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Typing of coagulase-negative staphylococci isolated from foreign body infections.

Twenty-six coagulase-negative staphylococci isolated from patients with various foreign body infections were characterised using different typing systems. Staphylococcus epidermidis was the most predominant species found. Phage typability was below 50% in all strains. The strains showed differences in surface properties--relative hydrophobicity or hydrophilicity--and ability to adhere to polystyrene with subsequent slime production (adherence tube test). Protein and polypeptide profiles as well as plasmid profiles demonstrated the heterogeneity of the strains. Thus, this preliminary study indicates that all coagulase-negative staphylococci of human origin may become involved in foreign body infections.

Bacterial Adhesion↗

Hide and seek: pre-operative ultrasonic localization of non radio-opaque foreign bodies.

Ultrasound has long been used as a diagnostic and therapeutic tool in surgery. We have extended its use to hand surgery, where is has several applications. Non radio-opaque foreign body extraction is invariably a frustrating exercise of 'hide and seek'. Accurate pre-operative localization with ultrasound illustrating size, shape, depth, soft tissue and bony relationships can ensure rapid and complete removal. Several cases are presented to demonstrate the use of ultrasound for the detection of non radio-opaque foreign bodies. The technique used will be described. We feel pre-operative localization by ultrasound is a useful technique to assist with the removal of non radio-opaque foreign bodies.

Adolescent↗

[Perforation of the colon by a foreign body].

Perforation of the colon carries a high mortality and morbidity. Perforations caused by foreign bodies are relatively rare and appear to be less often associated with postoperative complications than perforations due to organ disease. Depending upon the extent of the perforation and its anatomical site, as well as on the basis of the presence of diffuse or circumscribed peritonitis, the treatment of foreign-body perforation will vary from simple suturing, with or without a protective colostomy, to exteriorization in the form of a colostomy, and the Hartmann operation.

Colonic Diseases↗

Widespread foreign-body granulomas and elevated serum angiotensin-converting enzyme.

A patient had extensive foreign-body granulomatous inflammation of multiple skin sites and of the inguinal lymph nodes with splenomegaly, cutaneous anergy to common skin antigens, and peripheral blood eosinophilia. The patient had an elevated serum angiotensin-converting enzyme level. Histologically, the granulomas were of the foreign-body type with lymphocytes, histiocytes, eosinophils, and giant cells, some that contained doubly refractile crystalline material. Electron-probe x-ray microanalysis identified silicon, magnesium, iron, calcium, phosphorus, zinc, titanium, and chromium in the crystalline material. These findings suggest talc, cement, and inorganic pigment as possible sources of the crystals. This case is reported for its unusual clinical, laboratory, and morphologic features.

Biopsy↗

[Clinico-statistical analysis of the approach to retained foreign bodies in the extremities].

The investigation in 200 wounded in battles was performed by clinical-statistic analysis. The aim of the study was to analyze the procedure with foreign bodies in the extremities after the primary surgical management of the wound. It was established that primary surgical management of the wound, besides the coexisting difficulties (field work conditions, impaired supply etc.), was correctly performed with the early administration of 2 prophylactic antibiotics (Longaceph, Garamycin, Tolycar and Penicillin) in therapeutical doses during 3 to 10 days after the wounding. The "finishing" which included the repair of incompletely performed primary surgical management of the wound: incomplete nephrectomy, unadequate hemostasis, drainage, incorrect immobilization, etc. was performed in 32% of the wounded. The results imply that the accessible foreign bodies near the wound were removed without the excessive damage to the adjoining soft tissue. After the whole treatment, 3% of war wounds were found to be infected. Two fistulas from foreign bodies and 4 osteites were noticed and they were cured by the surgical treatment and antibiotic therapy.

Adolescent↗

[An unusual bronchial foreign body: an hydatid cyst membrane].

Long course bronchopneumonia in child imposes a bronchoscopy to research a foreign body. We report the case of a 4 years old child presenting an unusual foreign body overdraft at rigid tube bronchoscopy indicated for a training pneumonia. It was the membrane of burst pulmonary hydatic cyst obturing left bronchial tree. His total extraction permitted the complete recovery without retention of the membrane.

Airway Obstruction↗

Pars plana vitrectomy foreign body extraction assisted with a 24-gauge needle tunnel.

A 54-year-old man presented with corneal laceration, traumatized iris, small vitreous hemorrhage, lens opacity, and a 13-mm intraocular foreign body embedded in the retina. Pars plana vitrectomy and argon laser photocoagulation were performed. Using intraocular forceps, the object was forced into a 24-gauge needle that was inserted through the sclerotomy. The foreign body and the needle were removed from the eye. Phacoemulsification with foldable intraocular lens implantation in the ciliary sulcus was performed. Seven days after the surgery, the patient's visual acuity was 20/20 with spectacle correction of -3.5 diopters. The use of a needle tunnel during pars plana vitrectomy should be considered in similar cases of large, irregular intraocular foreign bodies to avoid severe and irreversible damage to the adjoining tissues.

Cornea↗

[Foreign bodies in the knee joint in children].

The diagnosis and methods of treatment in cases of foreign bodies in the knee joint of children has been poorly elucidated in the literature. A foreign body in the knee joint is an absolute indication for operation. The operation should be performed under narcosis and should bear the character of a primary postponed intervention. Migrating foeign bodies should be removed with the aid of a clamp under control of the x-ray screen.

Child↗

[Fever, coughing and/or wheezing in young children: consider the possibility of foreign body aspiration].

Three children, 2 girls aged 1.5 and 3 years and a 2-year-old boy, experienced coughing, wheezing and/or fever for several days or weeks. The first girl was treated for asthma, the other two children for pneumonia. Because the symptoms persisted in all three children after treatment was started, the diagnosis of foreign body aspiration was suggested and confirmed by bronchoscopy. The foreign body was removed during the bronchoscopy and in the boy, a mucosal lesion in the piriform fossa was sutured. Thereafter, all the children recovered completely. In children with persistent coughing, wheezing or fever despite treatment for pneumonia or asthma and in absence of a characteristic acute incident, foreign body aspiration should be considered.

Asthma↗

[Esophageal injuries caused by a swallowed foreign body. A life-threatening condition].

Report on a case in which a protracted foreign body in the esophagus (chicken bone) had perforated the wall in the cervical area and had led to premonitory bleeding and finally to massive hemorrhage. Neither before had further symptoms occurred regarding to the esophageal perforation such as mediastinitis or subcutaneous emphysema nor had the attempt been successful to picture the transmural lesion. With an appropriate history of the foreign body and relapsing gastro-intestinal hemorrhage--despite a negative endoscopic result--an esophageal lesion must be highly suspected as causing bleeding. The immediate thoracotomy for wound repair is strongly indicated.

Aged↗

Foreign body infection: role of fibronectin as a ligand for the adherence of Staphylococcus aureus.

Foreign bodies made of polymethylmethacrylate coverslips were implanted subcutaneously into guinea pigs, were explanted four weeks later, and were tested for in vitro adherence of Staphylococcus aureus strain Wood 46. In the presence of serum, the level of staphylococcal adherence to explanted coverslips was 20 times higher than that of adherence to unimplanted coverslips. Adherence to explanted coverslips was caused by fibronectin deposits on the foreign body surface and was inhibited in a dose-related fashion by specific antibodies to fibronectin.

Adhesiveness↗

[A case of interstitial pneumonitis with hemoptysis, BOOP (bronchiolitis obliterans organizing pneumonia) pattern, granulomas and foreign body giant cells in lung biopsy].

A 66-year-old male presented to our hospital in January 1990 with chief complaints of hemoptysis and cough. These symptoms had developed 10 months previously and had gradually increased. Fine crepitations were audible over the right lower lung field. There were no results suggesting an inflammatory process such as leucocytosis, elevation of ESR or positive CRP reaction. Chest X-ray film on the first visit showed fine nodular shadows in the right lower lung field, and chest CT revealed fine nodular shadows and mild dilatation of the right lower lobe bronchus. Transbronchial lung biopsy specimens showed granulomas with multinucleated giant cells, alveolitis and Masson bodies. The open lung biopsy specimens showed numerous macrophages and foreign body giant cells, and extensive organizing exudates in the bronchioles and alveolar spaces. Proliferation of smooth muscle and fibrosis around the dilated bronchioles were also seen. Thus, this patient demonstrated BOOP pattern, with granulomas and foreign body giant cells. His hemoptysis appeared to have resulted from inflammation of dilated bronchioles. His symptoms and abnormal shadows on chest X-ray improved without any therapy after admission. After treatment with corticosteroid, the diffuse fine nodular shadows disappeared. There has been no recurrence of symptoms to date, although this patient has continued living in the same environment as prior to admission. BAL findings during his prolonged follow-up revealed decrease in lymphocytes and elevation of CD4/CD8 ratio. Although the presence of granulomas suggests the possibility of an allergic reaction, no antigenic material could be identified in this case.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗