Biomedical subjects
Publications and source records attributed to T E Zimmers.
Twenty-six patients were treated with a gas-forming mixture of tartaric acid and sodium bicarbonate to relieve esophageal food impactions. A success rate of 65% was achieved, with one patient suffering a mucosal tear of the esophagus. Recommendations are made to limit the use of such gas-forming agents to impactions less than six hours old and in patients without chest pain.
The United States Customs Service policies the borders of the country for smuggling of contraband, sometimes accomplished within body cavities. If a person is suspected of body-cavity concealment, the Customs Service may request the assistance of emergency department personnel to determine the presence of material within a body cavity. This usually involves interpretation of radiographs of the abdomen and pelvis, as most of such smuggling is done within the gastrointestinal tract, either by swallowing or placement within the rectum. Additionally, the Customs Service may also request that the physician remove such smuggled material from the vagina or rectum of the suspect. The courts have found these body-cavity searches to be lawful. No successful litigation has yet been brought against either the Customs Service or the medical personnel involved.
Torsion of a wandering spleen is rare, usually presenting as an acute abdomen and commonly misdiagnosed. In our case, a 14-year-old girl was diagnosed preoperatively as having a twisted hemorrhagic ovarian cyst. On laparotomy, an infarcted spleen that was twisted on its pedicle was found in the lower abdomen. The patient recovered uneventfully. The clinical spectrum of wandering spleen is discussed briefly.
With most elbow or wrist injuries, if fractures are not evident, they are probably nonexistent. But in a small percentage of cases, these signs serve to lower diagnostic thresholds. Of the four fat plane signs reviewed, the posterior fat pad sign and the navicular fat stripe seem to be more valuable than the supinator and pronator quadratus signs. However, each is useful in its own way. Although the clinical appearance of the extremity may dictate the same initial treatment whether or not a fracture is found, early identification of more subtle fractures will avoid delay of definitive treatment and provide a better estimation of healing time. None of these signs alone is completely reliable; they should be used as adjuncts in fracture diagnosis. Finally, no sign is specific to one type of fracture, although one or two types of occult fractures are most commonly identified on supplementary views when such signs are positive.