Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients

Removal of foreign bodies from the airways and esophagus development of the method and equipment over the centuries

The problem of aspiration of foreign bodies was already known in antiquity. The first described death of man was the case of the Greek poet Anakreon, who in 475 BC choked himself with a grape. Initially, the treatment was limited to the pneumonia caused by the presence of a foreign body, then treatment of surgical procedures was attempted. The first documented case of tracheotomy (known as bronchotomy) for removing a foreign body was described in 1717 by Verdue. Unfortunately there was a significant disadvantage of the devices used to remove foreign bodies from the airways and esophagus - lack of a proper light source. At the beginning doctors were using candles, but their light was insufficient to observe anatomical structures. Philipp Bozzini developed the first light source which allowed to view the upper part of the esophagus - He called it a "lichtleiter". However a milestone in the endoscopy was made by the French urologist Antonin Desormeaux. He presented an improved device, which he called the "endoscope". For this reason, he was hailed as "father of endoscopy". Nevertheless scientific and technical progress is still continuing. Doctors have at their disposal more and more modern equipment for the diagnosis and removal of foreign bodies from the airways and esophagus. But even the most perfect endoscope will not replace the doctor's skills combined with assurance of maximum safety during and immediately after the procedure

Evaluation and management of pain in geriatric patients who were diagnosed in Emergency Department

Introduction and purpose of the work. Pain is one of the most common causes of medical rescue teams’ callings. Most of the cases are solved at patients’ homes. Some problems presented by geriatric patients are too difficult to be evaluated at home and need to be admitted to hospitals’ emergency departments(ED) for further diagnosis. Geriatric patients are often burdened with multiorgan dysfunctions which can cause pain. This problem in senior population is often overlooked or underestimated Material and method. Survey was conducted among 100 patients after 65 years of age who were admitted to ED because of pain. Location, the intensity of pain before and after application of analgesia, vital signs( heart rate, blood pressure, the number of breaths, temperature), previously administered pain killers and sociodemographic factors were evaluated and noted Results. Women predominated in the study group as well as the patients with posttraumatic pain (mostly fall from the same height). Forty five percent of patients took a painkiller at home. Preliminary average rating of pain numeric scale (NRS) was 7.49 points. Respondents who received painkillers before coming to the ED, felt more severe pain than those who did not take medications (NRS 7.93 vs. 7.41). Thirty minutes after application of analgesic pain intensity averaged 3.74 points. Conclusions. Pain is a common cause among elderly patients who report to ED, despite previously adopted analgesics. It remains underestimated in prehospital care and needs special attention in emergency departments

Mesothelioma - a growing medical problem with heterogeneous course

Mesothelioma is one of the most malignant neoplasms affecting the thin lining of the body's internal organs, known as the mesothelium. The incidence of mesothelioma in recent years has increased. It is assumed that the reason for this situation is the exposure in the past to natural mineral fibers (nickel, beryllium, silica dust), ionizing radiation, some organic compounds and SV40 virus but mostly to asbestos. The time from contact to the first symptoms is about 20-40 years. Probably the peak of morbidity is yet to come. Due to non-specific symptoms such as chest pain, shortness of breath, fluid in the pleural cavity, early detection is very difficult. Additionally, we can deal with mesothelioma which starting point is outside the pleural cavity. In such cases, diagnostics is even more difficult, because the only remaining symptom is pain. Therefore, it is important to pay attention to this growing problem

Plasma magnesium concentration in patients undergoing coronary artery bypass grafting

Introduction Magnesium (Mg) plays a crucial role in cell physiology and its deficiency may cause many disorders which often require intensive treatment. The aim of this study was to analyse some factors affecting preoperative plasma Mg concentration in patients undergoing coronary artery bypass grafting (CABG). Material and Methods Adult patients scheduled for elective CABG with cardio-pulmonary bypass (CPB) under general anaesthesia were studied. Plasma Mg concentration was analysed before surgery in accordance with age, domicile, profession, tobacco smoking and preoperative Mg supplementation. Blood samples were obtained from the radial artery just before the administration of anaesthesia. Results 150 patients were studied. Mean preoperative plasma Mg concentration was 0.93 ± 0.17 mmol/L; mean concentration in patients – 1.02 ± 0.16; preoperative Mg supplementation was significantly higher than in patients without such supplementation. Moreover, intellectual workers supplemented Mg more frequently and had higher plasma Mg concentration than physical workers. Plasma Mg concentration decreases in elderly patients. Patients living in cities, on average, had the highest plasma Mg concentration. Smokers had significantly lower plasma Mg concentration than non-smokers. Conclusions 1. Preoperative magnesium supplementation increases its plasma concentration. 2. Intellectual workers frequently supplement magnesium. 3. Smoking cigarettes decreases plasma magnesium concentration

The number of passively smoked cigarettes and the risk of lung cancer among the inhabitants of the Lubelskie Region (2013-2017)

According to WHO, clean air is considered as one of the basic criterion influencing  human health. Airborne particulate matters (PM) 2,5 are mixtures of organic and inorganic particles smaller than 2.5 µm. They have broad negative effect on health especially on respiratory and cardiovascular system. They could increase the sensitivity to air ways infections, worsen: allergic diseases, hypertension, myocardial infarction and also increase the risk of neoplastic diseases. NO2 pollution arises mainly during burning of fossil fuels, which is mainly related to road transport. On the basis of numerous scientific research, it is believed that the long term exposure to NO2 could increase inflammation  and eventually lead to  higher  cancer morbidity. We analyzed the data available in the Polish National Cancer Registry (PNCR), Chief Inspectorate for Environmental Protection and Air Quality Guidelines, We checked air pollution by the means of  PM2.5and NO2 and thanks to mathematical equation delivered by Saskia C. van der Zee converted them into number of  passively smoked cigarettes. Above data we compared to lung cancer morbidity in Lubelskie Region.Based on the latest available data and literature, we can conclude that in 2013-2017 each inhabitant of Lubelskie Region smoked average 8 cigarettes a day +/- 2. The incidence of lung cancer is more or less the same number. After 75 years everyone in the exanimated region had 30 package-years of passive smoking and high risk of lung cancer. Over same period of time cumulative risk of lung cancer according to PNCR were in women almost 2% and in men almost 6%Air quality in Poland is not satisfactory, exceeding the standards presented in the WHO Guidelines 2005, we can assume that this translates into a high risk of the incidence of lung cancer among our inhabitants

Pain Evaluation in the Paediatric Emergency Department: Differences in Ratings by Patients, Parents and Nurses

The pain experienced by paediatric patients is rarely evaluated in emergency departments. The aim of the present study was to compare the degree of conformity in patients’ pain severity when assessed by themselves (if possible), their parents and a triage nurse trained in pain evaluation. Methods: A cross-sectional observational study was conducted at a tertiary paediatric emergency department in Eastern Poland involving children (aged six months to eighteen years), their parents and nurses. The patients had their pain assessed while collecting a medical history. For children ≥ four years of age, the Numerical Rate Scale was used by patients, parents and nurses to evaluate pain. Patients under four years of age were evaluated by parents and nurses using the FLACC scale. Results: Eighty patients and their parents were enrolled in the study. For children ≥ four years, patients rated their pain significantly higher than both their parents (p = 0.03) and nurses (p < 0.001), with the latter group producing the lowest scores. For children under four years of age, parental pain assessments did not significantly differ from those of nurses. Conclusion: Compared to the patients themselves and their parents, nurses tended to assign lower pain scores for children. Pain should be assessed on admission to the ED and, whenever possible, by the patients themselves

Postępowanie u dziecka w przełomie miastenicznym

Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease.Myasthenia gravis is an autoimmune disorder of peripheral nervous system, leading to fluctuating muscle weakness. It is caused by circulating antibodies that block acetylcholine nicotinic postsynaptic receptors at the postsynaptic neuromuscular junction. Myasthenic crisis is a life-threatening complication, which is defined as weakness from acquired myasthenia gravis. In this paper we described a 15-year-old boy who was admitted to the Paediatric Intensive Care Unit due to myasthenic crisis. He had suffered not only from myasthenia gravis but also hypothyroidism, cerebral palsy and epilepsy. The patient required mechanical ventilation and was successfully treated with both plasmapheresis and intravenous immunoglobulins. He recovered from the crisis and then thymectomy was performed. Perioperative period and anaesthesia passed uncomplicated. Discharged home from the hospital after 2.5 month-treatment, for the last 4 years, he has only come on scheduled outpatient medical appointments. This case reveals that myasthenic crisis, albeit rare, may occur in male adolescents. In such cases multidisciplinary care followed by surgery becomes a procedure of choice. Concomitant medical problems, if well controlled, do not affect the results of outcome of the underlying disease