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The incidence of iatrogenic cardiovascular foreign bodies is increasing. The most common source is a fragment of an in-dwelling venous catheter. These objects have resulted in severe sequelae and death in many instances. Most should be removed. Percutaneous extraction is the method of choice. Surgery should be reserved for cases with failed percutaneous extraction.
The presence of an intraocular foreign body following eye trauma may not be readily apparent. Serous complications may include, inter alia, endophthalmitis, cataract, retinal detachment and siderosis bulbi. We report an iron intraocular injury due to hammering 'metal on metal', which was diagnosed using ultrasonic biomicroscopy and successfully removed. Two months post-operatively, unaided vision was 6/6.
Aspirated foreign bodies (FB) in the peripheral tracheobronchial tree may present challenging management problems for the bronchoscopist. Critical to successful removal is maintaining airway control while minimizing endoscopy time. An innovative approach utilizing rigid and flexible bronchoscopy in removal of a distal impacted airway is presented. Difficulties encountered as well as advantages of this combined approach are discussed.
We present a new localization system in orbital surgery. The procedure is based on the linkage of two methods. A preoperative thin-layer CT scan is taken and the image data are fed into a high-capacity computer which computes a three-dimensional model of the orbit. Intraoperatively, the volume model of the skull is linked to a mechanical arm for position measurement. Surgical instruments can be mounted to this arm. The computer then projects the position of the instrument into the volume model of the orbit, so that the surgeon can follow the movements of his instruments on the monitor. The surgeon has a means of checking position that comes close to constant intraoperative CT monitoring. Thereby the surgeon is able to localize even small foreign bodies without extensive explorations. We present six patients in whom orbital foreign bodies had to be extracted during the past 5 years. A 44-year-old man had an iron foreign body; the external wound was treated surgically elsewhere. Two patients (25 and 22 years old) had glass foreign bodies; in one of them the splinters were not seen using conventional X-ray. Choosing the exact level with the Hounsfield window, the foreign bodies could be demonstrated on the monitor. In three patients with orbital fractures and compression of the optic nerve, dislocated bone splinters were extracted. The localization of those splinters was easy using the imaging system, but would have been rather difficult by other means.(ABSTRACT TRUNCATED AT 250 WORDS)
This paper addresses the in situ expression of transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), and their receptors in the encapsulation process against a foreign body, using 20 cases of the titanium miniplate as a model of the foreign body, used clinically to fix a fractured mandible. Fibrous tissue formed during the encapsulation process was composed of scar-like and fibrogenic layers, with the former directly facing the foreign body. By immunohistochemistry using pre-fixed frozen sections, only the fibrogenic layer was characterized by expression of type I procollagen (PC-I). Spindle-shaped mesenchymal cells in the fibrogenic layer expressed TGF-beta isoforms and receptors, PDGF isoforms, and PDGF beta-receptor. In contrast, the scar-like layer had few such cells. In both layers, spindle-shaped cells did not express Ki-67 in their nuclei. Double immunofluorescence microscopy for cell identification revealed that most PC-I-positive fibroblasts expressed both isoforms and receptors of TGF-beta and PDGF in the fibrogenic layer, while in contrast, they were expressed by only a small number of CD68-positive macrophages. These results suggest that in the maintenance stage of the human encapsulation process against a foreign body, both TGF-beta and PDGF function cooperatively via their receptors in the fibrogenic layer, with such stimuli markedly diminished in the scar-like layer.
Foreign-body (FB) aspirations account for a reasonable percentage of respiratory emergencies in young children. Whereas 67% of aspirated FBs are of organic origin, metallic-ferromagnetic FBs are observed less frequently. We report the use of a wire with a magnetic tip fitting into the working channel of a rigid bronchoscope for removal of ferromagnetic FBs from the tracheobronchial tree.
Tracheobronchial foreign bodies continue to be a source of morbidity and mortality in the pediatric population. Technical advances in anesthesia and equipment have made the removal of these troublesome objects more feasible. Diligence must still be exercised and a coordinated team effort must be employed in order to achieve a satisfactory and safe outcome for the patient. The appropriate use of diagnostic studies and management techniques are discussed.
A case of 18 years old male with tracheoesophageal fistula as a result of esophageal foreign body (chestnut) is described. Foreign body was removed using esophagoscopy. Bronchofiberoscopy performed because of difficulties with swallowing and frequent airway infections revealed tracheoesophageal fistula. Fistula was closed from intratracheal access. Symptoms of dysfagia disappeared after surgery.
Late trans-diaphragmatic migration of a postoperative abdominal foreign body followed a left hepatectomy for injury. Operative treatment, by means of the low posterior thoracic approach consisted of partial resection of the right inferior lobe with immediate closure of the diaphragm and subphrenic drainage. The natural history of the course taken by this abdominal foreign body is used as a basis for discussing diagnostic and therapeutic factors, particularly the surgical route of approach.
BACKGROUND/PURPOSE: Aspiration of foreign bodies remains a major cause of morbidity and mortality in childhood. The aim of this study was to evaluate the predictive diagnostic value of clinical signs and symptoms, the history, and the radiology to perform early diagnosis and therapy. METHODS: From January 1990 to March 1998, 87 children were admitted to the Pediatric Surgery Department of Universita di Padova because of suspected foreign body aspiration. Sensitivity and specificity of the considered diagnostic tools were evaluated. RESULTS: Neither clinical signs and symptoms nor radiology have sufficient diagnostic sensitivity, and especially specificity, on which to rely for the diagnosis. Only the choking crisis, when present in the history, has good sensitivity and specificity (respectively, 96% and 76% in this series). CONCLUSIONS: A choking crisis in the child's history should alert physicians to the possibility of a foreign body aspiration. In the present series, complications always were related to the diagnostic delay.
A young male with intraocular foreign body (IOFB) and clear media had successful removal of the IOFB but sustained macular damage and permanent loss of vision secondary to operating microscope phototoxicity. Light damage to the eye can be thermal, mechanical, or photochemical and is dependent on source and wavelength of light, filters, and host factors. Removal of IOFB is important, but surgeons must be aware of potential light damage to the macula in lengthy surgical procedures and take appropriate precautions.
Foreign bodies of the upper aerodigestive tract in the pediatric population are a common occurrence. However, despite significant advances in prevention, first aid and endoscopic technology, they remain a diagnostic and therapeutic challenge. Early diagnosis is the key to successful and uncomplicated management of these accidents. An orderly and systematic approach to these patients including a careful history, physical exam and radiographic studies is detailed in this review.
Vagus reflex death in foreign body bronchoscopy as a rare incident that severely incriminates medical work is described via a personal observation in an infant of 2 3/4 years of age. Typical symptoms are probably "thorax rigidity", sphincter-like stenosis of the bronchial lumina, paravertebral contraction atelectasis and catarrhal mucous membrane alterations of the respiratory tract. The bulb rhythm producing structures between the tractus solitarius and the nucleus ambiguus must be considered as origins of respiratory arrest.
We studied 149 children aged seven months to 13 years (mean age 2.9 +/- 0.2 years) who had aspirated foreign bodies for age, sex, and type of foreign body. Symptoms, physical findings, chest x-ray, and fluoroscopy were compared with different sites of enlodgement. Positive history was obtained in 135 (91%). In 133 children, the diagnosis was made on admission. Frequent symptoms were cough (80%) and cyanosis (27%) following aspiration, while prevalent emergency department symptoms were cough (33%) and dyspnea (30%). Common physical findings on admission were decreased breath sounds (65%), tachypnea (43%), and fever (36%). Admission chest radiographs revealed emphysema (43%) and infiltrates or atelectasis (29%). Forty-one children (27%) were asymptomatic, and 43 children had normal chest x-ray. Fluoroscopy showed inspiratory mediastinal shift in 57%. Bronchoscopy performed within 48 hours of admission was successful in removing the foreign material in 88% of the children. Food particles were the most common type of foreign body. Hoarseness and stridor were significantly more common in upper airway enlodgement (P less than 0.01). Decreased breath sounds were significantly more common among children with lower airway enlodgement (P less than 0.001). A delay in diagnosis of longer than three weeks was associated with equivocal history of aspiration (P less than 0.05), and with significantly more wheezing (P less than 0.02) and atelectasis (P less than 0.01). Our study reemphasizes the importance of integrating various diagnostic tools in order to accurately evaluate and manage these children.
Foreign bodies were detected in the rectum in four male patients with ages ranging from 36 to 64 years. The materials were an iron rod, a specially shaped wooden device, and in two cases, deodorant caps. They were extracted with the patients in lithotomy position after anal dilatation, under general anesthesia in three cases, and spinal anesthesia in one case. No procedure-related complications occurred and the patients were discharged 24 hours after the operation.
Staphylococcus epidermidis infections on foreign bodies made of plastic are caused by special and complex mechanisms. The staphylococcal cells are able to adhere to and grow on polymer surfaces in vivo and in vitro. In the course of colonization they produce an extracellular substance ('slime') which eventually covers them. It is thought that the staphylococcal slime has several biological functions, including promoting adhesion and protection against both antibiotics and host defence mechanisms. In patients, the removal of a colonized device should be accompanied by the parenteral administration of highly effective antistaphylococcal drugs, such as vancomycin.
To evaluate whether a tracheobronchial foreign body (TBFB) itself or its removal by bronchoscopy with the patient under general anesthesia predisposed children to asthma, we surveyed 58 children who had a TBFB removed at the Mayo Clinic between 1970 and 1978. A control group included children who had undergone tonsillectomy or adenoidectomy. Asthma developed in four children in each group. Children with a TBFB do not seem to be predisposed to the development of asthma.
Pars plana vitrectomy after intraocular foreign body injuries led to a good or at least useful vision in 60% of the cases. Without exception, these were eyes which were practically blind or eyes which according to our experience would have been blinded without vitrectomy. Retinal detachments which have arisen preoperatively have a decisive negative effect on the prognosis: there is a low rate of healing in consequence of traumatic, contusional and metallotic retinal lesions and high MPP rate. Increasing surgical experience, so-called secondary vitrectomy 'in time' as well as improved and more refined vitrectomy instruments lead to better results.