Pharyngeal perforations are uncommon in children and are usually secondary to instrumentation or external penetrating injuries. A delay in management can lead to life-threatening complications such as retropharyngeal abscess, mediastinitis, and airway compromise. We report three children who had pharyngeal perforation due to apparently innocuous injury and who developed serious complications. A high index of suspicion for a significant pharyngeal injury, use of lateral soft-tissue x-ray films of the neck, and flexible endoscopy in the emergency room can assist in early diagnosis when evaluating patients with oropharyngeal and penetrating neck injury. Prompt administration of broad-spectrum antibiotics, local drainage, and debridement can avert life-threatening complications.
Life expectancy has increased during recent decades leading to a growing number of older population. The objective of this study was to evaluate the outcomes of coronary artery bypass grafting (CABG) in octogenarians and to compare the outcomes of the emergent CABG with elective surgery. Prospectively collected data from 31 consecutive octogenarian patients who underwent CABG between 1 January 2006 and 31 December 2008 were analyzed. Main outcomes of interest included mortality, length of ICU stay, length of hospital stay, priority of surgery, postoperative complications and functional status on follow-up. Fifteen patients were operated on an urgent basis. Patients operated on an urgent basis were in NYHA class III or IV preoperatively (P=0.0016). There were no significant differences in operative and postoperative variables. There were three in-hospital deaths and 23 patients (82%) were alive on follow-up and 19 were in functional class I or II. Quality of life assessment was performed using Seattle Angina Questionnaire and patients reported remarkable improvement in quality of life. Overall, 90% patients were not or slightly disabled in their daily activity. Satisfaction with their current quality of life was reported by 95% of patients. CABG may be performed in octogenarians with remarkable outcomes and improvement in quality of life.
The effect of Bacillus subtilis on the immune responses and morphometry of the immune organs was evaluated in broilers challenged with S. gallinarum. For this purpose, Salmonella-free birds (n = 240) were split into four groups with six replicates of ten birds each. Groups included an NC (negative control, non-infected + non-medicated), a PC-S (positive control, Salmonella-infected + non-medicated), an AT-S (Salmonella-infected + medicated with enrofloxacin), and a BS-S (Salmonella-infected + B. subtilis (2.0 × 10<sup>10</sup> cfu/g; 0.1 g/kg) group. On day 21, the thickness of the thymus cortex and medulla, germinal centre area of the spleen, bursal follicular length and bursal follicular area increased (P < 0.05) in the BS-S when compared to the NC and PC-S groups. On day 35, the BS-S group exhibited a higher (P < 0.05) antibody titre against the Newcastle disease virus (NDV), and cortex of the thymus was thicker (P < 0.05) compared to the other groups. A decrease in the thymus medulla thickness, germinal area of the spleen and bursal follicular number were noted in the PC-S group when compared to the other treatment groups. In conclusion, the prophylactic use of B. subtilis type probiotics alleviated the stress resulting from a Salmonella gallinarum infection and improved the immune organs development and function in infected broilers.
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