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      Metallic hairpin inhalation: a healthcare problem facing young Muslim females

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          Abstract

          Objectives

          To perform an epidemiological assessment of metallic hairpin inhalation in young Muslim females and highlight the need for a health education program in this population.

          Methods

          We performed a retrospective analysis of females with a history of metallic hairpin inhalation presenting to the Otolaryngology and Cardiothoracic Surgery Departments at Mansoura University Hospitals from January 2000 to October 2006.

          Results

          A total of 83 patients were identified with metallic hairpin inhalation, of which 2 were excluded as they were coughed and expelled by the patient. Ages ranged from 7 to 19 years. A history of inhaled foreign body (FB) was found in all cases but the majority of patients were asymptomatic, with only 6 patients (7%) presenting with cough. Chest x-rays confirmed the presence of metallic hairpin inhalation in all cases. The metallic hairpins were present in the trachea in 7 patients (9%), in the left bronchial tree in 43 patients (53%) and in the right bronchial tree in 31 patients (38%). Rigid bronchoscopy was performed in all patients with a retrieval rate of 80%. Repeat bronchoscopy was performed in 16 patients (20%), which was successful in 11 patients (14%). The remaining 5 patients required thoracotomy for removal of the metallic hairpin (6%).

          Conclusion

          The significant number of inhaled metallic hairpins in young Muslim females highlights the need for a health education program in this population. Rigid bronchoscopy remains the primary tool for retrieval of these inhaled foreign bodies. However, when repeat broncoscopy is necessitated, a thoracotomy may be required.

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          Most cited references11

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          Tracheobronchial foreign bodies: presentation and management in children and adults.

          To compare the clinical and management aspects of tracheobronchial aspirated foreign body (AFB) removal in children and adults; to assess the influence of the operator's experience on the outcome of the procedure. A retrospective review of a 20-year experience (from 1976 to 1996). A 900-bed university hospital. Eighty-four children up to 8 years old (the child group) and 28 adult patients (the adult group). The peak incidence of foreign body aspiration occurred during the second year of life in the child group and during the sixth decade in the adult group. The symptoms at presentation were similar in both age groups, but the diagnosis was significantly delayed in the adults. The AFBs were lodged preferentially in the right bronchial tree only in the adults; a central location was predominant (but not at all exclusive) in the children. Atelectasis was more common in the adults, and air trapping was more common in the children. The most frequent procedure was rigid bronchoscopy; when a flexible bronchoscope was used, it was always in the adult patients. When the operator was less experienced, a failed first attempt at bronchoscopy and the need for a second procedure were significantly more frequent. At presentation, the symptoms seen with AFBs do not differ according to the age of the patient; however, the delay to diagnosis, the location of the AFBs, and the radiographic images differ between child and adult populations. The removal of AFBs in patients of all ages can be performed by the same operators. Because the outcome associated with these procedures improves when the operator is experienced, the removal of AFBs should be performed in medical centers that are capable of acquiring and maintaining the necessary expertise.
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            Foreign body aspiration into the lower airway in Chinese adults.

            Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults. We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center. The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases). The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.
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              Turban pin aspiration: non-asphyxiating tracheobronchial foreign body in young islamic women.

              Foreign body aspiration is rare in adults. However, in recent years, the aspiration of pins which are used for securing turbans (headscarves) is seen frequently in young women. The aim of this article was to review 105 patients who were admitted to our hospital for turban pin aspiration. Chest X-rays were used for diagnosis. Various methods of treatment were performed: laryngoscopy in 6 patients, flexible fiberoptic bronchoscopy in 16, rigid bronchoscopy in 93, and thoracotomy in one patient, while in the other patient the turban pin was spontaneously expectorated. Localization of the pin in the right bronchial system was common (52%). In 6 patients, turban pins located in the larynx were extracted successfully by direct laryngoscopy. Turban pins were successfully removed with a flexible fiberoptic bronchoscope in 4 patients of the 16 (25%) and by rigid bronchoscope in 93 patients of 94 (99%). The average time until discharge was 18 hours and there was no mortality. Turban pin aspiration is common in Islamic populations and treatment usually requires bronchoscopic procedures. In order to minimize turban pin aspiration frequency, we recommend that turbans should be secured by traditional fastening methods or with an apparatus which cannot be aspirated.
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                Author and article information

                Contributors
                Journal
                J Otolaryngol Head Neck Surg
                J Otolaryngol Head Neck Surg
                Journal of Otolaryngology - Head & Neck Surgery
                BioMed Central
                1916-0208
                1916-0216
                2014
                2 August 2014
                : 43
                : 1
                : 21
                Affiliations
                [1 ]Clinical Lecturer of Surgery, Department of Surgery, Division of Otolaryngology – Head and Neck Surgery, 1E4.34 Walter Mackenzie Science Center, University of Alberta, Edmonton T6G 2B7, AB, Canada
                [2 ]Otolaryngology Department, Mansoura University, Mansoura, Egypt
                [3 ]Cardiothoracic Surgery Department, Mansoura University, Mansoura, Egypt
                Article
                s40463-014-0021-y
                10.1186/s40463-014-0021-y
                4746993
                25085592
                535fd82a-6e49-4e51-9a97-4326547f3f95
                Copyright © 2014 Rizk et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 2 December 2012
                : 25 June 2014
                Categories
                Original Research Article

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