Persistent Foreign Body Research Articles

Aspergillus Endophthalmitis Secondary to Infectious Scleritis: Utility of Diagnostic PCR.

To describe a case of delayed-onset Aspergillus fumigatus endophthalmitis secondary to infectious fungal scleritis diagnosed with broad range polymerase chain reaction (PCR) from scleral nodular debridement and vitreous sampling during vitrectomy. Retrospective case report with slit lamp photography, optical coherence tomography, and fundus photography. A 76-year-old man presented with right eye worsening vision and pain concerning for progressive nodular scleritis and endophthalmitis eight months following a reportedly innocuous tree branch injury. Following the injury, he underwent an MRI, surgical exploration, subconjunctival antibiotic administration, and culturing due to persistent foreign body sensation. Cultures were negative, and the patient was started on oral NSAIDs, oral prednisone, and periocular triamcinolone injections following negative/normal infectious and rheumatologic workup for scleritis. The patient was referred for worsened scleritis with development of endophthalmitis. He underwent lamellar sclerectomy, debridement, and culture of purulent material from scleral nodules in coordination with diagnostic vitrectomy, vitreous sampling, and subconjunctival and intravitreal antibiotic and antifungal treatment. Broad range PCR was positive for Aspergillus fumigatus and targeted antifungal treatment initiated. The eye did not regain visual function and was enucleated for progressive pain six months following diagnosis. Fungal scleritis and endophthalmitis results in significant morbidity. Diagnostic vitrectomy and broad range PCR can aid in prompt diagnosis and targeted treatment, and may be useful in refractory cases.

The role of foreign body response in peri-implantitis: What is the evidence?

Historically, there has been broad consensus that osseointegration represents a homeostasis between a titanium dental implant and the surrounding bone, and that the crestal bone loss characteristic of peri-implantitis is a plaque-induced inflammatory process. However, this notion has been challenged over the past decade by proponents of a theory that considers osseointegration an inflammatory process characterized by a foreign body reaction and peri-implant bone loss as an exacerbation of this inflammatory response. A key difference in these two schools of thought is the perception of the relative importance of dental plaque in the pathogenesis of crestal bone loss around implants, with obvious implications for treatment. This review investigates the evidence for a persistent foreign body reaction at osseointegrated dental implants and its possible role in crestal bone loss characteristic of peri-implantitis. Further, the role of implant-related material release within the surrounding tissue, particularly titanium particles and corrosion by-products, in the establishment and progression in peri-implantitis is explored. While it is acknowledged that these issues require further investigation, the available evidence suggests that osseointegration is a state of homeostasis between the titanium implant and surrounding tissues, with little evidence that a persistent foreign body reaction is responsible for peri-implant bone loss after osseointegration is established. Further, there is a lack of evidence for a unidirectional causative role of corrosion by-products and titanium particles as possible non-plaque related factors in the etiology of peri-implantitis.

A man with difficulty dysphagia

A 50-year-old man with history of type II diabetic mellitus attended the emergency department with persistent foreign body sensation after swallowing a drug pill. He also had mild odynophagia. Tracing his history, it was found that he had progressive dysphagia in previous 2 months. There was no coughing or choking immediately after swallowing the pill and speech quality was normal. He denied weight loss in last 6 months. On physical examination, no palpable mass or thyroid goiter was noted. Laboratory data were in acceptable range. A point-of-care ultrasound with a linear probe over the patient’s neck was done. Later, computed tomography was done for confirming the diagnosis.

Influence of the geometry of 3D printed solid oral dosage forms on their swallowability

3D printing can be used to realise a wide variety of geometries of oral dosage forms. In this work, the swallowability of 3D-printed dosage forms with comparable size and different shape using fused deposition modelling (FDM) from isomalt was investigated in a controlled, randomised crossover study design. To produce the required number of dosage forms, a commercial 3D printer was modified with regard to product safety and production time. The modifications carried out permit the printing of 4 pharmaceutical forms simultaneously as well as the printing of rigid filaments.Six 3D-printed placebo objects and two compressed placebo reference objects were tested by 12 subjects in a blinded design. A questionnaire was used to assess swallowability, foreign body sensation at the moment of swallowing, persistent foreign body sensation after swallowing and pain after swallowing. Furthermore, the amount of additional water drunk after administration was documented. With the modified printer, the required 576 test objects could be printed within a few days with good reproducibility. In all questions, the best results were obtained for the printed and compressed oblong tablets, followed by the printed and compressed round tablets, the football and the sphere. The worst results were obtained for the pyramid closely followed by the cuboctahedron. The study shows that the variety of shapes of oral dosage forms made possible by 3D printing needs to be tested in swallowability studies, as not every shape is also easy to swallow.

A clinical profile of revision cochlear implant surgery: MERF experience

Objective: To study the prevalence of revision cochlear implant study in a tertiary care referral center. To assess the various indications and surgical outcomes of revision cochlear implant surgery. Methods: A retrospective chart review of revision cochlear implant surgery done from June 1997 to December 2019. All the surgeries that were done in children of 12 years and below were included. The revision surgeries were either with or without explantation and reimplantation. The causes included were device failures, electrode extrusion/malposition, magnet migration, persistent foreign body reaction, facial twitching, wound infection, and cholesteatoma. Results: A total of 1636 pediatric cochlear implantation surgery were performed during the study period of 22 years. There were 94 (5.7%) revision surgeries done for various indications during this period. Out of them, 67 patients (71.3%) had device failure thus being the commonest indication for revision surgery, followed by infection in 12.8% of the total patients. Among the total revision, 81 (86.2%) patients had explantation and reimplantation of the new device. Conclusion: Indications of revision cochlear implant surgery are manifold that can be either device-related or patient-related. Revision surgery needs a highly skilled and experienced team of surgeons, audiologists, and habilitationists for achieving optimal results.

8. Modifiable polymer promotes a pro-osteogenic, M2-like macrophage phenotype and osteoblastic differentiation of progenitor cells

8. Modifiable polymer promotes a pro-osteogenic, M2-like macrophage phenotype and osteoblastic differentiation of progenitor cells

A Pediatric Foreign Body Appendicitis Can Cause a Pitfall in Imaging

Although foreign body (FB) ingestion is common in childhood, most cases do not have any clinical significance. Radiologic evaluation is crucial to determine the exact location of a persistent foreign body because it dictates the therapeutic approach. In this case report, we present a child with appendiceal perforation caused by a FB and emphasize pitfalls in preoperative imaging assessment. A 3-year-old boy presented with subtle abdominal pain duration for three months. The preoperative imaging examinations were consistent with an intraluminal metallic pin. However, the operative findings and postoperative pathological examination showed that the pin perforated the appendiceal wall, causing chronic inflammatory changes with an omental reaction around the extraluminal part of the pin. The patient underwent appendectomy with an uneventful course. Foreign body is a rare cause of appendiceal perforation with resultant appendicitis. Imaging may reveal some clues regarding the location, but the interpretation of radiologic data could be quite challenging.

An Elusive Fishbone: The Role for Repeat Imaging and Rigid Endoscopy

Accidental ingestion of fish bones with fear of oropharyngeal or esophageal impaction is a common emergency room presentation. Only 20-30% of patients, however, will have a confirmed retained fish bone. Sharp objects in the esophagus are a medical emergency given the risks of potentially fatal complications to include esophageal perforation, bacteremia, abscess and esophageal-aortic or tracheoesophageal fistula formation. Radiographic studies are recommended to localize foreign bodies as well as to evaluate for signs of perforation. We present a 50-year-old female with CT images confirming a fish bone impacted in the cervical esophagus despite normal flexible endoscopy. Our aim is to highlight the elusive nature of impacted fish bones and their appropriate management. A 50-year-old female with history of anxiety and dysphagia, presents with a suspected retained fishbone and odynophagia. She had a normal EGD one year prior to presentation. The patient was uncomfortable and drooling with a persistent foreign body sensation. An oral exam did not reveal any foreign bodies. A CT scan confirmed a 2.7cm linear density with a punctate focus of air. Otolaryngology performed a flexible laryngoscopy but did not identify the bone or any signs of trauma. Gastroenterology was then consulted for an EGD which was unremarkable. A repeat CT scan confirmed the bone had not passed and was still in the proximal esophagus. Rigid endoscopy was subsequently performed with successful removal of a 2.7 cm fish bone buried in the right posterolateral cervical esophageal wall. The patient was admitted, started on prophylactic antibiotics, and was discharged home the next day without complications. The majority of fish bones will become lodged in the oropharynx, posterior tongue, pyriform sinuses or cervical esophagus. Traditionally, impactions in the cervical esophagus and oropharynx can be removed with flexible endoscopy. Our case demonstrates the value of repeat imaging and potentially rigid endoscopy when flexible endoscopy fails to localize or remove a foreign body. Given the elusive nature of fish bones and the significant potential complications of this condition, providers should maintain a high index of suspicion even with negative flexible endoscopy.Figure 1Figure 2Figure 3

Large pore size and controlled mesh elongation are relevant predictors for mesh integration quality and low shrinkage – Systematic analysis of key parameters of meshes in a novel minipig hernia model

BackgroundProsthetic mesh implants in hernia repair are frequently used based on the fact that lower recurrence rates are detected. However, an undesirable side effect is persistent foreign body reaction that drives adhesions and shrinkage among other things in the course of time. Thereby a variety of meshes have been created in an attempt to alleviate these side effects, and particular relating to shrinkage, the ideal mesh has not been developed. Large pore size is one of the properties to get better ingrowth of the implants but could also be a risk factor to shrinkage behavior. The aim of this preclinical study was to determine optimal pore size based on mesh integration and shrinkage in a hernia minipig model. MethodsTwenty female minipigs were each implanted at four abdominal retromuscular sites with meshes (designed and knitted specifically for this study) that had various weights and pore sizes, but similar weave. At 3 and 21 weeks post-operation, ten pigs each were euthanized. Mesh integration and shrinkage were evaluated through macroscopic observation, biomechanical testing and histopathological analysis. ResultsThe large pore meshes (6.1–6.6 mm2) showed significantly better integration than small pore (0.9–1.1 mm2) counterparts, by biomechanical testing and histological assessment. This was independent of mesh weight. The lightweight small pore mesh exhibited significantly more shrinkage than any of the other meshes, while the three-dimensional heavyweight large pore mesh exhibited the least shrinkage. Mesh shrinkage and elongation at 50 Newton (N) as one parameter of the implant structural stability appeared to be strongly interrelated. ConclusionTissue ingrowth of meshes depends on increasing pore size. Macroporous mesh design >1.5 mm diameter appears to be optimal in terms of mesh integration. Lightweight meshes with a large pore size on one hand and a lack of structural stability on the other hand drives mesh shrinkage. High stretchability (Elongation >50 N) induces higher shrinkage and therefore elongation at 50 N appears to be a new parameter to estimate mesh shrinkage. Three-dimensional mesh constructions relate to the lowest shrinkage behavior caused by higher structure stability.

Thygeson’s Superficial Punctate Keratitis- Case Report and Review

Thygeson's superficial punctate keratitis is a subtle, chronic and bilateral condition of the corneal epithelium, typically manifests with acute exacerbations and remissions. The etiology remains uncertain, despite the possibility of viral etiology was suspected. Topical steroid administration is useful in aborting an acute phase; but steroid induced cataract and glaucoma developed on long term usage. Topical cyclosporine A was used successfully for prolonged periods with minimal ocular surface irritation. The purpose of this case study was to highlight the importance of diagnosing the problem clinically and also to report efficacy and ocular side effects of topical cyclosporine A. Twenty six year old boy presented with persistent foreign body sensation in July 2011, since one month in both the eyes. Slit lamp microscopic examination revealed bilateral, multiple and punctate corneal epithelial lesions. The lesions resolved on topical steroids but recurred after cessation of the therapy. With the daily instillation of topical cyclosporine A, recurrence was not observed in two year follow up. Although topical steroid was useful in aborting an acute phase, the disease remitted on cessation of the therapy. Topical cyclosporine A, used for two years was effective in controlling the exacerbations without discernible ocular side effects. 1.2 Thygeson's superficial punctate keratitis is essentially an objective opinion with other investigations proven to be discouraging. The disease manifests bilaterally with irritation, photophobia, excessive watering, and foreign body sensation and on occasions, with visual disturbances in the acute phase. The purpose of presenting the present case report is to highlight the importance of diagnosing the disease clinically by excluding the other causes that produce punctate epithelial lesions. And also to find out the efficacy of cyclosporine A on long term usage and its complications. The clinical findings and management in this section were correlated and discussed with the currently available literature.

Intense FDG Uptake around the Inguinal Surgical Mesh 5 Years after Operation: Case Report and Review of the Literature

We present the case of a 40-year-old man who underwent a FDG PET/CT study for restaging of renal cell carcinoma treated with left nephrectomy, for suspected metastasis in lung and retroperitoneal lymph nodes. The patient had a history of left inguinal hernia repair with implantation of mesh prosthesis 5 years ago. PET/CT image revealed linear intense FDG uptake in left inguinal region most likely corresponding to a persistent foreign body reaction. In this article, a case with an intense FDG uptake around mesh prosthesis after many years was reported, and a summary of the literature about surgical mesh and foreign body reaction causing FDG uptake was reviewed.Conflict of interest:None declared.

Needle in the haystack purulent pericarditis from injection drug use

Central needle embolization is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Previously reported cases of needle embolization to the heart have been managed conservatively (observation alone) or by surgical intervention. We report a case of purulent pericarditis without evidence of valvular vegetations resulting from an embolized, infected needle fragment. In the present case, the needle was successfully removed from the right ventricle percutaneously. This case illustrates the unique finding of purulent pericarditis due to a persistent foreign body in the right ventricle, and the nontraditional intervention performed for needle fragment removal which resulted in full clinical recovery of the patient.

Antibacterial Properties Of Artificial Eyes Containing Nano-sized Particle Silver

Background: The long-term use of an artificial eyes can lead to complications. Persistent physical stimulation and foreign body contact cause secondary infections. Secondary infection is an important complication after the placement of a artificial eyes and may be difficult to control without removing the artificial eyes. Because of these complications, patients get difficulties to wear prosthesis. Furthermore artificial eyes can change the normal bacterial flora of the patient’s conjunctiva. Such postoperative infections might be overcome by improving the antimicrobial properties of the prosthesis surface. Methods: The space in the mold previously occupied by wax was filled with polymethyl methacrylate (PMMA) resin containing silver at a concentration of 300–700 ppm (parts per million) and the prosthesis was then heat cured. Microorganisms were grown on the treated and control surfaces. We cultured for 24 hours, then counted the number of bacteria in resin compositions containing nano-sized silver particles and controls (Stomacher 400® POLY-BAG). Results: The surface of the artificial eye containing silver grew significantly fewer Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli on in vitro bacterial cultures. The antimicrobial activity was 4.8–6.2 times stronger than for the controls. The numbers of bacteria decreased by 99.9% using the PMMA resin containing silver. Conclusion: The artificial eyes containing silver that were produced in this study have antibacterial activity, cause little eye discharge, and emit far-infrared rays and anions, all of which promote the ocular health of the person wearing the artificial eye.

Baerveldt Tube Implantation After Bleb Dysesthesia: Case Report

Purpose: To report a case of bleb dysesthesia successfully treated after Baerveldt tube implantation. Case summary: A 37-year-old woman presented with a history of persistent foreign body sensation and pain in the left eye. The patient was referred to our hospital and was diagnosed as having had plateau iris syndrome. Having shown no improvement with conservative management, she eventually received trabeculectomy in the left eye six months prior to her current presentation. Under the impression of bleb dysesthesia, she received artificial tears and a bandage contact lens. These, however, failed to alleviate her symptoms. She then had a compression suture of the bleb and bleb revision. These were performed sequentially but neither was effective. Finally, a Baerveldt tube implantation was performed successfully, and, three months later, bleb revision was performed using a donor sclera, which resulted in no further complaint of ocular discomfort. Conclusions: Bleb dysesthesia, although not a common postoperative complication, can occur after trabeculectomy and can be successfully treated with Baerveldt tube implantation. Patients should receive appropriate counseling and advice on bleb dysesthesia prior to undergoing trabeculectomy.

Esophageal Food Disimpaction: But Doc, I Still Feel a Bone Stuck in My Throat

Purpose: Esophageal food impaction is a distressing condition requiring urgent endoscopic intervention. Meat with or without a sliver of bone seems to be the most common offending agent. It is not uncommon for patients to have persistent discomfort and a foreign body sensation in the throat despite disimpaction. It is usually accounted for trauma pertaining to the length of time the bolus was lodged and the characteristics of the food bolus itself. Therapeutic endoscopic intervention itself may result in trauma also. It is usually treated conservatively with throat lozenges or other topical therapies and usually improves with time. A 45 year old male presented to the local community hospital with a food impaction 12 hours after ingesting boneless grilled pork-chops. Although overnight, the food bolus seemed to have passed; he still continued to have a foreign body sensation in his throat as if a bone was stuck even though he ate boneless pork-chops. Urgent endoscopy revealed no evidence of food bolus but patches of erythema in the oropharynx, epiglottis and the cricopharyngeus. No strictures or webs were encountered. Careful evaluation of the area revealed a 2 cm long thin metal wire lodged behind the epiglottis. This was removed with a biopsy forceps with significant technical difficulty. It was later determined that this represented a piece of the wire brush that was used to clean the grill. This wire must have adhered to the boneless meat that was grilled. Conclusion: 1. The presence of a persistent foreign body sensation despite disimpaction of the meat bolus makes it imperative for the endoscopist to spend extra time to look for any other foreign objects which may have potential serious consequences, in this case a piece of metal wire. 2. Consideration should be given to soft tissue x-rays of the neck to look for any metal or opaque objects if endoscopy is unrevealing.

Histological Inflammatory Response to Transvaginal Polypropylene Mesh for Pelvic Reconstructive Surgery

We prospectively evaluated the histological inflammatory response to the large polypropylene transvaginal mesh used for pelvic organ prolapse surgery. Ten patients and 8 controls underwent vaginal punch biopsy sampling before surgery and patients also underwent it 1 year after pelvic reconstructive surgery using polypropylene mesh. Foreign body response to the mesh was assessed using a combination of histological, semiquantitative and computerized image based analysis. Compared to preoperative histology there was a significant postoperative increase in macrophage and mast cell counts (p = 0.03 and 0.01) but no significant changes in the count of cells involved primarily in the infectious cell response or collagen density and the elastin area fraction at the mesh-tissue interface (p = 0.2 and 0.3, respectively). Three cases of mild granuloma formation and 2 of mild erosion were observed. There was no significant change in epithelial thickness when comparing preoperative and postoperative samples. When used for pelvic reconstructive surgery, macroporous monofilament polypropylene mesh induces a mild but persistent foreign body reaction.

Foreign body ingestion: comparison of diagnostic accuracy of computed tomography versus endoscopy

To investigate and compare the sensitivity and specificity of computed tomography and of endoscopy, as diagnostic tests for foreign body ingestion. Over a two-year period, Asian patients with suspected foreign body ingestion were studied. The clinical findings, computed tomography images, endoscopic results, treatment and outcomes were prospectively analysed. Over the study period, 193 patients were admitted for foreign body ingestion, complaining of a persistent foreign body sensation in the neck. The sensitivity and specificity of computed tomography were 78 and 96 per cent, respectively; the positive predictive value was 75 per cent and the negative predictive value 97 per cent. The diagnostic accuracy of computed tomography was 94 per cent. Our study showed that computed tomography had high negative predictive value and accuracy in the diagnosis of foreign body ingestion. It was useful if endoscopy showed negative findings but the patient still had persistent symptoms of foreign body ingestion.

Carbon band implants in animal experiments. Light and transmission electron microscopy studies of biocompatibility

Part of the patella ligament was resected in rabbits and replaced by carbon fibre implants. After 1, 2, 3, 6 weeks, 3 and 12 months carbon implants with surrounding tissues as well as iliac lymph nodes were removed and examined by light- and transmission electron microscopy. Of special interest were the questions whether the carbon fibre implant, will be removed by phagocytosis and substituted by a new ligament or a adequate repair tissue? Our light- and transmission electron microscopic studies give no indication of successful removal of carbon fibres by phagocytosis. The carbon fibre implant was surrounded by dense connective tissue like a scar. In deep layers of the carbon implant was no vital dense or regular connective tissue, even not after 3 and 12 months. There is no replacement of the carbon fibre implant by a new ligament or tendon but a persistent foreign body reaction. With regard to these results it is very doubtful if good late results with ligament and tendon replacement by carbon fibre implants can be expected in patients.

Effects of Round Window Dexamethasone on Residual Hearing in a Guinea Pig Model of Cochlear Implantation

To study electric acoustic stimulation, we have developed a model of guinea pig cochlear implantation via a cochleostomy. Thirty minutes prior to implantation, a hyaluronic acid/carboxymethylcellulose bead, loaded with either dexamethasone or normal saline, was placed upon the round window membrane. Animals that did not receive beads acted as controls. Pure-tone auditory brainstem response thresholds were estimated before and after electrode insertion, and 1 and 4 weeks later. Selected cochlear histology was performed. Results: Dexamethasone could be detected in the cochlea for 24 h after cochlear implantation. Thresholds were elevated across frequencies in all animals immediately after surgery. These thresholds recovered completely at and below 2 kHz, and partially at higher frequencies by 1 week after implantation. At 32 kHz, but not the lower frequencies, the presence of dexamethasone had a significant protective effect upon hearing, which increased in magnitude over time. The protection was greatest in difficult implantations where an intractable resistance to electrode insertion was met. There was a persistent foreign body reaction at the site of implantation of saline-treated implanted ears but not in the dexamethasone-treated implanted ears. Conclusion: Short-term preoperative delivery of dexamethasone through the round window can protect residual hearing during cochlear implantation, especially during technically difficult surgery.

Pulmonary Toxicity of Expancel® Microspheres in the Rat

Expancel microspheres are thermoplastic microspheres enclosing hydrocarbon. These microspheres expand when heated, producing many applications. Because they have unknown biological persistence and toxicity, we investigated the toxicity of two unexpanded (11.1 and 15.4 micro m mean diameter) and two expanded (3.1 and 5.5 micro m mass median aerodynamic diameter) Expancel microspheres in intratracheally-instilled, male, Sprague-Dawley rats. Pulmonary histopathology was evaluated at 28 days postexposure. Bronchoalveolar lavage fluid was evaluated at days 1, 7, 14, and 28 days postexposure. Crystalline silica was the positive control. By histopathology, both unexpanded and expanded microspheres caused granulomatous bronchopneumonia characterized by macrophages and giants cells, suggesting a persistent foreign body response. Expanded, but not unexpanded microspheres, also caused eosinophilic bronchitis and bronchiolitis, mucous metaplasia of airways and organized granulomatous inflammation with associated fibrosis and frequent airway obstruction. In contrast, alveolar macrophage activation, polymorphonuclear leukocytes, LDH and albumin in bronchoalveolar laveage fluid were initially elevated but returned to near control levels at 28 days, and did not reflect the persistent granulomatous bronchopneumonia caused by Expancel microspheres. These findings emphasize the importance of histopathology for evaluating pulmonary toxicity, suggest that Expancel microspheres are a potential occupational hazard, and indicate a need for additional studies on their potential pulmonary toxicity. [Supplementary materials are available for this article. Go to the publisher's online edition of Toxicology Pathology for the following free supplemental resources: motion within unexpected microspheres in H&E-stained lung (supplementary Figure 1); broncholar epithelium 28 days following exposure to 551 DE 20 microspheres (supplementary Figure 2); membrane ruffling and some instances of phagocytosis within the microspheres (supplementary Figure 3)]