Esophageal foreign bodies

BACKGROUND: Recent epidemiologic studies in Europe using antigliadin (AGA) and anti-endomysium antibodies (AEA) for initial screening have shown that the overall prevalence of celiac disease (CD) is about 1:300. There are no comparable scientific data for the USA, where CD is considered rare. The main aim of this study was to determine the prevalence of increased AEA in healthy blood donors in the USA. METHODS: Sera from 2000 healthy blood donors were screened for IgG AGA and IgA AGA with an enzyme-linked immunosorbent assay test. All those with increased AGA levels, those with intermediate levels, and random samples with low levels were tested for AEA, using both monkey esophagus (ME) and human umbilical cord (HUC) cryosections as substrates. RESULTS: The mean age of the blood donors was 39 years, with 52% being men, 85.2% being Caucasian, 11.8% African-American, 1.5% Asian, and 1.5% Hispanic. Eight healthy blood donors had positive AEA tests on both monkey esophagus and human umbilical cord. Among the eight subjects with increased AEA levels seven were Caucasian and one was African-American. All the four examined AEA-positive donors carried the known susceptibility alleles for CD. CONCLUSIONS: The prevalence of increased AEA levels in healthy blood donors in the USA is 1:250 (8:2000). This is similar to that reported in countries in Europe, where subsequent small-intestinal biopsies have confirmed CD in all those with AEA positivity. On the basis of a high positive predictive value of the AEA antibody test, it is likely that the eight blood donors identified in this study have CD. These data suggest that CD is not rare in the USA and that there is need for a large-scale epidemiologic study to determine the precise prevalence of the disease in the USA.     

Intraretinal foreign bodies

PURPOSE: To present our experience with the removal of intraretinal foreign bodies. MATERIAL AND METHODS: 9 intraretinal foreign bodies were removed by pars plana vitrectomy. Laser photocoagulation of the retina surrounding the foreign body was performed either before surgery or intraoperatively (endolaser). Pars plana vitrectomy with foreign body removal through the sclerotomy site with endomagnet and/or forceps was performed. In some cases fluid-gas exchange was done. RESULTS: The average follow-up period was 6.2 months. Seven of nine foreign bodies were magnetic and two were nonmagnetic. Five of seven magnetic foreign bodies had negative magnetic traction as the first surgical procedure. In these 9 eyes, final visual acuity was below 1/50 in 2 eyes and over 5/50 in 7 eyes. CONCLUSION: Pars plana vitrectomy should be the method of choice in removal of intraretinal foreign bodies.     

Laryngeal foreign bodies in children

Laryngeal foreign bodies (F.B.) in children are relative rare, especially in infants under one year of age, and the diagnosis and removal are difficult. The history, the clinical and radiologic findings can be misleading. Seventeen patients with laryngeal F.B. (10 of them under one year of age) are presented, and the diagnostic problems and treatment are discussed. Foreign bodies were either objects of a sharp and thin quality, e.g. an eggshell fragment, or large, e.g. a piece of meat, causing apnea and death.     

Management of colorectal foreign bodies

Colorectal foreign bodies (CFBs) present a serious dilemma regarding extraction and management. In an 11-year period ending March 1994, 48 patients presented to the University of California, San Diego Medical Center and Hammersmith Hospital London with CFBs. Identified patients charts were reviewed in a retrospective manner and the medical literature was reviewed. A wide variety of CFBs were identified and all were extracted transanally. Circumstances surrounding CFB insertion was most commonly sexual stimulation (78%), but included sexual assault (10%). Extraction in the emergency department was successful in 31 (63%) patients. Operating room extraction was performed in 18 (37%) patients; in 12 cases the CFBs were simply extracted under anaesthesia, five patients required primary repair and diverting colostomy for rectal perforation and one required primary repair of an external anal sphincter laceration. Post-extraction observation following simple extraction ranged from immediate discharge to 72 h (mean 13.1 h) and there were no reported complications. A thorough history is essential in order to identify those cases that have resulted from assaults. With adequate sedation, most CFBs can be extracted transanally either in the emergency department or operative suite under direct vision. Sigmoidoscopy is required following extraction to evaluate mucosal injury or perforation. After effortless extraction of a smooth object, with no evidence of mucosal injury, the patient can be discharged after a short period of observation. Rectal perforation can be treated with primary repair and diverting colostomy with low morbidity. This is a relatively common surgical dilemma that requires a thorough history, physical examination, radiographs inventiveness to treat. Additionally, the physician should demonstrate a caring attitude and not subject the patient who is suffering pain and embarrassment to ridicule.     

Self-inserted sphenoid sinus foreign bodies

This report describes the case of a patient who inserted 3 foreign bodies into her right sphenoid sinus. The possible consequences of sphenoid sinus foreign bodies are described, as well as the importance of a psychiatric workup in such cases.     

Localization of intraorbital foreign bodies

A study was performed utilizing 3 mock eyes of different sizes to determine the precision and accuracy of 3 radiographic methods of localization of intraorbital foreign bodies. The Comberg method was found to be the most precise and accurate, next, the Sweet method, and then the modified spectacle frame method. However, the modified spectacle frame field expedient method of localization yielded a surprisingly high degree of accuracy in 2 of the 3 planes of reference, that is, mediolaterally and superointeriorly. A more accurate field expedient type of device which will permit greater accuracy in localization of intraorbital foreign bodies in the anteroposterior axis is currently under development.     

Unlikely foreign bodies in unusual facial sites

PURPOSE: To determine whether cataract in patients with atopic dermatitis is associated with higher levels of aqueous flare or cells. METHODS: In a prospective study, 35 consecutive patients examined during a 6-month period at the atopic dermatitis service in a university hospital underwent standardized ophthalmologic evaluations including the quantitative measurement of aqueous flare and cells by a laser flare-cell meter. RESULTS: Seven patients had bilateral cataract with anterior or posterior subcapsular opacities, or both; one patient had similar cataract in one eye and no cataract in the opposite eye; and 27 patients had no cataract in either eye. Fifteen eyes with cataract showed significantly higher levels of aqueous flare (2.1 to 33.9 photon counts per millisecond with a median of 18.0) compared with 55 eyes without cataract (2.4 to 16.0 photon counts per millisecond with a median of 9.2; Mann-Whitney U test, P = .0008). The association of cataract with higher levels of aqueous flare remained significant when only one eye (the right eye) of each patient was chosen for statistical analysis (P = .0024). CONCLUSION: Higher levels of aqueous flare caused by the breakdown of blood-aqueous barrier may contribute to the formation of cataract in patients with atopic dermatitis.     

Post-operative peritoneal adhesions and foreign bodies

One of the proven causes of adhesions is foreign microbodies which are present in up to 93% of all re-operated patients in which adhesions are analysed for evidence of external contamination. Studies are described which show the changing nature of foreign microbodies with time, associated with the development of new surgical practices. This paper concludes that although foreign bodies found today may not be the same as those found 30 years ago, they remain prominent in the aetiology of adhesions--the main cause of postoperative intestinal obstruction. Every effort should be made to minimise tissue contamination during operations with particulate debris such as glove powder.     

Rectal sexual trauma including foreign bodies

We used a potent and specific monoclonal antibody to somatostatin to test the physiologic inhibitory role of the tetradecapeptide somatostatin on pancreatic secretion. Somatostatin immunoneutralization increased both the total amylase and volume of pancreatic secretion. Cholecystokinin-A receptor antagonism abolished the stimulatory effect of somatostatin immunoneutralization. We conclude that somatostatin tonically inhibits, pancreatic secretion in fasted rats via inhibition of the release or action of cholecystokinin. Furthermore, the source of these peptides is likely islet delta cells and intrapancreatic neurons, respectively.     

Balloon extraction of esophageal foreign bodies in children

A study to determine the sensitivity, specificity, and positive and negative predictive values of several clinical diagnostic tests of subcutaneous Achilles tendon rupture was performed during a 13-year period. There were 174 patients with clinical diagnosis of unilateral complete subcutaneous Achilles tendon tear and 28 patients with unilateral suspected but no actual Achilles tendon tear. The following tests were used: palpation, calf squeeze, Matles, Copeland, and O'Brien. Palpation of the gap was the least sensitive clinical test with the patient awake (0.73), increasing to 0.81 when the test was performed under anesthesia; the Copeland and O'Brien tests showed a sensitivity of 0.8. Both the calf squeeze and Matles tests were significantly more sensitive than the other tests (0.96 and 0.88, respectively; 0.022 < P < 0.05). All tests showed a high positive predictive value, with no statistically significant difference between the various tests. In the 28 patients with no evidence of a subcutaneous Achilles tendon tear on imaging, the tests showed a high capability to detect that the Achilles tendon was intact (gap palpation specificity, 0.89; calf squeeze test specificity, 0.93; Matles test specificity, 0.85). Whichever tests were performed, at least two of them were positive for a subcutaneous tear of the Achilles tendon in all patients in this study.     

The percutaneous retrieval of vascular foreign bodies

Intravascular foreign bodies can cause significant complications: thrombosis, pulmonary and peripheral embolism, etc. It is therefore necessary to remove them, and this may be accomplished through surgery or by means of radiotherapy techniques. In the past year we have percutaneously extracted three foreign bodies originating in vascular access pathways.     

Cricoid calcification in the study of esophageal foreign bodies

Lateral radiography of the neck is performed for the study of radio-opaque esophageal foreign bodies that are not visualized by indirect laryngoscopy. This projection may reveal a calcified linear image behind the cricoid cartilage due to calcification of the posterior lamina. In such cases, esophagoscopy and/or computed tomography must be performed to determine whether the image is due to an anatomic variant or a true foreign body.     

Detection and management of foreign bodies in soft tissue

The discovery and management of foreign bodies in soft tissue are challenging problems for emergency physicians. History, physical examination, and thorough wound exploration serve as the screening test for the presence of foreign bodies. Various radiographic studies can be performed to confirm the diagnosis, to identify the object's composition and shape, and to determine its approximate location in the tissues. Once the object is discovered, the clinician must weigh the potential harm of the foreign body in its current location against the risks of attempting removal.     

Caustic ingestion and foreign bodies in the gastrointestinal system

Human platelets afford a suitable and physiologically relevant model to study receptor-dependent cell aggregation and ensuing biosignaling reactions. Since cell surface glycoconjugates can serve as ligands in recognitive protein--carbohydrate interactions, it is of interest to investigate the reactivity of such epitopes for a plant lectin and the elicited intracellular responses. Therefore, the galactose-specific lectin (Viscum album agglutinin, VAA) was employed as a tool for this purpose. It was found that VAA induced platelet aggregation at a concentration of 2.5 microgram/ml using 2.5. 108 cells/ml, composed of the formation of both lactose-sensitive (Lac+) and lactose-resistant (Lac-) intercellular contacts. Lac- aggregates were formed only by metabolically active platelets of about 70% of the samples from the group of studied volunteers. The requirement of metabolic activity for formation of these contacts which no longer depend on lectin--ligand recognition was underscored by the lack of their appearance in the presence of metabolic inhibitors such as nordihydroguaiaretic acid, trifluoperazine, N-ethylmaleimide and menadione. With respect to biosignaling, the effective aggregation of platelets did not affect the basal level of Ca2+ in cells and reduced the rate of the menadione-dependent generation of H2O2. In parallel series platelet aggregation induced by bovine thrombin (0.03 U/ml) triggered an increase in the cytoplasmic Ca2+ level and an enhancement of the H2O2 generation. Overall, these results imply metabolically controlled post-binding reactions which strengthen the lectin-induced cell association and demonstrate differential responses with respect to the Ca2+ level and H2O2-generation between lectin- or thrombin-mediated aggregation of human platelets.