512 The Management of Aural Foreign Bodies During the COVID-19 Pandemic - MKUH ENT Department Experience

Abstract Aim During the initial wave of the COVID-19 pandemic, ENT UK published a clinical guide on surgical prioritisation which suggested that aural foreign bodies can be removed between one and three months from initial presentation. This case series aims to investigate the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications, success rates of subsequent removal attempts and whether foreign bodies can clear themselves without intervention. Method Retrospective study of all aural foreign body referrals to the ENT emergency clinic over a 6-month period. Results Thirty-four patients were identified. The duration of foreign bodies left in-situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts, however there were no other significant complications. First attempts made by non-ENT specialists (68.8%) all failed and were associated with a high risk of trauma (36.4%). The chances of successful removal on second attempt (28.6%) reduced dramatically when compared to the first attempt (52.9%). Two patients had no foreign body visualised upon second attempt, suggesting it has cleared itself. A total of 7 patients (20.6%) required removal under general anaesthesia. Conclusions Due to the unique circumstances of the COVID-19 pandemic, this is the first case series to look specifically at the relationship between duration of aural foreign bodies left in situ for over 30 days from presentation and the risk of complications. Our data suggests that prolonged duration did not increase the incidence of complications.

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The Enigma in Management of Complicated Foreign Body Ingestion Impacted Distal to Oesophagus: A Case Series and Literature Review

10.21203/rs.3.rs-80657/v1 ◽

2020 ◽

Author(s):

Raymond Zhun Ming Lim ◽

Addy Aun Wei Ang ◽

Jih Huei Tan ◽

Ee Peng Lee ◽

Jun Loong Chiew ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Foreign Body ◽

Conservative Management ◽

Foreign Bodies ◽

Case Series ◽

Management Approach ◽

Luminal Diameter ◽

First Case ◽

Surgical Extraction ◽

Schizophrenic Patients

Abstract BackgroundIngestion of foreign bodies leading to impaction at the pharynx and oesophagus have been extensively described in English literatures. However, impactions at the gastrointestinal tract distal to the oesophagus are less commonly encountered due to the more capacious luminal diameter as it approaches the stomach. While intentional foreign body ingestions impacted distal to the oesophagus are often more complicated, literatures on the management of these distal oesophageal impactions are scarce. Case presentationWe present five cases of foreign body impaction at varying sites of gastrointestinal tract beyond the oesophagus, contrasting management approach comparing the role of endoscopy, open surgery and conservative management. Cases presented include patients aged 40 to 70 with intentional foreign bodies ingestion. The first case described a cerebral palsy patient with pica who had to undergo difficult evacuation under anaesthesia followed by colonoscopy; the second and third cases presented two different schizophrenic patients with two differing management approach. The second case was managed with multiple operations due to complications and died eventually, making the only mortality in our case series; whereas the third case was managed conservatively with acceptable outcome after multiple laparotomies prior. Fourth and fifth cases described two body packers who swallowed tobacco and two phones, respectively; the former was uneventfully managed conservatively, the latter, had to undergo surgical extraction. Individualized approach to these distal impactions of ingested foreign bodies are described with a review of available literatures which are tabulated and discussed in this case series. ConclusionEndoscopy, surgery, conservative management and sometimes a combination of approaches are utilised for the management of foreign bodies impacted distal to the oesophagus, especially in complex and recurrent cases. Decision, timing and approach of extraction must be individualised with consideration of risk weighed against the benefit of each intervention over the other.

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Unique Pattern of True Foreign-Body Ingestion in the Valley of Kashmir; Sharp Foreign Bodies Outnumbering the Blunt Ones

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_74_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 028-032

Author(s):

Nisar Ahmad Shah ◽

Showkat Ahmad Kadla ◽

Asif Iqbal Shah ◽

Bilal Ahmad Khan ◽

Inaam Ul Haq ◽

...

Keyword(s):

Foreign Body ◽

Success Rate ◽

Foreign Bodies ◽

Foreign Body Ingestion ◽

Young Females ◽

The People ◽

Early Endoscopy ◽

Normal Individuals ◽

Structural Abnormalities ◽

The Impact

ABSTRACT Background and Aims: Foreign-body ingestion is a common phenomenon, especially in children. In normal adults, foreign-body ingestion is usually accidental and mostly ingestion occurs with food and impaction is a result of structural abnormalities of the upper gastrointestinal tract (UGIT). However, accidental ingestion of nonfood products is unusual; especially ingestion of pins (scarf or safety pins) and needles is unknown. We come across ingestion of these unusual/sharp foreign bodies routinely from the past few years. The aim of this study was to observe, over a period of 1 year, the spectrum of nonfood or true foreign-body ingestion in our community and to see the impact of an early endoscopy on outcome or retrieval of the ingested objects. Materials and Methods: In a prospective observational study, we studied the profile of foreign-body ingestion in normal individuals of all ages and both sexes, excluding the individuals with any structural abnormalities of the gut and the people with psychiatric ailment. Results: Of total 51 patients with foreign-body ingestion, 42 (82%) were 20 or <20 years of age with females constituting 86.3% of the total and males constituting only 13.7%. Foreign bodies ingested included 38 pins (74.5%), seven coins (13.7%), four needles (7.8%), and one denture and a nail (2%) each. Overall 26 (51%) foreign bodies were seen in UGIT (within reach of retrieval) at the time of endoscopy and all of them were retrieved. Nineteen (37.3%) patients reported within 6 h of ingestion, and majority of them (16 = 84.2%) had foreign bodies within UGIT and all of them were removed. Those patients (n = 32; 62.7%) who reported beyond 6 h, only 10 (31.25%) had foreign bodies in UGIT as a result of which the success rate of removal in these patients was only 32%. Conclusion: Most of our patients were young females and the common foreign bodies ingested were sharp including scarf pins followed by coins and needles. The success rate of retrieval was high in those who reported within 6 h of ingestion of foreign body. The rate of retrieval was 100% if foreign body was found on esophagogastroduodenoscopy. Hence, we recommend an early endoscopy in these patients and some alternative to use of scarf pins.

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Unsuspected Foreign Bodies of the Aerodigestive Tract

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947808700409 ◽

1978 ◽

Vol 87 (4) ◽

pp. 515-518 ◽

Cited By ~ 9

Author(s):

William Banks ◽

William P. Potsic

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Chart Review ◽

Foreign Bodies ◽

Failure To Thrive ◽

Late Complications ◽

Aerodigestive Tract ◽

Endoscopic Removal ◽

Children's Hospital ◽

Prolonged Duration

The well-known tendency for children to place loose objects in their months not infrequently leads to the entrapment of foreign bodies in the aerodigestive tract. With prompt and adequate removal few complications occur. However, when the foreign body goes undetected or is neglected the patient may develop dysphagia, pneumonia, failure to thrive, lung or mediastinal abscesses, bronchopulmonary or bronchoesophageal fistulas, or erosion of major vessels. Fifteen cases of retained foreign bodies were identified in a chart review between 1971 and 1977 at the Children's Hospital of Philadelphia, calling attention to the problems of aerodigestive foreign bodies of prolonged duration. Early and late complications are discussed and early diagnosis and endoscopic removal emphasized.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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Case series of coronavirus (SARS-CoV-2) in a military recruit school: clinical, sanitary and logistical implications

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001482 ◽

2020 ◽

pp. bmjmilitary-2020-001482 ◽

Cited By ~ 6

Author(s):

Sascha J Baettig ◽

A Parini ◽

I Cardona ◽

G B Morand

Keyword(s):

Close Contact ◽

Case Series ◽

Armed Forces ◽

Index Patient ◽

Confined Space ◽

Serological Testing ◽

Military Recruit ◽

First Case ◽

Asymptomatic Patients ◽

The Impact

IntroductionA new coronavirus, called Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2), has emerged from China in late 2019 and has now caused a worldwide pandemic. The impact of COVID-19 has not been described so far in a military setting. We therefore report a case series of infected patients in a recruit school in Switzerland and the herein associated challenges.MethodsRetrospective review of COVID-19 cases among Swiss Armed Forces recruits in the early weeks of SARS-CoV-2 pandemic in the canton of Ticino, the southernmost canton of Switzerland. Positive cases were defined with two positive PCR testing for SARS-CoV-2 from nasopharyngeal swabs. Serological testing was performed with a commercially available kit according to manufacturers’ instructions.ResultsThe first case was likely contaminated while skiing during weekend permission. He became symptomatic 4 days later, tested positive for SARS-CoV-2 and was put into isolation. He showed complete symptom resolution after 48 hours. Quarantine was ordered for all recruits with close contact in the past 2 days, a total of 55 persons out of 140 in the company. Seven out of nine recruits in one particular quarantine room became mildly symptomatic. SARS-CoV-2 PCR was positive in one of them. Seven days after initial diagnosis, the index patient and the other one from the quarantine retested positive for SARS-CoV-2, although they had been completely asymptomatic for over 96 hours. Serological testing revealed positive for both patients. All others showed negative IgM and IgG.ConclusionsYoung healthy recruits often showed a mild course of COVID-19 with rapid symptom decline but were persistent SARS-CoV-2 carriers. This illustrates how asymptomatic patients may be responsible for covert viral transmission. An early and prolonged establishment of isolation and quarantine for patients and close contacts is essential to slow down the spread of SARS-CoV-2, especially in the confined space of a military environment.

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Exploring the Diabatic Role of Ice Microphysical Processes in Two North Atlantic Summer Cyclones

Monthly Weather Review ◽

10.1175/mwr-d-15-0253.1 ◽

2016 ◽

Vol 144 (4) ◽

pp. 1249-1272 ◽

Cited By ~ 20

Author(s):

C. Dearden ◽

G. Vaughan ◽

T. Tsai ◽

J.-P. Chen

Keyword(s):

Crystal Habit ◽

Ice Crystal ◽

Heating And Cooling ◽

First Case ◽

Storm Evolution ◽

In Situ Observations ◽

Microphysical Processes ◽

Ice Production ◽

The Impact

Abstract Numerical simulations are performed with the Weather Research and Forecasting Model to elucidate the diabatic effects of ice phase microphysical processes on the dynamics of two slow-moving summer cyclones that affected the United Kingdom during the summer of 2012. The first case is representative of a typical midlatitude storm for the time of year, while the second case is unusually deep. Sensitivity tests are performed with 5-km horizontal grid spacing and at lead times between 1 and 2 days using three different microphysics schemes, one of which is a new scheme whose development was informed by the latest in situ observations of midlatitude weather systems. The effects of latent heating and cooling associated with deposition growth, sublimation, and melting of ice are assessed in terms of the impact on both the synoptic scale and the frontal scale. The results show that, of these diabatic processes, deposition growth was the most important in both cases, affecting the depth and position of each of the low pressure systems and influencing the spatial distribution of the frontal precipitation. Cooling associated with sublimation and melting also played a role in determining the cyclone depth, but mainly in the more intense cyclone case. The effects of ice crystal habit and secondary ice production are also explored in the simulations, based on insight from in situ observations. However in these two cases, the ability to predict changes in crystal habit did not significantly impact the storm evolution, and the authors found no obvious need to parameterize secondary ice crystal production at the model resolutions considered.

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Paediatric aerodigestive foreign bodies: remember the nasopharynx

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000708 ◽

2010 ◽

Vol 124 (10) ◽

pp. 1132-1135 ◽

Cited By ~ 2

Author(s):

S D MacNeil ◽

J P Moxham ◽

F K Kozak

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Series ◽

Aerodigestive Tract ◽

Endoscopic Approach ◽

Lower Airway ◽

Endoscopic Evaluation ◽

Tertiary Referral ◽

Children's Hospital ◽

Distal Airway

AbstractIntroduction:Nasopharyngeal foreign bodies are relatively uncommon, compared with other aerodigestive sites. They may mimic a lower airway location, or may be coughed up into the nasopharynx prior to endoscopic evaluation.Objective:To describe our experience with nasopharyngeal foreign bodies mimicking a more distal airway location.Method:Case series from a tertiary referral children's hospital.Results:We present a series of four children who were initially thought to have a lower aerodigestive tract foreign body (three respiratory, one oesophageal), but who were finally diagnosed with nasopharyngeal foreign body. The concept of panendoscopy at all foreign body removals is suggested as a means to avoid a missed nasopharyngeal foreign body.Conclusion:Although nasopharyngeal foreign bodies are uncommon, their rare ability to mimic distal sites mandates a thorough endoscopic approach to ensure that all sites (i.e. larynx, lungs, oesophagus and nasopharynx) are evaluated endoscopically.

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Migrated pharyngeal fish bone causing spondylodiscitis. Case report

Coluna/Columna ◽

10.1590/s1808-185120141301rcc69 ◽

2014 ◽

Vol 13 (1) ◽

pp. 67-68 ◽

Cited By ~ 1

Author(s):

Aluizio Augusto Arantes Júnior ◽

Jose Augusto Malheiros ◽

Marco Tulio Domingos Silva e Reis ◽

Gustavo Meyer de Moraes

Keyword(s):

Case Report ◽

Cervical Spine ◽

Foreign Body ◽

Foreign Bodies ◽

Fish Bone ◽

Emergency Rooms ◽

Infectious Process ◽

Fish Bones ◽

First Case ◽

Longus Colli

Ingestion of foreign bodies is a common problem seen at emergency rooms and frequently involves chicken and fish bones. There are few cases of migrated foreign bodies through the retropharynx causing infectious process in the area but no one, despite the proximity, causing spondylodiscitis. Perhaps such condition is attributed to the integrity of the longus colli fascia covering and protecting the cervical spine. We described the first case of spondylodiscitis due to a foreign body (saw-toothed fish bone) that penetrated the longus colli fascia and carved into vertebral body C3.

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EFFECT OF BLASTING ON THE STABILITY OF LINING DURING EXCAVATION OF NEW TUNNEL NEAR THE EXISTING TUNNEL

Stavební obzor - Civil Engineering Journal ◽

10.14311/cej.2021.01.0004 ◽

2021 ◽

Vol 30 (1) ◽

Author(s):

Tuan Minh Tran ◽

Quang Huy Nguyen

Keyword(s):

Field Data ◽

Damage Zone ◽

Field Tests ◽

Surrounding Rock ◽

In Situ Test ◽

The Stability ◽

Relationship Of ◽

The Impact ◽

The Relationship

In recent years, experimental and numerical researches on the effect of blasting pressure on the stability of existing tunnels was widely obtained. However, the effect of the blasting pressure during excavation a new tunnel or expansion old tunnels on an existing tunnel has disadvantages and still unclear. Some researches were carried out to study the relationship of the observed Peak Particle Velocity (PPV) on the lining areas along the existing tunnel direction, due to either the lack of in situ test data or the difficulty in conducting field tests, particularly for tunnels that are usually old and vulnerable after several decades of service. This paper introduces using numerical methods with the field data investigations on the effect of the blasting in a new tunnel on the surrounding rock mass and on the existing tunnel. The research results show that not only predicting the tunnel lining damage zone under the impact of blast loads but also determination peak maximum of explosion at the same time at the surface of tunnel working.

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Unusual foreign bodies in nose and throat

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20205640 ◽

2020 ◽

Vol 7 (1) ◽

pp. 159

Author(s):

Gaveshani Mantri ◽

Monalisa Patsani ◽

Jayakrishnan Menon U. ◽

Subrat Kumar Behera

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Case Reports ◽

Review Of Literature ◽

Unusual Foreign Body ◽

First Case ◽

Surgical Emergencies ◽

Foreign Body Impaction ◽

Nose And Throat

Ear, nose and throat practice presents the surgeons with an amazing variety of foreign bodies to deal with, some of them are truly unusual.They may be inert, hygrophilic or corrosive. Foreign body impaction in ear,nose and throat is among the medical-surgical emergencies of otorhinolaryngological practice. Some foreign bodies have been well documented among the objects that normally get impacted in ear,nose and throat.Here we present two unusual cases that happened to be managed in our institution. First case was of a patient who came with an unusual foreign body lodged in the nose and nasopharynx and the second case was of a migrating foreign body in throat. The main aim and objective of these case reports is to highlight on unusual foreign bodies and their management .These foreign bodies were never found to have been reported previously in our review of literature.

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