ABSTRACT
INTRODUCTION: Foreign bodies in the external auditory canal are common in both adults and children. Removal of the foreign body requires skill, but is usually successfully performed in the emergency department. We report a case of a child with a bullet in ear canal which was pushed into the middle ear during an attempt to remove it. CASE PRESENTATION: A 6-year-old Thai boy went to the community hospital with his parents, who reported that their child had pushed a bullet into his ear. Otoscopic examination revealed a metallic foreign body in his external auditory canal. The first attempt to remove the foreign body failed and the child was referred to an otolaryngologist. We found that the tympanic membrane was ruptured, with granulation tissue in the middle ear and the bullet was located in the hypotympanum. The foreign body was removed via a post-auricular approach. CONCLUSION: Removal of a foreign body from external auditory canal is an essential skill for physicians. Careful removal can prevent further trauma and complications. When the first attempt fails, referral to an otolaryngologist is recommended.
ABSTRACT
OBJECTIVE: To clarify the peritonitis rate and to characterize the differences between the peritonitis and non-peritonitis group in ESRD children using continuous ambulatory peritoneal dialysis (CAPD) in Khon Kaen, Thailand. MATERIAL AND METHOD: The authors reviewed the medical records of ESRD children under 15 years old at the time of PD catheter placement, who received CAPD in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between 1994 and 2007. RESULTS: Eighteen male andfifteen female patients were identified Their mean age at the time of PD catheter placement was 11.48 +/- 3.12 years (range, 3.52-15.67). Twenty patients (11 male and 9female) were complicated with 47 episodes of peritonitis during 400.44 patient-months. The peritonitis rate was one episode every 8.52 patient-months. The three most frequent clinical presentations were cloudy effluent (78.72%), abdominal pain (76.60%) and fever (63.83%). Negative effluent culture was 42.55%. Staphylococcus aureus and Enterococcus species were the two most frequent causative organisms. The dialysis duration and serum creatinine level were significantly different between the peritonitis and non-peritonitis groups. CONCLUSION: Peritonitis frequently occurred in ESRD children treated by CAPD in Northeast Thailand, particularly from gram-positive organisms. The dialysis duration and serum creatinine level at the time of catheter placement were associated with PD peritonitis.
