Choking injuries and food products containing inedibles: a survey on mothers' perception in the United Kingdom.

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.

Are FPCIs a source of increased risk for children? Results of a multicenter, experimental study comparing children's behaviour with FPCIs and toys.

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.

The cost of foreign body injuries in the upper aero-digestive tract: need for a change from a clinical to a public health perspective?

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.

Foreign bodies in the upper airways: the experience of two Italian hospitals.

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.

Child mortality due to suffocation in Europe (1980-1995): a review of official data.

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.

Psychological aspects of risk appraisal in asphyxiation accidents: a review of the factors influencing children's perception and behaviour.

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.

Use of a hyaluronan-based biomembrane in the treatment of chronic cholesteatomatous otitis media.

OBJECTIVE: To test the efficacy and safety of a hyaluronan-based biomembrane in stimulating the healing process in patients undergoing tympanomastoid surgery. STUDY DESIGN: The trial was an open, two-arm, controlled, randomized, prospective, multicenter study conducted at two different hospitals. PATIENTS: Sixty subjects (18-65 years of age, both sexes) with chronic cholesteatomatous otitis media were enrolled and treated by the "one-stage open technique." Efficacy and safety parameters were assessed at 3, 5, 7, 9, 11, 13, 17, 21, and 25 weeks after surgery. Three sets of composite criteria were considered: patient's assessment of quality of healing, otomicroscopy, and audiometry. RESULTS: Of the 60 patients, 50 completed the study. Subjects treated with the biomembrane had statistically significant better scores than controls (no treatment) for all variables considered, excluding audiometry (no significant differences). No adverse events occurred in treated patients. CONCLUSION: Data demonstrate that the application of a hyaluronan-based biomembrane improves the healing of the mastoid cavity following "open" tympanoplasty. In particular, re-epithelialization was significantly faster after the application of the biomembrane. Moreover, the device neither caused any adverse events nor showed signs of ototoxicity. Re-epithelialization of open cavities and tympanic grafts still represents for surgeons an unpredictable step in the healing process. Hyaluronian-derivates may effectively contribute to the reduction of such variability.

[Orbital and endocranial complications in acute sinusitis in childhood]. / Complicanze orbitarie ed endocraniche delle sinusiti acute dell'infanzia.

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.

[Relations between pure-tone audiometry and cortical evoked auditory potentials]. / Relazione tra audiometria tonale liminare e potenziali evocati uditivi corticali.

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.

[Identification of the waveform of cortical auditory evoked potentials]. / Studio sulla riconoscibilità della forma d'onda dei potenziali evocati uditivi corticali.

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.

Immunological investigations on tonsillar and peripheral blood lymphocytes after adeno-tonsillectomy. Possible suggestions for phenotypical and functional differences.

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.

Peri and intratumoral macrophage infiltration in laryngeal carcinoma. An immunohistochemical study.

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.

[Prognostic significance of macrophage infiltration in laryngeal carcinoma]. / Significato prognostico dell'infiltrato macrofagico nel carcinoma laringeo.

We investigated the relationships between tumor associated macrofages (TAM) and tumor tissues and their possible prognostic significance in a laringeal carcinomas of patients operated in our Department for sovraglottic or total laringectomy. In our analysis we found a positive trend in Grade 3, but we could not find any correlations in the other cases. That shows that TAM have antithetic activities in the life of neoplasia.

Dichotic performance in elderly Italians with Italian stop consonant-vowel stimuli.

Dichotic listening tests were carried out at various interaural onset asynchronies (from 0 to 500 ms) on normal-hearing young and elderly subjects using a free recall method. The stimuli were Italian stop consonant and vowel syllables computer-edited to reduce prevoicing of the consonant and vowel syllables from the original 100-120 ms to 30 ms. Results suggest that right-ear advantage is uninfluenced by age, despite a significantly lower total dichotic performance and abnormal lag effect in the older group.

Hearing loss and desferrioxamine in homozygous beta-thalassemia.

The authors present the results obtained during an audiometric screening of 153 children aged 5-18 years, affected by beta-thalassemia and treated with regular blood transfusions and iron overload chelation by means of desferrioxamine. Thirty-eight percent of the patients showed a significant sensorineural hearing loss at high frequencies with recruitment. Younger patients had a greater hearing loss, indicating that cochlear damage was not due to the disease itself. Furthermore, hearing loss appeared to be correlated with the mean and peak desferrioxamine doses administered and was higher in subjects with lower iron load. Thus, the ototoxic effect seems to have been higher when a good iron chelation had been obtained. Among our patients, conductive hearing loss was not more frequent than in patients without beta thalassemia.