Foreign body aspiration in children: value of radiography and complications of bronchoscopy

PURPOSE: The authors undertook a 10-year review of bronchoscopies for airway foreign bodies in children to test assertions in previous reports that (1) characteristic abnormalities in chest radiographs are important indicators of the need for bronchoscopy and (2) experienced operators incur negligible complications. METHODS: The medical records of 293 children who underwent bronchoscopies by experienced pediatric surgeons for suspected airway foreign bodies were reviewed for patient age, symptoms, duration of symptoms before bronchoscopy, prebronchoscopy radiographs, type of foreign body, anatomic location of foreign body, success of bronchoscopic removal, length of hospital stay, and complications. RESULTS: Of the 293 bronchoscopies, 265 showed airway foreign bodies. A choking episode was recorded in 228 of the 265 patients with foreign bodies and 5 of the 28 with negative bronchoscopy. The surgeon thought that radiographs were normal at the time of bronchoscopy in 110 patients who had foreign bodies. Nine patients with foreign bodies had atypical radiographs; three had bilateral emphysema and six had upper lobe or bilateral atelectasis or pneumonia. There were three complications: one vocal cord injury requiring temporary tracheostomy, one tracheal laceration from removal of an aspirated tooth, and one severe postoperative subglottic edema requiring a 4-day hospital stay. The age of the patients, symptoms, types of foreign bodies, locations of foreign bodies, management, and outcomes were similar to those of previous reports. CONCLUSIONS: In children with airway foreign bodies, chest radiograph findings are frequently normal and can display abnormalities uncharacteristic for foreign body aspiration. Children witnessed to choke while having small particles in their mouths and noted subsequently to have raspy respiration, wheezing, or coughing should undergo prompt bronchoscopy regardless of radiographic findings. Complications of bronchoscopy for foreign body aspiration are uncommon but occur even in experienced hands.     

Induction of metallothionein-like cadmium-binding protein in the testis by oral cadmium administration in rats

PURPOSE: Intraorbital projectile metallic foreign bodies are associated with significant ocular and orbital injuries. The authors sought to evaluate epidemiologic factors, the incidence of associated ocular and orbital injury, and the nature and necessity of surgical intervention in these cases. METHODS: Charts of all patients with projectile intraorbital metallic foreign bodies seen at our institution (27) over the preceding 7 years were evaluated with respect to age, sex, type of injury, associated ocular and orbital injuries, location of the projectile (anterior, epibulbar, or posterior), postinjury visual acuity, and surgical intervention. RESULTS: The majority of patients were male, between the ages of 11 and 30, and had BB pellet injuries. Thirteen projectiles were lodged anteriorly, 4 were in an epibulbar position, and the remaining 10 were posterior to the equator. Twelve of 13 anterior, and 4 of 4 epibulbar foreign bodies were removed surgically, whereas only 2 of 10 posterior foreign bodies required surgery. No case of surgical intervention resulted in a decrease of visual acuity. Associated ocular injuries were both more common and severe in patients with posteriorly located foreign bodies. Final visual acuity was better at presentation and at discharge in patients with anteriorly located foreign bodies. CONCLUSION: Intraorbital projectile metallic foreign bodies can be a source of significant ocular morbidity. Management of these cases is dependent on the location of the projectile. Ancillary radiographic studies can be helpful. Surgery to remove the projectile should be considered in each case, but foreign bodies that are not readily accessible often may be left safely in place. Closer regulation of the pellet gun industry, with an emphasis on education and protective eyewear use, would be helpful in reducing these injuries.     

Delivery, distribution, and neuronal uptake of exogenous mannose-terminal glucocerebrosidase in the intact rat brain

OBJECTIVE: To show the utility of ultrasound biomicroscopy (UBM) in imaging small ocular foreign bodies of the anterior segment. DESIGN: Retrospective case series. PARTICIPANTS: Twelve eyes of 12 consecutive patients evaluated in the emergency department or referred to specialty services at 1 institution between August 1994 and November 1997 were examined. INTERVENTION: Ocular ultrasound biomicroscopy was performed. MAIN OUTCOME MEASURES: Detection and localization of an ocular foreign body were measured. RESULTS: An intraocular or superficial foreign body was detected by UBM in 9 (75%) of 12 eyes. The foreign body was classified as corneal in two eyes, subconjunctival in two, intrascleral in three, and intraocular in two eyes. The foreign body was not visible by ophthalmic physical examination in seven of the nine eyes with a confirmed ocular foreign body. In the remaining two eyes, UBM was used to determine the depth of a visible foreign body. In three of the eyes with a confirmed foreign body, computed tomography and/or contact B-scan ultrasonography was obtained and failed to show a foreign body. Six of the foreign bodies were nonmetallic. CONCLUSIONS: Clinical detection of ocular foreign bodies after trauma can be hindered by small size, haziness of the optical media, poor patient cooperation, or hidden location. Ultrasound biomicroscopy is a valuable adjunct in the evaluation of suspected ocular foreign bodies, especially in cases involving small, nonmetallic objects.     

Perceived side effects and benefits of coronary angioplasty in the early recovery period

BACKGROUND/AIM: Appendicitis and its complications remain a common problem affecting patients of all age groups. Foreign bodies are a rare cause of appendicitis. We tried to define potentially dangerous foreign bodies that may cause appendicitis and summarize general guidelines for their clinical management. METHODS: A 100-year literature review including 256 cases of ingested foreign bodies within the appendix with emphasis on: (1) objects that are more prone to cause appendicitis or appendiceal perforation; (2) foreign bodies that are radiopaque and may be detected during follow-up with plain abdominal films, and (3) guidelines for clinical management. RESULTS: Complications usually occur with sharp, thin, stiff, pointed and long objects. The majority of these objects are radiopaque. An immediate attempt should be made to remove a risky object by gastroscopy. If this fails, clinical follow-up with serial abdominal radiographs should be obtained. If the anatomical position of the object appears not to change and, most commonly, remains in the right lower abdominal quadrant, an attempt at colonoscopic removal is indicated. If this is unsuccessful, laparoscopic exploration with fluoroscopic guidance should be carried out to localize and remove the objects either by ileotomy, colotomy, or by appendectomy. CONCLUSION: Foreign bodies causing appendicitis are rare. However, if stiff or pointed objects get into the appendiceal lumen they have a high risk for appendicitis or perforation. These foreign bodies are almost always radiopaque.     

Inhalation of foreign bodies in children. Report of 500 cases

Inhalation of foreign bodies is a major cause of accidental death during childhood. Aspiration of foreign bodies is common in children aged 1 to 3 years, especially in boys. A past history of foreign body aspiration is itself an indication for bronchoscopic examination of the airways, because some children with aspirated foreign bodies are without symptoms and chest x-ray films may not show abnormalities. Bronchoscopic removal of the foreign bodies requires close communication between the anesthesiologist and the endoscopist. Forgotten foreign bodies in the airways cause chronic pulmonary infections, allergic asthma, bronchiectatic changes, and lung abscess. Foreign bodies that cannot be grasped by bronchoscopic forceps should be removed by thoracotomy and bronchotomy. This report describes our experience in 500 children with suspected foreign body inhalation. We routinely use prednisolone, 1 to 2 mg. per kilogram, and nebulization just after bronchoscopic examination of the airways. This medication greatly diminishes the rate of postbronchoscopic complications such as laryngeal edema, which require tracheostomy. In our series of 500 case, the incidence of postbronchoscopic tracheostomy is 1.4 per cent and the total mortality rate is 1.8 per cent.     

The ingestion of foreign bodies for the purpose of self-injury. The conservative treatment of 2 clinical cases

Although not rare, the ingestion of foreign bodies becomes uncommon when it is done with intent to cause self-damage. When used for this purpose, foreign bodies usually take the form of liquid substances, such as caustic agents, detergents, poisons, etc. It is less rare in certain situations like psychiatric and prison settings. The author reports two cases of foreign bodies voluntarily swallowed by patients in prison.     

The use of ultrasonography for the detection of retained wooden foreign bodies in the foot

The efficacy of ultrasonography for the detection of wooden foreign bodies in the foot was analyzed retrospectively. Twenty patients underwent real-time, high-resolution ultrasound studies (7.5 or 10 MHz, linear array transducers) to rule out the presence of a wooden foreign body in their feet. Ten out of the 20 patients had positive ultrasound findings for a wooden foreign body. With the aid of the ultrasound study and preoperative markings, the subsequent mean surgical time was 20.8 minutes, with a 100% retrieval rate of the foreign body. Ultrasound was found to be 100% sensitive in the detection of wooden foreign bodies in the soft tissues of the foot. Ultrasonography should be considered an important diagnostic modality in the foot and ankle surgeon's armamentarium for the detection of retained wooden foreign bodies.     

Intraretinal foreign bodies

PURPOSE: To present our experience with the removal of intraretinal foreign bodies. MATERIAL AND METHODS: 9 intraretinal foreign bodies were removed by pars plana vitrectomy. Laser photocoagulation of the retina surrounding the foreign body was performed either before surgery or intraoperatively (endolaser). Pars plana vitrectomy with foreign body removal through the sclerotomy site with endomagnet and/or forceps was performed. In some cases fluid-gas exchange was done. RESULTS: The average follow-up period was 6.2 months. Seven of nine foreign bodies were magnetic and two were nonmagnetic. Five of seven magnetic foreign bodies had negative magnetic traction as the first surgical procedure. In these 9 eyes, final visual acuity was below 1/50 in 2 eyes and over 5/50 in 7 eyes. CONCLUSION: Pars plana vitrectomy should be the method of choice in removal of intraretinal foreign bodies.     

Use of ultrasound for diagnosis of foreign bodies of the brain

With the aid of modern ultrasonic diagnostic devices experiments were conducted in order to receive signals from foreign bodies of a different composition, non-radiocontrast ones including. Experiments on 10 human brain preparations revealed the typical peculiarities of echo-signal from foreign bodies in the cerebral matter. In 30 adult mongrel dogs it was proved that foreign bodies can be diagnosed in the course of primary and secondary debridement of skull and brain wounds. It was found that the shape and size of the foreign bodies in the human brain can be most explicitly determined with the aid of a specially designed device having a high azimuthal resolution.     

Misdiagnosis of intraocular iron foreign bodies (author's transl)

Out of 393 intraocular foreign bodies (1961-1975) 361 were magnetically removed and 32 non-magnetically (copper 7,brass,2,lead 5, glass 10, stone 3, wood 4 and plastic 1).60% of the foreign bodies were caused by hammer and chisel injuries.73 foreign bodies were diagnosed too late, in 71 cases no x-ray was made. The incidence of complications (infection, siderosis, retinal detachment was considerably increased where the foreign bodies were removed late. From the 73 foreign bodies (18.5%) the patient did not consult a doctor in 37 cases because of "insignificance". 4 times the family doctor was consulted, who treated the patient symptomatically. In 4 cases occurring in the weekend no eye-specialist could be ostensibly found. In 26 cases the ophthalmologist performed no x-ray control, and small foreign bodies were twice described as "x-ray plate artefacts" from the roentgen specialist. It must be an absolute rule in the eye-doctor's practice that every injury received while working with metals necessitates an x-ray control!     

The problem of lower respiratory tract foreign bodies in children

The authors treat the problem of lower respiratory tract foreign bodies in children on the basis of their own longterm experience. In the years 1972-1991 in the Pediatric E.N.T. Clinic of the Pediatric Institute, Academy of Medicine in Poznań, 147 foreign bodies were removed. A positive history of foreign body aspiration was obtained in 45.7% of the cases. 44.7% of the foreign bodies were removed during the first 24 hours after their aspiration. Broncho-pulmonary complications occurred in 59.1% of the cases.     

Multiplanar imaging in the preoperative assessment of metallic intraocular foreign bodies. Helical computed tomography versus conventional computed tomography

OBJECTIVE: This study aimed to compare the effectiveness of helical computed tomography (CT) versus conventional CT in the preoperative assessment of metallic intraocular foreign bodies on axial, coronal, and multiplanar reconstruction images in clinical routine. DESIGN: Prospective comparative trial, alternate assignment of consecutive patients. PARTICIPANTS: Eighteen patients with penetrating eye injuries and suspected metallic intraocular foreign bodies were studied. INTERVENTION: Alternate patients were assigned to undergo either helical CT or conventional CT in the axial plane. Both the helical and the conventional data were transferred to a workstation, and reconstructions in the coronal and sagittal planes were performed. Additional direct coronal scanning was performed only when necessary for preoperative assessment. MAIN OUTCOME MEASURES: The quality of the directly obtained axial and coronal, as well as the reconstructed coronal and sagittal images, was assessed for each, imaging method based on the ability to detect and accurately localize foreign bodies. The size of the foreign bodies was measured and compared to the actual diameter. Total examination time and radiation dose delivered to the lens were measured for each imaging method. RESULTS: All foreign bodies were detected by each scanning method on the axial, the coronal, and on the reconstructed planes. The quality of the axial images was similar for helical and conventional CT. The helical technique provided high-quality reconstructed images comparable in quality to the directly obtained coronal planes in conventional CT. Reconstructions by conventional technique were not useful for preoperative assessment. The examination time for the total orbital volume was 18 seconds for helical CT examinations and 52 seconds for conventional CT examinations. Radiation dose delivered to the lens for the complete examination was 35 mGy for helical CT axial scanning, 56 mGy for conventional CT axial scanning, and 63 mGy for conventional CT coronal scanning. CONCLUSIONS: Helical CT multiplanar imaging offers several significant advantages for the preoperative assessment of metallic intraocular foreign bodies compared to the conventional CT technique in clinical practice, including short examination time, reduced motion artifacts, reduced radiation exposure, and the ability to obtain diagnostically useful coronal and sagittal reconstruction images without the need for additional scanning.     

The reasons for leaving foreign bodies in the abdominal cavity and the prevention of this complication

An investigation performed in 38 surgical and obstetrics-gynecology departments has established that during 20 years foreign bodies were forgotten in the abdominal cavity of 46 patients which makes up 0.03% of all laparotomies. In 30 patients they were forgotten in emergency operations and in 16 patients in elective operations. Among the victims there were 31 women. The textile foreign bodies such as gauze pads, tampons, towels were left most often (35 things), forgotten surgical instruments and other things were less frequent. The foreign bodies stayed in the abdominal cavity during the period from 6 hours till 15 years and in 26.1% of the patients they resulted in lethal outcomes. The main causes of accidental leaving the foreign bodies in the abdominal cavity during operative interventions are analyzed in detail. Means of prevention of such neglect of surgeons are proposed.     

Influence of 16-week monotherapy with acarbose on cardiovascular risk factors in obese subjects with non-insulin-dependent diabetes mellitus: a controlled, double-blind comparison study with placebo

A 49-year-old patient suffered from a binocular perforating trauma with metal foreign bodies in 1974. During an MRI examination in 1992 for a lumbar spine herniation a metal foreign body was mobilised from the deeper vitreal and retinal area, now causing optical disturbances freely floating in the anterior vitreous. Refusing an operation, the patient, an electrical engineer, tried himself to remove the foreign body out of the optical axis by exposing his head to the electro-magnetic field of an induction coil (pulsed magnetic induction B at t0 of 0.26 Tesla). The foreign body was split into multiple small parts no longer disturbing the patient. To early detect a siderosis regular ophthalmological controls including ERG are necessary. This example stresses that even small intraocular metal foreign bodies are a contraindication for the usually applied field strength of MRI examinations.     

Foreign bodies of the bladder and urethra. Apropos of 2 cases

The bladder and urethra can be the site of various types of foreign bodies. The authors report two cases of low urinary tract foreign bodies. The first case concerned a young man with psychiatric disorders who introduced a condom into his bladder and the second case was an elderly patient with a history of self-dilation who introduced a safety pin into his urethra. In the light of these two cases, the authors review the diagnostic features and management of bladder and urethral foreign bodies.     

Self-inserted sphenoid sinus foreign bodies

This report describes the case of a patient who inserted 3 foreign bodies into her right sphenoid sinus. The possible consequences of sphenoid sinus foreign bodies are described, as well as the importance of a psychiatric workup in such cases.     

The percutaneous retrieval of vascular foreign bodies

Intravascular foreign bodies can cause significant complications: thrombosis, pulmonary and peripheral embolism, etc. It is therefore necessary to remove them, and this may be accomplished through surgery or by means of radiotherapy techniques. In the past year we have percutaneously extracted three foreign bodies originating in vascular access pathways.     

A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group

PURPOSE: To evaluate the effectiveness of pressure patching in the treatment of noninfected, noncontact lens-related traumatic corneal abrasions and abrasions secondary to removal of corneal foreign bodies. METHODS: Two hundred twenty-three patients with noninfected, noncontact lens-related traumatic or foreign body removal-related corneal abrasions were followed daily after receiving topical antibiotics and mydriatics and after being randomized to receive either a pressure patch or no patch. RESULTS: Twenty-two patients were excluded from the study. For data analysis, the remaining patients were split into two sections: those with traumatic corneal abrasions (120 patients) and those with corneal abrasions secondary to removal of corneal foreign bodies (81 patients). Patients with traumatic corneal abrasions healed significantly faster, had less pain, and had fewer reports of blurred vision" when they were not wearing a patch. The amount of photophobia, tearing, and foreign body sensation were similar between the patch and no-patch groups. Similarly, for corneal abrasions due to removal of foreign bodies, patients healed significantly faster and had less pain when they were not wearing a patch. There was no difference in the amount of photophobia, tearing, foreign body sensation, or blurred vision. Finally, there was better compliance in the no-patch group. CONCLUSIONS: Noninfected, noncontact lens-related traumatic corneal abrasions as well as abrasions secondary to foreign body removal can be treated with antibiotic ointment and mydriatics alone without the need for a pressure patch.     

Rhabdoid tumor of the kidney associated with a tumor of the posterior fossa

This article reports our use of intraoperative sonography to guide in real time, the removal of radiolucent foreign bodies from five patients. Two of these patients had undergone previous unsuccessful attempts at surgical removal in the operating room. The technique is cost effective, readily available, and can be very helpful in locating difficult-to-find radiolucent foreign bodies at the time of surgery.     

Tracheobronchial foreign body in children. Is anamnesis alone enough to indicate tracheobronchoscopy?

From 1989-1993 we performed rigid bronchoscopies in 86 children in whom foreign body aspirations were suspected. In 72 cases, foreign bodies were identified in the tracheobronchial tree. In the remaining 14, no foreign body was found. Boys outnumbered girls. The most common type of foreign body was a peanut. The predilection of the foreign body was to fall into the right main bronchus. If the history indicated foreign body aspiration, a chest x-ray was not found to be necessary except for forensic interest.