Abstract
Aim
The data of the Turkish Esophageal Atresia Registry (TEAR) was evaluated to define the survival rate and risk factors of mortality in infants with esophageal atresia (EA).
Methods
The ...data of 389 cases registered by 23 centers between 2014 and 2018 were evaluated for demographic features, associated anomalies, surgical treatment and mortality-related outcome. Each parameter was evaluated for cases with mortality (CM) and compared with the results of survivors. Also, prognostic factors were investigated in CM.
Results
The overall survival rate was 81.09% and the mortality was 19.02% (n = 74). The male/female ratio was 1:1 in CM and 1.2:1 in survivors. The mean weight and height measurements in CM were lower than in survivors (1956 ± 658 g- 43.2 ± 5.7 cm vs 2534 ± 609 g-46.4 ± 4.3 cm) (P < 0.05). The incidence of associated anomalies was 90.6% in CM and significantly higher than survivors (59.6%) (P < 0.05). Neurological, cardiovascular, vertebral, and extremity anomalies were significantly higher in CM (P < 0.001). The most common type of anomaly was EA with distal fistula 89.2% in CM and 74.6% in survivors. The rate of primary anastomosis was also significantly lower in CM (67.6% vs 84.3%, P < 0.05). The gap length did not show statistical difference between CM and survivors (P > 0.05). Tube feeding was more common in CM and the incidence of full oral feedings was significantly higher in survivors (P < 0.01). According to the Spitz classification, the survival rate was 87.1% in Class I, 55.3% in Class II, and 16.7% in Class III. The most common causes of mortality were associated with cardiovascular disease, pneumonia, and sepsis.
Conclusion
The majority of national TEAR data comes from tertiary healthcare centers in Turkey. Therefore, the slightly increased mortality rates could be related to the inclusion of more complex and complicated cases. Birth weight–height, associated anomalies, and Spitz classification are significant risk factors of mortality in cases with EA.
The number of children on home mechanical ventilation (HMV) has increased markedly in Europe and North America but little is known about the HMV use and outcomes in children in Turkey.
To review ...clinical conditions and outcome of children who were discharged from the hospital on respiratory support.
Thirty-four patients assessed at the Marmara University Hospital in Istanbul who had been receiving ventilatory support at home for more than 3 months were included in the study.
Thirty-four patients with a median age of 5.1 years were discharged home with ventilatory support. HMV was started in 2001 at our institution and the number of children treated has increased substantially since then (2001: n = 1, 2002: n = 3, 2003: n = 3, 2004: n = 2, 2005: n = 14, 2006: n = 11). Ventilatory support was started at a median age of 1.8 years and continued for 13 months. Eleven (32.4%) patients received invasive mechanical ventilation via tracheostomy and 23 (67.6%) patients received noninvasive mechanical ventilation. Sixteen children (47.1%) were on noninvasive mechanical ventilation via nasal mask while 7 (20.6%) used a face mask. Seven (20.6%) patients received ventilatory support for 24 h and 27 (79.4%) patients were supported only during sleep. Twenty-four (70.6%) children received supplemental oxygen in addition to ventilatory support. Three patients successfully came off ventilatory support; 11 patients died during follow-up. None of the patients had home nursing and there were no life-threatening complications.
A rapidly rising trend of HMV use in chronic respiratory failure (CRF) has been observed in this study. HMV can be safely applied in selected children with CRF with close monitoring and proper follow-up in developing countries despite the lack of home nursing.
Summary Background Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and ...several factors affect the delay. Objectives To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis. Methods We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed. Results During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients ( n = 28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent ( n = 17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis. Conclusions Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.
Objective:
Early recognition of acute coronary syndromes (ACSs) is crucial in the emergency department. This study was designed to determine the diagnostic value of echocardiography, which was ...performed by an emergency medicine (EM) physician, to diagnosis ACS.
Materials and Methods:
This prospective and cross-sectional study was conducted between June 2011 and December 2011. All patients who were admitted with chest pain, to the EM department, and fulfilled the inclusion criteria were enrolled in this study. The focused echocardiography was performed by the EM physician. All echocardiography videos recorded were shown to the cardiologist. The final comments were compared with EM physician’s early findings.
Results:
Out of 48 patients, four were diagnosed with ACS. Three out of four patients diagnosed with ACS were detected by the EM physician with echocardiography. The EM physician’s prediction value with echocardiography in ACS diagnosis was 75% (95% confidence interval CI range 59%–100%), and the negative predictive value was 97% (95% CI range 77,9%-100%). There was no major cardiac event in the patient in whom the EM physician failed to detect a wall motion defect.
Conclusion:
Echocardiography is a bedside, noninvasive test for diagnosis of ACS. The EM physician who participated in this study was able to recognize ACS with the absence of a segmental wall motion defect, as well as the cardiologist providing the final report.
Purpose : The aim of this study to evaluate the exposure to workplace violence of emergency service workers and its effects on job satisfaction. Methods: Research data were collected from 136 ...emergency service workers of one university hospital between May and September 2019. Structured self-administered questionnaire and job satisfaction scale were used as data collection form. The findings obtained from the study were evaluated with the SPSS 22.00 package program and the significance level was accepted as p <0.05 in all analyses. Results: The mean age of the participants in the study was 30.94 ± 6.77, and the working year of the emergency service was 3.91 ± 4.01. It was determined that 61% of the participants were single, 38.2% were graduated from high school and 41.9% were nurses. It was determined that 86.6% of the participant was exposed to violence during the time they worked in the emergency service, 84.6% of the violence they suffered was verbal abuse, and 84.6% of the participants have been subjected to violence by patients' relatives. A statistically significant difference was found between the emergency service workers' exposure to workplace violence in the emergency service and their job satisfaction levels (p = 0.04). Conclusion: It was concluded that workplace violence reduces job satisfaction level, most of the emergency service workers are exposed to violence, the type of violence experienced is mostly verbal abuse and is practiced by the patient's relative.
Purpose : The aim of this study to evaluate the exposure to workplace violence of emergency service workers and its effects on job satisfaction. Methods: Research data were collected from 136 ...emergency service workers of one university hospital between May and September 2019. Structured self-administered questionnaire and job satisfaction scale were used as data collection form. The findings obtained from the study were evaluated with the SPSS 22.00 package program and the significance level was accepted as p <0.05 in all analyses. Results: The mean age of the participants in the study was 30.94 ± 6.77, and the working year of the emergency service was 3.91 ± 4.01. It was determined that 61% of the participants were single, 38.2% were graduated from high school and 41.9% were nurses. It was determined that 86.6% of the participant was exposed to violence during the time they worked in the emergency service, 84.6% of the violence they suffered was verbal abuse, and 84.6% of the participants have been subjected to violence by patients' relatives. A statistically significant difference was found between the emergency service workers' exposure to workplace violence in the emergency service and their job satisfaction levels (p = 0.04). Conclusion: It was concluded that workplace violence reduces job satisfaction level, most of the emergency service workers are exposed to violence, the type of violence experienced is mostly verbal abuse and is practiced by the patient's relative.
Abstract
Purpose
Despite technical and surgical improvements, treatment of recurrent tracheoesophageal fistula (rTEF) still remains a challenging problem in pediatric patients. Bronchoscopic closure ...of rTEF using different agents is described with different success rates in the literature. This study aimed to report results of patients with rTEF treated with chemocauterization using trichloroacetic acid (TCA) and with laser cauterization (LC) followed by fibrin glue (FG) application.
Methods
Nine patients with rTEF were included in the study from 2014 to 2018. Four patients underwent fistula closure with LC followed by FG application, while another four patients had chemocauterization with TCA. In one case both agents were used. Patients were checked for the success of the treatment by bronchoscopy. All patients had the diagnosis of rTEF. Seven patients had EA with distal TEF and the remaining two patients had H-type TEF as primary pathologies. FG application was performed by LC followed by injection of FG into the fistula. Application of the TCA was made by a TCA-soaked sponge for 30 seconds and 3 times each trial.
Results
Nine children of the age range 4 months to 5 years (mean 1.5 year) were treated endoscopically. Follow-up ranged between 3 months and 5 years (mean 28 months). Among the nine patients only in one patient with only laser coagulation with FG application the treatment was successful. In the remaining eight patients all attempts failed. All these patients underwent open surgical closure of the fistula. There were no acute or late complications related to either endoscopic method.
Conclusion
The results of this study suggest that endoscopic occlusion of recurrent TEF has a low success rate. Surgical closure is still a standard method with a high success rate. Even though endoscopic options are less invasive, they prolong the period of aspiration and may cause increased pulmonary problems.
Abstract
Purpose
Pulmonary alveolar proteinosis (PAP) is a rare cause of chronic interstitial lung disease in children. PAP is characterized by the accumulation of lipoproteins in alveoli. PAP is a ...heterogeneous disease and occurs in three clinically distinct forms: congenital, secondary, and acquired. Whole lung lavage (WLL) is currently the gold standard for therapy of PAP. This study aimed to describe the technique and results of WLL in two patients with PAP.
Methods
There is no established standard technique in the management of lung lavage in children in the literature. We isolated one lung with an inflated Fogarty balloon and inserted a suction catheter of appropriate size and washed that lung while ventilating the contralateral lung via rigid bronchoscopy.
Case 1: A 2-year-old boy presented with dispnoe, cough and required continuous oxygen supplementation. The patient was diagnosed with congenital PAP confirmed pathologically and genetically. This patient underwent 9 times left-sided and 7 times right-sided WLL during the 39-month period.
Case 2: A 13-year-old boy presented with respiratory distress and required continuous oxygen supplementation. The patient was diagnosed with congenital PAP and confirmed pathologically and genetically. This patient underwent WLL 3 times for left and 3 times for right side during the 13-month period.
Both cases showed significantly decreased oxygen support and radiological improvement after WLL. But WLL did not provide a definitive treatment for either patient. No significant acute or long-term complication was observed.
Conclusions
We suggest that repeated WLL is an effective but not definitive treatment of PAP. The technique we used is safe and effective because it enables direct visualization of both main bronchi, allowing early recognition of any possible catheter dislocation and eliminating the risk of contralateral lung contamination.
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