Esophageal wishbone extraction: not for the chicken-hearted.

OBJECTIVE: Ingestion of foreign bodies in the pediatric population is common and in the majority of cases involves spontaneous passage through the esophagus; however, they can become lodged in spaces of anatomical narrowing. Sharp foreign bodies are of particular concern due to a higher chance of perforation and other complications. The goal of this case report is to describe the safe removal of a chicken wishbone and 3 alternate options in the event that the initial choice was unsuccessful. METHODS: We report the case of a 2-year-old boy who presented to our pediatric tertiary center after unsuccessful endoscopic removal of a chicken wishbone from the esophagus. RESULTS: Radiologically, the wishbone was oriented with the tines pointing up. Endoscopic examination revealed the tips of both tines to be embedded deeply into the lateral walls of the esophageal mucosa. Esophagoscopy and protecting the sharp points of the wishbone were used to successfully extract the intact wishbone. CONCLUSION: Previous techniques have involved cutting the bone; however, in this case, tension was so high that it was felt that cutting the bone would result in perforation. Proper management of such cases requires planning and often multiple strategies.

Assessment of vocal fold mobility before and after cardiothoracic surgery in children.

OBJECTIVES: To assess the incidence of vocal fold immobility (VFI) after cardiothoracic surgery in children and to determine the factors potentially associated with this outcome. METHODS: Flexible laryngoscopy to assess vocal fold mobility was performed before surgery and within 72 hours after extubation in 100 pediatric patients who underwent cardiothoracic procedures. The 2 operating surgeons recorded the surgical technique and their impression of possible injury to the recurrent laryngeal nerve. The presence of laryngeal symptoms, such as stridor, hoarseness, and strength of cry, after extubation was documented. RESULTS: Of 100 children included in this study, 8 had VFI after surgery. Univariate analyses showed that these 8 patients were younger and weighed less than the patients with normal vocal fold movement. Monopolar cautery was used in all patients with VFI. On univariate analysis, factors statistically significantly associated with VFI were circulatory arrest and dissection or ligation of the patent ductus arteriosus, left pulmonary artery, right pulmonary artery, or descending aorta. However, multivariate analyses failed to show these associations. CONCLUSIONS: The incidence of VFI after cardiothoracic surgery in our population of children was 8.0% (8 of 100). Of several factors found to be potentially associated with VFI on univariate analysis, none were significant on multivariate analysis. This may be a result of the few patients with VFI. A larger multicenter prospective study would be needed to definitively identify factors associated with the outcome of VFI.

Cranial conjoined twins: surgical and anesthetic challenges for a routine procedure: adenoidectomy and examination of ears.

Craniopagus conjoined twins have long been the subject of interest because of the rarity and peculiarity of their juxtaposition. We present the surgical, airway and anesthetic challenges in craniopagus conjoined twins, in which one of the twins underwent adenoidectomy for obstructive sleep breathing disorder. The surgical procedure required a special setting from an anesthetic perspective whereby both children needed anesthesia due to the complex physiology of their brains and cardiovascular systems. As well, we took the opportunity to do bilateral ear examinations of both twins.

Efeito do anestésico local pré-incisional na dor pós tonsilectomia em crianças / Effect of preincisional local anesthesic on post-tonsillectomy pain in children

O objetivo do presente trabalho foi determinar o efeito da injeção de enestésico local (AL) pré-inciosional na dor pós-tonsilectomia em crianças. Ensaio clínico randomizado e duplo-cego realizado no Serviço de Otorrinolaringologia do Hospital São Lucas da PUCRS. Foram estudas 16 crianças de 6 a 12 anos submetidas à tonsilectomia sob anestesia geral. Os pacientes foram randomizados para receber infiltração pré-incisional de bupivacaína 0,5 ou placebo (soro fisiológico a 0,9%). A avaliação da dor pós-tonsilectomia foi realizada no pós-operatório por parcipante cego para a medicação empregada, utilizando-se uma escala analógica visual para crianças. Foi verificada a necessidade de medicação extra nas primeiras 24 horas pós-cirurgia. No pós operatório imediato e no 1º signitivamente menor (p=0,03). A partir do 3º pós-operatório o valor do escore no grupo do AL foi signitivamente menor (P=0,69), mas sem diferença estatística. Não Houve diferença na necessidade de analgesia extra entre os dois grupos. O uso do AL pré-incisional em crianças submetidas à tonsilectomia parece diminuir a dor no pós-opearatório.

Sinusite fúngica: relato de caso e revisäo da literatura / Fungal sinusitis: case-report and literature review

Sinusite fúngica primária e secundária em pacientes imunocomprometidos está bem documentada mas a incidência de infecçöes dos seios paranasais por fungos têm aumentado em pacientes imunocompetentes. A sinusite fúngica deve ser sempre considerada no diagnóstico diferencial de sinusite crônica ou recorrente resistente ao tratamento clínico adequado. Um alto índice de suspeiçäo é necessário para o diagnóstico e o exame clínico é raramento conclusivo. O diagnóstico definitivo depende do patologista na maioria dos casos. Relatamos um caso de sinusite fúngica, enfatizando seus aspectos diagnósticos e terapêuticos