Scarf pins sharp metallic tracheobronchial foreign bodies: presentation and management.

OBJECTIVES: Scarf pin inhalation is a cultural hazard in the Middle East young girls. So the aim of this work is to study the presentation of inhaled sharp airway foreign bodies (AFB) and its management. METHODS: Clinical and radiological presentation of inhaled sharp AFB was studied prospectively in 20 young females. All the sharp pins was extracted using rigid bronchoscopes with grasping forceps in 11 and magnetic extractor in 9. RESULTS: The most common presentation after inhalation was penetration syndrome (70%) (sudden onset of chocking and intractable cough). The distribution of AFBs was more significantly in the proximal 90% than the distal (p<0.05). It was significantly more in the left side (65%) than in the right side bronchial tree (5%) (p<0.05). The delay in diagnosis ranged from 6h to 1 week, with no complications on extraction. CONCLUSION: Scarf pins aspiration in females can be mainly presented with penetration syndrome. The site at presentation is mainly in left main bronchus. Early intervention, using rigid bronchoscopes with extraction using grasping forceps or magnetic extractor allowed easy and safe removal. Careful handling of these potentially sharp objects away from the mouth can prevent this critical problem.

Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma.

BACKGROUND: The authors used computed tomography (CT) scans to correlate the changes in tumor vascularity, necrosis, and size with response and survival after transcatheter arterial chemoembolization (TACE) in patients with advanced, unresectable, hepatocellular carcinoma (HCC). METHODS: The authors studied 72 patients with biopsy-proven, unresectable HCC and focused on 186 individual tumor masses. A baseline, multiphase, helical CT was performed and at least three follow-up CT scans were performed after treatment by TACE. Tumors were classified as hypervascular or hypovascular and patients were classified as responders or nonresponders based on CT evidence of altered tumor size, tumor necrosis, and the appearance of new tumors. A new scoring system was used to monitor patient response to TACE. RESULTS: Thirty-eight patients were responders and 34 were nonresponders. Patient survival was significantly increased (P = 0.009) in patients who were hypervascular responders. Survival also was increased in hypervascular nonresponders compared with hypovascular nonresponders (P = 0.008) and in hypovascular responders compared with hypovascular nonresponders (P = 0.002). Response to chemoembolization was found to be significantly (P = 0.02) and inversely proportional to tumor size, but the number of tumor foci in an individual patient was not predictive. CONCLUSIONS: TACE appears to result in improved survival among HCC patients with hypervascular tumors who responded to therapy. However, even patients classified by CT as hypervascular nonresponders and hypovascular responders have improved survival.