ABSTRACT
We report an oesophageal foreign body in a patient with a seizure disorder secondary to encephalitis disseminata who was transferred to our department of neurosurgery because of rising intracranial pressure. He presented with confusion, motor aphasia, and dysphagia. However, the diagnosis of increased intracranial pressure could not be confirmed clinically or by computed tomography. A routine chest X-ray film showed a dental prosthesis projecting on the area of the hypopharynx. Bronchoscopy and oesophagoscopy showed the denture to be lodged in the hypopharynx, but it was impossible to remove it endoscopically. Therefore, an oesophagopharyngotomy was performed and the foreign body extracted. The postoperative course was complicated by pneumonia, which responded well to antibiotic treatment. The patient made an otherwise uneventful recovery and was able to eat without difficulty.
Subject(s)
Esophageal Diseases/complications , Foreign Bodies/complications , Seizures/etiology , Adult , Dental Prosthesis , Encephalomyelitis/complications , Esophageal Diseases/diagnostic imaging , Esophageal Diseases/surgery , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Humans , Male , Radiography , Seizures/physiopathologyABSTRACT
1. Stimulation of the upper respiratory tract with water releases reflex respiratory arrest and very marked bradycardia due to conduction and impulse generation disturbances in the heart accompanied by ventricular hyperexcitability. 2. Asphyxia causes bradycardia as a result of an inhibition of sinus node and the development of vicarious rhythms with excessive ectopic ventricular excitability. The intensity and duration of bradycardia during asphyxia are less than during water stimulation of airways. 3. Urethane anaesthesia did not prevent the development of the above described changes appearing during stimulation of the upper airways while topical analgesia with lidocaine completely prevented their appearance. The observations seem to suggest that for safety, surgical treatment in the upper airways should be done under analgesia of the respiratory mucosa. 4. The mechanism of the development of these changes seems to depend mainly on nervous and humoral factors, although the influence of other factors cannot be excluded. 5. Reflex changes in the action of the heart caused by water stimulation of the upper airways may be one of important components of the complex physiopathological process leading to death in drowning persons.