Journal of Paediatric Care Insight A Deep Esophageal Injury from a Lithium Battery: A Case Report

Abstract Context: Over the last ten years the ingestion of disk batteries and its serious consequences have been increasing. The severity of injury is related to a growing diffusion of the new lithium battery that may cause catastrophic damages when lodged in the esophagus in children. Case report: A five-year-old boypresented to the Emergency Department of our tertiary pediatric Institute for a lithium battery lodged in the mid esophagus. Emergent esophagoscopy revealed a severe deep, mild bleeding ulceration of the wall in which the battery was partially wedged. The investigation was stopped and on-call cardio-vascular surgeon started left thoracotomy to exclude damages of the main vessels. With the thorax open, the endoscopy was repeated and a directional relationship between the battery and the aorta was excluded by means of transillumination. The cell, a CR2032 lithium battery, was then removed. Central line parenteral nutrition, i.v. omeprazole plus antibiotics were started with a drainage tube left in the chest. During the follow-up the child undergone several chest X-rays with the suspicion of esophageal perforation. Angio-TC done on day 7 showed air into the thickened esophageal wall and in the mediastinum with severe peri-aortic edema without lesion of the vessel. MRi performed on day 21 showed only a persistent thickening of the esophageal wall. On day 28 an esophagogram was normal and the child was discharged asymptomatic. Two months later the investigation was repeated resulting entirely normal. Conclusions: Treatment of disk battery ingestion requires a multidisciplinary approach that can be implemented only in a tertiary pediatric hospital. Surgery can play an important role. Severe complications can occur several days after battery removal

Acute epiglottitis as the initial presentation of pediatric Systemic Lupus Erythematosus

We report a case of a 5-year old girl, who initially presented with acute epiglottitis, sepsis and multi-organ failure. She was subsequently diagnosed as having Systemic Lupus Erythematosus. To the best of our knowledge, this article describes the first case of Haemophilus influenzae type f epiglottitis as the initial presentation of SLE in childhood

f(R) theories

Over the past decade, f(R) theories have been extensively studied as one of the simplest modifications to General Relativity. In this article we review various applications of f(R) theories to cosmology and gravity - such as inflation, dark energy, local gravity constraints, cosmological perturbations, and spherically symmetric solutions in weak and strong gravitational backgrounds. We present a number of ways to distinguish those theories from General Relativity observationally and experimentally. We also discuss the extension to other modified gravity theories such as Brans-Dicke theory and Gauss-Bonnet gravity, and address models that can satisfy both cosmological and local gravity constraints.Comment: 156 pages, 14 figures, Invited review article in Living Reviews in Relativity, Published version, Comments are welcom

2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.

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Balloon-assisted, ultrasound-guided percutaneous real-time thrombin injection, for the arteriovenous fistula pseudoaneurysm treatment

A pseudoaneurysm or false aneurysm is the consequence of a persistent blood leak caused generally by iatrogenic rupture of a vessel wall. The blood leak creates a new cavity delimited by surrounding tissues and allows blood flow to remain in continuity between this cavity and the vessel. In hemodialysis fistula, pseudoaneurysm generally results from repeated puncturing of the vein at the same site, leading to a bulging anatomical defect in the vein. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery, with different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. We reported a case report of successful treatment of arteriovenous fistula pseudoaneurysm with no-measurable neck. We performed ultrasound-guided percutaneous direct thrombin injection while an inflated balloon transiently obstructed flow out of the pseudoaneurysm, in order prevent non-target embolization

MI (2-methyl-4-isothiazolin-3-one) contained in detergents is not detectable in machine washed textiles

BACKGROUND: European legislation has banned the preservative methylisothiazolinone (MI) from inclusion in leave-on cosmetics. However, the risk for allergic reactions depends on exposure. The aim of this study was to determine the risk of MI in laundry detergents for household machine washing. METHODS: Different formulations of laundry detergents with commercial MI levels, up to one thousand ppm were used and three different types of clothes were washed in a normal household machine setting one time and 10 times. The level of MI was measured by HPLC. RESULTS: While MI could be retrieved in the positive control of clothes drenched with washing powder but not washed afterwards, MI could not be detected in any specimen of clothes washed under household conditions. The detection limit was 0.5 ppm. CONCLUSION: It is important to discuss the difference of risk and hazard. While MI clearly is a high hazard as a strong contact allergen, the risk depends on exposure. Regarding the risk of exposure levels for the consumer to MI in clothes it can be stated that the use of MI in laundry detergents is safe for the consumer if these products are used according to the instructions in the normal household setting machine wash