An impacted live fish in the oropharynx of an 8-year-old child

OBJECTIVE: To present an atypical case of a live fish lodged in the throat of a pediatric patient and discuss its management.METHODS:Design: Case ReportSetting: Tertiary Government HospitalPatient: OneRESULT: An 8-year-old girl swallowed a live fish when she accidentally fell in a body of water. Failed attempts to remove the live fish prompted consult in the emergency room of our hospital, where removal of the foreign body was successfully done using Mixter right angle forceps assisted with a gloved finger. Transient cyanosis and unresponsiveness during extraction was overcome with oxygen by mask and she regained consciousness. She was allowed to go home as no other untoward events or complications were observed.CONCLUSION: All ingested foreign bodies particularly in children require immediate attention. The survival of patients with upper aerodigestive and airway foreign bodies depends on early recognition and prompt multidisciplinary management.

Adult acute epiglottitis: An eight - year experience in a Philippine tertiary government hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review cases of adult acute epiglottis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes. <br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria. Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected.<br /><strong>RESULTS:</strong> There were 20 cases in 7 years and 8 months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73% and 83%, respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days.<br /><strong>CONCLUSION:</strong> Adult acute epiglottis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease. Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised. Intravenous antibiotics are necessary and corticosteroids may be of benefit. </p>

The effectiveness of intravenous tranexamic acid on blood loss and surgical time during endoscopic sinus surgery: A systematic review

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review the effectiveness of intravenous tranexamic acid in reduction of blood loss, surgical time and field visualization among patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis  (CRS).<br /><strong>METHODS:</strong> <br /> <strong>Data Sources:</strong> MEDLINE (PubMed), EMBASE, ScienceDirect, HERDIN, and the Cochrane Library.<br /><strong> Eligibility Criteria: </strong>Randomized controlled trials (RCT) between 2005-2014 that evaluated the effects of   tranexamic  acid or placebo in patients undergoing ESS for CRS.<br /> <strong>Appraisal and Synthesis Methods:</strong> Articles were selected by 2 independent reviewers and methodological quality was blindly evaluated using a Jadad scale. Data were compiled in tables for analysis of outcome measures (estimated blood loss, length of surgery and intraoperative surgical field visualization).<br /><strong>RESULTS:</strong> Two trials were included in the study, enrolling 128 patients. One arm of the study had been given tranexamic acid while the other arm was given placebo (saline solution). Results varied for both studies. The summary of the observed difference for blood loss had a standardized mean difference of -51.20 (Cl95 [-59.44, -42.95]) showing that the blood loss in millimeters was less in the tranexamic group compared to saline solution. The summary of the observed difference in surgical time had a standardized mean difference of -19.32   (Cl95 [-24.21, -14.43]) showing that the surgical time in minutes was shorter in the tranexamic group compared to saline solution.  The secondary outcome on surgical field visualization was not pooled together because the studies used different measurement scales.<br /><strong>LIMITATIONS:</strong> The most important weaknesses of the 2 included studies were the differences in dose of tranexamic acid, scales of measurement of field visibility and age groups of the patients. <br /><strong>CONCLUSION:</strong> Tranexamic acid reduced blood loss and shortened surgical time after ESS among patients with CRS. However, the additional benefit of tranexamic acid for better field visualization was not clear. Adverse effects were not considered in the study, however, results support the use of intravenous tranexamic acid intraoperatively as an option for ESS with blood loss  as a concern. Further randomized clinical trials and an update on the systematic review will strengthen the evidence on the effectivity of tranexamic acid for ESS.<br /><br /><br /><br />               </p>