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A case of cardiac foreign bodies associated with four types of tachycardias.

A case of cardiac foreign bodies leading to development of four varieties of automatic tachycardia is reported. A 51-year-old male with aortic regurgitation was admitted to our hospital because of palpitations. An electrocardiogram revealed junctional tachycardia with or without left bundle branch block, and two types of fascicular tachycardias. Computed tomography showed metallic foreign bodies from a fractured guidewire in the membranous portion of the interventricular septum, which was inadvertently retained when he underwent diagnostic cardiac catheterization at the age of 27.

Bundle-Branch Block↗

Foreign body infection: a new rat model for prophylaxis and treatment.

A subcutaneous catheter model in the rat was developed that allowed the study of prevention and treatment strategies for foreign body infection. In contrast to earlier models, the foreign body was inoculated with a low inoculum of Staphylococcus epidermidis just before implantation, thus mimicking intraoperative contamination with skin flora. Reproducible infection of all catheters followed if no prophylaxis was given. However, foreign body infection could be prevented or treated with antibiotics such as teicoplanin, which was marginally effective, and rifampicin, which proved very effective.

Animals↗

Evaluation of alimentary tract foreign body: clinical and imaging review of 100 consecutive cases.

We investigated the cases of 100 consecutive patients with alimentary tract foreign bodies for clinical findings and use of imaging and compared our findings with those of other reported series. Most of our patients were children, and the alimentary tract foreign body was metal in most cases. There was no undue morbidity or mortality related to either conservative or interventional treatment. Imaging was useful in diagnosis and management of cases. Use of computed tomography and magnetic resonance imaging in evaluation of alimentary tract foreign bodies is discussed.

Adult↗

Foreign body granuloma simulating solid neoplasm on MR.

We report a postoperative foreign body granuloma occurring in the thyroid bed after anterior cervical fusion. The magnetic resonance (MR) imaging finding of increased signal on T2-weighted images is atypical for this type of granuloma and is thought to be due to the large proportion of cellularity in the mass histologically. In the differential diagnosis of solid postoperative masses it is important to consider foreign body granuloma, as it can mimic neoplastic disease both clinically and radiographically.

Cervical Vertebrae↗

Handheld metal detector confirmation of radiopaque foreign bodies in the esophagus.

OBJECTIVE: To examine the utility of handheld metal detectors in confirming the position of radiopaque foreign bodies in the esophagus before delayed endoscopic removal. DESIGN: Prospective study of patients evaluated between June 1, 1997, and August 31, 1999. SETTING: Tertiary pediatric referral center. PATIENTS: Twenty-six of 139 children presenting consecutively for evaluation of esophageal foreign bodies met eligibility criteria and completed the study protocol. Inclusion in the study was contingent on a delay of at least 6 hours from the time of diagnosis to the time of endoscopic removal. All patients underwent both radiographic evaluation and handheld metal detector scanning of the chest and abdomen on presentation and immediately before endoscopic removal. RESULTS: All patients evaluated during the study period had coins lodged within the esophagus. Handheld metal detector scanning accurately confirmed this position before endoscopic removal in all cases. CONCLUSION: Our data suggest that handheld metal detectors may obviate the need for repeated radiographs in patients whose foreign bodies cannot be removed at presentation.

Child↗

Suprascleral removal of a foreign body from the retrobulbar muscle cone in two dogs.

The successful application of a suprascleral approach to remove a foreign body within the retrobulbar muscle cone in two dogs is described. The episcleral space was entered through a small opening in the paralimbal conjunctiva and bulbar vagina. Under ultrasound guidance, a curved haemostat with a fine tip was advanced along the scleral surface to the foreign body, which was then carefully grasped and removed using gentle traction. The conjunctival incision was left to heal secondarily. The suprascleral approach may allow the quick removal of non-cutting and non-barbed foreign bodies from the episcleral space or the retrobulbar muscle cone, without the need for extensive tissue dissection. To reduce the risk of damaging extraocular tissues, the procedure must be performed cautiously and under ultrasound guidance. The globe should be continuously observed for any movement suggesting traction or pushing forces on bulbar or adjacent anatomical structures.

Animals↗

Foreign-body reaction to dermal sheep collagen in interferon-gamma-receptor knock-out mice.

This study was performed to gain more insight into the role of interferon-gamma (IFN-gamma), a potent macrophage activator, in the foreign-body reaction to hexamethylenediisocyanate-crosslinked dermal sheep collagen (HDSC). Because the results of earlier studies aimed at modulating the foreign-body reaction in AO rats by local or systemic treatment with anti-IFN-gamma were not completely unambiguous, we extended our investigations to IFN-gamma-receptor knock-out (KO) mice. Several parameters (i.e., macrophages, giant cells, T-cells, B-cells, granulocytes, expression of MHC class II, stroma formation, and degradation and calcification of the biomaterial) were compared between wild-type (WT) and KO mice. Remarkably, the foreign-body reaction was very similar in WT and KO mice. In both, giant cells were formed, but in contrast to previous results in AO rats, phagocytosis of HDSC bundles occurred hardly at all up to 9 weeks, and MHC class II expression was minimal. Stroma formation and vascularization were high and calcification occurred. T-cells comprised less than 1%; a few plasma cells were present in the KO mice at later time points. Granulocytes, mainly eosinophils, were present at all explantation time points. Because of the similar results in WT and KO mice, we question whether IFN-gamma plays a role at all in the foreign-body reaction in mice.

Animals↗

Endoscopic removal of foreign bodies from gastrointestinal tract.

Forty-two children with ingestion of foreign bodies (FB) were managed conservatively. Thirty one (74%) of them were under 5 years of age. At presentation history revealed accidental ingestion in 95% and of being put in the oral cavity by elder sibs in 5% patients. Fifty seven per cent had respiratory distress, 38% had dysphagia and 12% had hematemesis. Foreign bodies were located in the gastrointestinal tract in the stomach (40%), esophagus (26%), small intestine (19%), duodenum (12%) and rectum (2%). A large majority of the FB were constituted by household objects. All the FB above the duodenojejunal junction and one in the rectum were retrieved successfully with fiberoptic endoscopes. In 19% patients, the FB had crossed duodenojejunal junction, and had come out in the stools during 4-5 days observation and these were mostly round in shape. Endoscopic procedures were carried out under intravenous diazepam or ketamine sedation. On endoscopic examination, 21% of them showed erosions in stomach and/or esophagus. No complications of endoscopic procedure or sedation were observed and none of the patients required surgical removal. Removal of FB with flexible fiberoptic endoscopes is less invasive and the best therapeutic option to avoid preventable complications of FB ingestion. In this procedure there is need of a trained and skilled Pediatric endoscopist with lot of patience and a good team work.

Child↗

Dental prostheses and the impacted swallowed foreign body.

A common belief exists that patients who wear false teeth are more likely to present with an impacted swallowed foreign body than those with a normal dentition. This study reviewed a series of 65 patients (with data available from 45) who presented with a swallowed impacted foreign body which required endoscopic removal under general anaesthesia. With the aid of a questionnaire the incidence of dental prostheses in these patients was determined. The number of patients in our study who had either false teeth or natural dentition was compared with the expected age-related incidence of wearing dental prostheses in the general population of the United Kingdom. There were no statistically significant differences between these groups. Patients presenting with an impacted swallowed foreign body are no more likely to be wearing false teeth than any other member of the population.

Adult↗

Visual outcome following penetrating globe injuries with retained intraocular foreign bodies.

BACKGROUND: In our institution the occurrence of endophthalmitis related to intraocular foreign bodies has been rare. In this review we analyse the outcome of eyes with retained intraocular foreign bodies presenting to two vitreoretinal surgeons over nearly 7 years. METHODS: Review of the records of 26 patients who presented to two surgeons in a tertiary care vitreoretinal service in Toronto between January 1989 and November 1995. Information documented included mechanism of injury, time from injury to definitive surgery, entry site, presence of vitreous hemorrhage, type of surgery performed, initial and final visual acuity, and development of endophthalmitis. RESULTS: All the injuries occurred in male patients, with a mean age of 36.1 (range 15 to 55) years. Most of the injuries occurred in the workplace, and in most cases (17 [65.4%]) the mechanism of injury was "metal on metal." The entry site was via a perforating wound of the cornea in 16 cases (61.5%). Almost all cases were repaired within 48 hours by means of pars plana vitrectomy. Concurrent lensectomy was required in 18 cases (69.2%) for lens damage at the time of the original injury. Vitreous hemorrhage was present in 22 cases (84.6%). One patient (3.8%) manifested clinically apparent endophthalmitis, which responded to intravitreal antibiotic therapy. Nineteen eyes (73.1%) had a final visual acuity of 6/24 or better. Eyes with coexisting or subsequent retinal detachment had significantly worse vision than those without retinal detachment (p < 0.001). INTERPRETATION: The incidence of endophthalmitis in our series is lower than that in other published series. Prompt definitive treatment was associated with a good prognosis in most cases.

Accidents, Occupational↗

Ultrastructure of multinucleated giant cell apoptosis in foreign-body granuloma.

To elucidate the role of apoptosis in the disappearance of multinucleated giant cells from the granulation tissue in cases of foreign-body granuloma, we induced a foreign-body reaction by implanting a collagen sponge into the dorsum of the rat and observed apoptotic changes within the multinucleated giant cells using electron microscopy. Two types of multinucleated giant cells were identified presenting apoptotic characteristics morphologically. One was characterized by apoptosis of only one nucleus, followed by cytoplasmic changes, rupture of the plasma membrane and necrosis evoking an inflammatory reaction. The other showed typical apoptotic changes in the majority or in all of the nuclei, followed by phagocytosis of the apoptotic syncytia. The results of the present study suggest that apoptosis occurring within only one nucleus might be triggered by overexpression of the p53 protein, because DNA abnormalities are confined to this single nucleus. In contrast apoptosis occurring simultaneously in the majority or all of the nuclei is most probably due to cell death caused by senescence.

Animals↗

[Reoperations on lower urinary tract due to foreign body after urinary incontinence surgery].

OBJECTIVE: The usage of non-absorbable synthetic materials in female incontinence surgery could give rise to serious complications. The aim of this study was to describe results of reoperations due to foreign body near or within lower urinary tract in female patients previously undergoing stress incontinence surgery. MATERIAL AND METHODS: This was a retrospective study of patients referred to the author with miscellaneous symptoms after stress incontinence surgery. The reoperations were performed in the period March 1996 to May 2004. All patients were followed after reoperation. Results are given as median, minimum and maximum value. RESULTS: Ten patients with median age 59,5 (28-82) years were reoperated between half and 56 months from the primary operation. Urinary infection, pain, incontinence and various lower urinary tract symptoms were the most common symptoms. Nine patients were diagnosed by cystoscopy. Four had previously undergone tension-free vaginal tape surgery (TVT), four needle suspension surgery and two retropubic colposuspension. Seven were reoperated with open retropubic surgery, in two cases TVT was removed below urethra and non-absorbable suture was removed transvaginally in one patient. Foreign body was within the lower urinary tract in seven cases. In three cases, transurethral endoscopic removal of foreign body was performed without long-term success and further surgery needed. The overall results of the reoperations was very satisfying in terms of complete removal of foreign bodies and regress of symptoms. Convalescence was uneventful and only one patient got superficial skin infection. No other complications occurred. None has needed further reoperations in the follow-up period (6-78 months). CONCLUSIONS: Complications after usage of non-absorbable material in stress incontinence surgery could be serious and give chronic urinary symptoms. It is very important for the surgeon to be aware of this in all patients having unsuccessful recovery after incontinence surgery.

Adult↗

Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature.

Four cases of primary endobronchial actinomycosis associated with an inhaled foreign body are described. In the light of these cases and those previously reported in the literature, we describe the main features of this uncommon association. All patients were > 55 years old, were predominantly men, and were usually in a debilitated state. In > 50% of cases, the clinical presentation was suggestive of lung cancer. Thoracic CT rarely revealed a foreign body, but the granulomatous reaction of the bronchial wall was sometimes suggestive of bronchial thickening. Sulfur granules identified on bronchial biopsies were highly suggestive of actinomycosis in most cases, but microbiological culture findings were usually negative. Antibiotics generally ensure good recovery. Extraction of the foreign body was delayed after antibiotic therapy in one half of cases, suggesting the need for endoscopic follow-up in bronchial actinomycosis.

Actinomycosis↗

[Undetected esophageal foreign body aspiration in a patient with seizures].

We report an oesophageal foreign body in a patient with a seizure disorder secondary to encephalitis disseminata who was transferred to our department of neurosurgery because of rising intracranial pressure. He presented with confusion, motor aphasia, and dysphagia. However, the diagnosis of increased intracranial pressure could not be confirmed clinically or by computed tomography. A routine chest X-ray film showed a dental prosthesis projecting on the area of the hypopharynx. Bronchoscopy and oesophagoscopy showed the denture to be lodged in the hypopharynx, but it was impossible to remove it endoscopically. Therefore, an oesophagopharyngotomy was performed and the foreign body extracted. The postoperative course was complicated by pneumonia, which responded well to antibiotic treatment. The patient made an otherwise uneventful recovery and was able to eat without difficulty.

Adult↗

A new retractable micromagnet for intraocular foreign body removal.

We have developed a new, self-contained, small-gauge, permanent, rare-earth magnet for use in conjunction with pars plana vitrectomy in the treatment of selected magnetic intraocular foreign bodies. This magnet allows controlled grasping and releasing of the foreign body by the surgeon, thus increasing surgical control in magnetic intraocular foreign body removal.

Equipment Design↗

An unsuspected alkaline battery foreign body presenting as malignant otitis externa.

We describe a case of an unsuspected button battery foreign body in the ear canal causing symptoms that mimic malignant otitis externa in a previously healthy 13 year old. Button batteries in the ear canal may cause extensive liquefactive necrosis of the surrounding tissue by leaking an alkaline electrolyte solution. Suspicion of a foreign body should be maintained in any child presenting with a complicated otitis externa. Prompt evaluation and removal of button batteries are necessary to prevent tissue destruction.

Adolescent↗

Management of ingested foreign bodies: a retrospective review of 5240 patients.

This review was carried out to assess the effectiveness of our protocol designed for the management of ingested foreign bodies. It was a retrospective review of 5240 patients with ingested foreign bodies admitted over a five-year period to the Ear Nose and Throat Unit. These patients were managed according to a standardized protocol which was adopted and modified from our previous study. Under his management protocol, the mean hospital stay was 1.6 days. Flexible oesophagoscopy under local anaesthesia, and rigid oesophagoscopy under general anaesthesia, were performed in 1.5 per cent and 7.7 per cent of cases respectively. Major complications including oesophageal perforation and deep neck abscesses occurred in 0.19 per cent of patients. There was no mortality. This management protocol for ingested foreign bodies was both safe and cost-effective when compared to similar studies reported in the literature.

Adolescent↗