pulmicort and Granuloma

Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation.. A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia. To treat his unstable cardiovascular status, surgery was performed to close his atrial septal defect. After the operation, stenosis was detected by auscultation and flow limitation worsened. A bronchoscopy revealed granulomas completely obstructing his right bronchus and partially obstructing his left bronchus. Dexamethasone infusion partially reduced the mass, after which removal by yttrium aluminium garnet laser was tried. The airway obstruction was not resolved, however, because of granuloma reproliferation. Budesonide (aerosol liquid) inhalation was started, and tissue was reduced using an yttrium aluminium garnet laser and physically removed using forceps. After continued budesonide inhalation, he was successfully liberated from the ventilator.. Life-threatening airway obstruction by granulomas developed in a translaryngeally intubated paediatric patient. The granuloma was detected after a couple of weeks of intubation. A bronchial granuloma is rare in paediatric patients. It should be suspected with evidence of bronchial obstruction. Treatment with corticosteroids and surgery using a laser maybe indicated.

Topics: Administration, Inhalation; Airway Obstruction; Anti-Inflammatory Agents; Bronchial Diseases; Bronchoscopy; Budesonide; Combined Modality Therapy; Granuloma; Humans; Infant; Intubation, Intratracheal; Lasers, Solid-State; Male

Topics: Adolescent; Biopsy, Needle; Budesonide; Crohn Disease; Diagnosis, Differential; Edema; Follow-Up Studies; Genital Diseases, Male; Granuloma; Humans; Immunohistochemistry; Lymphangitis; Male; Penile Diseases; Risk Assessment; Scrotum; Severity of Illness Index

As part of a study of the local anti-inflammatory activity of corticosteroid 16 alpha, 17 alpha-acetals it was found that on acetalization of 16 alpha-hydroxyprednisolone with n-butyraldehyde the two possible epimers were formed in the ratio of 1: 1. The reaction product was resolved by column chromatography on Sephadex LH-20. The isolated epimers were studied by NMR and mass spectrometry. The epimeric mixture of this new non-halogenated corticoid, 16 alpha, 17 alpha-(22R,S)-propylmethylenedioxypregna-1,4-diene-11 beta,21-diol-3,20-dione (budesonide), was shown to have a local antiinflammatory potency comparable to that of fluocinolone acetonide in cotton pellet tests in rats. In contrast, its systemic glucocorticoid activity was found to be 4--7 times lower than that of fluocinolone acetonide, however.

Topics: Animals; Budesonide; Chemical Phenomena; Chemistry; Glucocorticoids; Granuloma; Male; Organ Size; Pregnenediones; Rats; Thymus Gland; Triamcinolone Acetonide