Small bowel dose in subserosal tandem insertion during cervical cancer brachytherapy

Cervical cancer patients may sometimes experience subserosal tandem insertions during brachytherapy, which can lead to increased but unnoticed irradiations to the small bowel (SB). In this study, we aimed to quantify and further predict individual SB dose increase and to increase focus on the SB in subserosal tandem insertions. Images and dosimetry data of cervical cancer brachytherapy with subserosal insertion (SI) were reviewed. The percentage increases in the SB dose compared with intracavitary insertion (II) at 8 points of D(x)cc with 10 cc intervals were assessed. SI was classified into anterior and posterior SI according to the insertion site. The differences in minimum distance from the tandem tip to the SB on the axial view between these 2 insertions were tested using the Mann-Whitney test. The distance and D(x)cc were involved in the individual dose increase model by linear regression as prediction factors. A total of 27 insertions were evaluated, including 8 insertions with SI and 19 insertions with II. The median percentage increases in the normalized SB dose for all SI showed a logarithmic trend with a 55.4% increase at the hotspot. In contrast to posterior SI, anterior SI demonstrated a more significantly logarithmic trend, which featured highly increased doses at the hotspot (79.1% for the absolute SB dose and 137.8% for the normalized SB dose). The prediction models can predict the percentage dose increases in SI: Increased D(x)cc [%] = 31.370 – 7.865 $\ln$(distance) – 3.949 $\ln$(x) (absolute SB dose), and Increased D(x)cc [%] = 55.618 – 18.591 $\ln$(distance) – 7.232 $\ln$(x) (normalized SB dose). We developed prediction models for individual SB dose increase in SI in our study. SB hotspots in anterior SI require greater attention during cervical cancer brachytherapy. The models are new ones and are given for the first time.     

Textile foreign bodies left in the abdomen

The authors relate eleven cases of forgotten foreign bodies (5 swabs and 6 laparotomy pads) in the abdomen after laparotomies for biliary and digestive (5 cases), gynaecologic (3 cases), or abdominal-wall (3 cases) diseases. Ten patients recovered after surgical extraction of foreign bodies (morbidity: 2 cases) and one patient died before reoperation. This study emphasizes the severity of this complication which can and should be prevented.     

Thoracic foreign bodies in adults.

AIM: The aim of this pictorial essay is to illustrate a range of imaging manifestations of thoracic foreign bodies. METHODS AND RESULTS: The essay includes documented intrathoracic foreign bodies introduced by inhalation, aspiration, penetrating trauma or ingestion. Imaging modalities include chest radiography and computed tomography (CT). CONCLUSIONS: The majority of foreign bodies are seen on the plain chest radiograph. CT is helpful in demonstrating the presence of radiolucent foreign bodies and determining the exact location of the foreign bodies within the airways or lung parenchyma.     

Chest radiograph of foreign bodies in the tracheobronchial tree

Chest radiographs in 14 children with foreign bodies in the tracheobronchial trees were evaluated retrospectively. The most common causative materials were nuts, and both main bronchi were most commonly involved. The initial chest radiographs that were used for analysis were obtained one hour to 50 days after aspiration or onset of symptoms. Of the nine cases in which chest radiographs were taken within 7 hours after aspiration, six showed hyperlucency with (three cases) or without overinflation (three cases) in the affected lungs, and the other three showed normal chest radiographs. Two patients had indeterminate diagnoses on chest radiographs at inspiration: one patient underwent chest radiographs at expiration and the other underwent fluoroscopy. Air-trapping was demonstrated in both patients. Of another five cases in which chest radiographs were taken 18 hours after aspiration of a foreign body, three cases showed atelectasis or consolidation and the other two showed hyperlucent lung. From these observations, hyperlucent lung indicates an early stage of the disorder while atelectasis or consolidation indicates a fairly advanced stage. In patients with clinically suspected foreign bodies, we advocate that additional examinations be performed to establish a final diagnosis, even when chest radiographs are normal or indeterminate.     

Stereotactic removal of foreign bodies in the maxillofacial area

A technique is described for making it possible to localize any deep-seated radiopaque foreign body in the soft tissues and skeleton of the maxillofacial area. Using a stereotactic guide system, any point in the facial skeleton can be reached exactly, with precalculated precision, from any point outside the face. Thus, a foreign body can be exposed and subsequently removed by a surgical approach that gives minimal discomfort and carries low risk. The target probe serves the surgeon as a guide bar whilst the tissue is dissected. A precondition of successful stereotactic operations in the head and neck area is close cooperation between neurosurgeons and maxillofacial surgeons.     

X-ray findings in deliberately incorporated foreign bodies

Observations of 181 foreign body introductions in 99 patients are reported. It is possible to differentiate between an oral, transanal, transcutaneous, transurethral, transvenous, transaural way and exceptional cases. Orally introduced foreign bodies up to a length of 12-15 cm usually pass spontaneously: longer foreign bodies must be removed endoscopically or surgically. A special problem is connected with foreign bodies which are swallowed together in a parallel position and form a cross in the stomach. Intravenously introduced foreign bodies like metallic mercury and copper wire were well tolerated by the patients. - Individual observations concern a patient who swallowed a screw driver (about 10 cm in length) and water intoxication in 3 patients (one of whom died) who drank 9-17 liters during 1-2 hours.     

Sonographic detection of foreign bodies of the extremities

A prospective study to assess the accuracy of ultrasound in the detection and localization of foreign bodies of the extremities was undertaken. Forty-five patients with clinical suspicion of foreign bodies were included in the study. Among 20 patients with radio-opaque foreign bodies, ultrasonic detection of foreign bodies was achieved in 19 patients. In 25 patients, with no radiographic evidence of foreign body, ultrasonic detection of foreign bodies was made in seven patients and among these foreign bodies were confirmed and removed at surgery in five patients. Accurate pre-operative ultrasonic localization of foreign bodies was carried out in three patients.     

Aorto-oesophageal fistula and intestinal infarction secondary to volvulus following ingestion of foreign bodies in a schizophrenic patient

We present a case of death caused by voluntary ingestion of non-organic foreign bodies observed at the Institute of Legal Medicine of the University of Trieste. The victim was a young schizophrenic patient whose death, at first giving rise to suspicions of murder by another psychiatric patient, was found to be caused by an uncommon chronic permanence of foreign bodies at different locations of the digestive tract which suddenly evolved into a series of simultaneous lethal complications as yet never described. The case also raised the issue of possible responsibilities of the subject's healthcare providers.     

Problematic diagnosis of bronchial foreign bodies in children

Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. Fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies.