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Gonzalez-Anton D, Gallice T, Borges Da Silva A, Carrié C. Extubation failure: Upper airway obstruction by chewing gum. A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00026-X. [PMID: 38342303 DOI: 10.1016/j.redare.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/22/2023] [Indexed: 02/13/2024]
Abstract
Extubation failure can result from different complications, mostly well described in the literature such as laryngeal edema. Airway obstruction by foreign bodies is a less frequent and unexpected complication and its detection remains a challenge to healthcare professionals. In this case-report, we describe a patient admitted in an intensive care unit following a motor vehicle accident and who underwent an extubation failure and tracheostomy placement due to a misdiagnosed obstruction of a foreign body in the upper airway. Thus, screening of foreign bodies should be considered with a careful interpretation of medical imagery and clinical evaluation in these patients. Finally, cuff leak test, ultrasonography and videolaryngoscopy can be important adjuvants to the identification of suspected foreign bodies.
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Affiliation(s)
- D Gonzalez-Anton
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France.
| | - T Gallice
- Neurologic Intensive Care Unit and Neurosurgery Unit, Bordeaux Universitary Hospital, Bordeaux, France
| | - A Borges Da Silva
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France
| | - C Carrié
- Trauma and Surgical Intensive Care Unit, Emergency Unit, Bordeaux Universitary Hospital, Bordeaux, France
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Zugasti Murillo A, Gonzalo Montesinos I, Cancer Minchot E, Botella Romero F. Hospital management of the patient with dysphagia. Survey and recommendations of SEEN nutrition area. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:1-9. [PMID: 37468415 DOI: 10.1016/j.endien.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 07/21/2023]
Abstract
INTRODUCTION The prevalence of dysphagia in hospitalized patients is extraordinarily high and little known. The goal of care should be to assess the efficacy and safety of swallowing, to indicate personalized nutritional therapy. The development of Dysphagia Units, as a multidisciplinary team, facilitates comprehensive care for this type of patient. MATERIAL AND METHODS A observational, cross-sectional, web-based survey-type study, focused on Spanish Society of Endocrinology and Nutrition department heads, was conducted in September-October 2021. The following data were analyzed: size and type of center, existence of a dysphagia unit, dysphagia screening, dietary and nutritional therapy, education and training of professionals and patients, codification, and quality of life evaluation. RESULTS 65 responses (39% of the total Endocrinology and Nutrition departments). 37% of hospitals have a Dysphagia Unit and 25% are developing it. 75.4% perform screening, with MECV-V in 80.6%, and VED (61.4%) and VFS (54.4%) are performed as main complementary tests. The centers have different models of oral diet, thickeners and nutritional oral supplements adapted to dysphagia. In 40% of the centers, no information is offered on dysphagia, nor on the use of thickeners, dysphagia is coded in 81%, 52.3% have specific nursing protocols and only 8% have scales for quality-of-life evaluation. CONCLUSIONS The high prevalence and the risk of serious complications require early and multidisciplinary management at the hospital level. The information received by the patient and caregiver about the dietary adaptations they need, is essential to minimize risks and improve quality of life.
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Affiliation(s)
- Ana Zugasti Murillo
- Sección de Nutrición Clínica, Servicio Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete Área de Nutrición de la SEEN, Albacete, Spain
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Minghinelli FE, Recalde R, Socolovsky M, Houssay A. A new, readily accessed and low-cost, device for treating depressed ping pong fractures non-surgically: Technical note. Neurocirugia (Astur : Engl Ed) 2022; 33:328-333. [PMID: 34620579 DOI: 10.1016/j.neucie.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this paper is to describe a low-cost and readily accessed Manual Aspiration Reduction System (MARS) for use treating ping-pong fractures in three patients. METHODS The MARS is composed of a pediatric anesthesia mask, part of a macro dripper, a 3-way stopcock, and two 60-ml syringes. Prior to its use in our patient, the system was tested on five adult volunteers to maximum negative pressure, and none reported pain during the procedure or experienced any other complication. We present three clinical cases of patients with depressed ping-pong fracture who were treated with the MARS at the bedside without anesthesia. The patients were monitored by the neonatology team throughout the procedure. RESULTS Skull radiography revealed reduction of the fracture after the procedure performed with the MARS in all patients. The transfontanellar ultrasound and follow-up neurological examination were normal. The patient progressed favorably and was discharged from our service after 24 h. CONCLUSIONS Due to its components, the MARS is a low-cost and readily accessed system. In this case, it permitted satisfactory reduction of a ping-pong fracture in all patients. This system should greatly simplify the treatment of such fractures.
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Affiliation(s)
- Federico E Minghinelli
- División Neurocirugía, Hospital de Clínicas José de San Martín, Facultad de medicina UBA, Buenos Aires, Argentina.
| | - Rodolfo Recalde
- División Neurocirugía, Hospital de Clínicas José de San Martín, Facultad de medicina UBA, Buenos Aires, Argentina
| | - Mariano Socolovsky
- División Neurocirugía, Hospital de Clínicas José de San Martín, Facultad de medicina UBA, Buenos Aires, Argentina
| | - Alfredo Houssay
- División Neurocirugía, Maternidad Santa Rosa, Vicente López, Buenos Aires, Argentina; División Neurocirugía, Hospital Británico, Buenos Aires, Argentina
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Berridge CT, Kailavasan M, Logan M, Johnson J, Biyani CS, Taylor J. A training model to teach early management of priapism. Actas Urol Esp 2021; 45:220-224. [PMID: 33541743 DOI: 10.1016/j.acuro.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ischaemic priapism is a urological emergency with early treatment required to prevent irreversible loss of erectile function. Corporal aspiration is the first step in management. Currently, there are no satisfactory training models to develop skills in a controlled environment. We have therefore developed a novel training model to teach trainees the steps of penile aspiration in a safe and representative way. MATERIALS AND METHODS We have developed a priapism model using an old catheterisation teaching model. Face validity of the model was assessed by participants and experienced urologists teaching on a urology boot camp. All had managed at least 5 cases of actual priapism. Responses were reported using a 5-point Likert Scale. Data were analysed using IBM SPSS Statistics V25. The intra-class correlation was calculated using a «One-way Random model». RESULTS Eleven urologists and seven trainees participated in the evaluation. The model appearance was reported as the best simulation trait of the priapism model. Tactile feedback from needle insertion for aspiration was also felt to be realistic with 72.6% reporting it as «Good» or «very good» and 85.7% reported the model to be realistic for needle insertion. Intra-class correlation amongst experts was 0.552. Majority of trainees (83.3%) reported a realistic simulation. All evaluators agreed or strongly agreed that the model provided a good simulated experience that would be useful in training. CONCLUSION Our model provides a realistic simulation of corporal aspiration. It can be used repeatedly. Overall, the proposed model appears to be a promising tool for training junior doctors in the initial management of ischaemic priapism.
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Affiliation(s)
| | - M Kailavasan
- Bleicester General Hospital, Leicester, Reino Unido
| | - M Logan
- Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds, Reino Unido
| | - J Johnson
- Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds, Reino Unido
| | - C S Biyani
- Medical Education, Leeds Teaching Hospitals NHS Trust, Leeds, Reino Unido.
| | - J Taylor
- Forth Valley Royal Hospital, Escocia, Reino Unido
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García Romero R, Ros Arnal I, Romea Montañés MJ, López Calahorra JA, Gutiérrez Alonso C, Izquierdo Hernández B, Martín de Vicente C. [Evaluation of dysphagia. Results after one year of incorporating videofluoroscopy into its study]. An Pediatr (Barc) 2017; 89:92-97. [PMID: 29129487 DOI: 10.1016/j.anpedi.2017.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Dysphagia is very common in children with neurological disabilities. These patients usually suffer from respiratory and nutritional problems. The videofluoroscopic swallowing study (VFSS) is the most recommended test to evaluate dysphagia, as it shows the real situation during swallowing. OBJECTIVES To analyse the results obtained in our centre after one year of the implementation of VFSS, the clinical improvement after confirmation, and the prescription of an individualised treatment for the patients affected. MATERIAL AND METHODS VFSS performed in the previous were collected. The following variables were analysed: age, pathology, degree of neurological damage, oral and pharyngeal and/or oesophageal dysphagia and its severity, aspirations, prescribed treatment, and nutritional and respiratory improvement after diagnosis. A statistical analysis was performed using SPSS v21. RESULTS A total of 61 VFSS were performed. Dysphagia was detected in more than 70%, being moderate-severe in 58%. Aspirations and/or penetrations were recorded in 59%, of which 50% were silent. Adapted diet was prescribed to 56%, and gastrostomy was performed on 13 (21%) patients. A statistical association was found between neurological disease and severity of dysphagia. The degree of motor impairment is related to the presence of aspirations. After VFSS evaluation and treatment adjustment, nutritional improvement was found in Z-score of weight (+0.3SD) and BMI (+0.4SD). There was respiratory improvement in 71% of patients with dysphagia being controlled in the Chest Diseases Department. CONCLUSIONS After implementation of VFSS, a high percentage of patients were diagnosed and benefited from a correct diagnosis and treatment. VFSS is a fundamental diagnostic test that should be included in paediatric centres as a diagnostic method for children with suspected dysphagia.
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Affiliation(s)
- Ruth García Romero
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Infantil Miguel Servet, Zaragoza, España.
| | - Ignacio Ros Arnal
- Servicio de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Infantil Miguel Servet, Zaragoza, España
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Adel F, Ramia JM, Gijón L, de la Plaza-Llamas R, Arteaga-Peralta V, Ramiro-Perez C. [Extrahepatic and extrapulmonary hydatidosis]. CIR CIR 2017; 85:121-126. [PMID: 27609088 DOI: 10.1016/j.circir.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. OBJECTIVE To present our experience in extrahepatic and extrapulmonary hydatidosis. MATERIAL AND METHODS Period: May 2007-December 2014. Health area: 251,000 inhabitants. During that period, a total of 136 patients with hydatid disease were evaluated in our Hepato-pancreatic-biliary Surgery Unit. Extrahepatic and extrapulmonary hydatid disease was found in 18 (13%) patients. A retrospective review was performed on all medical records, laboratory results, serology, diagnostic methods, and therapeutic measurements of all patients. An abdominal ultrasound and CT, as well as hydatid serology was also performed on all patients. RESULTS The mean age of the patients was 44.5 years, with a range of 33-80 years. Half the patients (50%) had concomitant hepatic echinococcosis. Of the 18 patients with hydatid disease, 13 underwent surgery (radical surgery in 12 cases), and one underwent (endoscopic retrograde cholangiopancreatography)+puncture, aspiration, injection and re-aspiration. The remaining 4did not have surgery due to patient refusal (3), or advanced cancer (1). No recurrences have been observed. CONCLUSION The best surgical treatment in these cases is closed total cystectomy to prevent recurrence, except in the spleen where splenectomy is preferred. Conservative techniques are indicated in cases of multiple hydatid disease and in patients with high surgical risk.
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Affiliation(s)
- Farah Adel
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España.
| | - José Manuel Ramia
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
| | - Luis Gijón
- Servicio de Radiología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Roberto de la Plaza-Llamas
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
| | - Vladimir Arteaga-Peralta
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
| | - Carmen Ramiro-Perez
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
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Lluna J, Olabarri M, Domènech A, Rubio B, Yagüe F, Benítez MT, Esparza MJ, Mintegi S. [Recommendations for the prevention of foreign body aspiration]. An Pediatr (Barc) 2016; 86:50.e1-50.e6. [PMID: 27234822 DOI: 10.1016/j.anpedi.2016.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
The aspiration of a foreign body remains a common paediatric problem, with serious consequences that can produce both acute and chronic disease. Aspiration usually causes a medical emergency that requires a prompt diagnosis and an urgent therapeutic approach as it may result in the death of the child or severe brain injury. It typically involves organic foreign bodies (mainly food or nuts) aspirated by children under 5 years old, and usually at home. In this statement, the Committee on Safety and Prevention of Non-Intentional Injury in Childhood of the Spanish Paediatrics Association provides a series of recommendations, both educational (while eating and playing), as well as legal, to prevent such episodes.
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Affiliation(s)
- Javier Lluna
- Servicio de Cirugía Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, España.
| | - Mikel Olabarri
- Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Bilbao, España
| | - Anna Domènech
- Servicio de Cirugía Pediátrica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Bárbara Rubio
- Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Francisca Yagüe
- Servicio de Pediatría, Hospital Universitario de Son Espases, Palma de Mallorca, Baleares, España
| | - María T Benítez
- Instituto de Salud Pública, Ayuntamiento de Madrid, Madrid, España
| | - María J Esparza
- Atención Primaria, Centro de Salud Barcelona, Móstoles, Madrid, España
| | - Santiago Mintegi
- Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Bilbao, España
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