11/55. death from paraesophageal hiatus hernia: post-mortem assessment and forensic relevance.Hiatus hernias of the diaphragma are rarely recorded under forensic aspects. Their relevance is demonstrated by the case of an elderly lady who was suffering from severe abdominal pain after dinner. She vomited several times and died 4 days later. After a forgery of the notarial last will and testament was revealed, a post-mortem was performed and a paraesophageal hiatus hernia was detected. The toxicological investigation revealed high levels of pethidin, and a married couple, both of them medical doctors, responsible for the forgery of the last will was charged with murder. The pathogenetic reconstruction led to the conclusion that a mechanism of 'self-tamponing' was initiated on the grounds of a pre-existing paraesophageal hernia filled up by the last meal ingested. The blockage of the gastrointestinal passage way induced severe abdominal pain and permanent vomiting, furthermore resulting in hemorrhagic infarction and perigastritis. death from natural cause was finally appreciated by the court and the accused were acquitted. The post-mortem estimation of paraesophageal hiatus hernias is discussed, particularly, the necessity of an in situ preparation with separate incision of the translocated part and histological investigation. A synoptic expertise of clinicians, toxicologists and forensic pathologists is mandatory for estimating the relevance of high levels of analgesics.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
12/55. Activated charcoal laryngitis in an intubated patient.Activated charcoal is useful in the management of poisonings, but it is not harmless. We report the case of a patient who developed obstructive laryngitis secondary to aspiration of activated charcoal with a protected airway. CASE: A 2-year-old girl presented acute mental alteration secondary to presumed poisoning. Mechanical ventilation was initiated, and a single dose of activated charcoal was administered. She had an episode of vomiting during the respiratory weaning. Black-tinted tracheal secretions were suctioned through the tube immediately. Pulmonary auscultation and radiologic examination were normal. When she was extubed, she developed obstructive laryngitis. Fiberbronchoscopy was performed and showed edema and a significant amount of charcoal particles on the epiglottis, arytenoids, and arytenoepiglottic folds. charcoal particles were removed by bronchoscopy successfully. Later evolution was normal, and no symptoms were present when she was discharged at home. COMMENTS: Obstructive laryngitis is a new major complication of activated charcoals use in upper airway. It is remarkable that this complication occurred in a protected airway. charcoal is not an innocuous agent. This case shows that nasogastric administration of activated charcoals presents a significant degree of risk.- - - - - - - - - - ranking = 1.8741616453287keywords = upper (Clic here for more details about this article) |
13/55. Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.A 43-year-old man with dysphagia and a tendency to aspirate was found to have squamous cell carcinoma of the esophagus. Curative surgery was planned and preoperative computed tomography of the chest and abdomen was ordered. A ward nurse administered Gastrografin according to a "standing" order, 4 hours before the CT was to be done. The patient aspirated about 50 mL of Gastrografin, and went into cardiorespiratory arrest caused by pulmonary edema. He sustained severe brain damage and died. This is a first report of lethal aspiration of Gastrografin, given in preparation for CT. We advise alerting nurses who administer Gastrografin, especially to patients with dysphagia or impaired consciousness about the grave consequences that can result if the contrast agent is aspirated by the patient. We further advise that responsibility for using contrast agents in radiologic procedures be assumed by the radiologist and not by medical house staff.- - - - - - - - - - ranking = 6.8768398753565keywords = chest (Clic here for more details about this article) |
14/55. Hydrocarbon pneumonitis following diesel siphonage.In our country, siphoning of diesel/petrol from fuel tanks is a common practice. We describe a 50-year-old farmer, who accidentally aspirated fuel while siphoning from his tractor. A diagnosis of diesel induced aspiration pneumonitis was confirmed by the presence of foam cells on bronchial biopsy. The patient showed gradual recovery with the symptomatic therapy. However two weeks later, he developed sudden chest pain and irregularly irregular pulse that proved fatal. Diesel aspiration leading to bilateral pneumonitis is yet to be reported in our country.- - - - - - - - - - ranking = 7.3768398753565keywords = chest, pain (Clic here for more details about this article) |
15/55. Aspirated stoma button: an unusual complication.The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.- - - - - - - - - - ranking = 8.7510015206853keywords = chest, upper (Clic here for more details about this article) |
16/55. Massive aspiration of barium sulfate during an upper gastrointestinal examination in a child with dysphagia.barium sulfate is an agent used widely as a contrast material for imaging studies of the gastrointestinal tract and is not inherently toxic to lung tissue. Aspiration of barium sulfate has been reported on rare occasions, but is more frequently seen in patients with underlying anatomical or neurological defects such as head and neck deformity, esophageal stricture, diverticulum or fistula. We report a previously healthy child suffered from massive aspiration of barium sulfate during the investigation of dysphagia due to an impacted foreign body in the esophagus. Massive aspiration of barium sulfate is potentially life-threatening because of mechanical interference with gas exchange. An obstruction of the esophagus should be considered in the differential diagnosis for children with acute dysphagia and barium contrast should be used with great care in such instance.- - - - - - - - - - ranking = 7.4966465813149keywords = upper (Clic here for more details about this article) |
17/55. An unusual way of tracheal stoma cleaning could end up with foreign body aspiration in a laryngectomized patient.We report a case of a laryngectomized patient who accidentally aspirated a wooden stick through his tracheal stoma in highly unusual circumstances. He was in a habit of cleaning secretions of upper airway with a wooden stick covered with cotton on the tip soaked in olive oil, via tracheostomy. After applying topical aerolized lidocaine spray through the tracheostomy stoma a flexible video-brochoscopy was performed and a tree twig over 11 cm in length was removed. The patient's symptoms were resolved by a bronchoscopy. With experience and availability of accessories, the removal of the foreign body using flexible bronchoscope under local anesthesia can be performed safely and successfully. This case suggests that the physicians and otolaryngologists should educate their laryngectomized patients about stomal care and discuss any potential life-threatening situation they might encounter.- - - - - - - - - - ranking = 1.8741616453287keywords = upper (Clic here for more details about this article) |
18/55. Fire-eater's lung.Acute pneumonitis following aspiration of petroleum products is usually related to accidental poisonings in children. We describe here two cases of hydrocarbon pneumonitis in fire-eaters, caused by accidental aspiration of petroleum during the performance of fire-eating. Both patients had cough, dyspnoea, chest pain and fever. Chest x-rays showed basal lung infiltrates and, 2 weeks later, pneumatocele formations. Reversible bronchial hyperresponsiveness and restrictive ventilatory limitation were demonstrated in one of the patients. The bronchoalveolar lavage specimen showed cytoplasmic vacuolation of the macrophages and neutrophilia. After treatment with antibiotics and corticosteroids the symptoms disappeared and the lung function values returned to normal within 2-3 weeks. Radiological resolution of the pneumatoceles occurred within 2-12 months.- - - - - - - - - - ranking = 7.3768398753565keywords = chest, pain (Clic here for more details about this article) |
19/55. Reversal of laryngotracheal separation: a detailed case report with long-term followup.Chronic aspiration is a difficult and potentially lethal problem. patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.- - - - - - - - - - ranking = 1.8741616453287keywords = upper (Clic here for more details about this article) |
20/55. Video-assisted thoracoscopic surgery under local anesthesia for right empyema secondary to aspiration pneumonia caused by esophageal achalasia: case report.A 55-year-old man was admitted to the Department of internal medicine of our hospital with chief complaints of fever, cough, and right-sided chest pain. Plain radiography of the chest revealed widening of the mediastinum (attributed to esophageal achalasia), pneumonia, and right pleural effusion. According to the properties of the pleural fluid, empyema was diagnosed. Because the empyema was resistant to antibiotic treatment and was in the fibrinopurulent stage, it could not be drained effectively. Therefore, after treatment of the esophageal achalasia by balloon dilatation of the lower esophagus, the empyema was treated by video-assisted thoracoscopic surgery, i.e., by video-assisted thoracoscopic drainage and curettage of the empyema cavity, under local anesthesia.- - - - - - - - - - ranking = 14.253679750713keywords = chest, pain (Clic here for more details about this article) |
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