Cases reported "Foreign Bodies"

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1/21. body piercing in the accident and emergency department.

    Recently an increasing number of patients with complications related to pierced body jewellery have been seen. Often removal of the jewellery is indicated. Removal of these items may also be required for radiological purposes. If the doctor is familiar with the opening mechanism of the item, removal is not usually difficult. Uninformed attempts at removal may cause unnecessary trauma and distress. In a survey of 28 accident and emergency doctors, only six were able accurately to describe the opening mechanisms of all three commonly used types of jewellery. Descriptions of the types of jewellery currently used are not available in the medical literature. The aim of this article is to familiarize doctors with the types of jewellery used, describe their opening mechanisms, and suggest techniques for their removal. The complications of body piercing and the indications for the removal of body jewellery are also outlined.
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2/21. High-pressure injection injuries to the hand.

    High-pressure injection injury hides the true extent of the lesions behind an apparent small and harmless puncture of the finger or the hand. Through clinical description, we wish to point out the need for prompt treatment to avoid mutilating and function-threatening complications. We wish to outline the role of the emergency physician who must be aware of the incidence of high-pressure injection injury and become accustomed to early referral to a surgeon, experienced in extensive surgical exploration, removal of foreign bodies, and rehabilitation. The open-wound technique gives the best results. We also point out that failure to refer may become an increasing focus of negligence claims.
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3/21. Double fracture and wedging of a sewing needle interdentally in an attempt at self-treatment: a case report.

    Dental pain occurring whilst abroad may present the patient with a difficult decision: to try and bear it with self-medication until he/she returns home or to seek professional help. This case report outlines a Korean girl's attempt at self-treatment, which resulted in not one but two fragments of a sewing needle wedging between her teeth, the second fracturing as she tried to dislodge the first. Her self-treatment exacerbated her problem and resulted in the need for surgical access to the site to retrieve the broken fragments. The case also illustrates the use of parallax radiography in determining the position of the fragments.
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4/21. Options for immediate reconstruction of the traumatized temporomandibular joint.

    The management of condylar fractures is one of the most controversial topics in the repair of the maxillofacial skeleton. An extensive volume of literature exists describing the various indications for a specific treatment of this injury. This article outlines the absolute and relative indications for an open procedure and describes three different modalities for the immediate reconstruction of the temporomandibular joint system. Three different case reports are used to illustrate the respective procedures--replacement of the temporomandibular joint with autologous rib graft, replacement of the temporomandibular joint with an alloplast, and vertical ramus osteotomy for repositioning of the condylar stump. The discussion section reviews the findings and preferences of various treatment modalities described in the literature, along with the advantages and disadvantages.
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5/21. A report on missile injuries in cyprus 1974.

    This paper details the experiences of the Princess Mary's Royal air Force Hospital, Akrotiri (TPMH), during the last 6 months of 1974. TPMH was at that time a small hospital (120 beds) with a clinical staff of 17 situated in the south of cyprus (fig. 1). The series comprises 71 patients injured by bullets, shrapnel, bomb-blasts or mines, drawn from British personnel, united nations Forces and the local Cypriot military and civilian population, resulting from the coup d'etat of 15 July 1974 and the subsequent Turkish invasion and air attacks. The casualties were often severely wounded beyound the capabilities of the local hospitals. They were mostly admitted during a 2-week period, but many required multiple operations extending over the next 3 or 4 months, and altogether 119 operations were carried out on 41 patients at TPMH. The organization of the limited resources of the medical, nursing and supporting staff is outlined. The correct treatment of missile wounds is emphasized. resuscitation, wound excision, splintage and delayed suture or grafting are essential. Minimal morbidity and mortality are gained by a practised approach to the compounded results of violence.
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6/21. Button batteries in the ear, nose and upper aerodigestive tract.

    OBJECTIVES: With the miniaturization of electronic devices, the demand and usage of button batteries has risen. As a result, button batteries are more readily available for young children to handle and potentially mishandle. They are frequently inadvertently placed by children in their ears or noses. Occasionally they are swallowed and lodged along the upper aerodigestive tract. methods: We outline the pathophysiology of button battery-induced trauma and present key radiological features of button batteries that are important in preventing delayed diagnosis after pediatric ingestion. RESULTS: Button batteries of all sizes have a distinctive double contour on radiographs. CONCLUSIONS: Button battery ingestion requires prompt diagnosis and removal. A high index of suspicion along with radiographs help assist with the diagnosis. Potential tragic complications can be averted with expeditious removal.
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7/21. The missing hazelnut.

    This report describes a case of esophageal perforation caused by a hazelnut which became stuck in the upper esophagus but was not detected. We outline the pitfalls in diagnosis, complications and treatment in the pediatric population.
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8/21. CT of crack cocaine ingestion.

    The imaging findings of a crack cocaine "body stuffer" are presented along with findings from in vitro experimentation with crack cocaine. It has been shown previously that contrast enhanced radiographic examinations can often outline the vessel in which ingested cocaine is contained; our work demonstrates that the crack cocaine itself may be visualized with CT performed without intravenous or oral contrast material. Due to the cost of CT, however, it is indicated only when clinically warranted to guide treatment. Positive identification of ingested crack cocaine by CT might prove helpful for both medical and legal indications.
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9/21. Prawns masquerading as endobronchial tumours.

    This report details the events surrounding the case of an 89-year-old woman referred for surgery with a suspected endobronchial tumour. At rigid bronchoscopy she was found to have inspissated sputum within which the remains of organic foreign bodies (king prawns) were found obstructing the left main and left upper lobe bronchi. We outline her presentation, initial diagnosis and eventual outcome, and re-emphasise the importance of bronchoscopy as a vital tool in the assessment of any endoluminal lesion of the airway.
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10/21. Intravascular missile embolization in childhood: report of a case, literature review, and recommendations for management.

    A collective review of 20 cases of missile embolization among children (1961 to 1988) is analyzed, one case added, and guidelines for diagnosis and management are outlined. Causative agents were bullets (14 patients), pellets (5), and fragments (2). Their trajectory was arterioarterial (11), venovenous (5), paradoxical (4), and mixed (1). Diagnosis was suspected when an exit wound was absent and the foreign body was traced on regional x-ray. Embolization was predominantly to the legs, with a tendency for the left (5 of 8 cases). upper extremity emboli were exclusively to the right. Only one of five cardiac entries required closure to control bleeding compared with four of six aortic. embolectomy was performed in 16 patients. The overall mortality rate was 9.5%. Factors predicting a favorable outcome are early presentation, diagnosis, and intervention; location of cardiovascular entry and embolus site; and presence of soft tissue tamponade at entry wound. Although embolectomy for cerebral, asymptomatic pulmonary arterial, and silent venous emboli is controversial, universal agreement prevails regarding removal of systemic arterial as well as venous emboli that are potentially problematic.
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