A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years: A case report

Rationale:Intraocular foreign bodies (IOFBs) are common in ocular injuries, but asymptomatic metallic IOFBs retained in the anterior chamber for years are rare.Patient concerns:A 31-year-old female presented with blurred vision in her right eye after lumbar magnetic resonance imaging. Her best-corrected vision acuity was 0.6 in the right eye and 1.0 in the left eye. Slit-lamp examination revealed a brown granular foreign body in the anterior chamber and pigmentation of the limbus. Lens and retina examination indicated ocular siderosis. Corneal endothelioscopy revealed decreased endothelial cell density. A detailed history showed ocular globe injury 15 years earlier.Diagnoses:Anterior chamber IOFB with ocular siderosis.Interventions:Anterior chamber foreign body removal was performed with appropriate incision and forceps.Outcomes:The anterior chamber IOFB was successfully removed and examined as a magnetic metal foreign body. The best-corrected vision acuity was 1.0 at 1 day postoperatively. An abnormal electroretinogram with a 12% decrease in the “b” wave and a 91% decrease in the “a” wave was observed 3 months postoperatively. There were no intraoperative or postoperative complications during a 3-month follow-up.Lessons:Eye trauma should be examined carefully to exclude IOFBs. Asymptomatic anterior chamber foreign bodies can also cause corneal endothelial injury and ocular siderosis. Careful examination and timely management are needed in such cases.     

An interesting cause of recurrent haemoptysis: haemoptysis 7 years after a foreign body penetrated the lung parenchyma and aorta

A 43-year-old man presented with a 12-month history of recurrent haemoptysis. Postero-anterior chest X-ray of a patient with a history of a penetrating thoracic trauma 8 years previously showed a long wedge-shaped opacity just above the left hemidiaphragm, representing the 'tip of the knife' appearance, and penetrating from the lateral chest wall deep to the thoracic aorta. After consultation with the cardiovascular surgeons, it was decided that the patient should have an operation to remove the foreign body penetrating the aorta. During the operation, a piece of glass was located in the posterior segment of the left lower lobe, and it had also penetrated the aorta through to the posterior wall. The glass had a pointed end, was wedge-shaped and measured 8 cm x 3 cm x 0.5 cm. It was removed, and a 5-cm segment of aorta was replaced with dacron graft. Patients with penetrating chest trauma require routine chest X-rays as many will have a haemothorax, pneumothorax or a penetrating foreign body in the chest in the absence of clinical findings. Postero-anterior chest X-rays as well as lateral X-rays must be carefully and systematically examined for foreign bodies.     

An unusual iatrogenic foreign body (surgical gauze) in the trachea

We report the case of a 60-year-old male with history of surgery for tracheal stenosis 21 years prior to the onset of difficult asthma-like symptoms. Upon exploring the tracheobronchial tree using the fiberoptic bronchoscope, a surgical gauze was found. The foreign body migrated transluminally from the mediastinum into the trachea and its removal was possible with rigid bronchoscopy leading to a rapid recovery of his symptoms.     

Removal of a foreign body (artificial tooth) from the bronchial tree: a new method

A 70-year-old man who had aspirated an artificial tooth during treatment at a dental clinic visited our hospital. His symptoms and physical condition were not remarkable. CT of chest revealed a foreign body in the right middle bronchus; bronchoscopy revealed it was wedged there. First, the authors tried to remove it using a suction device attached to a bronchoscope, as well as by using a forcep; however, the attempt failed. Therefore, a second effort was made using a cap constructed of a nasogastric tube, based on the concept of attaching an endoscopic cap to a bronchoscope. The latter was successful.     

The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer

Background

Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and hysterectomy. The aim of the present study was to determine whether negative pressure therapy applied to closed perineal wounds after ELAPE improved wound healing and compare outcomes to the published literature and outcomes from a historical cohort of patients who had undergone ‘standard’ abdominoperineal resection (APR) and primary closure of the perineal wounds.

Methods

Prospective data on consecutive patients having ELAPE in the period from November 2012 to April 2015 were collected. The pelvic floor defect was reconstructed with biologic mesh. The adipose tissue layer was closed with vicryl sutures, a suction drain was left in the deep layer, the subcuticular layer and skin were closed, and the negative pressure system was applied. Any wound breakdown within the first 30 days postoperatively was recorded.

Results

Of the 32 consecutive ELAPE patients whose perineal wounds were closed within 30 days with the use of the negative pressure system, there was 1 patient with major perineal wound breakdown and 2 patients with a 1 cm superficial wound defect, which needed no further treatment. In the remaining 29 (90 %) patients, the perineal wounds healed fully without complications. Twenty-five patients underwent standard APR in 2010–2011 with primary closure of their perineal wounds. Ten out of 25(40 %) of patients who had undergone standard APR and primary closure of perineal wounds had major wound complications (p = 0.01).

Conclusions

Our results suggest that after ELAPE the application of a negative pressure system to the perineal wound closed with biologic mesh may reduce perineal wound complications and may reduce the need for major perineal reconstruction.

     

Cholesterol crystal embolization (CCE) after cardiac catheterization: a case report and a review of 36 cases in the Japanese literature

Cholesterol crystal embolization (CCE) is a complication of atherosclerosis. A 67-year-old Japanese man underwent coronary artery bypass grafting. After the surgery, he underwent coronary angiography via the right femoral artery. Twelve days later, he suddenly developed acalculous cholecystitis and was treated with antibiotics. Gradual deterioration in renal function, purplish discoloration of the distal portion of his toes, and eosinophilia were noted. We performed a skin biopsy and made a diagnosis of CCE. Cilostazol and intravenous heparin improved the symptoms and decreased the creatinine level. We retrospectively studied the clinical features of 36 cases registered with a diagnosis of CCE in the Japanese literature.     

Diphtheria antitoxin levels in Japanese adults (10-20 years after the last vaccination)

The serum diphtheria antitoxin levels in Japanese adults were investigated and the persistence of diphtheria toxoid effect was evaluated. The subjects consisted of 56 volunteers (20-31 years of age) who had received regular inoculations of diphtheria and pertussis vaccine (I and II or III phases). They had been immunized according to the Vaccination Law (old version) revised in 1958. The length of time after the last inoculation of diphtheria toxoid was speculated to range from 10 to 20 years. Serum diphtheria antitoxin was determined by passive hemagglutination method. Antitoxin level was 0.025 HAU/ml in 1 subject (1.8%), 0.05 in 2 (3.6%), 0.1 in 2 (3.6%), 0.2 in 8 (14.3%), 0.4 in 7 (12.5%), 0.8 in 12 (21.4%), 1.6 in 7 (12.5%) and more than 1.6 in 17 (30.4%). Results indicated that 55 of 56 (98.2%) possessed a higher level than the prophylaxis standard (0.05 HAU/ml). Since the current Vaccination Law prescribes a lower amount and fewer inoculations than the old law, the number of adults possessing prophylactic antitoxin level may decrease in the future. Further investigation of antitoxin level in adults needs to be continued.