An unusual infra-orbital foreign body.
A case report of a patient with a lower eyelid wound with a retained foreign body is given. The localisation, treatment and complications of orbital foreign bodies are discussed.
Child, Preschool↗
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[Removal of a bronchial foreign body in a child using the laryngeal mask].
The laryngeal mask (LM) was employed for the removal of a bronchial foreign body (screw) in a 2-year-old boy weighing 16 kg since the 6.0 mm external diameter fiberoptic bronchoscope (FBS) for extraction forceps could not be used under tracheal intubation. Anesthesia was induced with sevoflurane in 100% oxygen. After injection of fentanyl 25 micrograms and vecuronium 2 mg, a gastric tube and a size 2 LM were inserted. Throughout the extraction procedure by the FBS in the left main bronchus, the boy had one lung ventilated manually. The airway pressure was kept under 15 cmH2O to avoid gas leakage around the cuff and gastric inflation. Oxygen saturation of 100% with pulse oximetry and PETCO2 of 35 to 45 mmHg with capnometry were maintained. The foreign body was extracted by biopsy forceps. A Fogarty catheter was not effective because the balloon tip was broken by the screw. The LM does not prevent regurgitation and does not provide adequate ventilation under increased airway pressure, but it facilitates the use of a larger size FBS equipped with a variety of extraction forceps. Therefore, it seems to be a useful device for the removal of bronchial foreign bodies in children.
Bronchi↗
[Textile foreign bodies left in the abdomen].
The authors relate eleven cases of forgotten foreign bodies (5 swabs and 6 laparotomy pads) in the abdomen after laparotomies for biliary and digestive (5 cases), gynaecologic (3 cases), or abdominal-wall (3 cases) diseases. Ten patients recovered after surgical extraction of foreign bodies (morbidity: 2 cases) and one patient died before reoperation. This study emphasizes the severity of this complication which can and should be prevented.
Abdomen↗
[Textile foreign bodies retained in the abdomen].
The authors relate eleven cases of forgotten foreign bodies (5 swabs and 6 laparotomy pads) in the abdomen after laparotomies for biliary and digestive (5 cases), gynaecologic (3 cases), or abdominal-wall (3 cases) diseases. Ten patients recovered after surgical extraction of foreign bodies (morbidity: 2 cases) and one patient died before reoperation. This study emphasizes the severity of this complication which can and should be prevented.
Abdomen↗
Management of patients with foreign body gingivitis: report of 2 cases with histologic findings.
Foreign body gingivitis is an inflammation of the gingiva, characterized by foci containing particles of foreign material in the connective tissue, which can have either a granulomatous or a lichenoid microscopic appearance. In clinical terms, it differs from other immune-mediated gingival disorders in its limited involvement of tissues other than the gingiva, as well as its relative resistance to treatment by topical corticosteroids. Two cases are presented, with a review of the clinical features, including characteristic desquamation and mottling of the marginal gingiva and symptoms of localized tenderness and pain; gingival recession was observed in both of the reported cases. Histologic examination revealed damaged epithelium and degeneration of the basal layer, as well as a mixed inflammatory cell infiltrate in the connective tissue with refractile or opaque particles of foreign material. Gingival inflammation and the severity of gingival erosions improved dramatically with careful debridement, improved home care and more frequent, diligent periodontal maintenance therapy. Free gingival grafts, together with excision of affected tissues, served to stabilize and reinforce the marginal tissues, as well as eliminating further clinical signs of the disease; excision alone was not as effective. Patients require careful dental and periodontal management as well as appropriate oral home care to avoid further mechanical damage to the gingiva; in addition, the use of dental abrasives and polishing agents should be restricted, particularly if gingival lesions are present. Home care recommendations include avoidance of dentifrices with certain chemical additives and rinses with a high alcohol content.
Adult↗
Minimally invasive retrieval of a foreign body after penetrating lung injury.
Minimally invasive techniques are increasingly used in the management of trauma victims. We report the case of a young man in a motor vehicle crash who sustained a penetrating wound to the anterior left chest caused by the automobile stick shift. Subsequent imaging demonstrated a large foreign body in the left lung. The foreign body was removed successfully by videothoracoscopy, and the patient made a full recovery. This case demonstrates the inroads that minimally invasive surgery is making in care of the injured and highlights an excellent technique for dealing with pulmonary foreign bodies.
Accidents, Traffic↗
Dorsal flexion of head and neck for rigid oesophagoscopy--a caution for hidden foreign bodies dropped into the epipharynx.
A 32-month-old girl presented with a swallowed coin in the mid-oesophagus verified by chest radiography. Rigid oesophagoscopy was performed under general anaesthesia with muscle paralysis and tracheal intubation with dorsal flexion of the head and neck. The coin could be grasped using 'optical forceps'. When the oesophagoscope-forceps assembly was removed, the coin had disappeared. Repeated explorations of the oesophagus including direct laryngoscopy were unsuccessful. A further direct laryngoscopy, while placing the head in the neutral position, revealed the coin just dislodging from the epipharyngeal space in the hypopharynx, from where it was removed with a Magill forceps (Arnold Bott, Glattbrugg, Switzerland). Dorsal flexion of the head and neck during foreign body removal may allow entry of the foreign body or easily fragmented foreign bodies into the epipharyngeal cavity. Exploration is recommend using naso-pharyngeal suction and direct laryngoscopy with the head in the neutral position before tracheal extubation in order to avoid acute airway obstruction.
Airway Obstruction↗
Management of sharp and penetrating foreign bodies of the upper aerodigestive tract.
The aspiration or ingestion of a foreign body into the upper aerodigestive tract is a common accident that befalls children and adults alike. Sharp and pointed objects pose special problems. The basic principles of their extraction were meticulously developed by Chevalier Jackson, whose concepts of the mechanical problems encountered and demonstrations of their solutions are responsible for keeping morbidity and mortality figures at a minimum. The principles of evaluation and management of sharp and penetrating foreign bodies of the upper digestive tract are described.
Adolescent↗
Detection of orbital foreign bodies with computed tomography: current limits.
Detection and localization of known orbital foreign bodies with computed tomography was evaluated using a model that simulates as closely as possible in vivo conditions. The GE 8800 scanner proved to be an excellent instrument for detection and localization of most orbital or intraocular foreign bodies above certain minimum levels of detectability. The minimum detectable size varied according to the material, for example, 0.06 mm3 for steel, 1.82 mm3 for auto window glass in intraocular position, and slightly larger size for extraocular location. Small wood fragments were not detected.
Eye Foreign Bodies↗
Extraction of intraocular foreign bodies by pars plana vitrectomy. A retrospective study.
We reviewed the medical records of 44 patients who underwent a pars plana vitrectomy to remove posttraumatic intraocular foreign bodies. The group most affected was that of males with a mean age of 28 years, who sustained a job injury, presenting with a single corneal laceration less than 2 mm in extension. There were 31 (70.45%) metallic foreign bodies. At surgery, 27 (61.36%) of the 44 foreign bodies were removed with forceps and 17 (38.63%) with the rare-earth magnet. From these patients, 84.61% obtained a final visual acuity equal or better than that on admission. We did not find a statistically significant difference between the groups with different timing on their vitrectomy, nor between groups presenting with and without vitreous hemorrhage.
Adolescent↗
Diagnosis and management of a wooden orbital foreign body: case report.
The case history of a patient with a retained wooden orbital foreign body is presented. The report illustrates the diagnostic limitations of orbital CAT scanning and ultrasonography. Systemic corticosteroid therapy facilitated the localisation and surgical removal of the foreign body.
Eye Foreign Bodies↗
[Infections due to foreign bodies: primary prevention].
PATHOGENESIS: Subsequent to physico-chemical reactions, foreign bodies, for example catheters, can be colonized by Staphylococcus early at the time of insertion. Once the foreign body has been introduced, germs adhere to the proteins deposited on its surface by the host defense systems. A better understanding of the pathogenesis of these infections should help in developing new strategies for prophylaxis. PREVENTIVE MEASURES: Aseptic insertion with careful skin cleansing, adapted material, and impregnation of the catheter are all essential factors. It would appear that antiseptics are more effective than antibiotics for impregnating catheters. Silver-impregnated venous catheters have given promising results; similar findings have been reported for urinary catheters. EXTERNAL PACEMAKERS: In case of endocarditis, the best treatment is complete ablation of the material and antibiotic therapy. Relapse is inevitable if the material is not removed.
Catheters, Indwelling↗
[Foreign bodies of unknown origin found in a serosal hematoma between the stomach and the pancreas of a patient].
An autopsy of a 55-year-old man who had died suddenly revealed extensive intra-abdominal bleeding and a serosal hematoma between the stomach and the pancreas, in which numerous foreign bodies were found. They were located just adjacent to pancreatic tissue which had undergone changes of acute necrotizing pancreatitis. It was assumed that they had been shaped by a pathological mechanism contributing much to the sudden death of the patient. The nature of the foreign bodies was investigated by comparing their microscopic sections with those of various living organisms and by testing their chemical character with some histochemical methods. However, they had no similarities to known foreign bodies of animal or plant origin found in pathological sections of human tissues and no conclusive evidence on their chemical nature could be obtained either. Our unified opinion is that the foreign bodies might have been formed in human tissues in situ as a result of the pathological tissue changes. The morphological features of the bodies are described in detail and their significance is discussed.
Acute Disease↗
[Topographic diagnosis by two-dimensional echocardiography of an intramyocardial foreign body].
A nineteen-year-old male was diagnosed as having a foreign body in his cardiac muscle after a mild open thoracic injury. Diagnosis and follow-up was performed by two-dimensional echocardiography. He did not show any complications after a 6 month follow-up. We emphasize the rare presentation of this entity and the usefulness of echocardiography to attain the foreign body's size and place. Also, echocardiography helps therapeutic management and diagnosis of complications.
Adult↗
Foreign body granuloma mimicking a benign intraspinal tumour.
We describe the case of an intraspinal foreign body granuloma that became symptomatic 23 years after a lumbar discectomy. Preoperatively, the foreign body granuloma was misdiagnosed as spinal neurinoma.
Diagnosis, Differential↗
Foreign body giant cell reaction related to placement of tetracycline-treated polylactic acid: report of 18 cases.
Presented are 18 cases of foreign body giant cell reaction in mandibular third molar extraction wounds previously treated with 40 mg of dry tetracycline powder carried into the wound with a biodegradable polymer dressing. The lesions vary in intensity from local, soft tissue granulomas to osteolytic, central bone pathologies. Several reports of foreign body giant cell reaction to insoluble tetracycline preparations are cited, along with a brief review of the relationship between myospherulosis and various formulations of tetracycline powder in petroleum-based carrier vehicles. The authors suggest that the foreign body giant cell lesions reported here were initiated by micron-sized particles of insoluble tetracycline powder and were further aggravated by certain hydrophobic characteristics of the associated biodegradeable polymer. The authors caution against use of dry, powdered forms of topical antibiotics in fresh dental extraction wounds.
Bone Resorption↗
Hand-held metal detector identification of ingested foreign bodies.
The study purpose was to determine the ability of hand-held metal detectors (HHMDs) to identify the presence of ingested metallic foreign bodies (MFBs). Twenty-three children presenting to the emergency department with a complaint of MFBs ingested were enrolled. Sixteen of 23 patients had radiographically proven foreign bodies. The MFBs comprised coins (n = 11), a button battery (n = 1), a medallion (n = 1), a token (n = 1), a needle (n = 1), and a marble (leaded glass) (n = 1). The HHMD correctly detected 15 of 16 radiographically positive MFBs (93%) and correctly excluded a potential MFB in six of six radiographically negative cases. The only foreign body not detected was an ingested needle. One radiograph was equivocal. Radiographic localization of the ingested objects was as follows: esophagus, n = 4; stomach, n = 9; and intestines, n = 3. The HHMD correctly localized all detected MFBs. The HHMD had a sensitivity of 94%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. HHMDs are effective screening devices for possible ingested MFBs. Positive studies localized to the stomach and lower gastrointestinal tract do not require confirmatory radiographic studies.
Adolescent↗
Computed tomography of intraorbital foreign bodies.
Computed tomography (CT) has been shown to be an important diagnostic tool in the evaluation of intraorbital foreign bodies (IOFB). In order to further analyze the capacity and limitations of CT in this respect, 55 cases with IOFB (intraocular and extraocular) detected at CT were retrospectively analyzed. It was shown that CT was an excellent diagnostic modality in detecting and localizing IOFB of different material and superior to ultrasonography in this respect. Still, even with high resolution CT, there are some limitations of this modality that are discussed. CT is recommended as the primary diagnostic tool in the detection and localization of intraocular and extraocular foreign bodies.
Adolescent↗