Sharp PIN inhalation in tracheo-bronchial tree in women wearing hijab

To investigate the presence of sharp pin inhalation in tracheo-bronchial tree in women wearing a hijab. This was a descriptive study that was conducted in the thoracic surgical department in al-sader teaching hospital, Basra from February 2010 to March 2011. Detailed history was taken from all the patients. Clinical examination, chest radiography and rigid bronchoscopy under general anesthesia were done to all the patients included in the study. In those, where rigid bronchoscopy failed to remove the pin, thoracotomy was done. The mean age of the sample was 19.5 years. All females presented with cough while two of them had hemoptysis [5.5%] and five had unilateral wheeze on chest auscultation [13.8%]. The majority [n=28, 77.8%] of pins were located in the left main bronchus. The rest were either in the right main bronchus [n=5, 13.8%] or in trachea [n=3, 8.4%]. Pins from 32 [88.9%] patients were removed by Negus rigid bronchoscopy. In only 4 [11.1%] patients, thoracotomy was done to remove the foreign body. Sharp pin inhalation is a serious hazard and can have lethal outcome. It commonly occurs when women hold the pins in their teeth while wearing the hijab and talking to others at the same time

Abnormal post-operative bleeding in patients with congenital heart diseases undergoing open heart surgery

To report the incidence of postoperative bleeding and to evaluate perioperative parameters and its relationship with the volume of blood loss and blood transfusion requirement. This was a retrospective study of 49 patients with congenital heart diseases undergoing open heart surgery developing abnormal post operative bleeding in Ibn Al-Bitar hospital for cardiac surgery from January 1st, 2004 to December 31st, 2008, There were 29 males [59%], and 20 females [41%]. Age ranged from 3-38 years with an average of 20 years. The study involved data obtained when the patients arrived at the intensive care unit [ICU] and for the following 24 hours. Young children, female gender, lower body weight and surface area, cyanotic heart diseases, types of procedures, longer time of CPB and aortic clamping time, low temperature, type of oxygenator used in CPB [affinity], higher total intra- operative doses of heparin and protamine, all were shown to significantly increase postoperative blood loss and transfusion requirement. The incidence of postoperative bleeding was 9.35%. Twelve percent needed reoperation to control hemorrhage. The morbidity was 24.3% and the mortality was 4.1%. Factors that may contribute to increased blood loss and transfusion requirement include age below 10 years, female gender, low body weight and surface area, prolonged duration of CPB, hypothermia, preoperative anemia, and high doses of heparin and protamine

Fentanyl transdermal therapy system [ITS-patch] for post-traumatic blunt chest injury

Proper post-extubation pain control in traumatic blunt chest injury represents a challenge to provide adequate analgesia for proper lung inflation and to prevent re-intubation. In this case, the average opioid [Remifentanil] infusion drip in a traumatic blunt chest injury patient in the 48 hours prior to extubation was calculated and converted to the equivalent analgesic one of the Fentanyl Transdermal Therapeutic System [Fentanyl TTS Patch]. The analgesic gap before the onset of action for the applied fentanyl patch was covered by frequent injections of tramadol. Evaluation of the Fentanyl TTS effect through the post-extubation period was carried out by measuring the analgesic effect on a visual analogue scale, the alertness status by simple sedation score, while the respiratory performance was followed by the negative inspiratory force. The outcome in this case showed that Fentanyl Patch is a reliable, favorable, safe and non-invasive method that produces a good analgesic effect and positive impaction on the post-extubation course of respiratory performance with a satisfactory outcome and no side effects