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Removal of nasal foreign bodies with a Fogarty biliary balloon catheter.

Twenty-five children with a range of nasal foreign bodies, which were not easily amenable to anterior instrumental extraction, were considered for this study. These foreign bodies were removed by the use of a Fogarty biliary balloon catheter (Intimax) successfully in 23 children. In two children no foreign body was found. None of the children had any complications. This is a safe procedure which can be performed as an out-patient. Whilst the cost of the catheter may appear expensive, in comparison to the cost of admission for removal of similarly sited foreign bodies under general anaesthesia, the catheter fares favourably.

Ambulatory Care↗

[Foreign bodies in respiratory tracts of children treated at the Institute of Pediatrics in Krakow during the years 1987-1991].

Foreign bodies aspirated into respiratory tract may produce severe lung damage and threaten life. We have analysed retrospectively symptoms, physical findings, chest roentgenograms and bronchoscopy reports in 20 children with foreign body aspiration. Boys dominated in this group. Foreign body aspiration often accompanied by coughing, wheezing and vomiting. In chest X-ray examination it was revealed unilateral body trapping and obstructive emphysema. Foreign body aspiration should be considered in children with prolonged respiratory tract problems even when no adequate history is present and with negative chest roentgenograms.

Adolescent↗

[Intravesical foreign body caused arising from ureterostomy protective resin-gum].

OBJECTIVES: Bladder foreign bodies can arise from many factors and are iatrogenic in a high percentage. A case of intravesical foreign body from accumulated fragments of synthetic gum utilized to protect the ureterostomy is described. These problems can be avoided by correct management of the osteotomy and must therefore be emphasized to those responsible for the patient's care. METHODS/RESULTS: A case of a 7-year-old patient with chronic nephropathy and a bilateral high-loop ureterostomy is described. The migration and subsequent condensation of small fragments of the material protecting the ureterostomy led to the formation of a foreign body which took the shape of the bladder. Treatment was by vesicostomy. CONCLUSION: The possible complications arising from the passage of objects from outside into the urinary tract should always be taken into account in patients with an external urinary diversion.

Child↗

[Ultrasound pinpointing of foreign bodies. An in vitro study].

A study of ultrasonographic guided pinpointing of foreign bodies inserted into pork muscle tissue is presented. The optimal results were obtained using two needles inserted at an angle of approximately 90 degrees to each other and crossing just underneath the foreign body. This method facilitates surgical removal of foreign bodies considerably.

Animals↗

[Foreign body aspiration in children].

OBJECTIVES: The aim of this study was to present the demographic data of our patients who underwent bronchoscopy for suspected aspiration of a foreign body. We also assessed the sensitivity and specificity of history, symptoms, physical examination, and radiological findings in these patients. PATIENTS AND METHODS: One-hundred and two patients underwent bronchoscopy for suspected foreign body aspiration during a 23-month period. Bronchoscopy was performed under general anesthesia with a rigid bronchoscope. RESULTS: A foreign body was detected in 78 patients. The male-to-female ratio was 1.7:1, the mean age was 30.4 months, and the median age was 18 months. Nut and sunflower seeds were the most common types of foreign bodies. There were three minor complications and no death in our series. No tracheotomy or thoracotomy were required. The sensitivity and specificity of history, symptoms, physical examination, and radiological findings for suspected foreign body aspiration were 100% and 4.2%, 97.4% and 8.4%, 89.7% and 37.5%, 76.8% and 50%, respectively. CONCLUSION: A chocking crisis is an absolute indication for bronchoscopy. Our low complication rate allowed us to perform bronchoscopy more liberally in patients with suspected foreign body aspiration. The sensitivity of history, symptoms, and physical findings were very high, whereas the specificity of history and symptoms were very low.

Airway Obstruction↗

Multiplanar imaging in the preoperative assessment of metallic intraocular foreign bodies. Helical computed tomography versus conventional computed tomography.

OBJECTIVE: This study aimed to compare the effectiveness of helical computed tomography (CT) versus conventional CT in the preoperative assessment of metallic intraocular foreign bodies on axial, coronal, and multiplanar reconstruction images in clinical routine. DESIGN: Prospective comparative trial, alternate assignment of consecutive patients. PARTICIPANTS: Eighteen patients with penetrating eye injuries and suspected metallic intraocular foreign bodies were studied. INTERVENTION: Alternate patients were assigned to undergo either helical CT or conventional CT in the axial plane. Both the helical and the conventional data were transferred to a workstation, and reconstructions in the coronal and sagittal planes were performed. Additional direct coronal scanning was performed only when necessary for preoperative assessment. MAIN OUTCOME MEASURES: The quality of the directly obtained axial and coronal, as well as the reconstructed coronal and sagittal images, was assessed for each, imaging method based on the ability to detect and accurately localize foreign bodies. The size of the foreign bodies was measured and compared to the actual diameter. Total examination time and radiation dose delivered to the lens were measured for each imaging method. RESULTS: All foreign bodies were detected by each scanning method on the axial, the coronal, and on the reconstructed planes. The quality of the axial images was similar for helical and conventional CT. The helical technique provided high-quality reconstructed images comparable in quality to the directly obtained coronal planes in conventional CT. Reconstructions by conventional technique were not useful for preoperative assessment. The examination time for the total orbital volume was 18 seconds for helical CT examinations and 52 seconds for conventional CT examinations. Radiation dose delivered to the lens for the complete examination was 35 mGy for helical CT axial scanning, 56 mGy for conventional CT axial scanning, and 63 mGy for conventional CT coronal scanning. CONCLUSIONS: Helical CT multiplanar imaging offers several significant advantages for the preoperative assessment of metallic intraocular foreign bodies compared to the conventional CT technique in clinical practice, including short examination time, reduced motion artifacts, reduced radiation exposure, and the ability to obtain diagnostically useful coronal and sagittal reconstruction images without the need for additional scanning.

Adolescent↗

[Dental foreign body sinusitis].

INTRODUCTION: Unilateral chronic maxillary sinusitis is frequently attributed to dental origin. The goal of this retrospective study is to determine the frequency of maxillary sinusitis due to a foreign body of dental origin and its characteristics. METHODS: Review of 197 sinusitis cases with maxillary sinus involvement operated in our department from 1991 to 1999. Selection of the 17 cases preoperatively suspect to be due to a foreign body of dental origin. RESULTS: 9% of the 197 maxillary sinusitis were classified "odontogenic". Intra-sinusal foreign bodies were identified in 5%: 2% of dental origin, 1% dental or radicular remnants, 2% of "pseudo" foreign bodies of mycotic origin. CONCLUSION: Chronic maxillary sinusitis attributable to a dental foreign body is rare and overestimated. There exists an important disproportion between the number of intra-sinusal dental foreign bodies and the number of patients who are symptomatic. Treatment is surgical by oral antrotomy and/or endonasal meatotomy. Only a prospective study could give a real estimation of the proportion of symptomatic cases and determine the predisposing factors.

Dental Implants↗

[The radiolucent esophageal foreign body in children (author's transl)].

The symptoms of radiolucent esophageal foreign bodies in small children may be predominantly respiratory with stridor and dyspnea. In a 1 3/12 years old girl who suffered from inspiratory stridor and only later from dysphagia as well this diagnosis was delayed for 2.5 months. Air in the upper part of the esophagus was the first striking roentgenologic symptom of the foreign body which was then clearly outlined by a barium swallow examination. The foreign body was a plastic lid of a candy tube.

Age Factors↗

Foreign body in the oesophagus: review of 2394 cases.

A total of 2394 patients with a foreign body in the oesophagus was treated in our unit between 1965 and 1976, including 343 children in whom fish bones (146) and coins (134) were most commonly responsible; in adults, bones (fish and chicken) were commonest. Most of the foreign bodies were impacted in the cervical oesophagus. Pharyngoscopy and oesophagoscopy were carried out under general anaesthesia in all cases except those in which the foreign body was ejected spontaneously or when the patient refused the examination. Oesophageal perforation due to a foreign body was encountered in only one child. Two patients in the series developed the fearsome complication of oesophagoaortic fistula.

Adolescent↗

Foreign bodies of the upper gastrointestinal tract: current management.

The popularity of the flexible esophagogastroduodenoscope prompted us to reevaluate our management of foreign bodies. In this paper we report our experience and update treatment guidelines. In our series (from December 1975 to May 1982), 74 foreign bodies were removed: 12 with the rigid endoscope, 60 with the flexible endoscope, and two surgically. There was no morbidity or mortality. In the age group 1 to 10 years, there were 15 patients, while the age group 11 to 88 years had 59 patients. Although the rigid endoscope is less expensive and has a larger operating channel, the advantages of the flexible instrument are numerous. Foreign bodies of the pharynx and at the level of the cricopharyngeus muscle are best managed with a rigid endoscope; foreign bodies of the esophagus can be managed with rigid or flexible instruments, but are more easily managed with the latter. Foreign bodies of the stomach and duodenum that require removal can be managed only with the flexible panendoscope.

Adolescent↗

[Foreign body ingestion among prisoners].

The records of 261 prisoners who purposely ingested foreign bodies are analyzed retrospectively. The data include type, shape, and number of foreign bodies as well as localization, clinical repercussion, evolution of patients, and the treatment they received. Laparotomy was necessary in 41 cases (15.7%) due to severe complications like obstruction, hemorrhage or perforation. All of our patients operated on had an uneventful postoperative course, without mortality. In our series, there were patients with more than one episode of ingestion of foreign bodies and others who needed reoperation.

Adolescent↗

Management of intraretinal metallic foreign bodies without retinopexy in the absence of retinal detachment.

In the management of intraocular metallic foreign bodies impacting or embedded in the posterior retina but without retinal detachment, retinopexy can be difficult or dangerous because of surrounding retinal, subretinal, or choroidal hemorrhage, or the proximity of the foreign body to the optic disc and macula. The authors prospectively managed five such cases by pars plana vitrectomy and foreign body removal without intraoperative or postoperative retinopexy. Fluid gas exchange was performed in only one case. No attempt was made to create a posterior vitreous detachment in any of the cases. After follow-up, ranging between 8 and 35 months, all cases had attached retinas and chorioretinal adhesion around the foreign body site. None of the cases had preretinal macular fibrosis. Four of the five cases had a best corrected visual acuity of 20/20 or better. The other, an aphakic 3-year-old patient, was amblyopic. Spontaneous chorioretinal adhesion appears to obviate the need for retinopexy in these selected cases. The avoidance of retinopexy and fluid gas exchange may decrease the risk of retinal detachment and preretinal macular fibrosis.

Adolescent↗

Chronic retained foreign bodies in the esophagus.

Two cases of esophageal perforations consequent upon chronic retained foreign bodies are presented. In both patients a mediastinal mass associated with the foreign body was noted on chest radiography. Retrieval of the foreign bodies, although feasible by esophagoscopy in 1 patient, was unsuccessful in the second patient, thus necessitating thoracotomy.

Child↗

Intraocular copper foreign bodies. Use of dexamethasone to suppress inflammation.

In an attempt to prevent the intense inflammatory response to intravitreal copper foreign bodies in the rabbit eye, varying dosages of dexamethasone sodium phosphate were administered daily via the subconjunctival route. The steroid appeared to behave systemically and had similar effects in both the injected and the noninjected eyes. Its effect was similar also regardless of the concentration of copper within the foreign body. Nine days of dexamethasone therapy prevented a substantial number of copper foreign bodies from becoming totally encapsulated during that time. Furthermore, a delay in the onset of the inflammatory response to the foreign body was noted. In a few instances, inflammation was completely suppressed during the entire course of therapy.

Alloys↗

Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting?

OBJECTIVE: This study reviews the management of children with foreign bodies in the nose or ear in an attempt to see whether these children can be successfully managed in the Accident and Emergency (A & E) Department or whether they should be directly referred to the Otolaryngology service. METHODS: The records of all children with a foreign body in either the nose or ear who presented to the Accident and Emergency Department at The National Children's Hospital over a 2-year period were reviewed. RESULTS: 82 children presented with a foreign body in the nose and 53 (65%) were successfully managed in the A & E Department. In contrast, of the 58 children with a foreign body in the ear only 4 (7%) were successfully removed in the A & E Department. CONCLUSION: Most foreign bodies in the nose can be successfully removed in the Accident and Emergency Department. In contrast there is a high failure rate in removal of foreign bodies from the ear in the A & E Department and these should be referred directly to the ENT service.

Accidents↗

[Aspired foreign body in adulthood].

This is an analysis of the removal of tracheobronchial foreign bodies in a hospital for lung diseases in the last twenty years. On clinical, radiological and endoscopical data the localization of the foreign bodies is reported. The bronchological examinations for the removal of foreign bodies were performed under general anaesthesia using a rigid bronchoscope.

Adult↗

Removal of an intraocular foreign body from the optic nerve head.

A 29-year-old man sustained a metallic (98% iron) foreign body in the optic nerve head, which resulted in a massive vitreous hemorrhage and a secondary branch retinal artery occlusion. An initial pars plana vitrectomy was successful in removing the vitreous hemorrhage, but numerous attempts with pars plana and intravitreal electromagnets failed to dislodge the foreign body. A second operation using a microscalpel and foreign body forceps with the bimanual pars plana technique was successful in removing the steel foreign body from the optic nerve-head.

Adult↗