RESUMO
BACKGROUND/PURPOSE: Considerable debate surrounds the choice of technique for the removal of esophageal coins: endoscopic extraction versus dislodgement with a Foley balloon versus dislodgement using bougienage. The "penny-pincher" (PP) technique was developed as an alternative, incorporating the main advantages of these various approaches. METHOD: The PP technique is based on the insertion of a fluoroscopically guided device that consists of a grasping endoscopic forceps covered by a soft rubber catheter. The forceps provides a firm hold on the coin. The catheter protects the oropharynx and aligns the device with the coin. Once the tip of the catheter is close to the upper edge of the coin, the previously retracted radiopaque prongs of the grasping forceps are deployed and the edge of the coin firmly grasped and extracted. The procedure is done without anesthesia or sedation. RESULTS: Twenty coins were removed from 19 consecutive children with a mean age of 34 months. Average lip-to-lip removal (including fluoroscopy) time was 41 seconds. There were no complications, and all patients were discharged shortly after coin removal. CONCLUSION: The penny-pincher method for the removal of upper esophageal coins combines the simplicity, speed, and cost effectiveness of balloon catheter or bougie coin dislodgement with the safety and secure grasping of endoscopic or forceps removal.
Assuntos
Cateterismo/métodos , Esôfago , Corpos Estranhos , Cateterismo/instrumentação , Pré-Escolar , Humanos , Lactente , NumismáticaRESUMO
A child with cystic dysplasia of the testis (CDT) that presented as a solid mass by ultrasound imaging is reported. The child also had ipsilateral multicystic dysplasia of the kidney (MCDK). A search of the literature revealed that unilateral renal agenesis (URA) is commonly associated with CDT. It is possible that CDT, MCDK, and URA share a common pathogenesis. Cystic changes in the epididymis were found in the patient and might be more frequently associated with CDT than previously reported. CDT should be considered in the differential diagnosis of a solid testicular mass detected by ultrasound.
Assuntos
Cistos/complicações , Doenças Renais Císticas/complicações , Doenças Testiculares/complicações , Cistos/diagnóstico , Humanos , Recém-Nascido , Doenças Renais Císticas/diagnóstico , Masculino , Doenças Testiculares/diagnósticoAssuntos
Ureterocele/diagnóstico , Uretra , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , ProlapsoAssuntos
Doenças Renais Policísticas/patologia , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/patologia , Anormalidades Múltiplas/terapia , Adolescente , Criança , Pré-Escolar , Diagnóstico por Imagem , Humanos , Lactente , Recém-Nascido , Rim/patologia , Doenças Renais Policísticas/diagnóstico , Doenças Renais Policísticas/genética , Doenças Renais Policísticas/terapia , Prognóstico , SíndromeRESUMO
Esophageal atresia with tracheosophageal fistula may be associated rarely with distal esophageal stenosis. Three patients are reported with this combination of esophageal anomalies. In addition the clinical and radiologic features of 24 patients previously reported in the literature are reviewed. Careful evaluation of the distal esophagus during postoperative contrast studies in patients with esophageal atresia should be obtained to exclude distal stenosis. The presence of unrecognized distal esophageal stenosis may lead to complications of postoperative anastomotic leaks, poor healing of the anastomosis, aspiration, and impaction of a solid food bolus proximal to the stenosis.