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Complications of percutaneous coronary intervention (PCI) may have significant impact on patient survival and healthcare costs. PCI procedural complexity and patient risk are increasing, and operators must be prepared to recognize and treat complications, such as perforations, dissections, hemodynamic collapse, no-reflow, and entrapped equipment. Unfortunately, few resources exist to train operators in PCI complication management. Uncertainty regarding complication management could contribute to the undertreatment of patients with high-complexity coronary disease. We, therefore, coordinated the Learning From Complications: How to Be a Better Interventionalist courses to disseminate the collective experience of high-volume PCI operators with extensive experience in chronic total occlusion and high-risk PCI. From these conferences in 2018 and 2019, we developed algorithms that emphasize early recognition, effective treatment, and team-based care of PCI complications. We think that an algorithmic approach will result in a logical and systematic response to life-threatening complications. This construct may be useful for operators who plan to perform complex PCI procedures.

Objective: Examine literature for evidence of changes in button battery (BB) research over time including: amount and rate of literature output, levels of evidence, and the location of the research., Methods: Literature review of all peer-reviewed button battery literature available online through Pubmed and Embase was performed. Inclusion criteria were applied to ensure relevance. Publications were grouped into 4 time periods. Various study characteristics were compared between groups., Results: A total of 255 original research studies were reviewed. A significant increase in study number was found with a 664% increase comparing 2009-2018 and 1977-1988 (p < 0.001) and a 187% increase comparing 2009-2018 and all previous years. Average author number significantly increased over the study period (range: 2.8 to 4.4; p < 0.001). Case report or case series were consistently the most common type of study design (range: 56.5% to 84.0%). Level of evidence has remained at 4-5 for the majority of studies (range: 87% to 92.1%). First author specialty remained stable over time, with non-otolaryngologist surgeons being the most common authors, followed by pediatricians and otolaryngologists (28.8%, 18.9%, 18.5%, respectively). Location of research has diversified, with US publications falling from 50% to 29.5% of all studies when comparing 1977-1988 to 2009-2018 time periods., Conclusions: Button battery ingestion in the pediatric population has been an important topic of discussion among various medical specialties due to a rise in morbidity and mortality surrounding these ingestions. Despite the increase in number of studies and authors, the strength of these studies has remained largely unchanged., Competing Interests: Declaration of competing interest There are no conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: New strategies recently proposed to mitigate injury caused by lithium coin cell batteries lodged in the esophagus include prehospital administration of honey to coat the battery and prevent local hydroxide generation and in-hospital administration of sucralfate suspension (or honey). This study was undertaken to define the safe interval for administering coating agents by identifying the timing of onset of esophageal perforations., Methods: A retrospective study of 290 fatal or severe battery ingestions with esophageal lodgment was undertaken to identify cases with esophageal perforations., Results: Esophageal perforations were identified in 189 cases (53 fatal, 136 severe; 95.2% in children ≤4 years). Implicated batteries were predominantly lithium (91.0%) and 92.0% were ≥20 mm diameter. Only 2% of perforations occurred in <24 h following ingestion, including 3 severe cases with perforations evident at 11-17 h, 12 h, and 18 h. Another 7.4% of perforations (11 cases) became evident 24 to 47 h post ingestion and 10.1% of perforations (15 cases) became evident 48 to 71 h post ingestion. By 3 days post ingestion, 26.8% of perforations were evident, 36.9% by 4 days, 46.3% by 5 days, and 66.4% by 9 days., Conclusion: Esophageal perforation is unlikely in the 12 h after battery ingestion, therefore the administration of honey or sucralfate carries a low risk of extravasation from the esophagus. This first 12 h includes the period of peak electrolysis activity and battery damage, thus the risk of honey or sucralfate is low while the benefit is likely high., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: Unintentionally retained foreign objects (URFOs) remain the sentinel events most frequently reported to The Joint Commission. The objective of this study was to describe reports of URFOs, including the types of objects, anatomic locations, contributing factors, and harm, in order to make recommendations to improve perioperative safety., Methods: A retrospective review was undertaken of events involving URFOs reported to The Joint Commission from October 2012 through March 2018. Inclusion criteria were events meeting Joint Commission definitions of URFO and sentinel event. Exclusion criteria were sponges used intraoperatively and guidewires. Event reports included patients undergoing surgery, child birth, wound care, and other invasive procedures., Results: A total of 308 events involving URFOs were reported: instruments (102), catheters and drains (52), needles and blades (33), packing (30), implants (14), specimens (6), and other items (71). Many of the instruments were used in minimally invasive or orthopedic surgery. Items were most frequently retained in the abdomen or the vagina. Most URFOs occurred in the operating room. A total of 1,156 contributing factors were identified, most frequently in the categories human factors, leadership, and communication. In the majority of reports, the harm was categorized as unexpected additional care/extended stay. Five patients died as a result of the URFO., Conclusion: We describe events involving URFOs voluntarily reported to The Joint Commission. The variety of retained items, the departments involved, and the large number of contributing factors demonstrate the complexity of patient care and the need for a multifaceted plan for prevention. We make recommendations based on these findings., (Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.)

This study describes the pathologic findings and most probable causes of death (CD) of 224 cetaceans stranded along the coastline of the Canary Islands (Spain) over a 7-year period, 2006-2012. Most probable CD, grouped as pathologic categories (PCs), was identified in 208/224 (92.8%) examined animals. Within natural PCs, those associated with good nutritional status represented 70/208 (33.6%), whereas, those associated with significant loss of nutritional status represented 49/208 (23.5%). Fatal intra- and interspecific traumatic interactions were 37/208 (17.8%). Vessel collisions included 24/208 (11.5%). Neonatal/perinatal pathology involved 13/208 (6.2%). Fatal interaction with fishing activities comprised 10/208 (4.8%). Within anthropogenic PCs, foreign body-associated pathology represented 5/208 (2.4%). A CD could not be determined in 16/208 (7.7%) cases. Natural PCs were dominated by infectious and parasitic disease processes. Herein, our results suggest that between 2006 and 2012, in the Canary Islands, direct human activity appeared responsible for 19% of cetaceans deaths, while natural pathologies accounted for 81%. These results, integrating novel findings and published reports, aid in delineating baseline knowledge on cetacean pathology and may be of value to rehabilitators, caregivers, diagnosticians and future conservation policies., Competing Interests: The authors have declared that no competing interests exist.

Lithium-ion (Li-ion) batteries have been powering portable electronic equipment since the mid-1990s. Today, they are ubiquitous in portable electronics, with more than four billion manufactured each year. However, Li-ion batteries are also associated with a spectrum of injuries related to the type of device as well as the person using the device. These injuries range from cutaneous injuries due to flame burns and explosions to corrosion injuries from ingestion. This article describes how the composition of Li-ion batteries can cause injury, the types and extent of Li-ion battery-related injuries, and suggests strategies for prevention.

Serious and fatal complications after button battery ingestion are increasing worldwide. The aim of this study is to describe serious complications after battery ingestion in children in the Netherlands.All pediatric gastroenterologists in the Netherlands performing upper endoscopies were asked to report all serious complications after battery ingestion in children (0-18 years) between 2008 and 2016 retrospectively.Sixteen serious complications were reported: death after massive bleeding through esophageal-aortal fistula (n = 1), esophageal-tracheal fistula (n = 5), stenosis after (suspected) perforation and mediastinitis (n = 5), (suspected) perforation and mediastinitis (n = 3), vocal cord paralysis (n = 1), and required reintubation for dyspnea and stridor (n = 1). The median time interval between ingestion and presentation was 5 (IQR 2-258) h. All children were ≤ 5 (median 1.4; IQR 0.9-2.1) years. Vomiting (31.3%), swallowing/feeding problems (31.3%), and fever (31.3%) were the most common presenting symptoms; however, 18.8% of the patients were asymptomatic (n = 1 missing). All batteries were button batteries (75% ≥ 20 mm; 18.8% < 20 mm; n = 1 missing). The batteries were removed by esophagogastroduodenoscopy (50%) and rigid endoscopy (37.5%) or surgically (12.5%)., Conclusion: Sixteen serious complications occurred after small and large button batteries ingestion between 2008 and 2016 in both symptomatic and asymptomatic children in the Netherlands. Therefore, immediate intervention after (suspected) button battery ingestion is required. What is Known: • Button battery ingestion may result in serious and fatal complications. • Serious and fatal complications after button battery ingestion are increasing worldwide. What is New: • Sixteen serious complications after button battery ingestion occurred during 2008-2016 in children in the Netherlands. • Serious complications were also caused by small batteries (< 20 mm) in the Netherlands and also occurred in asymptomatic Dutch children.

Aim: Button battery ingestion (BBI) in children may cause severe complications. This analysis is a literature review of complications after pediatric BBI., Methods: Literature was searched on PubMed (1995-2015) using the terms "button battery," "ingestion," and "children." End points were age, type and diameter of battery, complications, affected organ, and fatality., Results: A total of 31 publications were analyzed. Patients from 4 months to 19 years old were included (n = 136,191, with n = 102,143 or 75% aged <6 y). In 6262, the diameter of the battery was documented. Batteries of 20 mm or greater in size were more prone to complications (n = 226). With regard to the anatomy, BBI caused complications mainly in the esophagus (n = 88, 38.94%). Sixty-one fatal outcomes were reported., Conclusions: Children younger than 6 years are the most prone to BBI, with lithium batteries of 20 mm or greater in size associated with complications. Complications have been estimated at 0.165%, with lethality of 0.04%. The esophagus is the most affected organ, but vascular involvement is often fatal.

Aim: To analyze the rate of mortality in children with foreign body aspiration (FBA)., Methods: We outlined a retrospective review of hospital data of patients between 1971 and 2013. FBA occurring in children 0 year to 14 years was considered for inclusion (patient ages ranged from 0.6 to 15 years, with a median age of 2.2 years). The gender structure within the investigated cases was 75.8% males and 24.2% females. During the study period, 772 patients undergoing rigid bronchoscopy with the diagnosis of FBA were included. Deaths on arrival were excluded., Results: Total rate of mortality (for whole investigated period) was 0.785. For last fifteen years of the investigated period the rate of mortality was zero., Conclusion: For prevention of foreign body aspiration in children and its mortality should be taken two strategies: non-medical (alterations in product design and public education campaigns) and medical (education of medical staff and improvement of equipment).

Objectives/hypothesis: Analyze morbidity and mortality among children undergoing bronchoscopy for foreign body removal., Study Design: Multicenter retrospective review using the American College of Surgeons Pediatric National Surgical Quality Improvement Program from 2014 and 2015., Methods: Patients were identified using Current Procedural Terminology code 31635. Demographics, time to surgery, operative times, hospitalization time, and complications were collected. Multivariate logistic regression was used to identify predictive factors for major adverse events., Results: Three hundred thirty-four patients were included (mean age 3.7 years, 59.0% male). Preoperative sepsis syndrome was present in 5.7% of patients and 8.1% had asthma. Of the patients, 5.1% percent of patients had a tracheostomy. Bronchoscopy was performed by an otolaryngologist (65.4%) or a pediatric surgeon (33.1%). Mean operative time was 27.4 minutes, whereas mean total operating room time was 54.6 minutes. Airway foreign bodies were located in 269 patients (80.5%), with 62.5% being located in the mainstem bronchus. Operative time was longer when foreign bodies were in the mainstem bronchus or distal to it. Mean time to surgery from admission was 0 days, and mean duration of hospitalization was 1 day. One patient (0.3%) required reoperation for respiratory reasons, and three (0.9%) required readmission for related reasons. No patients remained hospitalized at 30 days. Two (0.6%) had a postoperative pneumonia, and two (0.6%) required reintubation. One patient death (0.3%) occurred within 2 weeks of bronchoscopy. No significant differences were identified in operative time, time to surgery, or hospitalization time based on age, gender, presence of a tracheostomy, or surgical specialty., Conclusions: Bronchoscopy for identification and removal of airway foreign bodies had minimal morbidity in this group., Level of Evidence: 2b. Laryngoscope, 128:1226-1229, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Limited data exist describing risk factors for death, and long-term outcomes in dogs with esophageal foreign body (EFB) obstruction., Hypothesis/objectives: To evaluate short- and long-term outcomes, and analyze risk factors for death in dogs with EFB obstruction. We hypothesized duration of entrapment and treatment type would affect outcome., Animals: A total of 222 dogs were treated for EFB obstruction at an emergency and referral hospital between March 1998 and March 2017., Methods: Medical records for dogs with EFB were retrospectively evaluated., Results: Foreign material most frequently was osseous (180/222 [81%]), with distal esophagus the most common location (110/222 [49.5%]). Duration of clinical signs was not associated with risk of death (OR = 1.08, 95% CI 0.99-1.17; P = 0.2). Entrapment was treated by endoscopy (204/222 [91.8%]), surgery after endoscopic attempt (13/222 [5.9%]), and repeat endoscopy after surgery was recommended but declined (5/222 [2.3%]). In-hospital case fatality rate was 11/222 (5%). Risk of death was significantly higher with surgery (OR = 20.1, 95% CI 3.59-112.44; P = 0.001), and 5/5 (100%) of dogs died if undergoing endoscopy after surgery was recommended but declined. Increasing numbers of postprocedural complications (OR = 3.44, CI 2.01-5.91; P < 0.001), esophageal perforation (OR = 65.47, CI 4.27-1004.15; P = 0.003), and postprocedure esophageal hemorrhage (OR = 11.81, CI 1.19-116.77; P = 0.04) increased in-hospital risk of death. Esophageal strictures were reported in 4/189 (2.1%) of survivors available for follow-up., Conclusions and Clinical Importance: Death is uncommon in canine EFB; however, treatment type affects outcome, and these data should be used to guide decision-making in dogs with EFB., (Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Foreign body aspiration (FBA) is a preventable cause of mortality and morbidity in children. We conducted a chart review of children who presented to a university hospital due to FBA in the period 1999-2014. Children were either managed with bronchoscopy for removal of the foreign body or died due to FBA. A total of 103 children were seen due to FBA including 27 deaths. The majority of children were boys and were less than 3 years old. Most aspirated foreign bodies were food-related, mainly peanuts. The majority of children presented with acute choking incidents, a smaller number presented with recurrent chest infections, and few children's choking incidents were unwitnessed. X-ray had a high rate of false negatives and bronchoscopy was the gold standard technique for assessment and management. Aspiration of foreign bodies is a preventable, life-threatening condition that calls for increased parent education and awareness., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Airway foreign bodies (FB) are a common medical emergency within the pediatric population. While deaths are not uncommon, the in-hospital mortality rates and correlation with anatomic location of the airway foreign body have not been previously reported., Methods: The KID database was reviewed for 2003, 2006, 2009, and 2012 for pediatric patients with a discharge diagnosis of airway foreign body using ICD-9 codes (933.1, 934.x)., Results: 11,793 patients, ages 0-17, were found to have an airway FB. Of patients admitted for airway FB 21.2 % required mechanical ventilation during their hospitalization, and the overall mortality rate was 2.5 %. Location of the airway FB was dependent on age (p < 0.01). Use of mechanical ventilation was dependent on the location of the airway FB (p < 0.01) and being transferred from another hospital (OR 2.59, p < 0.01). Univariate analysis demonstrated differences in in-hospital mortality based on location (p < 0.01), use of a ventilator during hospitalization (OR 24.4, p < 0.01), and transfer from another hospital (OR 2.11, p < 0.01)., Conclusions: The in-hospital mortality rate for airway foreign bodies is 2.5 %. The anatomic location of airway FB in pediatric patients varies by age, and affects the need for mechanical ventilation and in-hospital mortality.

Gastrointestinal injuries secondary to button battery ingestions in children have emerged as a dangerous and difficult management problem for pediatricians. Implementation of a multidisciplinary team approach, with rapid and coordinated care, is paramount to minimize the risk of negative outcomes. In addition to providing a comprehensive review of the topic, this article outlines the authors' referral center's experience with patients with severe battery ingestion, highlighting the complications, outcomes, and important lessons learned from their care. The authors also propose an algorithm for clinical care that may be useful for guiding best management of pediatric button battery ingestion., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Retained foreign bodies remain an area of potential patient harm. This case describes a retained needle from distant surgery discovered at the time of the needle count after myomectomy.

The presentation, treatment and outcomes of 33 ingluvial fibrous foreign bodies in cockatiels (Nymphicus hollandicus) are described. Vomiting, lethargy and weight loss were the most common presenting signs. Diagnosis was made on palpation of a mass in the crop (ingluvies). Both surgical and non-surgical treatment regimens were evaluated. The overall mortality rate was 33%, suggesting fibrous materials are not safe for cockatiels to groom or ingest and should not be offered as cage accessories., (© 2015 Australian Veterinary Association.)

Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. Comparisons were made with non-inmate cases during the same period, using similar limitations. Body stuffers and body packers were analyzed as a subgroup. Seven hundred four inmate cases were compared to 106,260 non-inmate cases. Inmates were more likely to be younger, male, and to have engaged in drug misuse or abuse. They most commonly ingested methamphetamine, heroin, acetaminophen, and anticonvulsants. Inmates were more likely to receive activated charcoal (OR 9.87, 8.20-11.88), whole bowel irrigation (OR 44.50, 33.83-58.54), undergo endotracheal intubation (OR 4.09, 2.91-5.73), and to experience a major clinical outcome or death (OR 1.41, 1.05-1.89). When body stuffers and packers were removed, clinical findings were similar, though the odds of a major outcome or death became statistically non-significant. Body stuffers and body packers primarily used methamphetamine and heroin, and compared with other inmates had significantly higher odds of both adverse clinical effects and poor outcome. This large series provides a profile of symptomatic exposures among inmates, a little-studied population. The potential for high morbidity among body stuffers and packers suggests that a high index of suspicion of such ingestions be maintained when evaluating patients prior to incarceration.

Aim: To investigate predictive risk factors associated with complications in the endoscopic removal of foreign bodies from the upper gastrointestinal tract., Methods: We retrospectively reviewed the medical records of 194 patients with a diagnosis of foreign body impaction in the upper gastrointestinal tract, confirmed by endoscopy, at two university hospital in South Korea. Patient demographic data, including age, gender, intention to ingestion, symptoms at admission, and comorbidities, were collected. Clinical features of the foreign bodies, such as type, size, sharpness of edges, number, and location, were analyzed. Endoscopic data those were analyzed included duration of foreign body impaction, duration of endoscopic performance, endoscopic device, days of hospitalization, complication rate, 30-d mortality rate, and the number of operations related to foreign body removal., Results: The types of upper gastrointestinal foreign bodies included fish bones, drugs, shells, meat, metal, and animal bones. The locations of impacted foreign bodies were the upper esophagus (57.2%), mid esophagus (28.4%), stomach (10.8%), and lower esophagus (3.6%). The median size of the foreign bodies was 26.2 ± 16.7 mm. Among 194 patients, endoscopic removal was achieved in 189, and complications developed in 51 patients (26.9%). Significant complications associated with foreign body impaction and removal included deep lacerations with minor bleeding (n = 31, 16%), ulcer (n = 11, 5.7%), perforation (n = 3, 1.5%), and abscess (n = 1, 0.5%). Four patients underwent operations because of incomplete endoscopic foreign body extraction. In multivariate analyses, risk factors for endoscopic complications and failure were sharpness (HR = 2.48, 95%CI: 1.07-5.72; P = 0.034) and a greater than 12-h duration of impaction (HR = 2.42, 95%CI: 1.12-5.25, P = 0.025)., Conclusion: In cases of longer than 12 h since foreign body ingestion or sharp-pointed objects, rapid endoscopic intervention should be provided in patients with ingested foreign bodies.

Introduction: Retained weapon (RW) injuries are uncommon, but there is no current consensus on the best management approach., Methods: We reviewed our experience of 102 consecutive patients with non-missile RWs in a high-volume metropolitan trauma service managed over a 10-year period., Results: Of the 102 patients, 95 were males (93%), 7 were females (7%), and median age was 24 (21-28) years. Weapons: 73% (74/102) knives, 17% (17/102) screwdrivers, 5% spears, 6% (6/102) others [axe (1), glass fragment (1), stick (1), sickle blade (1), wire (1) and stone (1)]., Location: 8% (8/102) head, 20% (20/102) in the face, 9% (9/102) neck, 14% (14/102) thorax, 25% (26/102) abdomen, 23% (23/102) upper limb, 2% (2/102) lower limb. Four per cent (4/102) were haemodynamically unstable and proceed immediately to the operating theatre for operative exploration and weapon extraction. Imagining: 88 (86%) plain radiographs, 65 (64%) non-contrast CT scans, 41 (40%) contrast CT angiography, 4 (4%) formal angiography. Seventy-two underwent simple extraction, and 29 underwent extract plus open operation. One patient absconded. Specialist surgeons involved in extraction: trauma surgeons (74), neurosurgeons (10), ophthalmic surgeons (11) and ENT surgeons (4). Overall, 92% (94/102) survived to discharge., Conclusions: The vast majority of patients with RWs will be admitted in a stable condition and haemodynamic instability was almost exclusively seen in the anterior thorax. The most common site was the posterior abdomen. Detailed imagining should be used liberally in stable patients and unplanned extraction in an uncontrolled environment should be strongly discouraged.

Background: Little was known about gastrointestinal perforation secondary to foreign body in adults, which was only documented by several case series reports. The aim of this study was to characterize it with comparative methods., Methods: A retrospective study was conducted on twenty patients with the diagnosis of gastrointestinal perforation secondary to foreign body between January 2003 and October 2013. The perforations were all located in the small intestine and compared to eighty-seven patients with non-traumatic small intestinal perforation., Results: 35% of the patients in the foreign body group were over 65 years of age, which is much higher than the local elderly population ratio (p=0.002). In the foreign body group, more patients presented without diffuse abdominal physical signs (p=0.008) and preoperational CT scans had higher accuracy (p=0.027). Perforation repair was performed more often (p=0.024). Mean MPI was 19.9 and the morbidity rate was 35%, significantly lower than in the cases of other causes (p=0.001, 0.041). Mean duration of hospitalization was 11.5 days and was shorter compared to other causes (p=0.038)., Conclusion: Clinical performance of small intestinal perforation secondary to foreign body is atypical, and preoperative diagnosis relies on CT scans. Primary perforation closure is safe and effective, and relatively better outcomes can be achieved.

Objectives: To compare clinical signs, clinicopathological abnormalities, imaging findings and outcome of dogs with linear and non-linear foreign bodies in the gastrointestinal tract., Methods: Retrospective review of case records of dogs with a confirmed diagnosis of gastrointestinal foreign body. Signalment, history, clinical signs, clinicopathological data, diagnostic imaging studies, surgical and endoscopic procedures, hospital stay, costs and outcome were compared between groups., Results: A total of 176 dogs had linear and 323 had non-linear foreign bodies. Dogs with a linear foreign body were more likely to have a history of vomiting, anorexia, lethargy and pain on abdominal palpation. They were also more likely to have the foreign body anchored in the stomach and continuing into the small intestine, experience intestinal necrosis, perforation and peritonitis, and require intestinal resection and anastamosis. The duration of hospitalisation was longer for dogs with linear foreign body (3 versus 2 days), and the cost of treatment was 10% higher. However, in both groups, 96% of dogs survived to hospital discharge., Clinical Significance: Dogs with a linear foreign body had more severe clinical signs and gastrointestinal pathology, and an increased duration of hospitalisation and cost of care. However, overall survival rates were not different in dogs with linear and non-linear foreign bodies., (© 2014 British Small Animal Veterinary Association.)

Background: There is paucity of data regarding the morbidity and mortality of rigid bronchoscopy in children for foreign body (FB) retrieval from India. The aim was to audit data regarding anaesthetic management of rigid bronchoscopy in children and associated morbidity and mortality., Materials and Methods: Hospital records of all patients below 18 years of age undergoing rigid bronchoscopy for suspected FB aspiration (FBA) between January 1, 2002 and December 31, 2011 were audited to assess their demographic profile, anaesthetic management, complications, and postoperative outcomes. The children were divided into early and late diagnosis groups depending on whether they presented to the hospital within 24 hours of FBA, or later., Results: One hundred and forty children, predominantly male (75%), with an average age of 1-year and 8 months, presented to our hospital for rigid bronchoscopy during the study period. Majority of children presented in the late diagnosis group (59.29% vs. 40.71%). The penetration syndrome was observed in 22% of patients. Majority of patients aspirated an organic FB (organic: Inorganic FB = 3:1), with peanuts being the most common (49.28%). A significantly higher number of children presented with cough (P = 0.0001) and history of choking (P = 0.0022) in the early diagnosis group and crepitations (P = 0.0011) in the late diagnosis group. Major complications included cardiac arrest (2.1%), pneumothorax (0.7%), and laryngeal oedema (9.3%). The average duration of hospitalization in our series was 3.08 ± 0.7 days., Conclusions: Foreign body aspiration causes considerable morbidity, especially when diagnosis is delayed.

Background: Terrorist explosions occurring in varying settings have been shown to lead to significantly different injury patterns among the victims, with more severe injuries generally arising in confined space attacks. Increasing numbers of terrorist attacks have been targeted at civilian buses, yet most studies focus on events in which the bomb was detonated within the bus. This study focuses on the injury patterns and hospital utilisation among casualties from explosive terrorist bus attacks with the bomb detonated either within a bus or adjacent to a bus., Methods: All patients hospitalised at six level I trauma centres and four large regional trauma centres following terrorist explosions that occurred in and adjacent to buses in Israel between November 2000 and August 2004 were reviewed. Injury severity scores (ISS) were used to assess severity. Hospital utilisation data included length of hospital stay, surgical procedures performed, and intensive care unit (ICU) admission., Results: The study included 262 victims of 22 terrorist attacks targeted at civilian bus passengers and drivers; 171 victims were injured by an explosion within a bus (IB), and 91 were injured by an explosion adjacent to a bus (AB). Significant differences were noted between the groups, with the IB population having higher ISS scores, more primary blast injury, more urgent surgical procedures performed, and greater ICU utilisation. Both groups had percentages of nearly 20% for burn injury, had high percentages of injuries to the head/neck, and high percentages of surgical wound and burn care., Conclusions: Explosive terrorist attacks detonated within a bus generate more severe injuries among the casualties and require more urgent surgical and intensive level care than attacks occurring adjacent to a bus. The comparison and description of the outcomes to these terrorist attacks should aid in the preparation and response to such devastating events., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: This study sought to summarize the experience of diagnosis and treatment of tracheobronchial foreign bodies in children to effectively reduce complications and mortality., Methods: The medical records of 1024 pediatric patients admitted to our hospital from January 1997 to September 2011 and diagnosed with clinically suspected tracheobronchial foreign body aspiration were retrospectively analyzed., Results: Of the 1024 children patients, 674 were boys (65.8%) and 350 girls (34.2%). Two died of respiratory and circulatory failure (foreign bodies detected upon bronchoscopy but not retrieved) before surgery, 65 patients underwent direct bronchoscopic removal of foreign bodies due to their critical status, and 957 received chest radiographs and chest fluoroscopy or multidetector spiral computed tomographic scans (941 positive). Foreign bodies were expectorated before surgery in 3 cases. There were 953 cases of bronchoscopically proven airway foreign body aspiration, with a diagnostic accuracy of 94.5%. Ninety-eight foreign bodies were lodged in the main bronchus and/or bilateral bronchi, 506 in the right main bronchus, and 349 in the left main bronchus. Atelectasis was noted in 42 patients, including 11 with pulmonary consolidation, whose lungs were re-expanded by endobronchial lavage and sputum aspiration. In 3 patients with bronchiectasis, conservative treatment following foreign body removal was followed by no improvement, and pulmonary lobectomy was performed. Foreign bodies were successfully extracted at the first bronchoscopic attempt in 948 cases, accounting for 99.7% of the total. However, 3 patients had to undergo another bronchoscopy to remove the foreign bodies. The most common types of foreign bodies were peanuts, melon seeds, and beans., Conclusions: Timely accurate diagnosis and treatment of tracheobronchial foreign bodies in children can avoid delay in treatment and effectively reduce complications and mortality., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: To assess the common foreign bodies in urban areas of Sindh, and the presentation, problems and complications during their removal through rigid bronchoscopy., Methods: The descriptive study was conducted at the Ear, Nose and Throat Department and the Department of Head and Neck Surgery of Liaquat University Hospital, Hyderabad, and Abbasi Shaheed Hospital, Karachi, from April 2009 to October 2010. Fifty patients with strong suspicion of foreign body inhalation in whom rigid bronchoscopy was done were included in the study. A definitive diagnostic protocol was applied and rigid bronchoscopy was done to search and remove the foreign bodies. The data was fed into SPSS version 15 for descriptive analysis., Results: In our study,28(56%) cases were male and 22(44%) were female. The age range was 1-7 years. Most of the victims (n=21; 42%) were over 3 years of age. Commonest symptom of presentation was dyspnoea (n=34; 68%) and the commonest sign of presentation was decreased unilateral air entry (n=25; 50%). Most of the foreign bodies were impacted in the right main bronchus (n=26; 52%). The most retrieved foreign body was betel nut (n=23; 46%). The commonest complication of bronchoscopy was airway oedema which occurred in 13 (26%) patients. The successful removal of exogenous foreign body was achieved in 41 (82%), and the mortality rate was 3 (6%)., Conclusion: Delay in the diagnosis of foreign body inhalation translates into a higher risk of complications. Therefore, early bronchoscopy should be done on suspicion. Early recognition at both parental and clinical levels should be promoted through public awareness.

Background: The most frequent cause of accidental household death in children under 6 years of age is inhalation of a foreign body. Delayed management is blamed for death. The absence of a recognizable penetration syndrome complicates and delays not only the diagnosis but also the treatment of foreign body inhalation., Objective: This report aimed to highlight the problem of radiopaque foreign body inhalation and analyze part of our experience in the treatment of such cases., Methods: A multicenter experience in the management of radiopaque inhaled foreign bodies in 3 centers in Egypt and Saudi Arabia was reviewed retrospectively, including old and new techniques to remove the foreign body. The study included data from 136 cases., Results: The majority of patients were female (91.17%). The mean age was 12 years. More than one-third of the inhaled foreign bodies were found on the left side. A positive history of chocking was reported in more than 95%. Almost 87% presented in the first 24 h after inhalation., Conclusion: Early rigid bronchoscopic extraction of inhaled radiopaque foreign bodies can be achieved with acceptable results. Video-assisted bronchoscopic removal of an inhaled foreign body may be safer.

Objectives: Button battery ingestions are potentially life threatening for children. Catastrophic and fatal injuries can occur when the battery becomes lodged in the esophagus, where battery-induced injury can extend beyond the esophagus to the trachea or aorta. Increased production of larger, more powerful button batteries has coincided with more frequent reporting of fatal hemorrhage secondary to esophageal battery impaction, but no recommendations exist for the management of button battery-induced hemorrhage in children., Materials and Methods: We reviewed all of the reported pediatric fatalities due to button battery-associated hemorrhage. Our institution engaged subspecialists from a wide range of disciplines to develop an institutional plan for the management of complicated button battery ingestions., Results: Ten fatal cases of button battery-associated hemorrhage were identified. Seven of the 10 cases have occurred since 2004. Seventy percent of cases presented with a sentinel bleeding event. Fatal hemorrhage can occur up to 18 days after endoscopic removal of the battery. Guidelines for the management of button battery-associated hemorrhage were developed., Conclusions: Pediatric care facilities must be prepared to act quickly and concertedly in the case of button battery-associated esophageal hemorrhage, which is most likely to present as a "sentinel bleed" in a toddler.

Non-ulcerous duodenal perforations are a rare and seldom studied pathology. The present retrospective study analyses a group of 23 patients, over a 10 year period (Jan 1st 2000 - Dec 31st 2009) with this pathology. The most frequent etiology was iatrogenic (52.17 % after ERCP and 17.39% after upper gastrointestinal endoscopy). Other rare etiologies included were tumoral perforations, penetrating wounds, and ingestion of foreign bodies. The lesions vary from millimetric perforations to total necrosis of the wall of a duodenal segment and are often associated with other complex lesions. The overall mortality was 52.17%, a little lower for the post ERCP injuries (40%). Usually the iatrogenic lesions are diagnosed earlier (ex. 54.54% of the post ERCP lesions undergo surgery during the first 24 h), probably increasing the chance of surviving. 43.47% of cases undergo surgery in the condition of severe sepsis, with multiple organ failure, thus aggravating the prognosis. Sometimes the patient required multiple interventions (with a maximum of 8 in our group). In 26% of the cases the primary intervention was just paraduodenal and/or retroperitoneal drainage, suture of the duodenum (6 cases - 26%), usually under the protection of a gastro-enteroanastomosis (4 cases - 17.39%), suture of the duodenum around a decompression tube (26%), sometimes suture of the duodenum with a jejunal serous patch or duodeno-jejunal anastomosis. The bile drainage and the jejunostomy were associated sometimes. The procedures in this pathology have a significant morbidity, with a high rate of reinterventions (30.4%).

Objective: To determine risk factors and outcomes associated with a foreign body left during a procedure in a population of pediatric surgical patients., Design: Case-control study., Setting: The Nationwide Inpatient Sample and Kids' Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (aged 0-18 years) from 1988 to 2005., Patients: After data from 1 946 831 hospitalizations in children were linked to the Agency for Healthcare Research and Quality Pediatric Quality Indicator (PDI) software, 413 pediatric patients with foreign bodies left during a procedure (PDI 3) were identified. A 1:3 matched case-control design was implemented with 413 cases and 1227 controls. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes., Main Outcome Measures: To examine the relationship between PDI 3 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges., Results: Logistic regression analysis revealed a statistically significant higher odds of PDI 3 in the gynecology procedure category (odds ratio, 4.13; P = .01). Multivariable regression analysis revealed that patients with PDI 3 had an 8-day longer length of stay (95% confidence interval, 5.6-10.3 days; P < .001) and $35 681 higher total hospital charges (95% confidence interval, $22 358-$49 004; P < .001) but were not more likely to die (odds ratio, 1.07; P = .92)., Conclusions: Among pediatric surgical admissions, a foreign body left during a procedure was observed to occur with highest likelihood during gynecologic operations. The occurrence of this adverse event was associated with longer length of stay and greater total hospital charges, but not with increased mortality.

Objectives: To establish predilection sites of obstruction and to investigate clinical factors associated with a poor outcome., Methods: A retrospective study of 208 consecutive cases over a 48-month period from first-opinion practice., Results: Overall, 91 per cent of cases recovered with higher survival rates from discrete foreign bodies (94 per cent in dogs and 100 per cent in cats) as opposed to linear foreign bodies (80 per cent in dogs and 63 per cent in cats). English bull terriers, springer spaniels, Staffordshire bull terriers, Border collies and Jack Russell terriers were over-represented. In dogs, 63 per cent of obstructions occurred in the jejunum but foreign objects were encountered at all points along the gastrointestinal tract. A longer duration of clinical signs, the presence of a linear foreign body and multiple intestinal procedures were associated with significantly increased mortality. Neither the degree of obstruction (partial or complete) nor the location of the foreign body was shown to have a significant influence on survival., Clinical Significance: Prompt presentation, diagnosis and surgical intervention improve the outcome of gastrointestinal obstruction by foreign bodies. At surgery, the minimal number of intestinal procedures should be performed to restore the integrity of the alimentary tract.

This study aims to analyze accidents involving foreign bodies among children less than 15 years of age residing in Londrina, Paraná State, Brazil, in terms of first aid, hospitalization, and death (2001). Data were obtained from general hospital records and the Municipal Mortality Database. A total of 434 accidents were analyzed, with a 3.7% hospitalization rate and 0.7% mortality. Boys predominated (53.7%), and the incidence rate was highest among children one to three years of age (7.2 per 1,000 children). Foreign body penetration in natural orifices (eyes, nostrils, and ears) accounted for 94%, inhalation/ingestion of food 2.8%, inhalation/ingestion of objects 2.5%, and aspiration of gastric contents 0.7%, and these causes accounted for all the deaths. The results contribute to epidemiological knowledge on such accidents and indicate the need to restructure health services in order to decentralize care for less complex injuries, besides emphasizing the need for preventive measures.

If performed correctly, the rumenotomy procedure can be a safe and effective way to retrieve ingested foreign bodies and address other problems of the ruminant forestomachs. In the author's practice, rumen surgery has been associated with few postoperative complications. Morbidity and mortality in cases that have had a previous rumenotomy have mostly been associated with complications related to the original presurgical condition or from causes unrelated to the rumen surgery.

Objective: Body packers smuggle cocaine by swallowing containers filled with the drugs, whilst body pushers conceal the containers in the rectum or vagina. In a collaborative effort between the Department of General Surgery, two major airports and Poisons Centre, we performed a retrospective study to develop an algorithm for the treatment of ruptured cocaine-filled containers., Materials and Methods: The data of all cocaine body packers and body pushers who were identified at the airports of Frankfurt and Paris from 1985 to 2002 were evaluated concerning incidence, demographics and surgical aspects., Results: From 1985 to 2002, 312 body pushers and 4,660 body packers were identified. The sex ratio was 1:1. Sixty-four "mules" (1.4%) developed life-threatening symptoms of cocaine overdose after the rupture of a container. In 20 patients, an emergency laparotomy was performed and the containers were removed; all of these patients survived. Forty-four body packers died before surgical treatment could be performed. Only one body pusher required medical attention., Conclusion: Cocaine overdose can be life-threatening. If the cause is the rupture of a container in a body packer, the only possible treatment is immediate laparotomy for the removal of the container.

This study describes four cases of loggerhead sea turtles with fishhooks in the gastrointestinal tract. Two dead turtles with a hook in the esophagus had local fibrosis with an invagination of the keratinized stratified squamous epithelium surrounding the hook, isolating it from the subjacent stroma, one had a hook in the cloaca which was expelled spontaneously, and one had plication of the intestine with necrosis caused by the long monofilament line attached to the hook lodged in the esophagus. Lethal injuries were related to the effect of strangulation and traction produced by the line throughout the gastrointestinal tract rather than the presence of the hook in the esophageal mucosa. Hook size, point of attachment to the gastrointestinal tract, the presence or not of a long monofilament line, and the traction applied by it could be crucial for turtle survival.

Background: Landmine explosions cause most of the war injuries in the battlefield and pose a substantial public health risk. Although the lower limbs are usually affected, head injuries also occur. The aim of this study is to describe the types of head injuries caused by the explosion of landmines and the management of the victims., Patients and Method: Fifteen patients who sustained a head injury due to a landmine explosion were treated in the Department of Neurosurgery between 2000 and 2006. The average age of the patients was 22.5 (range between 20 and 33). The Glasgow Coma Scale (GCS) score ranged between 3 and 15 and was 8 or less in 4. Shrapnel, stone and earth were the wounding agents. Four patients underwent neurosurgical treatment and 11, apart from simple scalp closure, had conservative treatment. Ten patients had associated lesions in the other parts of the body including thorax, upper and lower limbs, and the abdomen., Findings: Two patients died. At the time of admission, one had a GCS score of 3 and the other a score of 4. Infection was observed among 4 patients and a cerebrospinal fluid (CSF) fistula in 1 patient., Conclusion: Landmines occasionally cause head injuries. Surgical intervention is seldom required and survival is likely unless the patient is in deep coma. Multidisciplinary approaches are required in case there are associated lesions in the other parts of the body.

Ninety juvenile yellowfin bream Acanthopagrus australis were angled from holding tanks, allowed to ingest nickel-plated, carbon-steel J-hooks and released (with their lines cut) into individual experimental tanks during 2 experiments in order to assess their (1) long-term (up to 105 d) health, mortality and rate of hook ejection and (2) short- and medium-term (< 42 d) temporal changes in health during hook ingestion. Equal numbers of control fish were scooped from holding tanks and similarly monitored in experimental tanks. Of 20 hook-ingested fish released during Expt 1, 3 died within 8 d, providing a non-significant mortality of 15%. Between Day 6 and Day 56 post-release, 13 of the surviving individuals ejected their hooks, which were typically oxidized to about 94% of their original weight and often broken into 2 pieces. At Day 105, there were no significant differences between the 20 control and 17 hook-ingested/-ejected fish in terms of their ability to digest and assimilate food (measured as changes in apparent digestibility coefficients), stress (measured as concentrations of plasma cortisol and glucose) or of morphological parameters that included weight (Wt) and maximum height (MH), maximum width (MW) and maximum girth (MG). During Expt 2, 3 individuals that still contained ingested hooks and 3 controls were sampled on each of 9 occasions between Day 3 and Day 42 post-release. All fish were sampled for blood cortisol and glucose and were then euthanized before being weighed and measured for total length (TL), MH, MW and MG. Hook-ingested individuals were also X-rayed to determine the position and orientation of hooks. There were no significant differences in plasma glucose between hook-ingested and control fish. Irrespective of the treatment of fish, concentrations of cortisol were elevated on some sampling occasions, indicating variable, acute stress. The MH and MG of fish were not significantly different between groups. Significant differences were detected for MG and Wt, with hook-ingested fish having weights similar to those of the control fish but a relatively greater MW (owing to stomach distension from ingested hooks) until 2 wk post-release, after which both morphological parameters generally declined. There was no significant temporal progression of hooks in the stomach of treatment fish; however, some hooks reorientated to positions that may have precluded passage along the digestive tract. We conclude that, for the J-hooks examined, cutting the line is an appropriate strategy that results in the greater majority of released hook-ingested yellowfin bream surviving with minimal negative long-term effects.

One field and 3 aquaria experiments were done to quantify the short-term mortality of yellowfin bream Acanthopagrus australis and mulloway Argyrosomus japonicus after being angled and subjected to 3 general handling treatments. Anglers were supplied with identical J-type hooks and asked to handle hooked fish by either (1) physically removing the hook or (2) cutting the line (5 cm from the mouth of the fish) and leaving the hook in. Some hooked A. japonicus were subjected to a third handling treatment where the line was cut underwater without exposing the fish to air. Technical and biological data were collected before all fish were released into sea cages and monitored for 5 d. Control fish were seined and similarly caged and monitored. Concentrations of plasma glucose and cortisol were collected from a sample of fish on the first and last day of the experiments. Significant predictors of mortality for both species involved the presence of blood at the mouth and an interaction between anatomical hook location and hook removal. A. australis and A. japonicus that had their ingested hooks removed experienced the greatest mortalities (87.5 and 72.7%, respectively). Typically, these fish suffered damage to their oesophagus, stomach wall and vital organs. Mortality rates of A. australis and A. japonicus were significantly decreased to 1.7 and 16%, respectively, when they were released with their lines cut, with some of these fish free of hooks after 5 d. In contrast, few mortalities occurred in either species when the hooks were removed or the lines cut on mouth-hooked fish or in A. japonicus when it was released with no air exposure. For A. australis, the field- and aquaria-based experiments provided comparable results in terms of identifying treatment-specific effects, but there were potential biases in rates of hook ingestion. Irrespective of the treatment of fish, all experiments caused physiological changes measured as elevations in either plasma cortisol or glucose. We concluded that anglers should cut the line from hook-ingested A. australis and A. japonicus, but remove the hook from mouth-hooked individuals to prevent subsequent ingestion. Further research is required to examine the longer-term consequences of these handling practices on fish health.

Background: During the last decade, increased rates of drug traffic have led the smugglers to use various methods. One of these methods of illicit drug smuggling is body packing. Smuggling by intra-abdominal concealment is called "body packing". In this research, mortality rate was investigated due to body packing in Tehran., Methods: A descriptive study (case series) was designed on all corpses referred to the Forensic Medicine Organization of Tehran between April 1999 - December 2000. Demographic data such as sex, age, marital status, addiction, job, education level, type of opioid and the weight, number of packets, and results of blood and urine morphine tests by thin-layer chromatographic method were investigated., Results: Continental system of law is used in Iran and 0.06% of the referred corpses to Forensic Medicine Organization of Tehran were body packers. There were 12 cases, all of them were men. The mean age of body packers was 43 years (range 20 - 62). The minimum weight of the packets was 20 g and the maximum weight was 1400 g (mean = 501 g). The minimum number of the packets was one and the maximum number of the packets was 48. Twenty five percent of the corps were putrefied and one corpse was mummified. None of the body packers had academic education nor were employed. Nine of them lived in cities. Twenty five percent of them were intravenous addicts. The corpses were found mostly in terminals (17%), roads (58%), and cities (25%)., Conclusion: Hospital physicians may neglect this type of gastrointestinal foreign body if they are not aware of the body packer syndrome. Body packing should be suspected in anyone with signs of drug-induced toxic effects after a recent arrival on city terminals or when there is no history of recreational drug use.

Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.

Objectives: The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment., Methods: Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment., Results: The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia., Conclusions: We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.

Objective: Airway foreign bodies present a diagnostic dilemma and has been recognized for many years. Since aspiration of foreign bodies can be a serious and sometimes fatal problem, early intervention and proper management is vital., Method: In this retrospective study, the results of 1887 bronchoscopies, which were performed between the years 1973 and 2004 for the suspicion of foreign body aspiration in children, were presented. Various instruments and techniques were used over 31-year period and rigid bronchoscopy was the preferred method of foreign body extraction., Results: There were 1106 boys and 781 girls with the median age of 2.3 years. Seventy-four percent of patients were less than 3 years old. The most common type of foreign body (89.9%) was organic; watermelon seeds (39.7%) were the most frequent organic foreign bodies. Eight hundred and twenty-three patients (43.6%) were referred to our clinic within the first 24h of the event while 4.5% of the patients were admitted to the hospital with the suspicion of foreign body in the airway later than one month. At bronchoscopy, a foreign body was identified in 79.1% of patients and no foreign body was seen in 20.9% of patients. Foreign bodies were encountered in 96.3% of the patients with positive history whereas 28.1% of the patients with negative history had foreign body. Of the patients with foreign bodies, 93.2% had positive history. Overall, the positive history was obtained from 85.2% of patients. The incidence of postbronchoscopic tracheotomy, thoracotomy, and overall mortality rate were 0.47, 0.15, and 0.21%, respectively., Conclusion: Otolaryngologists should consider foreign body aspiration in the airway in the differential diagnosis of any patient with the complaints of stridor, dyspnea, sudden onset of cough and intractable and recurrent lower respiratory tract infections. A careful history and physical examination were strong indicators of the diagnosis and raised the index of suspicion of an aspirated foreign body. Timely intervention with the experienced surgical team would decrease the complication rate and mortality rate. However, prevention of aspiration with the education of parents and caregivers is very important.

Objective: To determine the relationship between physical characteristics of the coin (size), age of the victim, the amount of coins in circulation, and the frequency and outcome of pediatric coin ingestion and aspiration injuries., Methods: Records of coin related ingestion and aspiration injuries occurring to children 14 years of age or younger were acquired from the US Consumer Product Safety Commission (CPSC). Logistic regression was conducted to control for mutual confounding among variables., Results: From 1994 to 2003, an estimated 252,338 children were treated in hospital emergency departments for non-fatal coin-related ingestion or aspiration, and additional 20 fatalities were reported during the same time span. Children 4 years of age or younger were at the highest risk. It is also observed that younger children are the most vulnerable victims of ingestion and/or aspiration of small coins (e.g., pennies), while older children are more likely to be treated due to ingestion and/or aspiration of larger coins (e.g., quarters). Pennies were involved in more incidents than all other coins combined. The hospitalization rate exhibited a negative correlation with the measure of the diameter and the weight of the coins. The overwhelming majority (94%) of the incidents were ingestion, whereas aspiration victims were more likely to encounter hospitalization., Conclusions: We hope that this study will raise public and health practitioners' awareness of the risk, and increase supervision, particular of the most vulnerable young children.

Autoerotic death by hanging or ligature is a method of autoeroticism well known by forensic pathologists. In order to analyze autoerotic deaths of nonclassic hanging or ligature type, this paper reviews all published cases of autoerotic deaths from 1954 to 2004, with the exclusion of homicide cases or cases in which the autoerotic activity was not solitary. These articles were obtained through a systematic Medline database search. A total of 408 cases of such deaths has been reported in 57 articles. For each case, the following characteristics are presented here: sex, age, race, method of autoerotic activity, cause of death, and location where the body was found. Autoerotic death practioners were predominantly Caucasian males. Victims were aged from 9 to 77 years and were mainly found in various indoor locations. Most cases were asphyxia by hanging, ligature, plastic bags, chemical substances, or a mixture of these. Still, atypical methods of autoerotic activity leading to death accounted for about 10.3% of cases in the literature and are classified here into five broad categories: electrocution (3.7%), overdressing/body wrapping (1.5%), foreign body insertion (1.2%), atypical asphyxia method (2.9%), and miscellaneous (1.0%). All these atypical methods are further discussed individually.

Radionuclide brain scintigraphy is a commonly performed examination for the confirmation of brain death. Although the absence of scintigraphically detectable flow of lipophilic tracers to the brain combined with the lack of uptake in the brain is considered consistent with brain death in the appropriate clinical scenario, the cause of death itself is usually not apparent on the scan. A case of bullet track and bullet visualization during a radionuclide brain death study with Tc-99m hexamethylpropyleneamine oxime (HMPAO) is described.

Objective: To analyze the experience for the diagnosis and treatment of pediatric tracheobronchial foreign body cases, so to the incidence of complications and mortality., Methods: 7260 tracheobronchial foreign body cases, from 1987 through 2003, were enrolled in this study. Early diagnosis, preoperative evaluation and perioperative treatment were strongly emphasized in this group of patients., Results: 7618 patients received rigid bronchoscopy and 7260 cases were confirmed with tracheobronchial foreign bodies. The confirmed diagnosis rate is 95.3%. Among the 7260 cases, 7007 (96. 4% ) patients were diagnosed and received bronchoscopic foreign body removal within 24 hours. Different food is the most common foreign body aspirated in infants and toddlers (under 4 year old), whereas older children are more likely to aspirate other foreign bodies. Peanuts and sunflower seed (6862) were noted as the most common ones. Pen caps (398) are much less. All patients were evaluated before surgery after 1996. Complications occurred in 7 patients (0.1%) . The mortality rate is zero. 7165 cases' foreign body were successfully removed the first time of brochoscopy. 95 patients received more than one times bronchoscopy. 67 cases' foreign bodies were smoothly removed with second bronchoscopy. 16 cases received flexible bronchoscopic foreign body removal when rigid bronchoscopic procedure failed. 12 cases received chest surgery for foreign body removal. 6933 cases received bronchoscopy with surface anesthesia or without anesthesia, while 327 patients with general anesthesia combined local surface anesthesia., Conclusions: Rapid diagnosis and treatment can reduce the complication and mortality rate. So that early diagnosis, preoperative evaluation and perioperative treatment should be strongly emphasized.