In vitro study of ingested coins: leave them or retrieve them?

BACKGROUND: Objects and notably coins are frequently swallowed by children 3 to 5 years old. Precisely how they should be managed after passing the gastroesophageal junction without causing symptoms remains controversial. This study was performed to assess dissolution of specific metals from coins immersed in simulated gastric juice. METHODS: Four types of euro and US coins were immersed in simulated gastric juice for 4, 24, 72, and 120 hours. Six metals were evaluated by inductively coupled plasma-atomic emission spectrometry. Weight loss and corrosive behavior were also determined. RESULTS: After only 4 hours, metals had dissolved from euro (Cu, 2.86-7.85 mg; Ni, 0.23-0.52 mg; Zn, 0.09-0.99 mg; Al, 0.24 mg; Sn, 0.02 mg) and US (Cu, 1.45-6.65 mg; Ni, 0-0.62 mg; Zn, 0-0.14 mg) coins. Their concentrations in simulated gastric juice peaked after 24 to 72 hours (milligrams/hours) in euro (Cu, 218/48; Ni, 82.50/72; Zn, 83.00/72; Al, 14.65/72; Sn, 0.66/72) and US (Cu, 126.50/24; Ni, 88.00/72; Zn, 149.00/24) coins. All coins underwent corrosion and weight loss (by 2.56%-4.8%). CONCLUSIONS: Coins retained in the stomach will release a number of heavy metals well known to cause dose-dependent poisoning. Studies to evaluate their toxicity and absorption are needed to optimize treatment.

Morbidity of breast cancer patients following complete axillary dissection or sentinel node biopsy only: a comparative evaluation.

INTRODUCTION: The usefulness of routine axillary dissection (AD) at levels I-II in breast cancer patients has been questioned for years because of the high postoperative morbidity in the shoulder and arm region, and the increasing number of patients with negative nodes. Sentinel node biopsy (SNB) was hoped both to reduce morbidity and to improve the reliability of staging. This study was designed to provide more evidence in this matter by comparing the follow-up data of patients with AD and those with SNB only. METHOD: One hundred forty patients who had undergone AD between 1993 and 1996 were questioned for their subjective and objective symptoms using a questionnaire and subsequently subjected to a clinical examination. Their data were compared with those of 57 patients who had undergone SNB only between 1998 and 2000. RESULTS: Local recurrences have not been seen to date. The difference between the two groups in terms of a loss of quality of life was negligible. The differences in overall complaints, number of symptoms, pain, limited range of motion of the operated upper extremity, numbness, paresthesias, and arm swelling as well as perceived disability in activities of daily living were significantly in favor of SNB. The length of hospital stay was significantly shorter for SNB patients. CONCLUSION: SNB appears to be an accurate procedure for axillary nodal staging in breast cancer patients and is associated with reduced postoperative morbidity and length of hospital stay. But it is still investigational and should not be implemented as therapeutical standard before results of randomized trials are published.