Metallic Foreign Body Research Articles

Intra-lenticular metallic foreign bodies – A series of three cases

Three consecutive cases presenting with intra-lenticular foreign bodies (ILFBs) were included in this series. ILFB retrieval with Kelman–McPherson forceps, along with cataract extraction and intraocular lens implantation in the bag was performed as a single-staged procedure for all under peri-operative systemic and topical steroids. Their visual recovery was excellent at 4 months with best-corrected visual acuity of 20/20, N6. Careful clinical and relevant radiological evaluation is paramount following penetrating ocular injury to rule out intraocular foreign body, especially ferrous, to avert the most visually debilitating sequelae of ocular siderosis. This series highlights a favourable outcome of ILFB removal with concurrent management of cataract.

Surrogate Thresholds for Iron Chelation in Patients with Hematological Malignancies

Background: The reference standard for evaluating the magnitude of body iron overload is measurement of the liver iron concentration (LIC). Until recently, the conventional clinical method for measuring LIC was through analysis of biopsy specimens considered the “gold standard” of LIC measurement. To counter the shortcomings of liver biopsy, several noninvasive techniques have been applied to estimate LIC. The spin-density projection-assisted (SDPA) R2-MRI (FerriScan) technique has been recently validated to estimate LIC. There are reports in the literature that ferritin levels in patients with hematological malignancies (HM) may not correlate sufficiently with LIC. We conducted R2-MRI Ferriscan sequencing in consecutive patients with HM followed in our center to better evaluate the diagnostic value of ferritin levels and packed red blood cell (pRBC) transfusions for iron overload.Methods: HM patients with a history of transfusion requirement were evaluated for inclusion in the study within the Liver Iron Cutino Network (Licnet) project. Patients were excluded if they had contraindications to MRI assessment (heart pacemaker, metallic foreign body or devices, and claustrophobia). Demographics and HM disease data were collected, together with ferritin levels and transfusion requirement. R2 LIC measures by FerriScan were defined as indicating normal/marginally high iron load for values 0 to <3, mild liver iron overload for values 3 to < 7, moderate between 7 and 15 and severe if >15. Correlations and the generation of receiver operating characteristic (ROC) curves were performed to test the diagnostic power of ferritin levels and volume of transfused blood (ml/kg in the preceeding 12 months) to indicate moderate-severe iron overload.Results: 28 patients (20 males) of mean age 62, SD 17 years with HM (myelodysplastic syndromes N=14; acute myeloid leukemia N=7, of which 5 post-transplant; acute lymphoblastic leukemia post-transplant N=2; aplastic anemia N=2; non Hodgkin lymphoma N=1; chronic lymphocytic leukemia N=1; erythroblastopenia N=1) were evaluated. Median baseline ferritin levels were 1617 (interquartile range 1185-2360). Mean R2 values were 10.9, SD 10.1 mg/kg. Three patients had normal or marginally high LIC, 12 patients had mild overload, 6 patients moderate and 7 patients severe overload. Both ferritin levels and amount of blood volume transfused in the preceding 12 months correlated well with R2 measures (Spearman rho=0.478, p=0.10 and r=0.509, p=0.006, respectively). However, neither ferritin levels nor transfusions correlated with R2 MRI in patients with normal-mild iron overload while the correlations were confirmed and highly significant in patients with moderate-severe iron overload (r=0.692, p=0.009 and r= 0.754, p=0.003, respectively). ROC curves denied the diagnostic power of ferritin levels and confirmed transfusions to indicate moderate to severe liver iron overload (Figure 1), indicating that 37 ml/kg/year (about 14 units of pRBC) has a sensitivity of 77% and a specificity of 80% to predict moderate-severe iron overloadConclusions: We confirm that, though ferritin levels do generally correlate with LIC, they are not to be considered an appropriate surrogate marker for iron overload in HM. R2 MRI sequencing is valuable to diagnose the state of LIC. The results of this study indicate that as soon as an HM patient begins to receive regular transfusions, since the probability of developing moderate-severe iron overload is high, it is warranted not to await high ferritin levels, nor a large number of pRBC units, to initiate iron chelation. [Display omitted] DisclosuresOliva:Celgene: Consultancy; La Jolla: Consultancy; Amgen Inc.: Consultancy; Novartis: Consultancy; Janssen: Consultancy.

Correlation Between Electroretinogram and Visual Prognosis in Metallic Intraocular Foreign Body Injury.

Purpose: This study aims to investigate the correlation between electroretinogram (ERG) and visual outcome in eyes with metallic intraocular foreign body (IOFB) injury.Methods: Cases with metallic IOFB injuries with preoperative ERG from January 2008 to May 2020 were reviewed retrospectively. Five ERG responses were recorded, including rod response, maximal response, oscillatory potentials, cone response, and 30-Hz flicker. The results were compared between the affected and the contralateral eyes. All patients received surgery to remove IOFBs. The correlation between amplitudes, implicit times, and grades of ERG with final best-corrected visual acuity (BCVA) was analyzed.Results: A total of 33 eyes of 33 patients were included. The eyes with IOFB had generally delayed implicit time and reduced amplitude in all waves. The maximum change was found in oscillatory potentials S3 and N1 (0.42 ± 0.42 and 1.95 ± 1.97 of the fellow eyes, respectively, p < 0.05). All amplitudes were negatively correlated with the final BCVA (rs: −0.676 to −0.459, all p < 0.05). In contrast, all implicit times were positively correlated with final BCVA, although, some of them were not statistically significant (rs: 0.035 to 0.687). Among them, oscillatory potential P3 has the highest correlation coefficient (rs = 0.687, p < 0.001). All grades of ERG waves were statistically correlated with the final BCVA (rs: −0.596 to −0.664, all p < 0.001).Conclusions: ERG can be used to assess visual outcome in metallic IOFB injury after surgery. Oscillatory potentials provided the most significant responses.

Intracardic migration of Kirschner wire from the right sternoclavicular joint: a case report

BackgroundMigration of wires and pins within the heart is an uncommon complication. Intracardic migration of Kirschner wire can cause several complications.Case presentationA 55-year-old male patient was admitted to the emergency service with dyspnea, stabbing chest pain. The patient’s medical history showed that he had undergone a fixation operation using Kirschner wire and plate for treatment of the right sternoclavicular joint dislocation about 5 months prior. Chest computerized tomography revealed a metallic foreign body locating in the pericardium between the aorta and the right ventricle. There were not any serious complications occurred before operation due to the timely detection of potential risks. Removal of the wire was performed via median sternotomy under general anesthesia without cardiopulmonary bypass. The symptoms of dyspnea and chest pain were relieved after surgery, and the patient recovered without any complications.ConclusionThe Kirschner wire should be used judiciously in amphiarthrosis in orthopedic surgery for the risk of breakage and migration. The possibility of intracardiac migration of wire should be considered when chest symptoms presenting after surgery with the Kirschner wire. Migrated wires must be removed immediately to prevent serious complications. Regular follow-up and early removal of fixation wires are recommended to prevent migration of wires.

Oliverio O. Segura, MD (1933-2021) Through A Son’s Eyes – A Tribute to Dad

Oliverio O. Segura, MD (1933-2021) Through A Son’s Eyes – A Tribute to Dad

Spontaneous Expulsion of Foreign Body Bronchus: Understanding the Mechanism.

Foreign Body (FB) aspiration pose a challenge to the otolaryngologist of its early diagnosis along with safe removal. Almost all airway foreign bodies require bronchoscopy and removal. Very rarely, spontaneous expulsion of bronchial FB may happen. We are reporting one such case of spontaneous expulsion of a metallic FB from right main bronchus in a fourteen-year-old boy. The mainstay of treatment for FB bronchus is bronchoscopic removal. Spontaneous expulsion occurs very rarely & may be associated with life threatening complications. Impaction of FB in sub glottis may lead to sudden choking & death. In this report we also have tried to provide insight into the physics and physiological mechanism facilitating spontaneous expulsion of a bronchial foreign body.

Radiographic findings of metallic foreign bodies due to permanently retained acupuncture needles

Radiographic findings of metallic foreign bodies due to permanently retained acupuncture needles

Trans-base and trans-vault low-velocity penetrating brain injury: A retrospective comparative study of characteristics, treatment, and outcomes

PurposeLow-velocity penetrating brain injury (LVPBI) caused by foreign bodies can pose life-threatening emergencies. Their complexity and lack of validated classification data have prevented standardization of clinical management. We aimed to compare the trans-base and trans-vault phenotypes of LVPBI to help provide guidance for clinical decision-making of such injury type. MethodsA retrospective study on LVPBI patients managed at our institution from November 2013 to March 2020 was conducted. We included LVPBI patients admitted for the first time for surgery, and excluded those with multiple injuries, gunshot wounds, pregnancy, severe blunt head trauma, etc. Patients were categorized into trans-base and trans-vault LVPBI groups based on the penetration pathway. Discharged patients were followed up by outpatient visit or telephone. The data were entered into the Electronic Medical Record system by clinicians, and subsequently derived by researchers. The demography and injury characteristics, treatment protocols, complications, and outcomes were analyzed and compared between the two groups. A t-test was used for analysis of normally distributed data, and a Mann-Whitney U test for non-parametric data. A generalized linear model was further established to determine whether the factors length of stay and performance scale score were influenced by each factor. ResultsA total of 27 LVPBI patients were included in this analysis, comprised of 13 (48.1%) trans-base cases and 14 (51.9%) trans-vault cases. Statistical analyses suggested that trans-base LVPBI was correlated with deeper wounds; while the trans-vault phenotype was correlated with injury by metal foreign bodies. There was no difference in Glasgow Coma Scale score and the risk of intracranial hemorrhage between the two groups. Surgical approaches in the trans-base LVPBI group included subfrontal (n = 5, 38.5%), subtemporal (n = 5, 38.5%), lateral fissure (n = 2, 15.4%), and distal lateral (n = 1, 7.7%). All patients in the trans-vault group underwent a brain convex approach using the foreign body as reference (n = 14, 100%). Moreover, the two groups differed in application prerequisites for intracranial pressure monitoring and vessel-related treatment. Trans-base LVPBI was associated with higher rates of cranial nerve and major vessel injuries; in contrast, trans-vault LVPBI was associated with lower functional outcome scores. ConclusionOur findings suggest that trans-base and trans-vault LVPBIs differ in terms of characteristics, treatment, and outcomes. Further understanding of these differences may help guide clinical decisions and contribute to a better management of LVPBIs.

Осложнения длительно пребывающего в глазу металлического внутриглазного инородного тела

Осложнения длительно пребывающего в глазу металлического внутриглазного инородного тела

Needle Loss in Minimal Invasive Surgery Is a Real Challenge: Innovative Technique for Retrieval

Introduction: Intraoperative retained needles is reported to be ~0.06% to 0.11% with its consequence medical and ethical significance.1 Such small needles can be detached from the sutures and fly away from the limited laparoscopic vision or hidden between bowel loops that makes its localization and retrieval extremely difficult even in the hands of best experienced surgeons.2 However, intraoperative radiographic images maybe used in detecting lost needle; smallest needle <13 mm can be unhelpful.3 Kandioler-Eckersberger et al. reported two cases in which a novel laparoscopic magnetic retrieval device was utilized along with fluoroscopy in retrieval of broken fragments without the need to convert to open surgery.4 Herein, we demonstrate an innovative technique in retrieving a small suture needle that was lost during robotic pyeloplasty. Methods and Materials: This is a 7-year-old boy who was recently found to have left-sided pelviureteral junction obstruction after frequent emergency department visits with colicky abdominal pain. Ultrasonography and nuclear scans showed high-grade hydronephrosis with an obstructive curve; therefore, he was posted for robotic pyeloplasty. During the procedure and while doing the ureteropelvic anastomosis through 6/0 polydioxanone suture, the needle detached from the suture and was lost from the camera vision. At the end of the procedure, exploration of the abdominal cavity was accomplished through laparoscopic camera without the ability to detect the small needle. We used the retrieval device of the magnetic Double-J stent that consists of Tiemann-type with 15F diameter and magnet through one of the working ports and started to scan the abdominal cavity in systemic way under supervision of the laparoscopic camera. This magnetic retrieval device is semifixable that does not damage the intra-abdominal organs and has a strong magnetic power that can attach with metallic foreign bodies such needles efficiently. Results and Conclusion: The lost small needle was retrieved easily and safely without the need for conversion to open surgery or exposure to radiation. The innovative technique of using the magnetic retrieval device of Double-J stents as an intracorporeal laparoscopic device can be a valid and safe alternative in the retrieval of small metallic objects such as needles. Source of the study: A clinical case was encountered during practice. No competing financial interests exist. Runtime of video: 3 mins 54 secs

High Output Heart Failure Secondary to Aorto-Caval Fistula Treated With an Amplatzer Septal Occluder: Case Report and Review of Literature

Aorto-caval fistula (ACF) is a rare cause of high output heart failure (HOHF). 80 % of cases are due to ruptured abdominal aortic aneurysm, while 10 to 20% are traumatic or congenital. Early diagnosis and treatment are crucial in order to prevent the progression to HOHF. Open surgical repair has been the mainstay therapy of arterio-venous fistulas including aorto-caval fistula; however endovascular approach has become an evolving therapeutic option in the last 20 years. Here, we present a case of high output heart failure secondary to traumatic aorto-caval fistula due to shrapnel injury to the abdomen. Our patient was managed with endovascular approach by the deployment of amplatzer septal occluder that excluded completely the fistula, resulting in the progressive improvement of HOHF. In this manuscript, we review etiologies of high output heart failure and summarize cases of aorto-caval fistula treated with amplatzer septal occluder reported in literature. We also highlight the importance of this endovascular device in the presence of metallic foreign body in the aorta.

Management of Metallic Intraocular Foreign Body Retained at Different Levels in The Eye

Management of Metallic Intraocular Foreign Body Retained at Different Levels in The Eye

Intraocular metallic foreign body ultrasound and computed tomography imaging

Orbital foreign bodies are still serious diagnostic problem even after the development of diagnostic imaging techniques. We present an interesting case report of a 42-year-old man who presented with a history of sudden loss of vision after sustaining injury to the left eye due to metallic piece while working. Grayscale ultrasound and computed tomography findings are discussed.

Ingestion of metallic foreign bodies: A Paediatric Emergency Research in the United Kingdom and Ireland survey of current practice and hand‐held metal detector use

To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand-held metal detectors (HHMDs) in EDs, including their role in clinical decision-making, and training in their use. Online multicentre cross-sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics. Fifty-five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut-off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter. There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision-making.

Semi-quantitative scoring of imaging modalities in detecting soft tissue foreign bodies: an in vitro study.

Accurate identification of foreign bodies (FB) using medical imaging is essential for diagnosis and determining the suitable retrieval technique. To compare the sensitivity of different imaging modalities for detecting various FB materials in soft tissue and assess the reproducibility of a scoring system for grading the conspicuity of FBs. Five FB materials (plastic, wood, glass, aluminum, and copper) were embedded in a tissue-mimicking phantom. Computed radiography (CR), ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) were compared using a semi-quantitative 5-point Likert scale scoring system. The intra- and inter-reader reproducibility of four independent readers was analyzed using Kendall's coefficient of concordance (W). Glass was visible on all imaging modalities. Plastic was only visible in excellent detail using ultrasound. Wood was detected in excellent resolution using ultrasound and CT using the default window while plain X-ray failed to detect it. Ultrasound was the only modality that showed aluminum in excellent quality while CT showed it with good demarcation from the surroundings. Copper was detectable in excellent detail using CR, ultrasound, and CT. MRI performance was suboptimal, especially with the plastic FB. The scoring system showed excellent intra-reader (W = 0.91, P = 0.001) and inter-reader (W = 0.88, P < 0.001) reproducibility. Ultrasound can be used as the first line of investigation for wood, plastic, glass, and metallic FBs impacted at superficial depths in soft tissue. The semi-quantitative FB scoring system showed excellent within- and between-reader reliability, which can be used to score and compare the detection performance of new imaging techniques.

What Radiologist Should Know about MRI Translational Forces and Hazard: An Ex-Vivo Simulation of Retained Metallic Shrapnel.

Background In a country immersed in endless rounds of wars, retained metallic foreign bodies remain a significant dilemma in the daily practice of every Lebanese radiologist. When a shrapnel's hazard is of concern, the decision between performing or refusing a justified MRI exam is not always straightforward. In this small trial, we aimed to better understand the shrapnel's MRI safety by mimicking our daily practice. Methods Five shrapnel with an incremental increase in their long axis were put in an animal flesh and then introduced into a 3 T magnetic field. The behavior of each shrapnel was concretely assessed by performing before and after magnetic field exposure CT acquisitions. Results Translation along the z-axis ranged from 0.9 mm to 2.8 mm. Torque angle ranged between 2.8 and 54 degrees with an average of 15.62 degrees. Conclusions Shrapnel's movements in the magnetic field are not negligible during the acute phase of injury where there is no reinforcing fibroblastic reaction and invite us to reconsider the MRI safety of these metallic foreign bodies. Standard radiographs may be sufficient, but a targeted CT scan may be of better value for a confident decision for assessment of shrapnel position near viscera and major vessels.

Laparoscopic removal of an aberrant acupuncture needle in the gluteus that reached the pelvic cavity: a case report

BackgroundIntrapelvic aberrant needles are rare in clinical practice. Long-term foreign bodies in the abdominal cavity may form granulation tissue or an abscess, and may cause organ injury. Therefore, such foreign bodies need prompt removal.Case presentationA 26-year-old male athlete was referred to our hospital for investigation of an aberrant acupuncture needle in the gluteus. The needle was unable to be removed during acupuncture treatment, and the end broke off and remained in the gluteus. Abdominal X-ray examination showed a thin, 40-mm-long, metallic foreign body resembling an acupuncture needle. Abdominal computed tomography showed an abnormal shadow in the gluteus. However, it was unclear whether the tip of the needle reached the pelvic cavity. Thus, it was decided to surgically extract the needle via laparoscopic surgery under X-ray guidance as a safe and minimally invasive method. Although X-ray fluoroscopy confirmed that the aberrant needle was located in the gluteus, the needle could not be felt with the forceps, as the peritoneum surrounding the needle had granulomatous changes due to inflammation. Therefore, the retroperitoneum was further dissected to search for the needle. Once the needle was identified, its flexibility enabled it to be easily removed by grasping it directly with a needle holder. The length of the aberrant needle was 40 mm. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 2.ConclusionsWhen a foreign body remains in the gluteus and its tip touches intrapelvic organs, such as the rectum, it is critical to determine the best approach for its safe removal. Given the anatomical location of the foreign body and the patient background, laparoscopic removal was considered the best approach in the present case.

Foreign Body Nose: An Unusual Presentation

Introduction This is a very interesting case of retained homicidal foreign body in the nose in contrast to most of the foreign bodies which are accidental. Case Report A 27 year old male presented to ENT emergency with alleged history of assault over face with sharp object following which patient developed nasal bleed. On examination vertical laceration of approximately 8 cm in length was present along left naso-orbital groove extending superiorly from medial canthus of left eye and inferiorly to nasal alar cartilage. On anterior rhinoscopy a metallic foreign body was seen in both nasal cavities, which appeared to be crossing from left to right side piercing the nasal septum. Foreign body was removed via open approach. Discussion Penetrating maxillofacial injury with foreign body impaction are less common. High index of suspicion is required in diagnosing these cases. Radiological intervention should be done to get idea of exact location and extent of foreign body. Lateral rhinotomy is a useful approach in removing these foreign bodies.

Multiple metallic foreign bodies in the urethra

Multiple metallic foreign bodies in the urethra

When is the Appropriate Time for Superficial Corneal Metallic Foreign Body Removal?

When is the Appropriate Time for Superficial Corneal Metallic Foreign Body Removal?