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A radical mastectomy was performed for a breast adenocarcinoma occurring 10 years after a subpectoral augmentation mammaplasty with silicone gel-filled prostheses. A foreign-body reaction to silicone was seen in two of the axillary lymph nodes resected.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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The complications due to migration of a Kirschner wire from the clavicle are described. The major complication of a vascular and pulmonary kind were found in five cases. Migration of the wire into major vessels (aorta, subclavian artery) were seen twice and in three cases, the wire entered the lung. Removal of the wire from the aorta had a fatal result. Before removing displaced fixation wires, accurate localisation is necessary, if necessary using angiography in order to plan the subsequent operation. To avoid migration of the wire, one end should be bent to form a walking-stick shape, and the arm should be immobilised.
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Toothpicks have been used since antiquity as instruments for mouth cleansing and as eating utensils. Toothpick injury to the gastrointestinal tract is often suspected only at the time of operation because patients rarely relate a history of swallowing toothpicks and most toothpicks are not radiopaque. The spectrum of toothpick injury to the gastrointestinal tract is illustrated by 5 patients who developed toothpick perforation of the gastrointestinal tract. Two patients died as a result of complications of toothpick injury, one of these presenting with recurrent gram negative sepsis with multiple organisms due to a duodenal-inferior vena caval toothpick fistula. In two instances the toothpicks were removed at operation and one that was penetrating the duodenum was removed with a fiberoptic duodenoscope.
Bullet embolization into the systemic and the pulmonary circulation is a rare complication of penetrating wounds. From 1966 to 1975 10 patients with bullet embolus (5 in the systemic and 5 in the pulmonary arteries) were treated at Grady Memorial Hospital. The embolization occurred shortly after the initial injury in all cases except for two in which it occurred within two weeks. The patients with bullet embolus were either asymptomatic or some of those with systemic arterial embolization had symptoms and signs of acute arterial occlusion and some of the patients with pulmonary embolization had symptoms and signs of pulmonary embolus. The diagnosis was suspected in all cases because there was no wound of exit and because of the plain regional xray studies, the missile was not present in the expected area. The diagnosis was strengthened when, on screening xray studies of the rest of the body, the missile was found in a remote area and it was confirmed by arteriography. Embolectomy was performed in all cases of both groups except one with pulmonary embolus, and all patients did well and have no residual disability related to the embolus. This study suggests that bullet embolization to the systemic or pulmonary circulation occasionally occurs following bullet wound injury. The diagnosis should be strongly suspected when there is no exit wound and when roentgenographically the missile is not found in the suspected area. In such cases, screening xray pictures of the rest of the body should be obtained, and, if the bullet is found in a remote area, arteriography should be performed to confirm the diagnosis. Embolectomy should be done as soon as feasible and it usually affords very good results.
In the Charnley total hip arthroplasty, periarticular foreign bodies represent potential foci for intraarticular migration at the time of hip dislocation. This complication, although very rare, should be verified radiographically to prevent unsucessful attempts at closed reduction. Although intraarticular radiopaque foreign bodies should be identified on plain radiographs of the hip, intraarticular radiolucent foreign bodies require positive-contrast arthrography for identification. Two illustrative cases are presented.
The rate migration of an implanted cardiac pacemaker from the subrectus area anterior to the peritoneum to the pelvis following a motor vehicle accident is reported. Discovery of dislodgement was made by observing a marked increase of pacemaker impulse amplitude in the three standard limb leads as measured on an oscilloscope.
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Rupture of the mercury-filled bag of an intestinal tube resulted in aspiration of metallic mercury 22 years ago in the patient reported. Immediate respiratory distress was treated with vigorous suctioning and postural drainage. Follow-up chest roentgenograms persistently showed radiopaque particles in the lungs. Signs and symptoms of chronic respiratory disease have since developed in the patient. Postmortem findings from the lungs included globules of metallic mercury surrounded by extensive fibrosis and granuloma formation, which we believe to be the result of local irritative effects of mercury.
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We report two complications of silicone elastomer finger joint prostheses. In one patient, the prostheses broke, with silicone particles present in synovium ("detritic synovitis"). In another patient, silicone particles were found in an axillary lymph node five years after insertion of prostheses in the ipsilateral hand (prostheses were intact at the time). Microscopically, silicone particles in synovium and lymph node were identical to particles abraded from a new prosthesis.