Oesophageal coins invisible on chest radiography: a case report

Background

Coins are made of metal, which is generally radiopaque, and so physicians often have the misconception that all coins are detectable by radiography. Here, we report a case of intentionally swallowed coins in the oesophagus of an adult; the coins could not be detected on chest radiography but were detected using computed tomography (CT).

Case presentation

A 46-year-old woman with a history of depression presented to the emergency department after an intentional medication overdose and ingestion of two Japanese 1-yen coins. She complained of persistent retrosternal discomfort. In order to confirm whether the coins were in the oesophagus or trachea, an anteroposterior chest radiograph was obtained; however, no coins were detected. Owing to her persistent symptoms, a chest CT was performed. On the initial CT scan, two 1-yen coins were observed in the oesophagus: one in the middle oesophagus and the other in the lower oesophagus. After the scanning, the patient drank water with permission, but vomited. No coins were found in her vomit, and the symptoms of retrosternal discomfort had completely disappeared. A subsequent CT scan revealed that the two 1-yen coins were in the patient’s stomach.

Conclusions

Japanese 1-yen coins are made of 100% aluminium, which is less radiopaque than the metals that make up coins (nickel, bronze, and lead), and so, they were not visible via chest radiography in our case. Detecting very small or thin radiolucent foreign bodies is not possible using a chest radiograph or contrast oesophagram, but is possible via CT. CT is both increasingly convenient and non-invasive, unlike endoscopy or bronchoscopy, and so, the use of CT scans should be considered in cases of possible radiolucent foreign body ingestion.

     

Plasma basal concentration of pancreatic polypeptide (PP) does not increase with ageing in the female Fischer (F-344) conscious rat

Plasma concentrations of pancreatic polypeptide (PP) were compared for young (6 to 12 month-old) and old (24 to 25 month-old) conscious female Fischer rats by means of a radioimmunoassay. Basal plasma PP concentration was not different between young and old rats, nor was PP release stimulated by cerulein in either age group. The mechanism of PP release in rats is quite different from that in other species such as dogs and humans.     

Pancreatic diabetes in a follow-up survey of chronic pancreatitis in Japan

Background We aimed to determine the cumulative rate of diabetes mellitus (DM) and the risk factors for DM in patients with chronic pancreatitis (CP) in Japan. Methods We conducted a follow-up survey of CP in 2002 in patients registered as having CP in 1994, and confirmed 656 patients to be checked in regard to the survey items concerning diabetes. We analyzed the cumulative rate of DM and the risk factors for DM over an 8-year follow up period. Results In 1994, 35.1% of 656 CP patients had DM, and the incidence of diabetes had increased to 50.4% in 2002. Of 418 patients without diabetes in 1994, 28.9% (121/418) were newly diagnosed with DM in 2002. Alcoholic CP was the most common type of CP in patients with newly developed diabetes, accounting for 67.8%. The incidence of DM was highest in those with alcoholic CP (34.3%) followed by idiopathic CP (23.0%). The risk of diabetes increased 1.32-fold after the onset of pancreatic calcification. Of 121 patients with newly diagnosed DM in 2002, 37 (30.6%) had pancreatic stones in 1994 and 49 (40.5%) had a stone in 2002. The highest incidence of newly diagnosed DM was observed in patients with continuous alcoholic intake (40.9%). Patients treated with camostat mesilate developed DM less frequently than those without camostat mesilate. Conclusions The present study showed that the incidence of DM in patients with CP increased with time. Of 418 CP patients without DM in 1994, 28.9% developed DM over a period of 8 years. Continuous alcoholic intake aggravated CP and increased the risk of DM in those with CP.     

Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: Final results of a randomized multi-institutional trial

Purpose  Although the outcome of surgery for locally advanced pancreatic cancer remains poor, it is improving, with 5-year survival up to about 10% in Japan. The preliminary results of our multi-institutional randomized controlled trial revealed better survival after surgery than after radiochemotherapy. We report the final results of this study after 5 years of follow-up. Methods  Patients with preoperative findings of pancreatic cancer invading the pancreatic capsule without involvement of the superior mesenteric or common hepatic arteries, or distant metastasis, were included in this randomized controlled trial, with their consent. If the laparotomy findings were consistent with these criteria, the patient was randomized to a surgery group or a radiochemotherapy group (5-fluorouracil 200 mg/m²/day and 5040 Gy radiotherapy). We compared the mean survival time, 3-and 5-year survival rates, and hazard ratio. Results  The surgery and radiochemotherapy groups comprised 20 and 22 patients, respectively. Patients were followed up for 5 years or longer, or until an event occurred to preclude this. The surgery group had significantly better survival than the radiochemotherapy group (P < 0.03). Surgery increased the survival time and 3-year survival rate by an average of 11.8 months and 20%, respectively, and it halved the instantaneous mortality (hazard) rate. Conclusion  Locally invasive pancreatic cancer without distant metastases or major arterial invasion is treated most effectively by surgical resection.     

Management and surgical resection for tracheobronchial tumors institutional experience with 12 patients

We reviewed the records of 12 patients with primary tracheobronchial tumors and various clinical characteristics treated at our institution to investigate our overall management experience with disease. Over a 21-year period, we treated 1405 cases of primary pulmonary neoplasms, of which 12 (0.9%) patients had primary tracheobronchial tumors with eight different histological types, including three adenoid cystic carcinomas, two bronchial carcinoids, two papillomas, one squamous cell carcinoma, one mucous gland adenoma, one inflammatory pseudotumor, one schwannoma, and one mucoepidermoid carcinoma. Eleven of the patients had symptoms of airway obstruction and/or secondary infection or bleeding. A complete resection was performed in ten, which included a sleeve lobectomy in seven, sleeve pneumonectomy in one, tracheal resection in one, and left main stem resection without lung resection in one. Median survival following complete resection was 91 months. When possible, a complete resection provides the best potential benefits and symptomatic relief for patients with tracheo-endobronchial tumors. Further, various options related to tracheobronchoplasty including conservative resection can be applied for surgical intervention.