Esophageal foreign bodies.

Foreign body ingestion is a common occurrence in children and in specific high-risk groups of adults such as those with underlying esophageal disease, prisoners, the mentally retarded, and those with psychiatric illnesses. Although most foreign bodies pass through the gastrointestinal tract without difficulty, sharp, pointed, and elongated foreign bodies are associated with a greater risk of perforation, vascular penetration, and other complications. Foreign body ingestion is usually diagnosed based on a history of ingestion given by the patient or an observer. However, children and impaired adults may be unable to give an accurate history, and a high index of suspicion must be maintained in these groups. Dysphagia and odynophagia are the usual symptoms of foreign body impaction in the esophagus. Respiratory symptoms due to compression of the adjacent trachea are also common in younger children and are occasionally the presenting symptom in adults. The preferred method of removal of esophageal foreign bodies is extraction with the flexible endoscope. This may be accomplished in both adults and children with the use of conscious sedation rather than general anesthesia. The availability of grasping instruments specifically designed for foreign body removal and snares greatly facilitates endoscopic extraction. An overtube conveys all of the advantages of the rigid esophagoscope to the flexible endoscope, enabling extraction of sharp and pointed foreign bodies while protecting the mucosa from injury. Adherence to the general principles of foreign body removal and proper preparation result in successful removal rates as high as 98%, with minimal or no complications. Nonendoscopic methods of removal are associated with increased risks of perforation and aspiration and generally should be avoided, with the exception of a trial of intravenous glucagon. Surgical removal is rarely indicated except in the event of perforation or other foreign body complications.     

Migratory traumatic cardiovascular foreign bodies.

Six cases of cardiovascular foreign bodies secondary to trauma are presented. The various modes of entry and travel within the vascular are reviewed. Routine radiographic examination and angiography are shown to be the most useful techniques in defining the location and subsequent course of the foreign body in the vascular system.     

Retained foreign body in a child

We present the case of a child who ingested or inhaled a foreign body that lodged between the esophagus and the trachea for more than 23 months. The only presenting complaint was of recurrent upper respiratory tract infections. The patient, a 3-year-old girl, required a tracheostomy to alleviate respiratory distress. She made a complete recovery after surgical removal of the foreign body through a neck incision.     

Colorectal foreign bodies

A nine-year experience with 55 colorectal foreign bodies extracted from 51 patients is presented. Adherence to a management protocol according to the classification of the level of the foreign bodies within the rectum is emphasized. The therapeutic principles of pre-extraction biplane abdominal roentgenograms, appropriate anesthesia for adequate sphincter relaxation, transanal extraction under direct vision whenever possible, proctosigmoidoscopy and inpatient observation following removal of the foreign body have resulted in no morbidity or mortality in this series.     

Soft tissue foreign bodies

Foreign bodies embedded in soft tissue can cause toxic and allergic reactions, inflammation, or infection, but the severity of these complications varies widely. Removal can be difficult and time consuming, and the potential damage to tissues caused by the procedure must be weighed against the risk posed by a particular foreign body. Plain and mammographic radiography, xeroradiography, computed tomography, and ultrasonography can be used to detect foreign bodies suspected during clinical evaluation. The exact position of an object buried in soft tissue is difficult to determine using two-dimensional imaging techniques. Surface markers, multiple-projection radiographs, wire grids, fluoroscopy, or stereotaxic devices may help to locate it. Not all foreign bodies are discovered during the initial patient encounter; several signs reveal the presence of a retained foreign body in a wound.     

Endocarditis due to accidental penetrating foreign bodies.

A 15 year old boy had an eight month history of recurrent fever, malaise and poor appetite. Chest roentgenogram revealed a foreign object overlying the right ventricle. Multiple blood cultures grew Enterobacter cloacae. The patients condition improved and blood cultures became negative following gentamicin and carbenicillin therapy. E. cloacae was isolated from the foreign body (a finishing nail) at surgery. Antimicrobial therapy was continued for a total of 30 days, and the patient made an uneventful recovery.     

Retained intracardiac spring: an unusual foreign body

A rare case of a penetrating intracardiac injury due to a ball-point pen in an adult male is reported. The patient presented with a retained metal spring embedded in the interventricular septum without any cardiac defects. A small metal tip of the pen was also present in the left lung. The patient was asymptomatic and without any cardiovascular compromise. The cardiac injury was managed conservatively. At two years after the injury the patient is still asymptomatic.     

吗啡与布托啡诺对腹部手术后患者腹内压的影响

目的比较吗啡与布托啡诺对胃肠道手术患者腹内压的影响。方法选取2016年11月至2017年9月期间徐州医科大学附属医院收治的胃肠道开腹手术术后入住ICU的患者80例,按照随机数字表法分为吗啡组和布托啡诺组,每组40例。吗啡组镇痛药为盐酸吗啡20 mg+生理盐水至40 ml;布托啡诺组镇痛药为酒石酸布托啡诺4 mg+生理盐水至40 ml。2组均以2 ml/h的速度持续泵入,用药时间24 h。比较2组患者的临床指标及不同时间点的腹内压水平。采用SPSS 21.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ2检验。结果布托啡诺组在用药后24 h[(13.38±2.03)vs(14.76±3.05)mm Hg(1 mm Hg=0.133 k Pa)]和48 h[(12.33±1.75)vs(14.04±2.70)mm Hg]的IAP水平均显著低于吗啡组(P0.05)。布托啡诺组患者的胃肠功能恢复时间[(2.65±0.66)vs(3.05±0.67)d]、术后住院时间[(10.08±1.64)vs(12.00±2.56)d]、恶心呕吐发生率(10.00%vs 27.50%)显著低于吗啡组,而嗜睡发生率(25.00%vs 7.50%)显著高于吗啡组,差异均具有统计学意义(P0.05)。结论相较于吗啡,布托啡诺更适合用于胃肠道开放手术患者的镇痛。     

Tracheobronchial foreign bodies in adults

STUDY OBJECTIVE: To define the clinical spectrum of tracheobronchial foreign body aspiration in adults, assess predisposing conditions, evaluate the efficacy of bronchoscopy, and determine outcome and complications. DESIGN: Retrospective analysis of a consecutive clinical series. SETTING: A tertiary care, referral-based medical center. PATIENTS: Sixty consecutive adult patients (over 16 years of age) evaluated for tracheobronchial foreign body aspiration. INTERVENTIONS: All 60 patients had bronchoscopic evaluation; 59 of them had foreign bodies identified and removal was attempted using either rigid or flexible fiberoptic bronchoscopy. MAIN RESULTS: Of 60 consecutive patients, 25 had underlying impairment of protective airway mechanisms (primary neurologic disorders, trauma with loss of consciousness, or sedative or alcohol use). Fifty-seven were successfully managed with bronchoscopy. Fiberoptic bronchoscopy was successful in 14 of 23 patients, and rigid bronchoscopy was successful in 43 of 44 patients, including 6 of 7 patients in whom previous fiberoptic bronchoscopy had failed. Thoracotomy was required in 3 patients. Complications of bronchoscopy were rare and not serious. Chronic complications of prolonged foreign body impaction included bronchiectasis in 3 patients. CONCLUSIONS: Although rare, tracheobronchial foreign body aspiration in adults can occur in various clinical settings. High clinical suspicion is necessary for diagnosis. Removal of foreign bodies can usually be accomplished with bronchoscopy.     

Retrieval of intravascular foreign bodies

The use of intravascular catheters for diagnostic and therapeutic purposes has resulted in an increased number of foreign body embolizations. The retained foreign body is a potential source of morbidity and mortality. In this communication we describe the different techniques that are used to remove foreign bodies from various locations within the heart or vascular tree. A brief review of the literature concerning the reported complications from retained foreign bodies is made to underline the importance of early percutaneous removal of these fragments.