Cases reported "Foreign Bodies"

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1/10. Fatal aspiration of sardine fry in a patient with lung cancer.

    We report a fatal case of death due to unusual aspiration of sardine fry in an elderly Japanese man with lung cancer. The cause of death was sudden respiratory arrest while eating. autopsy revealed peculiar materials with cell nests and pigmented particles, together with striated muscle and skin, in the ectatic bronchioles of the left lower lobe. Serial histologic sections suggested that the structures observed were the eyeballs of small animals that appeared to have been inhaled. The patient had habitually eaten sardine fry and rice gruel, which were also detected in the gastric contents. Therefore, the eyes were considered to be those of the fry, which is a popular food item in japan. This was confirmed by histologic examination of fry that were obtained commercially.
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2/10. Foreign body removal: a new role for the fiberoptic bronchoscope.

    Artificial and animal lung models initially were used to investigate the removal of foreign bodies from the tracheobronchial tree with the flexible fiberoptic bronchoscope. Different extraction instruments (claw, basket, forceps, and balloon catheter) were passed separately through the channel of the bronchofiberscope, and tested for usefulness prior to human application. The Fogarty balloon catheter served as a valuable aid in dislodging impacted objects so that the operator could then grasp them with the claw, basket or forceps. The wire claw recovered many of the metallic and organic objects, the wire basket was successful in retrieving only the bulky objects and the forceps (ACMI) was effective in capturing all of the metallic foreign bodies. These techniques, developed in our laboratory, are now being used to augment rigid bronchoscopy in the removal of foreign bodies from adults and older children. At the present time fiberoptic foreign body removal is not recommended for pediatric cases because of the small diameter of the trachea and glottis in infants and young children.
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3/10. Malignant fibrous histiocytoma developing in bone 44 years after shrapnel trauma.

    Tumors induced by foreign bodies are uncommon in humans, but they are a relatively common occurrence in some experimental animals. The development of sarcoma in association with metallic foreign bodies has rarely been reported. The development of a malignant fibrous histiocytoma in a 65-year-old man 44 years after shrapnel fragments lodged in his left arm is described. The literature regarding metallic foreign body-induced cancer in humans is reviewed.
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4/10. Angiosarcoma associated with foreign body material. A report of three cases.

    The production of tumors through solid-state mechanisms has been demonstrated in experimental animals, but foreign body tumorigenesis has not been proven definitively in man. The authors report three patients with angiosarcoma that occurred in intimate association with foreign material retained for prolonged periods. Although several etiologic factors have been defined in angiosarcoma, foreign bodies generally are not appreciated to have this potential. review of the literature disclosed six cases of angiosarcoma and 40 cases of sarcomas of other histologic types associated with foreign material, with latency periods of from 4 months to 63 years. Implanted foreign material thus should be considered capable of inducing virtually any form of sarcoma in humans.
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5/10. Hemorrhagic pulmonary edema associated with meat tenderizer treatment for esophageal meat impaction.

    We describe a case of acute hemorrhagic pulmonary edema caused by aspiration of Adolph's meat tenderizer, used in an attempt to relieve an esophageal meat impaction. We performed an animal experiment in which bronchial instillation of a similar solution reproduced the clinical findings in our patient. This is a previously unreported and potentially lethal complication of a therapy that has never been submitted to clinical trials. We recommend against the use of this therapy for patients with complete esophageal obstruction or in those otherwise at risk for aspiration.
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6/10. Evidence for macrophage activation in dialysis patients exposed to silicone filing.

    spleen cell suspensions of 2 dialysis patients with hepatosplenomegaly and pancytopenia were studied in vitro. spleen cells of a cadaver kidney donor were studied as control. In spleen macrophages of the patients, silicone particles could be demonstrated with TEM and electron microprobe analysis. Under basal conditions and after stimulation with zymosan and concanavalin a, release of PGE2, TXB2 and 6-keto-PGF1 alpha from patient cells was higher than control cells. This anecdotal observation parallels previous animal studies and suggests that loading of human macrophages with foreign material particles activates arachidonic acid metabolism.
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7/10. Foreign body removal with the flexible fiberoptic bronchoscope.

    Intrabronchial foreign bodies are occasionally encountered in adults but most available information in humans consists only of reports evaluating one or two cases. We surveyed our experience and found seven patients with intrabronchial foreign bodies who had been examined with the flexible fiberoptic bronchoscope, six of whom were managed successfully. Nine cases have been identified in the literature. Although there were no major complications in either our cases or those in the literature, several problems were identified which under other circumstances could have caused significant complications. We assessed all of these cases for situations which presented potential risk to the patient. These risks were grouped into the following problem categories: 1. selection of appropriate bronchoscope, 2. availability of appropriate instruments, 3. control of the foreign body, and 4. unexpected foreign bodies. Endoscopists planning to use the FFB in foreign body removal should be aware of the problems and hazards which may ensue if improperly managed, and should attempt to gain experience either in the animal laboratory or in models prior to approaching patients with foreign bodies with the flexible fiberoptic bronchoscope.
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8/10. Endoscopic removal of a large intragastric foreign body with an overtube: a case report.

    After amphetamine ingestion, a 39-year-old male attempted suicide by swallowing glass trifles, cigarette lighter and razor blades. All foreign bodies ingested were evacuated spontaneously and smoothly within one week, except for the 10-cm long lighter, which was removed by endoscopy via supplementary overtube with moderate difficulty. The subsequent clinical course was uncomplicated. More than 80% of the ingested foreign bodies which reach the stomach can be eliminated uneventfully through the gastrointestinal tract. The remainder may cause complications such as obstruction, perforation and hemorrhage. Usually the locations of obstruction are over the three anatomic narrowings of the esophagus, the pyloric ring and ileocecal valve. Perforation occurs with ingestion of long, sharp, metallic pointed objects or animal bones, and is more frequent among those who had previous abdominal surgery or intestinal diseases. Endoscopic removal as soon as possible is suggested for high risk groups, with use of the overtube method to prevent complications.
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9/10. Accidental injuries from captive-bolt guns (slaughterer's gun).

    Captive bolt guns or 'slaughterer's guns' are weapons used in slaughtering animals. Lesions caused by these weapons are likely to have a more serious character than is to be expected from the size of the entrance wound. The wounds are primarily contaminated and it is imperative to explore the wound thoroughly as foreign bodies are often deeply embedded. Three cases are reported of accidental injuries to personnel working with such weapons.
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10/10. Pediatric tracheobronchial foreign bodies: historical review from the Johns Hopkins Hospital.

    We investigated changing trends in pediatric tracheobronchial foreign body removal and resident experience from 1939 to 1991. We retrieved the records of 234 cases of tracheobronchial foreign body removal at Johns Hopkins. The mean number of cases per year was 5.9. The most common foreign bodies removed were peanuts, accounting for 38.9%. The average yearly incidence of pediatric tracheobronchial foreign bodies remained relatively constant during the period studied. Our data suggested little change in outcome or complications with the advent of optical telescopes in the mid-1970s, despite their great value in improved visualization. Resident experience and training were evaluated by the number of cases attended by each resident during his or her training. The number varied from 1 to 8 cases, not including experience acquired at our sister institutions. Although complete data could not be obtained in many of the older medical records, our review suggests that despite the advantage offered by the optical forceps technology, proper training and experience in traditional rigid endoscopic techniques is still crucial to optimize outcome and minimize the risk of complications in pediatric tracheobronchial foreign body removal. Chevalier Jackson's recommendation that residency training include an animal laboratory course in foreign body removal still applies.
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