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Eyelid ptosis associated with an undetected foreign body and a remote entrance wound.

A 12-year-old girl presented with ptosis 10 days after falling onto glass that penetrated the frontotemporal region. The immediate ptosis and palpable mass was attributed to an undetected foreign body. CT demonstrated a radiopaque foreign body. During surgery, the foreign body removed was found to be a piece of glass from a soda bottle. The ptosis resolved completely within the next 2 weeks. A retained foreign body should be considered in any case of prolonged ptosis after penetrating ocular trauma, even when the entrance wound is remote.

Accidental Falls↗

[An operated case of traumatic intrapulmonary foreign body persisting for 45 years].

A case with a bronchial foreign body which had an uncommon way of entry through a wound in the chest wall was described. A 70-year-old man was admitted to our hospital because of productive cough and weight loss. He had been injured by a fragment of a hand grenade which penetrated his anterior chest wall at the front in China 45 years ago. A chest x-ray film revealed a metallic foreign body, measuring 1.3 by 0.9 cm, in the upper lobe of the right lung. Computed tomography of the chest and bronchoscopy demonstrated a steel fragment lodging beside and in the right upper lobe bronchus. Right upper lobectomy was performed, and the patient remains well without any thoracic symptoms one and a half years after the operation. Problems in the treatment of traumatic intrapulmonary foreign bodies were discussed.

Aged↗

[Extraction of foreign bodies with rigid oesophagoscopy: personal experience].

The Authors report their personal experience with regard to extraction of foreign bodies with a rigid oesophagoscope carried out in the last 16 years. All the patients studied live in Northern Italy, in Brianza Est, in area of about 100,000 inhabitants. One hundred and sixty-two cases were treated from 1977 to 1992. In order to better evaluate pathological evolution, we divided this period into two parts: 1977-1984 and 1985-1992. The data revealed are as follows: 1) Women always prevailed over men (73% in the first period and 67% in the second); 2) Foreign body extraction increased by 57% in the second period; 3) Patients most frequently treated were between the ages of sixty and eighty; 4) Foreign bodies most frequently extracted were bones (at all ages), coins (in the children) and large meat bolus (in older subjects). The Authors affirm that they were able to extract all foreign bodies employing the rigid oesophagoscope. Occasional difficulties which emerged during extraction were overcome successfully thanks to the vast experience of the medical staff. As a matter of fact, their experiences leads them to reject abandoning the rigid oesophagoscope for the flexible optical fibres also because even those ENT Departments with vast experience in the use of fibres are not always able to remove all kind of foreign bodies.

Adolescent↗

Foreign body aspiration in children. The diagnostic value of signs, symptoms and pre-operative examination.

One hundred and fifteen patients, between 6 months and 12 years of age, had bronchoscopy on suspicion of foreign body aspiration. The histories of these patients were studied to examine the diagnostic value of signs, symptoms and examinations, and to determine the time that passed between aspiration and removal of the foreign body. The sensitivity of the symptoms choking and coughing was fairly high (81 and 78%), but the specificity was poor. The sensitivity of a chest radiograph was 82%, the specificity 44%. The sensitivity of radiographs on inspiration and expiration was 80%, the specificity 55%. The patients had been referred with the initial diagnosis foreign body aspiration (80), pneumonia (34), or subglottic laryngitis (1). In 85 patients a foreign body was identified and extracted. The other 30 patients had respiratory tract infections. The initial diagnosis of foreign body aspiration was correct in 61 out of 85 patients. In these cases, the period between aspiration and extraction of the foreign body was a mean 6 days, compared with 55 days, if the initial diagnosis was pneumonia or sub-glottic laryngitis. We conclude that the diagnosis of foreign body aspiration is too often missed, and that, apart from bronchoscopy, diagnostic tools are of little value.

Bronchoscopy↗

[A case of massive hemorrhage associated with the removal of longstanding intrabronchial foreign body].

A 46 year old male patient was admitted with fever and cough. A chest X-ray film revealed a foreign body shadow of a denture fragment in the right intermediate bronchus that he had swallowed one year and half ago. Rigid bronchoscopy was used to remove the foreign body under general anesthesia. During the procedure, massive hemorrhage occurred from bronchus, and the foreign body was not removed successfully and the patient sustained near cardiac arrest. Postoperatively, he recovered from the near fatal condition with support of mechanical ventilation in ICU for several days. After one month, pulmonary angiography was performed and it revealed the transfiguration of pulmonary artery and other vessels close to the foreign body. Granular tissue around the foreign body was observed by preoperative bronchoscopy. Disruption of such vessels and granular tissue by rigid and forced fiberscopy was suspected to have caused the massive bleeding. Later, the denture fragment was successfully removed by right thoracotomy. We should take this complication into consideration and preoperative fiberoptic bronchoscopy and pulmonary angiography may be beneficial to the anesthetic management of such patients.

Anesthesia, General↗

[Foreign bodies of the respiratory tract in children. A retrospective study of 100 cases].

Foreign body inhalation is a universal problem, most common cause of death from domestic accident in children aged five years and less. Over 15 years, one hundred children aged less than six years were evaluated in Hotel Dieu de France; findings are comparable to previous data, with one avoidable death; boys are chiefly concerned (64%); mean age is 22.5 months; circumstances are often hazy (65%); vegetables are prominently responsible (90%) especially peanuts and pistachios (48%); foreign bodies are seldom radiopaque (1%); autumnal predominance is noted. Inhalation is not reported in 25% of cases; immediate risk is subglottic impaction; the child survives if the foreign body is expelled one way or another. The most frequent site is the bronchial system (87%) with a slight right predominance (49%); symptoms include: dyspnea, persistent cough, and, in case of bronchial obstruction: wheezing and asymmetry of breath sounds; 15% of children are free of symptoms. Delay before hospital care is long (21.5 days), mostly because diagnosis is misread particularly in case of bronchial foreign body; pulmonary distension is a frequent finding (45%). In case of asphyxia, first aid resuscitation is performed immediately: in fact it is rarely useful, sometimes harmful. Extraction is mandatory with the stiff bronchoscope; otherwise, bronchopulmonary infection and destruction is the usual outcome ... (25%). Management is revisited, and prevention is recalled.

Age Factors↗

Foreign-body abscesses presenting as soft-tissue tumours: two case reports.

Foreign bodies in the extremities often present as bony extensions of soft-tissue masses. Wooden foreign bodies can be detected by computed tomography and magnetic resonance imaging, but these studies are often nonspecific and cannot detect small bodies. As illustrated by two cases reported in this paper, these masses are difficult to distinguish from primary soft-tissue sarcomas when the history and imaging findings suggestive of a foreign-body reaction are absent.

Abscess↗

[Foreign bodies in the rectum and colon].

On the basis of analysis of treatment of 80 patients with foreign bodies of the rectum and colon, the volume and character of the therapeutic measures required were defined. The endoscopic methods for removal of the foreign bodies, peculiarities of extraction of the large foreign bodies are presented. The cases of penetration of the foreign bodies into the colon via a natural, or artificial intestinal fistula are described.

Adolescent↗

[A case of transorbital intracranial foreign bodies due to windshield impact].

A case of transorbital intracranial foreign bodies due to windshield impact was reported. A 17-year-old man was admitted to our department after he had his face injured in a traffic accident. He was fully conscious, and had no neurological deterioration except for a disturbance in his left external ocular movement. Plain skull X-rays and a plain CT revealed foreign bodies in the left orbit and the left frontal lobe. Combined surgery, through the orbit and the subfrontal approach, was performed to remove many foreign bodies (crushed windshield glass). His external ocular movement returned to normal postoperatively. There were no complications of meningitis and liquorrhea, and he was discharged without any neurological deficiency. The law, enacted in 1988, obliges the use of high penetration resistant (H.P.R.) laminated windshield in all new cars in Japan. But many motor cars equipped with partially enhanced windshields are still in use. It should be noted that partially enhanced windshields cause more severe injuries than H.P.R. laminated ones.

Accidents, Traffic↗

Airway foreign bodies in childhood.

OBJECTIVE: To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications. METHODS: A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0+/-32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22, </=24 h after aspiration) and late diagnosed group (Group 2, n24 h after aspiration). The two groups were followed up prospectively for complications. RESULTS: A total of 72% of patients were under a 3-year age group. Choking episode history was reported in 32% of patients but when families were questioned about it more in detail the rate increased to 51%. Acute episode of choking seemed trivial most of the families. Cough (69.8%), decreased breath sounds (52.8%) and wheezing (45.1%) were predominant symptoms. Sunflower seed (32. 1%) and peanuts (15.1%) were noted as common aspirated materials. Air trapping (59%) and consolidation (47%) were the most frequent radiological findings especially in the late diagnosed group (P<0. 01). Patients who aspirated organic materials frequently developed pneumonia diagnosed in late period after aspiration. CONCLUSION: Pediatricians must be conscious to check for foreign body aspiration who have sudden onset of cough and wheezing episode. In any suspicion, a bronchoscopy should be considered even if there is not any positive history for aspiration. Children should be followed up after bronchoscopy for complications.

Age of Onset↗

Ultrasonographic detection of ingested and perforating wooden foreign bodies in four dogs.

Four dogs that had ingested wooden foreign bodies were examined. All 4 dogs were young and were examined because of lethargy and a mass involving the left flank that was partially responsive to antimicrobial treatment. Ultrasonography of the flank mass revealed inhomogeneous subcutaneous tissues representing seroma, edema, or reactive tissue. Long, linear, bright interfaces representing the wooden foreign bodies were identified in the stomach of 3 dogs and in the abdominal cavity of 1 dog. The interfaces were associated with uniform shadowing in 3 dogs. Local omental and mesenteric changes suggestive of focal peritonitis were evident in 1 dog. In all 4 dogs, the foreign bodies were removed through an exploratory celiotomy. All dogs recovered without complications.

Animals↗

Ultrasonographic patterns of iatrogenic foreign bodies in the in vitro study.

The purpose of the study was application of ultrasonography for description of imaging patterns of iatrogenic foreign bodies in an in vitro model. Examples of radiolucent and poorly radiopaque foreign bodies were embedded in containers filled with gelatine The ultrasound scanning was performed by means of ATL HDI 3500 machine with a high-frequency broadband linear transducer. There was determined the possibility of detection of various types of foreign bodies. All types of used materials were well visible and hyperechoic in ultrasound image. Variations in ultrasonographic image patterns of foreign bodies studied in vitro allowed differentiation of various types of the examined materials. In conclusion, ultrasonography may become a useful, widely available and cost-effective tool in detection and localisation of foreign bodies of iatrogenic origin that otherwise remain undetected.

Foreign Bodies↗

[Foreign bodies in the airways in children].

From 1984 to 1998 we treated 22 children (15 male, 7 female) with aspirated foreign bodies in their tracheobronchial tree. Most patients (17/22, 77%) were aged up to 3 years (two children were seven months old). Only 12 (54%) patients had history of aspiration. Most common clinical findings were prolonged expiration and impaired respiration on one side (12 patients, 54%) or impaired respiration on one side (7 patients, 32%). Chest x-rays mostly showed one-sided hyperinflation (64% of cases). 50% of children aspirated walnut into their airways. Foreign bodies in most children were installed tracheobronchially on the left and right side and in one child the foreign body was found in the larynx. The foreign bodies were successfully removed in 19 (85%) patients. In three children foreign bodies were not found on time, bronchial obliteration occurred, so pulmectomy of the left lung, lobectomy of the left lower lobe, or bilobectomy (lower and middle right lobe) had to be done.

Bronchi↗

Foreign bodies in the tracheobronchial tree in Sudanese patients.

A prospective study of patients with foreign bodies in the tracheobronchial tree attending Khartoum North Teaching Hospital was carried out. The duration of the study was 3 years. The number of patients studied was 46. The majority were toddlers aged between 18 months and 2 years. There was no sex predominance. The most frequently encountered foreign bodies in the bronchi were ful sudani (peanut, Arachis hypogea), and tasaly seeds (water melon, Citrillus vulgaris). The foreign bodies were found more commonly in the right bronchus in 87% cases. Negative roentogenogram did not exclude presence of foreign bodies in the bronchi. Persistence of symptoms and signs were taken as the indication for the bronchoscopy. The mortality rate in this series was 4.3%.

Adolescent↗

Management of tracheobronchial foreign bodies in children: a reevaluation of postural drainage and bronchoscopy.

The efficacy of the inhalation-postural drainage technique for removal of aspirated foreign bodies was compared with that of bronchoscopy in 76 children. Twelve of 49 children on postural drainage coughed out the foreign body (25%); the other 37 required bronchoscopy. The foreign body was successfully removed in 56 of 63 children who were bronchoscoped (89%). Our experience suggests that a trial of inhalation-postural drainage, administered in a hospital, may be valuable in the initial management of aspirated foreign bodies. If unsuccessful after several treatments, however, the technique should be abandoned, and bronchoscopy performed. Delay of foreign body removal beyond 24 hours may be associated with increased morbidity and prolonged hospital stay. With recent improvements in pediatric endoscopic instruments, the efficacy of bronchoscopy exceeds 90%.

Bronchi↗

[Ultrasonic echography. Current and future tasks in the finding of intraocular foreign bodies].

Unlike most publications ultrasonography is not seen as an alternative concept to x-ray localization of intraocular foreign bodies but as supporting aid. It is primarily used for the rather simple measurement of the form of the injured eye and not so much for direct search of the foreign body. The latter is rather difficult to perform intraoperatively. The combined method is based on the Comberg localization using a mobile x-ray television unit. The x-ray imagery shows quickly, exactly and clearly the localization of the foreign body in the orbita. The eye itself cannot be seen on the monitor, but ultrasonic data allow to add its contours, corrected individually. This work is done by a computer. The measurement of coordinates and angles usually performed by the investigator is done by a computer, too. The linkage of both x-ray and ultrasonic equipment to a computer relieves the surgeon of the graphical tasks and ultrasonic search for the foreign body; it also gives information about the localization of the foreign body in the individual case during the entire operation.

Computers↗