Un cuerpo extraño inusual de cianoacrilato en el oído. Presentación de un caso clínico y revisión de la literatura / An unusual cyanoacrylate foreign body in the ear. Presentation of a clinical case and literature review

El pegamento basado en cianoacrilato posee una gran capacidad de adherencia a los tejidos, representando un problema cuando se encuentra en el oído externo debido a sus características anatómicas particulares. Se presenta un caso clínico de cuerpo extraño de cianoacrilato que ocluye el conducto auditivo externo y el tímpano, alterando la audición. Se describen los hallazgos y los intentos de extracción utilizando las alternativas terapéuticas descritas en la literatura, sin obtener resultados positivos, debiendo recurrir a la extracción quirúrgica. Además, se presentan detalles del procedimiento y los resultados. El paciente recupera la audición y la normalidad anatómica.

Cyanoacrylate-based glue has a great capacity for adhering to tissue, which is a problem when it is placed in the ear canal due to the anatomy of this structure. A clinical case of a cyanoacrylate foreign body occluding the external auditory canal and the tympanic membrane is presented. The therapeutics alternatives described in the literature used in the case failed, so, it was surgically removed by drilling the glue. Details of the procedure and results are presented. The patient recovers the hearing and anatomical normality.

Divertículo de Meckel perforado por un cuerpo extraño / Meckel's Diverticulum Perforated by a Foreign Body

Introducción: El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Por lo general, cursa asintomático, y su diagnóstico es transoperatorio. Cuando presenta síntomas se deben a sus complicaciones, de las cuales la perforación constituye solo el 0,5 por ciento. Objetivo: Describir las características clínico-quirúrgicas de la presentación de un paciente con divertículo de Meckel perforado por cuerpo extraño. Caso clínico: Paciente adulto de 46 años de sexo masculino, piel blanca, que acude con dolor generalizado en el abdomen que se trasladó a Fosa Ilíaca Derecha, con febrícula. Se interviene quirúrgicamente y se halla divertículo de Meckel perforado por cuerpo extraño. Conclusiones: El pronóstico de esta enfermedad depende de la evolución, diagnóstico precoz y tratamiento aplicado en las distintas complicaciones, así como de la decisión de realizar tratamiento quirúrgico en los hallazgos casuales(AU)

Introduction: Meckel's diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It is generally asymptomatic, with an intraoperative diagnosis. When it presents symptoms, they are due to its complications, of which perforation accounts for only 0.5 percent. Objective: To describe the clinical-surgical characteristics of a patient who presented with a Meckel's diverticulum perforated by a foreign body. Clinical case: 46-year-old adult patient of the male sex and white skin, who presents with generalized pain in the abdomen that moved to the right iliac fossa and low-grade fever. The patient underwent surgery and a Meckel's diverticulum was found, perforated by a foreign body. Conclusions: The prognosis of this disease depends on the evolution, early diagnosis and applied treatment according to the different complications, as well as on the decision to perform surgical treatment in accidental findings(AU)

Caracterización epidemiológica del trauma ocular a globo abierto / Epidemiological characterization of open globe ocular trauma

RESUMEN Objetivo: Determinar las características clínico-epidemiológicas del trauma ocular a globo abierto. Métodos: Se realizó un estudio descriptivo, observacional y transversal en pacientes con trauma ocular a globo abierto y afectación del segmento posterior en pacientes hospitalizados en el Servicio de Vítreo-Retina del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre julio del año 2017 y julio de 2018. Resultados: El 68,18 por ciento de los pacientes fue menor de 50 años y el 88,64 por ciento fueron hombres. El trauma más común fue el penetrante (91,11 por ciento); el 68,89 por ciento de las lesiones ocurrió en zona 1, con predominio de las heridas menor o igual a 4 mm (75,56 por ciento). La circunstancia más común del trauma fue la laboral (50 por ciento). El mecanismo de producción predominante fue el martilleo sobre metal (71,11 por ciento); el 65,91 por ciento de los traumas ocurrieron en zona urbana; el 96,46 por ciento no usaba protección; el 57,77 por ciento tenía una agudeza visual inicial de cuenta dedo o mejor, y la presencia de cuerpo extraño intraocular ocupó el 77,78 por ciento. Conclusiones: En el trauma ocular a globo abierto predominan la edad por debajo de 50 años, el sexo masculino y los traumas penetrantes. La mayor parte se presenta de forma unilateral, durante las actividades laborales y sin protección ocular. Más de la mitad de los pacientes presentan agudeza visual inicial de cuenta dedos o mejor. Los signos oculares asociados más frecuentes son el cuerpo extraño intraocular y la catarata traumática(AU)

ABSTRACT Objective: Determine the clinical-epidemiological characteristics of open globe ocular trauma. Methods: A cross-sectional observational descriptive study was conducted of open globe ocular trauma and posterior segment damage in patients admitted to the Vitreous-Retina Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from July 2017 to July 2018. Results: Of the patients studied, 68.18 percent were under 50 years of age and 88.64 percent were men. Penetrating trauma was the most common type (91.11 percent); 68.89 percent of the lesions were found in zone 1, with a predominance of injuries smaller than or equal to 4 mm (75.56 percent). Most traumas occurred while at work (50 percent). The prevailing occupational activity being performed at the moment of the trauma was hammering on metal (71.11 percent); 65.91 percent of the traumas occurred in urban areas; 96.46 percent of the patients were not wearing the required protection equipment; 57.77 percent had an initial visual acuity of count fingers or better; and participation of foreign bodies accounted for 77.78 percent. Conclusions: In open globe ocular trauma a predominance is found of age under 50 years, male sex and penetrating traumas. Most are unilateral and occur while working without the required ocular protection. In more than half of the patients initial visual acuity is finger counting or better. The most common associated ocular signs are intraocular foreign body and traumatic cataract(AU)

Retención de cápsula endoscópica en enfermedad de Crohn ¿cómo manejarla? / Retained capsule endoscopy in Crohn´s disease: how to manage it?

Capsule endoscopy is a technique that allows the study of the small intestine, through a device that is swallowed by the patient, capturing images as it travels through the digestive tract. Capsule retention is the most serious complication. We report the case of a 69 year-old male presenting with iron deficiency anemia, with normal upper endoscopy and colonoscopy; but obscure gastrointestinal bleeding was diagnosed and therefore a study with capsule endoscopy was requested. The patient evolves with retained capsule in the small intestine with ulcerated stenosis as shown by imaging. This finding was confirmed by enteroscopy with biopsy, without being able to extract the capsule. Medical management with corticosteroids was indicated for intestinal obstruction secondary to inflammatory stenosis in the context of Crohn's disease: The capsule was expelled after 21 days of ingestion, with a positive outcome

La cápsula endoscópica es una técnica que permite el estudio del intestino delgado, mediante un dispositivo que es deglutido por el paciente y captura imágenes en su recorrido por el tubo digestivo. La complicación más grave es la retención de la cápsula. Se reporta el caso de un paciente de sexo masculino, de 69 años con anemia ferropénica, con endoscopia alta y colonoscopia normal; planteándose sangrado gastrointestinal de origen oscuro por lo que se solicita estudio con cápsula endoscópica. El paciente evoluciona con retención de la cápsula en intestino delgado, visualizándose en las imágenes la presencia de estenosis ulcerada, hallazgo que se confirma mediante enteroscopia con toma de biopsias, sin lograr extraer la cápsula. Se indica manejo médico con corticoides por obstrucción intestinal secundario a estenosis inflamatoria en contexto de enfermedad de Crohn, expulsando espontáneamente la cápsula al día 21 de su ingestión, sin complicaciones.

Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases / Retenção inadvertida de corpos estranhos após intervenções cirúrgicas. Análise de 4547 casos

Objective: this study aims to explore the experience of Brazilian surgeons on Unintentionally Retained Foreign Bodies (RFB) after surgical procedures. Methods: A questionnaire was sent to surgeons by electronic mail, between March and July 2012. The questions analyzed their experience with foreign bodies (FB), foreign bodies' types, clinical manifestations, diagnoses, risk factors and legal implications. Results: in the 2872 eligible questionnaires, 43% of the surgeons asserted that they had already left FB and 73% had removed FB in one or more occasions, totalizing 4547. Of these foreign bodies, 90% were textiles, 78% were discovered in the first year and 14% remained asymptomatic. Among doctors with less than five years after graduation, 36% had already left a FB. The most frequently surgical procedures mentioned were the elective (57%) and routine (85%) ones. Emergency (26%), lack of counting (25%) and inadequate conditions of work contributed (12.5%) to the occurrence. In 46% of the cases patients were alerted about the FB, and 26% of them sued the doctors or the institution. Conclusions: challenging medical situations, omission of security protocols and inadequate work conditions contributed to RFB. However, RFB occurs mostly in routine procedures such as cesarean or cholecystectomy, and at the beginning of the professional career, highlighting, particularly in poorest countries, the need for primary prevention. Textiles predominated causing clinical repercussions and they were diagnosed in the first postoperative months. Surgeons were sued in 11.3% of the RFB cases.

Objetivo: avaliar a experiência de cirurgiões brasileiros com a retenção inadvertida de corpos estranhos (RICE) após procedimentos cirúrgicos. Métodos : foi enviado por correio eletrônico um questionário para cirurgiões, de março a julho de 2012. As questões avaliavam a sua experiência com RICE, os tipos de corpos estranhos, suas manifestações clínicas, diagnósticos, fatores de risco e implicações jurídicas. Resultados : 2872 questionários foram analisados. Destes, 43% dos cirurgiões já teriam deixado algum corpo estranho (CE) e 73% removido um CE em uma ou mais ocasiões. De um total de 4547 CE, 90% eram têxteis, 78% foram descobertos dentro do primeiro ano, e 14% assintomáticos. No grupo dos médicos graduados há menos de cinco anos, 36% já havia deixado um CE. Os procedimentos operatórios mais relacionados eram eletivos (54%) e rotineiros (85%). Emergência (26%), ausência de contagem (25%) e condições inadequadas de trabalho também contribuíram com a ocorrência (12,5%). Em 46% dos casos os pacientes tomaram ciência da retenção e 26% deles processaram os médicos ou as instituições. Conclusão: s ituações médicas desafiadoras, omissão de protocolos de segurança e condições inadequadas de trabalho contribuíram com a RICE. Entretanto, as RICE ocorreram principalmente em operações de rotina, como cesarianas e colecistectomias, principalmente no início da carreira profissional, ressaltando, principalmente em países mais pobres, a necessidade de prevenção primária. Os têxteis predominaram, acarretando repercussões clínicas e sendo diagnosticados nos primeiros meses de pós-operatório. Os médicos foram processados em 11,3% dos casos de RICE.

When cheating goes wrong: hearing device migrated to the middle ear cavity

A twenty-four-year-old Bahraini male presented to emergency with bloody discharge from the left ear and mild earache. History revealed insertion of a hearing device in the left external canal, which migrated to the middle ear cavity. The device was removed under general anaesthesia; one mm in diameter foreign body was extracted with a surgical hook through the tympanic membrane perforation. The patient did not suffer any major complication

Cuerpo extraño en la vía aérea en pediatría / Foreign-body aspiration in children

It is a frequent pediatric event and a common cause of morbidity and mortality in children, requiring accurate diagnosis and proper treatment. Diagnosis is usually based on clinical manifestations such as cough, dyspnea. stridor, respiratory distress and asymmetric decreased air entry or unilateral wheeze. Choking crisis may be absent or minimized. Chest X-ray may have no abnormalities or show signs such as asymmetrical hyperinflation, massive, fixed or changing atelectasis. Occasionally, hyperinflation or obstructive emphysema with atelectasis can be present in the same hemithorax. Inspiratory and expiratory chest X-rays show ipsilateral mediastinum movements. Most foreign bodies are not visible to chest X-ray exploration. Acute suffocation must be treated with Heimlich procedure. In later stages, diagnosis and treatment require rigid bronchoscopy. Prognosis is fairly positive with an early and complete foreign-body extraction.

La aspiración de un cuerpo extraño (CE) a la vía aérea en pediatría es un accidente frecuente, presenta importante morbimortalidad, por lo que requiere un diagnóstico y tratamiento oportuno. El diagnóstico usualmente se establece mediante hallazgos clínicos, siendo los más frecuentes tos, síndrome de penetración, y con menor frecuencia dificultad respiratoria, estridor, sibilancias unilaterales. La radiografía de tórax puede ser normal o alterada, mostrando hiperinsuflación unilateral, atelectasia u otros signos. La mayoría de los CE son radiotransparentes. Durante la fase aguda debe practicarse la maniobra de Heimlich, en cambio en la fase crónica el diagnóstico y tratamiento definitivo se hace mediante broncoscopía. La prevención es fundamental evitando que niños menores manipulen objetos pequeños, advertir el riesgo de asfixia por aspiración en los envases de alimentos riesgosos y de juguetes de pequeño tamaño. El pronóstico es bueno si la extracción del cuerpo extraño es precoz y completa.

Gossipiboma após operação abdominal é situação clínica desafiadora e sério problema médico legal / Gossypiboma after abdominal surgery is a challenging clinical problem and a serious medicolegal issue

INTRODUÇÃO: O termo gossipiboma refere-se à matriz que contém material têxtil e à reação tecidual formada ao redor deste corpo estranho. As gazes e as compressas cirúrgicas são os materiais mais frequentemente retidos após laparotomias. OBJETIVO: Estudar a incidência e as causas de gossipiboma abdominal, além das medidas preventivas para reduzir a sua frequência e morbimortalidade. MÉTODO: Foi realizada revisão da literatura na língua inglesa no Medline / Pubmed. A pesquisa envolveu os últimos 10 anos, selecionando os seguintes descritores - gossipiboma, textiloma, corpo estranho retido e cirurgia abdominal.Trinta artigos foram considerados para a revisão. RESULTADOS: A incidência é subestimada, principalmente pelas implicações legais decorrentes de tal achado, mas também porque muitos pacientes permanecem assintomáticos. Ocorrem em 1/1000 a 1/1500 operações abdominais. A apresentação clínica é variável e depende da localização do corpo estranho e do tipo de reação inflamatória apresentado pelo hospedeiro. A migração transmural é rara. O tratamento recomendado é a excisão, realizado por via endoscópica, laparoscópica ou por laparotomia, com o objetivo de evitar as complicações que podem atingir alta mortalidade. A abordagem mais importante é a prevenção. As medidas preventivas incluem o uso de material têxtil com marcadores radiopacos, exploração detalhada da cavidade abdominal ao final do procedimento operatório e contagem meticulosa do material cirúrgico. CONCLUSÃO: Gossipiboma é problema médico-legal antigo, cuja incidência aparentemente está aumentando e que precisa ser reabordado para que medidas preventivas efetivas sejam adotadas na sala de operação.

INTRODUCTION: The term "gossypiboma" refers to a textile matrix surrounded by foreign body reaction. Gauze and surgical dressings are the most commonly retained materials after laparotomy. AIM: To evaluate the incidence of abdominal gossypiboma, its causes and the preventive measures to reduce the frequence and morbimortality. METHOD: Was conducted a literature review in Medline/Pubmed in english. The survey was about the last 10 years, selecting the headings: gossypiboma, textiloma, retained foreign body and abdominal surgery. Thirty articles were considered in this review. RESULTS: The incidence of gossypiboma is underreported, mostly due to the legal implications of their detection but also because many patients remain asymptomatic. Occur in 1/1000 to 1/1500 of intra-abdominal operations. Clinical presentation is variable, and depends on the location of the foreign body and on the type of inflammatory reaction presented by the host. The recommended course of treatment is excision, which can be accomplished endoscopically, laparoscopically, or via the open route, and seeks to prevent the complications that lead to a high mortality rate. The most important approach is prevention. Preventive measures required include exploration of the abdominal cavity at the end of the procedure, use of textiles with radiopaque markers and a meticulous account of surgical materials. CONCLUSION: Gossypiboma is a former medical-legal problem, whose incidence is apparently increasing. Therefore needs to be revised to take preventive measures in the operating room.

Successful coronary stent retrieval from the ascending aorta using a gooseneck snare kit

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.

Candida Septic Arthritis with Rice Body Formation: A Case Report and Review of Literature

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

Accidental ingestion of a barbed wire broach and its endoscopic retrieval: Prevention better than cure.

Ingestion of instruments is a potential complication that can occur during dental procedures. We report a case of accidental ingestion of an endodontic barbed wire broach during root canal treatment and its subsequent retrieval by endoscopic methods. Although prevention is the best approach, proper management of such an event is also crucial. The objective of this report is to draw attention to the potentially serious complications that can occur if preventive techniques are not practised, and to discuss the accepted guidelines for management of such an event.

Displacement of endodontic instruments in inferior alveolar canal.

Endodontic instrument breakage is a common occurrence during root canal treatment but the displacement of the separated instrument into the inferior alveolar canal is rare and has never been reported. We hereby present an unusual case of displacement of a separated instrument in the inferior alveolar canal and its retrieval by a simple technique.

Incisor tooth in the nose: Anecdotal sequel to dog bite in a 3-year-old child.

A 3-year-old male child presented to the casualty with history of unprovoked dog bite over the right lateral wall of nose. He was managed conservatively with antirabies prophylaxis and dressings. He presented after 3 months with a healed wound and the right upper central incisor projecting into the nostril. The Orthopantomogram showed a rotated temporary incisor with the roots of the permanent incisor placed normally. The tooth was extracted intranasally. Among the mutilating dog bite injuries referred to a plastic surgeon, this injury though thought provoking was also comical.

Eletrodo de marca-passo mal posicionado no ventrículo esquerdo / Pacemaker electrode misplaced in the left ventricle / Electrodo de marcapasos mal posicionado en el ventrículo izquierdo

Relatamos caso de implantação anômala de eletrodo de marca-passo VVI no ventrículo esquerdo (VE), diagnosticada durante avaliação de rotina, dois anos pós-implante. Trata-se de mulher de 65 anos e soropositiva para doença de Chagas. O eletrocardiograma (ECG) apresentava padrão de bloqueio do ramo direito. A radiografia de tórax em perfil mostrou trajeto com curvatura posterior do eletrodo. No ecocardiograma transtorácico, o diagnóstico final mostrou cateter que penetrava o átrio direito, atravessava o septo interatrial e descia pelo átrio esquerdo e orifício valvar mitral para se implantar na parede lateral do VE. Abordam-se os seguintes aspectos relacionados: possíveis trajetos de implantação, quadro clínico, radiológico, eletrocardiográfico, ecocardiográfico, complicações e opções terapêuticas.

This study reports the case of an anomalous implantation of VVI pacemaker electrode in the left ventricle (LV) diagnosed during routine evaluation, two years after implantation. The patient is a 65-year-old woman with Chagas disease. Electrocardiogram (ECG) revealed a pattern of right branch block. Profile chest X-ray showed electrode with posterior curvature path. In transthoracic echocardiography, the diagnosis revealed that the catheter penetrated the right atrium, crossed the atrial septum, descended through the left atrium and mitral valve orifice and deployed on the LV wall. The following related aspects are addressed: potential deployment routes, clinical, radiological, electrocardiographic and echocardiographic pictures, complications and treatment options.

Relatamos caso de implantación anómala de electrodo de marcapasos VVI en el ventrículo izquierdo (VI), diagnosticada durante evaluación de rutina, dos años post implante. Se trata de mujer de 65 años y seropositiva para enfermedad de Chagas. El electrocardiograma (ECG) presentaba estándar de bloqueo de rama derecha. La radiografía de tórax de perfil mostró trayecto con curvatura posterior del electrodo. En el ecocardiograma transtorácico, el diagnóstico final mostró catéter que penetraba el atrio derecho, atravesaba el septo interatrial y descendía por el atrio izquierdo y orificio valvar mitral para implantarse en la pared lateral del VI. Se abordan los siguientes aspectos relacionados: posibles trayectos de implantación, cuadro clínico, radiológico, electrocardiográfico, ecocardiográfico, complicaciones y opciones terapéuticas.