Swallowed foreign bodies

Of 98 swallowed foreign bodies demonstrated, 71 with fate definitely known are reported. Seventeen of 20 foreign bodies in the esophagus had esophagoscopic removal. Only two of 51 foreign bodies in the gastrointestinal tract had laparotomy, while 49 were spontaneously passed. Early esophagoscopic removal of foreign bodies lodged in the esophagus and conservative management of foreign bodies which have passed the esophagogastric junction are recommended. Laparotomy is rarely indicated in the management of swallowed foreign bodies, although various observers are not in full agreement as to the circumstances in which "watchful waiting" is advisable nor as to how long it is permissible to wait for spontaneous passage. In 20 of 71 cases of swallowed foreign bodies, the objects were in the esophagus at the time the patient was first examined. Esophagoscopic removal was carried out in 17 cases. In two cases a foreign body was passed per rectum and in one was vomited. Laparotomy for removal was done in only two of the 51 cases in which the foreign body was already in the stomach or bowel at the time of examination, and in one of them the operation probably could have been avoided.     

Endoscopic removal of a foreign body perforating the duodenum.

Perforation of the intestine by an ingested foreign body usually results in peritonitis or abscess formation and the treatment is surgical. In one case the duodenum was perforated by a toothpick, and hemorrhage from the upper gastrointestinal tract occurred 3 months later. Diagnosis and management were accomplished by operative endoscopy.     

Management of Ingested Foreign Bodies in Childhood

A total of 660 patients with ingested foreign bodies admitted to the general surgical services in two children''s hospitals in Liverpool are reviewed. Endoscopic removal (205 cases) is recommended for all foreign objects impacted in the oesophagus, with the exception of rounded or blunt objects in the lower third, which should be observed for a maximum of 12 hours. The indications for laparotomy for removal of a foreign body (43 cases, 6·5%) are the danger of perforation and failure of progression. The ingestion of a long slender object—for example a hair-grip—in a child under 2 years of age, is an absolute indication for prophylactic operative removal owing to the high incidence of impaction and perforation of the duodenum.     

Gene silencing in adult Aedes aegypti mosquitoes through oral delivery of double‐stranded RNA

The induction of the naturally occurring phenomenon of RNA interference (RNAi) to study gene function in insects is now common practice. With appropriately chosen targets, the RNAi pathway has also been exploited for insect control, typically through oral delivery of dsRNA. Adapting current methods to deliver foreign compounds, such as amino acids and pesticides, to mosquitoes through sucrose solutions, we tested whether such an approach could be used in the yellow fever mosquito, Aedes aegypti. Using a non‐specific dsRNA construct, we found that adult Ae. aegypti ingested dsRNA through this method and that the ingested dsRNA can be recovered from the mosquitoes post‐feeding. Through the feeding of a species‐specific dsRNA construct against vacuolar ATPase, subunit A, we found that significant gene knockdown could be achieved at 12, 24 and 48 h post‐feeding.     

Ultrastructure of the anterior alimentary tract of infective-stage Wuchereria bancrofti (Nematoda: Filarioidea).

The anterior alimentary tract of infective-stage Wuchereria bancrofti is divided into the following segments: stoma or buccal capsule, muscular esophagus, glandular esophagus, esophageal-intestinal valve, and intestine. Invaginated external cuticle lines only the anterior stoma. External cuticle and esophageal lining are not continuous and are ultrastructurally distinct; the latter is compared morphologically to the amorphous component of elastin. The glandular esophagus is a composite structure of a stellate contractile epithelial core, surrounded by a sleeve of secretory epithelium. The glandular cytoplasm shows evidence of formation and release of dense secretory granules. At least 2 nerve cell bodies lie within the esophagus approximately 15 micrometer anterior to the esophageal-intestinal valve and their associated processes pass forward and backward through the contractile epithelium. Materials interpreted as ingested flight muscle mitochondria of the mosquito vector appear in various stages of degeneration within the intestinal lumen. It is suggested that, although simple by comparison to some other nematodes, the anterior alimentary tract of infective-stage W. bancrofti functions in the ingestion and breakdown of nutrient materials. The ultrastructure of the excretory cell likewise suggests a functional capability.     

Removal of esophageal foreign bodies with a Foley balloon catheter under fluoroscopic control.

Between 1982 and 1985 removal of a nonorganic, smooth, radiopaque foreign body in the esophagus with a Foley balloon catheter under fluoroscopic control without sedation was attempted in 38 children. An ultra-low-dose fluoroscopic unit was used. In 35 children the foreign body (a coin) was either easily removed (in 29 cases) or advanced into the stomach (in 6). No complications of the procedure were observed. In three children the foreign body could not be removed by this means; it was subsequently removed by endoscopy (in two cases, both of coins) or esophagotomy (in two cases, both of coins) or esophagotomy (in one, of a stone). When carefully performed, removal of blunt, recently ingested esophageal foreign bodies with a Foley catheter under fluoroscopic control is a safe mode of treatment.     

Survival of foraminifera in the gut of holothuroids from Elba Island (Mediterranean Sea)

Detritivorous macroorganisms have important functions in nutrient remineralization and may exert significant predation pressure on meiofaunal communities. We have examined food excrements of detritus grazing holothuroids off Elba Island (Mediterranean Sea) to investigate whether ingested foraminifera survive the passage through the digestive tract. Our findings provide evidence that some benthic foraminifera pass through the complete digestive tract without being harmed by its predators. Sediment-feeding holothurians may thus affect microdistributional processes ultimately resulting in an allochthonous redistribution of foraminifera within the environment.     

On the fate of orally ingested foreign DNA in mice: chromosomal association and placental transmission to the fetus

We have previously shown that, when administered orally to mice, bacteriophage M13 DNA, as a paradigm foreign DNA without homology to the mouse genome, can persist in fragmented form in the gastrointestinal tract, penetrate the intestinal wall, and reach the nuclei of leukocytes, spleen and liver cells. Similar results were obtained when a plasmid containing the gene for the green fluorescent protein (pEGFP-C1) was fed to mice. In spleen, the foreign DNA was detected in covalent linkage to DNA with a high degree of homology to mouse genes, perhaps pseudogenes, or to authentic E. coli DNA. We have now extended these studies to the offspring of mice that were fed regularly during pregnancy with a daily dose of 50 g of M13 or pEGFP-C1 DNA. Using the polymerase chain reaction (PCR) or the fluorescent in situ hybridization (FISH) method, foreign DNA, orally ingested by pregnant mice, can be discovered in various organs of fetuses and of newborn animals. The M13 DNA fragments have a length of about 830 bp. In various organs of the mouse fetus, clusters of cells contain foreign DNA as revealed by FISH. The foreign DNA is invariably located in the nuclei. We have never found all cells of the fetus to be transgenic for the foreign DNA. This distribution pattern argues for a transplacental pathway rather than for germline transmission which might be expected only after long-time feeding regimens. In rare cells of three different fetuses, whose mothers have been fed with M13 DNA during gestation, the foreign DNA was detected by FISH in association with both chromatids. Is maternally ingested foreign DNA a potential mutagen for the developing fetus? Received: 15 April 1998 / Accepted: 15 June 1998     

Parasitism of the mosquito Culex pipiens by the nematode Heterorhabditis bacteriophora

Various concentrations of the nematode Heterorhabditis bacteriophora were added to dishes containing second, third, and fourth larval instars of the mosquito, Culex pipiens, respectively. The infective stage nematodes were ingested by the mosquito larvae, they then penetrated through the alimentary tract in the neck region and entered the hemocoel. A melanization reaction killed many invading nematodes, but heavier concentrations overwhelmed the hosts' defense reaction and 100% mortality of third- and fourth-instar larvae was achieved using between 170 and 200 nematodes per host. Death was either due to the nematode releasing cells of the symbiotic bacterium, Xenorhabdus luminescens, into the hemocoel or to foreign bacteria (mostly Pseudomonas aeruginosa), which were introduced by the penetrating nematodes. The potential use of this nematode as a biological control agent of larval culicine mosquito is discussed.     

Oesophageal foreign bodies.

Impaction of foreign bodies in the oesophagus was analysed in 54 patients, 45 of whom were children. Of the 45 children 28 were aged 2-4 years. Coins were the most common foreign body in children (27 cases) while in adults a bolus of meat was most common (nine cases). In 41 children there was no predisposing factor, but an underlying mechanism was detected in 88% of the adults. The mechanisms were of three types: oesophageal (stricture), neuromuscular (myasthenia gravis), and extrinsic and mechanical (ankylosing spondylitis). In children most of the foreign bodies were impacted in the upper oesophagus at the cricopharyngeal junction, which is the narrowest part of the oesophagus, while in adults the foreign body was usually impacted at the site of the predisposing lesion or in the lower oesophagus. In all patients oesophagoscopy was performed under general anaesthesia to remove the impacted foreign body. Complications were more frequent in adults, mainly owing to the underlying condition.     

Inoculation of the digestive tract of axenic mice with the autochthonous bacteria of mineral water

Summary The autochthonous bacteria present in mineral water from Vittel Grande Source were not able to establish themselves, i.e. to multiply and subsist in a great number in the digestive tract of axenic mice.The inocula of these bacteria ingested by the animals were either completely or only partly destroyed during their transit through the digestive tract of the animals.The autochthonous bacteria of the water, ingested in a very high amount or injected intraperitoneally, have never brought about detectable pathological disorders in the animals.     

Plastic bread-bag clips in the gastrointestinal tract: report of 5 cases and review of the literature

Plastic bread-bag clips have been identified as a cause of local perforation or obstruction at many sites in the gastrointestinal tract. This study is the largest case series yet reported, consisting of 3 cases presenting as small-bowel perforation, 1 case in which the clip was found incidentally in the small bowel at laparotomy during vascular surgery and 1 case in which the clip was found incidentally in the small bowel at autopsy. In all cases there was no radiographic evidence to suggest a foreign body in the gastrointestinal tract. People older than 60 years of age who have either partial or full dentures seem to be particularly at risk for the accidental ingestion of these devices. If accidentally ingested, plastic bread-bag clips represent a significant health hazard. As the population ages, small-bowel perforation secondary to ingestion of such clips may occur with increasing frequency. The authors recommend elimination or redesign of the clips, to prevent their being swallowed and becoming impacted in the small bowel or to allow them to be identified in the gastrointestinal tract by conventional radiography.     

Cologastric fistula with a foreign body in a patient with Crohn's disease

Although the medical management of fistulizing Crohn's disease is improving, a subset of patients does not respond to maximal medical therapy and is referred for surgical consultation. We report a case of Crohn's colitis with an ingested foreign body resulting in a cologastric fistula. The patient underwent segmental colectomy and takedown of the cologastric fistula. At the time of laparotomy, the foreign body was found in the fistulous colonic segment. The presence of an ingested foreign body likely contributed to a rare fistula that was refractory to medical management.     

Endoscopic Management of Genitourinary Foreign Bodies

Retrieval of foreign bodies from the genitourinary system, most commonly inserted for sexual satisfaction or as a result of a psychiatric illness, can pose a significant surgical challenge. Due to their breadth of size, shape, and location within the genitourinary system, endoscopic management can be difficult. Here, we review the management of four cases of foreign object insertion into the genitourinary system and their outcomes and management.Key words: Foreign body insertion, Sounding, Genitourinary foreign object, Endoscopic extractionForeign objects within the genitourinary tract present a challenging urologic finding due to the diversity and breadth of presentation. Although many objects are easily removed, more complex approaches may be required depending on the size, shape, and location of the object.^1,2 In this case series, we discuss the endoscopic management of four patients who presented with foreign bodies in the urethra. Two patients inserted beads into their genitourinary tract for the purpose of sexual stimulation and two patients had a history of psychiatric illness with multiple insertions of a diverse range of foreign objects. In all four cases, endoscopic management was successful in removing the objects, with no need for an open approach such as perineal urethrotomy or open cystostomy. In case 2, in which an open approach was attempted at an outside hospital, this open approach was associated with intraoperative complications.     

Immunocytochemical identification of neuroactive substances in the antennal lobe of the male silkworm moth Bombyx mori

As a first step towards understanding the functional role of neuroactive substances in the first olfactory center of the male silkworm moth Bombyx mori, we carried out an immunocytochemical identification of antennal lobe neurons. Antibodies against gamma-aminobutyric acid (GABA), FMRFamide, serotonin, tyramine and histamine were applied to detect their existence in the antennal lobe. In the present immunocytochemical study, we clarified four antenno-cerebral tracts from their origin and projection pathways to the protocerebrum, and revealed the following immunoreactive cellular organization in the antennal lobe. 1) Local interneurons with cell bodies in the lateral cell cluster showed GABA, FMRFamide and tyramine immunoreactivity. 2) Projection neurons passing through the middle antenno-cerebral tract with cell bodies in the lateral cell cluster showed GABA and FMRFamide immunoreactivity. Projection neurons passing through the outer antenno-cerebral tract with cell bodies in the lateral cell cluster showed FMRFamide immunoreactivity. 3) Centrifugal neurons passing through the inner antenno-cerebral tract b with cell bodies located outside the antennal lobe showed serotonin and tyramine immunoreactivity. Our results revealed basic distribution patterns of neuroactive substances in the antennal lobe and indicated that each projection pathway from the antennal lobe to the protocerebrum contains specific combination of neuroactive substances.     

A chimerical phagocytosis model reveals the recruitment by Sertoli cells of autophagy for the degradation of ingested illegitimate substrates

Phagocytosis and autophagy are typically dedicated to degradation of substrates of extrinsic and intrinsic origins respectively. Although overlaps between phagocytosis and autophagy were reported, the use of autophagy for ingested substrate degradation by nonprofessional phagocytes has not been described. Blood-separated tissues use their tissue-specific nonprofessional phagocytes for homeostatic phagocytosis. In the testis, Sertoli cells phagocytose spermatid residual bodies produced during germ cell differentiation. In the retina, pigmented epithelium phagocytoses shed photoreceptor tips produced during photoreceptor renewal. Spermatid residual bodies and shed photoreceptor tips are phosphatidylserine-exposing substrates. Activation of the tyrosine kinase receptor MERTK, which is implicated in phagocytosis of phosphatidylserine-exposing substrates, is a common feature of Sertoli and retinal pigmented epithelial cell phagocytosis. The major aim of our study was to investigate to what extent phagocytosis by Sertoli cells may be tissue specific. We analyzed in Sertoli cell cultures that were exposed to either spermatid residual bodies (legitimate substrates) or retina photoreceptor outer segments (illegitimate substrates) the course of the main phagocytosis stages. We show that whereas substrate binding and ingestion stages occur similarly for legitimate or illegitimate substrates, the degradation of illegitimate but not of legitimate substrates triggers autophagy as evidenced by the formation of double-membrane wrapping, MAP1LC3A-II/LC3-II clustering, SQSTM1/p62 degradation, and by marked changes in ATG5, ATG9 and BECN1/Beclin 1 protein expression profiles. The recruitment by nonprofessional phagocytes of autophagy for the degradation of ingested cell-derived substrates is a novel feature that may be of major importance for fundamentals of both apoptotic substrate clearance and tissue homeostasis.     

Survival of seaweeds ingested by three species of tropical sea urchins from Brazil

Three species of sea urchins, Echinometra lucunter, Lytechinus variegatus, and Arbacia lixula, common on the southeastern coast of Brazil, were selected for experiments on seaweed survival after passage through their digestive tract. L. variegatus and E. lucunter have more than 80% of their diet composed of algae. C. 24% of the species of algae present in the digestive tract survived. A. lixula has only 29% of its diet composed by algae, but the survival rate of the algae is c. 50%.Although Rhodophyta represent 51% of the ingested algae, their survival rate in the faeces is only 19%, while the Chlorophyta, with a survival rate of 63%, comprise only about 26% of the diet. Most species of algae that survived ingestion were r-strategists.     

Gastrointestinal stress as innate defence against microbial attack

The human gastrointestinal (GI) tract has been bestowed with the most difficult task of protecting the underlying biological compartments from the resident commensal flora and the potential pathogens in transit through the GI tract. It has a unique environment in which several defence tactics are at play while maintaining homeostasis and health. The GI tract shows myriad number of environmental extremes, which includes pH variations, anaerobic conditions, nutrient limitations, elevated osmolarity etc., which puts a check to colonization and growth of nonfriendly microbial strains. The GI tract acts as a highly selective barrier/platform for ingested food and is the primary playground for balance between the resident and uninvited organisms. This review focuses on antimicrobial defense mechanisms of different sections of human GI tract. In addition, the protective mechanisms used by microbes to combat the human GI defence systems are also discussed. The ability to survive this innate defence mechanism determines the capability of probiotic or pathogen strains to confer health benefits or induce clinical events respectively.     

Ingestion of Pythium spp. by larvae of the fungus gnat Bradysia impatiens (Diptera:Sciaridae)

Mycelium, oospores and zoospore cysts of Pythium spp. were fed to larvae of the fungus gnat Bradysia impatiens. The fungal structures were all ingested and provided a complete nutritional source for the insect's development from egg to adult. Mycelium seemed the major source of food as only empty fragments were found either in the digestive tract or in larval faeces. Oospores appeared intact and were viable both during passage through the tract and when expelled. Germination of oospores was normal. Most encysted zoospores also survived passage through the gut, although some appeared damaged. After transferring recently-fed larvae to a new food source, oospores were still detected in the digestive tract 48 h later. These results show that the larval stage of B. impatiens may serve as an important vector for Pythium spp.     

DIFFERENTIAL DIAGNOSIS OF OPERABLE DISEASE OF THE ESOPHAGUS

The time interval between ingestion and regurgitation and the stage of digestion in regurgitated food may be factors helpful in diagnosing disease of the esophagus. In most cases diagnosis can be made by x-ray alone, but where x-ray evidence is insufficient esophagoscopy is often justified.X-ray investigation for foreign bodies should include films of the neck. Cough is a common symptom of the presence of foreign bodies; obstruction may result from inflammation or edema.Perforation is most often caused by foreign bodies or by instrumentation. Esophagoscopy is hazardous in this condition and the findings are not likely to affect the course of treatment.Hiatal hernia, although probably occurring to some degree in 10 per cent of adults, seldom causes symptoms. Inflammation resulting from hernial obstruction may be mistaken for carcinoma.Esophageal carcinoma occurs most frequently in elderly persons and in men more than in women. Operation is necessary in many cases to prevent starvation. The postoperative mortality rate is as low as 11 to 24 per cent, and the proportion of five-year survivals is increasing.Achalasia or cardiospasm can generally be recognized by x-ray appearance. Bouginage is the usual treatment, but operation may be necessary.Late regurgitation of food is a common symptom of esophageal diverticulum.Atresia in a newborn infant is a dangerous condition. The effect of any of the four types of anomaly is the same: diversion of fluids from the stomach to the bronchi. Coughing, choking and cyanosis are the common symptoms in a newborn infant.Hematemesis may arise from a number of causes; esophageal hemorrhage most commonly is owing to varicosity from portal hypertension. Esophagoscopy is the quickest and safest method of determining whether hematemesis is of esophageal origin.