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A case of intra-orbital bamboo foreign body in a chronic stage is presented. This case seems to confirm the importance of radiological examination, including three-dimensional computed tomography to choose the optimal surgical approach to remove the foreign body.
The use of the Fogarty Catheter for the removal of a steel ball oesophageal foreign body in a child is presented. Moreover, the simple operation technique and the advantages compared to foreign body forceps are described.
OBJECTIVE: To assess the clinical and management aspects of tracheobronchial foreign body (FB) in children and adults; to judge the influence of the operator's experience on the outcome of the procedure and to evaluate the factors associated with delayed diagnosis of FB aspiration (FBA) in children; and to compare clinical, radiologic and bronchoscopic findings in the patients with suspected FB inhalation (FBI). STUDY DESIGN AND SETTING: Retrospective review of a 10-year experience (from 1995 to 2005), involving a 1512-bed Mansoura university hospital and a 184-bed Mansoura emergency hospital. MATERIAL AND METHODS: Three thousand three hundred patients underwent rigid bronchoscopy for suspected FBI between 1995 and 2005 in Mansoura, Egypt. The data were analyzed in 3 groups: the patients with negative bronchoscopy for FBI (group 1), early (group 2), and delayed diagnosis (group 3). Foreign body was removed using the rigid bronchoscope with or without using the extracting forceps (Egyptian novel technique; Sersar technique). RESULTS: The penetration syndrome and decreased breath sounds were determined in a significantly higher number of the patients with FBI. The plain chest radiography revealed radiopaque foreign bodies (FBs) in 23.56% of all patients with FBI. Pneumonia and atelectasis were more common in the groups with negative bronchoscopy and with delayed diagnosis (P < 0.01). The FBs were mostly of vegetable origin, such as seeds and peanuts. The Egyptian novel (Sersar) technique was used since 2004 April in 100 cases (4.62%) with a history of FBI (pins and or small rounded materials). It was successful in 73 cases of nonimpacted inhaled pins. CONCLUSIONS: Bronchoscopy is indicated on appropriate history and on suspicion. To prevent delayed diagnosis, characteristic symptoms, and clinical and radiologic signs of FBI should be checked in all suspected cases. Because clinical and radiologic findings of FBI in delayed cases may mimic other disorders, the clinician must be aware of the likelihood of FBI. EBM RATING: C-4.
OBJECTIVE: Foreign bodies in the ear are mainly encountered in children. This can often pose a problem especially in an accident and emergency department where a microscope or expert help is not routinely available. This paper presents a simple, safe, and effective way of ear syringing. The ease and simplicity of the procedure along with the equipment are described. METHOD AND RESULT: The equipment consists of a "disposable" sterile kit, consisting of a 20 ml syringe, saline at body temperature and 14 or 16 gauge cannula (without the needle). An in vitro experiment was conducted to calculate the pressure generated by the water jet on the eardrum. The pressure was well below the pressure required to burst a tympanic membrane, and hence this technique is safe to use. CONCLUSIONS: Ear syringing is an effective and easy way of removing most foreign bodies. A detailed history and an otoscopic examination must precede the procedure. The novel method of syringing described in this paper with the usual safeguards could be a useful adjunct in the management of this common condition.
Two cases of severe foreign body reaction to polymeric debris occurred following cemented total hip arthroplasty. The debris consisted of microfragments of both polyethylene and polymethylmethacrylate. Microfragments are believed to be primarily responsible for the extensive lytic reactions, which represent an extreme degree of the chronic inflammatory response that is commonly associated with loosening of cemented total hip arthroplasties. A schematic representation of the pathogenesis of component loosening, including the foreign body reaction, illustrates the relationship of this phenomenon to the general problem of aseptic loosening. Revision arthroplasty was successful in both cases, followed for a period of nine and 16 months, respectively.
We report a rare case of vesico-urethral foreign body with urinary fistula. On March 12, 2002, a 53-year-old single men inserted a 3 m vinyl tube 6 mm in diameter into his urethra by himself for the purpose of masturbation, but he could not remove the tube. He cut his urethra by himself and tried to remove the tube. The next day he was admitted to our hospital, with complaints of urinary fistula and fever. Open surgical removal of foreign body, cystostomy and repair of bulbous portion of the urethra were performed. At 24 days postoperatively the cystostomy and urethral catheter were removed and urination became smooth.
The records of 14 consecutive cases of esophageal foreign body obstruction in dogs that had undergone transthoracic esophagotomy for foreign body retrieval were reviewed. Clinical results were considered successful in 13 of 14 dogs. One dog was euthanized at surgery because of the severity of associated thoracic lesions. Clinical signs resolved in the remaining 13 dogs. Two dogs had postoperative complications. One dog developed a pyothorax, and one dog developed a subcutaneous seroma. The overall recovery rate was 93%.
Asphyxia due to aspiration of a foreign body is a common cause of accidental death in children. Foreign body aspiration is the most likely cause of accidental fatalities in children under 1-year-of-age. Children may die due to airway obstruction by food objects such as hot dogs, nuts, candies, grapes, seeds, and egg shells. Non-food objects such as balloons, coins, pop tops of beverage cans, pills, safety pins, ball bearings, marbles, and baby powder also may be fatally aspirated. To better understand and help prevent this well recognized health risk to children, we reviewed 10 years of cases at the Cook County Medical Examiner's Office in which deaths in children 14-years-of-age and younger were due to aspiration of foreign objects. The most common item that caused fatal aspiration in our series was a toy balloon.
Penetrating wounds of the orbit can have serious immediate and delayed effects on the eye and the CNS. Infection, vessel erosion, or interference with ocular function necessitates removal of the foreign object. Precise localization of the retained material and its relationship to the globe, extraocular muscles, optic nerve, and brain is essential, when surgery is contemplated. We describe two children with retained foreign bodies that required removal. Computed tomography (CT) was essential in one instance in planning the surgical approach. In the other patient, the retained foreign body and an associated brain abscess were recognized only by CT. The contribution of CT to the assessment of retained foreign bodies is discussed and its present limits are defined. Computed tomography is highly recommended as the single most informative diagnostic modality for this type of injury.
A case of a foreign body tumor resembling fungus ball pre-operatively diagnosed by bronchofiberscopic examination is reported. A 54-year-old male was referred with a complaint of fever. Chest X-ray and tomography showed a mass shadow with meniscus sign resembling fungus ball in the right lower lung field. Trans-bronchial lung biopsy revealed sulfur-granule of actinomycosis. In spite of local injection of sensitive antibiotics (ABPC) once a week for two months the mass shadow remained unchanged on X-ray. Bronchofiberscopic examination was performed again and a small piece of fibrous substance was obtained, which had been left in previous operation done 17 years before. Re-thoracotomy assured that the mass was a foreign body tumor caused by a gauze.
We report a case of a 12-month-old infant who developed acute respiratory distress with stridor from an impacted proximal esophageal foreign body. She was treated inappropriately as upper respiratory infections prior to the validation of the presenting complaint. Difficulties in diagnosis of esophageal foreign bodies arise, when the patient presents with atypical symptoms. Clinical suspicion remains the most important aid to diagnosis and endoscopic examination is essential for the diagnosis and successful management of foreign bodies in the esophagus.
OBJECTIVE: The study was carried out to assess the clinical and radiological findings and factors related to delay in definite diagnosis of foreign body aspiration and its removal. METHODS: Medical charts of 280 bronchoscopic-proven foreign body (FB) inhalators were reviewed. To analyze factors related to late removal, the population studied was divided into two groups according to time elapsed between injury and care-seeking (up to 24h and longer than 24h) followed by FB removal. RESULTS: Most children (69.5%) were under three, most were males (63.1%) and in 47.5%, rigid bronchoscopy was performed 24h after the accident. Organic foreign bodies were found in 63.4% of cases, most frequently peanuts (20.5%). Mortality related to FB aspiration reached 0.7%. In comparison with endoscopic diagnosis, clinical and radiological abnormalities were found in 99.3 and 84.3% (95% CI, 79.5-88.4%) of studied patients, respectively. The number of health services sought until definite diagnosis was the only factor associated with late removal (OR=23.0, 95% CI, 10.7-49.3%, p<0.001). CONCLUSION: The population studied presented a long delay in FB removal, thus demanding actions enhancing parent, physician and health services awareness, aiming at an earlier referral for diagnostic and therapeutic bronchoscopy.
OBJECTIVE AND IMPORTANCE: We describe the first reported use of temporary balloon occlusion of the cavernous internal carotid artery for controlled removal of a foreign object from the cavernous sinus. This endovascular approach may be an alternative to craniotomy in highly selected cases. CLINICAL PRESENTATION: A 34-year-old incarcerated male attempted suicide by stabbing the earpiece of his glasses through his right orbit into the intracranial compartment. He presented with complete ophthalmoplegia. The earpiece traversed the cavernous sinus, penetrating its posterior wall to enter the perimesencephalic cistern and cerebellum. Angiography demonstrated a small direct carotid-cavernous fistula. INTERVENTION: Removal of the foreign body was performed under general anesthesia in the angiography suite with the operating room on standby. Nondetachable and detachable balloons were inflated in the cavernous carotid artery to provide vascular control while the foreign body was withdrawn from the cranium at the orbit. Follow-up angiographic runs with the balloons deflated revealed minimal arteriovenous shunting, which disappeared on subsequent studies. The balloons were removed. The patient remained neurologically stable with his baseline right ophthalmoplegia and V1-V2 hemianesthesia. At the 6-week follow-up, the patient remained clinically stable with no evidence of carotid-cavernous fistula or interval abscess formation. CONCLUSION: Endovascular temporary balloon occlusion of the cavernous carotid artery provides immediate control of the vessel (with an option of permanent carotid sacrifice), allowing removal of a foreign body without craniotomy in appropriate cases.
Two cases are cited of patients who sometimes exhibited a condition of temporary unconsciousness which proceeded to spontaneous recovery without harmful sequelae. This type of cerebral arrest is frequently called general anesthesia:however, these patients had not received any drugs. What they did have was an irritant in the respiratory passages as shown by coughing. Three cases of general anesthesia are described wherein the duration of the phenomenon appeared to be partly due to the presence of an extra-integumentary foreign body, confined to the respiratory passages. In this trio there was evidence that the drugs did not affect the patients in any unusual way, whatever their effects on whichever side of the alveolar walls. Many anesthetic agents act like unabsorbable foreign bodies, in that they enter and leave the body unchanged, despite the fact that they do pierce the integument. Of course, almost everything, except inspirable and expirable air, but including anesthetic agents, is a foreign body in the respiratory tract. On the basis of these considerations, I suggest that one way, in which general anesthetic agents work, is an extra-integumentary foreign bodies, causing Reflex Coma by irritating or stimulating the trigger points in the walls of the respiratory tract, thereby arresting the cerebrum.
The adhesion and activation of monocytes and macrophages are thought to affect the foreign body response to implanted medical devices. However, these cells interact with devices indirectly, because of the prior adsorption of proteins. Therefore, we preadsorbed several "model" biomaterial surfaces with proteins and then measured foreign body giant cell (FBGC) formation, tumor necrosis factor alpha (TNFalpha) release, and procoagulant activity. The model surfaces were tissue culture polystyrene (TCPS), untreated polystyrene (PS), and Primaria, whereas the proteins used were albumin, fibronectin, fibrinogen, and immunoglobulin. FBGC formation, TNFalpha release, and procoagulant activity of monocytes were the highest for surfaces preadsorbed with IgG. FBGC formation was lower on surfaces with adsorbed fibrinogen and fibronectin than on uncoated surfaces. TNFalpha release and procoagulant activity of monocytes were similar on surface adsorbed with fibrinogen, fibronectin, or albumin. Monocyte activation was also affected by the surface chemistry of the substrates, because FBGC formation was the highest on PS and the lowest on TCPS. Monocyte procoagulant activity was the highest on Primaria. Adsorbed proteins and surface chemistry were found to have strong effects on FBGC formation, monocyte TNFalpha release, and procoagulant activity in vitro, providing support for the idea that these same variables could affect macrophage-mediated foreign body response to biomaterials in vivo.
A case of bladder tamponade caused by a foreign body (gauze) in the bladder of a 24-year-old man is reported. He had been treated with the Lambotte wire and screw to repair his pubic bone fracture caused by a traffic accident. About one year later, the wire and screw were removed from the patient. However, he suffered from gross hematuria and bladder tamponade on the 11th day after the 2nd operation, and he was transferred to our outpatient department on emergency. Further urological examinations were done for this case. The patient was diagnosed as having bladder tamponade caused by a foreign body, a gauze, in the bladder. Among these examinations NMR-CT gave us the most interesting and useful findings. NMR-CT showed that the gauze penetrated the bladder wall.
The case records of 110 patients (97 children and 13 grown-ups) with foreign bodies in the tracheobronchial tree during a period of 14 years (1970-1983) are reviewed. Atypical histories, misleading clinical and radiological findings and delayed diagnoses due to misinterpretations by the patients or their physicians were seen from time to time. Other findings in this survey were that organic material prevailed, with the majority of the objects in the right bronchial tree; there was a male predominance and the most common age for inhalation of a foreign body was about two years. Bronchoscopic extraction was the routine and only in one boy had the object to be removed by the transthoracic route. The venturi technique with oxygenation through the bronchoscope was applied at the extraction procedures. This principle for ventilation during general anaesthesia creates excellent working conditions for the endoscopist. The hazard at the removal of a foreign body is thereby reduced.
The purpose of the study was to compare two similar foreign body retrieval devices, the Texan (TX) and the Texan LONGhorn (TX-LG), in a swine model. Both devices feature a < or = 30-mm adjustable loop. Capture times and total procedure times for retrieving foreign bodies from the infrarenal aorta, inferior vena cava, and stomach were compared. All attempts with both devices (TX, n = 15; TX-LG, n = 14) were successful. Foreign bodies in the vasculature were captured quickly using both devices (mean +/- SD, 88 +/- 106 sec for TX vs 67 +/- 42 sec for TX-LG) with no significant difference between them. The TX-LG, however, allowed significantly better capture times than the TX in the stomach (p = 0.022), Overall, capture times for the TX-LG were significantly better than for the TX (p = 0.029). There was no significant difference between the total procedure times in any anatomic region. TX-LG performed significantly better than the TX in the stomach and therefore overall. The better torque control and maneuverability of TX-LG resulted in better performance in large anatomic spaces.