A case of mistaken identity: accidental ingestion of coins causing esophageal impaction in an elderly female. (1/21)

Coin impaction of the esophagus is infrequently seen in adults, and multiple coin impaction has not been described. The patient was an 85-year-old blind female who presented with 2 days of dysphagia and odynophagia following an attempt to take her medications at bedtime. She reported an esophageal injury from endotracheal intubation during a surgery 6 months earlier. Radiographs showed a radiopaque circular mass in the midesophagus. Endoscopy showed 3 US coins--a nickel, a dime, and a penny--stacked together and impacted on a stricture at 27 cm from the gums. An overtube was planned, but preplacement evaluation showed the lumen was smaller than the coin diameters. An attempt with a retrieval net was unsuccessful. The patient then underwent endotracheal intubation and the coins were removed individually with rat-tooth foreign body forceps. She recovered and underwent successful endoscopic dilation 3 weeks later. She remains asymptomatic since dilation. A brief review of coin impaction and endoscopic management is discussed. Endotracheal intubation for airway protection during endoscopy is recommended for these patients.  (+info)

Effects of gastric acid on euro coins: chemical reaction and radiographic appearance after ingestion by infants and children. (2/21)

OBJECTIVES: This study investigated whether coins of the new European currency (euro) corrode when they are exposed to gastric acid, and whether this change can be detected radiographically. METHODS: The eight different denominations of coins were immersed for seven days in 0.15 N hydrochloride acid (HCl), which corresponds to the level of post-prandial gastric acid. A Swedish crown coin and three different Austrian schilling coins were used as controls. The coins were weighed and radiographed daily to evaluate visible corrosions and HCl was analysed daily for possible dissolved substances. RESULTS: All coins lost weight within 24 hours after exposure to HCl. The 1, 2, and 5 euro cent coins developed changes that were visible on radiographs. The weights of all coins decreased by 0.43% to 11.30% during one week. The dissolved substances measured in the HCl corresponded to the different metals and alloys of the coins, except for copper, which does not dissolve in HCl. The highest absolute weight loss was observed in the Swedish crown coin (0.67 g), and the highest relative weight loss in the 1 Austrian schilling coin (11.30%). The two coins that showed the highest absolute and relative weight losses were the 2 euro (0.54 g or 6.35%) and the 1 euro (0.48 g or 6.39%) coin. CONCLUSIONS: A higher rate of toxicity for the new European coins compared with coins of other currencies is not expected, unless a massive coin ingestion occurs.  (+info)

A randomized clinical trial of the management of esophageal coins in children. (3/21)

CONTEXT: Children frequently ingest coins. When lodged in the esophagus, the coin may cause complications and must either be removed or observed to pass spontaneously. OBJECTIVES: (1) To compare relatively immediate endoscopic removal to a period of observation followed by removal when necessary and (2) to evaluate the relationship between select clinical features and spontaneous passage. DESIGN/SETTING: Randomized, prospective study of children <21 years old who presented to an emergency department with esophageal coins in the esophagus. Exclusion criteria were (1) history of tracheal or esophageal surgery, (2) showing symptoms, or (3) swallowing the coin >24 hours earlier. Children were randomized to either endoscopic removal (surgery) or admission for observation, with repeat radiographs approximately 16 hours after the initial image. OUTCOME MEASURES: Proportion of patients requiring endoscopic removal, length of hospital stay, and the number of complications observed. RESULTS: Among 168 children who presented with esophageal coins lodged in the esophagus, 81 were eligible. Of those eligible, 60 enrolled, 20 refused consent, and 1 was not approached. In the observation group, 23 of 30 (77%) children required endoscopy compared with 21 of 30 (70%) in the surgical group. Total hospital length of stay was longer in the randomized-to-observation group compared with the randomized-to-surgery group (mean: 19.4 [SD: +/-8.0] hours vs 10.7 [SD: +/-7.1] hours, respectively). There were no complications in either group. Spontaneous passage occurred at similar rates in both groups (23% vs 30%). Spontaneous passage was more likely in older patients (66 vs 46 months) and male patients (odds ratio: 3.7; 95% confidence interval: 0.98-13.99) and more likely to occur when the coin was in the distal one third of the esophagus (56% vs 27% [95% confidence interval: 1.07-5.57]). CONCLUSIONS: Because 25% to 30% of esophageal coins in children will pass spontaneously without complications, treatment of these patients may reasonably include a period of observation, in the range of 8 to 16 hours, particularly among older children and those with distally located coins.  (+info)

Detection of coins ingested by children using a handheld metal detector: a systematic review. (4/21)

To determine if the use of a handheld metal detector (HHMD) can safely reduce the number of radiographs requested in cases of coins ingested by children, a search was performed to identify prospective studies of the ability of an HHMD to identify the presence or absence of ingested coin in children (17 years or younger). Outcome measures were presence or absence of coin on metal detector screening, and accuracy of coin localisation. Inclusion and exclusion criteria were defined. Mantel-Haenszel (fixed effect model) pooling with 95% confidence intervals (CI) was used to calculate overall sensitivities and specificities. In total, 11 studies met the inclusion criteria. The overall sensitivity of the HHMD at detecting the presence of coins was 99.4% (95% CI 98.0 to 99.9%) and accuracy at localisation was 99.8% (98.5 to 100.0%). The overall specificity of the HHMD was 100% (76.8 to 100%). Use of the HHMD is an accurate, radiation free, and cost effective method of identifying and localising coins ingested by children. An algorithm for investigating children with coin ingestion is proposed.  (+info)

The life, achievements and legacy of a great Canadian investigator: Professor Boris Petrovich Babkin (1877-1950). (5/21)

The present paper reviews the life and achievements of Professor Boris Petrovich Babkin (MD DSc LLD). History is only worth writing about if it teaches us about the future; therefore, this historical review concludes by describing what today's and future gastrointestinal physiologists could learn from Dr Babkin's life. Dr Babkin was born in Russia in 1877. He graduated with an MD degree from the Military Medical Academy in St Petersburg, Russia, in 1904. Not being attracted to clinical practice, and after some hesitation concerning whether he would continue in history or basic science of medicine, he entered the laboratory of Professor Ivan Petrovich Pavlov. Although he maintained an interest in history, in Pavlov's exciting environment he became fully committed to physiology of the gastrointestinal system. He advanced quickly in Russia and was Professor of Physiology at the University of Odessa. In 1922, he was critical of the Bolshevik revolution, and after a short imprisonment, he was ordered to leave Russia. He was invited with his family by Professor EH Starling (the discoverer of secretin) to his department at University College, London, England. Two years later, he was offered a professorship in Canada at Dalhousie University, Halifax, Nova Scotia. After contributing there for four years, he joined McGill University, Montreal, Quebec, in 1928 as Research Professor. He remained there for the rest of his career. Between 1940 and 1941, he chaired the Department, and following retirement, he remained as Research Professor. At the invitation of the world-famous neurosurgeon, Wilder Penfield, Dr Babkin continued as Research Fellow in the Department of Neurosurgery until his death in 1950 at age 73. His major achievements were related to establishing the concept of brain-gut-brain interaction and the influence of this on motility, as well as on interface of multiple different cells, nerves and hormones on secretory function. He had a major role in the rediscovery of gastrin. He established a famous school of gastrointestinal physiologists at McGill University. He supported his trainees and helped them establish their careers. He received many honors: a DSc in London, England, and an LLD from Dalhousie University. Most importantly, he was the recipient of the Friedenwald Medal of the American Gastroenterological Association for lifelong contributions to the field. Dr Babkin taught us his philosophical aspect of approaching physiology, his devotion to his disciples and his overall kindness. Most importantly, he has proven that one can achieve international recognition by publishing mainly in Canadian journals. He is an example to follow.  (+info)

Accidental ingestion of coins by children: management at the ENT Department of the Joao XXIII Hospital. (6/21)

The ingestion of foreign bodies by children is frequently seen in emergency departments. ENTs can manage those lodged in the esophagus but experience is important for a successful intervention. AIM: Describe seven cases of children that ingested coins, managed at the ENT Department of Joao XXIII Hospital. STUDY DESIGN: Clinical/prospective. MATERIALS AND METHODS: We describe seven cases (gender, age, family status, coin size and treatment/evolution). RESULTS: Age ranged from one to nine years. Two patients were only children and five were the youngest in their families. Coins sizes ranged from 1.9 to 2.5 cm. After eight hours of observation, three cases were treated in the surgery room because the foreign body was lodged in the cricopharynx. Four cases resolved spontaneously. CONCLUSION: The ENT department has good results removing coins lodged in the upper esophagus using forceps and laryngoscopy; and also using rigid esophagoscopy for the lower esophagus. In this study it was not possible to establish the importance of coin size and patient age in attempting to predict spontaneous resolution, nor if the child being an only child or the youngest in the family may have some predisposition in this kind of accident.  (+info)

Lodged oesophageal button battery masquerading as a coin: an unusual cause of bilateral vocal cord paralysis. (7/21)

An 11-month-old girl with an oesophageal foreign body was presented: from the radiographic appearance it was presumed to be a coin. Microlaryngoscopy 5 h after ingestion revealed a button battery impacted in the hypopharynx with severe damage to the oesophageal mucosa. The patient was intubated for 6 days in the intensive care unit because of stridor and respiratory distress. Repeat microlaryngoscopy demonstrated bilateral vocal cord palsy, which was presumed to be secondary to the involvement of the recurrent laryngeal nerves in the injury. We recommend that in the absence of a history of observed ingestion, it should be assumed that coin-like foreign bodies are button batteries until proven otherwise.  (+info)

'Magic coins' and 'magic squares': the discovery of astrological sigils in the Oldenburg Letters. (8/21)

Enclosed in a 1673 letter to Henry Oldenburg were two drawings of a series of astrological sigils, coins and amulets from the collection of Strasbourg mathematician Julius Reichelt (1637-1719). As portrayals of particular medieval and early modern sigils are relatively rare, this paper will analyse the role of these medals in medieval and early modern medicine, the logic behind their perceived efficacy, and their significance in early modern astrological and cabalistic practice. I shall also demonstrate their change in status in the late seventeenth century from potent magical healing amulets tied to the mysteries of the heavens to objects kept in a cabinet for curiosos. The evolving perception of the purpose of sigils mirrored changing early modem beliefs in the occult influences of the heavens upon the body and the natural world, as well as the growing interests among virtuosi in collecting, numismatics and antiquities.  (+info)