Migração para veia hepática de cateter totalmente implantável para quimioterapia em paciente com carcinoma de mama: relato de caso / Hepatic vein migration of a totally implantable venous access port-a-cath for chemotherapy in a breast carcinoma patient: case report

Resumo O cateter totalmente implantável (CTI) é utilizado na administração da quimioterapia. Em menos de 1% dos casos de complicação, pode ocorrer migração do CTI para quimioterapia para a circulação sistêmica. O objetivo deste estudo foi descrever um caso de migração do CTI para a veia hepática. Uma paciente do sexo feminino, de 44 anos de idade, teve diagnóstico de câncer de mama com indicação de quimioterapia neoadjuvante. Realizou-se a implantação de cateter port-a-cath. Durante o procedimento de punção do cateter, houve retorno normal de sangue, e foi realizada infusão de soro fisiológico. Em seguida, houve um aumento de volume no local do port e não retorno de sangue à aspiração. A radiografia de tórax mostrou embolização do cateter em topografia hepática. Retirou-se o cateter pela técnica do laço (sem complicações), e a paciente recebeu alta no dia seguinte. Possíveis alterações no funcionamento do CTI devem chamar atenção da equipe responsável.

Abstract A totally implantable venous access port (TIVAP) is used for chemotherapy administration. Venous port migration to the systemic circulation occurs in less than 1% of complications. The aim of this study is to describe a case of TIVAP migration to the hepatic vein. A 44-year-old female patient with breast cancer was prescribed neoadjuvant chemotherapy. A port-a-cath was surgically implanted for chemotherapy. During the port puncture procedure, blood returned normally when aspirated. When the port was first accessed and flushed with saline solution, swelling was observed at the port site and blood could no longer be aspirated. A chest radiography showed catheter embolization in the region of the hepatic vein. The catheter was retrieved using a snare technique (without complications) and the patient was discharged the next day. The care team should be alert to possible TIIVAP malfunction.

Espina de pescado alojada en la glándula tiroides / Fishbone lodged in the thyroid gland

Los cuerpos extraños alojados en la vía aéreodigestiva superior son un motivo de consulta frecuente para el otorrinolaringólogo. Uno de los más frecuentes son las espinas de pescado. En raras ocasiones, éstas migran hacia tejidos adyacentes y generan complicaciones importantes. Presentamos el caso de una paciente que tras la ingesta de pescado manifiesta sensación de cuerpo extraño faríngeo, odinofagia y dolor látero cervical derecho. Dada la ausencia de hallazgos a la exploración física y laringoscópica se realiza una tomografia computarizada cervical, visualizando un cuerpo extraño alojado en la glándula tiroidea. Se interviene mediante cervicotomía media, realizando la extracción de la espina sin complicaciones. El diagnóstico precoz y manejo adecuado es determinante para prevenir complicaciones en estos casos.

Foreign bodies in the aerodigestive tract are commonly confronted in otolaryngology practice. The most frequent are the fish bones. In rare cases they can move and cause numerous complications. We report the case of a patient that manifest the sensation of pharyngeal foreign body, after fish ingestion. She also referred odynophagia and right cervical pain. Physical and laryngoscopic examination were normal. A cervical CT was performed, where a foreign body lodged in the thyroid gland was visualized, median cervicotomy was done and the foreign body was extracted. Early diagnosis and adequate management are crucial to prevent complications in these cases.

Embolization by Bullet Dislodged from the Heart

Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.

Stent-graft relining in a patient with acute aortic aneurysm and a completely migrated endograft

Abstract Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was treated by placing a second modular endograft within and above the migrated stentgraft. The patient returned 36 months later, with features of an acute myocardial infarction, severe bilateral lower limb ischemia, and renal failure. He was too ill for intervention and demised within 48 hours.

Duodenal gossypiboma: a case report and literature review / Gossypiboma duodenal: reporte de un caso y revisión de la literatura

Gossypiboma is a retained surgical cotton matrix material in the body after a surgical procedure. Cases are rarely reported due to medico-legal concerns. Although infrequent, it causes serious morbidity and even mortality if left undiagnosed. We present the case of a trans-mural migration of gossypiboma and a review of the literature. Gossypiboma’s trans-duodenal migration is a rare complication of retained gauzes. Cases reported in the literature were easy to diagnose based on clinical grounds and endoscopic studies.

La palabra gossypiboma define una gasa o matriz de algodón retenida en el organismo después de un procedimiento quirúrgico. Se reportan con poca frecuencia debido a las implicaciones médico-legales. A pesar de ser poco frecuentes, pueden ser causa de morbilidad si no se diagnostican. En el presente trabajo se reporta un caso de un gossypiboma con migración transduodenal. La migración transduodenal de un gossypiboma es una complicación rara que suele diagnosticarse sin dificultad con base a la clínica y a la endoscopía.

Dispositivo intrauterino parcialmente migrado e incrustado en serosa de rectosigmoides tras 8 años de inserción / Partially migrated intrauterine device embedded in the rectosigmoid serosa after 8 years of insertion

Se presenta el caso clínico de un dispositivo intrauterino parcialmente migrado a cavidad pélvica e incrustado en serosa de rectosigmoides luego de 8 años de su inserción. El diagnóstico se realizó mediante ecografía transvaginal y retiro del dispositivo por laparoscopia. Se realizó rafia de serosa rectal y de útero. La paciente tuvo un postoperatorio sin complicaciones.

It is shown the clinical case of an intrauterine device partially migrated to the pelvic cavity and embedded in the serous rectosigmoid eight years after insertion. The diagnosis was made by transvaginal ultrasound and laparoscopy removal of the device by laparoscopy. Suture of rectum serous and uterus were performed. The patient had an uneventful postoperative course.

Migration of Long Standing Fish Bone to Subcutaneous Tissues of the Neck: An Unusual Presentation.

Fish bone is one of the most common foreign bodies encountered in the upper aerodigestive tract region. Owing to its trivial size, smooth surface, and sharp ends, it has a great propensity to migrate in the neck and adjoining structures. Long standing migrated foreign bodies can cause devastating complications like neck abscess and injuries to the major blood vessels. Herein, we report a rare case of long-standing fish bone, which migrated to the subcutaneous tissues of the neck. The foreign body bypassed all the vital structures and was observed as a projection in the skin of the patient’s neck. A careful history and a detailed clinico-radiographic investigation helped to locate the bone and aided in its successful removal.

Dispositivo intrauterino migrado a la cavidad abdominal con embarazo intrauterino no evolutivo: reporte de caso / Intrauterine device migrated to the abdominal cavity with non-progressive intrauterine pregnancy: case report

La migración de un dispositivo intrauterino a la cavidad abdominal es una complicación poco frecuente de este eficaz método contraceptivo, sin embargo debe sospecharse ante la imposibilidad de visualizar los hilos del dispositivo vía vaginal y la ausencia intrauterina del mismo por ecografía. Si bien la migración abdominal puede ser asintomática, algunos casos pueden producir clínica de severidad variable incluyendo dolor abdominal y complicaciones derivadas de la formación de adherencias o la perforación de vísceras pélvicas y abdominales. Su detección intraabdominal debe sospecharse en primer lugar por ecografía y confirmarse mediante radiología simple de abdomen. Una vez localizado el dispositivo migrado, se recomienda su extracción inmediata, incluso en casos asintomáticos, con el fin de evitar las complicaciones derivadas de su desplazamiento. La laparoscopia será de primera elección en estos casos para la extracción. Presentamos un caso de migración intraabdominal de dispositivo intrauterino concurrente a un embarazo intrauterino no evolutivo.

Migration of an intrauterine device to the abdominal cavity is a rare complication of this effective contraceptive method, however, it must be suspected upon the inability to visualize the wires vaginally and the absence of intrauterine device by ultrasound. While its abdominal migration can be asymptomatic, some cases may produce variable clinical severity including abdominal pain and complications resulting from the formation of adhesions or perforation of pelvic and abdominal viscera. Its intraabdominal detection should be suspected first by ultrasound and confirmed by plain abdominal X-ray. Once the migrated device is located, immediate removal is recommended, even in asymptomatic cases, in order to avoid complications arising from its displacement. Laparoscopy will be the first choice in these cases for extraction. We report a case of intraabdominal migration of intrauterine device concurrent with a non-evolutive intrauterine pregnancy.

Metallic Foreign Body in Heart Mimicking Moderator Band

A foreign body in heart is rare, but it is more frequently encountered than the past as iatrogenic causes are increasing. Clinicians should be aware that foreign body could be mistaken for normal structure of heart. In order for accurate diagnosis, multi-imaging modalities should be used for information of exact location, mobility and hemodynamic effects. A decision to intervene should be made based on potential harms harbored by foreign bodies. Endovascular retrieval should be considered as an option. However, when fatal complications occur or when foreign bodies are embedded deeply, a surgical removal should be attempted.

Metallic Foreign Body in Heart Mimicking Moderator Band

A foreign body in heart is rare, but it is more frequently encountered than the past as iatrogenic causes are increasing. Clinicians should be aware that foreign body could be mistaken for normal structure of heart. In order for accurate diagnosis, multi-imaging modalities should be used for information of exact location, mobility and hemodynamic effects. A decision to intervene should be made based on potential harms harbored by foreign bodies. Endovascular retrieval should be considered as an option. However, when fatal complications occur or when foreign bodies are embedded deeply, a surgical removal should be attempted.

Intraoperative localization and monitoring of migrating foreign body using transesophageal echocardiography.

Radiological imaging is often used for the preoperative localization of foreign body following blast injury, but their utility in case of migration during intra‑operative period is limited. Transesophageal echocardiography (TEE) has been used for intra‑operative localization and removal of intra‑cardiac foreign body; however, reports for localization of extracardiac migrating foreign body are few. Preoperative radiological imaging, in a victim of factory blast‑injury, suggested foreign body in the posterior mediastinum. However, the intra‑operative TEE showed it in the left atrium, which later migrated into the left ventricle necessitating a change in surgical approach for its removal.

Pseudotumor of the Omentum Associated with Migration of the Ingested Crab-Leg

Foreign body ingestion is not uncommon in clinical practice, and it may occasionally lead to penetration injuries. Emergency physicians and radiologists sometimes fail to obtain complete histories including ingestion and may overlook the possibility of foreign body-induced complications. Herein, we report a case of stomach antrum perforation due to foreign body migration. We were unaware of the patient's history of eating the Korean delicacy "Kanjang-gaejang," which is raw crab seasoned with soy sauce. Several imaging diagnostic modalities had suggested the possibility of a malignant mass in the gastrocolic ligament area. During the operation, a crab leg was discovered as the cause of an intra-abdominal abscess. The patient underwent an antrectomy, a vagotomay, and a transverse colon wedge resection. We present this unusual case of a pseudotumorous lesion caused by ingestion of Kanjang-gaejang.

Control ecográfico post inserción de dispositivo intrauterino / Ultrasound control post insertion of intrauterine device

INTRODUCCIÓN: Los dispositivos intrauterinos (DIU) son métodos de anticoncepción reversible, ampliamente usados en el mundo. Se estima que 120 millones de mujeres usan un DIU en el mundo como método anticonceptivo. OBJETIVO: Evaluar los factores de riesgo que puedan relacionarse con una incorrecta inserción del DIU. MÉTODO: 93 pacientes de un Centro de Salud Familiar de la ciudad de Talca, Chile. Utilizando tablas de contingencia se calcularon diferentes medidas de asociación y se compararon los casos de DIU mal posicionado con los casos con uno o más factores de riesgo identificados. RESULTADOS: Se encontró una incidencia de DIU incorrectamente posicionado de un 15,8%, de los cuales hubo un 2,1% de perforación uterina, 2,1% para DIU incrustado y 11,8% para DIU descendido. Se identificaron como factores de riesgo de DIU incorrectamente posicionado la cicatriz de cesárea (RR: 2,31), inserción dificultosa (RR: 3,31) y opinión de un resultado dudoso (RR: 3,64), con una sensibilidad de 73,3%. CONCLUSIONES: La ecotomografía transvaginal es una herramienta crucial para la confirmación de una correcta inserción del DIU y debería ser un examen de rutina ante la presencia de cualquiera de los factores de riesgo identificados.

BACKGROUND: Intrauterine devices (lUDs) are reversible birth control methods that are widely used throug-hout the world. It is estimated that 120 million women use an IUD in the world as a contraceptive. AIM: To assess the risk factors that may relate to incorrect insertion of the IUD. METHODS: The sample included 93 patients of a Family Health Center, Talca, Chile. Using contingency tables, various measures of association were calculated, and the cases of incorrectly positioned IUD were compared with the cases where one or more risk factors were identified. RESULTS: We found an incidence of 15.8% of incorrectly positioned IUD, of which 2.1% presented with uterine perforation, 2.1% with embedment of the IUD and 11.8% with a descended IUD. We identified the following risk factors for incorrectly positioned IUD: cesarean section (RR: 2.31), difficulty on insertion (RR: 3.31) and practitioner's opinión of an uncertain result (RR: 3.64), with a sensitivity of 73.3%. CONCLUSIONS: Transvaginal ultrasound is a crucial tool for confirmation of proper insertion of an IUD and should be considered a routine examination when any of the identified risk factors are present.

Lipoid pneumonia: An uncommon entity.

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.