Pharyngeal Fish Hook Impaction: Case Report and Literature Review.

Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint. A swallowed foreign body can be embedded in the tonsil, the base of the tongue, the pyriform fossae, or any region of the upper esophagus. A 70-year-old woman presented with persistent left-sided pharyngeal pain with the sensation of a foreign body for 10 days. She felt a sudden sharp pain in her pharynx while eating a fish head 10 days before the presentation. On examination, an elderly woman was found in painful distress. Flexible fiberoptic laryngoscopy revealed a pool of saliva in the pyriform fossae and a diagnosis of a foreign body in the esophagus was suspected. She was planned for direct laryngoscopy, left (lateral/external) pharyngotomy, and removal of foreign bodies under fluoroscopic guidance of the C-arm. A metallic fish hook that hung over the greater left horn, buried in the neck muscles, was found during the surgery and was extracted. The patient did well postoperatively and was discharged from the clinic. Foreign bodies, particularly fish bones, in the hypopharynx and cervical esophagus are a common complaint, particularly in the African setting.

Global Unmet Needs in Cardiac Surgery.

More than 6 billion people live outside industrialized countries and have insufficient access to cardiac surgery. Given the recently confirmed high prevailing mortality for rheumatic heart disease in many of these countries together with increasing numbers of patients needing interventions for lifestyle diseases due to an accelerating epidemiological transition, a significant need for cardiac surgery could be assumed. Yet, need estimates were largely based on extrapolated screening studies while true service levels remained unknown. A multi-author effort representing 16 high-, middle-, and low-income countries was undertaken to narrow the need assessment for cardiac surgery including rheumatic and lifestyle cardiac diseases as well as congenital heart disease on the basis of existing data deduction. Actual levels of cardiac surgery were determined in each of these countries on the basis of questionnaires, national databases, or annual reports of national societies. Need estimates range from 200 operations per million in low-income countries that are nonendemic for rheumatic heart disease to >1,000 operations per million in high-income countries representing the end of the epidemiological transition. Actually provided levels of cardiac surgery range from 0.5 per million in the assessed low- and lower-middle income countries (average 107 ± 113 per million; representing a population of 1.6 billion) to 500 in the upper-middle-income countries (average 270 ± 163 per million representing a population of 1.9 billion). By combining need estimates with the assessment of de facto provided levels of cardiac surgery, it emerged that a significant degree of underdelivery of often lifesaving open heart surgery does not only prevail in low-income countries but is also disturbingly high in middle-income countries.