Child abuse with multiple sharp foreign bodies penetrating the chest wall causing hemothorax and cardiac tamponade in two separate occasions: Case report.

We present a case of repeated child abuse causing left-sided hemothorax and cardiac tamponade on two separate occasions. A 14-year-old cerebral palsy male presented with left-sided hemothorax and multiple metallic foreign bodies in the chest wall managed by small limited incision, removal of the foreign bodies and chest tube. One week later, he came to our emergency department (ER) with multiple chest wall foreign bodies and tamponade managed by median sternotomy, removal of the foreign bodies, one of them was in the LAD. He had a smooth postoperative course and the case is under investigation.

Metallic hairpin inhalation: a healthcare problem facing young Muslim females.

OBJECTIVES: To perform an epidemiological assessment of metallic hairpin inhalation in young Muslim females and highlight the need for a health education program in this population. METHODS: We performed a retrospective analysis of females with a history of metallic hairpin inhalation presenting to the Otolaryngology and Cardiothoracic Surgery Departments at Mansoura University Hospitals from January 2000 to October 2006. RESULTS: A total of 83 patients were identified with metallic hairpin inhalation, of which 2 were excluded as they were coughed and expelled by the patient. Ages ranged from 7 to 19 years. A history of inhaled foreign body (FB) was found in all cases but the majority of patients were asymptomatic, with only 6 patients (7%) presenting with cough. Chest x-rays confirmed the presence of metallic hairpin inhalation in all cases. The metallic hairpins were present in the trachea in 7 patients (9%), in the left bronchial tree in 43 patients (53%) and in the right bronchial tree in 31 patients (38%). Rigid bronchoscopy was performed in all patients with a retrieval rate of 80%. Repeat bronchoscopy was performed in 16 patients (20%), which was successful in 11 patients (14%). The remaining 5 patients required thoracotomy for removal of the metallic hairpin (6%). CONCLUSION: The significant number of inhaled metallic hairpins in young Muslim females highlights the need for a health education program in this population. Rigid bronchoscopy remains the primary tool for retrieval of these inhaled foreign bodies. However, when repeat broncoscopy is necessitated, a thoracotomy may be required.

Inhaled foreign bodies: management according to early or late presentation.

OBJECTIVE: This retrospective study aims to compare the early and late clinical and management aspects of tracheobronchial aspirated foreign body (AFB), to evaluate the factors associated with delayed diagnosis of foreign body aspiration (FBA) in children and to compare clinical, radiological and bronchoscopic findings in the patients with suspected FBA. A retrospective review of a 10-year experience (from 1995 to 2005). A 1512-bed Mansoura University Hospital and 184-bed Mansoura University Emergency Hospital. METHODS: The medical records of 3300 patients who underwent bronchoscopy for suspected FBA were reviewed. The data were analysed in three groups: the patients with negative bronchoscopy for FBA (group I), early (group II) and delayed diagnosis (group III). Foreign body was removed using the rigid bronchoscope with or without using the extracting forceps (Egyptian novel technique described in the hand made illustration). RESULTS: The majority of the patients with FBA were between 3 and 10 years of age. The penetration syndrome and decreased breath sounds were determined in a significantly higher number of the patients with FBA. The plain chest radiography revealed radio-opaque foreign bodies (FBs) in 23.56% of all patients with FBA. Pneumonia and atelectasis were significantly more common in the groups with negative bronchoscopy and with delayed diagnosis (P<0.01). The FBs were most frequently of vegetable origin, such as seeds and peanuts. A significant tissue reaction with inflammation and postbronchoscopic complications were more common in the delayed cases. The novel technique was used since then in 100 cases (4.62%) with a history of FBI (Pins and or small rounded materials). It was successful in 73 (73%) cases of non-impacted inhaled pins. Use of forceps was needed in 21 (21%) cases. Rebronchoscopy despite using both techniques was needed in six (6%) cases within 72h. Failed extraction of the inhaled FB occurred in three cases (3%) for whom bronchotomy was needed. CONCLUSIONS: Bronchoscopy is indicated on appropriate history and on suspicion. To prevent delayed diagnosis, characteristic symptoms, signs and radiological findings of FBA should be checked in all suspected cases. As clinical and radiological findings of FBA in delayed cases may mimic other disorders, the clinician must be aware of the likelihood of FBA.

Acute effects of lobectomy on right ventricular ejection fraction and mixed venous oxygen saturation.

BACKGROUND: Traditional methods of assessing the operative risk for lung resection provide only a modest ability to predict postoperative morbidity and mortality. The aim of this study was to evaluate the effect of lobectomy on pulmonary hemodynamic and gas exchange variables using the RV thermodilution ejection fraction/oximetric catheter. METHODS: We evaluated the acute postoperative effects of lung resection on hemodynamic and gas exchange parameters in 30 patients. Anesthesia was induced with thiopentone sodium and maintained with midazolam, fentanyl and pipecuronium. Intubation was performed with a double-lumen, left-sided endobronchial tube for one lung ventilation. The hemodynamic and gas exchange parameters were recorded before and after induction of anesthesia, and two hours after lung resection. These parameters were also recorded after the classification of the patients according to the underlying lung pathology. RESULTS: Lobectomy was associated with significant hemodynamic changes and good maintenance of gas exchange variables. SVI, LVSWI and RVEF were significantly decreased in the early postoperative period after lung resection. MPAP, COP, CI, SVRI, PVRI, RVSWI, and RVEDVI showed no significant changes during the perioperative period. SVO2 showed a significant increase after lung resection when compared with preinduction values, while VO2 significantly decreased. SaO2, a-A PO2, QS-QT, DO2, and O2ER showed no significant changes during the perioperative period. CONCLUSIONS: We conclude that in the acute post-resection period (up to 2 hours postoperatively) there is right and left ventricular dysfunction with good maintenance of gas exchange.

Epidermoid cyst radiologically mistaken as a left sided subpulmonic effusion.

A 33-year-old female had a left sided chest pain for the last 3 months. Chest X-ray showed a left basal opacity. Computed tomography chest suggested a left sided subpulmonic effusion (17.5x12.2x13 cm) with thick enhanced walls with marked collapse of the left lower lobe and displacement of the heart and mediastinum to the right side. Trial of thoracocentesis was done and it was positive. Trial of intercostal tube insertion was done with a sense of very thick pleura and the patient developed a vasovagal attack. Accordingly, exploratory thoracotomy was decided. Intraoperative assessment showed a huge anterosuperior mediastinal cyst attached to the pericardium and was successfully resected. The pathological findings were compatible with epidermoid cyst.