Microsievert Wide-Volume Versus Spiral Computed Tomography Using an Automatic Exposure Control System in the Diagnosis of Foreign Body Aspiration in Children.

BACKGROUND: Foreign body aspiration (FBA) in childhood is a life-threatening condition that necessitates prompt management to prevent devastating complications. Different imaging methods are used in the diagnosis of FBA. OBJECTIVE: The aim of this study was to compare the diagnostic value and dose of microsievert wide-volume computed tomography (µSv-WV-CT) with multidetector computed tomography using an automatic exposure control system (MDCT-AEC) in children with FBA. MATERIAL AND METHODS: In this single-center cross-sectional study, 102 cases diagnosed with FBA between September 2013 and September 2021 were retrospectively evaluated. The patients were divided into 2 groups according to the diagnostic modality used: group A, µSv-WV-CT (2016-2021) and group B, MDCT-AEC (2013-2021). The diagnostic performance and radiation dose of the 2 groups were statistically compared. RESULTS: The diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the 2 groups was similar. The mean effective radiation dose of group A was 34.89 ± 0.01 µSv, which was significantly lower than that of group B (179.75 ± 114.88 µSv) ( P < 0.001). CONCLUSION: In children with suspected FBA, µSv-WV-CT at a lower radiation dose had similar diagnostic performance to MDCT-AEC.

Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis.

BACKGROUND: Time of diagnosis (TOD) of benign esophageal perforation is regarded as an important risk factor for clinical outcome, although convincing evidence is lacking. The aim of this study is to assess whether time between onset of perforation and diagnosis is associated with clinical outcome in patients with iatrogenic esophageal perforation (IEP) and Boerhaave's syndrome (BS). METHODS: We searched MEDLINE, Embase and Cochrane library through June 2018 to identify studies. Authors were invited to share individual patient data and a meta-analysis was performed (PROSPERO: CRD42018093473). Patients were subdivided in early (≤ 24 h) and late (> 24 h) TOD and compared with mixed effects multivariable analysis while adjusting age, gender, location of perforation, initial treatment and center. Primary outcome was overall mortality. Secondary outcomes were length of hospital stay, re-interventions and ICU admission. RESULTS: Our meta-analysis included IPD of 25 studies including 576 patients with IEP and 384 with BS. In IEP, early TOD was not associated with overall mortality (8% vs. 13%, OR 2.1, 95% CI 0.8-5.1), but was associated with a 23% decrease in ICU admissions (46% vs. 69%, OR 3.0, 95% CI 1.2-7.2), a 22% decrease in re-interventions (23% vs. 45%, OR 2.8, 95% CI 1.2-6.7) and a 36% decrease in length of hospital stay (14 vs. 22 days, p < 0.001), compared with late TOD. In BS, no associations between TOD and outcomes were found. When combining IEP and BS, early TOD was associated with a 6% decrease in overall mortality (10% vs. 16%, OR 2.1, 95% CI 1.1-3.9), a 19% decrease in re-interventions (26% vs. 45%, OR 1.9, 95% CI 1.1-3.2) and a 35% decrease in mean length of hospital stay (16 vs. 22 days, p = 0.001), compared with late TOD. CONCLUSIONS: This individual patient data meta-analysis confirms the general opinion that an early (≤ 24 h) compared to a late diagnosis (> 24 h) in benign esophageal perforations, particularly in IEP, is associated with improved clinical outcome.

Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture.

UNLABELLED: Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. KEY WORDS: Chest pain; Coronary artery disease; Esophageal rupture; Misdiagnosis.

Delayed diagnosis of a case of Zenker's diverticulum. What may happen when a family physician does not visit his family physician.

INTRODUCTION: Zenker's diverticulum is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle. It occurs commonly in elderly patients (over 70 years) and the typical symptoms include dysphagia, regurgitation, chronic cough, aspiration and weight loss. CASE: We are reporting dysphagia in a 49-years old man who was treated as having Helicobacter Pylori gastritis for three years. Being a family physician himself, the patient applied to specialists in gastroenterology, bypassing primary care. During a casual interview on his symptoms, a family physician referred him to undergo a repeated endoscopy with suspected Zenker's diverticulum. After being diagnosed with Zenker's diverticulum, the patient underwent surgical intervention at the department of thoracic surgery and made a full recovery. He regained five kilograms at the end of five weeks after the operation. CONCLUSION: This case demonstrates once more the importance of history taking and follow-up in medical care. Attentive listening by a family physician could have probably prevented the delay of service in this case.

Complications of tracheobronchial foreign bodies.

BACKGROUND/AIM: Tracheobronchial foreign bodies may cause several complications in the respiratory system. We aimed to present the complications of tracheobronchial foreign bodies. MATERIALS AND METHODS: Between January 1990 and March 2015, 813 patients with suspected tracheobronchial foreign body aspiration were hospitalized in our department. Patients with complications related to foreign bodies in airways were included in this study. We retrospectively evaluated the records of patients according to symptoms, foreign body type, localizations, and complications. RESULTS: A foreign body was found in 701 of 813 patients (86.2%). Complications related to foreign bodies settled in airways were seen in 96 patients (13.7%). The most common complications were atelectasis and pneumonia in 36 (5.1%) and 26 (3.7%) patients, respectively. Other complications were bronchiectasis (n = 12, 1.7%), cardiopulmonary arrest (n = 11, 1.6%), bronchostenosis (n = 3, 0.4%), death (n = 2, 0.3%), migration of foreign body (n = 2, 0.3%), pneumomediastinum (n = 2, 0.3%), tracheal perforation (n = 1, 0.15%), pneumothorax (n = 1, 0.15%), and hemoptysis (n = 1, 0.15%). Coughing (n = 74, 77.1%) and diminished respiratory sounds (59.3%, n = 57) were the most common findings. CONCLUSION: Careful evaluation and rapid intervention are life-saving methods in tracheobronchial foreign body aspirations.

The increasing incidence of esophageal squamous cell carcinoma in women in Turkey.

BACKGROUND/AIM: This study assessed the trend changes in the histological types of esophageal cancer in a 25-year period in eastern Turkey. MATERIALS AND METHODS: We searched all cases of esophageal cancer from 1990 to 2015 according to their histological diagnosis and sex, grouping the patients in 5-year time periods to evaluate time trends. RESULTS: We identified 1462 cases of esophageal cancer. In terms of patient make-up, 742 were male and 720 were female. In general, 75.86% of the patients had squamous cell carcinoma (SCC), 19.56% of the patients had adenocarcinoma (ADC), and the remaining 4.58% patients were found to have other histopathologic disorders. While the SCC to ADC ratio was 1.76 between 1990 and 1994, this rate increased to 8.73 between 2010 and 2014; during these periods, the male to female ratio decreased from 1.43 to 0.86. Between these two periods, statistically significant changes were observed of SCC and the number of female patients (P < 0.001, P = 0.008, respectively). CONCLUSION: While the incidence of esophagus ADC and the number of male patients increased recently in Western countries, the number of female patients and SCC cases increased in our region in the last 25 years.

A rare thymoma type presenting as a giant intrathoracic tumor: lipofibroadenoma.

Type B1 thymoma (lipofibroadenoma) is extremely rare. The tumor is characterized by an organoid appearance rich in lymphocytes with medullary differentiation and perivascular spaces. A twenty-three-year-old female patient was admitted to our clinic with complaints of chest pain and dyspnea for six months. Chest computed tomography showed solid and fatty components of masses 21×7 and 5×7 cm with clear borders in the right thoracic cavity. The patient underwent a posterolateral thoracotomy in which the mass, arising from the anterior mediastinum, was resected. Histopathological examination showed that the mass was Type B1 thymoma, and the patient was presented in light of the literature.