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The Egyptian technique revisited (Sersar-Mansoura technique). How to remove some inhaled foreign bodies through rigid bronchoscopy without using a forceps
A Técnica Egípcia revisitada (Técnica de Sersar-Mansoura): como remover alguns corpos estranhos inalados através de broncoscopia rígida, sem recorrer ao uso de fórceps
S.I. Sersar
Mansoura University, Cardiothoracic Surgery Department, Algomhouria street, Mansoura, Egypt
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Di Naso, J.S. Pereira, S.J. Schuh, G. Unis" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F.C." "apellidos" => "Di Naso" ] 1 => array:2 [ "nombre" => "J.S." "apellidos" => "Pereira" ] 2 => array:2 [ "nombre" => "S.J." "apellidos" => "Schuh" ] 3 => array:2 [ "nombre" => "G." 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How to remove some inhaled foreign bodies through rigid bronchoscopy without using a forceps" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "222" "paginaFinal" => "224" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "S.I. Sersar" "autores" => array:1 [ 0 => array:3 [ "nombre" => "S.I." "apellidos" => "Sersar" "email" => array:1 [ 0 => "Sameh001@yahoo.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Mansoura University, Cardiothoracic Surgery Department, Algomhouria street, Mansoura, Egypt" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A Técnica Egípcia revisitada (Técnica de Sersar-Mansoura): como remover alguns corpos estranhos inalados através de broncoscopia rígida, sem recorrer ao uso de fórceps" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most common cause of accidental death at home among children under 6 years of age is foreign body aspiration (FBA).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A high index of clinical suspicion, combined with the medical history, physical signs and radiology is more conclusive than any one of these in isolation. The greater the availability of expertise and endoscopic equipment the more likely there is to be a favorable outcome without significant morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to limit the risk of complications, early diagnosis is vital and this is why fiberoptic bronchoscopy is so valuable in diagnosing suspected inhalation when there is no clinical or radiological confirmation. Rigid bronchoscopy is the only procedure that allows diagnosis and removal of the foreign body (FB).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Kiyan et al.<span class="elsevierStyleSup">4</span> found the clinical history and symptoms to have highest sensitivity compared to physical examination and radiology. They found the radiology to have the highest positive predictive value while physical examination had the highest negative predictive value and the clinical history the lowest.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Radiological signs related to foreign body inhalation are usually due to obstruction of the valve which may be any of the following: bypass, check, ball and stop valve obstruction.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The radiological signs of FBA include hyper inflation, atelectasis, radiopaque foreign bodies, pneumonic infiltration, bronchiectasis, pulmonary abscess or no abnormality detected.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Swanson et al.<span class="elsevierStyleSup">2</span>, proposed the following algorithm to evaluate and manage cases of suspected foreign body inhalation:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Rigid bronchoscopy if any of the following are present; asphyxia, a radiopaque foreign body, or associated unilaterally decreased breath sounds and obstructive emphysema.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Flexible bronchoscopy in all other cases.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0050" class="elsevierStylePara elsevierViewall">If flexible bronchoscopy identifies a foreign body, a rigid bronchoscopic extraction should be performed.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Focal hyperinflation, witnessed choking crisis, and elevated white blood cell count are closely associated with FBA; bronchoscopy is strongly recommended in the presence of at least 2 risk factors when FBA is suspected.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Cohen et al.<span class="elsevierStyleSup">7</span> 2009 suggested the following algorithm for cases with history suggestive of FBA:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1.</span><p id="par0065" class="elsevierStylePara elsevierViewall">For symptomatic children and/or abnormal physical findings and/or abnormal chest x-ray; either flexible or rigid bronchoscopy is indicated. If flexible bronchoscopy shows a FB, then rigid bronchoscopy is indicated to extract it. The indications for rigid bronchscopy are; asphyxia, radiopaque FB, mediastinal shift and localized findings on chest clinical or examination.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2.</span><p id="par0070" class="elsevierStylePara elsevierViewall">If the patient is asymptomatic without physical and radiological findings, then a follow up should be sufficient.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">Rafanan and Mehta<span class="elsevierStyleSup">8</span> suggested the following guidelines for bronchoscopic foreign body removal:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1.</span><p id="par0080" class="elsevierStylePara elsevierViewall">Complications occur when a bronchoscopy is performed for unclear reasons or for the wrong indications.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Preparation ensures 50% success.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Bronchoscopy is a three-handed procedure.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">4.</span><p id="par0095" class="elsevierStylePara elsevierViewall">A good bronchoscopist has excellent skills, but an excellent bronchoscopist is surrounded by excellent support and backup.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">5.</span><p id="par0100" class="elsevierStylePara elsevierViewall">Time and commitment are essential.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">6.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Know your limitations.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">7.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Each case should be seen as a teaching opportunity.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></li></ul></p><p id="par0115" class="elsevierStylePara elsevierViewall">The bronchoscopic accessories of different sizes should include the Grasping Forceps, Balloon Catheters, Dormia Basket,Fish-Net Basket, Three-, Four-, or Five-Pronged Snares, Magnet Extractor, Cryotherapy and Neodymium-yttriumaluminum- garnet (Nd- YAG) Laser. A serious misconception is that the FB is removed through the working channel of the bronchoscope. The FB is never removed this way. The key to removing FBs lies in being able to secure the object properly by grasping or enclosing it with a forceps or basket. Once the object is snared, all three items (bronchoscope, grasping instrument, and FB) are removed from the patient simultaneously. During removal, the bronchoscopist should make every attempt to visualize the FB continuously, always keeping it in the center of the airway.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">We consider headscarf (veil) pins dangerous as they are very sharp and the number of cases presented is currently increasing in our area. They may traumatize the airway during removal. Our method of removal used to with the rigid bronchoscopy, either just pulling the pin out from its tip or simultaneously with the bronchoscope or pulling the pin from the middle against the end of the bronchoscope bending it and then again just pulling out the pin simultaneously with the bronchoscope. We had one catastrophic bleeding and some baro-trauma, which was actually the stimulus for us to think about our egyptian technique; Sersar technique (MansouraTechnique) that was introduced in 2003-2004 and published later.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It is a new technique for removing a FB from the airway by using the rigid bronchoscope without the extracting forceps. It depends on very good cooperation between the thoracic surgeon and the anesthesia team. The thoracic surgeon and/or the interventional pulmonologist need good patient sedation and muscle paralysis. He (she) must tell the anesthesiologist that a very short period of anesthesia and paralysis may be needed, with the possibility of retrials. Good anesthesia should provide rapid induction, good ventilation and oxygenation, and a satisfactory degree of muscle relaxation with no or minimal post-operative complications. The rigid bronchoscope is introduced into the airway very slowly until the FB is reached, and then the bronchoscope is manipulated until its tip completely surrounds the tip of the FB. The bronchoscope is pushed distally while the FB is in the center of the tip of the bronchoscope, and the technician is asked to lower the head of the operating table gradually. Assisted by this postural drainage and chest percussions, the bronchoscope with the FB in the center of its tip is withdrawn under direct vision, maintaining the postural drainage. This procedure has the following advantages:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1.</span><p id="par0130" class="elsevierStylePara elsevierViewall">Minimal or no risk of airway tear.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2.</span><p id="par0135" class="elsevierStylePara elsevierViewall">A short time is needed.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3.</span><p id="par0140" class="elsevierStylePara elsevierViewall">It can be used for sharp objects with a small diameter as well as for friable organic rounded FB that cannot be caught by the forceps.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4.</span><p id="par0145" class="elsevierStylePara elsevierViewall">It can be easily taught to junior staff in the start of their career.</p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">This method has the following disadvantages and risks:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">1.</span><p id="par0155" class="elsevierStylePara elsevierViewall">It is not possible in all cases and it requires very good cooperation and harmony between the anesthesia and thoracic surgery teams.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a></p></li></ul></p><p id="par0160" class="elsevierStylePara elsevierViewall">Harischandra et al.<span class="elsevierStyleSup">12</span> stated that during pin extraction, it is important to ensheath the pointed end within the bronchoscope to protect the bronchial mucosa from damage. Two methods have been described, one using extraction forceps and the other using postural drainage to assist with suction, without forceps (the Sersar or Egyptian technique). When the pin point is impacted within the mucosa, pushing the pin distally or bending it in the middle may assist dislodgement.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">It is wise to stop and repeat the bronchoscopy if there is bleeding of granulation tissues or if a part of FB is difficult to extract. A second but safer session decreases complication rates.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Re-Re-bronchoscopy can even be advisable. It is better to perform a bronchoscopy to conclude that there is no FBA rather than to leave a FB in the bronchial tree.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–13,14</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Delaying the removal of suspected inhaled foreign bodies to allow optimal circumstances for manipulation of the pediatric airway is a safe practice at some institutions.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> We can conclude that this new type of foreign body inhalation (veil pins), and other sharp ended and some rounded organic and inorganic foreign bodies can be removed using the Egyptian technique (Mansoura Technique) in a reasonable percentage of patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lower respiratory tract foreign bodies: A retrospective review of morbidity, mortality and first aid management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Rouillon" 1 => "J.B. Charrier" 2 => "D. Devictor" 3 => "F. Portier" 4 => "I.K. Lebret" 5 => "P. Attal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2006.07.022" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2006" "volumen" => "70" "paginaInicial" => "1949" "paginaFinal" => "1955" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16950520" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Flexible bronchoscopic management of airway foreign bodies in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.L. Swanson" 1 => "U.B. Prakash" 2 => "D.E. Midthun" 3 => "E.S. Edell" 4 => "J.P. Utz" 5 => "J.C. McDougall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2002" "volumen" => "121" "paginaInicial" => "1695" "paginaFinal" => "1700" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12006464" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of children after bronchial foreign body inhalation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I. Wroblewski" 1 => "I. Pin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Fr Anesth Reanim" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "668" "paginaFinal" => "670" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12946503" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foreign body aspiration in children: The value of diagnostic criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Kiyan" 1 => "B. Gocmen" 2 => "H. Tugtepe" 3 => "F. Karakoc" 4 => "E. Dagli" 5 => "T.E. Dagli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2009.03.021" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "963" "paginaFinal" => "967" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19394092" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheobronchial foreign body aspirations in childhood: a 10-year experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. ğuzkaya" 1 => "Y. Akçali" 2 => "C. Kahraman" 3 => "M. Bilgin" 4 => "A. Sahin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "1998" "volumen" => "14" "paginaInicial" => "388" "paginaFinal" => "392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9845143" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of clinical, radiologic, and laboratory prebronchoscopy findings in children with suspected foreign body aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Heyer" 1 => "BollmeierME" 2 => "L. Rossler" 3 => "T.G. Nuesslein" 4 => "V. Stephan" 5 => "T.T. Bauer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpedsurg.2006.06.016" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "2006" "volumen" => "41" "paginaInicial" => "1882" "paginaFinal" => "1888" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17101364" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suspected foreign body inhalation in children: what are the indications for bronchoscopy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S Cohen" 1 => "A. Avital" 2 => "S. Godfrey" 3 => "M. Gross" 4 => "E. Kerem" 5 => "C. Springer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2009.02.040" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2009" "volumen" => "155" "paginaInicial" => "276" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19446848" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult airway foreign body removal. What's new?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.L. Rafanan" 1 => "A.C. Mehta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Chest Med" "fecha" => "2001" "volumen" => "22" "paginaInicial" => "319" "paginaFinal" => "330" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11444115" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel technique to remove an inhaled foreign body without using a forceps" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.S. Sersar" 1 => "A.K. Abdulla" 2 => "S.A. Abulela" 3 => "A.S. Elsaeid" 4 => "N.A. Abdulmageed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Cardiovasc Dis" "fecha" => "2004" "volumen" => "2" "paginaInicial" => "157" "paginaFinal" => "158" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled foreign bodies: presentation, management and value of history and plain chest radiography in delayed presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.I. Sersar" 1 => "W.H. Rizk" 2 => "M. Bilal" 3 => "M.M. El Diasty" 4 => "T.A. Eltantawy" 5 => "B.B. Abdelhakam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otohns.2005.08.019" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2006" "volumen" => "134" "paginaInicial" => "92" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16399187" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The heterodox nature of —Turban PinsII in foreign body aspiration; the central anatolian experience" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Kaptanoglu" 1 => "A. Nadir" 2 => "K. Dogan" 3 => "E. Sahin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2006.11.017" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2007" "volumen" => "71" "paginaInicial" => "553" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17224190" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The inhaled pin inaccessible to the bronchoscope: a management conundrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.V. Harischandra" 1 => "J. Swanevelder" 2 => "R.K. Firmin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0022215109005490" "Revista" => array:7 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2009" "volumen" => "123" "paginaInicial" => "1399" "paginaFinal" => "1401" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19454133" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1590865807004835" "estado" => "S300" "issn" => "15908658" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Foreign body aspiration in children: value of radiography and complications of bronchoscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.T. Zerella" 1 => "M. Dimler" 2 => "L.C. McGill" 3 => "K.J. Pippus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "1998" "volumen" => "33" "paginaInicial" => "1651" "paginaFinal" => "1654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9856887" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fibrobronchoscopic treatment of foreign body aspiration in children: an experience of 5 years in Hangzhou City, China" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.L. Tang" 1 => "M.Z. Chen" 2 => "Z.L. Du" 3 => "C.C. Zou" 4 => "Y.Z. Zhao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpedsurg.2006.08.041" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "2006" "volumen" => "41" "paginaInicial" => "e1" "paginaFinal" => "e5" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17161170" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Martin Bailey. Removal of inhaled foreign bodies—Middle of the night or the next morning?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Mani" 1 => "M. Soma" 2 => "Massey s" 3 => "C. id Albert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2009.04.005" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol" "fecha" => "2009" "volumen" => "73" "paginaInicial" => "1085" "paginaFinal" => "1089" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19477532" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08732159/0000001700000005/v2_201509041523/S0873215911000456/v2_201509041523/en/main.assets" "Apartado" => array:4 [ "identificador" => "9588" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Comentário" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001700000005/v2_201509041523/S0873215911000456/v2_201509041523/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215911000456?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 9 | 19 |
| 2024 October | 71 | 35 | 106 |
| 2024 September | 58 | 43 | 101 |
| 2024 August | 63 | 39 | 102 |
| 2024 July | 77 | 34 | 111 |
| 2024 June | 54 | 46 | 100 |
| 2024 May | 46 | 39 | 85 |
| 2024 April | 62 | 37 | 99 |
| 2024 March | 44 | 25 | 69 |
| 2024 February | 35 | 24 | 59 |
| 2024 January | 32 | 27 | 59 |
| 2023 December | 35 | 24 | 59 |
| 2023 November | 38 | 31 | 69 |
| 2023 October | 33 | 42 | 75 |
| 2023 September | 40 | 35 | 75 |
| 2023 August | 42 | 30 | 72 |
| 2023 July | 28 | 27 | 55 |
| 2023 June | 24 | 17 | 41 |
| 2023 May | 33 | 25 | 58 |
| 2023 April | 31 | 21 | 52 |
| 2023 March | 41 | 24 | 65 |
| 2023 February | 38 | 22 | 60 |
| 2023 January | 22 | 19 | 41 |
| 2022 December | 34 | 20 | 54 |
| 2022 November | 49 | 39 | 88 |
| 2022 October | 42 | 29 | 71 |
| 2022 September | 37 | 30 | 67 |
| 2022 August | 40 | 37 | 77 |
| 2022 July | 33 | 41 | 74 |
| 2022 June | 36 | 28 | 64 |
| 2022 May | 43 | 36 | 79 |
| 2022 April | 39 | 41 | 80 |
| 2022 March | 29 | 27 | 56 |
| 2022 February | 37 | 32 | 69 |
| 2022 January | 37 | 39 | 76 |
| 2021 December | 32 | 43 | 75 |
| 2021 November | 36 | 29 | 65 |
| 2021 October | 29 | 34 | 63 |
| 2021 September | 20 | 31 | 51 |
| 2021 August | 26 | 24 | 50 |
| 2021 July | 19 | 14 | 33 |
| 2021 June | 25 | 28 | 53 |
| 2021 May | 39 | 18 | 57 |
| 2021 April | 105 | 49 | 154 |
| 2021 March | 47 | 21 | 68 |
| 2021 February | 66 | 15 | 81 |
| 2021 January | 20 | 15 | 35 |
| 2020 December | 24 | 15 | 39 |
| 2020 November | 40 | 23 | 63 |
| 2020 October | 35 | 13 | 48 |
| 2020 September | 68 | 19 | 87 |
| 2020 August | 64 | 24 | 88 |
| 2020 July | 109 | 26 | 135 |
| 2020 June | 86 | 14 | 100 |
| 2020 May | 88 | 17 | 105 |
| 2020 April | 79 | 5 | 84 |
| 2020 March | 58 | 13 | 71 |
| 2020 February | 81 | 12 | 93 |
| 2020 January | 95 | 17 | 112 |
| 2019 December | 66 | 20 | 86 |
| 2019 November | 91 | 9 | 100 |
| 2019 October | 84 | 12 | 96 |
| 2019 September | 64 | 17 | 81 |
| 2019 August | 105 | 13 | 118 |
| 2019 July | 102 | 7 | 109 |
| 2019 June | 102 | 6 | 108 |
| 2019 May | 107 | 9 | 116 |
| 2019 April | 105 | 27 | 132 |
| 2019 March | 169 | 14 | 183 |
| 2019 February | 225 | 7 | 232 |
| 2019 January | 173 | 23 | 196 |
| 2018 December | 116 | 14 | 130 |
| 2018 November | 31 | 0 | 31 |
| 2018 October | 58 | 9 | 67 |
| 2018 September | 34 | 4 | 38 |
| 2018 August | 43 | 27 | 70 |
| 2018 July | 63 | 20 | 83 |
| 2018 June | 51 | 19 | 70 |
| 2018 May | 86 | 24 | 110 |
| 2018 April | 125 | 24 | 149 |
| 2018 March | 90 | 23 | 113 |
| 2018 February | 62 | 17 | 79 |
| 2018 January | 62 | 19 | 81 |
| 2017 December | 115 | 23 | 138 |
| 2017 November | 36 | 26 | 62 |
| 2017 October | 51 | 18 | 69 |
| 2017 September | 41 | 12 | 53 |
| 2017 August | 40 | 19 | 59 |
| 2017 July | 38 | 20 | 58 |
| 2017 June | 40 | 38 | 78 |
| 2017 May | 47 | 25 | 72 |
| 2017 April | 8 | 5 | 13 |
| 2017 March | 14 | 11 | 25 |
| 2017 February | 6 | 4 | 10 |
| 2017 January | 16 | 8 | 24 |
| 2016 December | 37 | 13 | 50 |
| 2016 November | 15 | 5 | 20 |
| 2016 October | 13 | 9 | 22 |
| 2016 September | 12 | 8 | 20 |
| 2016 August | 15 | 8 | 23 |
| 2016 July | 9 | 7 | 16 |
| 2016 June | 8 | 5 | 13 |
| 2016 April | 13 | 3 | 16 |
| 2016 March | 41 | 18 | 59 |
| 2016 February | 31 | 18 | 49 |
| 2016 January | 20 | 16 | 36 |
| 2015 December | 30 | 19 | 49 |
| 2015 November | 26 | 12 | 38 |
| 2015 October | 22 | 18 | 40 |
| 2015 September | 32 | 13 | 45 |
| 2015 August | 35 | 6 | 41 |
| 2015 July | 30 | 9 | 39 |
| 2015 June | 21 | 2 | 23 |
| 2015 May | 33 | 5 | 38 |
| 2015 April | 35 | 12 | 47 |
| 2015 March | 41 | 13 | 54 |
| 2015 February | 28 | 14 | 42 |
| 2015 January | 33 | 18 | 51 |
| 2014 December | 44 | 17 | 61 |
| 2014 November | 39 | 9 | 48 |
| 2014 October | 45 | 10 | 55 |
| 2014 September | 41 | 11 | 52 |
| 2014 August | 36 | 12 | 48 |
| 2014 July | 36 | 14 | 50 |
| 2014 June | 35 | 10 | 45 |
| 2014 May | 50 | 9 | 59 |
| 2014 April | 46 | 8 | 54 |
| 2014 March | 50 | 12 | 62 |
| 2014 February | 41 | 13 | 54 |
| 2014 January | 62 | 13 | 75 |
| 2013 December | 46 | 8 | 54 |
| 2013 November | 50 | 20 | 70 |
| 2013 October | 37 | 12 | 49 |
| 2013 September | 43 | 16 | 59 |
| 2013 August | 54 | 15 | 69 |
| 2013 July | 59 | 19 | 78 |
| 2013 June | 32 | 10 | 42 |
| 2013 May | 53 | 10 | 63 |
| 2013 April | 80 | 22 | 102 |
| 2013 March | 39 | 8 | 47 |
| 2013 February | 34 | 20 | 54 |
| 2013 January | 45 | 22 | 67 |
| 2012 December | 29 | 18 | 47 |
| 2012 November | 29 | 13 | 42 |
| 2012 October | 12 | 7 | 19 |
| 2012 September | 14 | 4 | 18 |
| 2012 January | 217 | 0 | 217 |
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