1
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Zhang SJ, Lin MY, Zhou M, Dan YZ, Gu HB, Lu GL. Hypoxaemia risk in pediatric flexible bronchoscopy for foreign body removal: a retrospective study. BMC Pediatr 2024; 24:359. [PMID: 38783220 PMCID: PMC11112929 DOI: 10.1186/s12887-024-04836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Hypoxemia represents the most prevalent adverse event during flexible bronchoscopy procedures aimed at foreign body retrieval in pediatric patients; if not expeditiously managed, it carries the potential for cardiac or respiratory arrest. The specific risk factors contributing to the occurrence of hypoxemia during foreign body FB removal via bronchoscopy have yet to be definitively established. METHODS This retrospective study included a cohort of 266 pediatric subjects from January 1, 2015, to December 31, 2022, who underwent flexible bronchoscopy for the purpose of FB extraction. In this cohort, the supraglottic airway was used to connect the anesthesia apparatus during the removal procedure. RESULTS In total, 45 of the pediatric patients (16.9%) experienced episodes of hypoxemia during the FB removal procedure. Multivariate analysis revealed that the following factors were significantly associated with the occurrence of hypoxemia: an operation time exceeding 60 min (odds ratio [OR] 8.55; 95% confidence interval [CI] 3.82-19.13), a maximum diameter exceeding 7 mm (OR 5.03; 95% CI, 2.24-11.29), and the presence of radiological evidence indicating pneumonia (OR 2.69; 95% CI, 1.27-5.69). CONCLUSION During flexible bronchoscopy procedures aimed at FB removal in pediatric patients, there is an increased susceptibility to hypoxemia. Factors including extended operation duration, larger FB dimensions, and radiographic evidence suggestive of pneumonia significantly contribute to a heightened risk of hypoxemia.
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Affiliation(s)
- Su-Jing Zhang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Min-Yi Lin
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China
| | - Min Zhou
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ying-Zhi Dan
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China
- Department of Anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Bin Gu
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China
- Department of Anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guo-Lin Lu
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Department of Anesthesiology, Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center), Fujian Key Laboratory of Women and Children's Critical Diseases ReseFujian Medical Universityarch, Fuzhou, China.
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
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2
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Zhi-Pan T, Qi L, Xiao-Fei S. Three different surgical methods of the special tracheobronchial foreign body (pen cap) in children: Case series. SAGE Open Med Case Rep 2024; 12:2050313X241241216. [PMID: 38524381 PMCID: PMC10958796 DOI: 10.1177/2050313x241241216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
We present three novel cases of tracheobronchial foreign bodies (TFBs) in children caused by pen caps. One was removed by the rigid bronchoscopy successfully, the second was removed by rigid bronchoscopy combined with tracheotomy, and the last one was treated by bronchotomy from an external thoracic approach. Rigid bronchoscopy is the most widely used for treating TFBs in clinics, especially treating large and special foreign bodies, because rigid bronchoscopy can provide a good view for observation and operation. Successful removal of a foreign body under rigid bronchoscopy (an experienced doctor, suitable instruments, etc.) can obviate tracheotomy/tracheostomy or thoracotomy/bronchotomy.
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Affiliation(s)
- Teng Zhi-Pan
- Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | | | - Shen Xiao-Fei
- Shen Xiao-Fei, Department of Otorhinolaryngology, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, Jiangsu 210008, China.
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3
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Kothari H, Jawahar AP, Badheka A, Chegondi M. Coin Aspiration Presenting as Chronic Cough and Tracheoesophageal Fistula. Cureus 2023; 15:e50283. [PMID: 38196443 PMCID: PMC10776182 DOI: 10.7759/cureus.50283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Chronic cough can be a diagnostic challenge in the pediatric population. Foreign body aspiration without typical signs and symptoms can often be overlooked as a cause of chronic cough in children. Coin aspirations in the trachea typically have a sagittal orientation on an anteroposterior (AP) chest radiograph. We report a rare case of a previously healthy five-year-old girl presenting with a chronic cough for five months caused by a coin with a coronal orientation on an AP chest radiograph. The coin, initially presumed to be lodged in the esophagus, was actually lodged in the cervical trachea, leading to the development of a tracheoesophageal fistula (TEF). Her AP chest radiograph showed a coronal, circular radio-opaque shadow and the lateral view a tangential radio-opaque shadow, prompting an initial evaluation by esophagogastroduodenoscopy, which was normal. She then underwent rigid bronchoscopy, revealing a coin lodged in the trachea along with a TEF. Surgical removal was achieved through an external approach with a vertical tracheotomy and insertion of a tracheostomy tube. Five days later, a repeat rigid bronchoscopy showed a well-healed TEF, and she was successfully decannulated. She was ultimately discharged home on room air and oral feeds. TEF as a complication of a foreign body lodged in the trachea or esophagus is rare but life-threatening. Foreign body aspiration should always be considered in the differential diagnosis when evaluating younger children with chronic cough.
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Affiliation(s)
- Harsh Kothari
- Pediatric Critical Care Medicine, Dayton Children's Hospital, Dayton, USA
| | - Aravinth Prasanth Jawahar
- Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Aditya Badheka
- Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Madhuradhar Chegondi
- Pediatric Critical Care Medicine, Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, Iowa City, USA
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4
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Flageollet J, Poujol L, Jolivet F, Baudin Trehiou C, Lafuma F, Bernardin F. Bronchoscopic findings in dogs with bronchial vegetal foreign bodies: 84 cases (2010-2020). J Small Anim Pract 2023; 64:384-391. [PMID: 36964986 DOI: 10.1111/jsap.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES To describe endoscopic findings, foreign body location, success rate of removal and complications in dogs with bronchial vegetal foreign bodies. MATERIALS AND METHODS The current study retrospectively evaluated the case records of dogs diagnosed with bronchial vegetal foreign bodies at a veterinary hospital centre between January 2010 and April 2020. Information retrieved included breed, sex, age, bodyweight, the season of presentation, presentation and duration of clinical signs, previous removal attempts performed by the referring veterinarian, foreign body location and endoscopic and imaging findings. RESULTS Eighty-four cases were included. Fifty-nine dogs (70%) presented during spring and summer. Cough (77 of 84; 92%) and fever (15 of 84; 18%) were the main clinical signs. One to 10 bronchial vegetal foreign bodies were removed from each dog. Purulent exudate was observed in the ventral larynx, trachea and bronchi in 49 (65%), 61 (81%) and 71 (95%) dogs, respectively. In most cases, only the barbules of the vegetal foreign bodies were initially observed during endoscopy. The presence of large bronchial nodules or an irregular mucosal surface was a frequent finding (62 of 75; 83%). Mild bleeding was the main complication (58 of 75; 77%) of endoscopic removal, which was successful in 67 of the 84 (80%) cases. CLINICAL SIGNIFICANCE Mucosal nodules associated with purulent material within the airways are frequent endoscopic findings in dogs with bronchial vegetal foreign bodies. Bronchoscopy is a relatively safe and useful technique for diagnosis and treatment of bronchial vegetal foreign bodies in dogs.
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Affiliation(s)
- J Flageollet
- Centre Hospitalier Vétérinaire Fregis, Arcueil, France
| | - L Poujol
- Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - F Jolivet
- Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | | | - F Lafuma
- Centre Hospitalier Vétérinaire Languedocia, Montpellier, France
| | - F Bernardin
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France
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5
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Bataev SM, Sosnova SP, Zurbaev NT, Molotov RS, Eremin DB, Bataev AS. Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2023-68-1-110-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract.Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.
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Affiliation(s)
- S. M. Bataev
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University; Speransky Children’s City Clinical Hospital No. 9
| | - S. P. Sosnova
- Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University
| | | | | | - D. B. Eremin
- Speransky Children’s City Clinical Hospital No. 9
| | - A. S. Bataev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology
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6
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Golan-Tripto I, Tsabari R, Picard E, Stafler P, Armoni Domany K, Goldbart AD, Aviram M, Gatt D, Bari R, Tsaregorodtsev S, Peled C, Melnik P, Bar-Yoseph R, Gut G. Foreign body aspiration in Israeli children during the COVID-19 pandemic. Pediatr Pulmonol 2023; 58:425-432. [PMID: 36224102 DOI: 10.1002/ppul.26203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 10/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, there has been a decline in pediatric emergency department visits. Our aim was to assess the pattern of pediatric foreign body aspiration (FBA) during the first year of the COVID-19 pandemic, in comparison to the prior years. METHODS In this retrospective multicenter study, we compared the number of children who presented with FBA during the COVID-19 year (March 1, 2020 to February 28, 2021) to the annual average of the years 2016-2019. We also compared the lockdown periods to the postlockdown periods, and the percentage of missed FBA, proven FBA, and flexible bronchoscopy as the removal procedure. RESULTS A total of 345 children with FBA from six centers were included, 276 in the pre-COVID-19 years (average 69 per year) and 69 in the COVID-19 year. There was no difference in the prevalence of FBA between the COVID-19 year and any of the prior 4 years. Examining the lockdown effect, the monthly incidence of FBA dropped from a pre-COVID-19 average of 5.75 cases to 5.1 cases during lockdown periods and increased to 6.3 cases in postlockdown periods. No difference in the percentage of missed FB or proven FB was observed. There was a significant rise in the usage of flexible bronchoscopy as the removal procedure (average of 15.4% vs. 30.4%, p = 0.001). CONCLUSION There were fewer cases of pediatric FBA during lockdown periods, compared to post-lockdown periods, presumably related to better parental supervision, with no difference in the prevalence of FBA during the COVID-19 year.
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Affiliation(s)
- Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Tsabari
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Pulmonology Unit and Cystic Fibrosis Center, Pediatric Department, Hadassah Medical Center, Jerusalem, Israel
| | - Elie Picard
- Shaare Zedek Medical Center affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aviv D Goldbart
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvir Gatt
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Romi Bari
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Chilaf Peled
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Pesah Melnik
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonology Institute, Ruth Rappaport Children's Hospital, Haifa, Israel
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7
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Zhang SJ, Gu HB, Zhou M, Lin MY, Zhang LX, Chen XY, Lu GL. Risk factors associated with reintubations in children undergoing foreign body removal using flexible bronchoscopy: a single-center retrospective cross-sectional study. BMC Anesthesiol 2022; 22:219. [PMID: 35831787 PMCID: PMC9277839 DOI: 10.1186/s12871-022-01756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/01/2022] [Indexed: 11/27/2022] Open
Abstract
Background Reintubation is a severe complication during foreign body (FB) removal that uses flexible bronchoscopy. Objective To investigate the incidence and risk factors for reintubations in children undergoing FB extraction by flexible bronchoscopy in a single center. Design A retrospective cross-sectional study. Setting All children with foreign body aspiration at Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2015 to December 2020. Patients Children with FB removal using a flexible bronchoscopy were enrolled in the trial according to the inclusion criteria. Measurements Both multivariable and logistic regression analyses were used to analyze the association between characteristic data and reintubations. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results In total, 244 patients met with the inclusion criteria and were included in the analysis. Among those participants, 28 children (11.5%) underwent reintubations after FB removal by flexible bronchoscopy. Independent factors associated with reintubations were identified as operative time ≥ 60 min [OR: 3.68, 95% CI (1.64–8.82)] and ASA ≥ III [OR: 5.7, 95% CI (1.23–26.4)]. Conclusions Children undergoing FB removal by a flexible bronchoscopy may encounter with a high incidence of postoperative reintubations. Both long operative duration and a severe physical status cause a growing risk of reintubations.
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Affiliation(s)
- Su-Jing Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Hong-Bin Gu
- Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Department of anesthesia, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Min-Yi Lin
- Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Long-Xin Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Xiu-Ying Chen
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China
| | - Guo-Lin Lu
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China. .,Department of Anesthesiology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fujian Children's Hospital, Fuzhou, China. .,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fuzhou, China.
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8
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Chantzaras A, Panagiotou P, Karageorgos S, Douros K. A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients. Acta Paediatr 2022; 111:1301-1312. [PMID: 35388522 DOI: 10.1111/apa.16351] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 12/23/2022]
Abstract
AIM Our aim was to summarise the evidence about flexible bronchoscopy for paediatric airway foreign body aspiration cases. METHODS We searched the PubMed database from 1 January 2001 to 9 October 2021 for peer-review papers published in English on the use, and success rates, of flexible bronchoscopy as the first-line treatment for foreign body aspiration cases. This process identified 243 potential papers. RESULTS We studied 23 papers comprising 2588 cases of foreign body aspiration and flexible bronchoscopy successfully removed the foreign bodies in 87.1% of cases. Complication rates were low in the 983 patients studied in 18 papers. The foreign bodies were organic materials in 78.3% of 1371 patients and mainly lodged in the right bronchial tree in 50.5% of 1402 patients. General anaesthesia was used before flexible bronchoscopy in 14/23 studies and laryngeal mask airways were mostly used in 10/23 studies to secure the airway during the procedure. Ancillary equipment was used to assist the foreign body removal in 57.3% of 1808 cases and these were usually baskets. CONCLUSION Flexible bronchoscopy was a feasible and safe therapeutic procedure for selected foreign body aspiration cases. Future studies need to focus on comparing the clinical outcomes of flexible and rigid bronchoscopies.
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Affiliation(s)
| | - Panagiota Panagiotou
- First Department of Pediatrics Aghia Sophia Children’s Hospital National and Kapodistrian University of Athens Athens Greece
- Evelina London Children’s Hospital London UK
| | - Spyridon Karageorgos
- First Department of Pediatrics Aghia Sophia Children’s Hospital National and Kapodistrian University of Athens Athens Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit 3rd Department of Paediatrics School of Medicine Attikon University Hospital National and Kapodistrian University of Athens Athens Greece
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9
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Ruangnapa K, Anuntaseree W, Saelim K, Prasertsan P. Acquired tracheo-oesophageal fistula in a child with unrecognised tracheal foreign body. BMJ Case Rep 2021; 14:14/4/e240947. [PMID: 33879464 PMCID: PMC8061822 DOI: 10.1136/bcr-2020-240947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 6-month-old girl who presented with recurrent pneumonia and growth failure. After full examination, she was diagnosed with long-standing, unrecognised tracheal foreign body, which was then successfully removed. However, her chronic respiratory symptoms did not improve, and she also had feeding intolerance. The persistence of symptoms indicated a second bronchoscopy and finally an acquired tracheo-oesophageal fistula was diagnosed. This case emphasises the challenges in diagnosis of an inhaled foreign body in young children. Late diagnosis of this condition can cause significant morbidities. A high index of suspicion and careful investigation are very important to prevent long-term complications.
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Affiliation(s)
- Kanokpan Ruangnapa
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Wanaporn Anuntaseree
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Kantara Saelim
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Pharsai Prasertsan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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10
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Callaham S, Kelly A, Stevens L, Thomas D, Carr MM. A Case of Pediatric Aspiration of a Metallic Spring. Cureus 2020; 12:e9987. [PMID: 32983687 PMCID: PMC7511068 DOI: 10.7759/cureus.9987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Prolonged retention of a foreign body after aspiration can lead to numerous respiratory complications. We present a case in which an unwitnessed aspiration of a metal spring by a child led to several months of unilateral wheezing and subsequent physical changes in his left mainstem bronchus. The prompt removal of an airway foreign body requires a high index of suspicion by the physician in order to facilitate proper workup to confirm the diagnosis, allow for prompt management, and minimize damage to the airway.
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Affiliation(s)
- Sarah Callaham
- Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, USA
| | - Andrew Kelly
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, USA
| | - Levi Stevens
- Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, USA
| | - David Thomas
- Pediatrics, West Virginia University School of Medicine, Morgantown, USA
| | - Michele M Carr
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, USA
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11
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Hughes CK, Christensen CL, Maturo SC, O'Connor PR, Dion GR. Organic vs. Inorganic Tracheobronchial Airway Foreign Body Aspiration: Does Type/Duration Matter? Laryngoscope 2020; 131:490-495. [PMID: 32797684 DOI: 10.1002/lary.29006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We sought to determine the time course of clinical and histologic differences between aspirated inorganic and organic foreign bodies. STUDY DESIGN In-vivo. METHODS Twenty Sinclair miniature swine (Sus scrofa domesticus) were divided into two groups-inorganic or organic foreign bodies. Either an organic (peanut) or an inorganic (Lego) foreign body was placed within a bronchus and left for 3, 5, 7, 14 or 21 days. The airway was reassessed at the predetermined endpoint at which time endoscopic, gross, and histopathological findings were documented. Specimens were scored with a pathologic scoring system to assess injury severity from the foreign body. RESULTS Foreign bodies were successfully placed in all 20 swine. Two animals required early euthanasia due to respiratory compromise. The foreign body was identified grossly in eight (40%) animals. An additional three (15%) had microscopic evidence suggestive of a previous foreign body of an undetermined duration. There was no difference in injury severity between organic and inorganic foreign bodies. The 3-day group had injuries limited to the bronchial lining, whereas the longer duration groups had bronchial and adjacent lung parenchymal involvement. There was no difference in injury severity between days 5 and 21. CONCLUSIONS Airway foreign bodies initially cause bronchial damage. After 5 days, the foreign body causes lung parenchymal changes. There was no difference in airway lesion severity between organic and inorganic foreign bodies. LEVEL OF EVIDENCE N/A Laryngoscope, 131:490-495, 2021.
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Affiliation(s)
- Charlotte K Hughes
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, San Antonio, Texas, U.S.A
| | - Christine L Christensen
- Clinical Investigation and Research Support, 59th Medical Wing, United States Air Force, San Antonio, Texas, U.S.A
| | - Stephen C Maturo
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Peter R O'Connor
- Department of Otolaryngology-Head and Neck Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, San Antonio, Texas, U.S.A.,Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, San Antonio, Texas, U.S.A
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12
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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Goussard P, Mfingwana L, Morrison J. Removal of distal airway foreign body with the help of fluoroscopy in a child. Pediatr Pulmonol 2020; 55:E5-E7. [PMID: 31944635 DOI: 10.1002/ppul.24653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/08/2020] [Indexed: 12/22/2022]
Abstract
Most foreign bodies are located in the central airways and can be reached and removed with either a flexible or rigid bronchoscope or a combination of the two methods. The removal of more distal foreign bodies can present a significant challenge. We describe a case of an 11-year-old child, who aspirated a sewing needle that lodged in a distal subsegment of the medial segment of the right lower lobe. As a result, it was visible only with the 2.8 mm flexible bronchoscope (FOB). Mono-planar fluoroscopic guidance was useful for confirming the placement of the 2.8 mm bronchoscope and allowing for a biopsy forceps to grasp the needle and move it to a larger airway, where it could then be removed safely using a larger FOB. Removal of radiopaque foreign bodies in the distal airways is possible with the aid of fluoroscopy and a small bronchoscope. This report also highlights the risk of aspirating sharp objects when they are placed into the mouth, especially by children, and the dangers posed by sharp object foreign body aspiration.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Lunga Mfingwana
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Julie Morrison
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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14
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Residual airway foreign bodies in children who underwent rigid bronchoscopy. Int J Pediatr Otorhinolaryngol 2019; 118:170-176. [PMID: 30639987 DOI: 10.1016/j.ijporl.2019.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/10/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze the causes of residual airway foreign bodies in children who underwent rigid bronchoscopy in order to improve the success rate of primary surgery. METHODS Clinical data from 1130 children with airway foreign bodies, including 736 males and 394 females aged 0.42-14 years, who underwent rigid bronchoscopy in our hospital from January 2015 to May 2018 were retrospectively collected and analyzed by cluster sampling. Clinical characteristics including sex, age, time of onset, location of the foreign body, type of foreign body and experience of surgeon were gathered. All patients were classified into two groups as Group A (with residual airway foreign bodies) and Group B (without residual airway foreign bodies) according to chest CT scans and fiberoptic bronchoscope examinations after rigid bronchoscopy. The values were compared between the two groups. RESULTS Thirty-one patients with residual foreign bodies were confirmed by fiberoptic bronchoscopy among 1130 children with airway foreign bodies who underwent rigid bronchoscopy under general anesthesia. The percentage of residual airway foreign body was 2.7%. The mean age was 1.55 ± 0.46 years (range 1-3 years). There were 24 male patients (77.4%), and 7 female patients (22.6%), with a male/female ratio of 3.43:1. The time of onset was 1.0 (interquartile range: 1.0-8.0) day. There were no significant difference in age, sex and time of onset between the two groups. Most residual foreign bodies were food-related: nuts (n = 27, 87.1%), beans (n = 3, 9.7%), and one case was unclear in nature (3.2%). The residual incidence of fragile foreign bodies was higher than non-friable foreign bodies (P = 0.028). The most common residual foreign body locations were left superior lobar bronchi (32.3%), left inferior lobar bronchi (25.8%) and right inferior lobar bronchi (25.8%). The residual rate of foreign bodies for surgeons with more than 5 years of operative experience was 1.92%, and 4.25% for surgeons with less than 5 years of operation experience, showing a significant difference (P = 0.022). CONCLUSION Friable foods, the complicated structure of the bronchus tree and the surgeon's experience are important causes of residual foreign bodies in the airway. Surgeons with sufficient experience are important for the success of the procedure, which is supported by chest CT and flexible bronchoscopy.
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15
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Xu Y, Ren HB, Jiang L, Wang SF, Feng RL, Li Q. Analysis of Related Factors for the Retention Time of Tracheobronchial Foreign Bodies in Pediatrics. J Surg Res 2019; 233:262-267. [DOI: 10.1016/j.jss.2018.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
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16
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Naime S, Batra SK, Fiorillo C, Collins ME, Gatti M, Krakovsky GM, Sehgal S, Bauman NM, Pillai DK. Aerodigestive Approach to Chronic Cough in Children. ACTA ACUST UNITED AC 2018; 4:467-479. [PMID: 30859056 DOI: 10.1007/s40746-018-0145-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of review Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.
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Affiliation(s)
- Samira Naime
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Suruchi K Batra
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Caitlin Fiorillo
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Maura E Collins
- Department of Hearing and Speech, Children's National Health System, Washington, DC, USA.
| | - Meagan Gatti
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Gina M Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Dinesh K Pillai
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
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A simple management option for chronically impacted sharp tracheobronchial foreign bodies in children. J Otolaryngol Head Neck Surg 2018; 47:26. [PMID: 29636112 PMCID: PMC5894130 DOI: 10.1186/s40463-018-0272-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/27/2018] [Indexed: 01/16/2023] Open
Abstract
Distally impacted chronic tracheobronchial sharp foreign bodies in children are a management challenge that presents with clinical subtlety and extreme variability. The use of image guided techniques, imaginative instrumentation, tracheotomy, thoracotomy, and even extracorporeal membrane oxygneation have been reported. Endoscopy is made difficult by the distal location, inflammatory reaction with granulation tissue formation, and bleeding obscuring the foreign body. Our aim is to describe our experience with two children who had removal of aspirated impacted sharp metallic foreign bodies from the distal airway using rigid bronchoscopy, preceded by maximal medical therapy.
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18
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Goussard P, Morrison JL, Nadine Appel I, Green LL. Multiple foreign body aspiration. BMJ Case Rep 2017; 2017:bcr2017219248. [PMID: 28331024 PMCID: PMC5372182 DOI: 10.1136/bcr-2017-219248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Julie Lyn Morrison
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ilse Nadine Appel
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Lindy-Lee Green
- Department of Paediatrics and Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
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