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PubMed2002

[Risk factors for secondary retinal detachment after extraction of intraocular foreign bodies].

BACKGROUND: Better identification of patients at risk for retinal detachment after intraocular foreign body removal would guide management as well as help prevent this complication. We performed a study to identify risk factors for secondary retinal detachment in eyes with retained intraocular foreign bodies. METHODS: We reviewed the records of 102 consecutive patients (95 males and 7 females with a mean age of 31.6 years) seen between 1990 and 1995 at one ophthalmology service for intraocular foreign body after penetrating ocular injury. All eyes underwent primary surgical repair and foreign body removal (via electromagnet or vitrectomy). The mean length of follow-up was 2 years (range 6 months to 6 years). Survival analysis (Kaplan-Meier, Cox regression) was performed to determine predictors of retinal detachment. RESULTS: The foreign body was metallic in 95% of cases and magnetic in 60%. The largest diameter was 3 mm or more in 35% of cases (range 1 mm to 25 mm, mean 3.6 mm). The foreign body was preretinal or intraretinal in 24 patients (24%), intravitreal in 47 (46%), located in the sclera in 16 (16%) and located in the anterior segment in 15 (15%). A secondary retinal detachment developed in 25 patients (24%) after foreign body removal, with a mean delay of 4.6 (standard deviation 7.6) months (range 7 days to 31 months). The posterior pole was detached in 15 patients (60%). The retinal detachment was total in 13 patients (52%). Proliferative vitreoretinopathy was noted in 13 cases (grade B in 3, grade CI in 3, grade CI in 1, grade C3 in 1, and grade C4 in 5). Univariate analysis using Kaplan-Meier survival showed that firearm injuries, visual acuity less than 20/200, presence of hyphema, presence of tissue prolapse and presence of vitreous hemorrhage at the initial examination were significantly associated with the occurrence of secondary retinal detachment. On multivariate analysis (Cox regression), two independent and combined factors were predictive of retinal detachment: initial visual acuity less than 20/200 (odds ratio 5.5, p = 0.02) and presence of vitreous hemorrhage (odds ratio 2.2, p = 0.05). INTERPRETATION: Patients at risk for secondary retinal detachment after penetrating ocular injury with retained intraocular foreign body can be identified at the initial examination.

Adolescent↗

PubMed1996

Ultrasound versus radiography in the detection of soft-tissue foreign bodies.

STUDY OBJECTIVE: To determine the usefulness of ultrasound and radiography in detecting foreign bodies in soft-tissue models closely duplicating puncture-wound trauma and hand anatomy. METHODS: In this randomized, blinded descriptive study, two radiologists independently evaluated 120 chicken thighs for foreign bodies with the use of standard two-view radiography and 7.5-MHz transducer ultrasonography. All chicken thighs were manipulated with hemostats to ensure uniform tissue damage. In 60 thighs, one foreign body had been inserted (10 each: gravel, metal, glass, cactus spine, wood, and plastic). RESULTS: The sensitivity of ultrasound in detecting gravel was 40%, that for metal was 45%, that for glass was 50%, that for cactus spine was 30%, that for wood was 50%, and that for plastic was 40%. The overall sensitivity, specificity, and false-negative and false-positive rates for ultrasound were 43%, 70%, 50%, and 30%, respectively. No individual foreign body had an ultrasound detection rate of 50%. Radiography detected foreign bodies generally considered radiopaque (gravel, glass, metal) 98% of the time, but it never detected bodies considered radiolucent (wood, plastic, cactus spine). The false-negative and false-positive rates for radiography were 50% and 1.6%, respectively. CONCLUSION: Ultrasound detection of foreign bodies by skilled operators in this animal model revealed poor sensitivity and specificity. Radiographic detection was highly sensitive for foreign bodies considered radiopaque. Our data suggest that ultrasound should not be relied on to rule out the possibility of a retained foreign body in the distal extremities.

Animals↗

PubMedDate not supplied

Nasal foreign bodies: description of types and complications in 420 cases.

UNLABELLED: Nasal cavities foreign bodies are common accidents in children, sometimes leading, in accordance with the literature, to complications such as epistaxis and bronchoaspiration. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful. AIM: To evaluate 420 cases of nasal foreign bodies removed in ENT Service of Souza Aguiar Hospital, Rio de Janeiro, as related to sex, age, type of foreign body and complications. MATERIALS AND METHOD: 420 cases of nasal foreign bodies removed in the ENT service of Souza Aguiar Hospital between December 1992 and December 1998 were evaluated according to the parameters related above. RESULTS: We found higher incidence between 0 and 4 years of age, and the most frequently found foreign bodies were foam fragments, plastic pieces of little toys, beans and paper fragments. Complications occurred in 9.05% of the cases, epistaxis and vestibulitis being the commonest. CONCLUSION: Nasal foreign bodies are especially found between the ages of 0 and 4 years. In our study, foam fragments and small plastic objects were the most frequent foreign bodies found. Complications were found in 9.05% of the cases, headed by epistaxis and nasal vestibulitis.

Adolescent↗

PubMedDate not supplied

Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals.

A question frequently asked by clinicians who are treating small animals suspected of having gastrointestinal foreign bodies is whether one imaging test such as survey radiography or ultrasonography is sufficient to make the diagnosis. A study was undertaken to try and answer this question. Survey abdominal radiography and ultrasonography was performed on 16 small animals (11 dogs, five cats) with clinical signs of an obstruction because of a confirmed gastrointestinal foreign body. The majority of the foreign bodies (14/16) were confirmed by surgical removal and were located in the small intestine. A gastric foreign body was retrieved endoscopically and a colonic foreign body was passed in the feces. Radiographically identifiable foreign bodies were evident in nine animals. Small intestinal overdistension was present radiographically in seven animals. Ultrasonography detected a foreign body in all 16 animals. The foreign bodies were identified by their distal acoustic shadowing and variable degrees of surface reflection. An intestinal perforation was detected sonographically but not radiographically. The value of additional sonographic findings including thickening of the gastrointestinal wall and loss of layering, free peritoneal fluid, and lymphadenopathy in these animals is discussed. The findings in this series suggest that in a small animal with a gastrointestinal foreign body, ultrasonography alone could be used to make the diagnosis and may be a more appropriate choice than survey radiography.

Animals↗

PubMed1998

[Diagnosis and removal of foreign bodies of the trachea and bronchi].

The article presents results of examination and treatment of patients with foreign bodies in the tracheobronchial tree. It was noted that clinical manifestations were not leading in diagnosis of aspirated foreign bodies. The X-ray diagnosis is also not sufficiently effective, especially in cases with organic foreign bodies. Fiber bronchoscopy was used in 45 patients for diagnosis and removal of foreign bodies from the tracheobronchial tree. Practical recommendations are given on the method of removal of the foreign bodies depending on the shape, size and kind of the foreign body. The authors consider that the main criterion for fulfilling diagnostic fiber bronchoscopy in cases of suspected foreign body is information from the patient of probable aspiration of a foreign body. High efficiency of both diagnostic and curative fiber bronchoscopy for foreign bodies in the tracheobronchial tree is noted.

Adolescent↗

PubMedDate not supplied

Intralenticular foreign bodies: case reports and surgical review.

Management of intralenticular foreign bodies (ILFBs) is controversial. Correlation between visual outcome, foreign body characteristics, the need for surgical intervention, and the choice of surgical technique are not well established. We report five cases of traumatic ILFBs all managed surgically. Three ILFBs were metal, one was presumably also metal, and one was wood. We chose to proceed with foreign body removal and simultaneous cataract extraction with intraocular lens implantation as a single-staged procedure in four cases. In one case of planned extracapsular cataract extraction, a foreign body was identified only after the expressed nucleus was sent for pathological examination. Visual outcomes were 20/30 or greater in all cases at 5 to 18 month follow up.

Adolescent↗

PubMed2000

Tracheobronchial foreign body management in an acutely ill neonate.

Pediatric foreign body management has become refined in recent years, both from a diagnostic and therapeutic standpoint. History, physical examination, and radiographic evaluation performed in a timely manner can lead to safe and successful foreign body retrieval. Advancement in videoendoscopic instrumentation and anesthetic techniques enable the airway surgeon to achieve simultaneous airway stabilization and foreign body removal. In the emergency setting, the surgeon may not have access to such instrumentation. We present a case of an acutely ill, extremely low birthweight infant who incurred foreign body aspiration. Basic tools of expediency and control of the airway remind us once again that technique must precede technology.

Acute Disease↗

PubMed1990

[The analysis of foreign bodies in the anterior chamber in 165 cases].

One hundred and sixty-six eyes of 165 patients with foreign bodies in the anterior chamber who were treated at our center from 1966 to 1988 were retrospectively reviewed. Among them there were 109 eyes with nonmetal foreign bodies, 55 eyes with metal foreign bodies and three eyes with foreign bodies of unknown nature. Most of these foreign bodies were stone or iron. 83.6% of the patients were in the age range from 7 to 40 years, and the left eyes were affected more than the right eyes. Mostly, the foreign bodies were located on the surface of iris (97 cases) and at the anterior chamber angle (40 cases). The rates of blindness were 27.8% and 16.3% before and after operation. The postoperative visual acuity were: 0.05-0.2 in 27 eyes, 0.3-0.9 in 66 eyes, greater than 1.0 in 43 eyes and the rest of the eyes lower than 0.05. The presurgery treatment such as miosis and reduction of intraocular pressure, the selection of operative methods according to the nature, size, location of the foreign bodies and tissue wrapped up were discussed. If combined procedures should be done, it is better to remove the foreign bodies first and then perform the operation for complications.

Adolescent↗

PubMed1990

[The analysis of foreign bodies in the anterior chamber in 165 cases].

Adolescent↗

PubMed1990

Radiological diagnosis of aspirated foreign bodies in children: review of 343 cases.

In our series of 400 Chinese children with foreign body aspiration (FBA), 343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per cent of cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 per cent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.

Adolescent↗

PubMed1984

The use of pigtail catheters for retrieval of foreign bodies from the cardiovascular system.

Snare retrieval of foreign bodies is a common procedure but in certain cases, location of the foreign body requires another system. We present three cases in which only the use of a pigtail catheter gave a good grip for gentle traction and removal or repositioning of the foreign body. A careful review of the world literature up to December 1982 gave rise to two previous similar reports. Both our experience and that found in the literature seem to suggest that in cases where there are no free ends to snare, pigtail catheters may be the first instrument used to start retrieval.

Adult↗

PubMed1975

Foreign bodies in the ear, nose, and throat.

Foreign bodies of the ear should be removed by irrigation, suction, or forceps. General anesthesia may be necessary. Foreign bodies of the nose should be removed with suction or forceps, and sometimes intubation may be necessary. Most foreign bodies in the throat can be removed by use of a mirror and a long hemostat.

Drainage↗

PubMed1993

A new protector device for safe endoscopic removal of sharp gastroesophageal foreign bodies in infants.

The accidental ingestion of sharp foreign bodies into the upper-gastrointestinal tract is not uncommon in children. Endoscopic extraction of these objects poses technical difficulties, and a number of dangerous complications can occur. We present two cases of successful retrieval of large, sharp gastroesophageal foreign bodies in small children using a new, commercially available endoscopic end protector hood that prevents exposure of the esophageal and pharyngeal wall to injuries and laceration by the foreign body. This device is simple to use, versatile, and effective and advances the safe endoscopic removal of a variety of gastroesophageal foreign bodies in pediatric patients.

Child, Preschool↗

PubMedDate not supplied

Diagnosis, management and complications of oesophageal and airway foreign bodies.

A five-year experience at the University of Ilorin Teaching Hospital with 52 patients with oesophageal foreign bodies, six patients with airway foreign bodies and two patients with both oesophageal and airway obstruction from foreign bodies is presented. Our use of jet anaesthetic ventilation for endoscopic removal of airway foreign bodies, clinical features and management problems of foreign body patients are also presented. Oesophageal diameters at six levels including those known conventionally as constrictions and dilatations were measured at autopsy in 40 foetuses and neonates constituting a randomized quarter of a larger series. Oesophageal diameters were found to be wider just below the cricopharyngeus muscle than at the bronchoaortic constriction or midway between this constriction and the cricopharyngeus. The conclusion is drawn that the frequent impaction of foreign bodies at the so-called superior oesophageal constriction has little or no anatomical basis referrable to oesophageal diameters as measured in the cadaver.

Adolescent↗

PubMed2002

Foreign body aspiration.

OBJECTIVE: To analyze the clinical and radiological profile of foreign body aspiration in children reaching a tertiary care center and identify areas of possible interventions for proper management of such cases. SETTING: Tertiary level teaching hospital. SUBJECTS: Case records of patients suspected to have foreign body aspiration over the past four years were analyzed. Clinico-radiological features, types and location of foreign bodies were studied. RESULTS: Of 75 children who underwent rigid bronchoscopy, 70 had tracheo-bronchial foreign bodies. History of choking was elicited in 90 percent cases. In 30 percent cases chest radiographs were non-contributory, while the commonest finding (63 percent) was distal emphysema. Over three-fourth of the cases were below the age of 2 years. Vegetative foreign bodies, mainly peanuts, were commonly present. In many cases, referral was delayed as the diagnosis was missed initially. CONCLUSION: Foreign body aspiration remains a common unintentional childhood injury due to improper exposure of young children to otherwise innocuous looking nuts and other small objects.

Child↗

PubMed2001

[Management of irregular shaped airway foreign body in children].

OBJECTIVE: To explore proper operative methods for removal of irregular shaped foreign bodies in children. METHODS: Forty-eight emergency cases of irregular shaped airway foreign bodies (plastic ball-pen cap, mini-toys, whistle, pin, thumbtack, milk tooth, pen, steel ball, stone of apricot, chicken bone and screw nail) from Jan. 1998 to Nov. 2000 have been reviewed, especially the operative procedure for removing foreign bodies. The youngest patient was 9-month old and eldest 14 year-old. The average age was 8.3 year-old. The male female ratio was 2.4 storz tracheoscope (Made in German) was applied. RESULTS: Forty-six of the 48 foreign bodies were removed through tracheoscope. The foreign bodies slipped off at the level of the glottis in 3 cases, they were then removed from the opposite bronchus (respiratory difficult syndrome developed in these cases); a thumbtack was removed by tracheotomy; one stone of apricot was removed through. CONCLUSIONS: An accurate pre-operative diagnosis is most important in operative management of cases of irregular shaped foreign bodies. General anesthesia, is usually. If the foreign body is too big to pass through the glottis, removing by tracheotomy should be considered.

Adolescent↗

PubMed1996

[Percutaneous extraction of intravascular foreign bodies: a series of 38 cases].

BACKGROUND AND OBJECTIVES: Retained foreign bodies or embolization in cardiac chambers is a relatively common clinical problem. As experience was acquired, it became apparent that failure to remove such fragments could result in morbility or mortality. In the past, surgical removal was the only method available. We present our experience of percutaneous extractions of embolized foreign bodies. The technical aspects are discussed. PATIENTS AND METHODS: Twenty eight cases (age between 1 and 80 years) of cardiac and intravascular foreign bodies seen in two hospitals are reported. Seventeen were plastic catheters or fragments (two were radiotransparent), 5 guide wires in vena cava, right atrial and ventricle, pulmonary artery and abdominal aorta, 4 patients had pacemaker electrodes in the right atrium or ventricle. Stent embolization was observed in two patients. The stents were stripped from the delivery catheter and removed from iliac artery. A pigtail catheter was sometimes used to remove the fragment found in the right ventricle. In 8 cases the capture and extraction was made using a loop snare with a 0.025 inch guide J-wire device folded in half at its midsection and inserted through a long introducer, and in another 20 cases a Dormia basket system was used. In all four patients with pacemaker electrodes, simple counteraction was used with a 10 F left coronary directional atherectomy guide catheter. RESULTS: In two patients removal was impossible--in one the pacemaker electrode was caught but not retrieved because was densely adhered to the endocardium for several years; in another a guide wire was found in a child one year old--. In the other 26 patients, foreign body extraction was performed percutaneously without any complication with a basket or snare; only in one case (a radiotransparent catheter) both systems were used. CONCLUSIONS: Percutaneous removal of centrally embolized foreign bodies, cardiac or vascular, is a safe and successful procedure. The basket system needs to be used more carefully.

Adult↗

PubMed1987

Magnetic resonance imaging and intraocular foreign bodies.

We conducted in vitro and in vivo experiments to study magnetic resonance imaging of intraocular foreign bodies. Diamagnetic and paramagnetic foreign bodies were imaged without artifact and without movement during the imaging process, while ferromagnetic foreign bodies produced large amounts of artifact that prevented meaningful images. All fetromagnetic foreign bodies moved during in vitro imaging. During in vivo imaging, three of four ferromagnetic bodies moved, producing substantial retinal injury. We concluded that magnetic resonance imaging is contraindicated in traumatized eyes with suspected ferromagnetic foreign bodies.

Animals↗