ABSTRACT
BACKGROUND: Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. METHODS: We retrospectively analyzed 37 pediatric case records who presented from January 2014-December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. RESULTS: Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non -vegetative. CONCLUSION: Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.
Subject(s)
Bronchoscopy , Foreign Bodies/diagnosis , Radiography, Thoracic , Algorithms , Bronchi , Child , Child, Preschool , Cough/etiology , Delayed Diagnosis , Dyspnea/etiology , Emergency Service, Hospital , Female , Humans , Infant , Lung/diagnostic imaging , Male , Respiratory Sounds/etiology , Retrospective Studies , TracheaABSTRACT
BACKGROUND: For patients with end-stage renal disease, a good vascular access is essential for chronic haemodialysis. Surgically created access arteriovenous fistula for haemodialysis is associated with multiple complications, and ruptured pseudoaneurysm being the most life threatening and dreaded of all. The management of this complication warrants emergency procedure, although timely diagnosis and arteriovenous fistula salvage has been emphasised. In this study, we describe the surgical technique and outcomes of ligation of the proximal arteriovenous fistula as a plausible alternative and life-saving procedure. METHOD AND RESULTS: This is a retrospective study performed between January 2011 and December 2016. A total of 588 native arteriovenous fistula-related surgeries were performed, of which 18 patients (3.06%) developed delayed complication of infected pseudoaneurysm and rupture. All presented to the emergency care with life-threatening bleeding. We describe the surgical technique as a life-saving measure to this fatal complication. CONCLUSION: Proximal arteriovenous fistula has higher incidence of aneurysmal complications than distal ones. Ligation of the brachial artery which was a 'grey zone' of unpredictable prognosis has yielded good results and can be safely performed in desperate situations with low complication rates.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Infected/surgery , Aneurysm, Ruptured/surgery , Arteriovenous Shunt, Surgical/adverse effects , Brachial Artery/surgery , Kidney Failure, Chronic/therapy , Renal Dialysis , Upper Extremity/blood supply , Adult , Aged , Aneurysm, False/diagnostic imaging , Aneurysm, False/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/microbiology , Brachial Artery/diagnostic imaging , Emergencies , Female , Humans , Ligation , Male , Middle Aged , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young AdultABSTRACT
Ventricular septal defect (VSD) with valvar pulmonary stenosis (PS) is a combination of cardiac defects for which treatment by means of percutaneous catheter-directed intervention is sometimes considered. Septal occluder device embolization is a rare but potentially dreadful complication. Adequate precautions are of great importance, as operator-related and anatomical factors can contribute to the risk of device embolization. In this report, we present a case of a five-year-old patient with a perimembranous VSD and valvar PS with infundibular muscle hypertrophy. The PS was treated with balloon pulmonary valvotomy, and the VSD was closed with a catheter-directed duct occluder device. Soon after deployment, the device embolized to the aortic arch, possibly as a result of the single disc device being "milked" out of VSD by dynamic contractions of hypertrophied muscle in the right ventricular outflow tract. The embolized device was successfully retrieved and removed using cardiopulmonary bypass and a period of circulatory arrest.
