Glide video laryngoscope for the management of foreign bodies impacted at the hypopharyngeal level in adults.

BACKGROUND: Cricopharyngeal foreign bodies (FBs) impaction in adults is a common clinical problem; without treatment, the sequelae may be lethal due to local and/or mediastinal infection. When direct laryngoscopy and flexible fiberoptic endoscopy are ineffective, rigid endoscopy is the method of choice requiring general anesthesia. The new video laryngoscopes represent a great advancement in the assessment of the laryngeal inlet. Aim of the study was to assess the feasibility of identifying and removing FBs impacted at crycofaringeal and upper oesophageal sphincter by the video laryngoscope. METHODS: In a period of 30 months, on an urgent basis, we systematically assessed by GlideScope® video laryngoscope all adult patients with a diagnosis of impacted crycofaringeal upper esophageal FB, after unsuccessful removal attempts in the otolaryngology or gastroenterology unit. RESULTS: Twenty-six consecutive patients were evaluated. In conscious sedation by video laryngoscope 17 FBs were identified and removed from the hypopharynx or upper esophageal sphincter. In 9 patients rigid endoscopy in general anesthesia and tracheal intubation was necessary to remove FBs impacted beyond the upper esophageal sphincter. CONCLUSION: In our experience video laryngoscope, because of the magnified vision, the better patient comfort and no requirement of general anesthesia, represents a great improvement in identifying and removing in conscious sedation even small and thin foreign bodies not recognized by radiological and otolaryngology examination and not readily detected by direct endoscopy.

[A triphalangeal thumb associated with otological abnormalities. A new syndrome?]. / Pollice trifalangeato associato ad anomalie otologiche. Una nuova sindrome?

We report a newborn with triphalangeal thumb and auricolar defects. We suggest that our patient represents a new syndrome or a mild form of Townes syndrome.

Early behavioural development of preterm infants.

In this study 17 male and 13 female infants with gestational ages between 27 and 34 weeks (mean 30.7) and birthweights between 750 and 2020g (mean 1545) were evaluated with the Brazelton Neonatal Behavioral Assessment Scale at 35, 38, 40 and 44 weeks postconceptional age. All were in room air at the time of observation and none was being treated with mechanical ventilation. In the motor performance cluster, all five items improved with advancing postconceptional age and in the orientation cluster four of six items improved with age: these show better behavioural evolution compared with other clusters. There was no change in auditory response, with good response from 35 weeks onward. Behavioural development did not proceed evenly in all areas, and within the same cluster certain features developed earlier than others. From 35 to 44 weeks, auditory responsiveness was similar to that of previously evaluated healthy term infants.

Behaviour of preterm newborns reaching term without any serious disorder.

We studied the behaviour of 20 preterm infants (average gestational age 33 weeks) brought to term, without any serious disorder. These infants were compared with a group of 21 healthy term infants. To evaluate behaviour we used the 26 items of the Brazelton Neonatal Behavioural Assessment Scale (BNBAS). Our preterm infants had on the whole better scores than those reported in the literature for preterm infants with various disorders. Apart from lower ability to bring hand to mouth and in getting used to visual stimuli (these differences are statistically significant) they had, in the items of orientation a lower score only in ability to follow a voice and a face (not statistically significant). These results show that preterm infants reaching term without any serious disorder do on the whole as well as full-term infants. This correlates with the observations of Dubowitz on behaviour and particularly on visual function of preterm infants and confirms the preliminary report of Daum regarding the influence of the type of neonatal pathology on the ability of orientation at the moment of term.

A systems approach to the child, school, family, and community in an urban area.

Fifteen eighth-grade students, their parents, teachers, and relevant school administrators received a multilevel systems consultation from a community mental health center. Clients were conceptualized and worked with in terms of the subsystem to which they belonged and with regard to the interrelationships of the other subsystems comprising the school-community system. Theoretical considerations following Lewin's life-space concept are described as a basis for this approach in contrast to more traditional ones which typically fail to treat directly, simultaneously, and/or sequentially all client subsystems, e.g., child, school, family, and community. The consultation is described as a case example with each client contributing to the evaluation of the intervention. Although the consultation could not be carried out entirely along the lines originally conceived, it serves as a helpful model for making a more potent impact in school interventions.