The use of bone wax

Bone wax is a nonabsorbable product used for providing hemostasis in bleeding bone. It may be used in podiatric surgery in areas of bleeding bone where bone healing and soft tissue attachment are not desired. As in any material implanted within body tissues, bone wax has possible side-effects. These may include foreign body reaction or increased susceptibility to infection.     

Spontaneous migration of a bullet in the central nervous system

An example of spontaneous migration of a metallic foreign body within the subarachnoid space is illustrated. An intracranial bullet is shown to move within the cisterns of the posterior fossa and then down the subarachnoid space of the spinal canal. The patient's symptoms correlate well with the movement of the foreign body.     

The missed thorn.

Following surgical exploration, a swelling on the back of a boy's hand was thought to be a tuberculous granuloma and was treated as such. Eleven months later, when the lump was re-explored, a plant thorn was retrieved from the middle of a foreign body granuloma. Even though a definite history of trauma is not given, an organic foreign body lesion should be considered in the differential diagnosis of a lytic lesion of bone.     

A retroperitoneal tumor as a late complication of the use of bone wax

Ordinary bone wax was used to stop bleeding from the iliac crest after procurement of autogenous bone graft harvesting. This gave rise to a large, symptomatic retroperitoneal tumor, which had to be removed operatively 19 years later. Microscopically, a bone wax granuloma was diagnosed. As far as the authors know this is the first case reported with such late and severe clinical complications after the use of bone wax.     

Reaction of the bone- and soft tissues to implanted bone wax in the sheep]

2,5 gr. of bone wax (Knochenwachs) were implanted in the iliac crest of 10 sheep. The induction of a foreign body reaction and chronic inflammation was proven demonstrable until the 12th week after implantation of the bone wax. In this period only partial resorption of the wax occurred simultaneously with significantly retarded osseous regeneration. From a clinical point of view it therefore seems necessary when using bone wax to pay particular attention to inflammatory reactions, reduced new bone formation and eventual occurrence of pseudo-arthrosis.     

Reaction of the human tibia to bone wax

In 12 patients treated by elevation of the tibial tubercle, bone wax was used to prevent bleeding from the cut surface. Biopsy specimens of the tissues obtained at the time of removal of the screws, five to 13 months after the operation, showed a definite foreign body giant cell reaction. Giant cells endocytosed bone wax from the site. The giant cell response culminated in a marked fibrous reaction.     

Infected granuloma and inclusion cyst secondary to a retained foreign body

Foreign body granuloma formation and epidermal inclusion cyst formation are a common result of retained foreign bodies. The subsequent rupture of an inclusion cyst will result in abscess formation along with ulceration. The following is a review of pathology involved in granuloma formation, as well as a presentation of an interesting case involving granuloma formation secondary to a retained foreign body.     

Sponge Rubber Revealed Two Years After Penetrating Injury: A Case Report

The present report illustrates a very rare case report of a foreign body granuloma of the foot associated with a 2-year period of a retained spongeous rubber foreign body after a penetrating injury. Because it appeared almost 2 years after the injury, the history of trauma was minimized, the foreign body had migrated from the plantar to the dorsal side of the foot, and the radiographic appearance resembled a malignant process, it was difficult to rule out the possibility of a malignant tumor. This case shows the weakness of magnetic resonance imaging in detecting spongeous rubber in the body. Also, a bone osteoblastic reaction to the foreign body has very rarely been noted. To the best of our knowledge, just 5 cases have been previously reported. Provided suspicion exists of previous trauma with an embedded foreign body, the differential diagnosis of a bone neoplasm should consider the possibility of a foreign body reaction. Biopsy proved to be the best diagnostic tool.     

Foreign body granuloma mimicking a benign intraspinal tumour

We describe the case of an intraspinal foreign body granuloma that became symptomatic 23 years after a lumbar discectomy. Preoperatively, the foreign body granuloma was misdiagnosed as spinal neurinoma.     

Eosinophilic granuloma of the spine

The contribution to the clinical picture of eosinophilic granuloma of the spine. This tumor-like, osteolytic bone lesion presents both diagnostic and therapeutic problems. Solitary eosinophilic granuloma of the spine is not common. Compared to the multiple manifestation of eosinophilic granuloma, which seldom spares the spine, vertebral involvement is rare in cases of solitary eosinophilic granuloma (about 10 p.c.). Spinal involvement of this disease is mainly characterized by an undramatic, uneventful clinical course, even in cases of extensive osteolytic bone defects, varying laboratory findings as well as partial or complete collapse of a vertebra, mostly in form of a true vertebrae plana. Open biopsy is recommended instead of needle aspiration biopsy in solitary eosinophilic granuloma of the spine in order to exclude Ewing's sarcoma, neuroblastoma, or bony manifestations of leukemia. In cases of solitary eosinophilic granuloma various therapeutic methods have been tried. Some authors have registered good results by means of prolonged immobilization, similar to fracture treatment. Others have used radiation therapy in moderate doses. We suggest operative treatment of solitary eosinophilic granuloma. Our procedure comprises open biopsy, frozen section examination, and curettage of the affected vertebral body, taking care not to destroy the epiphyseal plate or the intervertebral disc. Vertebral body replacement is achieved by means of a bone graft, taken from the iliac crest. The original height of the vertebra is thus restored and immediate stability of the involved area guaranteed. Undisturbed bone growth of the end plated of the vertebral body can be observed. This technique is to prevent disturbances of spinal growth and permanent deformities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Injuries from palm tree thorn simulating tumoral or pseudotumoral bone lesions

Three cases of bone changes caused by foreign bodies that appeared to be tumoral lesions or pseudotumors, were observed in young male patients who presented with pain, localized inflammation, and radiographic and bone scan findings suggestive of tumoral or pseudotumoral lesions. Accurate diagnosis was made at surgery when the foreign body was retrieved. Following removal of the foreign body, postoperative recovery was satisfactory. The common causative agent in all these cases was a palm tree thorn.     

Barium granuloma involving urinary bladder

The first case of barium granuloma involving urinary bladder is reported. Surgical removal was the treatment of choice. Histological diagnosis was foreign body granuloma with xanthomatous inflammation. The foreign body was identified as barium by analytical electron microscopy.     

Delayed Onset of Infectious Foreign Body Granuloma for Nonabsorbable Sutures After Open Achilles Tendon Repair: A Case Report

Foreign body granulomas from sutures are more common among non-absorbable sutures compared to absorbable sutures and have been reported as a postoperative complication in a variety of medical fields. However, only a few cases of delayed foreign body reaction have been reported and addressed with orthopedics. We present a patient with systemic lupus erythematosus who developed an infectious suture granuloma that extended to the entire Achilles tendon and was induced by nonabsorbable sutures that were used for open Achilles tendon repair 20 years before. This granuloma was resistant to antibiotic treatment and drainage and required surgical intervention. The tumor was marginally resected, and the continuity of the Achilles tendon was preserved. Histopathological examination detected many suture materials surrounded by xanthochromic necrotic lesions and the lesion was diagnosed as a foreign body granuloma. At 1 year after the operation, the patient did not exhibit exacerbation of infection or recurrence of the tumor, and she became able to walk by herself. To the best of our knowledge, this represents the first report of an infectious delayed foreign body granuloma in autoimmune disorder patient after open Achilles tendon repair. Surgical intervention should be considered, as treatment with conservative therapy such as antibiotics may be difficult.     

Delayed myelopathy after a stab wound with a retained intraspinal foreign body: case report.

A case of delayed myelopathy appearing 15 years after a stab wound to the thoracic spine with a retained foreign body in the spinal canal is reported. Severe inflammatory reaction to iron corrosion was found, with granuloma and sterile pus formation. Removal of the foreign body and partial excision of the granuloma resulted in clinical improvement. Reaction to foreign body corrosion is believed to be the major cause of delayed neurologic deficit and is an important guideline for removal of asymptomatic intraspinal foreign bodies.     

Glass foreign body granuloma of the nose

Almost any material may produce a foreign body granuloma. An unusual case is presented in which a foreign body granuloma of the nose was proved to be due to glass particles following an old injury. The clinical aspects of the case are discussed.     

Relief of intractable perineal pain by coccygeal nerve block in anterior sacrococcygeal ligament after surgery for rectal cancer

Intractable perineal pain often appears in the anal region following abdominoperineal resection for the treatment of rectal cancer. In such cases, a subarachnoid block or transsacral block is generally used to control pain. However, these procedures sometimes cause complications such as dysuria or sensory paralysis of the pudendum. A new method of pain control is presented herein using absolute alcohol as a neurolytic agent to relieve localized perineal pain through a coccygeal nerve block in the anterior sacrococcygeal ligament. Five cadavers were necropsied to localize the coccygeal nerve. A loop consisting of S4, S5, and Co was found to exist in the space surrounded by the anterior surface of the coccygeal bone and the anterior sacrococcygeal ligament. Absolute alcohol was injected into this space. It is essential that the neurolytic agent remain localized in this space to avoid complications and to successfully block perineal pain. In all patients, we found that this method was extremely effective in blocking localized perineal pain without any complications.     

Aseptic loosening of total hip replacement presenting as an anterior thigh mass

Aseptic loosening is one of the commonest complications of total hip replacement that can cause pain and instability. The chronic inflammatory response to the wear debris from the polyethylene or metal can cause osteolysis and implant failure. We report a case of aseptic loosening of the hip, presented with a swelling over the anterior thigh without any pain or instability in the joint. This mass was a foreign body granuloma formed secondary to the polyethylene wear debris due to the instability of the polyethylene in the metal shell. The patient underwent successful revision hip arthroplasty after the removal of the foreign body granuloma.     

Thorn-induced granuloma of the medial cuneiform.

A lytic lesion of the medial cuneiform of a 10-year-old boy was explored surgically, and a date palm thorn was identified. Histology revealed an aseptic granuloma. Even in the absence of a definite history of trauma, an organic foreign body lesion should be considered in the differential diagnosis of a lytic lesion of bone.     

The foreign body granuloma after pyeloplasty: report of a case

We report a rare case of foreign body granuloma on plain catgut which developed after Anderson-Hynes pyeloplasty for obstruction of the ureteropelvic junction in a 3-year-old boy. We use plain catgut as the suture material on pyeloplasty and seldom experience such a complication. Regarding suture material on pyeloplasty, excessive sutures intended to make anastomosis water-tight to prevent urinary leakage should be avoided in children because they are apt to form foreign body granuloma.     

Suture Foreign Body Granuloma Masquerading as Renal Neoplasm

Foreign body granulomas and pseudotumors due to retained surgical linen are well known in surgical practice. These lesions usually correspond to the actual size of residual foreign body and have characteristic presentation according to the anatomy involved. Renal suture granuloma is a rare postoperative complication of renal surgery due to persistence of sutures used to close the pelvicalyceal system/nephrotomy incisions and usually present as incidentally detected small mass lesions. This case of a suture foreign body granuloma presenting with hematuria, large peripheral mass lesion and characteristic computed tomography picture of renal cell carcinoma confounded the diagnosis and underwent laparoscopic radical nephrectomy. In retrospect, such lesions warrant the use of selective needle biopsy and intraoperative frozen section confirmation to clinch diagnosis. Mass lesions occurring in a previously operated kidney should have granuloma as a differential diagnosis.