By M. Mufassa. University of Wisconsin-Milwaukee.

A contrast enhanced com- 5 puterised tomography (CT) examination will confirm the diagnosis geriforte 100mg on line. Laryngomalacia Laryngomalacia is a relatively common condition that generally presents during the neonatal period as inspiratory stridor cheap 100 mg geriforte free shipping. The condition occurs as a result of the epiglottis and arytenoid cartilages collapsing on inspiration and it is usually self- limiting with symptoms disappearing by approximately 2 years of age. The investigative examination of choice is microlaryngobronchoscopy, although The chest and upper respiratory tract 33 Fig. Subglottic stenosis Subglottic stenosis may occur congenitally in infants with Down’s syndrome as a result of a narrow larynx. However, it is seen more commonly as a consequence of prolonged endotracheal intubation in premature infants (Figs 4. Endo- scopic evaluation is the investigation of choice and plain film radiography is NOT indicated. Croup (acute infectious laryngotracheobronchitis) Croup is a combination of stridor, ‘barking’ cough and respiratory distress as a result of upper airway obstruction, and usually occurs as a consequence of a viral infection in children between the ages of 6 months and 3 years. A defini- tive diagnosis can normally be made following clinical examination and plain film radiography is NOT indicated. Note the typical ‘wine bottle’-shaped airway on antero-posterior (AP) projection. Epiglottitis Epiglottitis is an inflammatory condition of sudden onset and progression that presents in children between the ages of 2 and 7 years. The child will typically sit forward, open mouthed and drooling and, as this condition is a paediatric emergency, should be transferred to a paediatric intensive care unit where inves- tigative laryngoscopy will be undertaken to confirm the clinical diagnosis. The lower/intra-thoracic airway Asthma Asthma is an umbrella term for a variety of paediatric chest conditions that result in a persistent or episodic wheeze, possibly associated with a cough. Symptoms typically present in children over the age of 3 years and are more common in the winter months, due to an increase in viruses, and in autumn/spring as a conse- quence of pollen. A child known to suffer from asthma does not require radiographic examina- tion with each episode.

It is delicate buy geriforte 100 mg on-line, precise work that will show in the patient’s scars for the rest of his or her life purchase geriforte 100 mg with amex. It is no longer a small skin graft but a complex procedure that commences with good preoperative planning and ends after months of intensive rehabilitation intervention. Choice of Skin Grafts Patients with minor burns present with many donor sites. The only excuse for their use is surgeons’ comfort, to avoid postoperative hematoma and serum collections under the skin graft. Surgeons who mesh grafts tend to forget that our goal is the patient’s well being. A meshed graft will show the scar pattern for the rest of the patient’s life and is completely unacceptable (Fig. Every little cut that is made on the surface of a skin graft will become scar; thus it should be avoided. It is also the author’s belief that there it is not necessary to make drain cuts on the surface of the skin graft. Good hemostasis can be achieved with topical and subcutaneous epinephrine solutions and tourniquets. There is no rebound effect and skin grafts heal uneventfully without the need for any other intervention (Fig. Split-skin grafts are normally used, but small full-thickness skin grafts may be necessary in specific areas (lips, eyelids, nose, hand/fingers, toes, and genita- lia). In general, medium-thickness split-skin autografts are used (14–16/1000 inch), which provide a good color and texture to the grafted site. As soon as the burn wound has been excised, the defect is measured and a drawing that resembles the excised burn wound is created on the donor site.