Foreign body ingestion is a common presentation but the extraluminal migration of a foreign body is rare. A 46-year-old man presented with protruded sharp swelling left side of neck, X-rays and CT scan of the neck sho...Foreign body ingestion is a common presentation but the extraluminal migration of a foreign body is rare. A 46-year-old man presented with protruded sharp swelling left side of neck, X-rays and CT scan of the neck showed a needle migrating from the pyriform fossa to the skin. Carotid angiography was also done to see the relations of foreign body with great vessels. Transcutaneous removal of foreign body was done under general anesthesia. The migrated foreign body was a sewing needle which patient unknowingly swallowed two days back. Migrated ingested foreign bodies from the upper digestive tract have the potential to cause life-threatening complications. Cases of spontaneous expulsion of ingested foreign bodies to the skin of the neck are quite rare.展开更多
BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We re...BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.展开更多
A 52-year-old female presented to our clinic after accidentallyingesting a push-through pack(PTP). After determining that the PTP was present in the stomach, we successfully and safely removed it endoscopically by usi...A 52-year-old female presented to our clinic after accidentallyingesting a push-through pack(PTP). After determining that the PTP was present in the stomach, we successfully and safely removed it endoscopically by using a handmade endoscopic hood fashioned from a cut endotracheal tube. Foreign body ingestion is a common clinical problem, and most ingested foreign bodies pass spontaneously. However, the ingestion of sharp objects, such as PTPs, increases the risk of complications, and urgent endoscopy is recommended to remove such objects. Previous studies have reported the use of other devices, both commercial and handmade, for the safe endoscopic removal of foreign bodies. The novel design of our handmade hood for the removal of the PTP, which was fashioned from a cut endotracheal tube, was beneficial in terms of maintaining a wide visual field, patient safety and tolerance, and easy preparation compared to previously reported commercial and handmade devices. It may be a viable and safe device for the retrieval of PTPs and other sharp foreign bodies.展开更多
Background: Although foreign body ingestion is a common problem, poor knowledge for the treatment still remains a major obstacle, especially in preventing complications. Phosphate enemas were applied for chronic const...Background: Although foreign body ingestion is a common problem, poor knowledge for the treatment still remains a major obstacle, especially in preventing complications. Phosphate enemas were applied for chronic constipation for a long period of time. This study aims to evaluate the effect of a single dose of phosphate enema on bowel movements in patients who suffer from foreign body ingestion. Materials and Methods: Forty consecutive patients admitted to our emergency unit for foreign body ingestion were randomized into two groups. Patients in both groups were followed up with daily imaging and physical examinations. Cases in Group SP received daily doses of sodium phosphate enemas, while Group C did not. Demographics, number of X-rays, radiation dose, and period of the foreign body passage were recorded and compared between two groups. Also, data of patients who ingested pins (Group P) were compared with of those who ingested other materials (Group O). Results: There was no statistical difference between groups (Group SP vs. Group C and Group P vs. Group O) comparing demographics, number of X-rays, total amount of radiation doses (p > 0.05 for all comparisons). The period of foreign body passage was shorter in Group SP (3.4 ± 1.6 days vs. 6.2 ± 3.8 days;p = 0.005). Also, patients who ingested pins were compared to patients who ingested other materials. Pins were ingested by 23 (65%) patients. These were older (16.6 ± 9.4 years vs. 4.8 ± 3.5 years;p = 0.001) and generally females (78.3% vs. 29.4;p = 0.006). Contrary to the other cases, pins were less frequently confirmed in stool in patients who ingested pins (p = 0.02). Conclusion: A single dose of phosphate enema use may hasten the passage of the foreign bodies. Ingestion of pins is the more common especially in young females. The evacuation of pins is generally recognized with direct examination of the stool, so daily imaging may not be necessary for this group of patients.展开更多
Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in childre...Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes.展开更多
Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth a...Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth and the extension of GI caustic injury,but also to guide the appropriate treatment.Intriguingly,contrast-enhanced computed tomography(CECT)has recently emerged as a promising non-invasive and more accurate alternative to endoscopy in this setting.However,to date,evidence concerning the role of CECT as an alternative or complementary diagnostic tool to endoscopy in caustic ingestion is still limited.The aim of our review was to summarize and discuss the current evidence concerning the role of CECT in the emergency diagnosis of caustic ingestion and its value in assessing injury severity among non-pediatric patients.展开更多
BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects...BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.展开更多
BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an altern...BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an alternative approach for the endoscopic removal of a large,irregular,and sharp foreign body(chicken bone)when traditional protective devices are inadequate,thus contributing to the management of such ingestions.CASE SUMMARY A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone.Emergent endoscopy showed it was tightly embedded in the esophageal wall,with minor bleeding.The chicken bone was grasped and moved cautiously using a foreign forceps.It was loosened after repeated attempts but could not pass through the pharynx.Considering possible mucosal damage,it was carefully pushed into the stomach cavity and then wrapped in a condom.The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps.No additional damage was found,except for primary esophageal injuries caused by the embedded chicken bone.The patient was discharged on the following day.Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.CONCLUSION Condoms can serve as an alternative when traditional protective devices are unsuitable.Because of its smooth and oily nature,it can provide mucosal protection and lubrication during endoscopic removal.展开更多
Rotating Instability (RI) is a typical unsteady flow phenomenon in compressors and may cause severe aerodynamic noise and even potential nonsynchronous vibration. Most studies of RI are based on the uniform inflow, ig...Rotating Instability (RI) is a typical unsteady flow phenomenon in compressors and may cause severe aerodynamic noise and even potential nonsynchronous vibration. Most studies of RI are based on the uniform inflow, ignoring the influence of inlet distortions. This study investigates the mechanism of RI in a transonic rotor through full-annulus unsteady simulations, with a particular focus on the effects of boundary layer ingesting distortions. The results show that at the uniform inflow, the RI fluctuations with the broadband hump can be observed over a relatively wide mass flow rate range, and its origin can be attributed to the coupling effect between the tip leakage flow and shear layer instability. At the inlet distortions, the broadband hump only occurs with partial circumferential locations. This kind of flow phenomenon is defined as Partial Rotating Instability (PRI). The PRI only occurs in a narrower mass flow rate range in which the circumferential range of strong shear is sufficiently large and the self-induced unsteady effects are strong enough. Further, this study confirms that the averaged tip leakage flow axial momentum at the onset of RI or PRI is close, so it can be used as the parameter to determine whether RI or PRI occurs.展开更多
BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are...BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.展开更多
We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophag...We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophageal injuries following ingestion of glue containing toluene.展开更多
Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is r...Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is reported of a psychiatric,but in other respects asymptomatic,patient who presented with an ingested metal key deeply impacted within the appendix.The patient underwent urgent coloscopy for retrieval.Initially all conventional endoscopic instruments proved ineffective and the key was finally extracted using a simple manoeuvre, described herein.展开更多
The protein, carbohydrate and lipid contents of the food ingested and their absorption in the intestine ofHepsetus odoe in Ado-Ekiti Reservoir, Ekiti State, Nigeria were investigated. Samples were analysed chemically ...The protein, carbohydrate and lipid contents of the food ingested and their absorption in the intestine ofHepsetus odoe in Ado-Ekiti Reservoir, Ekiti State, Nigeria were investigated. Samples were analysed chemically for protein, fat and carbohydrate using the official methods of analysis described by the Association of Official Analytical Chemist. The ingested food had mean total protein, mean total carbohydrate and mean total lipid of 60.2% - 8.55%, 15.4% ± 1.9% and 15.6% ±1.1% of the organic content respectively. Calculated mean total percentages absorbed were 72.4% protein, 52% carbohydrate and 51.5% lipid. The foregut had the highest percentage absorption while the hindgut had the lowest for all the nutrients. Different sizes of fish showed different dietary protein, carbohydrate and lipid contents. Absorptive capacity for these components of the food also varied with fish size.展开更多
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and ...Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.展开更多
AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED be...AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED between January 1stand December 31stof 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.RESULTS:A total of 100 patients presented with a complaint of foreign body ingestion during the study period.Overall,an X-ray was performed on 75 patients,and a fiberoptic evaluation was performed on45 patients.A foreign body was detected in 46(46%)patients.The diagnostic yield of the X-ray was 27(36%)out of 75 patients,while the diagnostic yield of the fiberoptic evaluations was 21(47%)out of 45 patients.The detected foreign bodies were mostly located in the esophagus(17 out of 46 foreign bodies detected).When the types of ingested foreign bodies were evaluated,52(52%)patients reported ingesting food,and19(19%)patients reported swallowing pins.An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases.In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation,the foreign material was detected and removed.CONCLUSION:Plain radiography is helpful in the localization of radiopaque swollen foreign bodies,while fiberoptic methods are useful as both diagnostic and therapeutic tools,regardless of radiopacity.展开更多
A streamwise-body-force-model （SBFM） is developed and applied in the overall flow simulation for the distributed propulsion system, combining internal and external flow fields. In view of axial stage effects, fan or...A streamwise-body-force-model （SBFM） is developed and applied in the overall flow simulation for the distributed propulsion system, combining internal and external flow fields. In view of axial stage effects, fan or compressor effects could be simplified as body forces along the streamline. These body forces which are functions of local parameters could be added as source terms in Navier-Stokes equations to replace solid boundary conditions of blades and hubs. The val- idation of SBFM with uniform inlet and distortion inlet of compressors shows that pressure performance characteristics agree well with experimental data. A three-dimensional simulation of the integration configuration, via a blended wing body aircraft with a distributed propulsion system using the SBFM, has been completed. Lift coefficient and drag coefficient agree well with wind tunnel test results. Results show that to reach the goal of rapid integrated simulation combining internal and external flow fields, the computational fluid dynamics method based on SBFM is reasonable.展开更多
The intentional ingestion of foreign objects(IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional fac...The intentional ingestion of foreign objects(IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects(e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrenceas subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.展开更多
AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 w...AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 were included in the study. They swallowed the capsule in the standing(Group A= 30),supine(Group B=30)and right supine positions (Group C=30).Baseline patient characteristics, difficulties in capsule ingestion,esophageal transit times(ETT)and Z-line visualization were noted. RESULTS:No significant differences were found between the groups with regard to baseline patient characteristics,ingestion difficulties and complete SB examinations(P>0.05).At least 1 frame of the Z-line was detected in 15.8%,46.7%and 90%of patients in groups A,B and C,respectively(P<0.001).The average number of Z-line images was 0.21±0.53,3.23 ±6.59 and 5.53±7.55 and the mean%of the Z-linedetected was 71.3,25.1 and 8.3,in groups A,B and C, respectively(both P<0.001).ETT times were longer in the supine group followed by the right supine and the standing groups(median of 237 s vs 64 s and 39 s, respectively;P<0.001). CONCLUSION:Z-line visualization in patients undergoing SBCE can be accurately achieved in most cases when the capsule is swallowed in the right supine position.展开更多
In this paper, the effect of different amount of protrusion on various parameters in rotor–stator system was experimentally studied by measuring CO_2 concentration and pressure, in order to obtain the optimal protrus...In this paper, the effect of different amount of protrusion on various parameters in rotor–stator system was experimentally studied by measuring CO_2 concentration and pressure, in order to obtain the optimal protrusion amount.The parameters of different dimensionless sealing flow were measured under the condition that the annulus Reynolds number was 4.39 × 10~5 and the rotating Reynolds number was 1.05 × 10~6.The results show that the change of the amount of protrusions has little effect on the static pressure in the cavity, and the static pressure change near the sealing ring is almost negligible.But the total pressure and sealing efficiency increase first and then decrease with the increase of the amount of protrusion.The variation of power consumption is the same.A complex vortex structure will appear at the high radius region when the protrusion is installed.On the other hand, the protrusion can effectively reduce the minimum sealing flow of the rotor–stator cavity.Furthermore, considering the sealing efficiency and power consumption,the best range of the protrusion amount is about 36.The ratio near this range can optimally balance the alleviation of the gas ingestion and the reduction of the power consumption.展开更多
AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointes...AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal （GI） dysfunction. METHODS： From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns （LAB） were admitted, who were classified into three stages according the therapeutic protocols used at the time： Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS： The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly Dower than that in stage 1 （P 〈 0.05）. No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients （P 〈 0.05 or P 〈 0.01）, and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients （P 〈 0.05）. CONCLUSION： Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.展开更多
文摘Foreign body ingestion is a common presentation but the extraluminal migration of a foreign body is rare. A 46-year-old man presented with protruded sharp swelling left side of neck, X-rays and CT scan of the neck showed a needle migrating from the pyriform fossa to the skin. Carotid angiography was also done to see the relations of foreign body with great vessels. Transcutaneous removal of foreign body was done under general anesthesia. The migrated foreign body was a sewing needle which patient unknowingly swallowed two days back. Migrated ingested foreign bodies from the upper digestive tract have the potential to cause life-threatening complications. Cases of spontaneous expulsion of ingested foreign bodies to the skin of the neck are quite rare.
文摘BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion.Less than 100 cases have been reported to date.CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach.The patient presented with persistent epigastric pain.Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe.Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object.As the abscess was refractory to antibiotic treatment,laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma.Following surgery,symptoms fully resolved without any sequelae.CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess,particularly in abscesses of unknown origin that are resistant to antibiotic therapy.Clinical suspicion,early diagnosis,and prompt removal of the foreign body could lead to improved outcomes in these patients.
文摘A 52-year-old female presented to our clinic after accidentallyingesting a push-through pack(PTP). After determining that the PTP was present in the stomach, we successfully and safely removed it endoscopically by using a handmade endoscopic hood fashioned from a cut endotracheal tube. Foreign body ingestion is a common clinical problem, and most ingested foreign bodies pass spontaneously. However, the ingestion of sharp objects, such as PTPs, increases the risk of complications, and urgent endoscopy is recommended to remove such objects. Previous studies have reported the use of other devices, both commercial and handmade, for the safe endoscopic removal of foreign bodies. The novel design of our handmade hood for the removal of the PTP, which was fashioned from a cut endotracheal tube, was beneficial in terms of maintaining a wide visual field, patient safety and tolerance, and easy preparation compared to previously reported commercial and handmade devices. It may be a viable and safe device for the retrieval of PTPs and other sharp foreign bodies.
文摘Background: Although foreign body ingestion is a common problem, poor knowledge for the treatment still remains a major obstacle, especially in preventing complications. Phosphate enemas were applied for chronic constipation for a long period of time. This study aims to evaluate the effect of a single dose of phosphate enema on bowel movements in patients who suffer from foreign body ingestion. Materials and Methods: Forty consecutive patients admitted to our emergency unit for foreign body ingestion were randomized into two groups. Patients in both groups were followed up with daily imaging and physical examinations. Cases in Group SP received daily doses of sodium phosphate enemas, while Group C did not. Demographics, number of X-rays, radiation dose, and period of the foreign body passage were recorded and compared between two groups. Also, data of patients who ingested pins (Group P) were compared with of those who ingested other materials (Group O). Results: There was no statistical difference between groups (Group SP vs. Group C and Group P vs. Group O) comparing demographics, number of X-rays, total amount of radiation doses (p > 0.05 for all comparisons). The period of foreign body passage was shorter in Group SP (3.4 ± 1.6 days vs. 6.2 ± 3.8 days;p = 0.005). Also, patients who ingested pins were compared to patients who ingested other materials. Pins were ingested by 23 (65%) patients. These were older (16.6 ± 9.4 years vs. 4.8 ± 3.5 years;p = 0.001) and generally females (78.3% vs. 29.4;p = 0.006). Contrary to the other cases, pins were less frequently confirmed in stool in patients who ingested pins (p = 0.02). Conclusion: A single dose of phosphate enema use may hasten the passage of the foreign bodies. Ingestion of pins is the more common especially in young females. The evacuation of pins is generally recognized with direct examination of the stool, so daily imaging may not be necessary for this group of patients.
文摘Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes.
文摘Caustic ingestion is a relatively rare but potentially catastrophic gastroentero-logical emergency.Upper gastrointestinal(GI)endoscopy is currently regarded as the gold standard modality not only to assess the depth and the extension of GI caustic injury,but also to guide the appropriate treatment.Intriguingly,contrast-enhanced computed tomography(CECT)has recently emerged as a promising non-invasive and more accurate alternative to endoscopy in this setting.However,to date,evidence concerning the role of CECT as an alternative or complementary diagnostic tool to endoscopy in caustic ingestion is still limited.The aim of our review was to summarize and discuss the current evidence concerning the role of CECT in the emergency diagnosis of caustic ingestion and its value in assessing injury severity among non-pediatric patients.
文摘BACKGROUND Venlafaxine,a serotonin-norepinephrine reuptake inhibitor,is widely prescribed for the treatment of major depressive disorder.At therapeutic dose,it is generally safe,with a low incidence of adverse effects.However,massive venlafaxine inge-stion can cause serious cardiotoxicity,leading to life-threatening arrhythmias.CASE SUMMARY A 31-year-old woman with a history of depression ingested 14.8 g of venlafaxine along with 6 mg of estazolam and 6 mg of flunitrazepam.On admission,2 hours post-ingestion,she presented only with mild QTc prolongation.At 4 hours post-ingestion,she developed a generalized tonic-clonic seizure.Following endo-tracheal intubation,intravenous midazolam infusion was initiated and 50 g of activated charcoal was administered via a nasogastric tube.At 15 hours post-ingestion,she developed ventricular tachycardia that rapidly progressed to refr-actory ventricular fibrillation,which was successfully treated with veno-arterial extracorporeal membrane oxygenation.Toxicological analysis revealed serum ve-nlafaxine and O-desmethylvenlafaxine concentrations 17µg/mL and 10µg/mL,respectively,at 15 hours post-ingestion.CONCLUSION In cases of massive venlafaxine ingestion,continuous intensive monitoring,particularly of QTc,is essential for at least 24 hours,even when initial clinical signs are mild.If refractory ventricular arrhythmias occur,prompt ini-tiation of veno-arterial extracorporeal membrane oxygenation should be considered.
文摘BACKGROUND Sharp foreign body ingestion can cause gastrointestinal tract mucosa injury and requires proper endoscopic removal.Typically,protective devices are used to reduce mucosal damage.This case presents an alternative approach for the endoscopic removal of a large,irregular,and sharp foreign body(chicken bone)when traditional protective devices are inadequate,thus contributing to the management of such ingestions.CASE SUMMARY A 57-year-old male presented with a history of swallowing an irregular and sharp-pointed chicken bone.Emergent endoscopy showed it was tightly embedded in the esophageal wall,with minor bleeding.The chicken bone was grasped and moved cautiously using a foreign forceps.It was loosened after repeated attempts but could not pass through the pharynx.Considering possible mucosal damage,it was carefully pushed into the stomach cavity and then wrapped in a condom.The chicken bone was retrieved uneventfully by grasping the open edge of the condom with foreign forceps.No additional damage was found,except for primary esophageal injuries caused by the embedded chicken bone.The patient was discharged on the following day.Our experience demonstrated that condoms can be an alternative as a protective device under such conditions.CONCLUSION Condoms can serve as an alternative when traditional protective devices are unsuitable.Because of its smooth and oily nature,it can provide mucosal protection and lubrication during endoscopic removal.
基金supports of the National Natural Science Foundation of China(Nos.52076129,92360308,52376027)the Shanghai Municipal Education Commission of China(No.2023-02-4)+1 种基金the Fundamental Research Funds for the Central Universities of Chinathe United Innovation Center(UIC)of Aerothermal Technologies for Turbomachinery of China.
文摘Rotating Instability (RI) is a typical unsteady flow phenomenon in compressors and may cause severe aerodynamic noise and even potential nonsynchronous vibration. Most studies of RI are based on the uniform inflow, ignoring the influence of inlet distortions. This study investigates the mechanism of RI in a transonic rotor through full-annulus unsteady simulations, with a particular focus on the effects of boundary layer ingesting distortions. The results show that at the uniform inflow, the RI fluctuations with the broadband hump can be observed over a relatively wide mass flow rate range, and its origin can be attributed to the coupling effect between the tip leakage flow and shear layer instability. At the inlet distortions, the broadband hump only occurs with partial circumferential locations. This kind of flow phenomenon is defined as Partial Rotating Instability (PRI). The PRI only occurs in a narrower mass flow rate range in which the circumferential range of strong shear is sufficiently large and the self-induced unsteady effects are strong enough. Further, this study confirms that the averaged tip leakage flow axial momentum at the onset of RI or PRI is close, so it can be used as the parameter to determine whether RI or PRI occurs.
文摘BACKGROUND Cases of esophageal,airway,and pericardial perforations caused by chicken bone ingestion are rare worldwide,but their incidence has shown an upward trend in recent years.Injuries caused by chicken bones are often more severe,leading to infections and,in extreme cases,perforation of the common carotid artery,pericardium,trachea,or even the heart,posing life-threatening risks.CASE SUMMARY We present a case of a patient who sustained combined esophageal and pericardial injuries with subsequent pericardial effusion due to chicken bone ingestion.The clinical manifestations included chest pain and widespread ST-segment elevation on electrocardiography.CONCLUSION The patient’s symptoms and signs were not entirely consistent with myocardial infarction.Chest computed tomography played a crucial role in clarifying the etiology and provided critical evidence for devising an effective treatment strategy.
文摘We present an unusual case of corrosive esophageal injury following liquid glue ingestion. The endoscopic f indings were tissue sloughing and blackened appearance of the esophagogastric junction,due to caustic esophageal injuries following ingestion of glue containing toluene.
文摘Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is reported of a psychiatric,but in other respects asymptomatic,patient who presented with an ingested metal key deeply impacted within the appendix.The patient underwent urgent coloscopy for retrieval.Initially all conventional endoscopic instruments proved ineffective and the key was finally extracted using a simple manoeuvre, described herein.
文摘The protein, carbohydrate and lipid contents of the food ingested and their absorption in the intestine ofHepsetus odoe in Ado-Ekiti Reservoir, Ekiti State, Nigeria were investigated. Samples were analysed chemically for protein, fat and carbohydrate using the official methods of analysis described by the Association of Official Analytical Chemist. The ingested food had mean total protein, mean total carbohydrate and mean total lipid of 60.2% - 8.55%, 15.4% ± 1.9% and 15.6% ±1.1% of the organic content respectively. Calculated mean total percentages absorbed were 72.4% protein, 52% carbohydrate and 51.5% lipid. The foregut had the highest percentage absorption while the hindgut had the lowest for all the nutrients. Different sizes of fish showed different dietary protein, carbohydrate and lipid contents. Absorptive capacity for these components of the food also varied with fish size.
文摘Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
文摘AIM:To study a retrospective analysis of patients who presented to the emergency departments(ED)with complaints related to foreign body ingestions.METHODS:Patients older than 16 years of age who presented to the ED between January 1stand December 31stof 2010 with complaints related to swallowed foreign bodies were identified from electronic health records and patient charts.RESULTS:A total of 100 patients presented with a complaint of foreign body ingestion during the study period.Overall,an X-ray was performed on 75 patients,and a fiberoptic evaluation was performed on45 patients.A foreign body was detected in 46(46%)patients.The diagnostic yield of the X-ray was 27(36%)out of 75 patients,while the diagnostic yield of the fiberoptic evaluations was 21(47%)out of 45 patients.The detected foreign bodies were mostly located in the esophagus(17 out of 46 foreign bodies detected).When the types of ingested foreign bodies were evaluated,52(52%)patients reported ingesting food,and19(19%)patients reported swallowing pins.An X-ray was performed on 33 patients with accidental food ingestions but yielded a positive result in only two cases.In 12 out of 21 patients with accidental food ingestion who underwent fiberoptic evaluation,the foreign material was detected and removed.CONCLUSION:Plain radiography is helpful in the localization of radiopaque swollen foreign bodies,while fiberoptic methods are useful as both diagnostic and therapeutic tools,regardless of radiopacity.
基金supported by the National Natural Science Foundation of China (No.51176005)
文摘A streamwise-body-force-model （SBFM） is developed and applied in the overall flow simulation for the distributed propulsion system, combining internal and external flow fields. In view of axial stage effects, fan or compressor effects could be simplified as body forces along the streamline. These body forces which are functions of local parameters could be added as source terms in Navier-Stokes equations to replace solid boundary conditions of blades and hubs. The val- idation of SBFM with uniform inlet and distortion inlet of compressors shows that pressure performance characteristics agree well with experimental data. A three-dimensional simulation of the integration configuration, via a blended wing body aircraft with a distributed propulsion system using the SBFM, has been completed. Lift coefficient and drag coefficient agree well with wind tunnel test results. Results show that to reach the goal of rapid integrated simulation combining internal and external flow fields, the computational fluid dynamics method based on SBFM is reasonable.
文摘The intentional ingestion of foreign objects(IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects(e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrenceas subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to monitor patients and provide psychiatric care are potential best-practice strategies. This article aims to provide state-of-the art review on the topic, followed by a set of basic recommendations.
文摘AIM:To evaluate the Z-line visualization by the PillCamTM SB2 using three different ingestion protocols. METHODS:Ninety consecutive patients undergoing small bowel capsule endoscopy(SBCE)between January and May 2008 were included in the study. They swallowed the capsule in the standing(Group A= 30),supine(Group B=30)and right supine positions (Group C=30).Baseline patient characteristics, difficulties in capsule ingestion,esophageal transit times(ETT)and Z-line visualization were noted. RESULTS:No significant differences were found between the groups with regard to baseline patient characteristics,ingestion difficulties and complete SB examinations(P>0.05).At least 1 frame of the Z-line was detected in 15.8%,46.7%and 90%of patients in groups A,B and C,respectively(P<0.001).The average number of Z-line images was 0.21±0.53,3.23 ±6.59 and 5.53±7.55 and the mean%of the Z-linedetected was 71.3,25.1 and 8.3,in groups A,B and C, respectively(both P<0.001).ETT times were longer in the supine group followed by the right supine and the standing groups(median of 237 s vs 64 s and 39 s, respectively;P<0.001). CONCLUSION:Z-line visualization in patients undergoing SBCE can be accurately achieved in most cases when the capsule is swallowed in the right supine position.
文摘In this paper, the effect of different amount of protrusion on various parameters in rotor–stator system was experimentally studied by measuring CO_2 concentration and pressure, in order to obtain the optimal protrusion amount.The parameters of different dimensionless sealing flow were measured under the condition that the annulus Reynolds number was 4.39 × 10~5 and the rotating Reynolds number was 1.05 × 10~6.The results show that the change of the amount of protrusions has little effect on the static pressure in the cavity, and the static pressure change near the sealing ring is almost negligible.But the total pressure and sealing efficiency increase first and then decrease with the increase of the amount of protrusion.The variation of power consumption is the same.A complex vortex structure will appear at the high radius region when the protrusion is installed.On the other hand, the protrusion can effectively reduce the minimum sealing flow of the rotor–stator cavity.Furthermore, considering the sealing efficiency and power consumption,the best range of the protrusion amount is about 36.The ratio near this range can optimally balance the alleviation of the gas ingestion and the reduction of the power consumption.
基金The National Natural Science Foundation of China, No. C30600646
文摘AIM： To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal （GI） dysfunction. METHODS： From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns （LAB） were admitted, who were classified into three stages according the therapeutic protocols used at the time： Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS： The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly Dower than that in stage 1 （P 〈 0.05）. No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients （P 〈 0.05 or P 〈 0.01）, and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients （P 〈 0.05）. CONCLUSION： Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.
