Clinical and pathological aspects of gossypiboma in a dog: case report / Aspectos clínico-patológicos do gossipiboma em cão: relato de caso

A female dog was treated at the Veterinary Hospital Governador Laudo Natel for symptomscaused by an intra-abdominal gossypiboma (gossypium: cotton; boma: place of hiding). Showing high morbidity and mortality, the gossypiboma is a granulomatous reaction that is formed in response to exposure to a textile matrix. The objective of this report is to describe the clinical and pathological findings of an intra-abdominal gossypiboma in a female dog. This patient arrived at urgent care showing increased abdominal volume, pain, and cachexia. Ultrasonography showed a regular contour formation that could not be completely delimited. The patient underwent exploratory laparotomy and died in the postoperative period. The gossypiboma had a smooth, firm, and purple-gray exterior surface. Microscopy revealed a severe reaction of desmoplasia around the necrotic region, residual textile material, and adipose tissue. Negligence by veterinarians leading to this condition can result in patients' death as well as causing psychological damage to owners.(AU)

Uma cadela foi atendida no Hospital Veterinário "Governador Laudo Natel", apresentando sinais clínicos oriundos de gossipiboma intra-abdominal (gossypium: algodão e boma: local de ocultação), tais como aumento de volume abdominal, regurgitação e caquexia. A ultrassonografia evidenciou formação de contorno regular que não podia ser totalmente delimitada. A paciente foi submetida à laparotomia exploratória e veio a óbito no período pós-operatório. O gossipiboma mostrou-se com superfície externa lisa, firme e roxo-acinzentada apresentando-se à microscopia como reação severa de desmoplasia ao redor de material necrótico, resíduos de material têxtil e do tecido adiposo. A negligência por parte dos médicos veterinários pode levar pacientes ao óbito, bem como trazer prejuízos psicológicos aos proprietários. Objetiva-se, com este relato, descrever os achados clínicos e patológicos de uma cadela que apresentou um gossipiboma intra-abdominal.(AU)

Surgical item left in the abdomen six years after abdominoplasty: case report / Corpo estranho retido cirurgicamente em abdômen seis anos após abdominoplastia: relato de caso

The retained surgical item in patients after closure of the wound is a situation that although rare is preventable and requires specific care such as institutional protocols for prevention. We report a case of removal of an already encapsulated pads by fibrin tissue (textiloma) from a patient six years after an abdominoplasty, which formed a palpable mass in her abdomen. The retained surgical items lead to variable symptoms such as palpable masses, compressions, non-absorptive loss and, sometimes, severe complications. The diversity of manifestations combined with their few frequency, most of the times, lead to underdiagnosis. Treatment should be individualized for each case, although in case of symptoms removal is indicated in most cases. Surgical removal is associated with complications as longer as objects remain in patient's body.

A permanência de corpos estranhos em pacientes após o fechamento da ferida operatória é uma situação que, embora rara, é evitável e demanda cuidados específicos como protocolos institucionais de prevenção. O caso relata a retirada de uma compressa já encapsulada por tecido de fibrina (textiloma) de uma paciente seis anos após abdominoplastia, formando uma massa palpável em seu abdômen. A permanência desses itens cirúrgicos leva a sintomas variáveis como massas palpáveis, compressões, síndromes disabsortivas e, algumas vezes, graves complicações. A diversidade de manifestações combinada a sua pouca frequência levam, muitas vezes, ao subdiagnóstico. O tratamento deve ser individualizado para cada caso, embora na presença de sintomas a retirada é indicada na grande maioria das vezes. A cirurgia de retirada está mais associada a complicações quanto maior tempo de permanência dos objetos no corpo do paciente.

Artritis seudoséptica presenta sinovitis por cuerpo extraño en un paciente con gota / Pseudoseptic arthritis with foreign body synovitis in a patient with gout

La monoartritis es un reto diagnóstico para el clínico, ya que es extensa la lista de patologías asociadas. En pacientes con diagnóstico establecido de enfermedad articular inflamatoria, se acepta que la monoartritis corresponde a la exacerbación de la enfermedad de base; sin embargo, ignorar el abordaje sistematizado de las monoartritis puede generar omisiones e implicaciones diagnósticas erróneas. En este reporte se analiza el abordaje de un caso de artritis seudoséptica, simulando un ataque agudo de artritis por urato monosódico recurrente en un paciente con retención de cuerpo extraño intraarticular.

Monoarthritis is a diagnostic challenge for the clinician, as the list of associated conditions is quite long. It is accepted that in patients with a diagnosis of inflammatory joint disease monoarthritis represents exacerbation of the underlying disease. However, ignoring the systematized approach to monoarthritides may lead to omissions and mistaken diagnostic implications. This report describes the approach to a case of pseudoseptic arthritis that mimicked an acute episode of recurrent arthritis due to monosodium urate in a patient with retention of an intraarticular foreign body.

Impacted foreign bodies in orbital region: review of nine cases / Corpo estranho impactado na região orbital: revisão de nove casos

Orbital injuries with a foreign body may result in severe structural and functional damage to the eye or orbital contents. Management and prognosis depend on the composition and location of the foreign body and whether there is secondary infection. Metallic objects and glass are the most frequently encountered and well-tolerated, whereas organic foreign bodies can elicit an inflammatory reaction and lead to serious complications. Despite the modern imaging methods, it is often difficult to identify and locate organic intraorbital foreign bodies. This paper presents a review of nine cases of impacted foreign bodies in the orbital region and discusses the diagnosis and treatment of this kind of injury. The following data were collected: age, gender, etiology of injury, occurrence of fracture, anatomical location of fracture, type of object, signs and symptoms, type of imaging exam used, approach, transoperative complication and occurrence of death. Foreign body injuries in the orbital region can be treated with a combination of clinical suspicion, basic knowledge and diagnostic tests and depend on the skill and experience of the surgeon, thereby decreasing the surgical risk of iatrogenic injury in relation to the inherent risk of retaining an organic intraorbital foreign body.

A apresentação clínica do corpo estranho orbitário é variável. Traumatismos orbitários com um corpo estranho podem provocar danos estruturais e funcionais graves para os olhos ou o conteúdo orbital. O tratamento e o prognóstico dependem da composição, localização e presença ou não infecção secundária. Objetos metálicos e de vidro são os mais frequentes e bem tolerados, enquanto corpos estranhos orgânicos podem provocar reação inflamatória que leva a sérias complicações. É frequentemente difícil identificar e localizar corpos estranhos orgânicos intraorbitais, apesar de modernos métodos de exames de imagens. Com vista a ilustrar e discutir o diagnóstico e tratamento deste tipo de lesão, este estudo apresenta uma revisão de nove casos de corpos estranhos impactados na região orbital. Os seguintes dados foram coletados: idade, sexo, etiologia, ocorrência de fratura, localização anatômica da fratura, tipo de objeto, sinais e sintomas, tipo de exame de imagem utilizado, abordagem, complicação trans-operatória e a ocorrência de morte. Ferimentos provocados por corpos estranhos na região orbital podem ser tratados pela combinação da suspeita clínica, testes de conhecimentos básicos de diagnóstico, habilidade e experiência do cirurgião. A soma de tais fatores leva à redução do risco de iatrogenia em relação ao risco inerente de retenção intraorbitária de corpo estranho orgânico.

Atypical presentation of an unusual foreign body.

A 14-year-old boy presented with intractable diplopia for 10 days following an assault. A thorough history revealed that he was unaware of any penetrating injury. However, imaging demonstrated a radiolucent foreign body between the globe and the orbital floor. On surgical exploration, it was found to be the proximal part of a ball point pen. Its removal resulted in complete resolution of diplopia. Thorough clinical and radiological examination is recommended when a foreign body is suspected in pediatric patients. Prompt diagnosis will aid in early intervention and prevention of long-term complications.

Amalgam tattoo: a cause of sinusitis?

Little attention has been paid to the toxicity of silver amalgam fillings, which have been used over the centuries in Dentistry. Amalgam particles may accidentally and/or traumatically be embedded into the submucosal tissue during placement of a restoration and perpetuate in such area. This article presents a case of amalgam tattoo and investigates whether it is related to the patient's repeated episodes of sinusitis. The patient was a 46-year-old woman with a 2 mm diameter radiopaque lesion in the right oral mucosa detected on a panoramic radiograph and presented as a black macula clinically. A complete surgical resection was carried out. The histopathological examination revealed deposits of dark-brownish pigments lining the submucosal tissue with adjacent lymphocytic inflammatory infiltrate and multinucleated giant cells phagocyting pigments. There was a negative staining for both iron and melanin. One year after lesion removal, the patient reported that the sinusitis crises had ceased after repeated episodes for years. It may be speculated that the inflammatory process related to amalgam tattoo seems to lead to a local immune response that causes sinusitis because it enhances the human leukocyte antigen DR (HLA-DR) tissue expression.

Unusual palatal foreign body: Case presentation

A two- year old Yemeni boy was referred to the Oral and Maxillofacial Clinic of the Aden University because his father had noticed a white lesion on the palate three days before; the child was examined by many dentists and a pediatrician prescribing medical treatment without improvement of the lesion. Questions to the father had not provided any interesting data about previous traumatism, ingestion of caustic substance or history of general disease. A rigorous oral and maxillofacial examination showed a white smooth lesion around 1.5 cm on the middle of the hard palate. According to previous experiences, the final diagnosis was a foreign body adhered to mucosa of the hard palate, the internal cover of a cap from drug bottle, which was removed by the use of a dental probe and college tweezers, leaving a concavity in the involved area that was healed without problems after a few days

Abdominal Epilepsy and Foreign Body in the Abdomen - Dilemma in Diagnosis of Abdominal Pain

There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.

Surgical removal of stones in the stomach of a tiger shovelnose catfish

A seven months old, tiger shovelnose catfish was referred to the veterinary medical teaching hospital of the college of veterinary medicine, Konkuk university because of suspecting a foreign body in the stomach. By physical and radiologic examinations, the catfish revealed abdominal enlargement, vomiting, inactivity and radiopaque foreign bodies in the stomach. Under general anesthesia with dilute isoflurane solution, celiotomy was performed. Stomach was atonic, and three foreign bodies were palpated in the stomach. In this process, three stones came out through mouth. Abdominal muscles were closed with a simple continuous suture pattern, and skin was closed with a simple mattress suture pattern. Sutured site was covered with glue and mucous taken from allogenic skin. On the second day after surgery, the patient recovered to normal condition, showing increased appetite and activity.

The subcutaneous capsules for foreign body in fetal rabbits: preliminary report

In terms of wound healing, there are fundamental intrinsic and extrinsic differences between fetuses (scar-free healing) and adults. The fetus exhibits less typical inflammatory response (signifiquently neutropenic) with an underdeveloped self-nonself immunologic identity and a lack of cellular immunity. The recruitment of inflammatory cells to a wound may play an important role in the resulting cellular processes and ultimately affect the quality of the healing response. Foreign bodies can act as a source of infection and immunologic reactions. In contrast, there have been few studies of the wound healing of fetus with foreign bodies, where in adults, wounds are healed by tissue regeneration rather than capsule formation and a foreign body reaction. In this study, the wound healing process in an adult rabbit and fetus group, in which either silicone or a sponge was inserted in the uterus, were compared. All specimens showed capsule formation with fibroblast, collagen deposition, neovascularization, and infiltration of inflammatory cells. However, the fetal specimen exhibited mainly acute inflammatory responses and the capsule contained less fibroblasts and collagen deposition. In addition, myofibroblast expression, which mediates wound contracture, was lower in the fetal specimen. These findings were common with cotton implants, which were expected to induce a severe inflammatory response. The inflammatory response induced by foreign materials in fetal tissue showed similar response with that of incisional wound healing. This study may provide a basis for the use of implants such as silicone in future fetal surgery.

Extracción de cuerpos extraños en el esófago. Experiencia en 215 casos / Management of foreign bodies in the esophagus. Experience in 215 cases

Objetivo. Mostrar la experiencia obtenida en el manejo de cuerpos extraños en esófago en nuestro hospital. Antecedentes. Con el advenimiento de la fibroendoscopia, el uso de equipo rígido de endoscopia para extracción de cuerpos extraños del esófago es menos común. La facilidad de contar con equios flexibles ha permitido adquirir mayor experiencias. El manejo endoscópico para la extracción de cuerpos estraños en el esófago se modifica de acuerdo al material ingerido. Métodos. Entre enero de 1984 a diciembre de 1994, se realizaron 9,500 procedimientos endoscópicos del tubo digestivo proximal; se investigaron los Archivos del Departamento y se revisaron 215 de cuerpos extraños extraídos del esófago, los que correspondieron a 151 pacientes pediátricos y 64 a pacientes adultos. Resultados. En todos ellos, se utilizó equipo flexible de endoscopia que permitió la extracción del cuerpo extraño en 214 casos (99.5 por ciento) y en el restante fue necesaria la práctica de cirugía. Las monedas fueron los objetos más comúnmente ingeridos en los niños (119), mientras que en los adultos, la comida impactada fue la causa más común (35 casos). Hubo asociación de estenosis de esófago en quince adultos (once de tipo benigno, uno con adenocarcinoma de unión esófago-gástrica, dos con trastornos motores y el restante con síndrome de Plummer-Vinson). No existió morbilidad ni mortalidad atribuible al procedimiento endoscópico tanto en adultos como en niños. Conclusiones. La esofagoscopia flexible realizada en forma oportuna para el diagnóstico y tratamiento de cuerpos extraños en esófago, es la mejor opción con que se cuenta en la actualidad

Cuerpos extraños en vías respiratorias

Este es un estudio de cuerpos extraños en las vías respiratorias inferiores realizado durante el período de enero de 1990 a diciembre de 1992, realizado en el centro de Cirugía Cardíotorácica del Hospital "Eugenio Espejo". Se analiza edad, sexo, tipo, localización de cuerpo extraño, tratamiento y complicaciones. En 21 casos se realizó endoscopía rígida para su extracción. En dos casos la endoscopía fue infructuosa y recurrimos a la toracotomía para realizar la broncotomia. En el primer caso se trató de un tornillo metálico enclavado en un bronquio segmentario basal derecho y en el segundo caso, de una semilla de chirimoya enclavada en el bronquio principal derecho. En los tipos de procedimiento, la mortalidad fue del 0 por ciento.

Visual results after ocular trauma among Arabs in Kuwait

Eye trauma is a major cause of blindness, especially in children. A substantial proportion of trauma patients develop serious complications. This study includes 319 Arab patients with ocular trauma ranging in age from 4 to 60 years [median 17.6]. In 180 cases [56%], the cause was blunt trauma which precipitated hyphaema. A further 114 cases [36%] were caused by perforated ocular wounds, and there were 15 [8%] intraocular foreign bodies. The complication rate was 65.6%: cataract in 160 [50%], vitreous haemorrhage in 23 [7%], retinal detachment in 21 [6.6%], traumatic maculophathy in 7 [2%], endophthalmitis in 2 and glaucoma in 5. Visual results included 25 monocular blindness [7.8%], 58 [18%] who could only count fingers or perceive light [monocular], 18 with vision between 6/36 and 6/60, 27 [8.2%] between 6/18 and 6/24, and 191 [60%] with 6/12 or better