RESUMEN
OBJECTIVE: This paper addressed the impact in terms of direct costs of the injuries in children due to foreign bodies in the upper aero-digestive tract. METHODS: Two thousand one hundred and three consecutive cases were collected from 2000 to 2002 in 16 European hospitals, 1 hospital for each participating country, and referred to children aged until 14 who had FB injuries. Costs were based on the extraction of the FB procedures and on hospitalization length, based on DRGs. Determinants of costs and of length of stay (LOS) were analyzed using a multilevel model. RESULTS: The major cost of the treatment of FB injuries is covered by the ENT Departments, which are usually the first choice of referral, directly from the patients. Children had a mean LOS of 2.13 days (95% C.I. 1.99-2.29). Treatment of the FB was associated with a mean cost of euro 1017.37 (95% C.I. 963.27-1073.51). In the multivariable analysis higher costs are related to the modality of arrival to the hospital by walk, to the site of the injury (ICD-933, ICD-934, ICD-935 in particular) and to the use of surgery in removing the FB. DISCUSSION: Foreign bodies injuries are posing a great threat not only with regards to the clinical aspects but also from the public health perspective, their treatment being associated with high costs, in particular when surgery is needed.
Asunto(s)
Bronquios/lesiones , Cuerpos Extraños/economía , Costos de la Atención en Salud , Necesidades y Demandas de Servicios de Salud , Hospitalización/economía , Salud Pública/economía , Tráquea/lesiones , Adolescente , Niño , Europa (Continente)/epidemiología , Femenino , Cuerpos Extraños/epidemiología , Cuerpos Extraños/cirugía , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Factores de Tiempo , Heridas y Lesiones/economía , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
INTRODUCTION: Food Products Containing Inedibles (FPCIs) are believed to represent a source of higher choking risk in children. The aim of this study was to set up a controlled study, conducted on children aged 3-6 in a laboratory setting, in order to understand their behavior when interacting with FPCIs (with reference to mouthing activities, double nature recognition, and toy assembling ability). METHOD: The experimental phase was divided into two sessions: a FPCI session and a Toy session, to which 247 children were randomly assigned. During these sessions children were observed in order to catch their mouthing activity according to the two types of objects available to them (FPCIs and Toys). RESULTS: This study shows that: (a) children's behavior with respect to toys contained in FPCIs and toys presented alone is not significantly different; (b) children's ability to distinguish between the edible and non-edible part of the FPCI was very high; and (c) mouthing episodes of the inedible parts were negligible and comparable between FPCIs and toys presented alone. This strongly suggests that, with respect to choking risk, FPCIs are not per se distinguishable from toys containing small parts. IMPACT ON INDUSTRY: Restrictions on the sale of FPCIs with small toys exist in the U.S. market. In Europe, FPCIs are allowed to be on sale, under the condition that, in case, they will follow the general regulatory requirements of small toys packaged and sold alone. In this case, they must provide age warnings and labels. Our findings do not justify the different attention that toys in FPCIs are at times afforded by regulators when compared to "stand alone" toys.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Conducta Infantil , Seguridad de Productos para el Consumidor , Industria de Alimentos/normas , Juego e Implementos de Juego/lesiones , Obstrucción de las Vías Aéreas/epidemiología , Niño , Preescolar , Deglución , Embalaje de Alimentos/normas , Humanos , Medición de Riesgo , Estados UnidosRESUMEN
OBJECTIVE: To study the pattern of foreign bodies in the upper airways as emerging from the hospital records in the Bologna and Siena hospitals in Italy 1997-2002. METHODS: A retrospective review of hospital records was performed using a standardized protocol. All injuries with ICD9 (International Classification of Diseases, 9'h revision) codes ranging from 931 to 934 which occurred in children age 0-14 were considered for the database. RESULTS: One hundred ninety seven patients were included in the database with a diagnosis of Foreign Bodies (FB) over the study period, 78 with ICD931, 105 with ICD932, 12 with ICD933 and 2 with ICD934 discharge diagnosis. Of the 197 patients, 51.90% of the patients were males and the 48.10% were female. Median age was 4 (2, 6). At the moment of the injury, the child was eating (11%), playing (83%) or studying (4%) or cleaning ears (2%). The child was supervised by an adult in doing his/her activities at the moment of injury in the 84.2% of the cases. The child reached the hospital using always private transport (100%), never by using an emergency transport (0%). Most commonly, FB were extracted in ambulatory (95.4%), more rarely using an endoscopic procedure (4.1%), and never using surgery. Hospitalization was required in the 0.5% of cases (1). CONCLUSIONS: Our study showed the substantial epidemiological similarity of the Italian data with the experience of other center in the world. The burden of chocking was very limited in our country, as proven by the limited access to emergency and more invasive procedures. Nevertheless, some consideration can be made from the preventive point of view. Quite surprisingly, the majority of injuries occurred under the supervision of an adult in playing or recreational activities.
Asunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Cuerpos Extraños/epidemiología , Hospitales Públicos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Clasificación Internacional de Enfermedades , Italia/epidemiología , Masculino , Auditoría Médica , Estudios Retrospectivos , Medicina EstatalRESUMEN
This report outlines the current status of the official statistical data available concerning mortality rates for suffocation in children <15 years of age, stratified according to sex and country in Europe, in the years 1980-1995. The data source is the WHO Mortality Database, which comprises deaths registered in national vital registration systems, with underlying cause of death as coded by the relevant national authority. To assess the impact of the problem of suffocation, the total potential years of life lost have been calculated. In addition, for Italy, and for the years 1999-2000, data related to deaths and hospitalizations for foreign body in the pharynx and larynx are presented. In Italy, in the years 1999-2000, the ratio between the number of hospitalizations and the mortality rates is approximately one death every 10 hospitalizations (x 100,000). The European mortality rate exceeds nearly one death per 100,000 persons. No evidence of any geographical pattern or cyclic trend emerged from the analysis of this official data.
Asunto(s)
Asfixia/mortalidad , Sistema de Registros , Adolescente , Asfixia/etiología , Niño , Mortalidad del Niño , Preescolar , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , PrevalenciaRESUMEN
Psychological aspects determining children's behaviour in response to asphyxiation risk due to ingestion of foreign matter have been rarely and non-systematically examined in the literature. Aim of this report is to highlight--through a review of the most significant psychological research in the literature--which factors influence the behaviour, perception and assessments of children 0 to 14 years of age, in a risk situation. In particular, attention is focused on the direct experience of a child at risk, assuming that this experience can play a significant role in future dangerous situations. Outcomes of studies taken into consideration have highlighted the influence of age, sex, socio-economic status, parents' role, peer group, personal traits, television and personal experience. The latter refutes the initial hypotheses, showing an unexpected and clearly negative effect on future evaluation and behaviour in response to similar contexts of asphyxiation risk. The implications for research on asphyxiation due to ingestion of foreign matter are examined.
Asunto(s)
Accidentes Domésticos/estadística & datos numéricos , Asfixia/epidemiología , Asfixia/etiología , Actitud , Conducta Infantil , Cuerpos Extraños/complicaciones , Adolescente , Niño , Conducta Alimentaria , Femenino , Humanos , Masculino , Factores de Riesgo , Asunción de Riesgos , Factores Sexuales , TelevisiónRESUMEN
In previous research the authors have remarked that some hystological patterns--macrophagic hyperplasia and thymus-dependent areas hyperplasia--when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value. In this study the possible relationship between the results of E and EAC-rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found. Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.
Asunto(s)
Neoplasias Laríngeas/diagnóstico , Ganglios Linfáticos/patología , Formación de Roseta , Humanos , Hiperplasia , Neoplasias Laríngeas/inmunología , Neoplasias Laríngeas/patología , Cuello , PronósticoRESUMEN
The role of lymphokines in modulating the immune response in patients suffering from neoplastic disease is still controversial. Recent studies indicate that in patients with head and neck cancer, a decrease in LIF (leukocyte migration inhibiting factor) production is usually present in advanced disease. In this study, the authors investigate: the LIF production in lymphocytes derived from the peripheral blood and cervical nodes of patients with laryngeal carcinoma by using an autologous pattern (i.e., for each patient, the specific LIF production was challenged by means of an autologous cell extract derived from his own tumor); the influence of histologically confirmed cervical node metastases on LIF production. Our results indicate that: There is a significant decrease in LIF production in patients with histologically proven cervical node metastases as compared to patients with no metastatic foci. The decrease of LIF production is related to the presence of mononuclear adherent cells. When the latter are removed, there is a significant reversal of specific LIF suppression. The possible meaning of the data is discussed.
Asunto(s)
Neoplasias Laríngeas/inmunología , Factores Inhibidores de la Migración de Leucocitos/biosíntesis , Ganglios Linfáticos/inmunología , Metástasis Linfática/inmunología , Linfocinas/biosíntesis , Adhesión Celular , Humanos , Linfocitos/inmunología , Monocitos/fisiología , CuelloRESUMEN
The specific tumor-induced leukocyte inhibition factor (LIF) production in laryngeal cancer patients has been investigated before and after the removal of adherent cells in order to evaluate the existence of a suppressor activity; 20 patients served as subject. The LIF production, after challenging the lymphocytes with 3MKC1 autologous tumor extracts, was significant in 12 patients and showed a further significant increase after the removal of adherent cells. In 3 patients with no previous significant LIF production, there was a conversion to significance when the adherent cells were removed. The other patients did not show any significant variation. These data seem to suggest the existence of a suppressor activity exerted by adherent cells in laryngeal cancer patients on LIF production.
Asunto(s)
Neoplasias Laríngeas/inmunología , Factores Inhibidores de la Migración de Leucocitos/biosíntesis , Linfocitos/inmunología , Linfocinas/biosíntesis , Linfocitos T Reguladores/inmunología , Anciano , Inhibición de Migración Celular , Femenino , Humanos , Neoplasias Laríngeas/sangre , Factores Inhibidores de la Migración de Leucocitos/inmunología , Linfocitos/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
The existence of a clear circadian rhythm in the local secretion of nasal IgA is well-known phenomenon which is confirmed in the present research. Since the temporal pattern of secretory IgA (SIgA) strictly parallels the ACTH-cortisol cycle, a dependence was hypothesized in previous research, but the suppression of adrenal rhythm by means of massive doses of exogenous corticosteroids showed no influence on the SIgA cycle. In the present research a more sophisticated method of corticoid-incretion suppression was used; the single-dose suppression test with dexamethasone, which influences only the impulsive phase of the rhythm. In this case too, however, no influence was demonstrated on nasal SIgA secretion.
Asunto(s)
Ritmo Circadiano , Inmunoglobulina A Secretora/inmunología , Inmunoglobulina A/inmunología , Terapia de Inmunosupresión/métodos , Mucosa Nasal/inmunología , Dexametasona/administración & dosificaciónRESUMEN
Natural killer (NK)-mediated cytotoxicity against the K562 cell line was evaluated in normal subjects and in patients with laryngeal cancer. Results showed reduced lymphocyte cytotoxicity in patients with neoplastic disease and further reduction in NK activity following postoperative radiation therapy. The authors discuss the possibility of using this test in the immunological monitoring of patients with laryngeal carcinoma.
Asunto(s)
Citotoxicidad Inmunológica , Células Asesinas Naturales/inmunología , Neoplasias Laríngeas/inmunología , Línea Celular , Humanos , Células Asesinas Naturales/efectos de la radiación , Neoplasias Laríngeas/radioterapia , Persona de Mediana EdadRESUMEN
The specific tumor-induced LIF production in 30 laryngeal cancer patients has been investigated before and after the removal of adherent cells to evaluate the existence of a suppressor activity. LIF production, after challenging lymphocytes with 3 M KCI autologous tumor extracts, was significant in 16 patients and showed a further significant increase after removal of adherent cells. A conversion to significance when the adherent cells were removed was shown in 6 patients, with no previous significant LIF production. These data suggest the existence of a suppressor activity exerted by adherent cells on LIF production in laryngeal cancer patients.
Asunto(s)
Neoplasias Laríngeas/inmunología , Factores Inhibidores de la Migración de Leucocitos/biosíntesis , Linfocinas/biosíntesis , Linfocitos T Reguladores/inmunología , Antígenos de Neoplasias/aislamiento & purificación , Adhesión Celular , Inhibición de Migración Celular , Separación Celular , Células Cultivadas , Humanos , Factores Inhibidores de la Migración de Leucocitos/inmunologíaRESUMEN
The production of leukocyte migration inhibition factor (LIF) from lymphocytes after stimulation with 3 M KCl soluble tumor and normal mucosa extracts was investigated in 30 patients with laryngeal carcinoma at different development stages and in 30 normal donors. The experiments were performed in heterologous and autologous systems. In heterologous systems 3 M KCl tumor extracts induced LIF production by heterologous lymphocytes from patients in 91% of the cases, and normal mucosa extracts induced LIF production by heterologous lymphocytes from patients in 73% of the cases and from normal donors in 90% of the cases. In autologous systems 3 M KCl tumor extracts induced LIF production by autologous lymphocytes from the same patients in 65% of the cases, whereas the normal laryngeal mucosa extracts induced LIF production by the same autologous lymphocytes in the 6% of the cases. The high positivity percentage of the test in heterologous systems could be related to differences in the major histocompatibility complex. The 65% test positivity in autologous systems using tumor extracts could be related to the presence of tumor associated antigens.
Asunto(s)
Antígenos de Neoplasias/inmunología , Neoplasias Laríngeas/inmunología , Factores Inhibidores de la Migración de Leucocitos/biosíntesis , Leucocitos/inmunología , Linfocitos/inmunología , Linfocinas/biosíntesis , Inhibición de Migración Celular , Humanos , Neoplasias Laríngeas/cirugía , Laringe/cirugíaRESUMEN
The phenotypical and functional aspects of tonsillar (TMNC) and peripheral blood mononuclear cells (PBMNC) obtained from 40 patients who had undergone adeno-tonsillectomy for different tonsillar diseases were investigated. TMNC and PBMC were separately tested at the time of surgery; then a further investigation on the peripheral blood lymphocytes was performed three months after surgery. The most interesting findings are presented and discussed with particular attention to their clinical implications.
Asunto(s)
Adenoidectomía , Tonsila Faríngea/inmunología , Leucocitos Mononucleares , Tonsila Palatina/inmunología , Tonsilectomía , Adolescente , Adulto , Anticuerpos Monoclonales , Niño , Preescolar , Femenino , Humanos , Interleucina-2/biosíntesis , Leucocitos Mononucleares/inmunología , Activación de Linfocitos/inmunología , MasculinoRESUMEN
The role of macrophages infiltrating tumor tissue is still poorly explained; the data available are sparse and, to the best of our knowledge, there is no study relating the characteristics of such infiltration to tumor evolution and final outcome. We decided to investigate the spatial relationships between macrophages and neoplastic tissue and their possible prognostic significance on a series of laryngeal carcinomas (98 patients) all of which were operated in our Department and had a follow-up of at least 3 years. In order to identify the macrophage infiltration, formaline-fixed/paraffin-mounted specimens of the tumor were treated with MoAb HAM56. No statistically significant relationship could be established between the degree of macrophage infiltration and the clinical outcome (recurrence), even when the N status was taken into account (N- vs. N+). However, a clear trend was observed when the analysis was confined to grade 3 cases, where the presence of a significant number of macrophages was correlated with a higher probability of recurrence.
Asunto(s)
Neoplasias Laríngeas/patología , Macrófagos , Movimiento Celular , Humanos , Recurrencia Local de Neoplasia , PronósticoRESUMEN
The authors report the first results concerning the systematic use of "immunological monitoring" in patients suffering from well-developed laryngeal cancer. The authors have also studied, in 50 cases in different stages of development, the activity of T-cells using the cutaneous tests (BCG, PPD, PHA and SK-SD), the E-rosette test and the PHA-induced lymphocytic blastization test (it is well known that the T-cells are responsible for a cytotoxic effect against neoplastic cells). The authors have also studied the activity of B-lymphocytes by means of the EA and EAC rosette test and of IgG, IgA, IgM and complement serum titles. They have observed a progressive depression of the T-cell activity after surgical intervention, whereas the B-cell activity in several cases tends to increase. The authors discuss these immunological results and the possibility that these findings may represent the basis for a complementary immunotherapy following the surgical treatment and/or radiotherapy or chemotherapy. Finally, the authors discuss the possibilities and the limitations of these immunological methods from the point of view of clinical application.
Asunto(s)
Proteínas del Sistema Complemento , Inmunidad Celular , Inmunoglobulinas , Neoplasias Laríngeas/inmunología , Linfocitos B/inmunología , Proteínas del Sistema Complemento/análisis , Pruebas Inmunológicas de Citotoxicidad , Humanos , Inmunoglobulinas/análisis , Neoplasias Laríngeas/terapia , Recuento de Leucocitos , Activación de Linfocitos , Formación de Roseta , Pruebas Cutáneas , Linfocitos T/inmunologíaRESUMEN
Acute infection the paranasal sinus is a rather frequent pathology in children. On the contrary, local orbital complications are rare. The employment of antibiotics reduces the incidence of complications but can sometimes conceal their appearance so that diagnosis is delayed. Orbital as well as intracranial complications of ethmoidal and maxillary sinusitis are most often encountered in childhood. Within a brief time span, 8 patients with complicated frontal and ethmoid-maxillary sinusitis were diagnosed and treated: 4 cases of periorbital cellulitis, 2 of subperiorbital abscess and 2 of orbital abscess (one of which with cavernous sinus thrombosis). Particularly relevant from the diagnostic point of view was the employment of C.T. scan which furnished an accurate definition of the orbit and its surrounding structures which influenced treatment choice. Under antibiotic cover all patients but one (who had been treated very early and had responded immediately to intensive antibiotic therapy) were treated surgically and the clinical course of the disease showed significant improvement very shortly after surgical drainage.
Asunto(s)
Sinusitis del Etmoides/complicaciones , Sinusitis Frontal/complicaciones , Sinusitis Maxilar/complicaciones , Enfermedades Orbitales/etiología , Absceso/diagnóstico , Absceso/etiología , Absceso/cirugía , Enfermedad Aguda , Adolescente , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/etiología , Celulitis (Flemón)/cirugía , Niño , Preescolar , Edema/diagnóstico , Edema/etiología , Edema/cirugía , Sinusitis del Etmoides/diagnóstico , Sinusitis del Etmoides/cirugía , Enfermedades de los Párpados/diagnóstico , Enfermedades de los Párpados/etiología , Enfermedades de los Párpados/cirugía , Femenino , Sinusitis Frontal/diagnóstico , Sinusitis Frontal/cirugía , Humanos , Masculino , Sinusitis Maxilar/diagnóstico , Sinusitis Maxilar/cirugía , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/cirugíaRESUMEN
Slow vertex response (SVR) audiometry is presently one of the methods of choice in objective auditory threshold assessment. The aim of this study was to evaluate, as objectively possible, the relationship existing between the thresholds of SVR and or pure tone audiometry (PTA). The study was carried out on twenty subjects with hearing losses of various degrees and types. While mean differences between SVR and PTA thresholds ranged between 6 to 13 dB, in some cases values over 30 dB were found. No statistically significant intra- and interindividual discrepancies were found, even though in some cases the thresholds were given different in evaluations by different examiners. No statistically significant difference in SVR versus PTA thresholds was found in patients with sensory-neural and conductive hearing loss, while in subjects with normal hearing the difference between the thresholds was greater. Our results suggest that SVR is a reliable technique in objective threshold evaluation but that in single cases its threshold cannot be directly compared to that of pure tone audiometry.
Asunto(s)
Audiometría de Tonos Puros , Potenciales Evocados Auditivos , Diagnóstico Diferencial , Trastornos de la Audición/diagnóstico , Humanos , Simulación de EnfermedadRESUMEN
Slow vertex response (SVR) audiometry is presently one of the methods of choice in objective auditory threshold assessment. The aim of this study, carried out on twenty subjects with various degrees and types of hearing loss, was to evaluate the difficulties found in N1P2 complex identification. Tracings, presented as single averages and super-imposed averages, were examined separately by two Authors who had not been received any information concerning the audiometric thresholds of the subjects under investigation. Results showed that erroneous identification of SVR waveforms occurred frequently, especially near threshold level. The rate of false negatives (i.e. a waveform present but not identified) was higher than the rate of false positives (i.e. erroneous identification of a non-existing N1P2 complex). High intra- and interindividual discrepancies were also found. Our results appear to indicate that the SVR waveform is not easily identifiable and thus that SVR audiometry cannot, therefore, be considered a truly objective audiometric test since analysis of the tracings may be influenced by the high degree of variability in individual interpretation.
Asunto(s)
Audiometría de Respuesta Evocada , Potenciales Evocados Auditivos , Adolescente , Adulto , Diagnóstico Diferencial , Femenino , Trastornos de la Audición/diagnóstico , Humanos , Masculino , Simulación de Enfermedad , Persona de Mediana EdadAsunto(s)
Asfixia/etiología , Asfixia/prevención & control , Cuerpos Extraños/complicaciones , Laringe/fisiopatología , Nasofaringe/fisiopatología , Otolaringología/estadística & datos numéricos , Heridas y Lesiones , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Heridas y Lesiones/etiología , Heridas y Lesiones/fisiopatología , Heridas y Lesiones/prevención & controlRESUMEN
Although recent investigations showed no specific hazard resulting from Food Products Containing Inedibles as compared to the wider category of toys, in view of recent findings and subsequent study of the European Registry of Foreign Bodies Injuries, a potential threat has been identified in a lack of parental supervision in the event of injury. Indeed, according to the report of the European Registry of Foreign Bodies Injuries, almost 80% of the injuries occur under parental supervision, which is obviously inadequate. The aim of this short contribution is to present the results of a Computer Assisted Personal Interviewing survey in the UK focused on the knowledge that mothers, fathers and other adults have on the issue of choking. A total of 1946 interviews have been conducted in the UK, in January 2001, all of which directed to subjects over 15 years of age. Data are presented as percentages and absolute numbers. The statistical significance of group differences has been evaluated with the chi-square test with continuity correction. All analyses have been performed using the R system. Those replying to the interview comprised 804 males and 1102 females. Of these, 10% had a child between 0 and 36 months, 9% between 3 and 4 years, 16% between 5-10 years and 13% between 11-15 years. Of those responding, 7% had bought Kinder Surprise within the last two weeks before the interview, 14% within the last three months, and the remaining 53% before, while 26% had never bought Kinder Surprise. These findings would appear to offer a confirmation that mothers tend to balance potential risks with the benefits of exposing the child to a stimulating activity. This mechanism of a controlled exposure to risk, has already been identified as one of the important mechanisms in the psychological development of the child.