a role in its pathogenesis. Except for the oral cavity, involvement of gastrointestinal tract is quite rare and there are no reports of hypopharyngeal involvement. We report a case of hypopharyngeal pyogenic granuloma most likely secondary to prolonged nasogastric tube insertion in an immuno-compromised host.
International Journal of Pediatric Otorhinolaryngology Extra, 2006
ABSTRACT Background: Major venous thrombophlebitis and/or thrombosis in association with acute he... more ABSTRACT Background: Major venous thrombophlebitis and/or thrombosis in association with acute head and neck infection is a serious but uncommon event. The action of specific bacterial toxins causes the thrombophlebitis, which has the propensity of systemic complications and local circulatory effects. Lemierre's syndrome (LS) is a specific entity within this group, often caused by the anaerobe Fusobacterium necrophorum (FN). Objective: Review of six consecutive pediatric cases and a critical revision of diagnostic categories. Setup: Tertiary referral center. Study design: Case series of pediatric craniocervical infections complicated by internal jugular vein thrombophlebitis (IJVT). Demographics, record of anti-thrombosis management, imaging, and antimicrobial management, duration of admission, clinical picture and sequelae were retrospectively collected. Results: Six cases (three girls and three boys; age range from 7 to 16 years old) were identified over a period of 3 years. One case was a certain LS; four were probable LS cases and one possible diagnosis. Six children had IJVT diagnosed on imaging, which also demonstrated embolic seeding to the knee on one occasion and to the ankle in another. Anti-thrombosis management as outpatients was instituted for 3 months in five out of the six. None had permanent sequelae except one (unilateral high tone sensory hearing loss). In four cases, the duration of admission was 10 days or less, whereas the other two cases stayed for 2 and 5 weeks, respectively. Conclusions: Thrombogenic head and neck infections may occur in children more readily than currently believed. Failure to detect the characteristic anaerobe and the low index of suspicion of IJVT may contribute to missing cases. Modern imaging modalities represent a window of opportunity to detect the key pathogenic process to arguably the most morbid event, namely the IJVT. By incorporating their findings from the outset, the disease is categorized and its devastating complications prevented.
Objective: To compare postoperative respiratory complications in obese and nonobese children foll... more Objective: To compare postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. Study Design: Case-control study. Setting: Pediatric tertiary care center. Subjects and Methods: All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Subjects were identified from a prospective surgical database. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared. Multivariable analysis was performed to identify predictive factors. Results: Forty-nine obese children were identified (20:29, female:male). There were no differences in mean age or type of surgical procedures ( P > 0.05). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications ( P = 0.000, OR 8.54 [95% CI 3.44-21.19]). Ten obese patients and two controls incurred major events ( P = 0.012, OR ...
Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study ... more Esophageal foreign body (FB) impaction is a common emergency in children. The goal of this study was to compare rigid versus flexible endoscopy in esophageal FB extraction in children. In a retrospective cohort study with consecutive data, children with esophageal FB impaction who were admitted between January 2005 and December 2008 to the Stollery Children's Hospital, Edmonton, Canada, were included. Nature of the procedure for FB removal (flexible vs. rigid endoscopy), duration of the procedure, complications, and associated pathology were documented. A total of 140 children were included (81 boys; mean age, 59.8 ± 48.6 (range, 4-203) months). More than half (54%) of patients were aged 3 years or younger. Coins were the most common foreign body (77.9%). Flexible endoscopy was used in 89 patients, rigid in 49, and both in 2 patients. The mean duration of the endoscopic procedure was 10.50 ± 12.2 minutes for FE (95% confidence interval (CI), 7.94-13.08) and 16.49 ± 21.1 minutes for RE (95% CI, 13.75-22.45; p = 0.04). Biopsies were taken in 19% of patients undergoing FE and in 6% of RE (p = 0.04). Both rigid and flexible endoscopy techniques appear to be equally safe and effective in esophageal foreign body extraction. However, performing flexible endoscopy for esophageal foreign body takes a substantial shorter duration compared with rigid endoscopy. Flexible endoscopy would probably allow a better and more thorough examination and, hence, biopsying esophageal mucosa compared with rigid endoscopy.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2012
To report on airway endoscopic findings and gastrointestinal and atopic conditions in a large con... more To report on airway endoscopic findings and gastrointestinal and atopic conditions in a large consecutive series of atypical croup. Case series with chart review. Tertiary pediatric referral center. A surgical database was searched for all children who underwent full airway endoscopy to investigate atypical croup. The primary outcome measure was the prevalence of large airway lesions in patients with atypical croup undergoing endoscopy. Demographics, secondary diagnoses, and rate of positive findings were documented. Age and atopy were correlated using Spearman's correlation coefficient, and multivariate analysis identified predictors of large airway lesions. Eighty patients were identified over a period of 8 years (58 boys; mean [SD] age 4.8 [3.8] years; range, 46 days to 13.7 years). Of the 80 children, 31 had positive airway findings, with 33 large airway lesions demonstrated, including 10 subglottic stenosis, 7 laryngeal clefts, 6 subglottic hemangiomas, 4 tracheomalacia, an...
International Journal of Pediatric Otorhinolaryngology, 2014
To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/compl... more To document the mode and age of primary aerodigestive presentation of Pierre Robin sequence/complex (PRS/C) children to the otolaryngologist and to explore predictive factors of upper airway type and management. This is a retrospective cohort study conducted in a tertiary pediatric referral center. A prospective surgical database was searched for children who were diagnosed with PRS/C. Demographics, presenting complaint, secondary diagnoses, type of upper airway obstruction, secondary airway lesions, presence of cleft palate, and airway interventions were collected. Multiple linear regression analysis was performed to predict upper airway obstruction type and intervention. Seventy-seven potentially eligible patients were identified. Forty-six were included (20 females). Mean age at presentation was 20.4±36.9 months (range 1-191.25 months). Twenty-three primarily presented with respiratory failure, 14 with sleep disordered breathing, and nine with swallowing dysfunction. Children with presentations other than respiratory failure were older (p=0.004). Nineteen were syndromic. Overt cleft palate was more common in those presenting with respiratory failure (p=0.01). The type of airway obstruction encountered and use of tracheostomy were positively predicted by the primary presenting feature of respiratory failure (p<0.05) and male gender (p<0.05). A substantial number of PRS/C patients present later than the neonatal period with presentations other than respiratory failure. Both male gender and presentation with respiratory failure predicted a more severe airway obstruction type and the need for trachesotomy.
International Journal of Pediatric Otorhinolaryngology Extra, 2009
ABSTRACT Pyogenic granuloma is a polypoidal capillary hemangioma that occurs on the skin and muco... more ABSTRACT Pyogenic granuloma is a polypoidal capillary hemangioma that occurs on the skin and mucosal surface. Trauma, hormonal changes seen in pregnancy and use of the oral contraceptive pill have a role in its pathogenesis. Except for the oral cavity, involvement of gastrointestinal tract is quite rare and there are no reports of hypopharyngeal involvement. We report a case of hypopharyngeal pyogenic granuloma most likely secondary to prolonged nasogastric tube insertion in an immuno-compromised host.
International Journal of Pediatric Otorhinolaryngology Extra, 2006
ABSTRACT Background: Major venous thrombophlebitis and/or thrombosis in association with acute he... more ABSTRACT Background: Major venous thrombophlebitis and/or thrombosis in association with acute head and neck infection is a serious but uncommon event. The action of specific bacterial toxins causes the thrombophlebitis, which has the propensity of systemic complications and local circulatory effects. Lemierre's syndrome (LS) is a specific entity within this group, often caused by the anaerobe Fusobacterium necrophorum (FN). Objective: Review of six consecutive pediatric cases and a critical revision of diagnostic categories. Setup: Tertiary referral center. Study design: Case series of pediatric craniocervical infections complicated by internal jugular vein thrombophlebitis (IJVT). Demographics, record of anti-thrombosis management, imaging, and antimicrobial management, duration of admission, clinical picture and sequelae were retrospectively collected. Results: Six cases (three girls and three boys; age range from 7 to 16 years old) were identified over a period of 3 years. One case was a certain LS; four were probable LS cases and one possible diagnosis. Six children had IJVT diagnosed on imaging, which also demonstrated embolic seeding to the knee on one occasion and to the ankle in another. Anti-thrombosis management as outpatients was instituted for 3 months in five out of the six. None had permanent sequelae except one (unilateral high tone sensory hearing loss). In four cases, the duration of admission was 10 days or less, whereas the other two cases stayed for 2 and 5 weeks, respectively. Conclusions: Thrombogenic head and neck infections may occur in children more readily than currently believed. Failure to detect the characteristic anaerobe and the low index of suspicion of IJVT may contribute to missing cases. Modern imaging modalities represent a window of opportunity to detect the key pathogenic process to arguably the most morbid event, namely the IJVT. By incorporating their findings from the outset, the disease is categorized and its devastating complications prevented.
Objective: To compare postoperative respiratory complications in obese and nonobese children foll... more Objective: To compare postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing. Study Design: Case-control study. Setting: Pediatric tertiary care center. Subjects and Methods: All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Subjects were identified from a prospective surgical database. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared. Multivariable analysis was performed to identify predictive factors. Results: Forty-nine obese children were identified (20:29, female:male). There were no differences in mean age or type of surgical procedures ( P > 0.05). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications ( P = 0.000, OR 8.54 [95% CI 3.44-21.19]). Ten obese patients and two controls incurred major events ( P = 0.012, OR ...
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Papers by Hamdy Elhakim