Foreign Bodies Causing Asphyxiation in Children: The Experience of the Buenos Aires Paediatric ORL Clinic

Inhalation or aspiration of a foreign body (FB) occurs relatively frequently in young children. The size, shape, type and site of arrest of the FB lead to variability in the clinical picture. The present study included data from 65 cases of FB inhalation presenting over 1 year at the Children's Hospital Gutierrez, Buenos Aires, Argentina, compared with information from four well-known published case series chosen as representative of other cultural and geographical backgrounds: the USA, Europe, North Africa (Egypt) and Asia (India). The mean age of children studied was 4.03 years. Injuries happened mainly at home (53 cases [81.54%]) and under adult supervision (59 cases [90.77%]). The most frequently inhaled FB was nuts, however, in contrast to previous reports, the majority of incidents involved inhalation of an inorganic, rather than an organic (food) FB. Complications included pneumonia (three cases), atelectasis (two cases) and pneumonitis (one case). No deaths were recorded. These data suggest that children play with objects inappropriate for their age, such as pins and nails, that adults may not be aware of the choking risks, and that more effort is required in educating caregivers about these risks

NUOVI STRUMENTI DIAGNOSTICI E NUOVE PROSPETTIVE PER LA SALUTE DELL\u2019OSSO

Sebbene l'osso trabecolare rappresenti solo il 20% dello scheletro, la resistenza dell\u2019osso \ue8 fortemente influenzata, oltre che dalla densit\ue0, anche dalla micro-architettura della struttura trabecolare. Un metodo diagnostico innovativo di recente introduzione, BESTEST\uae, mediante il BSI (Bone Structure Index) misura la risposta elastica alle sollecitazioni da parte della struttura ossea, ricavata da simulazioni di carico condotte con metodi ingegneristici su una biopsia virtuale del paziente, ottenuta da radiogrammi planari dell'epifisi prossimale della mano. I risultati dell\u2019esame sono espressi in termini statistici, BSI_T-score e BSI_Z-score, di significato analogo ma non correlati a quelli utilizzati in densitometria. \uc8 ben noto che i regolatori ipofisari, gli inibitori dell'aromatasi e il tamoxifene nelle donne in pre-menopausa e i chemioterapici hanno tutti un impatto negativo sulla salute delle ossa poich\ue9, bloccando l'attivit\ue0 degli estrogeni o degli androgeni, aumentano il turnover osseo portando ad un rischio crescente di fratture. L'incidenza globale del rischio di fratture nei pazienti in trattamento ormonale per carcinoma mammario varia dall'1,37% all'11%. In questo lavoro, vengono discussi i risultati preliminari ottenuti nella valutazione del BSI_T-score in 100 pazienti di sesso femminile sottoposte a trattamento per carcinoma del seno. I risultati dimostrano che la micro-architettura ossea \ue8 effettivamente influenzata dal trattamento oncologico e che il BESTEST\uae pu\uf2 fornire un prezioso aiuto alla densitometria nella valutazione di queste alterazioni, specialmente quando associate a fratture. Questo studio preliminare fornisce inoltre una base razionale per ulteriori e pi\uf9 approfondite indagini sull'uso di questa nuova tecnica, rapida e sicura, per monitorare l'effetto delle terapie contro il cancro della mammella sulle alterazioni della micro-architettura ossea

Foreign Bodies Causing Asphyxiation in Children: The Experience of the Buenos Aires Paediatric ORL Clinic

Inhalation or aspiration of a foreign body (FB) occurs relatively frequently in young children. The size, shape, type and site of arrest of the FB lead to variability in the clinical picture. The present study included data from 65 cases of FB inhalation presenting over 1 year at the Children's Hospital Gutierrez, Buenos Aires, Argentina, compared with information from four well-known published case series chosen as representative of other cultural and geographical backgrounds: the USA, Europe, North Africa (Egypt) and Asia (India). The mean age of children studied was 4.03 years. Injuries happened mainly at home (53 cases [81.54%]) and under adult supervision (59 cases [90.77%]). The most frequently inhaled FB was nuts, however, in contrast to previous reports, the majority of incidents involved inhalation of an inorganic, rather than an organic (food) FB. Complications included pneumonia (three cases), atelectasis (two cases) and pneumonitis (one case). No deaths were recorded. These data suggest that children play with objects inappropriate for their age, such as pins and nails, that adults may not be aware of the choking risks, and that more effort is required in educating caregivers about these risks

Foreign bodies injuries in children: Analysis of Thailand data

Objectives: Suffocation due to foreign bodies (FB) is a leading cause of death in children aged 0-3 and it is common also in older ages, up to 14 years old. Based on the RPA report the estimated number of incidents per year in children aged 0-14 is in European Union (EU) of approximately 50,000, 10% of which are fatal. The need of an improvement of knowledge led to the development of the pan European study ESFBI (European Survey on Foreign Bodies Injuries) that collected data on FB injuries in the aerodigestive tract in paediatric patients from 19 European Hospitals (Austria, Belgium, Bulgaria, Croatia, Czech Republic, Denmark, Finland, Germany, Greece, Italy, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, Swiss, Turkey and United Kingdom). Recognizing that the rapid management is one of the main goals in the presence of such injury the aim of this paper is to confront data coming from 4 ESFBI case series with a Thailand's case series, in order to broaden the knowledge on FBs injuries characteristics, knowing that features like shape, dimension, consistency are fundamental in determine the consequences that might occur. Methods: Data coming from the Siriraj Hospital, Thailand from June 2006 to 2010 were collected and compared with 4 case series chosen amongst the ESFBI study cases (Finland, Slovenia, Sweden and Turkey). Results: 172 cases were collected from the Siriraj Hospital in Bangkok, Thailand. The chosen ESFBI members were Finland, Sweden, Slovenia and Turkey, with a sample numerosity respectively of 307, 235, 104 and 196 cases. All countries showed a male prevalence higher than the female one, and injuries occurred most frequently in children younger than 3 years old. The most frequent retrieval location was the digestive system (oesophagus) in Thailand data (97 cases, 56.40% of cases), whilst European cases involved more frequently the nose in Slovenia (58.65%), Finland (37.79% of cases) and Sweden (54.47%). In Turkey's case series, the highest prevalence of cases interested the airways. In Thailand and Finland case series, the main FB's type were represented by bones (respectively 66 case, 38.37% and 48 cases, 15.64%), whilst pearl, ball and marble were the most frequent FB both in Slovenia (16, 15.38%) and Sweden (83, 35.32%). Turkey case series had nuts, seeds and grain as most prevalent FB (126, 64.29%). Conclusions: The nature of foreign bodies varies from country to country and is dependent on diverse cultural, social, religious and economic factors that include parental attitudes, eating habits, availability and types of potentially threatening objects, and prevention strategies. The need to study in more depth specific characteristics of foreign bodies associated with increased hazard, such as nature, size, shape, hardness or firmness, lubricity, pliability and elasticity, in order to better identify risky foods and to describe more precisely the pathogenetic pathway is therefore a necessity

Foreign Bodies in the Oesophagus: The Experience of the Buenos Aires Paediatric ORL Clinic

The ingestion of foreign bodies causing esophageal injuries is a common event, mostly in children's population. The aim of the present paper is to present foreign body (FB) ingestion cases observed in a five-year period at the Children's Hospital Gutierrez, Buenos Aires, Argentina and to compare the main findings with data coming from other well-known case series, already published in scientific literature. A prospective study on 320 of esophageal foreign body was carried out , with regard to age and sex distributions, type, dimensions and consistency, location, clinical presentation, removal and complications. In the majority of cases injuries happened while children were playing and in 85.3% adults were present. Children most frequently ingested coins (83.8% cases). Removal was performed in all cases under general anaesthesia, in 34 by esophageal forceps and in 286 cases by Magill hypopharyngeal forceps. Just one case showed complications, presenting esophageal perforation. The final results of this study show that injuries usually happen under adults' supervision and highlight that FBs involved in the incident belong to classes of objects not conceived for children's use and not suitable for their age. Therefore, educational strategies regarding safe behaviours have a key role in FB injuries prevention

Stationery injuries in the upper aerodigestive system: results from the Susy Safe Project.

Rationale and aim: Foreign body (FB) injuries are a relatively frequent event in young children. Clinical picture can be evidently affected from different variables. Among those size, shape, type and FB location cover an important issue. Increased attempts have been made in order to encourage normative interventions for products devoted to children's care and entertainment, reaching acceptable safety level; on the contrary, fewer efforts have been devoted to investigate the risk associated to objects that - even if not expressly created for children - are easy accessed by children, like stationery.The aim of the present study is to characterize the risk of complications and prolonged hospitalization due to stationery items according to age and gender of patients, FB characteristics and FB location, circumstances of the accident, as emerging from the Susy Safe Registry. Methods: From 2005 to 2010 case were collected from 70 centers in 32 different countries. Details on the injuries, identified by means of the International Classification of Diseases, Ninth Revision (ICD-9) codes listed on hospital discharge records, were gathered through a standardized case report form, that provides a full set of information on injuries, with specific details on age and gender of the child, location, shape, volume, consistency and ellipticity of the foreign body, behavioral aspects linked to the injury, like the supervision of the parents or the activity concomitant to the accident, any complication occurred, length of hospitalization. Results: In the years 2005-2010 a total of 17,205 FB injuries in children aged 0-14. years were registered in Susy Safe Database. Among them 425 (2.5%) were due to a stationery item. The majority of FBs were retrieved in the nose (179, meaning 42.1%) and in the ears (176, 41.4%) only 5 cases were observed in children younger than 1. year, while most of the cases, 80.6%, were recorded in children older than 3. years. 193 patients (45.4%) were female, while 232 (54.6%) were male. Adult supervision was indicated in 212 cases. In 143 of these accidents the adult was present (33.6% of the whole group). The most frequent stationery retrieved was rubber, counting for 209 cases (49.2%). According to the FBs types, mostly all cases reported a 3D volume and a rigid or semirigid consistency (49.3%). Looking to the outcomes, 31 (7%) children needed hospitalization and complications were seen in 38 children (8.9%). No significant associations were seen between the outcomes and the FBs' characteristics, excluded those between the consistency of the FB (rigid) and the necessity of hospitalization and the shape (2D) and the presence of complication. Conclusions: Injuries are events that in many cases can be prevented with appropriate strategies. Passive environmental strategies, including product modification by manufacturers, are the most effective. However, regulation regarding small parts of potentially dangerous objects covers products addressed to children use but objects not projected for children, such as stationary items, are excluded. Our study testifies that stationary is involved in a non-negligible percentage of FB injuries, mainly due to insertion in the ears. Frequently, injuries happen under adult supervision. These results confirm the fact that when passive preventive strategies are not practical, active strategies that promote behavior change are necessary and information about this issue should be included in all visits to family pediatricians