Herbert G. Birck

Esophageal Burns Secondary to Disc Battery Ingestion

Accidental ingestion and impaction of disc batteries in the esophagus has been a constant predictor of severe morbidity presumably due to leakage of highly caustic potassium or sodium hydroxide contained in these electric cells. Fewer than ten reports of esophageal burns from disc battery ingestion have appeared in the medical literature; an additional case involving ingestion of a mercury disc battery was recently encountered at the James Whitcomb Riley Hospital for Children, Indiana University School of Medicine. Two children died as a direct result of the impaction and resultant esophageal burn; six children experienced perforation of the esophagus, with four children developing tracheoesophageal fistulae. We report the ingestion of a 1.35-V mercury camera disc battery by a 10-month-old girl in whom a severe burn of the anterior midesophagus was noted 18 to 22 hours after impaction. The child subsequently developed a tracheoesophageal fistula and esophageal stricture at the site of the burn and required tracheotomy, closure of the fistula, partial esophagectomy and gastrostomy for eventual successful management. Stimulated by this experience, we have conducted an in vivo study of the time course and severity of esophageal burns resulting from alkaline and mercury battery ingestion in 15 cats. Mucosal damage can be seen as early as one hour after ingestion, rapidly progressing to involvement of all muscular layers by four hours. Removal of this foreign body should be assigned highest priority to prevent rapid development of these burns and the long-term sequelae mentioned above. Additionally, manufacturers of these batteries (commonly used in cameras, calculators and other electronic devices) and the general public should be made aware of the severe nature of these burns and the need for proper disposal of these batteries.

Pediatric caustic ingestion.

Accidental caustic ingestion in the pediatric age group continues to be a controversial and difficult problem. This retrospective study gives clinical support to treating this problem with early esophagoscopy, steroids, antibiotics and dilatation. Four hundred two patients were evaluated for possible caustic burn of the esophagus. Of the 70 patients who had esophageal burns demonstrated at esophagoscopy and who were treated with steroids, antibiotics and dilatation, none developed strictures. The two patients not treated in this fashion developed strictures.

Secretory lysozyme of the human middle ear mucosa: immunocytochemical localization.

Lysozyme was demonstrated by an immunocytochemical technique in the biopsied mucosa obtained from the promontory of the fifteen patients who had chronic middle ear effusions. Lysozyme was localized in the mucigen granules of the secretory cells, as well as in the specific granules of the polymorphonuclear neutrophilic leukocytes (PMN) and macrophages. The specimens obtained from patients with mucous effusions showed numerous secretory cells that contained lysozyme, in sharp contrast to the serous type in which only a few secretory cells could be found. The present morphological finding was in agreement with the biochemical finding which demonstrated higher lysozyme level in mucous effusions than that of the serous type. It was concluded that human middle ear mucosa provided lysozyme and that its secretion was active in serous otitis media, particularly of mucoid type.

Symposium on prophylaxis and treatment of middle ear effusions.: I. The morphological basis for understanding middle ear effusions.: An electron microscopic, cytochemical, and autoradiographic investigation†‡§

An attempt was made to elucidate the cytological nature of the defense mechanisms of the normal middle ear with special emphasis on the secretory system.

Surgical correction of choanal atresia in the neonate.

The purpose of this paper is to present a technique of endonasal puncture and stenting for bilateral choanal atresia in the neonate that is easily performed and may be definitive. The procedure described is original only in its details, its broad principles are well known. A method of placing the nasal stent is reported that is particularly applicable in the premature, even as small as five pounds. No antibiotics or steroids are given in the postoperative period. Three months is the recommended duration of stenting. Four patients were operated on using this technique, between July 1978 and August 1979; 3 were complete successes; 1 was a bilateral failure, but was re-operated on and was then a unilateral success. Shortest follow-up was 16 months. We feel endonasal puncture and stenting of bilateral choanal atresia in the neonate can be definitive, and is the first procedure of choice.The purpose of this paper is to present a technique of endonasal puncture and stenting for bilateral choanal atresia in the neonate that is easily performed and may be definitive. The procedure described is original only in its details, its broad principles are well known. A method of placing the nasal stent is reported that is particularly applicable in the premature, even as small as five pounds. No antibiotics or steroids are given in the postoperative period. Three months is the recommended duration of stenting.

Antibody Activity in Otitis Media with Effusion

Bacteria were isolated from a high percentage of the effusions from patients with otitis media with effusion (OME, serous otitis media). In an attempt to determine if the isolated bacteria were involved in the disease process, we analyzed the serum and effusion of 25 OME patients for the presence of antibacterial antibodies by the indirect immunofluorescence antibody method. Specific antibody activity was detected in 20 of 25 effusions (80%) and 19 of 22 sera (86%). IgG antibodies were the most frequently found class of antibodies in both sera and effusions, but IgA antibodies were detected more frequently in the effusions than in the sera. Hemophilus influenzae, Streptococcus pneumoniae, and diphtheroids were the most frequently isolated organisms, and antibody activity to all bacterial species isolated was detected. The results support the concept that the isolated bacteria are not contaminants but are actively involved in the disease process.

Immunoglobulin E in Chronic Middle Ear Effusions Comparison of Rist, Prist, and RIA Techniques

To investigate the possible role of allergy in otitis media with effusion (OME), the immunoglobulin E (IgE) content of 138 middle ear effusions (MEE) and paired serum samples from patients with chronic otitis media with effusion was determined. The initial 62 paired specimens were assayed for IgE by the radioimmunosorbent test (RIST), while the later 76 paired specimens were assayed for IgE by the paper radioimmunosorbent test (PRIST). When the results obtained by these two techniques were compared, it was noted that the PRIST procedure gave significantly lower IgE values for effusions than the RIST method. When the effusion-to-serum ratios (E/S ratios) were computed from the PRIST data, the E/S ratio was less than one, while RIST data gave an E/S ratio greater than one. The results obtained with the PRIST procedure were confirmed by double antibody radioimmunoassay for IgE. Thus, the PRIST procedure appears to measure the IgE content of MEE more accurately, and the results obtained by this procedure fail to support the concept of allergy as a major causative factor in OME.

Laryngeal problems following infant esophageal surgery

This paper focuses on vocal cord paralysis in children after operation for tracheoesophageal fistula and/or esophageal atresia. We reviewed the charts of 65 children who were operated upon for congenital esophageal atresia and/or tracheoesophageal fistula during a period from 1964 to 1974. Ten of these children manifested laryngeal symptoms. Five had laryngeal paralysis. Two were untreated. One was treated with cordectomy and stent. Two were treated successfully with the Thornell arytenoidectomy, one of these being done without a tracheotomy in place. Mention is made of a third case of bilateral vocal cord paralysis due to hydrocephalus treated successfully by the Thornell procedure.

Septal dermoplasty for von willebrand's disease in children†‡

The purpose of this paper is to describe the application of a well known surgical procedure, septal dermoplasty, in children afflicted with the severe form of von Willebrands disease. This operation allows a lasting control over the childs epistaxis problem and frees it for a meaningful active childhood.