Multiple projectile injuries secondary to motorized lawn edger use

A case of projectile injuries secondary to lawn edger use is presented. A 32-year-old man was seen in the emergency department with the complaint of bilateral shoulder pain and initially without a history of trauma. When small scars were noted at the sites of pain, a history was elicited of possible injury six months previously while using a gasoline-powered lawn edger. Radiographic evaluation revealed bilateral wire missiles embedded in soft tissue. These were later removed uneventfully.     

成人下呼吸道异物20例临床分析

目的总结及分析成人下呼吸道异物的临床特点,评价纤维支气管镜(纤支镜)对下呼吸道异物的诊治价值。方法回顾性分析本院近12年收治的成人下呼吸道异物患者的临床资料。结果其中男16例、女4例;年龄28～73岁;左侧2例,右18例。12例明确下呼吸道异物;8例误诊,误诊率40%。在常规纤支镜检查确定为异物后使用异物钳分别对20例患者下呼吸道的异物进行钳取,均获得成功,治愈率达100%,无1例出现并发症。结论部分患者因病史诉说不清,临床缺乏特异性,易误诊为其它呼吸系统疾病,纤支镜可作为对下呼吸道异物诊断和钳取的重要工具,具有重要价值。     

A subglottic foreign body mimicking croup: A case report

Introduction:Foreign body (FB) aspiration is one of the causes of respiratory distress in infants is an extremely dangerous and potentially life-threatening event. The diagnosis of FB aspiration is difficult because the signs and symptoms vary according to the degree of airway blockage or location of the FB.Patient concerns:An 11-month-old female infant visited a hospital because of a sudden onset cough. She was relatively healthy without fever, rhinorrhea cyanosis, or poor feeding. On physical examination, auscultation revealed inspiratory stridor without wheezing and crackles.Diagnosis:Croup was suspected when considering the history, physical examination, and imaging. However, she did not respond to a 4-day course of treatment for croup. Flexible laryngoscopic examination was performed, and we identified a thin, flat, and sharp FB embedded in the subglottic region.Interventions:Emergency surgery was performed to remove the FB. Short-term intravenous corticosteroids and antibiotics were used to prevent laryngeal swelling and aspiration pneumonia.Outcomes:One week after the procedure, the laryngeal mucosa had completely healed.Conclusion:FB aspiration should be considered in an infant with an impression of croup. In particular, if there is no response to medical or conservative treatment for croup, further evaluation is needed.     

Analyte flux at a biomaterial-tissue interface over time: implications for sensors for type 1 and 2 diabetes mellitus

Objective

The very presence of an implanted sensor (a foreign body) causes changes in the adjacent tissue that may alter the analytes being sensed. The objective of this study was to investigate changes in glucose availability and local tissue metabolism at the sensor–tissue interface in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Method

Microdialysis was used to model implanted sensors. Capillary glucose and subcutaneous (sc) microdialysate analytes were monitored in five T1DM and five T2DM patients. Analytes included glucose, glycolysis metabolites (lactate, pyruvate), a lipolysis metabolite (glycerol), and a protein degradation byproduct (urea). On eight consecutive days, four measurements were taken during a period of steady state blood glucose.

Results

Microdialysate glucose and microdialysate-to-blood-glucose ratio increased over the first several days in all patients. Although glucose recovery eventually stabilized, the lactate levels continued to rise. These trends were explained by local inflammatory and microvascular changes observed in histological analysis of biopsy samples. Urea concentrations mirrored glucose trends. Urea is neither produced nor consumed in sc tissue, and so the initially increasing urea trend is explained by increased local capillary presence during the inflammatory process. Pyruvate in T2DM microdialysate was significantly higher than in T1DM, an observation that is possibly explained by mitochondrial dysfunction in T2DM. Glycerol in T2DM microdialysate (but not in T1DM) was higher than in healthy volunteers, which is likely explained by sc insulin resistance (insulin is a potent antilipolytic hormone). Urea was also higher in microdialysate of patients with diabetes mellitus compared to healthy volunteers. Urea is a byproduct of protein degradation, which is known to be inhibited by insulin. Therefore, insulin deficiency or resistance may explain the higher urea levels. To our knowledge, this is the first histological evaluation of a human tissue biopsy containing an implanted glucose monitoring device.

Conclusions

Monitoring metabolic changes at a material–tissue interface combined with biopsy histology helped to formulate an understanding of physiological changes adjacent to implanted glucose sensors. Microdialysate glucose trends were similar over 1-week in T1DM and T2DM; however, differences in other analytes indicated wound healing and metabolic activities in the two patient groups differ. We propose explanations for the specific observed differences based on differential insulin insufficiency/resistance and mitochondrial dysfunction in T1DM versus T2DM.     

Soft tissue foreign bodies

Foreign bodies embedded in soft tissue can cause toxic and allergic reactions, inflammation, or infection, but the severity of these complications varies widely. Removal can be difficult and time consuming, and the potential damage to tissues caused by the procedure must be weighed against the risk posed by a particular foreign body. Plain and mammographic radiography, xeroradiography, computed tomography, and ultrasonography can be used to detect foreign bodies suspected during clinical evaluation. The exact position of an object buried in soft tissue is difficult to determine using two-dimensional imaging techniques. Surface markers, multiple-projection radiographs, wire grids, fluoroscopy, or stereotaxic devices may help to locate it. Not all foreign bodies are discovered during the initial patient encounter; several signs reveal the presence of a retained foreign body in a wound.     

An improved snare system for the nonsurgical retrieval of intravascular foreign bodies

We have modified a snare technique originally described for transcolonoscopic removal of colonic polyps for the retrieval of intravascular foreign bodies. The key difference from other snare techniques is the employment of a wire snare with a crimp in its midportion that enables the formation of a loop in a plane perpendicular to the axial direction of the guiding catheter. With this technique we have quickly removed a variety of objects from the right heart and pulmonary arteries in four patients.     

Asymptomatic esophageal perforation by a coin in a child

Ingestion of coins by children is a common event that rarely causes serious complications. We present a case of asymptomatic esophageal perforation by a penny in a child who presented with wheezing six months after the ingestion. When esophagography and triple endoscopy failed to show the perforation, thoracotomy resulted in successful removal of the foreign body, which was encased in granulation tissue between the trachea and esophagus. Complications of foreign body ingestion are discussed.     

Coronary embolization of a gauze fragment: a cautionary case report.

A 44-year-old woman underwent fractional flow reserve (FFR) assessment of a stenosis of the left circumflex coronary artery. The FFR was within normal limits, however, shortly after leaving the catheterization laboratory the patient developed refractory angina. Repeat angiography demonstrated a new filling defect in the mid left anterior descending coronary artery. Aspiration thrombectomy was performed, and analysis of the effluent revealed a strand of gauze material with adherent thrombus. The gauze fiber was likely unknowingly injected with flush solution during FFR measurement. This previously unreported but potentially dangerous phenomenon underscores the importance of not using a single receptacle to hold moist gauze and saline flush solution, as is the practice in some catheterization laboratories.     

Foreign body retrieval from the heart by two catheter technique

Foreign bodies that lodge accidentally in the heart or great vessels can be retrieved successfully without thoracotomy. This report describes retrieval of a 15-centimeter-long central venous catheter lodged in the right side of the heart. Two catheters were introduced to effect retrieval, one from the arm and the other from the leg. To our knowledge this approach has not been described previously.     

Acute management of foreign body injuries of the hand

A review of the identification of foreign body hand injuries is presented with criteria for removal of a foreign body in the emergency department. Indications for acute surgical intervention are presented, and expectant management is discussed.     

Spontaneous migration of a catheter embolus from the left inferior to the right inferior pulmonary artery

This is the first reported case of a spontaneous migration of an embolized catheter fragment from the left side of the pulmonary arterial system to the right side. Cathet. Cardiovasc. Diagn. 43:463–465, 1998. © 1998 Wiley-Liss, Inc.