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We report two cases in which foreign bodies were retrieved from the bronchus after intervals of 25 years or more. Both occurred in women in their 30s, in neither case was there a history of aspiration, and both patients were asymptomatic for many years. The literature on protracted retention of bronchial foreign bodies is reviewed using a Medline search and relevant bibliography.
A previously described photoradiographic camera used to localize intraocular or intraorbital foreign bodies has been modified to a more versatile unit. One photograph and one radiograph are taken simultaneously, and the pictures are combined, whereby the eye appears as its own indicator on the radiophotograph. More than 50 foreign bodies have been successfully localized with the camera which is easy to handle and can be used in any x-ray film room where an overhead tube is available.
Many different lesions can be difficult to distinguish from malignant melanomas of the choroid. With the use of modern diagnostic facilities the misdiagnosis rate has been greatly reduced. In a recent report from the Collaborative Ocular Melanoma Study Group the incidence of misdiagnosis was only 0.48%. The presence of a retained intraocular foreign body presenting as a raised pigmented choroidal mass similar to a uveal melanoma is rare. We report two cases in which retained intraocular foreign bodies presented clinically as raised pigmented intraocular lesions. Retained intraocular foreign bodies should be considered in the differential diagnosis of ocular tumours, especially if there are any atypical features.
A 54-year-old man complained of severe throat pain and showed subglottic oedema on fibre-optic endoscopy with a distinctly narrowed subglottic space on anteroposterior radiography of the neck and dense linear opacity at the level of the cricoid cartilage on lateral plain radiography. These findings suggested a foreign body just posterior to the cricopharyngeus, but a computed tomography (CT) scan demonstrated a dense calcified ridge on the posterior lamina of the cricoid cartilage but no foreign body.The patient improved symptomatically with systemic antibiotics and topical steroids, and gastrointestinal endoscopy did not detect any foreign body. This is a rare case of vertical ossification of the cricoid lamina masquerading as a foreign body.
We report the case of a severely mentally handicapped 30-year-old woman with Sturge-Weber syndrome who developed obstructive sleep apnea syndrome (OSA) following esophageal aspiration of two foreign bodies, which were discovered incidentally during a neck CT scan. Initial polysomnography findings revealed significant OSA with an apnea-hypopnea index (AHI) of 40.8 events per hour. Repeat polysomnography following endoscopic removal of the foreign bodies revealed marked improvement of her OSA with a decrease of AHI to 15.6 events per hour. Our report highlights the importance of considering foreign body aspiration as a cause for OSA in mentally handicapped patients.
BACKGROUND: Diagnostic and therapeutic instrumentation of the lower gastrointestinal tract has been reported to result in bacteremia and endocarditis. No such case has been reported in persons with a history of rectal foreign body insertion despite its potential for greater trauma. CASE PRESENTATION: A 58-year-old male was admitted with confusion and inability to speak. His past history was notable for hospitalization to extract a retained plastic soda bottle from the rectosigmoid two years prior. On examination, he was febrile, tachycardic and hypotensive. There was an apical pansystolic murmur on cardiac examination. He had a mixed receptive and expressive aphasia, and a right hemiparesis. On rectal examination he had perianal erythema and diminished sphincter tone. Magnetic resonance imaging of the brain showed infarction of the occipital and frontal lobes. Transesophageal Echocardiography of the heart revealed vegetations on the mitral valve. All of his blood culture bottles grew methicillin sensitive Staphylococcus aureus. He was successfully treated for bacterial endocarditis with intravenous nafcillin and gentamicin. The rectum is frequently colonized by Staphylococcus aureus and trauma to its mucosa can lead to bacteremia and endocarditis with this organism. In the absence of corroborative evidence such as presented here, it is difficult to make a correlation between staphylococcal endocarditis and anorectal foreign body insertion due to patients being less than forthcoming CONCLUSION: There is a potential risk of staphylococcal bacteremia and endocarditis with rectal foreign body insertion. Further studies are needed to explore this finding. Detailed sexual history and patient counseling should be made a part of routine primary care.
In the last 30 years 1,484,576 patients with traumatic lesions of different kind of seriousness were observed and managed. By mean of retrospective investigation, the authors selected and statistically analysed a sample of 95 patients treated for accidental tracheobronchial foreign bodies inhalation: authors' aim was to punctually determinate--step by step--diagnosis and treatment procedure in a "time-saving" frame. Inhalation of foreign bodies is a very dangerous event, particularly in children. In authors' experience, in 60% of cases they were children under 3 years; in 25% of cases children under 10; in 10% patients from 10 to 60 and in 4.5% over 60. As regards the gender of the patients, the male/female ratio has been 2 to 1 in favour of male. Since 85% of the study population was represented by children under 10, its clear that male children in this range of age has a greater statistical risk for accidental tracheobronchial foreign bodies inhalation.
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PURPOSE: To identify the risk factors for retinal detachment after posterior segment intraocular foreign body (IOFB) injuries and to study the association between the development of retinal detachment and visual outcome. METHODS: Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Vitrectomy techniques were used in primary and secondary treatment. Two eyes were eviscerated after primary repair because of Clostridium perfringens endophthalmitis. Factors analyzed included (1) entrance wound location, (2) presence of uveal prolapse, (3) presence of vitreous prolapse, (4) presence of traumatized iris, (5) presence of endophthalmitis, (6) location of IOFB, (7) size of IOFB, (8) use of scleral buckling and/or an encircling band, (9) use of gas tamponade, (10) use of lensectomy. Data were analyzed using univariate and multivariate logistic regression analysis. RESULTS: Retinal detachment was present in 6 eyes at presentation and occurred in another 19 eyes after vitrectomy. After a mean follow-up of 8.6 months, 63 (65.6%) eyes achieved visual acuities of 20/200 or better, and total retinal detachment complicated by inoperable proliferative vitreoretinopathy was present in 9 (9.4%) eyes. Multivariate analysis identified retinal detachment as a factor significantly associated with a poor visual outcome (odds ratio = 4.54, 95% confidence interval [CI] = 1.05-19.6). Foreign body size of more than 4 mm (odds ratio = 5.8, 95% CI = 1.66-2.03) and presence of endophthalmitis (odds ratio = 11.7, 95% CI = 2.57-52.9) were identified as the only predictive factors for the development of retinal detachment after vitrectomy. Use of prophylactic scleral buckling and/or an encircling band reduced the risk of developing postoperative retinal detachment. CONCLUSIONS: Retinal detachment after posterior segment IOFB injuries is associated with a poor visual outcome. Large IOFB and presence of endophthalmitis are the strongest predictive factors for the development of retinal detachment.
Calcium alginate dressings have beneficial effects on wound healing by providing a moist wound environment. However, cytotoxicity and the nonbiodegradable nature of calcium alginate dressings induce unresolved chronic foreign-body reaction. In this study, a novel freeze-dried alginate gel dressing (AGA-100) low in calcium ions was evaluated for cytotoxicity to L929 cells in vitro and in full-thickness pig wounds in vivo. Cytotoxicity testing on L929 cells showed the cytocompatibility of AGA-100 extracts, while extracts from Kaltostat, a well-established alginate dressing, induced cytopathic effects. In an in vivo study using pigskin, AGA-100, Kaltostat, and gauze were applied on 1-in-diameter circular full-thickness wounds on the back of pigs and the time course of wound closure was evaluated. Kaltostat and gauze dressings were used as controls. For histologic evaluation, wound tissue was harvested on day 18. AGA-100-treated wounds showed rapid wound closure compared to control wounds on day 15. Foreign-body reaction was marked in Kaltostat- and gauze-treated wounds, and differed significantly from AGA-100-treated wounds. Based on these data, AGA-100 could reduce the cytotoxicity to fibroblasts and foreign-body reaction that have been observed with currently available calcium alginate dressings; it was also found to be useful as an alginate dressing.
Between 1986 and 1998, 200 rigid bronchoscopic procedures under general anesthesia were carried out at the Principal Hospital in Dakar, Senegal for foreign body extraction from the distal airways of 194 children. For the study period, the incidence of this accident was 3.7 p. 1000. Sixty-three percent of patients were male and 77 p. 100 were under 4 years of age. Most patients (69 p. 100) were examined within 48 hours after the accident. Examination of clinical records showed that aspiration was mentioned during anamnesis in only 56 p. 100 of cases. Persistent coughing (80 p. 100) and mild dyspnea (70 p. 100) were the most common symptoms. Auscultation of the lungs was negative in 25 p. 100 of cases and anterior x-ray of the neck and chest were normal or poorly informative in 59 p. 100. In 154 of the 200 procedures, extraction of the foreign body was successful from the trachea in 35 p. 100 of cases, the larynx in 13 p. 100, the right main stem bronchus in 31 p. 100 and the left main stem bronchus in 21 p. 100. In the remaining 46 cases, extraction was unsuccessful. The most frequent foreign body was a peanut. No deaths occurred in this series but cardiac arrest was observed in 6 patients during or immediately after endoscopy. This experience confirms the indication for immediate rigid bronchoscopy in cases involving aspiration or persistent respiratory symptoms. The high incidence of this accident suggests that information campaigns should be undertaken in health care facilities, households, and schools.
Lateral radiography of the neck is performed for the study of radio-opaque esophageal foreign bodies that are not visualized by indirect laryngoscopy. This projection may reveal a calcified linear image behind the cricoid cartilage due to calcification of the posterior lamina. In such cases, esophagoscopy and/or computed tomography must be performed to determine whether the image is due to an anatomic variant or a true foreign body.
We report a rare case of tricuspid valve incompetence caused by a needle-like foreign body with an unknown route of invasion. A 55-year-old woman who had suffered from chronic heart failure for more than 25 years was diagnosed as having Ebstein's anomaly after a transthoracic echocardiogram with Doppler imaging showed severe tricuspid regurgitation and displacement of the septal leaflet toward the right ventricle inlet. Surgery revealed a foreign body attached to the tricuspid valve, causing regurgitation. Valve replacement was performed and the patient's condition improved remarkably thereafter.
A case of unusual intrapulmonary foreign body in the form of a pencil is described. The penetration occurred following an insignificant fall. The diagnosis was made on CT scan and subsequently surgical removal was undertaken successfully.
Hypertrophic osteopathy was diagnosed in a dog with a bronchial foreign body and lobar pneumonia. Hypertrophic osteopathy is generally associated with primary or secondary neoplasms of the lungs and rarely associated with nonneoplastic thoracic lesions. The foreign body and affected lung lobe were removed by pneumonectomy, resulting in recovery of the dog and resolution of the hypertrophic osteopathy lesions.
Three cases of impaction and penetration of a unique type of foreign body in the gastric antrum are reported. The foreign body-woodstick needles-used to staple leaves together to produce disposable leaf-plates (khalli-patra) was accidentally swallowed with food and presented as a case of acute abdomen. Awareness of this possibility is essential for a timely diagnosis in regions where the practice of using khalli-patra is in vogue, particularly eastern India.
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