Foreign bodies of the gastrointestinal tract.

Gastrointestinal foreign bodies are a common occurrence in most emergency room settings and should be dealt with in an organized manner to bring about their retrieval expeditiously. Approximately 1500 to 1600 persons in the United States die from ingestion or placement of foreign bodies every year. This study of foreign bodies of the gastrointestinal tract reports an 8-year span in which 60 cases were compiled from a 540-bed private, inner city hospital. The average hospital stay was 3.2 days. Foreign bodies were retained in the esophagus in 68.3 per cent of patients, in the stomach in 11.6 per cent, and in the colon or rectum in 13.3 per cent. In 3.3 per cent the object passed spontaneously, and in 3.3 per cent it resulted in perforation.

Apudomas.

Apudomas are neoplasms known to produce many biologically active amines. Some of these tumors have been known for 70 years, but over the last 15 years a wealth of new knowledge has been obtained. This study reports experience with apudomas over an 8-year period (1975-1983) at The Piedmont Hospital. There were 159 tumors with the potential for producing various ectopic hormones as well as biologically active amines, including 112 oat cell carcinomas, 37 carcinoid tumors, 4 paragangliomas, 2 pancreatic islet cell tumors, 2 medullary thyroid carcinomas, 1 pituitary adenoma, and 1 pinealocytoma. Of the 112 oat cell carcinomas, only 2 per cent had hormone-related symptoms. Of the carcinoid tumors, 12 were found in the appendix, 9 in the small intestine, 9 in the lungs, 4 in the colon and 2 in the rectum. Nineteen of the 37 carcinoids had hormone-related symptoms but none had a classic carcinoid syndrome. A third group of apudomas included several of relative rarity, the paragangliomas, the medullary thyroid carcinomas, the pancreatic islet cell tumors, pituitary adenomas, and pinealocytomas. Of this latter group, only the pancreatic islet cell tumors had symptomatology that could be related to ectopic hormone production.

Indirect intracranial volume measurements using CT scans: clinical applications for craniosynostosis.

This paper describes a method for obtaining indirect intracranial volume measurements using CT scans with CTpak, a software package for quantitative analysis of CT scan data. The validity of this technique was confirmed by comparing direct measurement of the intracranial volume of five dry skulls with axial scans at 1.5- and 4-mm slice intervals to determine indirect volume. The indirect intracranial volume measurement technique was then used to compare preoperative and postoperative intracranial volume in 30 patients with craniosynostosis who underwent cranial vault and orbital osteotomies with reshaping and advancement. Our findings show that the suture release and simultaneous reshaping procedures usually carried out are, in fact, associated with increased intracranial volume. The observed intracranial volume gain is attributable to a combination of factors, including the surgical procedure carried out and ongoing growth. These factors are further modified by the diagnosis, age of the patient, and time interval between CT scans.

A modified occlusal splint to avoid tracheotomy for total midface osteotomies.

A modified occlusal splint is described which may be used to avoid tracheostomy when a total midface osteotomy is required. We demonstrate the accuracy of the modified splint by using the technique in a control subject who underwent alginate impressions, dental casts, and a face-bow transfer. A modified splint was constructed on the articulated dental models and was found to be accurate within the range of rotational movement of the temporomandibular joint. The technique is demonstrated in a patient with Crouzon's syndrome undergoing cranial vault reshaping and a monobloc (midface) advancement. The modified occlusal splint provides an alternative method of airway management when precise intraoperative occlusal relationships are important.