Zusammenfassung
Ein 17-jähriger Patient wurde aufgrund eines impaktierten Nahrungsbolus von den Kollegen der Hals-Nasen-Ohren-Klinik in der internistischen Notaufnahme vorgestellt. Die HNO-ärztliche Untersuchung zeigte deutliche Speichelseen in beiden Recessus piriformes, die radiologische Untersuchung des Ösophagus ergab einen 1,6 cm messenden Fremdkörper im Bereich des ösophagogastralen Übergangs mit einem proximalen Kontrastmittelspiegel.
In der klinischen Untersuchung und der Laborchemie fanden sich keinerlei Auffälligkeiten. Es folgte die Durchführung einer Notfallösophagogastroskopie. Hier zeigte sich der in der Breischluckuntersuchung nachgewiesene Fremdköper im Bereich des gastroösophagealen Übergangs. Der als Nahrungsbolus identifizierte Fremdkörper wurde mittels Gastroskop vorsichtig in den Magen vorgeschoben. Im Magen befanden sich weitere Nahrungsreste, so dass die Untersuchung bei Aspirationsgefahr abgebrochen wurde. In einer am Folgetag elektiv durchgeführten Gastroskopie wurden aus dem Ösophagus Stufenbiopsien bei klinischem V.a. eosinophile Ösophagitis (EÖ) entnommen. Die histologische Aufarbeitung ergab eine deutliche Eosinophilie (> 15 Eosinophile/HPF bei 400facher Vergrößerung) und reaktive Veränderungen im distalen Ösophagus. Somit wurde die Diagnose einer EÖ gestellt. Eine Therapie mit Fluticason führte zu einer deutlichen Symptombesserung, erneute Bolusimpaktionen traten im Verlauf nicht mehr auf.
Abstract
A 17-year-old patient was transferred to the emergency room with an impacted food bolus by colleagues from the Department of Otorhinolaryngology. The examination of ear, nose and throat revealed significant amounts of saliva in both recessus piriformes, a radiologic examination of the esophagus showed a foreign body with a diameter of 1.6 cm in the region of the transitional zone of esophagus and stomach with a support level of the contrast medium.
Clinical examination and laboratory tests showed no abnormalities. An emergency gastroscopy was performed. The foreign body, already evident in the barium swallow, was found in the distal esophagus. The foreign body was identified as a food bolus and gently advanced into the stomach with the aid of the gastroscope. In the stomach further food residues were detected and the examination was aborted because of increased risk of aspiration. On the next day, an elective gastroscopy was performed. Several biopsies were obtained from the esophagus because eosinophilic esophagitis (EE) was suspected due to clinical symptoms. Histological work-up showed a significant amount of eosinophilic granulocytes (> 15 eosinophils/HPF, 400×) and reactive changes in the distal esophagus. Therefore, EE was diagnosed. Fluticasone therapy led to amelioration of symptoms and there was no evidence of recurring bolus impaction during follow-up.
References
Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S, Kelly ME, Rowbotham MC and Petersen KL (2007). Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial. Neurol 68: 515–521.
Adriani M, Piccioni E and Standardi A (2000). Effect of different treatments on the conversion of ‘Hayward’ kiwifruit synthetic seeds to whole plants following encapsulation of in vitro-derived buds. N Z J Crop Horti Sci 28: 59–67.
Bapat VA, Mhatre M and Rao PS (1987). Propagation of Morus indica L. (mulberry) by encapsulated shoot buds. Plant Cell Rep 6: 393–395.
Bapat VA and Rao PS (1990). In vitro growth of encapsulated axillary buds of mulberry (Morus indica L.). Plant Cell Tiss Org Cult 20: 69–70.
Bing X, Ning L, Jinfeng T and Nan G (2007). Rapid tissue culture method of Cannabis sativa for industrial uses. CN 1887043 A 20070103 Patent, p 9.
Bornman CH (1993). Maturation of Somatic Embryos. In: Synseeds: Application of Synthetic Seeds to Crop Improvement (Ed. Redenbaugh K.), CRC Press, Boca Raton, Florida, pp. 105–114.
Brenneisen R, Egli A, Elsohly MA, Henn V and Spiess Y (1996). The effect of orally and rectally administered -tetrahydrocannabinol on spasticity. A pilot study with two patients. Int J Clin Pharm Ther 34(1): 446.
Brischia R, Piccioni E and Standardi A (2002). Micropropagation and synthetic seed in M.26 apple rootstock (II): A new protocol for production of encapsulated differentiating propagules. Plant Cell Tiss Org Cult 68: 137–141.
Castillo B, Smith MAL and Yadava UL (1998). Plant regeneration from encapsulated somatic embryos of Carica papaya L. Plant Cell Rep 17: 172–176.
Duke JA and Wain KK (1981). Medicinal Plants of the world, Computer index with more than 85.000 entries In: Handbook of Medicinal Herbs (Ed. Duke J.A.), CRC press, Boca Raton, Florida, pp. 96.
Fowke LC, Attree SM and Pometry MK (1994). Production of vigorous desiccation-tolerant white spruce (Picea glauca {Moench} Voss.) synthetic seeds in a bioreactor. Plant Cell Rep 13: 601–606.
Fujii JA, Slade D and Redenbaugh K (1993). Planting of artificial seeds and somatic embryos. In: Synseeds: Application of Synthetic Seeds to Crop Improvement (Ed. Redenbaugh K.), CRC Press, Boca Raton, Florida, pp. 183–202.
Ganapathi TR, Suprasanna P, Bapat VA and Rao PS (1992). Propagation of banana through encapsulated shoot tips. Plant Cell Rep 11: 571–575.
Ganapathi TR, Srinivas I, Suprasanna P and Bapat VA (2001). Regeneration of plants from alginated-encapsulated somatic embryos of banana cv. Rasthali (Musa spp. AAB group). Biol Plant 37: 178–181.
Grinspoon L and Bakalar JB (1995). Marihuana as medicine. JAMA 273: 1875–1876.
Guri AZ and Patel KN (1998). Compositions and methods to prevent microbial contamination of plant tissue culture media. United States Patent 5: 750, 402.
Hao YJ and Deng XX (2003). Genetically stable regeneration of apple plants from slow growth. Plant Cell Tiss Org Cult 72: 253–260.
Larkin PJ, Davies PA and Tanner GJ (1988). Nurse culture of low number of Medicago and Nicotiana protoplasts using calcium alginate beads. Plant. Sci. 58: 203–210.
Lata H, Chandra S, Khan I and ElSohly MA (2008). Thidiazuron induced high frequency direct shoot organogenesis of Cannabis sativa L. In vitro Cell Dev Biol Plant (accepted).
Long LE, Malone DT and Taylor DA (2005). The pharmacological actions of cannabidiol. Drugs of the Future 30(7): 747.
Mandolino G and Ranalli P (1999). Advances in biotechnological approaches for hemp breeding and industry. In: Advances in hemp research (Ed. Ranalli P.), Haworth Press, New York, pp. 185–208.
Mathur J, Ahuja PS, Lal N and Mathur AK (1989). Propagation of Valeriana wallichii DC using encapsulated apical and axial shoot buds. Plant Sci 60: 111–6.
Mattes RD, Egelman K, Shaw LM and Elsohly MA (1994). Cannabinoids appetite stimulation. Pharmacol Biochem Behav 44(3): 745–747.
Mechoulam S, Lander N, Dikstein S, Carlini EA and Blumenthal M (1976). On the Therapeutic Possibilities of Some Cannabinoids. In: The Therapeutic Potential of Marihuana (Eds. Cohen, S. and Stillman, R) Plenum Press, New York pp. 36.
Micheli M, Pellegrino S, Piccioni E and Standardi A (2002). Effects of double encapsulation and coating on synthetic seed conversion in M.26 apple rootstock. J. Microencap 19(3): 347–356.
Micheli M, Hafiz IA and Standardi A (2007). Encapsulation of in vitro-derived explants of olive (Olea europaea L. cv. Moraiolo) II Effects of storage on capsule and derived shoots performance. Sci Horti 113: 286–292.
Murashige T and Skoog F (1962). A revised medium for rapid growth and bioassays with tobacco tissue cultures. Physiol Plant 15: 473–497.
Onishi N, Sakamoto Y and Hirosawa T (1994). Synthetic seeds as an application of mass production of somatic embryos. Plant Cell Tiss Org Cult 39: 137–145.
Pattnaik S and Chand PK (2000). Morphogenic response of the alginate encapsulated axillary buds from in vitro shoot cultures of six mulberries. Plant Cell Tiss Org Cult 64: 177–185.
Piccioni E and Standardi A (1995). Encapsulation of micropropagated buds of six woody species. Plant Cell Tiss Org Cult 42: 221–226.
Pryce G and Baker D (2005). Emerging properties of cannabinoid medicines in management of multiple sclerosis. Trends in Neurosci 28(5): 272–276.
Richez-Dumanois C, Braut-Boucher F, Cosson L and Paris M (1986). Multiplication vegetative in vitro du chanvre (Cannabis sativa L.) Application a la conservation des clones selectiones. Agronomie 6: 487–495.
SAS Institute, Inc. (2003). Statistical Analysis Systems User’s guide: Statistics version 9.1. SAS Institute, Cary, NC.
Sharma TR, Singh BM and Chauhan RS (1994). Production of disease free encapsulated buds of Zingiber officinale Rose. Plant Cell Rep 13: 300–302.
Sirikantaramas S, Taura F, Morimoto S and Shoyama Y (2007). Recent Advances in Cannabis sativa Research: Biosynthetic Studies and Its Potential in Biotechnology. Curr Pharma Biotechnol 8(4): 237–243.
Slusarkiewicz-Jarzina A, Ponitka A and Kaczmarek Z (2005). Influence of cultivar, explant source and plant growth regulator on callus induction and plant regeneration of Cannabis sativa L. Acta Biol Craco Series Bot 47(2): 145–151.
Small E and Marcus D (2002). Hemp: A new crop with new uses for North America. In: Trends in new crops and new uses (Eds. Janick, J. and Whipkey, A.), ASHS Press, Alexandria, VA, pp. 284–326.
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Gäbele, E., Endlicher, E., Zuber-Jerger, I. et al. Eine impaktierte „Wiener Semmel“ im Ösophagus – Erstmanifestation einer eosinophilen Ösophagitis bei einem 17-jährigen Patienten. Med Klin 104, 386–391 (2009). https://doi.org/10.1007/s00063-009-1077-8
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DOI: https://doi.org/10.1007/s00063-009-1077-8