Efficacy of Foreign Body Removal using a Cryoprobe in Flexible Bronchoscopy / 고신대학교의과대학학술지

OBJECTIVES: Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy. METHODS: This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80degrees C, and the bronchoscope was removed with the probe after crystal formation on the contacted area. RESULTS: The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic,silicon,and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure. CONCLUSIONS: The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.

A Clinical Study of Child Abuse Present to In-hospital Child Abuse Center

OBJECTIVE: To promote awareness and efforts by in-hospital child abuse center to identity and prevent child abuse by investigation of victim and types of injury caused by child abuse. METHODS: A retrospective study was performed with 51 patients who had been diagnosed or suspected as child abuse at Shiny kid child abuse center in Soonchunhyang Gumi Hospital from January 2008 to December 2011. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, type of abuse, perpetrator, type of injury, final diagnosis, and follow-up success rate. RESULTS: The mean age of the subjects was 7 years old. Twenty-one patients were between 1 and 6 years old, 14 patients between 7 and 12 years old, 12 patients over 13 years old, and 4 cases less than 1 year old. The sex distribution was 47% (n=24) of male and 53% (n=27) of female. Thirty-five percentage of these patients reported with mixed abuse, 40% neglect, 29% physical abuse, 18% emotional abuse, 10.3% abandonment, and 2.5% sexual abuse, respectively. Twelve cases (23.5%) of them were found out the Routine health checkup. Bleeding and bruising (17.6%) were the second. Contusion and laceration were diagnosed in 9 cases, failure to thrive in 8 cases, tension headache in 5 cases, irritable bowel syndrome in 4 cases, sepsis of newborn in 4 cases, nephrotic syndrome in 3 cases, chronic otitis externa and media in 3 cases, mental retardation in 2 cases, congenital brain anomaly in 2 cases, major depression in 2 cases, pulmonary tuberculosis in 2 cases, diabetes mellitus in 1 case, and others in 6 cases, respectively. CONCLUSION: In-hospital child care team may experience the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.

A Case of Gitelman Syndrome

Gitelman's syndrome is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria that has recently been reported to be linked to thiazide-sensitive Na-Cl cotransporter gene mutation. We have experienced one patient whose initial complaint was paresthesia of hand and feet, who had hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria. We report the case of Gitelman's syndrome with a brief review of related literature.