Ingestion of small flat disc batteries

Management of ingestions of small flat disc batteries has been controversial. The Nassau County Medical Center's Long Island Regional Poison Control Center has had 30 calls concerning battery ingestions in the past 16 months. In 1976, the National Clearinghouse for Poison Control Centers reported 42 battery ingestions for the entire nation. Only one of our cases required surgery because the battery remained in the cecum for five days. The battery was removed intact. Management guidelines for ingestions of batteries containing alkali or toxic metals are suggested.     

Management of a child with acute thyroxine ingestion

We report a case of thyroxine overdose in a child. Despite extremely high thyroxine (T4RIA) levels on admission, the patient's only symptoms were mild hypertension and tachycardia. Both symptoms responded to propranolol, with a drop in pulse rate and a decrease in blood pressure to normal levels. After four days of cardiac monitoring, the patient was released and received propranolol for five additional days as an outpatient.     

Endoscopic removal of accidental aspirated and ingested dental foreign bodies: A cross-sectional study

The incidence of accidental ingestion and aspiration of foreign body (FB) is likely to occur. Many FBs are discharged spontaneously, but many dental FBs are often sharp and may remain in the pharynx, esophagus, and stomach, causing serious complications such as hemorrhage, asphyxia, perforation of the digestive tract, mediastinal emphysema, peritonitis, and ileus. We aimed to examine which type of dental foreign bodies can be removed by endoscope.In this study, we enrolled 32 patients who were evaluated at the Emergency and Critical Center between January 2014 and December 2019 and who accidentally ingested or aspirated dental FBs. Medical records were reviewed to determine the patients’ sex, age, medical history, time from accidental ingestion of a FB to consultation, cause, location, occurrence status, nature of the FB, location of retained FB, treatment, complications, and outcome.We enrolled 32 patients (14 men, 18 women), with a mean age of 74.5 ± 12.8 years. Accidental ingestion at treatment was common. The most frequent site where the FB was retained was upper gastrointestinal tract (26 cases, 81.3%). In this study, endoscopic removal was indicated for dentures under the size of 43.3 mm, for dental FB (except dentures) more than 13.6 mm. In dentures, between the number of missing teeth, clasp, type, and endoscopic removal was not statistically significant.Dentures under the size of 43.3 mm was likely to be removed by endoscope. Dental FB (except dentures) more than the size of 13.6 mm was likely to be removed by endoscope. There were no indications for endoscopic removal except for size.     

A Case of Penetration of the Large Intestinal Wall by a Toothpick

A 66-year-old man was admitted to hospital with symptoms of acute abdomen. Based on colonoscopic findings, localized peritonitis due to penetration of the sigmoid colon by a toothpick was diagnosed. During colonoscopy, the toothpick was removed using a grasping forceps, meaning that surgery was avoided. In cases where abdominal pain of unknown origin is observed, physicians should proceed with routine medical care while considering the possibility of foreign body ingestion, and work toward an early diagnosis.     

Effects of eating on plasma hyaluronan in patients with cirrhosis: Its mechanism and influence on clinical interpretation

Circulating levels of hyaluronan (HA) may be a clinically useful non-invasive test in liver disease to evaluate, for example, the degree of fibrosis or cirrhosis. Healthy subjects exhibit a two-fold or greater postprandial elevation of plasma HA. We undertook this work to determine the effect of eating on plasma HA in patients with cirrhosis, to define mechanisms underlying the changes observed and to examine whether using fasting samples improves the discriminating value of plasma HA as a clinical test. Plasma HA was measured using a protein-binding assay in serial samples obtained over 2.5 h, during which a 2100 kJ meal and/or intravenous infusion of octreotide (25 μg stat, 25 μg stat, 25 μg/h) were given, or in paired random and fasting samples from patients with cirrhosis. In six patients with Pugh's A cirrhosis, plasma HA increased more than two-fold after food ingestion, peaking after 75–90 min. In four patients (one Pugh's A), no response was observed. Octreotide transiently increased plasma HA by a mean of 20%, but, in combination with eating, reduced the peak plasma HA by 80% in responding patients. In 30 patients with cirrhosis, random plasma HA was abnormal in only 70% compared with 93% of autologous fasting samples, using the respective normal ranges ( P =0.01). Ingestion of food markedly increased plasma HA in patients with compensated but not decompensated cirrhosis, most likely due to a postprandial increase in splanchnic blood flow. Fasting patients prior to taking blood improves the clinical discriminating value of plasma HA.     

Diquat intoxication

Reported is the case of a 23-year-old man who ingested 300 mL of Reglone. He developed vomiting five to 10 minutes after ingestion. Shortly thereafter, he developed renal and central nervous system manifestations of toxicity, followed by cardiovascular collapse and death 14 hours after admission. Autopsy findings revealed esophagitis, tracheitis, gastritis, and ileitis. Prompt, aggressive therapy that included fluid replacement and removal of the toxin was unsuccessful.     

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.     

Cut endotracheal tube for endoscopic removal of an ingested push-through pack

A 52-year-old female presented to our clinic after accidentally ingesting a push-through pack (PTP). After determining that the PTP was present in the stomach, we successfully and safely removed it endoscopically by using a handmade endoscopic hood fashioned from a cut endotracheal tube. Foreign body ingestion is a common clinical problem, and most ingested foreign bodies pass spontaneously. However, the ingestion of sharp objects, such as PTPs, increases the risk of complications, and urgent endoscopy is recommended to remove such objects. Previous studies have reported the use of other devices, both commercial and handmade, for the safe endoscopic removal of foreign bodies. The novel design of our handmade hood for the removal of the PTP, which was fashioned from a cut endotracheal tube, was beneficial in terms of maintaining a wide visual field, patient safety and tolerance, and easy preparation compared to previously reported commercial and handmade devices. It may be a viable and safe device for the retrieval of PTPs and other sharp foreign bodies.