Septal Necrosis Research Articles

CARDIOGENIC SHOCK IN A PATIENT WITH SEVERE AORTIC VALVE STENOSIS AND MULTIVESSEL CORONARY DISEASE: ADVANCED THERAPEUTIC STRATEGIES

Abstract We describe a case of a 58 years old man. He was referred to emergency room for episodes of vomiting and epigastric pain for about a week. Upon admission he was confused with systolic–diastolic blood pressure values ​​70/40 mmHg, heart rate 120 bpm, sinus rhythm. pO2 was 80 mmHg and SO2 in air 97%. Lactate values 10, blood sugar > 300 mg/dl. The electrocardiogram showed sinus tachycardia with the results of antero–septal necrosis and incomplete left bundle branch block. The fast echocardiogram showed a dilated left ventricle with severe depression of the ejection fraction (EF about 10–15%), severe low flow–low gradient aortic valve stenosis (AVA bidimensional was approximately 0.9 cm²), severe mitral valve insufficiency due to a dual mechanism. The dimension of Inferior vena cava was 1.5 cm, collapsible. There was thrombotic stratification in the apex of the left ventricle and VA coupling was 2. The patient was admitted to the ICU with stage C cardiogenic shock according to SCAI classification. We found a value of PVC 3 mmHg. After fluide challenge there was an increase in blood pressure values to 100/60 mmHg. Noradrenaline vasopressor was started and subsequently a low dose of adrenaline. Blood pressure values maintained around 90/60 mmHg and undergo a sudden drop after increasing the dosage of the vasopressor. Diuresis was approximately 50 ml/h, lactates clear completely after approximately 4 hours. After 6 hours, due to a new sudden reduction in blood pressure, the patient was referred for IABP and coronary angiography control. In the context of multivessel coronary artery disease and cardiogenic shock he was therefore a candidate for urgent cardiac surgery of aortic valve replacement, by–pass and mitral anulovalvuloplasty. This case gave us the opportunity to analyze how to proceed in such a critical conditions with the below conclusions: a) the choice of vasopressors and inotropes is limited in case of severe aortic valve stenosis b) the presence of left ventricular intracavitary thrombosis limits the choice of ventricular assistance system c) in case of cardiogenic shock and severe aortic valve stenosis the patient must be a candidate for valve replacement surgery as soon as possible.

Safety of bubble nasal intermittent positive pressure ventilation (NIPPV) versus bubble nasal continuous positive airway pressure (NCPAP) in preterm infants with respiratory distress.

Nasal Intermittent Positive Pressure Ventilation (NIPPV) is an effective therapy for infants in respiratory distress. We here report the safety of a novel, low-cost, non-electric bubble NIPPV device in comparison with bubble NCPAP. At Paramitha Children's Hospital (Hyderabad, India), preterm (n = 60) neonates with moderate respiratory distress were pragmatically allocated to bubble NCPAP (5-8 cm H2O) or bubble NIPPV (Phigh 8-12 cm H2O/Plow 5-8 cm H2O) based on staff and equipment availability. Primary outcomes to assess safety included clinically relevant pneumothorax, nasal septal necrosis, or abdominal distention. One patient in each arm developed minor nasal septal injury (grade 3 on NCPAP, grade 2 on NIPPV); no patients in either arm developed a clinically significant pneumothorax or abdominal distention. The similar rates of nasal septal injury, pneumothorax and abdominal distention suggest that bubble NIPPV has a similar safety profile as bubble NCPAP for preterm infants in respiratory distress.

Tumor Progression Locus 2 Protects against Acute Respiratory Distress Syndrome in Influenza A Virus-Infected Mice.

ABSTRACTExcessive inflammation in patients with severe influenza disease may lead to acute lung injury that results in acute respiratory distress syndrome (ARDS). ARDS is associated with alveolar damage and pulmonary edema that severely impair gas exchange, leading to hypoxia. With no existing FDA-approved treatment for ARDS, it is important to understand the factors that lead to virus-induced ARDS development to improve prevention, diagnosis, and treatment. We have previously shown that mice deficient in the serine-threonine mitogen-activated protein kinase, Tpl2 (MAP3K8 or COT), succumb to infection with a typically low-pathogenicity strain of influenza A virus (IAV; HKX31, H3N2 [x31]). The goal of the current study was to evaluate influenza A virus-infected Tpl2−/− mice clinically and histopathologically to gain insight into the disease mechanism. We hypothesized that Tpl2−/− mice succumb to IAV infection due to development of ARDS-like disease and pulmonary dysfunction. We observed prominent signs of alveolar septal necrosis, hyaline membranes, pleuritis, edema, and higher lactate dehydrogenase (LDH) levels in the lungs of IAV-infected Tpl2−/− mice compared to wild-type (WT) mice from 7 to 9 days postinfection (dpi). Notably, WT mice showed signs of regenerating epithelium, indicative of repair and recovery, that were reduced in Tpl2−/− mice. Furthermore, biomarkers associated with human ARDS cases were upregulated in Tpl2−/− mice at 7 dpi, demonstrating an ARDS-like phenotype in Tpl2−/− mice in response to IAV infection.IMPORTANCE This study demonstrates the protective role of the serine-threonine mitogen-activated protein kinase, Tpl2, in influenza virus pathogenesis and reveals that host Tpl2 deficiency is sufficient to convert a low-pathogenicity influenza A virus infection into severe influenza disease that resembles ARDS, both histopathologically and transcriptionally. The IAV-infected Tpl2−/− mouse thereby represents a novel murine model for studying ARDS-like disease that could improve our understanding of this aggressive disease and assist in the design of better diagnostics and treatments.

Comparative Histopathology of Bovine Acute Interstitial Pneumonia and Bovine Respiratory Syncytial Virus-Associated Interstitial Pneumonia

Acute interstitial pneumonia (AIP) is a significant disease of cattle and many aetiologies have been implicated on the basis of the characteristic pathological lesions. Bovine respiratory syncytial virus (BRSV) is one of the key aetiological factors in bovine respiratory disease complex and several studies have suggested, controversially, that BRSV may be an underlying cause of bovine AIP. BRSV infection is known to cause several distinctive histopathological changes, including epithelial syncytia formation and intracytoplasmic viral inclusions. However, distinguishing bovine AIP from BRSV-related pneumonia by clinical presentation, gross pathology or histopathology can sometimes be challenging. In order to identify the potential distinguishing features, we compared the histopathological findings of AIP that were, and were not, associated with BRSV infection in naturally occurring cases. We found that multinucleated giant cells were more frequently identified in cattle with AIP while bronchiolitis was more common in BRSV-infected cattle. However, this was not considered a sole indicator of either disease group. Statistically, we identified that a combination of several histopathological features, including alveolar septal necrosis, presence of multinucleated giant cells and bronchiolitis, can serve as an excellent indicator for distinguishing between idiopathic AIP and BRSV-related pneumonia, with a strong statistical significance (P=0.0004). Based on the results of this retrospective study, we present a histopathological scoring system for predicting BRSV-associated AIP.

Sino-nasal hemangiopericytoma: a case series and systematic literature review.

Hemangiopericytoma is a rare tumor of the sino-nasal tract. Its clinical behavior is controversial. Whereas some describe an indolent course, others consider it to be an aggressive lesion with a tendency toward rapid local recurrence. Here, we describe our experience in the management of sino-nasal hemangiopericytoma (SN-HPC), comparing our experience with the current literature, and evaluating signs and tools to improve diagnosis and treatment. All cases of SN-HPC between 2010 and 2020 were extracted and reviewed from our institutional electronic medical records. SN-HPC cases from PubMed and EMBASE between 2010 and 2020 were analyzed in a systematic literature review using the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Data regarding demographics, presentation, diagnosis, treatment, and outcome were collected. We identified four cases of SN-HPC in the nasal cavity in our institution and an additional 53 cases in previous reports. The mean age at the time of diagnosis was 59years, with a 1.2:1 male to female ratio. SN-HPC mostly appears unilaterally, arising in the ethmoid sinus (42.1%). The most common presenting symptoms were epistaxis (47.3) and nasal obstruction (47.3%). Both computed tomography (CT) and magnetic resonance imaging (MRI) were required for diagnosis and for tailoring the treatment plan. Endoscopic surgical excision was used in 85.9% of the patients, and in 15.7%, an additional preoperative embolization was performed, which was associated with septal necrosis in one patient (2.6%). The recurrence rate was 7%. Although previous reports attribute an aggressive tumoral behavior to SN-HPC, our experience and the literature review support a more indolent course with low recurrence rates following complete endoscopic resection. Preoperative embolization can be useful in certain cases, but due to potential complications, it should not be routinely indicated.

Septal Necrosis as Primary Presentation for Mucormycosis in Covid-19 Era

Septal Necrosis as Primary Presentation for Mucormycosis in Covid-19 Era

Assessment of Nasal Airflow and Pain, Safety and Cost of an Improvised Nasal Airway (Nasogastric) Tube After Endoscopic Sinus Surgery

ABSTRACT
 Objective: To compare subjective nasal airflow and overall pain score (as well as safety and added cost of) using an improvised nasal airway tube (nasogastric tube) versus nasal packing after endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyposis (CRSwNP).
 Methods:Design: Quasi - Experimental Prospective Cohort StudySetting: Tertiary Government Training HospitalParticipants: Twenty-six (26) consecutive patients aged 18 to 77 years old diagnosed with CRSwNP who underwent ESS were alternately assigned to an experimental group (A) of 13, where an improvised nasal airway (nasogastric) tube was placed in addition to the nasal pack or a control group (B) of 13 with nasal packing alone.
 Results: There was a significant difference in subjective nasal airflow between experimental (A) and control (B) groups during the immediate postoperative period where the mean subjective airflow was 8.07 and 0.00 over 10.00, respectively. No significant difference was noted between the groups in terms of age, gender, severity of polyposis and overall pain score. No complications such as bleeding, Toxic Shock Syndrome, vestibular or alar injury and septal necrosis were noted immediately post-op and after one week follow-up in both groups. An approximate cost of PhP 25 was added to group A.
 Conclusion: An improvised nasal airway using a nasogastric tube provides adequate airflow without additional pain in the immediate postoperative period. It is safe to use and an affordable option for patients in need of nasal airway stents residing in areas where a preformed nasal packing with incorporated tube stent is not available.

Differential diagnosis of sinonasal extranodal NK/T cell lymphoma and diffuse large B cell lymphoma on MRI

PurposeTo evaluate whether imaging features on conventional magnetic resonance imaging (MRI) can differentiate sinonasal extranodal natural killer/T cell lymphomas (ENKTL) from diffuse large B cell lymphoma (DLBCL).MethodsConsecutively, pathology-proven 59 patients with ENKTL and 27 patients with DLBCL in the sinonasal region were included in this study. Imaging features included tumor side, location, margin, pre-contrast T1 and T2 signal intensity and homogeneity, post-contrast enhancement degree and homogeneity, septal enhancement pattern, internal necrosis, mass effect, and adjacent involvements. These imaging features for each ENKTL or DLBCL on total 86 MRI scans were indicated independently by two experienced head and neck radiologists. The MRI-based performance in differential diagnosis of the two types of lymphomas was evaluated by multivariate logistic regression analysis.ResultsAll ENKTLs were located in the nasal cavity, with ill-defined margin, heterogeneous signal intensity, internal necrosis, marked enhancement of solid component on MRI, whereas DLBCLs were more often located in the paranasal sinuses, with MR homogenous intensity, mild enhancement, septal enhancement pattern, and intracranial or orbital involvements (all P < 0.05). Using a combination of location, internal necrosis and septal enhancement pattern of the tumor in multivariate logistic regression analysis, sensitivity, specificity, and accuracy in differential diagnosis of ENKTL and DLBCL were 100%, 79.4%, and 91.9%, respectively, for radiologist 1, and were 98.3%, 81.5%, and 93.0%, respectively, for radiologist 2.ConclusionMRI can effectively differentiate ENKTL from DLBCL in the sinonasal region with a high diagnostic accuracy.

Comparative study of nasal mask versus nasal prong in terms of nasal septal necrosis for delivering nasal continuous positive airway pressure in newborns with respiratory distress

Background: Respiratory distress syndrome (RDS) requires management by oxygen therapy and mechanical ventilation. Continuous positive airway pressure (CPAP) being simple, cost-effective, and non-invasive respiratory support is used to prevent airway injury as well as the development of bronchopulmonary dysplasia. Objectives: The study was to describe the comparison of nasal septum necrosis and to categorize severity of nasal septum trauma while using nasal prongs and nasal masks for nasal CPAP (nCPAP) in neonates with RD. Materials and Methods: A prospective randomized controlled study was carried out in 200 neonates admitted in neonatal intensive care unit and these neonates were randomized to receive either nasal mask or nasal prong as an interface for nCPAP. Complete blood count, C-reactive protein, blood culture, and chest X-ray were done. All infants were observed for 72 h for the development of nasal septal necrosis in each interface. All variables were analyzed with the help of Chi-square test. Results: Of the total 200 neonates included in the study, 9% neonates of prong group developed nasal septum necrosis, while no incidence of septum necrosis noted in mask group. Conclusion: Nasal masks were comparatively better than nasal prongs as nasal septum trauma occurred only in neonates with nasal prongs group.

Rinoplastia reparadora com enxerto de cartilagem costal em caso de necrose septal em paciente com Granilomatose com Poliangeite

Descrita em 1937, por Friedrich Wegener, a Granulomatose com Poliangeíte (GPA) – anteriormente conhecida como Granulomatose de Wergener – é uma condição autoimune rara. Trata-se de uma vasculite que acomete vasos de pequeno a médio calibre e inflamação granulomatosa necrotizante. Vasos de grande calibre raramente são afetados. Acomete regiões de cabeça e pescoço com regular frequência. Possui predileção pelo trato respiratório alto, pulmões e rins, no entanto pode acometer qualquer órgão. As regiões de orelha, nariz e garganta são as mais comuns em manifestações primárias da doença. Objetivo: Relatar a abordagem cirúrgica reparadora em quadro de deformidade nasal, em paciente com diagnóstico de GPA há 25 anos. Descrições: Paciente do sexo feminino, 41 anos de idade com diagnóstico de GPA há 25 anos. Apresenta quadro de deformidade nasal há aproximadamente 19 anos. Apresenta desabamento do arcabouço cartilaginoso desencadeada por necrose de septo nasal. Não foram relatadas queixas funcionais. Programada rinoplastia aberta com confecção de neosepto em L a partir de enxerto de cartilagem costal. Atualmente a paciente apresenta sustentação da ponta nasal, reversão completa do quadro de nariz em sela, sem queixas funcionais. Conclusão: A GPA é uma doença rara que em acometimentos nasais a perfuração de septo é um evento comum. Raramente, com um longo tempo de doença, pode causar destruição mais extensa da cartilagem nasal, gerando deformidades. Este artigo apresenta um caso raro, de uma paciente com longo período de doença, apresentando deformidade nasal. Foi realizada rinoplastia reparadora com enxerto de cartilagem costal. A cirurgia foi realizada no Serviço de Cirurgia Plástica do Hospital Universitário Pedro Ernesto.

Nasal Trauma in Neonates receiving CPAP And its Prevention in tertiary care hospital.

Objectives: This study was done to evaluate the frequency and severity of nasal trauma secondary to nasal continuous positive airway pressure (NCPAP) in neonates and different methods to reduce the nasal septum injury via CPAP&#x0D; Methods: This is a prospective study carried out in the Neonatal Care Unit (NCU) of LAL DED maternity hospital associated with department of pediatrics Government Medical College, Srinagar, Kashmir. The study included newborns that underwent NCPAP with prongs on admission and those receiving NCPAP after weaning from ventilator, from 1st January 2016 - 1st jan 2017. Neonates noses were monitored from the first day of NCPAP treatment until its weaning. Nasal trauma was reported into Three Grades: (I) Erythema/pressure indentation (II) superficial Erosion and (III) Septal necrosis.&#x0D; Results:-258 newborns were included in study, 136 males and 122 females. All enrolled newborn received CPAP. Babies were randomly allocated to different groups in which no barrier and different barriers were applied. Randomization ofgroup of infants who received no barrier(group 0) and different barriers( group 1,2,&amp;amp;3) was done by systematic allocation, in which first newborn was randomly designated to no barrier group 0 on particular day of admission ,and subsequently alternating with other three groups i.e group 1,group 2, group 3. The mean gestational age, birth weight and CPAP days in each group is 31wk (GA28-35 wks),1200 gms(0.7kg-1.8kg) &amp;amp; 5 days(3-10days) respectively. Incidence of Septal necrosis was 26.7% in the babies that had ‘No barrier applied at septal hudson prongs interface (Group0), which was significantly more (p&amp;lt;0.001) when compared with other three groups, within which its incidence was 2.8% in Cotton applied at septal and hudson prongs interface with glycerine (Group1), 7.1% in Danaplast applied at interface(Group2) and 0.0% in Cotton soaked with normal saline(Group3) respectively. In Group 0 nasal septal injury Grade 1 is (35%),grade 2 (35%),and grade 3(30.0%), in Group 1, grade 1 septal injury is (84%), grade 2(12.7%) &amp;amp; grade 3(2.8%),In Group 2 grade 1 is (65.7%),grade2(30.0%),grade3 (4.3%) and Group3 grade1(80.7%),grade2(19.3%) and Grade3 (0.0%)&#x0D; Conclusions: Nasal trauma is a frequent complication of NCPAP, especially in preterm babies and babies requiring nasal prongs for longer duration. And can be prevented by applying a barrier as in group 1,2 &amp;amp;3 in our study shows statistically significant decreased in severe nasal septal injury. JMS 2017;20(2):96-100&#x0D;

An incidental finding of a long-standing button battery in the floor of the nose during a routine orthodontic examination

Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.

Cosmetic Concerns Related to the Posttraumatic Nose without Nasal Obstruction.

Because of its prominent position on the facial skeleton, the nose is commonly injured. Though significant trauma can result in nasal obstruction, there is also considerable concern for potential cosmetic deformity. Repairing traumatic deformities is complex and can involve all aspects of the nose, including the bony and cartilaginous framework as well as the soft tissue envelope. Trauma can result in deflection, asymmetry, and deformity of the bony nasal dorsum, midvault, and nasal tip. Any serious nasal trauma places patients at risk for complications that may include nasal septal hematoma, septal perforation, and possible cerebral spinal fluid leak. Unrecognized or untreated septal hematomas can result in cartilaginous septal necrosis followed by saddle nose deformity. Though damage to structural scaffolding is often the cause of cosmetic deformity following nasal trauma, the nasal soft tissue envelope is also commonly affected. This can result in lacerations, avulsions, and traumatic tattooing. The following will discuss the evaluation, diagnosis, and management of these cosmetic concerns relating to nasal trauma.

A case series of button batteries as nasal foreign bodies among children

Foreign bodies are a common occurrence in children that may be either accidental or self-induced as a matter of habit. Various materials have been reported as foreign bodies like metal, plastic toy parts, food matters, etc. Button batteries have been reported as foreign bodies in the nose and are especially relevant, due to their early chemical disintegration in contact with mucosal surface; hence, need emergency surgical intervention to avoid complications like septal necrosis and perforation. Here, we report four cases of button batteries in the nose at various stages of presentation with their sequelae along with a review of literature.

The effects of α-tocopherol on oxidative damage and serum levels of Clara cell protein 16 in aspiration pneumonitis induced by bile acids

Our aim in this study is to examine the effects of α-tocopherol (AT) on rats with aspiration pneumonitis induced with bile acids (BAs). The animals were divided in to four groups, namely saline group (n=7), saline+AT group (n=7), BA group (n=7), and BA+AT group (n=7). Saline and BA groups aspirated intratracheally with 1ml/kg saline and 1 ml/kg bile acids, respectively. AT was given at 20 mg/kg/day dosage for 7 days to the groups. AT group was given 20mg/kg/day AT for 7days. Malondialdehyde (MDA), Clara cell protein 16 (CC-16), catalase (CAT), superoxide dismutase (SOD), as well as peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, and necrosis were evaluated. The CAT activity of the BA group was significantly lower than the saline group. In the BA+AT group, there was a significant increase in SOD and CAT activities when compared with that of the BA group. The CC-16 and MDA contents in the BA group were significantly higher than in the saline group. The CC-16 and MDA levels of the BA+AT group were significantly lower than BA group. Histopathologic changes were seen in BA group, and there was a significant decrease in the BA+AT group. In conclusion, AT might be beneficial in the treatment of aspiration pneumonitis induced by BAs because AT decreased oxidative damage and resulted in a decrease in CC-16 levels.

An endoscopic approach to reconstruction of skull base defects using a vascular pedicled nasoseptal mucoperiosteal flap

To introduce a method and the clinical effects of repairing skull base defects and dural defects using vascular pedicled nasoseptal mucoperiosteal flaps through an endoscopic endonasal approach. The clinical and follow-up data for 8 patients who underwent endoscopic endonasal reconstruction of skull base defects and cerebrospinal fluid rhinorrhea with a vascular pedicled nasoseptal mucoperiosteal flap between July 2008 and March 2010 were retrospectively reviewed. All patients were male. The age of these patients ranged from 28 to 60 years (average 41 years). The diagnosis for these patients included one hemangiopericytoma of the anterior skull base one olfactory neuroblastoma (type of Kadish C), one ethmoid sinus cancer, three local recurrent cancers of the nasopharynx after radiotherapy, one carcinoid of skull base and one traumatic cerebrospinal fluid rhinorrhea with recurrent intracranial infection. There were six anterior skull base defects and two middle cranial fossa defects. An endoscopic endonasal surgical approach was used for the repair. A pedicled flap using the nasal septal mucoperiosteum based on the posterior nasal artery was harvested from the ipsilateral side. The tissue flap was used to cover the dural defects. The margin was covered with gelatin sponge and fixed with fibrin glue. The nasal cavity was packed with iodoform gauze, a Foley catheter balloon and Merocel in this sequence to secure the flap in place. Nasal packing was removed 5 to 7 days postoperatively. Partial septal flap necrosis was found in one case, but the flaps in the other 7 cases survived. A postoperative cerebrospinal fluid leak occurred in one case 7 days after surgery. This was re-explored and successfully repaired with abdominal fat. All cases healed well, with no delayed cerebrospinal fluid leaks or intracranial infections during the 6 to 24 months follow-up period. The vascular pedicled nasoseptal mucoperiosteal flap is a reliable choice for endoscopic endonasal skull base reconstruction.

Severe Nasal Presentation of Antiphospholipid Syndrome

We report a rare and severe nasal presentation of antiphospholipid syndrome in a 41-year-old man with systemic lupus erythematosus and end-stage renal disease. His nasal signs included total septal necrosis, along with external nasal swelling and erythema. Prior to the correct diagnosis, multiple medical and surgical treatments were attempted without success. After initiation of intravenous immunoglobulin and anticoagulation therapy, his nasal symptoms promptly resolved. The nasal complication of antiphospholipid syndrome is a relatively unknown and rare finding with limited discussion in the otolaryngology literature.

Nasal foreign bodies: the experience of the Buenos Aires pediatric otolaryngology clinic

The aim of the present paper is to present nasal foreign cases observed at the Children's Hospital Gutierrez in Buenos Aires, Argentina, over a 4-year period and to compare the main findings with data from other case series. A prospective study was undertaken on children having inhaled/aspired a foreign body (FB), with regard to age and sex distribution, FB type, dimensions and consistency, FB location, clinical presentation, removal and occurrence of complications. A total of 1559 cases of foreign body inhalation were observed. The mean age of the children was 3.48 years (SD 1.60). Injuries frequently occurred during recreational activities: in 1154 cases (74.1%) the child was playing, while in 52 cases the accident occurred during a party. In 1417 cases (90.9%) adults were present. Children frequently (1123 cases) insert small objects with a rigid consistency in their noses, like pearls or little metal objects. In the majority of cases nasal FB injuries are due to insertion of inorganic objects (72.7%). Injuries are frequently due to the incorrect manipulation of objects not conceived for children use, including pins, nails, screws and floats. Batteries and magnets deserve particular mention because they require immediate treatment, as they can cause septal necrosis and perforation within hours. Unfortunately, an adult being present does not seem to be sufficient to prevent injuries, and parents are frequently unaware of the danger. The dissemination of information regarding safe behaviors could be fundamental in preventing injuries and need to be promoted by family pediatricians and health practitioners.

Ventilator-Associated Lung Injury Superposed to Oleic Acid Infusion or Surfactant Depletion: Histopathological Characteristics of Two Porcine Models of Acute Lung Injury

Background: The pathophysiological concept of acute lung injury (ALI) in combination with ventilator-associated lung injury (VALI) is still unclear. We characterized the histopathological features of intravenous injection of oleic acid (OAI) and lung lavage (LAV) combined with VALI. Methods: Pigs were randomized to the control, LAV or OAI group and ventilated by pressure-controlled ventilation. Measurements included: haemodynamics, spirometry, blood gas analysis, lung wet-to-dry weight ratio (W/D), total protein content in broncho-alveolar lavage fluid (BALF), and lung pathological description and scoring. Results: Five hours after lung injury induction, gas exchange was significantly impaired in both the OAI and the LAV groups. Compared to controls, we found an increase in W/D and histopathological total injury scores in both the LAV and OAI groups and an increase in BALF total protein content in the OAI group. In contrast to the LAV group, the OAI group showed septal necrosis and alveolar oedema. Both groups exhibited dorsal and caudal atelectasis and interstitial oedema. In addition, the OAI group demonstrated a propensity to dorsal necrosis and congestion whereas the LAV group tended to develop ventral overdistension and barotrauma. Conclusions: This study presents a comparison of porcine OAI and LAV models combined with VALI, providing information for study design in research on ALI.

Thermal Ablation of Lung Tissue: In Vivo Experimental Comparison of Microwave and Radiofrequency

This study was designed to compare feasibility, safety, and effectiveness of microwave (MW) ablation versus radiofrequency (RF) ablation of lung tissue in a rabbit model. Twenty New Zealand White rabbits were submitted to MW (n = 10, group A) or RF ablation (n = 10, group B). The procedures were performed with a prototype MW ablation device with a 1.6-cm radiating section antenna (Valleylab MW Ablation System) and with a 2-cm exposed-tip RF electrode (Cool-tip RF Ablation System). At immediate computed tomography increase in density, maximum diameters (D1-D3) of ablation zones were measured and ablation volume was calculated. Histopathologic assessment was performed 3 and 7 days after the procedure. Technical success was achieved in nine of 10 rabbits in each group. One death occurred in group B. Complications included pneumothorax (group A, n = 4; group B, n = 4), abscess (group A, n = 1; group B, n = 1), and thoracic wall burn (group A, n = 4). No significant differences were demonstrated in attenuation increase (P = 0.73), dimensions (P = 0.28, 0.86, 0.06, respectively, comparing D1-D3) and volume (P = 0.17). At histopathology, ablation zones were similar, with septal necrosis, edema, hemorrhage, and peripheral lymphocytic infiltrate. Complete thrombosis of more than 90% of vessels up to 2 mm in diameter was depicted at the periphery of the ablation zone in group A specimens. In group B specimens, complete thrombosis was depicted in 20% of vessels. Feasibility and safety of MW and RF ablation are similar in a lung rabbit model. MW ablation produces a greater damage to peripheral small vessels inducing thrombosis.