[Unusual route of a metallic splinter in neck injury].
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Embolization of a prosthetic valve poppet, a rare complication following valve replacement, has been, until recently, generally fatal. Immediate recognition followed by replacement of the poppet or valve and extraction of the embolized poppet is the only feasible approach. Recently, a patient was seen was seen shortly after the onset of acute pulmonary edema with wide-open mitral regurgitation. A diagnosis of extrusion of the poppet from a previously placed prosthetic valve was confirmed and a successful mitral valve replacement accomplished. The nonradiopaque poppet, subsequently localized by an ultrasound B-sac, was removed from the lower abdominal aorta at a later operation. We believe this to be the second reported case of survival following successful reoperation for embolization of a prosthetic poppet.
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In case of childish haemorrhage it is absolutely necessary to consult a gynaecologist without delay, who has special knowledge of anatomy and physiology of the still unripe genital organs. The following publication informs about a rare hurt by a stick causing a perforation of the abdominal cavity of a five-year old girl, who was taken to a gynaecological hospital in a bad peritoneal shock only about six hours later.
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The first case of successful diagnosis and operative removal of a vena caval umbrella which had become detached and migrated to the right ventricle is reported. Complications from the employment of this device are discussed. In all cases of umbrella embolization to the right heart and pulmonary arterial tree, immediate operative removal is indicated. Precautions regarding umbrella insertion which minimize the likelihood of dislodgment and embolization are also mentioned.
Endoscopic removal of ingested foreign bodies should be attempted if the object is not spontaneously passed through the pylorus. This can be safely accomplished with the wire snare technic, or with special grasping forceps that are currently available.
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Injuries to subclavian artery are infrequent and usually occur due to gunshot or stab wounds and occasionally by blunt trauma to the chest. An early diagnosis and control of hemorrhage is essential to prevent death which may occur due to exsanguinating hemorrhage. A case of injury to the subclavian artery due to migration of a Hagie pin, which was used to treat the acromioclavicular separation, is reported. The subclavian artery was ligated initially, which produced an ischemic and functionless upper extremity. Revascularization of the arm was successfully accomplished by an axilloaxillary bypass grafting procedure. This simple procedure is advocated in situations requiring ligation of the subclavian artery following trauma, when direct reconstruction is not feasible.
Accounting for each wounding bullet represents an important part of the emergency room evaluation of gunshot victims. Physical examination must include a thorough search for exit wounds. Medical personnel must be aware of the possibility of intra-arterial passage of a wounding missile and routinely obtain appropriate roentgenagraphic studies so that patients with arterial bullet embolization will be identified preoperatively and can receive optimal surgical repair of their injuries.
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In a 20 year old woman, sudden death due to hemopericardium ensued on osteosynthesis with Kirschner wire of a dislocated sternoclavicular joint. The wire moved to the aorta ascendens and to the right auricle thus causing lethal bleeding into the pericardium. The pathogenesis of the wandering wire is discussed and compared with observations in the literature describing causes, history and clinical phenomena. Wandering after osteosynthesis due to dislocation of the sternoclavicular joint is particularly dangerous, whereas in the case of broken clavicle, dislocation of the acromioclavicular joint, fracture of the humereus or in the region of the hips, no serious complications occur as a rule. Present-day text-books on surgery do not make sufficiently detailed reference to the wandering wire syndrome.
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