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Numerous transorbital wooden foreign bodies in the sphenoid sinus.

A very rare case of numerous transorbital wooden foreign bodies penetrating into the sphenoid sinus in a 47-year-old male is reported. His right eye was nonreactive to light, and the oculomotor, trochlear and abducens nerves were completely disturbed. Although a minor injury was observed on the inner side of the right eyebrow, the wound was not serious or infectious. Computed tomographic scanning of the orbit and parasinus revealed an isodense linear shadow to muscle and an irregular shadow of the lamina papyracea. However, the findings were difficult to discriminate from an optic canal fracture preoperatively. We detected foreign bodies penetrating the optic nerve rise, which were successfully removed in combination with an endoscopic transethmoidal and transorbital approach. Various and careful imaging examinations are recommended to diagnose and manage paraorbital trauma, when a penetrating wound of the face is observed.

Blindness↗

Acute pancreatitis from a duodenal foreign body in a child.

A 14-month-old child was admitted to the hospital with acute pancreatitis, abdominal pain, and shock. An abdominal radiograph revealed a paper clip standing out at the duodenal level. The foreign body was removed by endoscopy, revealing an edematic and hemorrhagic duodenal papilla. The patient progressed favorably after the foreign body was removed. This observation underlines the necessity of digestive transit surveillance of a foreign body that has not been endoscopically removed and the relevancy of duodenal endoscopy for acute pancreatitis of indefinite etiology.

Acute Disease↗

[Current prognosis for foreign bodies in the respiratory and digestive tracts? Report of 840 cases collected over a 5-year period (1969-1974)].

This is a resume of a survey involving 240 foreign bodies in the air passages and digestive tract over a period of five years. Those in the oesophagus were all except one removed by means of endoscopy and among the complications there were 22 strictures of the oesophagus and 8 abscesses, one of them fatal. All the foreign bodies in the air passages were removed by means of bronchoscopy without any accidents or complications. Endoscopy is therefore the main method while surgery remains the exception. New endoscopic techniques combined with antibiotics and electrolytic check-ups so essential in cases of tracheotomy, make present-day prognosis in cases of foreign body excellent.

Bronchoscopy↗

Metallic foreign bodies in the tongues of 16 horses.

The history, clinical signs, results of diagnostic imaging, treatment methods and outcome of 16 adult horses with a metallic foreign body in the tongue are reviewed. All the horses had a swollen tongue, they salivated excessively and were partially to completely anorexic. Less common clinical signs were fever, an enlarged and painful intermandibular space, dysphagia, unilateral tongue paralysis and halitosis. Most of the horses had shown clinical signs for less than 24 hours. The foreign bodies were diagnosed by oral examination, radiography and ultrasonography; they were removed from the tongue of four of the horses during the initial oral examination, and were removed surgically from nine others; the other three horses were treated medically without attempts being made to extract the foreign bodies. Twelve of the bodies were small pieces of wire and one was a hypodermic needle. All the horses received a combination of antimicrobial and non-steroidal anti-inflammatory drugs and they all made an uneventful recovery. Feeding hay and the use of cable-framed tractor tyres as feeders were commonly associated with the cases.

Animals↗

Perforations and foreign bodies of the rectum: report of 28 cases.

A series comprised of 28 patients (five with perforations of the recto-sigmoid colon and 23 with lodged rectal foreign bodies) is presented. The symptomatology, physical, laboratory and x-ray findings are described. Methods of management are discussed, with emphasis on the operative management of perforations and the conservative approach to retained foreign bodies. It is felt that these protocols will be useful to physicians who see this practice less frequently. X-rays of two more unusual cases are depicted. A thorough review of the literature is also presented. This is the largest reported series of patients with retained rectal foreign bodies and/or perforations. The series includes two female patients, a heretofore unreported occurrence.

Abdomen, Acute↗

[Foreign bodies in the lower respiratory tract--experience based on material gathered in the ENT Department of Kalisz between 1984-2001].

Between 1984 and 2001, 33 patients were treated because of foreign bodies in their lower respiratory tract. The age of patients ranged from 0 to 74 years, but the most numerous group was children between 0 and 5 years--16 cases and between 6 and 15 years--9 cases. The most often met foreign bodies were: organic--17 cases, metal bodies 7, plastic 7. We found proliferous changes in 2 patients. In all cases foreign bodies were removed by means of rigid bronchoscopy. In 30 cases they were treated within 48 hours. Only in one case, a ring, retained for 6 weeks. We didn't have any complications.

Adolescent↗

Delayed diagnosis of a foreign body in the spinal canal.

The absence of neurologic deficit does not preclude the diagnosis of stab wound injury of the spinal cord. Adequate radiologic examination is fundamental in detecting retained foreign bodies. Surgical extraction of foreign bodies is indicated to avoid infection and myelopathy.

Adult↗

Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review.

The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent. We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms. Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.

Deglutition Disorders↗

Use of Xe-133 gas in the detection of foreign bodies in the lower respiratory tract.

Six patients with a clinical picture of inhaled foreign body and normal chest radiograph were selected for a study with Xenon 133 screening of the lung. The scan was positive in 3 cases from whom a foreign body was removed. The remaining 3 cases in whom the scan was negative were discharged and an uneventful follow-up was recorded. Xenon 133 scanning was found to be useful in the selection of patients for bronchoscopy.

Child, Preschool↗

[Value of bronchoscopy in the diagnosis and treatment of foreign bodies of the trachea and bronchi].

10-year experience gained at the Moscow Endoscopic Center attached to S. P. Botkin City Hospital with bronchoscopic investigations for tracheobronchial pathology verification covers 14542 procedures. Foreign bodies were detected in 38 patients, of these 12 patients had aspirated the bodies long before the investigation. There were 18 males and 20 females aged from 15 to 85 years. To remove the foreign bodies, a bronchofibroscope was used in 34, a rigid bronchoscope in 4 patients. Sharp bodies and dentures were extracted with a metal loop, those of complex configuration were pulled out by a forked forceps. The removal was followed by toilet bronchoscopy. Complications due to the diagnostic or therapeutic bronchoscopy in patients with foreign bodies were not recorded.

Adolescent↗

Application of data for prevention of foreign body injury in children.

BACKGROUND: To develop design criteria for consumer products, based on foreign body injury and fatality data, to prevent airway obstruction injuries to children. METHOD: Beginning in 1988, RAM Consulting has created a worldwide database of foreign body injuries. This ongoing project now includes approximately 7000 data points from 51 children's hospitals in 15 countries located on five continents. Statistical analysis of these data, especially in terms of size, shape and consistency of the object and obstruction location and severity of injury for the patient has allowed the creation of an injury prevention criterion. RESULTS: Analysis of these data reveals that adoption of an injury prevention criteria based on the use of a 1.50 in. (38.10 mm) diameter gauge for non-spherical objects and a 1.75 in. (44.50 mm) diameter gauge for spherical objects would greatly reduce airway obstruction injuries to children. Furthermore, the data show that this criterion is independent of country and culture. However, the data suggest that a child's exposure to the "mix" of objects that may cause airway obstruction varies with the country and culture of the child. For example, coins are well represented in the database, however, some countries make more coins than other countries and the exposure level may have made the difference in the occurrence of incidents. CONCLUSIONS: Airway obstruction injuries from consumer products could be greatly decreased by the adoption of the presented injury prevention criteria that is founded in a statistical analysis of known objects that have caused injury. This criteria is dependent on object characteristics and is independent of the country or culture of the child.

Adolescent↗

Surface reaction on glass anterior chamber foreign-body removed 24 hours after injury.

An early stage in the formation of a reactive membrane on the exposed surface of a glass foreign body in the anterior chamber is demonstrated. It is emphasized that the formation of reactive membranes on the surface of foreign bodies in the anterior segment of the eye give the cytologic impression of different stages of successful adaptation.

Adolescent↗

[Middle ear cholesteatoma caused by cannonball foreign bodies impacted in the bony eustachian tube: a case report].

We present a 76-year-old male patient with adhesive-type cholesteatoma and with metal foreign bodies which were shown to be located in the bony eustachian tube by computed tomography. He sustained a burn injury of the left tympanic membrane when he was struck by a bomb 52 years ago, during World War II. The cannonball fragments that entered the tympanic cavity were apparently transported to and stuck in the eustachian tube isthmus by mucociliary action after spontaneous closure of the tympanic membrane perforation. Persistent tubal obstruction due to the impacted foreign bodies and surrounding granulation tissue seems to have caused chronic adhesive otitis, leading to cholesteatoma which developed in the attic and mastoid antrum. No foreign bodies became visible after cholesteatoma removal by an intact canal wall technique in conjunction with anterior tympanotomy for wide exposure of the supratubal recess and the tympanic osteum of the eustachian tube. Therefore, anterior tympanotomy was further extended anteriorly to open the enlarged bony eustachian tube, allowing visualization and safe removal of two cannonball-fragments firmly impacted within it. We call this surgical approach to the bony eustachian tube "extended anterior tympanotomy". The transmastoidal accessibility of the bony eustachian tube produced by this technique should be assessed by preoperative computed tomography.

Aged↗

Detection of foreign bodies in soft tissues: experimental comparison of ultrasonography and xeroradiography.

The value of xeroradiography and of high-resolution ultrasonography was compared on minute samples of foreign bodies of various radiographic density (wood, plastic, metallic wires and needles, glass, fish bones). The samples were introduced into pieces of veal meat at different angles with respect to the surface. Xeroradiographic images were taken at 60 kVp, with 32 mAs, and were developed in both positive and negative mode. The echographic examinations were performed using a real-time sector 10 MHz probe placed directly over the specimen, with constant gain rates. The results confirm the value of xeroradiography and demonstrate the effectiveness of high-resolution ultrasonography for the detection of minute foreign bodies. Some materials showed a peculiar echographic pattern, like sand, that corresponded to a frank acoustic shadow, or like metal and glass, showing a comet tail of reverberation artifacts. Wood and fish bones were well outlined, while plastic was less effectively represented. High-resolution ultrasonography is considered to be a first-line technique in searching for many kinds of minute foreign bodies, to be used in combination with xeroradiography in routine clinical examination.

Animals↗

The subcutaneous capsules for foreign body in fetal rabbits: preliminary report.

In terms of wound healing, there are fundamental intrinsic and extrinsic differences between fetuses (scar-free healing) and adults. The fetus exhibits less typical inflammatory response (significantly neutropenic) with an underdeveloped self-nonself immunologic identity and a lack of cellular immunity. The recruitment of inflammatory cells to a wound may play an important role in the resulting cellular processes and ultimately affect the quality of the healing response. Foreign bodies can act as a source of infection and immunologic reactions. In contrast, there have been few studies of the wound healing of fetus with foreign bodies, where in adults, wounds are healed by tissue regeneration rather than capsule formation and a foreign body reaction. In this study, the wound healing process in an adult rabbit and fetus group, in which either silicone or a sponge was inserted in the uterus, were compared. All specimens showed capsule formation with fibroblast, collagen deposition, neovascularization, and infiltration of inflammatory cells. However, the fetal specimen exhibited mainly acute inflammatory responses and the capsule contained less fibroblasts and collagen deposition. In addition, myofibroblast expression, which mediates wound contracture, was lower in the fetal specimen. These findings were common with cotton implants, which were expected to induce a severe inflammatory response. The inflammatory response induced by foreign materials in fetal tissue showed similar response with that of incisional wound healing. This study may provide a basis for the use of implants such as silicone in future fetal surgery.

Aging↗

[Aspiration of foreign bodies in the bronchi in children].

Records on 28 children (19 boys and 9 girls), mean age 3.1 years (range 6 months to 11 years), treated for foreign body aspiration (FBA) at the Department of Pediatrics, Split Clinical Hospital, during the 1992-1997 period, were analyzed. The mean hospital stay was 12.3 days (range 1 h to 92 days). History data on tracheobronchial FBA were available in 23 (82%) children. Radiologic findings pointed to FBA in 22 (77%) children. Rigid tracheobronchoscopy was performed in all patients, and proved successful in 26 (93%) of children. Digestible foreign bodies and food particles were removed in 22 (78%) children. Right-sided and left-sided bronchial FBA was recorded in 14 (50%) and 13 (46%) patients, respectively, whereas bilateral obstruction was present in one patient. The importance of suspected FBA in children with pronounced symptoms of coughing, dyspnea and choke is emphasized. Rigid tracheobronchoscopy and foreign body removal by forceps under anesthesia is an efficient and safe method, and we recommend its wider use in clinical practice.

Bronchi↗

[Rupture of the cervical esophagus. Apropos of a case of perforation by a foreign body].

The Authors describe a case of perforation of the cervical oesophagus by a foreign body (dental prosthesis). After outlining the clinical and instrumental elements which may be useful in the diagnosis, the Authors go on to tackle the topic of the most appropriate choice of therapy in the course of foreign-body perforation and in perforation of the oesophagus in general.

Aged↗