Other conditions of the lung (abscesses,inhaled foreign bodies,bullous lung disease,hydatid)

Lung abscess remains a common complication of pneumonia and aspiration, particularly in immunosuppressed patients, and must be differentiated from a cavitary form of lung cancer. The conservative treatment with antibiotics is still the main therapeutic approach; however, percutaneous drainage may be employed in selected cases.     

Laparoscopic retrieval of intraabdominal foreign bodies

The use of laparoscopy has been described as the means of removing intraabdominal foreign bodies, both intraperitoneal and intraluminal, from the stomach or bowel. An early report detailed the laparoscopic removal of translocated intrauterine devices from the peritoneal cavity [2]. Laparoscopic removal of a retained surgical sponge also has been reported [1]. For large ingested objects that cannot be retrieved by flexible endoscopy, laparoscopic gastrotomy and foreign body removal have been described [3] . The authors recently had three cases of laparoscopic foreign body retrieval. The first case involved a young man who had ingested latex gloves, causing gastrointestinal bleeding. Endoscopic retrieval was unsuccessful. A laparoscopic gastrotomy was performed, with the retrieval of four gloves, followed by intracorporeal, sutured closure of the gastrotomy. The second case involved the laparoscopic removal of a Penrose drain around the distal esophagus. The patient had initially undergone a laparoscopic Nissen fundoplication, vagotomy, and gastrojejunostomy for the management of reflux and a duodenal stricture. He had persistent dysphagia after surgery, prompting takedown of the fundoplication several months later. When his dysphagia did not improve, a retained Penrose drain that had been placed around the distal esophagus at the initial operation was discovered on computed tomography. This was removed laparoscopically. At this writing, 18 months after the initial operation, the patient has complete resolution of dysphagia. The third case involved a duodenojejunal fistula caused by multiple ingested magnets that had eroded through the bowel wall. The fistula was divided laparoscopically, and 16 disk-shaped magnets were removed. The duodenum and jejunum were repaired with laparoscopic suturing and stapling. All three patients did well after surgery. Laparoscopy can be an excellent method for abdominal foreign body retrieval. Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

The management of foreign bodies in the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO)

INTRODUCTION

We describe our experience of the diagnosis and removal of foreign bodies from the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO) under local analgesic. The advantages of this novel instrumentation and technique are discussed.

PATIENTS AND METHODS

Patients were examined with a Pentax 80K Series Digital Video Endoscope after local analgesia. The instrument was passed transnasally examining the oro- and hypopharynx, and then passed into the oesophagus. The presence, type and site of a foreign body could then be established. If a foreign body was detected, such as fish bone, it was extracted using flexible grabbing forceps passed down the instrument channel and delivered through the nasal or oral cavity. The object was then inspected to ensure removal in its entirety.

RESULTS

Five cases have been successfully managed using TNFLO.

CONCLUSIONS

TNFLO represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies.     

Infections and foreign bodies in ENT

Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications, therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.     

Infections and foreign bodies in ENT

Infections of the ear, nose and throat are common. The majority of these infections are managed by the primary care physicians and they settle with conservative and medical management. However, a small group can progress to become troublesome and develop complications to the extent that they may require surgical intervention. Some of the infections can lead to life-threatening complications therefore awareness and correct diagnosis along with appropriate management is paramount. Foreign bodies in the ear, nose and throat are commonly encountered. The location and type of foreign body can have an implication on the urgency of action and the possible complications. In this article the common ENT infections and foreign bodies and their management are discussed.     

Radiographic griding of subcutaneous soft tissue metallic foreign bodies in emergency department

Radiographic grid for localization of soft tissue metallic foreign bodies is a modification of traditional radiography. Twenty localization procedures using simple radiographic grid was successfully performed. Its low cost and easy to perform makes it a useful tool in emergency setting.     

Anesthesia for removal of inhaled foreign bodies in children

BACKGROUND: Foreign body aspiration may be a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. Both controlled and spontaneous ventilation techniques have been used during anesthesia for bronchoscopic foreign body removal. There is no prospective study in the literature comparing these two techniques. This prospective randomized clinical trial was undertaken to compare spontaneous and controlled ventilation during anesthesia for removal of inhaled foreign bodies in children. METHODS: Thirty-six children posted for rigid bronchoscopy for removal of airway foreign bodies over a period of 2 years and 2 months in our institution were studied. After induction with sleep dose of thiopentone or halothane, they were randomly allocated to one of the two groups. In group I, 17 children were ventilated after obtaining paralysis with suxamethonium. In group II, 19 children were breathing halothane spontaneously in 100% oxygen. RESULTS: All the patients in the spontaneous ventilation group had to be converted to assisted ventilation because of either desaturation or inadequate depth of anesthesia. There was a significantly higher incidence of coughing and bucking in the spontaneous ventilation group compared with the controlled ventilation group (P = 0.0012). CONCLUSION: Use of controlled ventilation with muscle relaxants and inhalation anesthesia provides an even and adequate depth of anesthesia for rigid bronchoscopy.     

Thoracoscopic retrieval of intra-parenchyamal foreign body of lung

Thoracoscopy is an innovative procedure. We have retrieved intraparynchymal lung foreign body by thoracoscopy. Intraoperative imaging by ‘C’ arm facilitated the procedure. Thoracoscopy is a therapeutic option of choice for projectile thoracic injuries, provided patient is hemodynamically stable.     

肺切除术治疗延迟性吸入性支气管异物17例分析

目的 总结接受肺切除术治疗的延迟性吸入性支气管异物患者的临床病理资料,对该疾病的临床特点和治疗选择进行探讨.方法 1980年1月至2010年6月,利用肺切除术治疗延迟性吸入性支气管异物患者17例,其中男性12例,女性5例,年龄10～66岁,平均年龄36岁.症状包括咳嗽、咯血、发热、咳脓痰、气急等,发病时间间隔为3个月～8年,平均2年.术前确诊8例,9例误诊为其他疾病.行右肺下叶切除术4例,右中叶切除术3例,右中下叶切除术1例,右下叶切除术+肋床引流术1例,右下叶切除+胸膜剥脱术1例,胸腔镜下右肺下叶部分切除术1例,左全肺切除术4例,左下叶切除术1例,左上叶切除术1例.结果 术后死于肺部感染1例,并发支气管胸膜瘘2例.异物位于右侧11例,左侧6例,异物种类最多为骨片(8例),其次为辣椒尖(3例)和笔套管(2例).伴随肺内病理改变包括慢性支气管肺炎8例,支气管扩张7例,肺实变4例,慢性肺脓疡伴毁损肺3例,机化性肺炎2例,肺发育不全1例.结论 应重视延迟性支气管异物的诊断,降低误诊率,尽可能避免行肺切除术.对于肺内感染病变明显的病例,应及时行肺切除术,以免肺部病变发展为肺化脓症和脓胸等严重感染.     

Laparoscopic management of foreign body perforation in diverticular disease

A case is described where laparoscopic principles in the management of spontaneous sigmoid diverticular perforation are applied to foreign body perforation.     

胃窦异物肉芽肿性炎致幽门梗阻的影像学表现

胃窦异物肉芽肿性炎导致幽门梗阻临床罕见。其临床表现没有特异性,常需联合x线、CT、胃镜检查明确诊断;同时需与消化性溃疡、胃癌、十二指肠梗阻性病变相鉴别。2012年4月13Et浙江省嘉兴市第二医院收治了1例胃窦异物肉芽肿性炎致幽门梗阻患者,总结该病的影像学表现,以为其临床诊断与治疗提供参考和帮助。     

16层螺旋CT后处理技术诊断食源性食管异物

目的探讨16层螺旋CT后处理技术诊断食管异物的价值。方法对52例临床怀疑食管异物者均行X线平片、食管吞钡棉检查、CT平扫,比较不同方法对异物的检出率,并与食管镜或手术结果进行比较。CT后处理技术包括多平面重建（MPR）、最大密度投影（MIP）、容积再现（VR）等。结果经食管镜或手术证实的28例患者的食管异物为鸡骨、鸭骨、鱼刺等,形态、大小、长度及所在部位各异,均能被16层螺旋CT后处理技术清晰显示,X线平片发现5例,检出率为17.86%,食管吞钡棉检查发现8例,检出率为28.57%。结论16层螺旋CT后处理技术相对于X线平片、食管吞钡棉检查可明显提高食管异物的检出率,并可评价食管损伤程度及周围脓肿、食管气管瘘等并发症的情况及范围。     

肾周脓肿25例的诊断与治疗

目的：提高肾周脓肿的诊断与治疗水平。方法：回顾性分析25例肾周脓肿患者的临床资料。结果：25例患者明确诊断为肾周脓肿，72％患者尿培养阳性，CT确诊率92％。3例(12％)死亡。10例患者脓肿直径1.8cm，单独使用抗生素治疗平均住院10d；11例脓肿平均直径11cm，采用抗生素联合经皮穿刺引流治疗，平均住院30d；4例最后进行了外科探查和肾切除。结论：肾周脓肿临床变化特点并不典型，CT检查是目前确诊最可靠的方法，通过明确的分期以获得理想的疗效。     

31例无异物残留腹腔镜阑尾切除术的疗效

目的观察无异物残留的腹腔镜阑尾切除术的疗效。方法比较无异物残留(微波刀 套扎器)腹腔镜阑尾切除术、传统(电刀 钛夹)腹腔镜阑尾切除术和开腹阑尾切除术的手术时间、手术后肠功能恢复时间、术后住院日、切口愈合情况等各项指标。结果无异物残留的腹腔镜阑尾切除术组手术时间、肛门排气时间较其它两组明显缩短(P<0.05,P<0.01);术后镇痛剂应用、住院时间、切口感染率、粘连性肠梗阻发生率及腹腔残余感染发生率等指标优于开腹阑尾切除术(P<0.01),与传统腹腔镜阑尾切除术组无明显差异(P>0.05)。结论无异物残留的腹腔镜阑尾切除术明显优于传统的腹腔镜阑尾切除术及开腹阑尾切除术。     

下消化道异物的诊治体会：附25例报告

目的 探讨下消化道道异物的诊断和治疗。方法 对2001年9月~2010年12月间入住我科25例非外伤性肠道异物患者的临床资料进行回顾性分析。结果 18例（72%）经开腹手术取出异物。5例（20%）直肠异物在骶麻下经肛门取出。2例（8%）经保守治疗后异物自然排出体外。所有患者均治愈出院,未发现并发症。 结论 对于肠道异物要采用正确的治疗措施才能取得良好的效果。     

Curious foreign body in the bladder of an adolescent

We report the case of a 14 year old boy who presented at our emergency department because of increasing alguria and dysuria one year after inserting a wire cable into his bladder for autoerotic purposes. Endoscopic transurethral removal of the foreign body proved to be impossible because the cable was of a stiff consistency and was trapped in scar tissue at the bladder neck. The foreign body therefore had to be extracted using a Pfannenstiel approach. Urethrocystoscopy and uroflow performed one week later were normal. Filiform intravesical foreign bodies can create particular challenges. Adequate diagnostic imaging, awareness of possible complications, and knowledge of the different available techniques are essential in planning safe extraction.     

Diverticulitis, pelvic and other intra-abdominal abscesses (including laparoscopic management)

Diverticular disease became prevalent at the beginning of the last century, and is now the commonest acquired disease of the colon. Complications can arise from bleeding, perforation and stricturing, and surgical management remains a challenge in both the acute and elective setting. This article discusses pathophysiology, complications and trends in management including the use of laparoscopic surgery.     

Postoperative adverse respiratory events in preschool patients with inhaled foreign bodies: an analysis of 505 cases

Objectives: To identify the risk factors associated with postoperative adverse respiratory events in preschool‐aged children with inhaled foreign bodies (FBs) undergoing rigid bronchoscopy. Background: Foreign bodies aspiration is the most common cause of admission in pediatric emergency in otolaryngology service. Performance of rigid bronchoscopy is the standard treatment for removal of FBs in children. In some cases, severe respiratory events (complete laryngospasm and pneumothorax) may cause anesthesia‐related morbidity and mortality. However, the association between patient‐related factors and postoperative complications in preschool‐aged children with inhaled FBs undergoing rigid bronchoscopy is unclear. Methods: We carried out a large prospective, single‐institution review of anesthesia for 505 American Society of Anesthesiologists I–III preschool children aged ≤7 with inhaled FBs undergoing rigid bronchoscopy. Patients with postoperative adverse respiratory events were classified into two groups: the minor events group [hemorrhage, minor desaturation, and partial laryngospasm (wheezing, stridor, and dyspnea)) and the major events group (complete laryngospasm, including major desaturation, and pneumothorax). Results: The incidence of postoperative adverse respiratory events was 9.5% in preschool‐aged children with inhaled FBs undergoing rigid bronchoscopy. Preoperative respiratory impairment was associated with an increased risk for the complicate (P < 0.01). Pneumothorax occurred in 4 (0.8%) patients. There was 1 (0.2%) death from severe respiratory‐related complications. Conclusions: Preoperative respiratory impairment may develop the patients with FBs into postoperative adverse respiratory events.     

Dashboard (in the) Knee

We present the case of a 19-year-old individual presenting to an orthopaedic outpatient clinic several months following a dashboard knee injury during a road traffic accident with intermittent mechanical symptoms. Despite unremarkable examination findings and normal magnetic resonance imaging, the patient was identified subsequently as having an intra-articular plastic foreign body consistent with a piece of dashboard on arthroscopic knee assessment, the retrieval of which resulted in a complete resolution of symptoms.     

Chronic perforation of the urinary bladder by self-inserted foreign body

We report on a 14-year-old girl with pyelonephritis, secondary to a foreign body, in her urinary bladder. A self-inserted pencil led to stone formation and bladder perforation at two sites. Eighteen months after insertion, the pencil was removed by suprapubic cystotomy.