Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including five (9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%) patients cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the proportion of males in the surgical group was higher (21/23 vs 15/28, p=0.004), and the time from ingestion to arriving at the hospital was longer (80(72) vs 26(5), hours, p=0.008). Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 hours, even in asymptomatic patients. Trial registration The study will be retrospectively registered.

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Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China

BMC Pediatrics ◽

10.1186/s12887-021-02642-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Gastrointestinal Obstruction ◽

Asymptomatic Patients ◽

Significant Difference ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5–336) vs 26(2–216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.

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Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China.

10.21203/rs.3.rs-35857/v3 ◽

2020 ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Gastrointestinal Obstruction ◽

Asymptomatic Patients ◽

Significant Difference ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36（70.6%） males and 15（29.4%） females. The magnets were passed naturally in 24（47.1%） patients and removed by intervention in 27（52.9%） patients, including 5（9.8%） cases by endoscopy and 22（43.1%） cases by surgery. Twenty-two（43.1%）cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer（［80（5-336） vs 26（2-216）］hours, p<0.001）while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 hours, even in asymptomatic patients.

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Retrospective Analysis of Pediatric Patients with Multiple Rare-Earth Magnet Ingestion: A Single-Center Experience from China.

10.21203/rs.3.rs-35857/v1 ◽

2020 ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Single Center Experience ◽

Management Algorithm ◽

Magnet Ingestion ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients with multiple rare-earth magnet ingestion in a single-pediatric medical center, reveal the harm of rare-earth magnets foreign bodies in digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnets foreign bodies in digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 to December 2019, with a subset of medical data including clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including five(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. 22(43.1%) cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the proportion of males in the surgical group was higher (21/23 vs 15/28, p=0.004), and the visiting time to hospital was longer (80(72) vs 26(5), hours, p=0.008). Conclusions The rate of surgical intervention is high in multiple rare-earth digestion cases and the consequences are serious, and a more efficient management algorithm for these cases should be needed. A policy for strictly restricted or prohibited the sale of the toys with multiple rare-earth magnets needed to put into the agenda. Trial registration The study will be retrospectively registered.

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Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract of Adults

BioMed Research International ◽

10.1155/2015/658602 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Chih-Chien Yao ◽

I-Ting Wu ◽

Lung-Sheng Lu ◽

Sheng-Chieh Lin ◽

Chih-Ming Liang ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Foreign Body Ingestion ◽

Endoscopic Management ◽

Study Cohort ◽

Food Bolus ◽

Surgical Interventions ◽

Asymptomatic Patients ◽

Food Bolus Impaction ◽

Bolus Impaction

Background. Foreign object ingestion and food bolus impaction are a common clinical problem. We report our clinical experiences in endoscopic management for adults, foreign body ingestion, and food bolus impaction.Method. A retrospective chart review study was conducted on adult patients with foreign body ingestion and food bolus impaction between January 2011 and November 2014. Patients with incomplete medical records were excluded.Results. A total of 198 patients (226 incidents) were included in the study (male/female: 1.54/1; age 57 ± 16 years). Among them, 168 foreign bodies were found successfully (74.3%). 75.6% of the foreign bodies were located in the esophagus. Food bolus impaction was most common (41.6%). 93.5% of foreign bodies in current study cohort were successfully extracted and 5 patients required surgical interventions. Comparisons between symptomatic and asymptomatic patients revealed that locations of foreign bodies in the pharynx and esophagus were the significant relevant factors (P<0.001). Shorter time taken to initiate endoscopic interventions increased detection rate (289.75 ± 465.94 versus 471.06 ± 659.93 minutes,P=0.028).Conclusion. Endoscopic management is a safe and highly effective procedure in extracting foreign body ingestion and food bolus impaction. Prompt endoscopic interventions can increase the chance of successful foreign bodies’ detection.

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1685. Inappropriate Treatment of Asymptomatic Bacteriuria in Elderly Patients: A Quality Improvement Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1863 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S826-S826

Author(s):

Tuhina Cornelius ◽

Kiran K Patel ◽

Michael Rubinson ◽

Nadia Aslam ◽

Ashish Rana ◽

...

Keyword(s):

Elderly Patients ◽

Educational Opportunity ◽

Clinical Symptoms ◽

Medical Center ◽

Asymptomatic Bacteriuria ◽

Provider Education ◽

Diagnostic Challenge ◽

Asymptomatic Patients ◽

Inappropriate Treatment ◽

N 93

Abstract Background Asymptomatic bacteriuria is often misdiagnosed as Urinary Tract Infection (UTI) in elderly patients. Studies suggest that 15-30% of males and 25-50% of females have asymptomatic bacteriuria. We wanted to estimate the percentage of elderly patients who are treated for UTI at our facility and if treatment was appropriate. The goal was to provide the staff with an educational opportunity and help decide if more antibiotic restriction policies would be beneficial. Methods A retrospective study of patients > 65 years of age who were started on antibiotics for presumed UTI at a single medical center between 7/2018 and 12/2018. Reviewed data included demographics, admitting diagnosis, presence or absence of symptoms of UTI and urine culture results. The data was presented at educational conferences and at antimicrobial stewardship meetings in our facility. Results: 234 patients were started on antibiotics on the basis of pyuria on admission. Of these, only 47% (n=110/234) had symptoms suggestive of UTI. Positive urine cultures were more common in symptomatic patients (n=93/110) compared with asymptomatic patients (n=47/80). In addition, ninety patients had a change in mental status on presentation and were started on antibiotics for suspected UTI. Approximately one third of these patients had eventual negative urine cultures. Conclusion: Elderly patients with pyuria and asymptomatic bacteriuria represent a diagnostic challenge due to their inability to vocalize signs or symptoms of UTI. In addition, a percentage of patients who are asymptomatic and admitted for another reason were often started on antibiotics inappropriately on the basis of pyuria alone. Studies have shown that treating asymptomatic bacteriuria does not add a mortality benefit or lower risk of infection. The CDC emphasizes the importance of assessing for clinical symptoms of UTI before treatment is considered. Our study highlights the importance of provider education in the management of asymptomatic bacteriuria in elderly patients. We also feel that antibiotic restriction policies may limit use of antibiotics for asymptomatic bacteriuria. This would in turn improve patient outcomes and decrease incidence of clostridium difficile associated colitis. Disclosures All Authors: No reported disclosures

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Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.marapr02 ◽

2011 ◽

Vol 16 (2) ◽

pp. 8-9

Author(s):

Marjorie Eskay-Auerbach

Keyword(s):

Clinical Symptoms ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Disc Space Narrowing ◽

Disc Disease ◽

Disc Space ◽

Radiographic Findings ◽

Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019

Military Medicine ◽

10.1093/milmed/usab191 ◽

2021 ◽

Author(s):

Agnes S Montgomery ◽

Michael B Lustik ◽

Susan A Reichert-Scrivner ◽

Ronald L Woodbury ◽

Milissa U Jones ◽

...

Keyword(s):

Military Personnel ◽

Influenza A ◽

Clinical Symptoms ◽

Medical Center ◽

Signs And Symptoms ◽

Military Operations ◽

Military Population ◽

Viral Pathogens ◽

Viral Pathogen ◽

Medical Treatment Facility

ABSTRACT Introduction Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations. We conducted a retrospective analysis of respiratory viral pathogen (RVP) samples collected from U.S. military personnel stationed in Hawaii and tested at Tripler Army Medical Center from January 2014 to May 2019 in order to describe the etiology, distribution, and seasonality of RVP exposure in a military population. Materials and Methods Samples were analyzed by viral culture or multiplex PCR. Distribution of respiratory viruses over time was analyzed as well as subject demographic and encounter data. Presenting signs and symptoms were evaluated with each RVP. Results A total of 2,576 military personnel were tested, of which 726 (28.2%) were positive for one or more RVP. Among positive tests, the three most common viral pathogens detected were influenza A (43.0%), rhinovirus (24.5%), and parainfluenza (7.6%). Symptoms were generally mild and most frequently included cough, fever, and body aches. Conclusion Our study evaluated respiratory virus prevalence, seasonality, and association with clinical symptoms for military personnel in an urban tropical setting in Oahu, HI, over a 5-year period. We show that viral prevalence and seasonality in Hawaii are distinct from those of the CONUS. Results contribute to the broader understanding of seasonality, clinical manifestation, and demographics of RVP among active duty military personnel stationed in Hawaii.

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COVID-19 in an Asymptomatic Renal Transplant Recipient Employed in the Health Care Setting: A Case Report

International Journal of Angiology ◽

10.1055/s-0041-1725183 ◽

2021 ◽

Author(s):

Harsha Adnani ◽

Akshay Khatri ◽

Nirav Agrawal ◽

Ernesto Molmenti ◽

Madhu Bhaskaran

Keyword(s):

Health Care ◽

Renal Transplant ◽

Transplant Recipient ◽

Renal Transplant Recipient ◽

Clinical Symptoms ◽

Severe Disease ◽

Care Facility ◽

Health Care Facility ◽

Asymptomatic Patients

AbstractDuring the ongoing pandemic, there have been varying presentations of coronavirus disease 2019 (COVID-19) infection, with the concern that patients who are immunosuppressed (due to underlying medical conditions and/or therapies) are at higher risk of severe disease. We report the case of an elderly renal transplant recipient working in a long-term health care facility who was being monitored by weekly surveillance testing and tested positive for COVID-19 by polymerase chain reaction (PCR) testing, despite having no clinical symptoms. He recovered with supportive care, despite being on multiple long-term immunosuppressant drugs and having multiple comorbidities. Additionally, it was found that he did not mount an antibody response, when he tested negative by serologic testing. Through this case, we wish to highlight the unique clinical scenario of asymptomatic patients who may have an underwhelming immune response to COVID-19, but may nevertheless be an important source of dissemination. We further discuss the probable mechanism of such asymptomatic presentations in immunosuppressed patients, while reinforcing the importance of self-isolation of COVID-19 patients (particularly in asymptomatic health care workers).

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Digestive Tract Injuries Caused by Ingested Foreign Bodies Containing Magnets

Indian Pediatrics ◽

10.1007/s13312-021-2171-0 ◽

2020 ◽

Vol 58 (3) ◽

pp. 280-281

Author(s):

Ze-Li Su ◽

Dong Liu ◽

Xue-Hong Zhou ◽

Xuan-En Tian ◽

Zhen-Chao Shan ◽

...

Keyword(s):

Digestive Tract ◽

Foreign Bodies

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Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency

Hernia ◽

10.1007/s10029-021-02380-1 ◽

2021 ◽

Author(s):

P. U. Oppelt ◽

I. Askevold ◽

R. Hörbelt ◽

F. C. Roller ◽

W. Padberg ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Surgical Repair ◽

Clinical Symptoms ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Gastric Surgery ◽

Hiatal Hernia Repair ◽

Single Center ◽

Asymptomatic Patients

Abstract Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

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