Ingestion Of Foreign Material Research Articles

A complicated case of bowel obstruction with sepsis and methamphetamine toxicity in a child with pica

In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent's medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.

Dental Objects Requires Particular Care- Swallowing of a Rubber Dam Clamp by Child

Introduction: Ingestion of a rubber dam clamp is a very rare condition that occurs due to careless manipulation of a rubber dam insertion especially in pediatric dentistry. Case report: The present paper reports a case in which a rubber dam clamp was accidentally swallowed by child undergoing pulpotomy in his upper right deciduous second molar, which entered esophagus and got stuck supraclavicular. Discussion: Ingestion of foreign materials may cause serious complications. Owing to the shape and sharpness of the instrument, there are chances of perforation. Once the instrument is lost in the oropharynx, it is very important to determine whether the instrument has entered the digestive tract or respiratory tract. Conclusion: Dentist should be able to manage an emergency situation, in which patient accidentally swallow a dental instrument.

Endoscopic Closure of Esophageal Perforations By Means of a Retractable Covered Nitinol Stent: A Randomized Controlled Animal Study

Background and Aims: Esophageal perforations during upper endoscopy are rare. However, since endoscopic techniques like EMR and ESD are increasingly used, so may the incidence of esophageal perforations. In addition, Spontanous esophageal perforations can occur due to barotrauma or ingestion of foreign material. Intentional opening of the esophageal wall has been used to perform NOTES mediastinoscopy. Material and Methods: In 12 domestic pigs 15mm oesophageal perforations were created using needle knife incision and a 15mm dilatation balloon with the animals under general anaesthesia. After randomisation pigs were assigned to either surgical repair (n=6) or endoscopic closure (n=6). A self-expandable nitinol stent covered by a plastic membrane preloaded in an emergency delivery system (SX-ELLA stent, ELLA-CS, diameter 25mm, length 135mm) was used for perforation closure. Surgical repair was achieved by open thoracoscopy. Pressurized leak tests of the perforation closures were performed following necropsy. Additionally pressurized leak test were performed in an ex vivo evaluation of hand-sewn closures of 15mm large esophageal scalpel incisions (n=15) and of healthy esophageal tissue (n=20). Tissue for ex vivo evaluation was obtained from freshly killed pigs. Results: Mean time for endoscopic stenting was 7 min. (Range 4-12 min., SD 2.8). No complication occurred during any of the closure procedures. At necropsy and macroscopic examination all perforation sites were completely covered by the stent membrane. Pressurized leak test showed a mean burst pressure of 138 mmHg (Range 100-270, SD 66) for stent closures and a mean burst pressure of 180 mmHg (Range 60-300, SD 103) for surgical sutures. Ex vivo hand-sewn sutures of 15mm scalpel incisions exhibited a mean burst pressure of 174 mmHg (Range 50-300, SD 89) and ex vivo esophageal tissue exhibited a burst pressure of >300 mmHg in 17/20 cases and a burst pressure of 300 mmHg in 3/20 cases. Ex vivo esophageal tissue burst pressure was significantly higher compared to stent closure (p<0.01), in vivo surgical closures (p<0.01), and ex vivo hand-sewn closures (p<0.01). Stent closures were comparable to surgical closures (p=0.428) and to ex vivo hand-sewn closures (p=0.378). In vivo surgical closures were comparable to ex vivo hand-sewn closures (p=0.912). Conclusions: Endoscopic closure of 15mm esophageal perforations by means of the retractable, covered nitionol stent is feasible. Further research in survival studies has to be conducted to evaluate wound healing of the esophageal perforations sites.

A note on behaviour of stabled horses with foraging devices in mangers and buckets

Processed feed for stabled horses is usually presented in buckets or mangers, and is easily and rapidly consumed. Foraging devices based on the Edinburgh foodball can be used to provide part of the ration. Current designs are all placed on the floor, raising concerns regarding ingestion of foreign materials along with the dispensed food. Alternative devices were evaluated, when presented within suitable, clean containers to prolong food-handling times but avoid such issues. In four Latin square designed replicated trials we investigated behaviour of 12 stabled horses with three foraging devices. These were separately presented for 5 min, varied in sensory complexity (round, square, polyhedral) and contained 500 g high fibre pellets. In Trials 1 and 2 six geldings were presented with devices in buckets then mangers. All individuals foraged successfully from at least one device and behaviour was compared. However, all individuals exhibited some frustration while using the devices (either pawing or biting them). Horses frequently removed the devices from the buckets in Trial 1 terminating these sessions. In Trial 2 mean device foraging duration was ranked polyhedral > round > square. Mean pawing rate in Trial 2 was calculated for horses (frequency of pawing per individual/summed duration manipulation and foraging) and was highest with square (0.11, n pawers = 6). In Trial 3 six stabled mares were presented with the same foraging devices in mangers. Mean foraging duration with devices again ranked polyhedral > round > square. Mean pawing rate was highest with round device (0.08, n pawers = 4). Trial 4 investigated behaviour of six horses when devices initially containing five high fibre pellets became empty. Mean foraging duration with devices ranked round > polyhedral > square. Mean pawing rate was highest with square device (0.11, n pawers = 4). All horses foraged successfully from at least one foraging device in buckets and mangers. Devices met initial objectives but the unpredictability of reward suggests a source of frustration and warrants further investigation.

DEGRANULATION OF POLYMORPHONUCLEAR LEUCOCYTES FOLLOWING PHAGOCYTOSIS OF MICROORGANISMS

A marked reduction in numbers of cytoplasmic granules in rabbit and human polymorphonuclear leucocytes takes place following ingestion of various microorganisms or of a yeast cell wall preparation. The degranulation occurs within 30 minutes of phagocytosis, and is directly related to the quantity of material engulfed. White cells completely degranulated following phagocytosis of large numbers of microorganisms remain viable for at least 1 hour. The granules of polymorphonuclear leucocytes contain the antimicrobial agent, phagocytin, and various digestive enzymes. These substances thus are released into the cytoplasm or into vacuoles following ingestion of foreign material. The granule system and granule lysis mechanism may well play a central role in the primary function of these specialized cells; namely, that of destroying invading microorganisms.

The ingestion of proteins and colloidal materials by columnar absorptive cells of the small intestine in suckling rats and mice.

Proteins and colloidal materials, administered orally to suckling rats and mice, were ingested by columnar absorptive cells of the jejunum and ileum, but not of the duodenum. Bovine gamma globulin and ovalbumin were identified in the apical cytoplasm by staining with fluorescent antibody; trypan blue, Evans blue, saccharated iron oxide, and colloidal gold were detected intracellularly by their color, specific staining, and appearance in the electron microscope. Each substance was segregated in membrane-enclosed vacuoles, apparently part of a system of potentially interconnecting vacuoles and tubules in the apical cytoplasm which is continuous in places with the apical cell membrane. We postulate that ingestion of foreign materials was accomplished by pinocytosis, that is, by invagination of the apical cell membrane to form vacuoles containing material from the intestinal lumen. Approximately 18 days after birth columnar absorptive cells lost the ability to ingest proteins and colloids, and no longer contained large vacuoles and numerous tubules. At this age rats and mice lose the ability to absorb antibodies from the intestine in an immunologically intact form, and we conclude that cellular ingestion is part of the mechanism of absorption of intact proteins in suckling animals. Particulate fat apparently is absorbed in both newborn and adult animals by micropinocytosis. Thus adult animals may not have lost the capacity for pinocytosis, but rather have become selective as to what substances provoke it. Cortisone acetate, administered subcutaneously to rats 8 to 10 days old alters the columnar absorptive cells within 72 hours so that they resemble the cells in adult animals and no longer ingest proteins.