Therapeutic experience from 1428 patients with pediatric tracheobronchial foreign body

Purpose

Tracheobronchial foreign body (TFB) aspiration is a life-threatening emergency for children. Knowing how to reduce the incidence of complications and mortality during the management of TFB is critically important.

Methods and Patients

Pediatric patients with TFB, who were treated in the Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Medical College Qingdao University, Qingdao, Shandong Province, China, were included in this analysis during 1985 to 2007. One thousand four hundred twenty-eight patient records with TFB were retrospectively reviewed. This study mainly reported location and type of foreign body, complications, anesthesia methods, and outcome.

Results

Among the 1428 patients, 1424 (99.72%) underwent successful removal of a foreign body by bronchoscopy. First-attempt removal was successful in 1347 whose bronchoscopy was done under general anesthesia combined with topical anesthesia and in 65 cases with inhaled anesthesia by ether combined with topical anesthesia, respectively. Second-attempt removal was successful in 12 patients whose bronchoscopy was done under inhaled anesthesia by ether combined with topical anesthesia. Foreign bodies were located in the trachea in 75 cases (5.25%), right bronchial tree in 780 patients (54.62%), left bronchial tree in 567 cases (39.71%), and bilateral bronchial tree in 6 cases (0.42%). Types of foreign body included peanuts (1244 cases, 87.12%), beans (93 cases, 6.51%), and others (91 cases, 6.37%). Tracheotomy was performed in 4 patients. Three patients (0.21%) died in this study. Four patients developed toxicity from tetracaine during topical anesthesia.

Conclusions

Bronchoscopy under general anesthesia augmented with topical anesthesia is a very safe and effective procedure for patient with TFB. Surgeons and anesthetists must be aware of the risk of tetracaine toxicity and other complications.     

Periorbital Trauma from Pit Bull Terrier Attacks

Purpose: To report the nature of periorbital trauma after pit bull attacks. While these attacks have been well-characterized in the popular media, no case series has documented the ophthalmic manifestations of this trauma.

Methods: We retrospectively reviewed all cases of pit bull terrier attacks that presented to the oculoplastic and orbital surgery service at Albany Medical Center between 2008 and 2011. The age, gender, extent of the injuries, care provided, follow up interval, and complication rate were evaluated for each patient.

Results: Seven patients were identified, with a mean age of 17.2 years. Six of the seven patients were in the pediatric age group. All patients suffered eyelid lacerations, and only one patient had additional injuries. Four patients (57.2%) suffered a canalicular laceration. Despite the lack of post-operative oral antibiotic use, no patient developed a wound infection.

Conclusions: In the ophthalmic setting, pit bull terrier attacks most frequently involve children and result in eyelid lacerations. Canalicular injuries are common after these attacks.     

多层CT容积漫游技术在先天性气管支气管狭窄的诊断价值

目的:探讨多层CT容积漫游技术(VRT)在先天性气管支气管狭窄的诊断价值。方法:搜集经影像学检查及临床病史证实的先天性气管支气管狭窄32例,所有病例均行多层CT薄层扫描及支气管树VRT重建,评价VRT在先天性气管支气管狭窄的诊断优势及不足。结果:VRT立体显示气管、主支气管及叶支气管近端单发或多发狭窄32例,其中环形狭窄8例,不规则狭窄15例,锥形狭窄9例;累及长轴范围最长46mm,最短2mm;轻度狭窄8例,中度狭窄13例,重度狭窄11例。18例阻塞性肺气肿中,VRT清晰显示16例,患侧肺组织体积增大,含气增多,其中6例伴有纵隔疝。结论:多层CT-VRT可立体显示先天性气管支气管狭窄部位、范围、程度及阻塞性肺气肿,弥补了CT轴位长轴范围显示不足,图像不直观的缺点,对临床治疗具有重要指导意义;对叶支气管远端及以下支气管狭窄、局限性肺不张及阻塞性肺炎显示有一定限度,诊断时应结合CT二维图像。     

脑挫裂伤患者脑脊液ApoE多态性与周围脑组织水肿的关系

目的探讨脑挫裂伤患者脑脊液载脂蛋白E基因(ApoE)多态性与周围脑组织水肿的关系。方法用聚合酶链反应-限制性片段多态性(PCR-RFLP)技术检测36例脑挫裂伤患者ApoE基因型频率,根据CT片计算脑水肿指数,统计学分析它们之间的关系。结果脑水肿指数与ApoE3呈负相关,而与ApoE4呈正相关,两者都具有统计学意义,脑挫裂伤患者脑脊液ApoE3和ApoE4与周围脑组织水肿具有相关性。结论脑挫裂伤患者脑脊液ApoE多态性可能是影响周围脑组织水肿的因素之一。     

双侧额颞脑挫裂伤保守及手术治疗临床对比研究

目的通过分析双侧额颞脑挫裂伤患者的临床救治经验,探讨其保守及手术治疗的指征。方法对我科1995年1月￣2005年4月收治的159例双侧额颞脑挫裂伤患者进行回顾性总结,统计分析。结果159例病人中手术治疗83例,保守治疗76例;其中格拉斯哥预后评分恢复良好68例(42.8%),中度残疾41例(25.8%),重度残疾14例(8.8%),植物生存12例(7.5%),死亡24例(15.1%)。结论本组资料表明,双侧额颞脑挫裂伤患者应根据患者的病情相应采取保守治疗,在保守治疗过程中应密切观察病情变化,在达到手术指征时及时采取手术治疗。     

提高斜形损伤肌腱缝合强度的实验研究

目的探讨提高斜形肌腱损伤修复强度的有效方法。方法40根猪跖深屈肌腱按照切割方向及两端缝合距离随机分为4组:第1组肌腱为横形损伤,中心缝合边距为10mm;第2、3、4组肌腱为45°斜形损伤,中心缝合边距分别为4mm、7mm、10mm,10根肌腱,各组均采用改良Kessler法缝合。分别检测缝合肌腱的2mm间隙形成负荷、最大抗张强度及最大功耗,并采用ANOVA法进行统计分析。结果肌腱斜形损伤修复的强度显著低于用等长距离(20mm)缝合的横行损伤修复的强度(P<0.01),当其短边的缝合边距由4mm增大到7mm时,其修复的强度显著增大(P<0.01),但当短边的缝合边距增大到10mm时,其抗张强度与短边的缝合边距7mm相比增加不显著。结论在肌腱斜形损伤时,延长中心缝合边距是一种有效的提高肌腱修复强度的方法。     

气道内异物误诊并气胸1例及文献复习

目的：提高气道内异物诊断治疗的水平,并对误治后造成气胸的处理进行探讨。方法回顾我院收治的1例气道内异物误诊为气胸患者病历资料,并复习相关文献,探讨成人气道内异物的诊断,及误治引起气胸后的诊断、处理。结果中年男性、脑外伤术后昏迷、气管切开患者,突发呼吸困难,外院误诊为气胸,治疗无效。入我院确诊为气道内异物,异物取出后好转。结论成人气道内异物易出现误诊,支气管镜检查对诊治有重要价值。阻塞性肺不张与气胸同时存在时诊断难度增加,其处理宜及时采取措施改善通气。     

多发性子宫肌瘤伴大便失禁患者一例的护理

目的总结多发性子宫肌瘤合并大便失禁患者的护理经验。方法术前了解患者的护理需求及心理状态、手术方法及特点,提前制定护理计划,并在术后按计划实施护理。结果患者顺利度过围术期,未发生护理并发症。结论针对有护理难点的特殊病例,提前制定围术期特别护理计划,有助于提高护理质量,促进患者康复。     

三种冲洗液用于产妇会阴冲洗效果的研究

目的 探讨0.2％碘伏、肤疾洗剂、温开水三种洗液用于产妇会阴冲洗的效果.方法 将150例有会阴伤口的产妇随机分为三组各50例.分别用0.2％碘伏、肤疾洗剂、温开水每日冲洗会阴2次,比较三组伤口甲级愈合率、皮肤采样的结果、患者疼痛程度.结果 三组疼痛程度比较,差异有统计学意义(P＜0.01);伤口甲级愈合、冲洗后即刻皮肤细菌及霉菌检出率无统计学差异(均P＞0.05);冲洗后3h,伤口皮肤细菌检出率差异有统计学意义(P＜0.01).结论 碘伏、肤疾洗剂或温开水均有较好的抑菌作用,温开水取材方便、患者舒适度高,可作为产妇会阴冲洗的首选.     

环形管植入并下泪小管断裂吻合28例

目的：探讨外伤性泪小管断裂患者行环形管植入并下泪小管断裂吻合的疗效。 方法：选取外伤性下泪小管断裂患者28例,显微镜直视下探针引导寻找泪小管的泪囊侧断端并环形植入硅胶管,行泪小管断裂吻合,追踪观察6mo~2a。 结果：泪道断裂修复患者28例中,手术均1次吻合成功,治愈24例（85.7%）;好转3例（10.7%）;无效1例（3.6%）。 结论：显微镜直视下用探针引导寻找泪小管的泪囊侧断端并环形植入硅胶管治疗泪小管断裂,方法简便,效果好。其可保持正常的泪流,不影响外观,稳定性好,操作实用方便,但应注意手术技巧。