Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.913
Filtrar
2.
J Otolaryngol Head Neck Surg ; 49(1): 66, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928308

RESUMO

We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered.


Assuntos
Betacoronavirus , Brônquios , Broncoscopia/métodos , Infecções por Coronavirus/complicações , Corpos Estranhos/cirurgia , Pandemias , Pneumonia Viral/complicações , Broncoscópios , Criança , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pneumonia Viral/epidemiologia , Radiografia
3.
Korean J Intern Med ; 35(5): 1027-1030, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32664710

RESUMO

Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.


Assuntos
Algoritmos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência , Endoscopia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Colangite/diagnóstico , Colangite/etiologia , Colangite/terapia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Corpos Estranhos/diagnóstico , Corpos Estranhos/etiologia , Corpos Estranhos/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária
4.
Medicine (Baltimore) ; 99(22): e20480, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481458

RESUMO

Foreign body (FB) aspiration is a common and serious problem in childhood as it requires early recognition and treatment to avoid potentially lethal consequences. This study aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population.A retrospective review of medical records of children aged 0 to 14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between January 2013 and December 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs.Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years old. The male to female ratio was about 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal X-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. There was a trend that in children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was performed in 82.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during rigid bronchoscopy due to acute respiratory failure.FBs is a frequent pathology among Chinese children. Tracheobronchial FBs should be strongly suspected in young children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent.


Assuntos
Corpos Estranhos/diagnóstico , Aspiração Respiratória/diagnóstico , Adolescente , Brônquios , Broncoscopia , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Incidência , Lactente , Recém-Nascido , Laringoscopia , Masculino , Aspiração Respiratória/epidemiologia , Aspiração Respiratória/terapia , Estudos Retrospectivos , Traqueia
5.
Am J Emerg Med ; 38(8): 1697.e5-1697.e7, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32482484

RESUMO

Foreign body(FB) in soft tissue is a common injury in trauma, but it is rare for FB to enter the blood vessel. Typical causes of intravascular FB include iatrogenic and non-iatrogenic factors.A 65-year-old Chinese worker's left hand was hit by two colliding metal blocks while operating a machine tool. Then, he referred to our hospital's emergency department of orthopedics. The X-rays showed that metal FB could be seen in trapezium bone regions of the left hand. During the operation, the FB was found in the cephalic vein of his left hand, so the FB was removed by surgery. After six weeks of follow-up, he has returned to normal working conditions.The purpose of this article is to describe the diagnosis and treatment of a rare condition in the emergency department. In our emergency work, it is easy to miss the diagnosis of intravascular FB caused by trauma. To our knowledge, this is the third reported intravascular FB caused by trauma and the first reported intravascular FB was located in the vein of the hand. Detailed medical history and auxiliary examinations are the key to the diagnosis of FB in the blood vessels.


Assuntos
Corpos Estranhos/diagnóstico , Veias , Idoso , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/terapia , Traumatismos da Mão/complicações , Traumatismos da Mão/diagnóstico por imagem , Humanos , Masculino , Radiografia
7.
Pediatr Pulmonol ; 55(7): 1697-1704, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32442360

RESUMO

INTRODUCTION: Foreign body (FB) aspiration is a frequent and preventable source of morbidity and mortality, especially in children under 4 years of age. Few comprehensive studies exist on presentation and outcome of apple aspirations in children. METHODS: In a retrospective analysis of bronchoscopy records of a tertiary medical care center from January 2007 to August 2019, we identified pediatric cases of suspected apple aspirations. RESULTS: A total of 11 suspected apple aspirations were identified (observation time 12.7 years, n = 5858 bronchoscopies, n = 226 interventions due to suspected FB aspirations in total). The mean age of patients was 24 months (standard error mean, 7 months; range, 8-83 months), and 6 out of 11 cases (55%) were male. Bronchoscopy confirmed apple aspiration in n = 6/11 cases (55%). In n = 2/11 cases (18%), a bite of the apple was located in the esophagus causing significant tracheal narrowing, and in n = 3/11 cases (27%), no FB was found. In all cases of airway FB identification, extraction was successful. Hypersalivation was associated with esophageal FB location, whereas persistent cough, stridor, or dyspnea were associated with airway FB location. Outcomes ranged from complete reconstitution 1 day after bronchoscopy in most cases to hypoxemia with severe brain damage in one patient. DISCUSSION: This analysis shows that apple aspirations are not entirely uncommon in children and may lead to disastrous complications. Typical signs of airway location are persistent cough, stridor or dyspnea, whereas hypersalivation may point toward an esophageal location. In each case of suspected apple aspiration, timely bronchoscopy with possible FB extraction should be performed by an experienced team.


Assuntos
Corpos Estranhos , Malus , Aspiração Respiratória , Broncoscopia , Criança , Pré-Escolar , Tosse/etiologia , Dispneia/etiologia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Lactente , Masculino , Aspiração Respiratória/complicações , Aspiração Respiratória/diagnóstico , Aspiração Respiratória/cirurgia , Sons Respiratórios/etiologia , Sialorreia/etiologia , Resultado do Tratamento
8.
Ir Med J ; 113(1): 12, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-32298562

RESUMO

Presentation We describe an unusual presentation of sigmoid colon perforation secondary to an ingested chicken bone. Diagnosis The patient presented with a 4 day history of abdominal pain and distension. On examination there were signs of peritonism. Inflammatory markers were raised. Computed tomography revealed a linear density projecting through the wall of the colon. Treatment The patient underwent emergency laparotomy and a Hartmann's procedure. A chicken bone was found to be the causative foreign object. Conclusion Foreign body ingestion is an uncommon cause of sigmoid perforation which may mimic more common surgical presentations such as diverticulitis.


Assuntos
Colo Sigmoide , Corpos Estranhos/complicações , Perfuração Intestinal/etiologia , Idoso de 80 Anos ou mais , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/cirurgia , Emergências , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Laparotomia , Tomografia Computadorizada por Raios X
9.
Ann R Coll Surg Engl ; 102(6): e125, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233880

RESUMO

A postoperative radiograph demonstrated a folded radio-opaque structure in the nasopharynx, resembling a retained throat pack, despite her not having any respiratory symptoms. Retention of a throat pack is a never event.


Assuntos
Artefatos , Achados Incidentais , Procedimentos Cirúrgicos Ortognáticos/instrumentação , Osteotomia/instrumentação , Faringe/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Corpos Estranhos/diagnóstico , Humanos , Má Oclusão/cirurgia , Período Pós-Operatório , Radiografia , Tampões de Gaze Cirúrgicos
10.
Ann R Coll Surg Engl ; 102(7): e158-e160, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32320263

RESUMO

Paediatric stridor can indicate serious pathology and requires prompt evaluation and management. Causes range from laryngomalacia to aerodigestive tract foreign bodies. We report on a chronic presentation of paediatric stridor, discuss the workup, management and lessons learned. A seven-month-old boy presented with chronic intermittent biphasic stridor for the previous five months. Diagnostic microlaryngoscopy and bronchoscopy revealed significant localised tracheomalacia. Urgent chest computed tomography was performed to investigate further. Radiological findings revealed an oesophageal foreign body prompting immediate rigid oesophagoscopy and removal of an embedded pistachio shell. The patient had an uneventful recovery. Foreign bodies in the airway and oesophagus are quite common in children, causing symptoms from the aerodigestive tract. It is uncommon for oesophageal foreign bodies to present with stridor in the absence of digestive tract symptoms. The otolaryngologist should consider this as a diagnosis, particularly in young children with an atypical presentation and symptoms.


Assuntos
Esôfago , Corpos Estranhos/complicações , Sons Respiratórios/etiologia , Broncoscopia/métodos , Diagnóstico Diferencial , Esofagoscopia/métodos , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Lactente , Laringoscopia/métodos , Masculino , Sons Respiratórios/diagnóstico
11.
Am Surg ; 86(2): 110-115, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167045

RESUMO

Several randomized trials comparing self-gripping mesh with polypropylene (PL) mesh in Lichtenstein hernioplasty revealed that the self-gripping mesh significantly reduced the operation time. In these studies, some enrolled only male patients, and in others, the proportion of women was extremely low. The aim of this research was to compare outcomes after self-gripping mesh repair with PL mesh secured with sutures in female Lichtenstein hernioplasty. Female patients with primary unilateral inguinal hernia were assigned randomly to undergo Lichtenstein hernioplasty with a self-gripping ProGrip (PG) mesh or a sutured PL mesh, followed-up at one week, one month, three months, one year, and two years. Demographics, hernia characteristics, and operative outcomes data were analyzed. Pain was assessed with a visual analog scale (0-10), and quality of life (QOL) was estimated by a 36-item short-form general survey (0-26). Forty eight patients in the PG group and 51 participants in the PL group completed the follow-up. The operation time of the PG (54.1 ± 12 minutes) group was significantly shorter than that of the PL (60.9 ± 11.3 minutes) group (P = 0.045). At the one-month follow-up, the incidence of foreign body feeling in the PG group was significantly higher than that in the PL group (P = 0.031), whereas no significant difference was observed in visual analog scale ≥3 and QOL. In a follow-up of three months, one year, and two years, there was no significant difference in foreign body feeling, chronic pain, QOL, and recurrence between two groups. The surgical outcomes of self-gripping mesh are comparable to those of the ordinary PL mesh with a reduced operation time in female Lichtenstein hernioplasty. Registration number: ChiCTR1800017360 (http://www.chictr.org.cn).


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Corpos Estranhos/diagnóstico , Herniorrafia/instrumentação , Humanos , Duração da Cirurgia , Medição da Dor/métodos , Dor Pós-Operatória/diagnóstico , Polipropilenos , Estudos Prospectivos , Qualidade de Vida , Recidiva , Telas Cirúrgicas/efeitos adversos , Suturas , Fatores de Tempo , Resultado do Tratamento
13.
Ulus Travma Acil Cerrahi Derg ; 26(2): 247-254, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185763

RESUMO

BACKGROUND: Foreign body (FB) ingestion is frequently encountered in all departments that treat children. FB may bring about significant anxiety for parents and physicians. The present study aims to determine the appropriate approach for FB ingestion in children. METHODS: The records of 1000 children with a history of FB ingestion between the years 2005 and 2017 were reviewed retrospectively in this study. RESULTS: Of 1000 children, 53.8% were male. The most common types of FBs were coins (35%). X-ray was negative in 49% of the patients, and 86% of these patients received no intervention. Of the 504 (51%) X-ray-positive patients, the oesophagus (68%) was the most common location. Life-threatening complications were tracheo-oesophageal fistula (1), Meckel's diverticulum perforation (1), and perforation due to rigid endoscopy (1). CONCLUSION: We demonstrated that coins, which are the most commonly ingested FBs, have various types and sizes according to their countries of origin, and this affects spontaneous passage. We found that only 48% (quite low compared to the literature) of the coins passed spontaneously. In asymptomatic patients with a gastric button battery, we suggest a "watchful waiting" approach. The patients should be observed and managed at home. In our study, we found that 85% of the button batteries that reached the stomach passed spontaneously.


Assuntos
Corpos Estranhos , Adolescente , Criança , Pré-Escolar , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Turquia , Conduta Expectante
16.
Pediatr Pulmonol ; 55(3): 690-696, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31909897

RESUMO

OBJECTIVE: The diagnosis of foreign body aspiration (FBA) is challenging. In a previous study, we developed a computerized scoring system (CSS) to support decision-making. In the present study, we aimed to validate it on a further cohort. STUDY DESIGN: In this observational study, 100 children referred to the emergency department of a tertiary pediatric hospital for suspected FBA and treated according to standard protocol, were assigned a probability score using the CSS, between 0 and 1 (0, very low probability; 1, very high). The diagnosis of FBA was based on bronchoscopy, and if discharged without bronchoscopy, determined via telephone questionnaire, 4 to 6 months after discharge, supplemented by clinical re-evaluation and bronchoscopy, if respiratory symptoms persisted. RESULTS: Thirty-five out of 100 children (35%) underwent bronchoscopy with 12 of 35 (34%) positive for FBA. Sixty-five patients were discharged without bronchoscopy and completed a telephone questionnaire. Seven patients required clinical re-evaluation for persistent respiratory symptoms, in two out of them, additional bronchoscopies were performed and were negative. The CSS median probability score was 0.94 in patients with FBA, as compared to 0.73 in patients without FBA (P = .007). The CSS area under the receiver operating curve was 0.74. At a probability score threshold of 0.6, the sensitivity and specificity were 100% and 41%, respectively. CONCLUSION: The present validation study suggests a high sensitivity of the CSS for the identification of FBA in children. We suggest that it might aid decision-making with regard to the need for bronchoscopy in children presenting to the emergency room.


Assuntos
Corpos Estranhos/diagnóstico , Adolescente , Broncoscopia , Criança , Pré-Escolar , Estudos de Coortes , Tomada de Decisões , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Pulmão/cirurgia , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Centros de Atenção Terciária
18.
Medicine (Baltimore) ; 98(50): e18373, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852147

RESUMO

RATIONALE: Foreign body ingestion is a common clinical event, but serious complication such as perforation is uncommon. Here we present a case of gastrointestinal perforation caused by fish bone, which was treated effectively and successfully by totally laparoscopic management. PATIENT CONCERNS: A 63-year-old man who was admitted to our hospital with epigastric pain for 1 month. Computed tomography of the abdomen at the local hospital revealed a linear, hyperdense, foreign body in the lesser curvature of gastric antrum that had penetrated through the posterior wall of the gastric antrum. DIAGNOSIS: The laparoscopic exploration found that a 2.5 cm × 0.3 cm fish bone had penetrated through the posterior wall of the gastric antrum. INTERVENTIONS: A totally laparoscopic surgery was performed to remove the foreign body and repair the perforation eventually. OUTCOMES: After surgery, the patient underwent uneventful recovery and was discharged on postoperative day 7. During the 3 months of follow-up visit, the patient appeared healthy and did not report abdominal symptoms. LESSONS: In this case, the advantages of laparoscopic techniques in the diagnosis and treatment of gastrointestinal perforation caused by foreign body was confirmed, and which may be considered as the primary choice in similar cases.


Assuntos
Corpos Estranhos/cirurgia , Laparoscopia/métodos , Estômago/cirurgia , Animais , Osso e Ossos , Peixes , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/lesões , Tomografia Computadorizada por Raios X
19.
Medicine (Baltimore) ; 98(50): e18111, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852071

RESUMO

RATIONALE: Large bowel perforations by a foreign body are rarely diagnosed pre-operatively due to non-specific clinical symptoms. The safety and efficacy of foreign body removal via upper endoscopy is well-established and strongly recommended. There is far less experience of endoscopic treatment of sharp foreign bodies impacted in lower parts of gastrointestinal tract. PATIENT CONCERNS: The patient was 78-year-old female with abdominal pain and nausea. Symptoms had begun 48 hours prior to hospital admission. She had lost over 10 kg of body weight in the previous couple of months DIAGNOSIS:: A multidetector-row computed tomography (MDCT) examination of the abdomen revealed mural thickening and enhancement of the cecum with haziness and linear areas of high attenuation in the pericecal fat tissue. A colonoscopy showed, the clear presence of a sharp 5.5-cm-long chicken bone perforating the cecal wall at the antemesenteric site close to the Bauchini valve. INTERVENTIONS: A quarter of the bone that had penetrated the cecal wall was pulled out with a flexible colonoscopy using a polypectomy snare. Due to the form and length of the bone, it was withdrawn through the entire colon, using pointed end trailing. OUTCOMES: The patient was discharged three days after colonoscopy with normal laboratory results and without any pain. LESSONS: In cases where sharp foreign bodies stuck into the large bowel, it is highly advisable to try to remove them via colonoscopy, before deciding to resolve the issue through a surgical intervention.


Assuntos
Doenças do Ceco/cirurgia , Ceco , Colonoscopia/métodos , Corpos Estranhos/cirurgia , Perfuração Intestinal/cirurgia , Idoso , Doenças do Ceco/diagnóstico , Doenças do Ceco/etiologia , Ingestão de Alimentos , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Perfuração Intestinal/diagnóstico , Tomografia Computadorizada Multidetectores/métodos
20.
Ethiop J Health Sci ; 29(6): 779-782, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31741650

RESUMO

Background: Peritoneal loose bodies are rare lesions that are usually found as an incidental finding during abdominal surgery. Large loose bodies, measuring more than 5 cm, are rare and only a few cases are reported in the literature. Peritoneal loose bodies are usually infarcted appendices epiploicae, which become detached and appear as a peritoneal loose body in the abdominal cavity. Case Presentation: We report here the first case, in the local Ethiopian context, of a giant "egg-like" loose peritoneal body measuring 7 × 6 cm found in a 50-year-old man who presented with a cramping abdominal pain and features of abdominal obstruction. The current hypothesis as regards these bodies and the diagnostic challenges is discussed. Conclusion: Small peritoneal loose bodies are common but giant and symptomatic ones', like the one discussed here, are very rare and a diagnostic challenge. And, in the context of intestinal obstruction, a high index of suspicion is needed in order to diagnose them.


Assuntos
Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Cavidade Peritoneal/fisiopatologia , Cavidade Peritoneal/cirurgia , Doenças Raras/diagnóstico , Etiópia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA