Lower complication rates associated with bronchial foreign bodies over the last 20 years

A retrospective comparison of all endoscopic bronchial foreign body (BFB) removals performed at Children's Hospital and Medical Center, Seattle, Washington, during two separate 5-year periods is reported. There were 54 patients between July 1, 1964, and June 30, 1969, and 119 patients between July 1, 1984, and June 30, 1989. Bronchoscopic removal of foreign bodies in the late cohort was performed almost exclusively with Hopkins telescope-guided foreign body graspers as opposed to traditional forceps guided by the naked eye in the first group. There were no differences in the average age, foreign body type, anesthetic technique, operative length, or anatomic distribution between cohorts. There were significantly fewer complications in the late cohort than the early. Complication rates increased with the duration of the BFB in situ. There were significantly fewer missed BFBs at initial bronchoscopy in the late cohort (4) than the early (10). Inability to endoscopically remove the BFB resulted in thoracotomy in 3 patients in the early cohort and 1 patient in the late cohort. There was one instance in which foreign body migration from right to left main stem occurred during the delay between diagnosis and operation, resulting in the necessity for emergent bronchoscopy with the patient in extremis. Prompt endoscopy in patients with suspected BFBs using the Hopkins rod bronchoscopic system will result in fewer complications and fewer missed foreign bodies.

Factors that influence stroke in Dahl salt-sensitive rats

Japanese rat chow and cerebral sympathetic denervation increase the incidence of stroke in stroke-prone spontaneously hypertensive rats. The purpose of this study was to determine if Japanese rat chow and sympathetic denervation would result in a high incidence of stroke in Dahl salt-sensitive (DS) rats, which have not been reported to be stroke prone. At 3 to 4 weeks of age, DS rats of both sexes began consumption of a high salt Japanese or American chow and underwent unilateral superior cervical sympathetic ganglionectomy. The rats fed American chow were found to have a high incidence of stroke (46%). Rats fed Japanese chow had shorter survival and a higher incidence of stroke (78%) than rats fed American chow (p less than 0.05). Blood pressure increased faster in DS rats fed Japanese chow (p less than 0.05). Metabolic studies indicated that increased sodium consumption accounted for only part of the acceleration of hypertension by Japanese rat chow. In DS rats grouped for equal levels of blood pressure, those fed Japanese chow had modestly reduced survival (p less than 0.05) compared with those fed American chow and had a greater incidence of stroke (85% vs 38%; p less than 0.05). Location of stroke was not influenced by removal of sympathetic nerves.(ABSTRACT TRUNCATED AT 250 WORDS)