Nasal foreign bodies: a review of management strategies and a clinical scenario presentation.
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ABSTRACT:
SUBMITTER: Patil PM
PROVIDER: S-EPMC3208336 | biostudies-other | 2011 Mar
REPOSITORIES: biostudies-other
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Project description:Ear and nose foreign bodies are common problems affecting the children but adults are not an exception. A prospective study involving 87 patients is undertaken concentrating on presentation of patients with various types of ear or nasal foreign bodies. In the present study common presenting complaints and uncommon presentation scenarios encountered by us like a nasal foreign body with intra cranial complications, an impacted middle ear foreign body with mastoiditis is discussed. The present article emphasizes the need of considering presence of foreign bodies even in the absence of appropriate clinical signs and symptoms suggestive of a foreign body in ear or nose.
| S-EPMC3244580 | biostudies-literature
Project description:Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to.Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback".Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment.Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.
| S-EPMC4604740 | biostudies-other
Project description:BACKGROUND:Anatomical feline models can aid in understanding the relationships between clinical findings and anatomical features and the course of foreign bodies passing through the oesophagus. This study has two goals 1) to assess feline oesophageal foreign bodies in feline patients using physical, radiologic and endoscopic examination and, how their location influences treatment plans and complications. 2) How the anatomical sharp angle of the oesophagus contribute to foreign body lodgement. Thirty-five cats were enrolled in this study; 30 of them were clinically ill, and five cats were used for anatomical study. RESULTS:Cats with clinical signs underwent complete clinical and radiologic examination. Endoscopy was performed in only five cases. The site with the highest occurrence of foreign body lodgement was the oesophageal entrance, caudal to the pharynx (63.3%), followed by the thoracic inlet (26.7%) and the mid-cervical region of the oesophagus (10%). Two types of foreign bodies were identified: sewing needles (25/30) and bone (5/30). Radiography was able to identify the location and nature of the foreign body in all 30 affected cats. Therapeutic regimens were applied according to the nature and location of the foreign body and any associated complications. Removal of the foreign body was achieved using Rochester pean artery forceps in 17/30 cases, using full surgical intervention in 8/30 cases, and during endoscopy in 5/30 cases. CONCLUSION:The results suggest that the location of the foreign body is strongly related to combination of consumed foreign body type and anatomic features of the cat oesophagus. The feline oesophagus has a variety of sharp angles that facilitate the entrapment of rigid linear and angular foreign bodies. Radiographic imaging remains the most frequently used diagnostic modality for determining the lodgement site and nature of radiopaque foreign bodies. Over all complication rate was low (6/30).
| S-EPMC7266337 | biostudies-literature
Project description:BackgroundPatients with a rectal foreign body (RFB) are still a rare entity in general surgery departments but with an increasing incidence over the last years. This case is sometimes difficult to treat, and due to a lack of standardized treatment options, the aim of the study was to present our clinical experiences with the diagnostic and therapeutic approach to RFBs and a review of the currently available literature.Materials and methodsData were collected retrospectively from the patient's records of 20 patients who were treated due to an RFB between 2006 and 2016. Patient's demographics, circumstances of insertion, inserted objects, clinical presentation, laboratory and imaging results, as well as surgical treatment and duration of hospital stay were analyzed. Additionally, a review of the literature was performed with the search items "rectal foreign body" and "surgical therapy". Because many publications were just case reports, we did not perform a meta-analysis or a systematic review.ResultsTwenty-two cases in 20 patients (80% male) presented to the emergency room. The mean age was 38.5±13.7 years. In 68.2% of the cases, the cause of RFB was due to sexual preferences. The following objects were inserted: six dildos, three vibrators, two bottles, one glass, one deodorant, one apple, one fever thermometer, multiple glass fragments and razor blades in one patient and six unknown objects. For 18 RFBs, manual peranal removal without anesthesia was possible in the emergency room, but two patients required intravenous analgesia. Two patients were transferred to the operating room and the foreign body was removed via the anus under general anesthesia. Open surgery with a laparotomy was necessary for two complicated cases. One patient was in need of surgery due to a vacuum generated by the RFB, whereas the second patient suffered from a sigmoid perforation. In all cases, there was no morbidity or mortality.ConclusionIn most cases, the removal of an RFB can be performed peranally in the emergency room without further complications, therefore representing the therapy of choice for RFB. Only in cases with perforation, acute abdomen, or failed peranal approaches, surgery is indicated to remove the foreign body.
| S-EPMC6754005 | biostudies-literature
Project description:PurposeButton battery nasal impactions pose serious risks due to complications and the need for prompt removal, yet research on interventions remains limited due to its rare occurrence. To delineate the clinical manifestations of nasal foreign bodies associated with button batteries and to explore treatment approaches focused on minimizing the reliance on general anesthesia and surgical interventions.MethodsThis study focuses on 176 cases of children who received treatment for nasal cavity button battery impactions. It encompasses various factors including age, gender, battery location, impaction duration, methods of extraction, and associated complications.ResultsThe incidence of nasal button battery cases among nasal foreign body instances was 1.16%, with a majority being males (60.23%) aged 1-5 years (98.29%). Utilizing a specially designed nasal foreign body hook and following established treatment protocols enabled the successful outpatient management of the majority of cases. Only 12 cases (6.82%) necessitated removal under general anesthesia due to management challenges in an outpatient setting. Furthermore, our findings indicated no linear correlation between the duration of battery retention and the risk of nasal septal perforation, which was observed in 31 cases (17.61%).ConclusionNasal foreign bodies caused by button batteries in children demand urgent attention due to their potentially grave outcomes. Our research is directed towards enhancing diagnostic and therapeutic strategies to bolster the success rates of outpatient removal, curtail the duration of foreign body retention, and diminish the reliance on general anesthesia.
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Project description:Key clinical messageThe routine way to access the uncomplicated airway is via direct laryngoscopy. When this is not possible, there are a number of other techniques to help visualization such as the video laryngoscopy. These require a degree of mouth opening. With almost complete trismus, the clinician should resort to awake fibreoptic nasal intubation to secure the airway.
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Project description:Central retinal artery occlusion (CRAO) is an ophthalmic emergency and the ocular analogue of cerebral stroke. Best evidence reflects that over three-quarters of patients suffer profound acute visual loss with a visual acuity of 20/400 or worse. This results in a reduced functional capacity and quality of life. There is also an increased risk of subsequent cerebral stroke and ischaemic heart disease. There are no current guideline-endorsed therapies, although the use of tissue plasminogen activator (tPA) has been investigated in two randomized controlled trials. This review will describe the pathophysiology, epidemiology, and clinical features of CRAO, and discuss current and future treatments, including the use of tPA in further clinical trials.
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Project description:Although spinal cord injuries are frequent causes of myelopathy in young patients, stab wounds of the spinal cord rarely occur and are typically maximal symptomatic immediately after the trauma.A 31-year-old male developed delayed onset of symptoms 4 years after a stab wound to the cervical spinal cord attributed to a plant needle (plant called Mandacaru). Following removal of the foreign body and decompression/excision of scarring at the C34 level, the patient's symptoms resolved.Surgical excision should be encouraged to remove chronic penetrating foreign bodies to both decompress and untether the spinal cord.
| S-EPMC5523475 | biostudies-other
Project description:Lentigo maligna (LM) is a type of melanoma in situ that has distinctive characteristics regarding epidemiology, risk factors and clinical features. In addition, LM has a potential to progress to an invasive tumor with potentially aggressive behavior: lentigo maligna melanoma (LMM). Overall, LM has a very good prognosis, whereas LMM has the same prognosis as other invasive melanomas with similar Breslow thickness. LM/LMM represents a challenging entity not only regarding the diagnosis but also regarding the management. Diagnostic criteria are not well established, and there is an overlap of clinical, dermoscopic and pathological features with other benign pigmented skin lesions such as lentigines, pigmented actinic keratoses or macular seborrheic keratoses. LM/LMM's common appearance within photodamaged skin makes lesion border identification difficult. Wide excisions are often required, but since LM/LMM typically appears on cosmetically sensitive areas such as the face, sometimes large excisions are not possible nor desirable. In this sense, specialized approaches have been developed such as margin-controlled surgery or image-guided treatment using reflectance confocal microscopy. Other treatments for LM such as cryosurgery, imiquimod, radiotherapy or photodynamic therapy have been proposed, although recurrence/persistence is common. The current manuscript reviews extensively the published data regarding the diagnosis, treatment and management of both complex entities LM and LMM.
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Project description:Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS.We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS.There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss).ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.
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