Fatal aorto-esophageal fistula in child: A case report

Esophageal foreign body ingestion is especially frequent in childhood and may cause fatal complications in case of late diagnosis and delayed treatment. We present a case of 2-year old girl who was admitted to emergency department with massive bleeding. However, she died due to an unrecognized foreign body resulted an aorto-esophageal fistula.At autopsy an aorto-esophageal fistula was detected by gross examination. Tissue samples were obtained from the organs and fistula region. In histopathological examination, a calcified body with multinucleated giant cell and surrounding granulation tissue was detected at the bleeding site. An ulcerated fistula tract ran from the intima to the adventitia, passing through layers of esophageal wall was also noticed.The mortality rate for foreign body ingestion is less than 1%, except in cases of perforation. Therefore the presented case is among rare examples of fatal foreign body ingestions.     

Milestones in atypical and secondary Parkinsonisms

During the last decades, atypical parkinsonian disorders such as multiple system atrophy, dementia with Lewy bodies, progressive supranuclear palsy, and corticobasal degeneration along with secondary parkinsonian disorders have been increasingly recognized as important causes of parkinsonism. Although treatment options are largely limited to date, remarkable progress has occurred through advances in the fields of molecular biology and diagnostic neuroimaging, resulting in intense preclinical drug discovery programs. Early‐investigation‐assisted clinical diagnosis has become more crucial than ever because disease‐modifying therapies will hopefully become available within this decade. © 2011 Movement Disorder Society     

Curious foreign body in the bladder of an adolescent

We report the case of a 14 year old boy who presented at our emergency department because of increasing alguria and dysuria one year after inserting a wire cable into his bladder for autoerotic purposes. Endoscopic transurethral removal of the foreign body proved to be impossible because the cable was of a stiff consistency and was trapped in scar tissue at the bladder neck. The foreign body therefore had to be extracted using a Pfannenstiel approach. Urethrocystoscopy and uroflow performed one week later were normal. Filiform intravesical foreign bodies can create particular challenges. Adequate diagnostic imaging, awareness of possible complications, and knowledge of the different available techniques are essential in planning safe extraction.     

Dendritic cells in the host response to implanted materials

The role of dendritic cells (DCs) and their targeted manipulation in the body’s response to implanted materials is an important and developing area of investigation, and a large component of the emerging field of biomaterials-based immune engineering. The key position of DCs in the immune system, serving to bridge innate and adaptive immunity, is facilitated by rich diversity in type and function and places DCs as a critical mediator to biomaterials of both synthetic and natural origins. This review presents current views regarding DC biology and summarizes recent findings in DC responses to implanted biomaterials. Based on these findings, there is promise that the directed programming of application-specific DC responses to biomaterials can become a reality, enabling and enhancing applications almost as diverse as the larger field of biomaterials itself.     

Metabolic profiles in closely controlled diabetic pregnancies during the third trimester

Summary In 5 closely controlled pregnant diabetics (duration of pregnancy 237–266 days) and 5 pregnant non-diabetics (duration of pregnancy 210–278 days) 4-hourly blood samples were taken throughout a 24 h period and analyzed for blood glucose, lactate, pyruvate, 3-hydroxybutyrate and acetoacetate, plasma non-esterified fatty acids (NEFA), glucagon and cortisol. 24 h urine specimen was analyzed for total catecholamines and 4-hydroxy-3-methoxymandelic acid. There were few significant differences in concentrations of metabolites and hormones in the two groups at any time, although the variations about the mean was usually greater in the diabetics. Thus for blood glucose in diabetics, mean value was 4.4 mmol/l, coefficient of variation 43%; in non-diabetics 4.1 mmol/l and 10% respectively. Mean plasma 3-hydroxybutyrate in diabetics was 0.47 mmol/l, coefficient of variation 55%; in non-diabetics 0.44 mmol/l and 37% respectively. Plasma non-esterified fatty acid levels were significantly higher in the diabetics (0.47 mmol/l) than in the non-diabetics (0.26 mmol/l). Coefficients of variation were 46% and 33% respectively. Two conclusions can be drawn; first, when near normal mean values for blood glucose are achieved, other metabolite and hormone levels are also near normal; second, even when the available means for diabetic control, strict diet and insulin-mixtures twice daily, are used at their maximum, metabolism in diabetics is more unstable than in non-diabetics.     

Retained surgical sponge after laparotomy

Erosion of a retained surgical sponge into the intestine is an unusual occurrence and may make its appearance months or years later. The demonstration of a distended bowel by the barium-impregnated mass with multiple polypoidal filling defects in a patient who has undergone previous laparotomy should lead the physician to suspect a retained surgical sponge. Surgical intervention is rewarding.