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Background : Acute respiratory obstructions are caused by foreign bodies in the trachea. In children the most common obstructions are inhaled playthings of food (such as nut). An unusual cause is that inhaled fractured inner tracheostomy tube.Objective : To describe an unusual tracheobronchial foreign bodySetting : Department of Otolaryngology, Faculty of Medicine, Khon Kaen University, Khon KaenResults : A 7-year-old boy had subglottic stenosis wuth trachestomy tube dependent. He presented with pneumonia and we discovered a fractured inner tracheostomy tube lodged in the left main bronchus. We removed the foreign body with bronchoscope via the tracheostoma.Conclusion : A report of the removal of an unusual tracheobronchial foreign body and suggested methods for management of tracheostomy tubes to prevent such incidents.
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Background: In 2004, most medical-school hospitals in Thailand stopped taking new registrations for the social security scheme because the scheme was predominantly used by persons with severe or chronic diseases. Srinagarind Hospital itself initiated a private clinic network in order to increase admissions eligible for funding under the social security scheme, but also found expenditure is increasing.Objective: To determine the proportion of the utilization of health services of the group that was new for Srinagarind Hospital, but previously registered at other hospitals(nfs group), compare to all new registrants .Design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, ThailandSubjects: Between May 1 and July 31 2004, 113 persons came for treatment at Srinagarind Hospital.Results: We found that the nfs group accounted for 57.4% (95% CI : 48.3, 66.5 )of the number of health visits of all new registrants but 84.2% (95% CI : 77.5, 90.9 ) of the total expenditures. By contrast, the new and never registered anywhere else’ group (nn group) accounted for 43% of the number of health visits of all new registrants but only 16% of the expenditures. Age and sex were not statistically significant factors when comparing the two groups. The nfs/nn ratio was 3.92 (i.e. 6,921.4 vs. 1,763.5 Baht) for the treatment cost per patient and 5.11 (i.e. 21.5 and 4.2%) for the inpatient admission rate.Conclusion: The study confirms an existing of the selection bias by patients with expensive and chronic diseases for healthcare provided by the social security scheme. Further study is needed to get the appropriate risk adjustment figures to make the scheme more efficient.
RESUMO
Background : Laryngo-tracheo-esophageal cleft (LTEC) is a rare congenital anomaly resulting from failure of the posterior cricoid larmina to fuse and incomplete development of tracheoesophageal septum . In symptomatic cases, early presentation is with feeding problems, choking, chronic coughing, wheezing, cyanotic spells and apnea. Aspiration pneumonia may result and cause of life-threatened morbidity. The awareness of unusual clinical features of LTEC will lead to early investigations and diagnosis, which can prevent further complications. Surgery is the treatment of choice to correct this anomaly. These 2 LTEC cases would make medical personals familiar with clinical presentation and surgical management.Objective : To review and report surgical management in 2 cases of LTEC at Srinagarind HospitalStudy Design : Case report by clinical data collection from medical record of LTEC patients who admitted during 1 December 2005 and 31 July 2006Results : These 2 LTEC cases recently presented within 5 month-interval at Srinagarind Hospital throughout the last 20 years. Both cases had the same symptoms of dyspnea, cyanosis and aspiration pneumonia. Only one case is still alive after definite surgery. The first LTEC was a 1800-gram-male newborn of 36 year-old mother, G1P0, GA 42 wks. He was normally labored with APGAR score 8,9,10, and developed dyspnea and cyanosis after 1 hour later. His anomaly was detected during intubation and needed 2 endotracheal tubes insertion. Under direct laryngoscopic and bronchoscopic finding, the LTEC classified as type VI (complete cleft from arythenoid throughout carina). He had severe aspiration pneumonia and needed gastrostomy tube for decompression. And he finally got esophageal ligation to completely control regurgitation and jejunostomy tube for enteral feeding. The definite surgery was planed as soon as his weight reached 3 kg. Unfortunately, he got severe pneumonia and septicemia, and terminated with respiratory failure.The second case was a 3000 gm female newborn of 19 year-old mother,G1P0, GA 39 wks. She was obviously diagnosed anal atresia with ano-vestibular fistula, and later suspected LTEC due to frequent endotracheal tube dislodgement. Direct laryngoscopy and bronchoscopy identified LTEC type III (cleft extent from arythenoids to distal trachea at level of 2.5 cm above carina). She got gastrostomy tube for gastric decompression and jejunostomy tube for early feeding. Finally the surgical separation of trachea and esophagus was performed on the 33rd day of live. She has had excessive secretion and needed tracheostomy tube for secretion clearance. At present, she can suck nibble well but hardly swallow infant formular. The radiological investigations reviewed slightly narrowing of the esophageal lumen without leakage. The further surgical plan is esophageal dilatation and correction the rest laryngeal cleft. The development of laryngeal function should be periodic examined and physiotherapy are considered to improve air way clearance.Conclusions : Even LTEC is a rare aerodigestive anomalies, intensive medical care is needed throughout the admission. Early diagnosis is the important factor to decrease risk of complications. Surgery is the main treatment for survival. Postopertive care is necessary to improve the quality of life. Key words : laryngo-tracheo-esophageal cleft, laryngotracheal cleft, posterior laryngeal cleft