Risk factors predicting the development of complications after foreign body ingestion.

BACKGROUND: The aim of this study was to determine the predictive risk factors for complications resulting from foreign body ingestion. METHODS: A consecutive series of 1338 patients with suspected foreign body ingestion presenting from 1996 to 2000 were studied retrospectively. The potential risk factors for complications after foreign body ingestion were analysed by multivariate logistic regression and included concurrent medical illness, age, duration and types of symptoms, types of foreign body ingested, positive cervical radiographic findings and the level of foreign body impaction. RESULTS: Fish bone (62.7 per cent) was the commonest type of foreign body ingested. Most of the objects were impacted at or above the cricopharyngeus, the commonest site being the valleculae (31.4 per cent). Multivariate analysis showed that presentation delayed for more than 2 days (P < 0.001), positive cervical radiographic findings (P < 0.001) and foreign body impacted at the cricopharyngeus (P = 0.009) or upper oesophagus (P = 0.005) were significant independent risk factors associated with the development of complications after foreign body ingestion. CONCLUSION: In patients with a foreign body seen on plain cervical radiography, presentation delayed for more than 2 days after ingestion, and foreign body impacted at the level of the cricopharyngeus or oesophagus there is a high degree of correlation with the occurrence of complications. Awareness should be raised when these risk factors are present.

Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial.

AIM: Recurrent bleeding after initial haemostasis is an important factor that directly relates to the outcome in the management of peptic ulcer bleeding. Conflicting reports have been published concerning the effectiveness of scheduled second therapeutic endoscopy on ulcer rebleeding. We investigate the use of scheduled second endoscopy with appropriate therapy on peptic ulcer rebleeding. METHODS: From August 1999 to January 2001, we prospectively randomised patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of acute bleeding, visible vessel, or adherent clot into two groups. Endoscopic therapy was standardised to initial epinephrine injection and subsequent heater probe application. The study group (n = 100) received scheduled second endoscopy 16-24 hours after initial haemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. The control group (n = 94) were observed closely. Those patients that developed rebleeding in either group underwent operation if further endoscopic therapy failed. Outcome measures included ulcer rebleeding, transfusion, duration of stay, and mortality. RESULTS: After initial endoscopic haemostasis, 194 eligible patients were randomised into two groups. Thirteen patients in the control group developed recurrent bleeding within 30 days while five patients in the study group sustained recurrent bleeding (p = 0.0314) (relative risks 0.33, 95% confidence interval 0.1-0.96). The number of patients that required surgery for recurrent bleeding was six in the control group and one in the study group (p = 0.05). There was no difference in duration of hospital stay, transfusion, or mortality between the two groups. CONCLUSIONS: A scheduled repeat endoscopy with appropriate therapy 16-24 hours after initial endoscopic haemostasis reduces the number of cases of recurrent bleeding.

Use of botulinum toxin type A in a case of persistent parotid sialocele.

Sialocele is an uncommon complication of parotidectomy. Most cases resolve after conservative therapy consisting of repeated aspiration and pressure dressing. The condition is, however, occasionally resistant to such therapy. We report on a 52-year-old Chinese man who had a 10-year history of right parotid swelling. Following fine-needle aspiration cytology, Warthin's tumour was diagnosed, but after elective parotidectomy, a swelling developed and parotid sialocele was diagnosed. Botulinum toxin type A was given after the sialocele had persisted for almost 3 weeks after surgery, and after conservative management had been tried; the sialocele disappeared after two doses of treatment. Botulinum toxin therapy was thus an effective method of treating persistent sialocele.

Endoscopic management of submandibular sialolithiasis.

BACKGROUND: Transoral removal and sialoadenectomy are the two main modalities of treatment for submandibular stones. However, missed ductal stones are not uncommon, and there is a risk of lingual or hypoglossal nerve injury. We attempted to avoid these complications by using an endoscopic technique. METHODS: The case notes of the patients who had undergone endoscopic removal of submandibular stones were studied retrospectively. The procedure was performed under general anesthesia. The submandibular orifice was incised by carbon dioxide laser, and a 3.1-mm rigid scope was inserted under direct vision with normal saline irrigation after dilatation. The stones were either broken down by laser or removed with a Dormia basket or forceps. RESULTS: A total of 13 patients underwent the procedure. The duration of median follow-up was 15 months. In 11 patients, the stones were identified and removed. No stone was found in two patients (15.4%). There were no false negatives, since no stones were discovered subsequently in these two patients. One, two, three, and four stones were present inside the ducts in seven patients (54.6%), one patient (7.7%), two patients (15.4%), and one patient (7.7%), respectively. The symptoms subsided completely in 11 patients within 4 weeks after the procedure. Persistent swelling occurred in two patients. In one of them, no residual stone was revealed by CT scan. The other patient had a large calculus that was only partially fragmented by laser lithotripsy at the initial operation. No lingual nerve or hypoglossal nerve injury was detected in any patient. CONCLUSION: Sialoendoscopy is a safe and efficacious treatment for submandibular ductal stones. It reduces the incidence of missed stones, and nerve injury, as well as the need for sialoadenectomy.

Lymphoepithelioma-like carcinoma of oral cavity: report of three cases and literature review.

Lymphoepithelioma-like carcinoma is a rare tumour in the oral cavity and is characterized histologically by non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. Three consecutive cases of intraoral lymphoepithelioma-like carcinoma are reported. A review of the literature reveals a similar biological behaviour to that of nasopharyngeal lymphoepithelioma: a high incidence of cervical nodal spread and remarkable radiosensitivity. Chemotherapy should be considered when nodal or distant metastases are present. The association of the Epstein-Barr virus with this tumour remains unclear but our experience suggests a positive correlation in Chinese individuals.