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Volume 53 (2002)
- Issue 6 Pages 445-
- Issue 5 Pages 379-
- Issue 4 Pages 313-
- Issue 3 Pages 245-
- Issue 2 Pages 55-
- Issue 1 Pages 1-
Volume 53, Issue 5
Displaying 1-9 of 9 articles from this issue
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Special Issue of Foreign Bodies in the Airway and Food Passage
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Hideki Hirabayashi2002 Volume 53 Issue 5 Pages 379-387
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSManagement of foreign bodies is very important in the field of broncho-esophagology. The history of foreign body removal parallels human history. Every foreign body has its own episode. Young mothers know that foreign bodies are dangerous for children. Thus, every mother usually screams when a child tries to chew on a stone. Then, the surprised child frequently inhales the foreign body. Every health institution not only has to provide the best training and an experienced team but also must make public announcements to prevent foreign body cases. Many cases of foreign body aspiration are not children but adults. Case series from the last decade reflect that children younger than 5 years of age account for approximately 80% of cases and children younger than 3 years of age account for 70%. Boys are involved more frequently than girls at a ratio of approximately 2:1. Differences between countries relate not to the rate of occurrence or method of treatment but rather to the type of foreign body. For example, the most common foreign body inhaled in Japan, the United States and Europe is the peanut, whereas in Egypt, the watermelon seed is the prime culprit and dried pumpkin seeds are most common in Greece. During the last three years Japanese publications listed over 150 cases of digestive tract perforation due to foreign body. Broncho-esophagologist has to care not only for throat cases but also other digestive tract locations of foreign body problems.View full abstractDownload PDF (2751K) -
Yukio Ohmae, Manabu Mogitate, Mutsumi Sugiura2002 Volume 53 Issue 5 Pages 388-393
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSAspiration of foreign bodies into the airway is a life-threatening emergency, in which the major issues involve the accurate diagnosis and immediate retrieval of the foreign bodies. In general, a foreign body in the tracheobronchial tree is more common in children than in adults. However, foreign-body aspiration in adults happens in various situations which contribute to the aspiration. This paper presents two adult cases of aspirated foreign bodies and discusses the debilitating factors that will predispose adults to foreign-body aspiration.
Case 1 is a 70-year-old man with ALS, who repeatedly aspirated foods or his false teeth. The patient exhibits premature spillage from the mouth to the hypopharynx before swallowing and oropharyngeal residue after swallowing. Case 2 is a 70-year-old man with tracheostomized due to bilateral laryngeal paralysis. He demonstrated a foreign body (bread crust) in the trachea, and it was removed with a basket forceps through a fiberscopic bronchoscope.
The definitive treatment in tracheobronchial foreign-body aspiration is removal as soon as possible. It is universally agreed that a ventilation bronchoscope under general anesthesia is the instrument of choice in extracting foreign bodies. However, a fiberscopic bronchoscope may be a valuable therapeutic option for specific adult cases. On the other hand, a swallowing examination in adults may show premature spillage and pharyngeal delay, and these findings relate to the accidental aspiration of foreign bodies into the airway. To prevent the aspiration of foreign bodies in adults, it is important to treat swallowing performance.View full abstractDownload PDF (1163K) -
Osamu Katayama, Shuichi Yamada2002 Volume 53 Issue 5 Pages 394-399
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSEsophageal foreign bodies are defined as foreign bodies that remain in the hypopharynx and/or the esophagus. More patients with esophageal foreign bodies have been both diagnosed and treated with flexible endoscopes such as electronic endoscopes or fiberscopes, so that we cannot know if the number of these patients is increasing or not. At least, patients with PTP foreign bodies have greatly decreased in Japan according to surveys by the Japan Bronchoesophageal Society and the responses of pharmaceutical companies. As most esophageal foreign bodies, including radiolucent ones, are definitely diagnosed with flexible endoscopes, it is better to treat them with flexible endoscopes. To accomplish this, we must choose and use the best foreceps and endoscope attachments including balloons, hoods and overtubes as shown by experiences with rigid esophagoscopes.View full abstractDownload PDF (2321K) -
Fumiyo Kudo2002 Volume 53 Issue 5 Pages 400-405
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSForeign body aspiration affects respiration immediately. Remaining in the lung, some foreign bodies may cause devastating pulmonary damage or inflammation. In spite of widespread education to parents, foreign body aspiration is still one of the serious emergent events in infants and children.
The diagnosis process and post-operative management will be discussed to achieve a successful treatment for foreign body aspiration, based on previous reports and recent therapeutic results in our department.
Food aspiration is found in approximately 90% of patients. In this 90%, foreign body aspiration is mainly of nuts, especially peanuts. 70% of patients are less than 2 years. The majority of the patients are one year old or a bit more. The aspiration of foreign bodies often occurs in association with rapid inspiration. Physical findings are mainly respiratory sounds, such as cough and stridor, with constitute 80% of all the symptoms.
Careful interview and chest auscultation are critical to diagnose foreign body aspiration. Chest X-ray roentogenography, CT scanning and MR imaging also may helpful for diagnosis. If there is good evidence for foreign body aspiration, endoscopic examination should also be performed.
Foreign bodies are usually taken out under general anesthesia, using a ventilation bronchoscopie, rigid bronchoscope with an adapter required for anesthesia. 20% foreign bodies lodge in the trachea and 70% in the main bronchus, with no statistical difference between the right and left main bronchus. There may be more two foreign bodies in the airways, and they may lodge in different places.
The rigid bronchoscope should be operated very carefully to avoid unfavorable complications, such as injury to the tracheobronchial mucosa. Post-operative management include therapy for pneumonia caused by foreign bodies and prevention complications.View full abstractDownload PDF (908K) -
Tadashi Hatakeyama, Tomonori Higuma, Yuko Bitoh, Masao Yasufuku, Tetsu ...2002 Volume 53 Issue 5 Pages 406-411
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSWe reviewed 40 cases of tracheo-bronchial foreign bodies in children who had been admitted to the Pediatric Surgery Department of Takatsuki General Hospital between April 1980 and March 2002. The male-female ratio was about 2:1, Approximately 88% were under 3 years of age, with the peak incidence of foreign-body aspiration occurring around the age of one year. The types of foreign bodies removed included nuts in 80% and peanuts in 60% of the cases. In our series, all foreign bodies could be removed with a ventilation bronchoscope. We removed the nut foreign bodies with a Fogarty balloon catheter, and other foreign bodies with a forceps. In 3 cases, we had to remove the foreign bodies in two procedures, and in 10 cases, where inflamation and granuloma occurred in the airway, we had to re-examine the airway almost 10 days later. In cases where the foreign body had been in the airway for a long time, removal was usually very difficult. Early diagnosis was therefore very important to prevent complications in an cases.View full abstractDownload PDF (1257K) -
Yoshinori Iwase, Hideaki Sakio2002 Volume 53 Issue 5 Pages 412-416
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSA review of anesthesia for airway foreign body was discussed in terms of pathophysiology, practical management and specific backup technology. We emphasized the genesis of hypoxic pulmonary vasoconstriction and reexpansion pulmonary edema due to dislodgement, as well as atelectasis due to occlusion by airway foreign bodies. Anesthesia required skilled and careful management to prevent unintentional hypoxia and maintain appropriate ventilation throughout the perioperative period. A percutaneous cardiopulmonary support system (PCPS) and intubating videolaryngoscope were introduced to facilitate and assist the dislodgement of airway foreign bodies.View full abstractDownload PDF (507K)
Original
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Masaru Sawataishi, Kenichi Takaya, Michio Kimura, Toshiko Yoshida, Ken ...2002 Volume 53 Issue 5 Pages 417-429
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSNeoplastic cells from human esophageal cancer cell lines, SGF-3, SGF-4 and SGF-5, maintained in a hypothermic state at 21.5°C were examined under electron microscope. Ultrastructural alterations, including nucleolar lesions, were found in the cells. SGF cell nucleoli showed characteristic changes under hypothermia, consisting of a segregation of the granular component, the fibrillar center and the fibrillar component. Both morphological apoptotic features and regenerative features were disclosed by electron microscopy. Segregated nucleoli extruded from the nucleus into the cytoplasm were revealed in these hypothermic cells. RNA staining distinguished the nucleoli from the nuclear material extruded into the cytoplasm, indicating the nucleoli in the nucleus, the migration of the nucleoli into the cytoplasm and a RNA-positive material, probably nucleolus origin of budding with the cytoplasmic membrane under hypothermia.View full abstractDownload PDF (9898K)
Case Report
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Kuniko Yoshida, Masayo Ueda, Junji Asano, Kazuto Fukushima, Go Tei, Sh ...2002 Volume 53 Issue 5 Pages 430-435
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSThis paper presents 2 infant cases of foreign body in the air passage, which were treated at our department during the last year and where a long time elapsed before an operation could be performed. One case involved a soybean, which was a moving object and undetected by X-ray but was diagnosed by CT scan. The other case involved a paper clip, and the first examiner failed to ascertain that a foreign body was swallowed before he gave the patient a chest X-ray. The first case took 9 days and the second case took 7 days to operation. In both cases, we performed the extraction of the foreign body with a ventilation bronchoscope under general anesthesia. As the soybean had become moist and soft during its stay in the trachea, it broke into pieces as soon as we touched it. We carefully removed all the pieces with aspiration. The recovery went well in both cases. We should always recognize the risk of death caused by foreign bodies in the air passage, and we must educate the general public as to their danger.View full abstractDownload PDF (1417K)
Short Communication
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Hirotaka Hara, Naoko Murakami, Mitsuji Tamura, Hiroshi Yamashita2002 Volume 53 Issue 5 Pages 436-440
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSGlottis dilatation is required to manage dyspnea due to bilateral abductor vocal cord paralysis. Since the method of vocal cord laterofixation reported by Ejnell et al. is relatively non-invasive and has benefits related to postoperative laryngeal function, it has been considered as the first choice in treating case of bilateral abductor vocal cord paralysis in recent years. However, two problems with this method need to be resolved. One is the difficulty of getting a good endolaryngeal view in the case of poor laryngeal extension, and the other is how to prevent looseness in the nylon knot on the thyroid lamina.
To resolve these problems, we used a rigid endoscope with Ejnell's method to get a clear endolaryngeal view instead of the usual microscope. We also used a titanium plate called an ”Endobottun” as a spacer between the thyroid lamina and the nylon knot to prevent looseness.View full abstractDownload PDF (1439K)
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