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A juvenile rough-toothed dolphin (Steno bredanensis) was live-stranded and rescued in Kanagawa Prefecture, Japan. From the results of diagnostic examinations, blood tests indicated that the dolphin was malnourished, dehydrated, and anemic. The dolphin died on sixth day of rescue despite treatment. At autopsy, 570 g of foreign material, including 34 pieces of cellophanes and plastic debris (PD), were found in the forestomach. Additional gross findings, including some endoparasitism and presence of accessory spleens were also identified. This is the first case in Japan which accidental ingestion of foreign bodies, including PD, was suspected to be the cause of death in a cetacean. [ABSTRACT FROM AUTHOR]

Background: Patient safety is associated with patient outcomes. However, there is insufficient evidence of patient safety in the dental field. This study aimed to compare incidents reported by dentists and physicians, compare the type of errors made by them, and identify how dentists prevent dental errors. Methods: A mixed-methods study was conducted using open data from the Japan Council for Quality Health Care database. A total of 6071 incident reports submitted for the period 2016–2020 were analyzed; the number of dentists' incident reports was 144, and the number of physicians' incident reports was 5927. Results: The percentage of dental intern reporters was higher than that of medical intern reporters (dentists: n = 12, 8.3%; physicians: n = 180, 3.0%; p = 0.002). The percentage of reports by dentists was greater than that by physicians: wrong part of body treated (dentists: n = 26, 18.1%; physicians: n = 120, 2.0%; p < 0.001), leaving foreign matter in the body (dentists: n = 15, 10.4%; physicians: n = 182, 3.1%; p < 0.001), and accidental ingestion (dentists: n = 8, 5.6%; physicians: n = 8, 0.1%; p < 0.001), and aspiration of foreign body (dentists: n = 5, 3.4%; physicians: n = 33, 0.6%; p = 0.002). The percentage of each type of prevention method utilized was as follows: software 27.8% (n = 292), hardware (e.g., developing a new system) 2.1% (n = 22), environment (e.g., coordinating the activities of staff) 4.2% (n = 44), liveware (e.g., reviewing procedure, double checking, evaluating judgement calls made) 51.6% (n = 542), and liveware-liveware (e.g., developing adequate treatment plans, conducting appropriate postoperative evaluations, selecting appropriate equipment and adequately trained medical staff) 14.3% (n = 150). Conclusion: Hardware and software and environment components accounted for a small percentage of the errors made, while the components of liveware and liveware-liveware errors were larger. Human error cannot be prevented by individual efforts alone; thus, a systematic and holistic approach needs to be developed by the medical community. [ABSTRACT FROM AUTHOR]

Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes. We conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders. We analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73–88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and the witnesses intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/407). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39–0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23–3.95). Bystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between cumulative visits for care of minor injuries and risk of traumatic brain injuries in children aged ≤36 months.Methods: We conducted a retrospective analysis of children born from 2009 to 2012, using a health insurance claims database in Japan. We investigated the total number of visits where children aged 0-36 months presented for treatment of minor injuries such as superficial injuries, fractures, burns and foreign body ingestions. Logistic regression analysis was used to evaluate the association between the cumulative number of visits for treatment of minor injuries and traumatic brain injuries in children aged ≤36 months.Results: A total of 91 011 children were included in the analysis, 51% of whom were boys. Traumatic brain injuries were identified in 0.7% of these children. Cumulative visits for care of minor injuries among children aged 0-36 months were significantly associated with traumatic brain injuries by 36 months of age, with an odds ratio of 2.12 (95% confidence interval: 1.68-2.68) for multiple visits.Conclusion: Cumulative visits for treatment of minor injuries during the first 36 months of life were associated with increased risk of traumatic brain injuries by 36 months of age. [ABSTRACT FROM AUTHOR]

Objective: Foreign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.Methods: From April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0-15 years of age) with ear FBs, and 1999 children (0-15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency.Results: The incidence of throat FBs was significantly higher in July and January (p<0.05, analyzed by ANOVA and Tukey-Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r=0.76, p=0.0043; r=0.57, p=0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose.Conclusions: FBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs. [ABSTRACT FROM AUTHOR]

Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion.Wepathologically evaluated porcine lower esophageal tissue using a scratch tester. Using porcine esophageal tissue, scratch tests were performed with 4 test objects and pathological damage was compared. It was assumed that each object was accidentally ingested. The objects were polyvinylidene chloride (PVDC)-coated polyvinyl chloride (PVC) PTP, soft PThPa, round PTP, and a disposable scalpel. The porcine esophagus was replaced with a silicon sheet, and an automatic friction machine was used for quantitative evaluation. The silicon sheet was scratched using HHS 2000 with 750-g load at 50 mm/min. We investigated the frictional force exerted on the surface for each of the objects. The degree of damage (depth) was the highest for the disposable scalpel, followed by PVDC-coated PVC PTP, while the degree of damage (depth) was the lowest for soft PThPa and round PTP. The mean frictional forces on the silicon sheet were 524.0 gf with PVDC-coated PTP, 323.5 gf with soft PThPa, 288.7 gf with round PTP, and 922.7 gf with the disposable scalpel. We developed approaches to qualitatively and quantitatively evaluate the risk of esophageal damage after accidental PTP ingestion. Our findings indicate that the risk of gastrointestinal damage after accidental PTP ingestion is low with soft PTP and round PTP. [ABSTRACT FROM AUTHOR]

Objective: To reveal the age distribution and capture the longitudinal trend in otolaryngological surgeries performed in Japan, where society is rapidly aging.Methods: Using the Diagnosis Procedure Combination database, we extracted data on patients who were hospitalized and underwent any type of otolaryngological surgery in departments of otolaryngology or head and neck surgery from fiscal year 2007 to fiscal year 2013. Type of surgery, patient's age, and fiscal year were compared. We categorized >200 types of surgeries into eight specialties: ear surgery, functional endoscopic sinus surgery (FESS), other types of paranasal surgery (except for malignancy), head and neck cancer surgery, benign tumor surgery, upper airway surgery (including pharynx and larynx), removal of foreign body, and other.Results: In total, 558,732 patients were included. The proportions of patients in each age category formed two peaks in middle age and in children aged ≤9years. The proportion of all surgeries made up by FESS, other paranasal surgery, benign tumor surgery, and head and neck cancer surgery gradually increased with age, forming a peak in patients in their 60s. The proportion of ear surgery was highest in patients aged ≤9years (34.0% of all surgeries, mostly myringotomy and transtympanic ventilation tube insertion) and formed a gradual peak in patients in their 60s (mostly tympanoplasty). The proportion of upper airway surgery (tonsillectomy and adenoidectomy) was highest in patients aged ≤9years (25.3% of all surgeries). The proportion of foreign body removal was highest in patients aged ≤9years (52.2% of all surgeries) and increased slightly with age. In 2013, compared with 2007, those aged 65-74 years and ≥75years made up a larger percentage of patients undergoing each specific surgery, including tympanoplasty, stapedectomy/stapedotomy, FESS, head and neck cancer surgery, pharyngolaryngectomy, total/subtotal glossectomy, thyroid lobectomy, parotidectomy (for a benign tumor), submandibular gland resection, tonsillectomy, and vocal fold polypectomy.Conclusion: The age distribution of otolaryngological surgeries varied by specialty. We found an increased proportion of patients aged 65-74 and ≥75years in most specific surgeries. [ABSTRACT FROM AUTHOR]

The aging Japanese population has led to an increase in the number of accidentally swallowed dentures. Therefore, we report the case of an elderly Japanese woman with dementia who accidentally and sequentially swallowed two dentures. The patient presented to our hospital with a diagnosis of a single impacted denture in her hypopharynx although we subsequently identified a second impacted denture in her rectum after taking a careful clinical history. Open surgery was required to remove the second denture from her rectum. This case highlights the importance of carefully considering the patient’s history if there is a possibility of latent swallowed dentures. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is commonly seen in paediatrics. Magnets, button batteries and sharp objects can cause life threatening complications. Intestinal obstruction, peritonitis and fistula formation between bowel loops are reported complications to multiple magnets ingestion. We report a case of a 5-year-old who swallowed 52 toy magnets. He presented with peritonitic abdomen which required abdominal exploration, resection of necrotic bowel segments and 6 bowel anastomosis. The postoperative course was uneventful. The earliest report of multiple magnets ingestion was reported from Japan in 1995, which was complicated by bowel perforation. If the magnetic foreign bodies remain in a fixed position on repeated abdominal x-rays, surgical treatment should be considered even if the patient is asymptomatic, because, in such patients, entero-enteric intestinal fistulas are likely to have formed. The ingestion of multiple magnets can lead to life-threatening complications in children. One must have a low threshold for performing diagnostic imaging in children presenting with vague abdominal symptoms if there is a history of potentially ingesting a foreign body, even if unwitnessed. [ABSTRACT FROM AUTHOR]

Background/Aims: Almost all previous studies related to rectal foreign bodies were based on bizarre and striking cases, resulting in a reporting bias. Our aim was to clarify the clinico-epidemiological findings of rectal foreign body (RFB) in a general population. Methods: Using a national administrative database in Japan, we identified patients who underwent in-hospital treatment for rectal foreign bodies from 1 July 2007 to 31 March 2013. Results: A total of 648 RFB patients with 666 presentations were identified during the study period. The number of male patients was 526 (81.1%). The incidence of a RFB was most frequently seen in males who were in their 60s and in females who were in their 80s. The overall in-hospital mortality was 1.2%. Compared with males, females had a significantly higher proportion of in-hospital death (0.4 vs. 4.8%, p = 0.001), perforation and peritonitis (5.2 vs. 12.8%, p = 0.004), and sepsis (1.1 vs. 4.0%, p = 0.04). Conclusion: This study showed the clinico-epidemiological findings of rectal foreign bodies in a general population, and established that there was a low mortality rate. It was also found that females were significantly more likely to have a severe outcome following a RFB than males. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Twenty-three cases of accidental ingestion during dental procedures, which occurred at the Center for Dental Clinics of Hokkaido University Hospital between 2006 and 2010, were analyzed retrospectively. We examined not only the objects ingested, but also details of the circumstances (treated teeth, types of treatment, professional experience of the practitioners). Except for two cases (an unidentified endodontic file and the tip of an ultrasonic scaler, which were recovered by vacuuming), the other 21 accidentally ingested objects were all found in the digestive tract, and none in the respiratory tract, by radiographic examination of the chest and abdomen. The ingested objects were mostly metal restorations (inlays or onlays) or prostheses (crowns or cores). Ingestion occurred more frequently during treatment of lower molars, and when procedures were being conducted by practitioners with less than 5 years of experience. No adverse events related to ingestion were reported. The present study found no cases of aspiration or complications related to the ingested objects. However, considering the risk of life-threatening emergencies related to accidental aspiration and ingestion, dentists must take meticulous precautions and be ready to deal with this kind of emergency during dental procedures. [ABSTRACT FROM AUTHOR]

Objective This study assessed the risk factors of mortality from foreign bodies in the respiratory tract using the Japan Collaborative Cohort Study for the Evaluation of Cancer Risk data. Methods Data of 110,585 participants 40-79 years old living in 45 areas in Japan were collected between 1988 and 2009. Mortality from foreign bodies in the respiratory tract was assessed in a multivariable-adjusted analysis using a Cox proportional hazard regression model. Results Among all participants, 202 deaths occurred from foreign bodies in the respiratory tract. In the multivariable-adjusted model, older age [50-59 (hazard ratio, 4.93; 95% confidence interval, 1.91-12.74), 60-69 (hazard ratio, 14.96, 6.01-37.25) and 70-79 (hazard ratio, 53.81; 95% confidence interval, 21.44-135.02) years old compared to 40-49 years old], male sex (hazard ratio, 2.34; 95% confidence interval, 1.54-3.54), a history of apoplexy (hazard ratio, 7.04; 95% confidence interval, 4.24-11.67) and the absence of a spouse (hazard ratio, 1.56; 95% confidence interval, 1.05-2.32) were associated with an increased risk of mortality from foreign bodies in the respiratory tract. Conclusions Older age, male sex, medical history of apoplexy and the absence of a spouse were potential risk factors of mortality from foreign bodies in the respiratory tract. Especially in elderly men, social connections, such as cohabitation or relationships, may be important for ensuring the early detection of asphyxia and preventing death due to foreign bodies in the respiratory tract.

Abstract: Background: Foreign body aspiration (FBA) is a common cause for a respiratory emergency in young children and can be a life-threatening event. We, therefore, conducted the first nationwide survey in Japan. Methods: We asked doctors of 261 tertiary hospitals across the nation to fill out a case card of FBA-diagnosed cases they had experienced for the past 2 years. In the case card, age and gender of the patients, elapsed time until being referred to the hospital, presenting symptoms, previous diagnosis, suspected aspiration episode, type and location of aspirated foreign body, and consequences were inquired. This retrospective survey was carried out during 21 months, since January 2005 through September 2006. Results: Replies from 169 hospitals (64.8%) revealed that 163 cases of FBA had been treated in 114 hospitals during the past 2 years. Median age of cases was 1 year (2 months to 15 years), and 66.5% were male. Only 50.9% of the cases were referred to hospitals within 24h. Comparing these early-diagnosed cases, children with delayed diagnosis had similar age and sex distribution. In respect of presenting symptoms, characteristic ones such as choking or dyspnea were observed significantly more often in the early-diagnosed cases, whereas significantly predominant symptoms in children with delayed diagnosis were non-specific ones like coughing and wheezing (both, p <0.05). Although significantly more cases with early diagnosis reported suspected aspiration episodes (p <0.05), even in the delayed diagnosis group more than half cases (65%) had suspected episodes as well. Severe consequences occurred in seven cases (4.3%): four cases of irreversible hypoxic brain damage and one death due to multiorgan failure in the early diagnosis group; one bronchiectasis and one recurrent pneumonia in the delayed diagnosis group. Conclusions: Characteristics of FBA among children in Japan were not substantially different from the reports from other countries. Suspected episodes were important, and there were some differences in presenting symptoms between early and delayed diagnosis cases. However, there are still no key sings to make a prompt diagnosis. In order to prevent FBA and make a timely diagnosis, continuous and extensive educational programs should be provided. [Copyright &y& Elsevier]

Case 1 (42-year-old man) : The patient was examined for penoscrotal swelling that had continued for 1 month. An annular erosive skin ulcer was observed at the penoscrotal base, with distal swelling. Asking the patient about the history of his condition was difficult due to a history of mental illness. We suspected his symptoms were due to an embedded foreign object. As computed tomography indicated the presence of a subcutaneous foreign object, surgery was performed to remove it. A rubber band was found wrapped twice around the area. After releasing the strangulation, penoscrotal swelling improved. Case 2 (72-year-old man) : Penoscrotal swelling appeared after having an automobile tow hook attached to the penoscrotal base for 2 weeks. The patient was examined at the emergency room because he could not remove it on his own. A rescue squad was called, and they cut the strangulating object with an electric saw. After releasing the strangulation, penoscrotal swelling improved. Although we experienced 2 cases of penoscrotal strangulation involving strangulating objects with different characteristics, improvement was achieved in both by releasing the strangulation. The cases of penoscrotal strangulation reported in Japan with known strangulation type are reviewed.