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Procedures and outcomes for pediatric esophageal foreign body removal were analyzed. Traditional methods of battery removal were compared with a magnetic tip orogastric tube (MtOGT). A single institution retrospective review from 1997 to 2014 of pediatric patients with esophageal foreign bodies was performed. Balloon extraction with fluoroscopy (performed in 173 patients with 91% success), flexible endoscopy (92% success in 102 patients), and rigid esophagoscopy (95% in 38 patients) had excellent success rates. A MtOGT had 100 per cent success in six disc battery patients, when other methods were more likely to fail, and was the fastest. Power analysis suggested 20 patients in the MtOGT group would be needed for significant savings in procedural time. Thirty-two per cent of all foreign bodies and 95 per cent of batteries had complications (P = 0.002) because of the foreign body. Overall, 1.2 per cent had severe complications, whereas 10 per cent of batteries had severe complications (P = 0.04). Each technique if applied appropriately can be a reasonable option for esophageal foreign body removal. Magnetic tip orogastric tubes used to extract ferromagnetic objects like disc batteries had the shortest procedure time and highest success rate although it was not statistically significant. Disc batteries require emergent removal and have a significant complication rate.

The natural history of isolated calf deep venous thrombosis (CDVT) or noncompressible filling defects is controversial. We aimed to characterize our patient population by differentiating those who had just an isolated, asymptomatic deep venous thrombosis (DVT) limited to the calf from those with a symptomatic CDVT. The presence of edema or pain in the calf and findings of thrombus formation within the soleal, gastrocnemius, posterior tibial, or anterior tibial veins describe symptomatic CDVT. Our objective was to study the incidence, evolution, and clinical consequence of asymptomatic CDVT within the critical care population.Methods: A retrospective analysis incorporating venous duplex ultrasound scans of neurocritical care patients was performed during a 32month period from January 2016 to September 2018. Based on a risk assessment profile score >5, a venous duplex ultrasound scan was obtained 3 days after the patient's admission and weekly thereafter until discharge. Demographics including age, sex, comorbidities, anticoagulation status, principal admission problem, and in-hospital mortality were noted. Symptomatic patients with a diagnosis of a DVT were excluded. The development of a proximal DVT or pulmonary embolus vs resolution of the thrombus during the study period was also recorded.Results: Approximately 5375 lower extremity venous studies were performed. CDVT was identified in 121 (2%) asymptomatic patients. The main admitting diagnosis was traumatic brain injury. The majority (83 patients) underwent follow-up scans consistent with recommendations. During the 32-month period, approximately 50% of them (42/83) had no changes, whereas 36% of patients (30/83) had a complete resolution of the calf vein thrombus. Approximately 13% (11/83) progressed while remaining asymptomatic. Of those 11 patients, 3 patients subsequently developed symptomatic above-knee DVT (3/83 [3.6%]). No pulmonary embolism was recorded. There was no recorded in-hospital mortality.Conclusions: CDVT was identified in only a small percentage of our high-risk patient population who remain without symptoms. Moreover, the rate of progression from asymptomatic CDVT to symptomatic above-knee DVT was only 3.6%. Asymptomatic CDVTs rarely lead to significant clinical consequences and did not correlate with hospital mortality. We recommend against repeated DVT scans after diagnosis of asymptomatic CDVT, more appropriately termed noncompressible venous filling defects, solely based on protocols and without symptoms.

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the TEVAR group and 8.3% (7 of 84) in the STABLE group (P ¼ .22). The 30day rate of malperfusion-related mortality (deaths from bowel/mesenteric ischemia or multiple organ failure) was 12% (5 of 41) in the TEVAR group and 2.4% (2 of 84) in the STABLE group (P ¼ .038). Thirty-day morbidity, for the TEVAR and STABLE groups, respectively, included bowel ischemia (9.8%, 4 of 41 vs 2.4%, 2 of 84; P ¼ .09), renal failure requiring dialysis (7.3%, 3 of 41 vs 9.5%, 8 of 84; P > .99), paraplegia or paraparesis (4.9%, 2 of 41 vs 3.6%, 3 of 84; P ¼ .66), and stroke (2.4%, 1 of 41 vs 11%, 9 of 84; P ¼ .16). The occurrence of 30-day secondary intervention was similar in the TEVAR and STABLE groups (7.3%, 3 of 41 vs 7.1%, 6 of 84; P > .99). Conclusions: In patients with acute type B aortic dissection in the setting of branch vessel malperfusion, the use of a composite device with proximal stent grafts and distal bare aortic stent seemed to result in lower malperfusion-related mortality than the use of stent grafts alone. Thirty-day rates of morbidity and secondary interventions were similar between the groups.