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BMC Surgery May 2024Because the cases are quite scarce, we aimed to review cases of foreign body impaction penetrating the neck through the esophagus to analyze the characteristics of these...
BACKGROUND
Because the cases are quite scarce, we aimed to review cases of foreign body impaction penetrating the neck through the esophagus to analyze the characteristics of these cases. The open surgery skills of the surgeon, the treatment procedure and the surgeons' experience in the rare diseases were analyzed.
METHODS
We collected and analyzed all cases from 2015-2020 in our hospital. Surgical skills and procedures for fasting and anti-infection treatment were reviewed retrospectively. Follow-up was telephone communication.
RESULTS
Our series included 15 cases. Tenderness in the pre-cervical site was a physical sign for screening. Thirteen cases underwent a lateral neck open surgery with the incision including the left side of neck and only two cases were incised from the right side of the neck. Pus was found 3 days after the impaction in one case, the shortest time observed in our series. The esophageal laceration was only sutured primarily in 5 cases (33.33%) among all fifteen cases. After sufficient drainage (average more than 9 days), antibiotic treatment and fasting (normally 2-3 weeks), patients gradually began to switch to solid foods from fluids after complete blood counts and confirmations from esophageal radiography result. No severe complications occurred, and all the patients have no swallowing dis-function and recovered well.
CONCLUSION
Surgery should be performed as soon as possible after impaction. Lateral neck approach surgery and the therapeutic procedure described in this article are safe and effective treatments.
Topics: Humans; Foreign Bodies; Male; Female; Adult; Retrospective Studies; Middle Aged; Esophagus; Neck; Young Adult; Adolescent; Aged
PubMed: 38762478
DOI: 10.1186/s12893-024-02449-5 -
Journal of Occupational Medicine and... May 2024Despite the relative importance, the prevalence of workplace safety and health issues in hospital food service workers is not well studied. This study describes the...
BACKGROUND
Despite the relative importance, the prevalence of workplace safety and health issues in hospital food service workers is not well studied. This study describes the epidemiology of work-related injuries and occupational diseases among hospital food service workers (FSWs) in a tertiary hospital in Singapore.
METHODS
Using a total population sampling approach, a cross-sectional self-administered questionnaire was distributed to all FSWs employed at a major tertiary hospital in Singapore.
RESULTS
The response rate was 98.4% (n = 125). The overall prevalence of workplace injuries and musculoskeletal symptoms was 35% (n = 43) and 53% (n = 65) respectively. The most common workplace injuries were cuts/lacerations (35.8%), muscle strain (25.4%) and burns (19.4%). The prevalence of workplace injuries among staff performing food preparation duties was higher at 56.3% as compared to 21.6% among staff with no food preparation duties (p < 0.01). The prevalence of workplace injuries among staff performing cooking duties was also higher at 47.5%, compared to 29.3% among staff with no cooking duties (p = 0.05). Staff performing food preparation duties had a higher prevalence of musculoskeletal symptoms at 66.7% as compared to 44.6% among staff with no food preparation duties (p = 0.02). Obese staff had a higher prevalence of musculoskeletal symptoms at 78.9%, compared to overweight staff at 53.8% and staff with normal weight at 43.1% (p = 0.03).
CONCLUSION
FSWs with jobs involving cooking and preparation of food, and those with obesity, are at higher risk of sustaining workplace injuries or musculoskeletal symptoms. Targeted interventions should be implemented for injury prevention and to mitigate these risks.
PubMed: 38760819
DOI: 10.1186/s12995-024-00413-w -
Cureus Apr 2024Traumatic hemothorax is typically easy to diagnose because of the distinct onset of trauma with significant complaints such as severe chest pains. However, in elderly...
Traumatic hemothorax is typically easy to diagnose because of the distinct onset of trauma with significant complaints such as severe chest pains. However, in elderly patients, the clinical symptoms are less clear and the frequent use of antithrombotic therapy may prolong the bleeding from a minor fracture. We report a case of traumatic hemothorax from an isolated thoracic vertebral fracture in an elderly patient on anticoagulant and antiplatelet therapy. A 91-year-old male on anticoagulant and antiplatelet therapy was admitted to our hospital with a complaint of persistent hemoptysis after a fall. A computed tomography (CT) demonstrated a worsening right hemothorax and thoracic vertebral fracture without lung or diaphragm injury, rib fracture, or contrast medium extravasation. The patient was taken to the operating room for the exploratory thoracoscopy and evacuation of the hemothorax without a preoperative diagnosis of the bleeding source. The bleeding was from the transverse laceration of the 10th thoracic vertebra exposed to the pleural space. The minor bleeding from the cancellous bone was prolonged, possibly due to the use of anticoagulant and antiplatelet therapy, which was not identified as contrast medium extravasation on chest CT before surgery. In cases of hemothorax with an unclear bleeding source, a vertebral fracture could be considered a source of bleeding even without any signs of bone dislocation or contrast medium extravasation on a CT scan.
PubMed: 38756266
DOI: 10.7759/cureus.58422 -
International Journal of Nursing... Dec 2023Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid...
BACKGROUND
Perineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid the pain that may be caused by perineal repairs with sutures.
OBJECTIVE
To evaluate the effectiveness of surgical adhesive glue in reducing perineal pain when compared to sutures in first-degree perineal tears resulting from vaginal birth.
DESIGN
Open-label parallel-group randomised controlled trial.
SETTING
An alongside birth centre in Sao Paulo, Brazil.
PARTICIPANTS
84 intrapartum women with first-degree perineal tears needing repair.
METHODS
In the experimental group ( = 42), the perineal tears were repaired with Epiglu® surgical glue (ethyl-2-cyanoacrylate); in the control group ( = 42), the tears were repaired with Vicryl Rapide® (polyglactin 910) sutures. The primary outcome was the intensity of perineal pain after birth measured by a numeric pain rating scale ranging from 0 to 10 points. The secondary outcomes were healing, measured by the "Redness, Oedema, Ecchymosis, Discharge, and Approximation" scale; women's satisfaction with the perineal repair, measured by a visual analogue scale; and the time necessary to complete the repair. Data were collected during postpartum hospitalisation and 10-20 days after discharge, from December 2020 to May 2021. Data were analysed using bivariate analysis and linear models by intention-to-treat.
RESULTS
36-48 h after birth, the mean of perineal pain was 0.2 (95% Confidence Interval [CI] 0.1-0.8) in the experimental group and 0.9 (95% CI 0.5-1.5) in the control group; the perineal healing score was 0.7 (95% CI 0.4-1.2) and 0.8 (95% CI 0.5-1.2), in the experimental and control groups, respectively; satisfaction was higher among women in the experimental group (88.1% versus 83.3% in the control group). After discharge, the mean of perineal pain was 0.1 (95% CI 0.0-0.5) in the experimental group and 1.4 (95% CI 0.8-2.2) in the control group; the perineal healing score was 0.0 (95% CI 0) and 1.0 (95% CI 0.7-1.3) in the experimental and control groups, respectively. Satisfaction was higher in the experimental group (94.9% versus 75.0%). The longitudinal analysis showed statistically significant differences between the groups regarding perineal pain and women's satisfaction. The average time necessary for perineal repair was 6.0 (95% CI 4.7-8.7) minutes in the experimental group and 9.7 (95% CI 8.3-11.5) in the control group ( < 0.001).
CONCLUSIONS
Surgical glue resulted in less perineal pain, faster repair, and greater satisfaction than perineal sutures after birth. The healing process was similar in both cases.
TWEETABLE ABSTRACT
Surgical glue was less painful and promoted greater satisfaction after birth compared to sutures in women with first-degree perineal tears.
REGISTRATION
Registered on The Brazilian Clinical Trials Registry number RBR-52y5tq (http://www.ensaiosclinicos.gov.br/rg/RBR-52y5tq/), on July 16, 2020. The first recruitment was on December 17, 2020.
PubMed: 38746582
DOI: 10.1016/j.ijnsa.2023.100130 -
Journal of Medical Case Reports May 2024Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often...
INTRODUCTION
Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.
CASE PRESENTATION
We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.
DISCUSSION
This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient's subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.
CONCLUSION
Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.
Topics: Humans; Male; Middle Aged; Foreign Bodies; Calcinosis; Glass; Diagnosis, Differential; Metacarpophalangeal Joint; Periarthritis; Arthralgia; Radiography
PubMed: 38741133
DOI: 10.1186/s13256-024-04475-6 -
Cureus Apr 2024This case report describes persistent urinary retention lasting over 30 days postpartum in a 23-year-old primiparous female after an otherwise uncomplicated vaginal...
This case report describes persistent urinary retention lasting over 30 days postpartum in a 23-year-old primiparous female after an otherwise uncomplicated vaginal delivery at 37 weeks gestation. Notable risk factors present included epidural anesthesia, episiotomy, third-degree perineal laceration, and inability to void spontaneously before leaving the delivery room. Despite initial catheterization draining a large volume, the patient experienced recurrent failed voiding trials requiring ongoing intermittent catheterization during her admission. One month after delivery, voiding trials were finally successful, and she regained normal spontaneous voiding without catheterization. This case highlights persistent postpartum urinary retention (PUR) as an uncommon but potentially serious obstetric complication requiring prompt diagnosis and appropriate management to prevent adverse events and optimize outcomes. Although most cases are self-limited, a high index of suspicion is needed to institute timely treatment with intermittent catheterization given the morbidity associated with sustained bladder overdistension postpartum.
PubMed: 38738167
DOI: 10.7759/cureus.57956 -
BMC Health Services Research May 2024During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at...
Overlooked by the obstetric gaze - how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study.
BACKGROUND
During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.
METHODS
In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.
RESULTS
Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.
CONCLUSIONS
Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.
Topics: Humans; Female; Perineum; Qualitative Research; Adult; Sweden; Pregnancy; Lacerations; Health Services Accessibility; Interviews as Topic; Postpartum Period
PubMed: 38724992
DOI: 10.1186/s12913-024-11037-5 -
Surgical Case Reports May 2024The rectal and vaginal walls are typically sutured if severe perineal lacerations with rectal mucosal damage occur during vaginal delivery. In case of anal incontinence...
BACKGROUND
The rectal and vaginal walls are typically sutured if severe perineal lacerations with rectal mucosal damage occur during vaginal delivery. In case of anal incontinence after the repair, re-suturing of the anal sphincter muscle is standard procedure. However, this procedure may not result in sufficient improvement of function.
CASE PRESENTATION
A 41-year-old woman underwent suture repair of the vaginal and rectal walls for fourth-degree perineal laceration at delivery. She was referred to our department after complaining of flatus and fecal incontinence. Her Wexner score was 15 points. Examination revealed decreased anal tonus and weak contractions on the ventral side. We diagnosed anal incontinence due to sphincter dysfunction after repair of a perineal laceration at delivery. We subsequently performed sphincter re-suturing with perineoplasty to restructure the perineal body by suturing the fascia located lateral to the perineal body and running in a ventral-dorsal direction, which filled the space between the anus and vagina and increased anal tonus. One month after surgery, the symptoms of anal incontinence disappeared (the Wexner score lowered to 0 points), and the anorectal manometry values increased compared to the preoperative values. According to recent reports on the anatomy of the female perineal region, bulbospongiosus muscle in women does not move toward the midline to attach to the perineal body, as has been previously believed. Instead, it attaches to the ipsilateral surface of the external anal sphincter. We consider the fascia lateral to the perineal body to be the fascia of the bulbospongiosus muscle.
CONCLUSIONS
In a case of postpartum anal incontinence due to sphincter dysfunction after repair of severe perineal laceration, perineoplasty with re-suturing an anal sphincter muscle resulted in improvement in anal sphincter function. Compared to conventional simple suture repair of the rectal wall only, this surgical technique may improve sphincter function to a greater degree.
PubMed: 38724859
DOI: 10.1186/s40792-024-01917-7 -
Annals of Cardiac Anaesthesia Jan 2024Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old....
Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients' vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.
Topics: Humans; Female; Middle Aged; Intubation, Intratracheal; Trachea; Conservative Treatment; Lacerations; Tomography, X-Ray Computed; Mediastinal Emphysema; Subcutaneous Emphysema; Postoperative Complications; Anti-Bacterial Agents
PubMed: 38722131
DOI: 10.4103/aca.aca_106_23 -
JMA Journal Apr 2024We examined the risk factors for fourth-degree perineal lacerations (intrapartum anorectal mucosal lacerations) and rectovaginal fistulas as one of the later...
INTRODUCTION
We examined the risk factors for fourth-degree perineal lacerations (intrapartum anorectal mucosal lacerations) and rectovaginal fistulas as one of the later complications.
METHODS
We reviewed the obstetric records of all singleton vaginal deliveries after 22 weeks of gestation at our institute between January 2006 and December 2018 (n = 19,370).
RESULTS
Of the 19,370 deliveries, 61 had fourth-degree perineal lacerations (0.31%). Of the 61 women, 5 (8.2%) developed rectovaginal fistulas 2-3 weeks after their deliveries. Upon multivariate analysis, nulliparity (Adjusted odds ratios (OR) 3.58, 95% confidence interval (CI) 1.6-8.1, p < 0.01), midline episiotomy (Adjusted OR 2.10, 95% CI 1.0-4.2, p = 0.03), vacuum extraction (Adjusted OR 7.01, 95% CI 3.5-14, p < 0.01), and forceps delivery (Adjusted OR 22.0, 95% CI 7.8-61, p < 0.01) were independently associated with fourth-degree perineal lacerations, while mediolateral episiotomy (Adjusted OR infinity, 95% CI 2.1-infinity, p = 0.03) and forceps delivery (Adjusted OR infinity, 95% CI 14.5-infinity, p = 0.01) were independently associated with rectovaginal fistulas. In addition, in the women with fourth-degree perineal lacerations, mediolateral episiotomy was associated with rectovaginal fistulas (OR infinity, 95% CI 1.8-infinity, p = 0.04).
CONCLUSIONS
Midline episiotomy and instrument-assisted delivery are independent risk factors for fourth-degree perineal lacerations after vaginal delivery. Mediolateral episiotomy and forceps delivery were independently associated with rectovaginal fistulas. Once fourth-degree perineal lacerations occurred, women with mediolateral episiotomies were more likely to develop rectovaginal fistulas.
PubMed: 38721072
DOI: 10.31662/jmaj.2023-0131