| Clinical Studies on the 96 Cases of Croup |
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Min Ho Choi, Duk Hyun Chung |
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Deparτment of Pediatrics, Presbyterian Medical Center, Chun Ju |
| Croup 96 例에 對한 臨床的 觀察 |
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崔民鎬, 鄭德鉉 |
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全州예수病院 小兒科 |
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| Abstract |
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96 cases of croup were clinically observed for 8 years from 1960 to 1967. The summary of the clinical
and labaratory findings are as follows：
Analysis of the yearly prevalence revealed 62% of cases in 1967, which seems sufficient to reflect
clear epidemic pattern. A preponderance of cases (83 cases, 86%) occurred between December and
March. Most frequent month was February (25 cases, 26%). This reflects the pattern of admission
to this hospital for other acute respiratory disease. The most frequent age group was early childhood
in the range of 3-5 years of age (51 cases, 53%) with the sex ratio of male 1,3: female 1. Almost
all cases developed in Cholla Puk Do, suggesting strongly the evidence of local epidemic and more
frequently in rural area(57 cases, 59.3%). Most of the patients (77.1%) visited and admitted
to the hospital within 48 hours after the initial complaints. The clinical picture is characterized by an
abrupt onset, fulminating course, difficulty in breathing (90.6%), hoarseness (85.4%), barking cough
(71.9%), larygeal stridor(50.0%) and etc. The course, if untreated, is usually rapidly disastrous over
the next several hours, resulting rapidly progressive respiratory obstruction, onset of cyanosis, shock
and death shortly thereafter. Upon examination, there was definite swelling and redness of tonsils,
pharynx and epiglottis (92%). Significant retraction of the intercostal spaces and of the accessory
respiratory muscles was apparent in 58% of cases. Other findings are as follows：
Coarse breathing sound (43.8%), excessive mucus in posterior pharynx (37.5%), pseudomembrane
(20%) and etc. Cervical adenitis was not so popular. On the peripheral blood counts, 80.2% of the
patients had mild to moderate degree of anemia and polymorpho leukocytosis was detected on the 84.
4% of the cases with the range of 10, 000-25,000/mm3. Corynebacterium diphtheriae and Hemophilus
Influenzae were never detected in any of the cases. Throat smear and culture yielded streptococci
(70.4%), staphylococci (11.3%), micrococcus tetragenus (5.6%) and etc. Immediately on admission
to the hospital all patients were placed in a humidified atmosphere, given general supportive therapy
and kept under constant nursing and medical surveillance. Tracheostomy was carried out on 40. 6% of
the patients. The cornerstone of treatment for the respiratory obstruction was tracheostomy in our
experiences. It is our opinion that 2 cases of 4 death in this series might have been prevented by early
tracheostomy. Bronchopneumonia was found in 43.8% of cases by chest X-ray. Mild pneumomediastinum
(3.1%) and subcutaneous emphysema(2.1 %) were complicated during tracheostomy. 4 cases (4.2%)
were expired.
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