Fever, coughing and/or wheezing in young children: consider the possibility of foreign body aspiration

Three children, 2 girls aged 1.5 and 3 years and a 2-year-old boy, experienced coughing, wheezing and/or fever for several days or weeks. The first girl was treated for asthma, the other two children for pneumonia. Because the symptoms persisted in all three children after treatment was started, the diagnosis of foreign body aspiration was suggested and confirmed by bronchoscopy. The foreign body was removed during the bronchoscopy and in the boy, a mucosal lesion in the piriform fossa was sutured. Thereafter, all the children recovered completely. In children with persistent coughing, wheezing or fever despite treatment for pneumonia or asthma and in absence of a characteristic acute incident, foreign body aspiration should be considered.     

多层螺旋CT对小儿支气管异物方面的临床诊断价值分析

目的：探讨经多层螺旋CT诊断小儿支气管异物的临床价值。方法2013年7月30日-2014年7月30日,我院接收52例支气管异物患儿,经PHILIPS Brilliance 64排螺旋CT对52例患儿进行诊断。结果异物类型：坚果类异物,玉米,果蔬类异物,豆类异物,骨块等;异物所处位置：气管分叉,左侧支气管,右侧支气管,左主支气管,右侧中叶支气管,右中间支气管,右侧下叶段支气管,左肺下叶段支气管,左肺下叶支气管;间接征象：4例肺气肿,1例胸腔积液,1例气胸,1例纵隔气肿,1例肺不张,2例皮下气肿,6例肺炎;直接征象：支气管腔内存在高密度阴影,管腔阻塞或者狭窄,支气管异物多以柱状的形态存在,此外,也存在不规则状、半圆形、环形、三角形、管状。结论经PHILIPS Brilliance 64排螺旋CT对支气管异物患儿进行诊断,病症确诊率高,无创,具有很高的临床诊断价值。     

螺旋CT及多平面重建技术在小儿支气管异物诊断中的价值

目的探讨多排螺旋CT(multi-slice spiral CT,MSCT)及多平面重建(multiplanarreformation,MPR)技术、曲面重建(curve multiplanar reformation,CPR)技术在小儿支气管异物影像诊断中的价值。方法确诊支气管异物患儿10例,男孩9例,女孩1例,年龄为(1.2~10.0)岁;在常规螺旋CT检查的基础上,再结合MPR,CPR显示支气管狭窄、异物及其所在的位置,以及异物阻塞所致的间接征象。结果螺旋CT检查结果提示,支气管异物并经支气管镜检确诊,位于右侧主支气管者8例,位于左侧主支气管者2例;低密度异物8例,包括花生米3例、开心果皮、玉米粒、瓜子仁、蚕豆和肉丝各1例,高密度异物,如牙齿和鱼刺残留各1例;螺旋CT检查结果显示,肺炎7例,肺不张4例,肺气肿3例,纵隔气肿4例,皮下气肿4例,气胸2例。结论螺旋CT加MPR/CPR技术对小儿支气管异物的显示率高,定位准确,并可显示各种合并症,对气道异物的诊断和鉴别诊断有极重要的价值。     

Tracheobronchial foreign bodies. Diagnostic and therapeutic aspects in children

In this retrospective study, the authors reviewed 31 cases of tracheobronchial foreign body in children ranging in age from one to 15 years, recruited in Ariana hospital since 1987. 74% of the patients were male, and only 26% were less than 3 years old. The foreign body is mostly revealed by a radio-clinical presentation of a feverish bronchopneumonia (32%); children were referred to the hospital within 15.4 months. Although penetration syndrome was reported in 61% of patients, it represented the reason of consultation in only 19% of cases, and children were referred within 4.5 days. The main radiographic findings were atelectasis (32%) and non specific foci of pneumonia (19%). Air trapping was noted in just 10% of cases. 55% of foreign bodies were vegetable in nature, with sunflower seeds at the head of the list (16%). They have been lodged preferentially in the right bronchial tree (58%) and 51% of them were found in the mainstem bronchus. 71% were removed by endoscopic procedures; a surgical operation was performed in 6 cases (19%): one case of pneumotomy to extract a metallic foreign body from distal respiratory tract, and five cases of parenchymal excision, including four for bronchiectasis. 77% of patients had symptoms that lasted at least 2 weeks before diagnosis; the long delay in diagnosis (average of 7.6 months) explains the high-level of bronchiectasis in our study (22%). The authors emphasize the necessity to promote preventive measures by information parents and physicians on risks of foreign body aspiration, which early diagnosis can save much trouble in children.     

An unusual bronchial foreign body: an hydatid cyst membrane

Long course bronchopneumonia in child imposes a bronchoscopy to research a foreign body. We report the case of a 4 years old child presenting an unusual foreign body overdraft at rigid tube bronchoscopy indicated for a training pneumonia. It was the membrane of burst pulmonary hydatic cyst obturing left bronchial tree. His total extraction permitted the complete recovery without retention of the membrane.     

Two patients with a perforation of the esophagus and hypopharynx,respectively, caused by a bone in their food

Two patients, men aged 58 and 28 years, developed pain in the throat while eating chicken and pork, respectively. In the emergency clinic and during a check-up on the following day, no foreign body could be found. On the third visit to the hospital, oesophagoscopy was performed. In one patient a chicken bone was found lying transversely in the oesophagus; after removal of this bone extraluminal pus was seen. In the other patient a pork bone was found in the right piriform recess, with a great deal of local pus. Both foreign bodies were removed during oesophagoscopy. The recovery of both patients was uneventful. A foreign body is found in the upper digestive tract in approximately one-third of the patients presenting to an emergency department with a history of foreign body ingestion. Serious complications occur in less than 1%; however, these complications can be life-threatening. If, based on the anamnesis, physical examination or radiological evaluation, there is suspicion of a foreign body in the oesophagus, or if the examination is incomplete, then oesophagoscopy should be performed.     

成年女性阴道异物滞留10年一例

报告1例28岁女性阴道异物滞留10年的病例。该患者自述10年前有被性侵史,未就医。2年前开始同房出现间断阴道出血,1年前出现腹痛、发热症状,盆腔磁共振成像提示阴道异物可能。本次入院后行宫腹腔镜联合手术,腹腔镜探查见盆腔脏器表面均被覆大量炎性粘连带,双侧输卵管僵硬、迂曲,未见阴道异物突入盆腔,宫腔镜探查示阴道中段大量炎性质硬息肉状赘生物,其间可见直径1 cm孔洞,宫腔镜探入后,可见右侧穹窿部一桶状质硬黑色异物,长约3 cm,直径约2 cm,此异物与穹窿及阴道壁广泛致密粘连,行宫腹腔镜联合阴道异物取出术+宫腔镜下阴道炎性赘生物切除术+阴道修补术,术后恢复良好。     

放射影像技术在诊断小儿气管、支气管异物中的应用分析

目的：对比分析放射影像技术中普通X线检查和螺旋CT扫描在诊断小儿气管、支气管异物中的临床应用效果。方法：选取2012年1月-2013年12月在本院进行治疗的小儿气管、支气管异物患者80例,按检查方法将其分为实验组和对照组,每组40例患者,实验组应用螺旋CT扫描进行疾病诊断,对照组应用普通X线检查,对比两组患者异物检出率,在异物征象观察中,将全部患儿分别进行螺旋CT和X线检查,并根据检查方式将其分为螺旋CT组和X线组,对比两组异物征象检查结果。结果：实验组患者检出率为100%,明显高于对照组的82.50%,在异物征象观察中,螺旋CT组异物征象（纵隔位置改变、支气管阻塞、肺气肿、肺炎）检出率明显高于X线组,差异有统计学意义（P〈0.05）。结论：相对于普通X线而言,螺旋CT对小儿气管、支气管异物检查准确率高,并能准确判断出异物大小、形态、位置以及伴随病变,建议在临床上推广应用。     

Chronic unilateral rhinorrhea in childhood

A 13-year-old patient was referred to the ENT department because of a ring-shaped radiopaque foreign body in her right nasal cavity demonstrated on an orthopantomogram. Her medical history revealed long-standing right-sided rhinorrhea thought to be caused by an inhalation allergy. In case of unilateral rhinorrhea in a child a nasal foreign body has to be excluded.     

Management of patients with bronchial foreign bodies

The aspiration of foreign bodies into the bronchus frequently occurs in children as well as in elderly people. Foreign bodies in the airway not only cause chronic cough and pneumonia, but also result in life-threatening conditions, such as dyspnea and cyanosis. This report presents the clinical characteristics of 6 patients with bronchial foreign bodies who were treated between 2006 and 2010, including 4 male and 2 female patients. The age of the patients ranged from 8 to 83 years old. Foreign bodies were located in the right bronchial tree in all the patients. Chest X-rays showed pneumonia or atelectasis in 5 out of 6 patients. The foreign bodies were an artificial teeth or a tooth in 5 patients, and a fish bone in 1 patient. Five patients had fiberoptic bronchoscopy under local anesthesia, although an 8-year-old girl required general anesthesia with a laryngeal mask. Surgery was needed in only one case. Bronchial foreign bodies present a large range of symptoms, from trivial symptoms to irreversible damage to the bronchus and the lung, which can be life threatening. Nonspecific respiratory symptoms may be mistakenly attributed to other medical diagnoses unless there is a clear history of aspiration. However, an early diagnosis is very important, because inflammatory granulation due to long-term impaction of foreign bodies makes its removal difficult.     

多层螺旋CT三维重建对不同部位儿童气管支气管异物的诊断价值

目的 探讨多层螺旋CT三维重建对不同部位儿童气管支气管异物的诊断价值.方法 回顾性分析湖南省儿童医院2011年9月至2013年2月经纤维支气管镜检查并确诊为儿童气管支气管异物的患儿114例,所有患儿检查前均行胸部多层螺旋CT三维重建.结果 气管异物病例的CT阳性率最低（7.70%）,其次为叶及叶以下支气管异物病例,CT阳性率为58.33%,右主支气管异物、左主支气管异物病例的CT阳性率相对较高,分别为81.82%、74.19%,差异有统计学意义（χ2=34.82,P〈0.0001）.结论 多层螺旋CT三维重建对不同部位儿童气管、支气管异物的诊断价值存在差异,气管异物CT阳性率低,易漏诊、误诊,需尽早行支气管镜检查确诊.     

小儿呼吸道异物的诊治

目的提高小儿呼吸道异物诊疗水平。方法对1984～2004年32例小儿呼吸道异物的误诊误治病例进行分析。结果误诊误治的病种有:急性喉炎、急性喉气管炎、急性支气管炎、肺炎、肺脓肿、喉及气管肿瘤等。结论体征不典型,询问病史不仔细及有些医生对其认识不足是小儿呼吸道异物误诊误治的主要原因。     

儿童气管支气管异物延误诊断的原因及影响分析

目的探讨儿童气管支气管异物延误诊断的原因及影响,为进一步提高对该病的认识提供临床依据。方法选取2016年1月1日至2017年12月31日在西安市儿童医院呼吸一科因气管支气管异物住院的患儿342例,在患儿呛咳或出现症状后,≤7天确诊为早期诊断组(228例),>7天确诊则为延误诊断组(114例),对其临床资料进行回顾性分析。结果患儿发病年龄集中在≥1~<3岁(85.7%),男∶女=2∶1,植物性异物占绝大多数(90.4%),1、2月份气管支气管异物发病率较高,分别为10.2%,14.9%。与早期诊断组相比,延误诊断组患儿来自农村的比例及病程中发热的比例均明显升高(χ~2值分别为6.637、42.092,均P<0.05),院外接受抗生素或激素治疗比例、无并发症比例均显著增高(χ~2值分别为129.848、10.206,均P<0.01),住院时间明显延长(t=-4.470,P<0.01),家属提供呛咳史的比例明显减少(χ~2=43.589,P<0.01)。结论患儿家长未主动提供呛咳病史、医生的诊断意识不够、不恰当地使用抗生素或激素是造成延误诊断的主要原因,延误诊断可增加肺气肿、肺炎、肺不张等并发症发生,对反复呼吸道感染、慢性咳嗽、反复喘息的患儿应酌情考虑行支气管镜检查。     

三维CT在眼部异物定位诊断中的临床研究

目的对运用三维CT后处理成像系统确定眼内异物位置的临床应用价值进行探讨。方法回顾性分析黑龙江省医院近3年就诊的眼内异物患者,共47例（48只眼）经眼眶三维CT检查并经过后处理成像技术处理的临床资料。47例（48眼）眼内异物伤患者中,9例（10眼）为眶内异物（包括眶壁异物）,38例为球内异物,包括前房异物、晶状体、玻璃体、以及视网膜异物等,其中金属异物41例．非金属异物6例7眼。结果三维CT后处理成像系统对眼内异物定位准确率100％。结论三维CT后处理成像系统对眼内异物定位诊断有重要的临床应用价值。     

小儿肺炎支原体肺炎的临床诊治分析

目的:探讨小儿肺炎支原体肺炎的临床特点,提高小儿肺炎诊治水平。方法:回顾性分析该院在2011年5月～2012年5月收治并经过临床确诊的120例患者的临床资料。结果:120例患儿经过3～5天临床治疗后有99例患儿体温明显下降,咳嗽明显减轻。治疗7～9天后有18例患儿体温平稳,咳嗽明显减轻,其中有3例患儿合并军团菌感染高热持续11天后体温才恢复正常,临床对于合并其他的细菌感染18例患者给予头孢类或美洛西林治疗,对该组患儿临床经过12天治疗后经过复查X线胸片好转后出院进行随访,经1个月随访,所有患儿全部治愈。结论:小儿肺炎支原体肺炎是临床常见的疾病,临床表现为除呼吸道疾病外,常合并肺外多系统的损害,咽拭子支原体DNA检测阳性可以作为临床早期诊断的重要手段,对于小儿肺炎支原体肺炎临床采用阿奇霉素和红霉素治疗效果好。     

Acute respiratory insufficiency in children

Acute respiratory distress in children is often a consequence of asthma. Other causes are subglottic laryngitis, epiglottitis, aspiration of a foreign body, acute bacterial pneumonia or pneumothorax. History and physical examination should differentiate between the various diseases. Asthma is characterized by recurrent symptoms and signs, while this is not the case with the other causes of acute breathlessness described. An asthma exacerbation is often preceded by one or more prodromes. In case of aspiration of a foreign body, like a peanut, immediate action is needed to prevent irreversible damage to the airways. Subglottic laryngitis and epiglottitis are both characterized by an inspiratory stridor; in case of epiglottitis immediate action is needed, while in case of subglottic laryngitis observation time is available in most cases. Pneumothorax as a cause of acute breathlessness is rare in childhood; it should be considered in male smoking leptosomic asthmatic adolescents.     

眼球后段异物取出后的长期随访

目的 对成功取出眼球后段异物的患者进行长期随访观察.方法 回顾性分析23例患者(23眼)经玻璃体切除术成功取出眼球后段异物后的临床随访资料.结果 所有病例随访3～36个月,4例患者(4眼)发生了孔源性视网膜脱离,对其进行处理后,视力结果良好.结论 成功取出眼球后段异物后的主要并发症是孔源性视网膜脱离,可以发生在初次术后的数月以内,对孔源性视网膜脱离可根据脱离的范围、位置和引起裂孔的原因应用不同的方法进行处理,因此对成功取出眼球后段异物的患者进行长期随访观察具有重要的临床意义.     

Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status

Mortality and hospitalization rates for pneumonia have increased among older Americans during recent years (1979-86), despite a national commitment to the reduction of premature deaths from pneumonia. A prospective study of deaths and hospitalizations attributable to pneumonia was conducted among 5,474 subjects ages 55 and older who participated in the NHANES I Epidemiologic Followup Study. Prevalent chronic conditions, health behaviors, and nutritional status indicators, measured at baseline, were examined in relation to pneumonia hospitalization and death during 12 years of followup. Mortality and hospitalization rates for pneumonia were higher among men than women, and higher among those ages 65 and older than among those 55-64 of both sexes. Risk of pneumonia death was higher among subjects with a history of congestive heart failure, stroke, cancer, or diabetes. Risk of pneumonia hospitalization was higher among subjects with a history of chronic obstructive pulmonary disease and among men who were current smokers. Daily alcohol consumption did not increase risk of pneumonia in this study population. Four measures of nutritional status were examined taking age, prevalent chronic conditions, and cigarette smoking into account: body mass index, arm muscle area, and serum albumin and hemoglobin levels. Risk of pneumonia death was 2.6 times higher in men in the lowest quartile, compared with men in the highest quartile, of body mass index. Similarly, the risk was 4.5 times higher among men in the lowest quartile of arm muscle area. Risk of death from pneumonia was 3.6 times higher among women in the lowest quartile of serum albumin levels compared with women in the highest quartile. Relative risks for these nutritional status indicators remained elevated after adjusting for age and the medical history risk factors. These risk factors should be taken into account when designing and evaluating pneumonia vaccination trials and community prevention programs.     

102例SARS患者胸片分析

目的　探讨严重急性呼吸综合征 (SARS)临床特点和转归。方法　回顾性分析北京某 SARS定点医院收治的 10 2例患者 ,对其病程中不同时期胸部 X线片进行分析。结果　 3日内有 79.6 %、7日内有 97.4 %的患者出现胸片异常 ,10日内所有患者均出现胸片异常 ;首次异常胸片中 ,右侧肺炎占 4 3.1% ,以右下肺炎多见 ;双侧肺炎占 32 .4 % ,多叶肺炎占 4 0 .2 % ;19.6 %的患者在 <2周、32 .4 %的患者在 <3周、2 8.4 %的患者在 <4周肺炎吸收 ,仍有 8.8%的患者需要 >4周的时间吸收好转 ;<2周肺炎吸收好转的患者平均年龄较低 ;4例死亡患者 3例为双侧肺炎。结论　 SARS可造成肺部多发炎症改变 ,大多 <4周吸收好转 ,有部分年龄较高者吸收延迟。     

High-energy ocular trauma and changes in vision: a reason for a careful search for an intraocular foreign body

A 50-year-old man visited his family physician one day after he had felt something entering his left eye following the blow of a metal hammer on metal, after which he began to see black spots. After the eye had been occluded for 4 days, his visual acuity had decreased to 0.1. Ophthalmologic examination revealed a defect in the cornea and iris, a foreign body in the vitreous and local cataract. Following surgical removal of the metal splinter and the lens, the visual acuity was restored to 0.8. Implantation of an artificial lens was planned. Ocular trauma is a major cause of permanent visual loss or blindness in (young) adults in the western world. Traumas in which a foreign body is propelled into the eye with high energy are most likely to penetrate the sclera. Damage and complications due to intraocular foreign bodies may lead to loss ofvision. The entry site of an intraocular foreign body may be difficult to find and the diagnosis may be missed. Therefore, an ophthalmologist should be consulted in case of a high-energy trauma in combination with visual loss.