Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography.

BACKGROUND: Bronchoscopy is the standard of care for diagnosis and treatment of foreign body aspiration (FBA). Drawbacks of this approach include its invasiveness, the potential for exacerbation of reactive airway disease, and the need for general anesthesia. Computed tomography (CT) can potentially identify patients with FBA, thereby avoiding unnecessary bronchoscopies in patients with at-risk reactive airways. METHODS: A retrospective review was performed to identify patients who underwent CT and/or bronchoscopy for suspected foreign body aspiration (FBA) from June 2012 to September 2018. Variables included clinical history, exam findings, radiographic findings, and operative findings. A telephone survey was performed for patients who had a CT without bronchoscopy. Three radiologists performed rereads of all CTs. RESULTS: A total of 133 patients were evaluated for FBA, and 84 were treated with bronchoscopy. For those with a CT demonstrating a foreign body, findings were confirmed on bronchoscopy in 17/18 (94.4%). For those with bronchoscopy alone, 39/64 (60.9%) were found to have a foreign body (p < 0.01). CT excluded FBA in 49 patients. Sensitivity was 100%, specificity was 98%, and interobserver reliability was excellent (κ = 0.88). CONCLUSION: CT is an accurate and reliable diagnostic tool in the evaluation of FBA that can increase the rate of positive bronchoscopy. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.

Pediatric Triplane Ankle Fractures: Impact of Radiographs and Computed Tomography on Fracture Classification and Treatment Planning.

BACKGROUND: The purpose of this study was to compare the reliability of triplane fracture classification, displacement measurement, and treatment planning with the use of radiographs with and without computed tomography. METHODS: One pediatric radiologist, one musculoskeletal radiologist, and three fellowship-trained pediatric orthopaedic surgeons rated a spectrum of twenty-five triplane fractures with use of radiographs alone and then with computed tomography scans on two separate occasions (two to four weeks apart). Raters classified the fracture pattern with use of the Rapariz classification system, measured the maximum intra-articular displacement, and drew the fracture on four outlines of the distal part of the tibia: one lateral view, one anteroposterior view, one axial view above the tibial physis, and one axial view below the physis. Reliability was assessed with kappa values and intraclass correlation coefficients. RESULTS: The Rapariz triplane fracture classification had poor inter-rater reliability (a kappa of 0.17) and intra-rater reliability (a kappa of 0.31) with radiographs alone but moderate inter-rater reliability (a kappa of 0.41) and intra-rater reliability (a kappa of 0.54) with the addition of computed tomography. After reviewing computed tomography, raters changed the fracture pattern in 46% of ratings, the displacement from ≤2 mm to >2 mm in 39% of ratings, the treatment from nonoperative to operative in 27% of ratings, and either the orientation or number of screws in 41% of ratings. CONCLUSIONS: Computed tomography had a definite impact on the fracture classification, displacement, and treatment plan, supporting its use as an adjunct to radiographs for the treatment of pediatric triplane fractures.

Essiac tea: scavenging of reactive oxygen species and effects on DNA damage.

Essiac, a tea reportedly developed by the Ojibwa tribe of Canada and widely publicized as a homeopathic cancer treatment, is prepared from a mixture of four herbs Arctium lappa, Rumex acetosella, Ulmus rubra and Rheum officinale. Each of these herbs has been reported to possess antioxidant and anti-cancer activity. Essiac itself has also been reported to demonstrate anti-cancer activity in vitro, although its effects in vivo are still a matter of debate. We prepared an extract of Essiac tea from a concentration of 25mg/mL and boiled it for 10 min. From this preparation we used concentrations of 5, 10, 25 and 50% to measure Essiac effects. In this study, we examined the effects of Essiac on free radical scavenging and DNA damage in a non-cellular system, as well as the effects Essiac on lipid peroxidation using the RAW 264.7 cell line. We observed, using electron spin resonance, that Essiac effectively scavenged hydroxyl, up to 84% reduction in radical signal at the 50% tea preparation concentration, and superoxide radicals, up to 82% reduction in radical signal also at the 50% tea preparation concentration, as well as prevented hydroxyl radical-induced DNA damage. In addition, Essiac inhibited hydroxyl radical-induced lipid peroxidation by up to 50% at the 50% tea preparation concentration. These data indicate that Essiac tea possesses potent antioxidant and DNA-protective activity, properties that are common to natural anti-cancer agents. This study may help to explain the mechanisms behind the reported anti-cancer effects of Essiac.