Foreign bodies in the stomach are usually ingested by children under the age of 5 years, persons with dentures and alcoholics or mentally disturbed individuals. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metal, fish bones and etc. A toothpick in the stomach has been rarely reported in an alert adult. Here, we present a case of a patient with toothpick stuck in the stomach, that she did not realize she had swallowed. It was removed by an endoscopy without any complications. A 57 year-old woman was admitted to Uijoagbu St. Mary's hospital because of epigastric pain for 10 days. The pain persisted constantly in the epigastrium and aggravated after meals. Sbe had an episode of vomiting during these days. A yellowish white, thin, stiff material 1.5 cm long was found by an endoscopic examination stuck at the less curvature of the antrum. It was removed by the endoscopic biopsy forceps and was proved to be an wooden toothpick, sharp at both ends, with a length of 6.6cm and a diameter of 0.2 cm. There was a small ulcer at the site of the removed toothpick and mild bleeding from the ulcer. The epigastric pain was relieved after the removal of the toothpick. She did not realize she had swallowed the toothpick. Four days later, a follow-up endoscopic examination revealed closed ulcer and no bleeding. She was discharged without complications.
Adult ; Alcoholics ; Biopsy ; Child ; Dentures ; Endoscopy ; Female ; Follow-Up Studies ; Foreign Bodies ; Hemorrhage ; Humans ; Meals ; Middle Aged ; Numismatics ; Parents ; Stomach* ; Surgical Instruments ; Ulcer ; Vomiting

Tuberculous bronchoesophageal fistula is a rare disease. We experienced a case of the tuberculous bronchoesophageal fistula, which was found by endoscopy and surgically confirmed. A sixty seven years old female patient complained of foreign body sensation in the throat and frequent aspiration, especially after liquid meal. Esophagoscopic ex- aminatian showed the orifice of the fistula in the midesophagus at the level of 28 cm from the incisors. Esophagogram showed bronchoesophageal fistula between midesophagus and the right intermediate bronchus. A bronchoscopy visualized fistulous tract with granulation in the right intermediate bronchus. Biopsy specimens obtained from the bronchus revealed the esophageal tissue with granulation and multinucleated giant cells. Fistulectomy with wrapping procedure was performed successfully. Surgical pathologic findings confirmed a small focal granuloma and chronic inflammations, compatible with tuberculosis. There was no evidence of malignancy at the specimens. She was treated with anti-tuberculous agents and became well.
Biopsy ; Bronchi ; Bronchoscopy ; Endoscopy ; Female ; Fistula* ; Foreign Bodies ; Giant Cells ; Granuloma ; Humans ; Incisor ; Inflammation ; Meals ; Pharynx ; Rare Diseases ; Sensation ; Tuberculosis

Maternal hyperventilation may cause neonatal depression. For the evaluation of relationship between maternal acid-base status and neonatal state in elective cesarean section, we observed maternal arterial blood gases and umbilical venous blood gases, and compared them according to maternal pH. Umbilical venous PO2 in group ll(maternal pH between 7.35 and 7.45) and group lll(maternal pH more than 7.45)were significantly low, compared to group l (maternal pH less than 7.35). However, Apgar score at 1 minute and 5 minute didn't show any significant differences in each group.
Apgar Score ; Cesarean Section ; Depression ; Female ; Gases ; Hydrogen-Ion Concentration ; Hyperventilation ; Pregnancy

BACKGROUND: In major burn patients, many invasive monitors including a pulmonary artery catheter (PAC) are often required to assess hemodynamic status. An esophageal Doppler monitor (EDM), as a noninvasive method of measuring hemodynamic parameters, may be a substitute for a PAC in this clinical circumstance. This study was conducted to evaluate the validity of Doppler derived hemodynamic indices in comparison to that of a PAC. METHODS: A total of 20 critically ill, severe burn patients, scheduled for an elective escharectomy and application of artificial dermis, were enrolled for the placement of a PAC and EDM. Simultaneous data was collected in regular intervals and the various parameters were compared between the two methods. RESULTS: A total of 158 pairs of data in 20 patients were gathered. Among all the parameters, cardiac output (CO) and stroke volume (SV) showed consistently 20% less in EDM. Correlation coefficients of heart rate (HR), CO, SV and systemic vascular resistance (SVR) were 0.97, 0.54, 0.62, and 0.68 respectively. Corrected flow time (FTc) had poor correlations with central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). In the mean time, significant, but very weak correlations with FTc vs. CO and SV were demonstrated. CONCLUSIONS: EDM may be a substitute for a thermodilution (TD) PAC technique, it can be used with usefulness for hemodynamic and preload assessment in major burn patients.
Burns* ; Cardiac Output ; Catheters* ; Central Venous Pressure ; Critical Illness ; Dermis ; Heart Rate ; Hemodynamics* ; Humans ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Stroke Volume ; Thermodilution ; Vascular Resistance

BACKGROUND: Carbon dioxide insufflation during an endoscopic thyroidectomy may cause an adverse effects on blood gas and hemodynamic status. This study was conducted to evaluate the safety of low pressure carbon dioxide insufflation during an endoscopic thyroidectomy. METHODS: Patients in ASA physical status I or II, scheduled for an endoscopic thyroidectomy (n = 70) were gathered for the evaluation. During the operative procedure, minute ventilation at a tidal volume 10 ml/kg and respiratory rate 10/minute was maintained. End-tidal carbon dioxide tension, blood pressure and heart rate were measured and compared before and at 10, 20, 30, 60 and 90 minutes after CO2 insufflation. RESULTS: End tidal carbon dioxide tension significantly increased up to 30 minutes and plateaued thereafter. Mean blood pressure significantly increased up to 30 minutes but there was no change in heart rate after CO2 insufflation. Complications were not reported. CONCLUSIONS: We concluded that low pressure carbon dioxide insufflation during an endoscopic thyroidectomy was safe and useful.
Blood Pressure ; Carbon Dioxide* ; Carbon* ; Cholecystectomy, Laparoscopic ; Heart Rate ; Hemodynamics ; Humans ; Insufflation* ; Respiratory Rate ; Surgical Procedures, Operative ; Thyroidectomy* ; Tidal Volume ; Ventilation

Purpose: We assessed prenatal detection rates of congenital heart disease (CHD) and associations between maternal serum biomarkers and non-chromosomal CHD in singleton pregnancies. Materials and Methods: This study was conducted as a secondary analysis of data obtained during a multicenter prospective cohort study that investigated the cost-effectiveness of prenatal testing for fetal aneuploidy. We analyzed the prenatal detection rate and accuracy for CHD screening via ultrasound during the second trimester, as well as associations between serum biomarkers and CHDs, in singleton newborns without chromosomal abnormalities. Results: Among 6715 women, 142 (2.1%) newborns were born with CHDs, of which 67 (1.0%) newborns had major CHDs. The prenatal detection rate for all CHDs and major CHDs were 34.5% and 58.2%, respectively. After excluding isolated ventricular septal defects, the detection rate for critical CHDs was 85.9%. Women with low pregnancy-associated plasma protein A (PAPP-A) (<0.4 multiples of the median, MOM) face increased risks of non-chromosomal CHDs [adjusted odds ratio (aOR) 2.76; 95% confidence interval (CI) 1.36–5.13] and major CHDs (aOR 7.30; 95% CI 3.18–15.59), compared to those without CHDs. A higher inhibin A level (≥2.5 MOM; aOR 4.84; 95% CI 1.42–12.46) was associated with non-chromosomal major CHDs. Conclusion Ultrasonography performed during the second trimester by obstetricians detected over 85% of critical CHDs. Low maternal serum PAPP-A or high inhibin-A was associated with non-chromosomal CHDs. These results may contribute to an improvement in prenatal diagnosis of CHDs.