Sharp Metallic Objects Research Articles

Death in the high mountains: Evidence of interpersonal violence during Late Chalcolithic and Early Bronze Age at Roc de les Orenetes (Eastern Pyrenees, Spain).

To test a hypothesis on interpersonal violence events during the transition between Chalcolithic and Bronze Age in the Eastern Pyrenees, to contextualize it in Western Europe during that period, and to assess if these marks can be differentiated from secondary funerary treatment. Metric and non-metric methods were used to estimate the age-at-death and sex of the skeletal remains. Perimortem injuries were observed and analyzed with stereomicroscopy and confocal microscopy. Among the minimum of 51 individuals documented, at least six people showed evidence of perimortem trauma. All age groups and both sexes are represented in the skeletal sample, but those with violent injuries are predominantly males. Twenty-six bones had 49 injuries, 48 of which involved sharp force trauma on postcranial elements, and one example of blunt force trauma on a cranium. The wounds were mostly located on the upper extremities and ribs, anterior and posterior. Several antemortem lesions were also documented in the assemblage. The perimortem lesions, together with direct dating, suggest that more than one episode of interpersonal violence took place between the Late Chalcolithic and the Early Bronze Age in northeastern Spain. The features of the sharp force trauma indicate that different weapons were used, including sharp metal objects and lithic projectiles. The Roc de les Orenetes assemblage represents a scenario of recurrent lethal confrontation in a high mountain geographic context, representing the evidence of inferred interpersonal violence located at the highest altitude settings in the Pyrenees, at 1836 meters above sea level.

Incidents of Complications after Reconstruction of Neglected Achilles Tendon Injury by Baker's Procedure

Introduction: Neglected Achilles tendon ruptures present a significant challenge in orthopedic surgery, with varied outcomes and complications. This study aims to evaluate the effectiveness of Baker's Procedure in the reconstruction of neglected Achilles tendon ruptures and to analyze the associated postoperative outcomes and complications. Methods: This prospective interventional study was conducted from January 1, 2012, to May 31, 2013, at multiple centers in Dhaka, Bangladesh. It included 42 patients aged 18 to 60 years with neglected Tendo-Achilles ruptures, defined as injuries untreated for over 4 weeks. Baker's Procedure, involving gastrocnemius aponeurosis advancement, was employed for reconstruction. Result: Of the 42 participants, 71.43% were male, with a mean age of 30.7 years. Injuries predominantly occurred in the right Achilles tendon (57.14%) and were mainly caused by sharp-metal objects (57.14%) and toilet-pan accidents (35.71%). Postoperative complications included stitch or wound infections (21.43%), pain (14.29%), stiffness (28.57%), and calf-muscle weakness (35.71%). Excellent, good, and fair outcomes were achieved in 64.29%, 21.43%, and 14.29% of patients, respectively. Conclusion: Baker’s Procedure is effective in reconstructing neglected Achilles tendon ruptures, with a majority of patients achieving excellent or good outcomes. However, the relatively high rate of postoperative complications, particularly infections, calf muscle weakness and stiffness, highlights the need for improved surgical and postoperative strategies. These findings underscore the importance of tailored.

Head Scarf Pin in the Airway and Challenges in Rigid Bronchoscopy: A Case Series.

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal.

Tic-“tack”-toe, out I go: A strategic implementation of flexible bronchoscopy in the removal of an aspirated thumbtack

Thumbtack aspiration is a medical emergency as the sharp end poses a risk of injuring the respiratory tract and potentially causing fatal complications. Its removal can be difficult, even under bronchoscopy guidance, as the sharp end can potentially lead to bronchial mucosal tears and perforation. We present a case of a 16-year-old male who was admitted following the unintentional ingestion of a thumbtack which was removed via flexible bronchoscopy. These sharp metal objects are commonly removed using rigid bronchoscopy, but removal by flexible bronchoscopy, although challenging, is still possible.

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes

PurposeTo evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract. Material and methodsData of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups. ResultsThe mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group. ConclusionTraumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.

Paediatric traumatic cataracts in Southwest China: epidemiological profile.

BackgroundPaediatric traumatic cataracts are an important but preventable cause of acquired blindness. Understanding the epidemiology of paediatric traumatic cataracts is a prerequisite for prevention. This study aimed to characterize the epidemiological profile of paediatric traumatic cataracts in southwest China.MethodsThe medical records of children (age range, 0–14 years old) who developed traumatic cataracts following open-globe injuries and were hospitalized at the Department of Ophthalmology at West China Hospital, between January 2011 and December 2020 were retrospectively analyzed. The demographic data, causes of injuries, posttraumatic complications, and visual acuity were recorded and analysed.ResultsA total of 716 eyes from 716 patients were analysed in this study, including 521 (72.8%) males and 195 females in a gender ratio of 2.67:1; 117 of the patients were of ethnic minorities. Paediatric traumatic cataracts occurred more frequently in winter (32.5%). Sharp metal objects (scissors/knives/needles/sheet metal/nails/darts) – induced ocular injuries accounted for the highest proportion, followed by botanical sticks (wooden sticks /bamboo sticks /bamboo skewers)-induced injuries, and then stationery items (pencils/pens/rulers/paper)-induced injuries. The majority (68.7%) of the patients were aged 2–8 years, and the peak range of age was 4 - 6 years. The injuries were a result of penetrating trauma in 64.9% of patients, and blunt force trauma in the remainder (35.1%). Additionally, 131 (18.3%) cases developed posttraumatic infectious endophthalmitis after injuries. Patients with eye injuries caused by needles (P < 0.001), wooden sticks (P = 0.016), and bamboo skewers (P = 0.002) were at a greater risk of developing infectious endophthalmitis. The most common identified foreign organism was Streptococcus, which accounted for 42% (21/50) of all culture-positive specimens and was sensitive to vancomycin. Among the children who were younger than 5 years, 44.4% (55/124) of those with traumatic cataracts presented a corrected distance visual acuity less than or equal to 0.1 after undergoing cataract surgery, but among the children who were older than 5 years, this proportion was significantly smaller, just 20.4% of children aged 6-10 years (P < 0.001) and 18.4% of children aged 11-14 years (P < 0.001).ConclusionThe main causative agents of paediatric traumatic cataracts in southwest China were sharp metal objects, botanical sticks, and stationery items. Specific preventive measures are essential to reduce the incidence of paediatric traumatic cataract.

Pediatric ocular trauma with pars plana vitrectomy in Southwest of China: clinical characteristics and outcomes.

To investigate the clinical characteristics and predictive factors of pediatric ocular trauma patients with vitrectomy. Pediatric ocular trauma patients (aged 14y or younger) who received vitrectomy in Southwest Hospital between January 2007 and December 2017 were reviewed retrospectively. Age, gender, mechanism of injury, final visual acuity (VA), and prognostic factors were analyzed. A total of 139 eyes in 139 pediatric patients were included in the study. The mean age was 7.4±3.7 years old and the male-to-female ratio was 5:1. There were 104 (74.8%) open globe injuries and 35 (25.2%) closed globe injuries. The top one traumatic eye injuries were penetrating injuries occur through sharp metal objects (43.9%). After vitrectomy, 116 patients had favorable anatomic outcome at the last follow-up, and 30 eyes (21.6%) achieved VA of 20/200 or better. Following univariate analysis, we found zone III injuries (P=0.021), poor initial VA (P=0.005), endophthalmitis (P=0.024), and recurrent retinal detachment (P<0.001) were poor prognostic factors for pediatric ocular trauma. After Logistic regression analysis, the poor initial VA (odds ratio: 8.276, 95%CI: 1.597-42.897, P=0.012) and recurrent retinal detachment (odds ratio: 6.455, 95%CI: 2.372-17.562, P<0.001) were significantly correlated with unfavorable vision outcome in pediatric ocular trauma. The treatment of vitrectomy for severe ocular trauma results in favorable anatomic outcomes, but VA improvement is not as good as anatomic outcomes. Initial VA and recurrent retinal detachment are the independent prognostic indicators for unfavorable visual outcome of severe pediatric ocular trauma.

Ultrasound diagnosis of reticular diaphragmatic hernia in bovines

ABSTRACT: A reticular diaphragmatic hernia is a congenital or acquired alteration resulting from protrusion of the reticulum into the thoracic cavity. In ruminants, lesions to the diaphragmatic muscle, due to penetration of sharp metallic objects, is the most common cause of this disease. Therefore, given the low number of reports on this disease in the bovine species, the current study aims to describe the clinical, laboratory, and anatomopathological findings, with special emphasis on the ultrasound diagnosis of five cattle with reticular diaphragmatic hernia. The laboratory data were analyzed using mean and standard deviation, and clinical, ultrasound, and pathological findings were evaluated using descriptive statistics. Clinically the animals exhibited varying degrees of dehydration, abdominal distension, tympany, and alterations in ruminal motility, in addition to cardiorespiratory alterations such as murmur, dyspnea, and muffling of lung sounds. The laboratory examination showed neutrophilic leukocytosis and hyperfibrinogenemia. The ultrasonographic images demonstrated reticulum inside the thoracic cavity adjacent to the lung and heart, although no reticular motility was observed. The pathological lesions confirmed the findings of the ultrasound exams. Thus, the current study demonstrated that ultrasonography was efficient in diagnosing reticular diaphragmatic hernia in the bovine species.

S3443 Recurrent Acuphagia: Endoscopy or Not?

INTRODUCTION: Acuphagia is uncontrollable ingestion of metal or sharp objects. It is a psychiatric disorder. Few cases of recurrent acuphagia are reported in literature. We describe the case of a 27-year-old lady with recurrent episodes and the dilemma faced in management. CASE DESCRIPTION/METHODS: 26-year-old lady with a past medical history multiple psychiatric disorders and an 8 year history of recurrent radio-opaque foreign body ingestion. She ingested a screw driver shaft and had previously ingested razor blades, 60 paper clips, spoons, bobby pins, pens, phone stylus. She required many esophagogastroduodenoscopies(EGDs) .Open laparotomy was done once for gastric perforation. Recurrent ingestion was related to craving anesthetic agents as a means of relieving anxiety. At review, her vital signs were stable. The foreign body was visualized on x ray and successfully removed from the stomach using a snare at EGD.Her medications were adjusted by psychiatry. She represented a month later after swallowing an unfolded paper clip confirmed on imaging. Due to lack of symptoms and adjudged low risk, EGD was not done, leaving her dissatisfied. DISCUSSION: Foreign body ingestion is more common in children compared to adults. Adult foreign body ingestion is increasing.(1) Recurrent intentional ingestion is more common in the elderly, prisoners and people with underlying psychiatric disorders.(2) Acuphagia is a form of pica, the consumption of non-nutritious substances. This patient had many psychiatric diagnoses. Most foreign bodies pass through the gastrointestinal tract spontaneously. Some require intervention. European guidelines recommend conservative management for asymptomatic patients with ingestion of small, blunt objects (except batteries and magnets)(3). Indications for endoscopy include symptomatic patients, ingestion of sharp or pointed materials, batteries, magnets and large substances. Those with complications, for example perforation, intestinal obstruction require surgery. Our patient required multiple upper gastrointestinal endoscopies. Although largely asymptomatic, she mainly ingested sharp metal objects that put her at a risk for perforation.Managing this patient was challenging due to multiple presentations. Medication readjustments to manage anxiety thereby preventing recurrences were not fully successful. The threshold for endoscopy was raised. Propofol is being avoided for endoscopy as much as possible as this was the specific agent she craved.Figure 1Figure 2

EXTRACTION OF SEWING PIN FROM LEFT LOWER LOBE USING RIGID BRONCHOSCOPY

SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aspiration of foreign bodies are potentially life-threatening. Eighty percent of foreign body aspirations occur in patients under fifteen years of age. Most frequently aspirated items are organic items, such as seeds and nuts (1). Among inorganic items, sewing and scarf pins are common. These items are held between the teeth commonly while working on crafts or adjusting clothes. Because of the vertical orientation, foreign bodies typically go to the right mainstem bronchus. Foreign bodies within the left lung are more difficult to access, resulting in more incidences of thoracotomy (2). CASE PRESENTATION: A 25-year-old female with no previous medical history presented to outside emergency room after accidental inhalation of a sewing pin while repairing pants. She was holding the pin in her mouth when she accidentally gasped, resulting in the inhalation of the pin. Initial imaging demonstrated the pin in the trachea. Flexible bronchoscopy was performed in the emergency room that led to the pin being advanced further into the lung, resulting in the transfer to our facility. Rigid bronchoscopy was performed at our center. After intubation, the rigid scope was carefully placed in the left mainstem bronchus. Using flexible bronchoscope, the foreign body was visualized within the posterior-basal segment of the left lower lobe. Using rigid forceps, the needle was pulled into the rigid scope, and the rigid scope was removed. Patient was intubated with a 7.5 mm endotracheal tube until the effects of sedation wore off. Later, she was extubated and discharged home in stable condition. DISCUSSION: Flexible and rigid bronchoscopy are fundamental for foreign body aspiration diagnosis and treatment. Complications from foreign body aspiration include pneumonia, bronchiectasis, obstructive emphysema, pulmonary abscess, pulmonary effusion, pneumo-mediastinum, atelectasis, vascular injury and granulation tissue formation (2). It is crucial, as shown in this case, to avoid pushing the foreign body distally during the extraction procedure. Aspiration of sharp metallic objects is best treated with rigid bronchoscopy (2, 3). If flexible bronchoscope is attempted initially, it should be done in a room equipped for definitive airway management and with rigid bronchoscopy immediately available which allows for better ventilation, visualization, and manipulation of the foreign body (4). Particularly with sharp object aspiration, the rigid bronchoscope allows the sharp tip to be secured inside the bronchoscope while removing it from the lungs, preventing mucosal injury (1). CONCLUSIONS: Aspiration of sewing and scarf pins to the left lower lobe creates distinct anatomical challenges making extraction potentially difficult. Removal of sharp foreign objects is best performed by a combination of flexible and a rigid bronchoscope. Reference #1: Ragab A. et al. Scarf Pins Sharp Metallic Tracheobronchial Foreign Bodies: Presentation and Management. Int J Pediatr Otorhinolaryngol 2007 May; 71(5):769-73. Reference #2: Fenane H. et al. Scarf pin inhalation: clinical characteristics and surgical treatment. J Cardiothorac Surg 2015; 10: 61 Reference #3: Baram A. et al. Scarf Pin-Related Hijab Syndrome: A New Name for an Unusual Type of Foreign Body Aspiration. J Int Med Res. 2017 Dec;45 (6): 2078-2084 DISCLOSURES: no disclosure on file for Fawad Chaudry; No relevant relationships by Taha Khan, source=Web Response no disclosure on file for Raza Khan; No relevant relationships by Jennifer Neff, source=Web Response

Differences between intentional and accidental ingestion of foreign body in China

BackgroundsPrevious reports of foreign-body ingestion focused primarily on accidental ingestion and very few studies focused on intentional ingestion of foreign body (FB) in China. Our study aimed to compare the prevalence of different age, gender, types, locations and management of FB ingested between intentional ingestion and accidental ingestion of FB in Northern China.MethodsA retrospective case series studied all patients with suspected FB ingestion in Digestive Endoscopy Center of Beijing Friendship Hospital, between January 2011 and January 2019. The patients were divided into 2 groups. Group A included the patients who intentionally ingested FBs, and Group B included the patients who accidentally ingested FBs. Patients’ database (demographics, past medical history, characteristics of FB, endoscopic findings and treatments) were reviewed. Statistical analyses were conducted using SPSS software.ResultsGroup A consisted of 77 prisoners, 2 suspects and 11 psychologically disabled persons. Group B consisted of 1020 patients with no prisoners, suspects or psychologically disabled persons. In Group A, there were no food-related foreign bodies, and the majority of FBs were metallic objects (54.44%). However in Group B, food-related FBs were the most common (91.37%). In Group A, 58 cases (64.44%) were located in the stomach, while in Group B, 893 cases (87.55%) were located in the esophagus (P < 0.05). 1096 patients successfully underwent endoscopic removal and 14 failed, including 9 cases in Group A and 5 cases in Group B. The duration of FBs impaction was longer in Group A than that in Group B (P < 0.05).ConclusionsIn our study, the patients who intentionally ingested FB were mainly prisoners, FBs were mostly sharp metallic objects, the duration of FBs impaction was longer, and the rate of successful endoscopic treatment was lower than that of the general population. Attention should be focused on these patients.

Endoscopic retrieval of magnetic foreign body ingestions with a nasal bridle: description of a novel technique (with video)

Accidental and intentional foreign body ingestions are common and frequently require endoscopic intervention. Sharp metallic objects pose a risk of perforation to the entire GI tract and are often difficult to visualize among food and other matter in the stomach. Three patients with histories of multiple ingestions are considered. Metallic foreign bodies can be easily removed using a nasal bridle. A snare and magnetic catheter are used as endoscopic tools to extract various metallic items. The bridle technique was used in 68 endoscopies in 3 patients who presented numerous times for foreign body ingestions. The technique was successful in 66 of the 68 procedures, with no adverse events. The bridle technique is an easy and effective way to remove metallic foreign bodies and has many advantages over traditional, mechanical modes of foreign body retrieval.

Plastic Pirates sample litter at rivers in Germany – Riverside litter and litter sources estimated by schoolchildren

Rivers are an important source of marine anthropogenic litter, but the particular origins of riverine litter itself have not been well established. Here we used a citizen science approach where schoolchildren examined litter at riversides and identified possible sources at over 250 sampling spots along large and small rivers in Germany, during autumn 2016 and spring 2017. Litter densities have an overall median of 0.14, interquartile range 0–0.57 items m−2 and an overall average (±standard deviation) of 0.54 ± 1.20 litter items m−2. Litter quantities differed only little by sampling year. The principal litter types found were plastics and cigarette butts (31% and 20%, respectively), followed by glass, paper, and metal items, indicating recreational visitors as the principal litter source. At many sites (85%), accumulations of litter, consisting principally of cigarettes and food packaging, have been found. At almost all sampling sites (89%), litter potentially hazardous to human health has been observed, including broken glass, sharp metal objects, used personal hygiene articles and items containing chemicals. In the search for litter sources, the schoolchildren identified mainly people who use the rivers as recreational areas (in contrast to residents living in the vicinity, illegal dumping, or the river itself depositing litter from upstream sources). These results indicate the urgent need for better education and policy measures in order to protect riparian environments and reduce input of riverine litter to the marine environment.

Traumatic Cataract in Children in Eastern China: Shanghai Pediatric Cataract Study

Traumatic cataract is a main cause of visual impairment in pediatric populations and is preventable. Awareness of the causes and consequences of pediatric eye trauma play roles in health education and prevention of blindness. We conducted a retrospective chart review based on 5-year clinical data of pediatric traumatic cataract cases treated at the Eye and Ear, Nose and Throat Hospital of Fudan University, Shanghai, China. Clinical features including demographic data, injury mechanism, and causative agents were analyzed. A total of 321 eyes of 321 children (male, 74.1%) were included. Penetrating injury accounted for 76.6% of all injuries; 65% of children with such injuries underwent their first surgery on the day of injury. The average age at injury was 6.3 ± 3.7 years, while the peak age was from two to eight years. The main causes of ocular injury were sharp metal objects, toys, and wooden sticks. The causative agent changed with increasing age; however, scissors were the leading cause within almost all age groups. Cataract surgery significantly improved visual acuity in children with traumatic cataract. These findings add information regarding the characterization of pediatric traumatic cataract in China and can help guide safety education and preventative measures.

Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency.

Foreign body ingestion is a common problem for which children present to the emergency department. The most common ingested foreign bodies among children are coins. Metal detector is an equipment, which measures a change in inductance of a coil when an electroconductive material is placed near it and produces an audio-visual signal. The present study was conducted to determine the effectiveness and feasibility of HMD in the local Pediatric population. This was a prospective study conducted in the pediatric emergency department among children presenting with history of foreign body ingestion. The outcome measured was presence or absence of metallic foreign body detected on handheld metal detector examination. During the study period, 36 patients with history of foreign body ingestion presented to the emergency department. Among these, 28 were metallic foreign body ingestions. Coins were the most common type of foreign body ingested. Among the metallic foreign bodies ingested, all the coins were accurately identified by the handheld metal detector. Non-coin metallic foreign bodies like metallic screw, needle and stapler pin were not identified by the handheld metal detector. The study demonstrates that handheld metal detector can be safely and reliably used as a screening tool in the process of detecting ingested coins. The plain radiograph still appears to be superior as it accurately localizes sharp metallic objects as well as cell batteries (button batteries) which need to be detected early and removed in order to prevent complications. Handheld metal detector is an effective tool that can be used in the follow up of patients to confirm whether the coin like metallic foreign body has been expelled. Handheld metal detector examination is more sensitive than traditional X-ray examination to detect radiolucent metallic foreign bodies like aluminium.

Great News from the West of England: Witchcraft and Strange Vomiting in a Somerset Village

This article looks the vomiting of pins, nails and other sharp metallic objects brought up in connection with English witchcraft trials, focusing on a particularly well-documented case in Selwood forest in the late seventeenth century. The strange vomiting is not an isolated behavior, however, or peculiar to the Selwood Forest case. At least twenty separate cases involving one or more victims of strange vomiting for the period up to 1689 survive in the English record and at least six more span the following three decades. At first sight these look like they might be seventeenth-century invention, but this article argues that they may not be. Through the juxtaposition of similar contemporary cases concerning the cause and character of the eating disorder commonly called “pica,” in particular in its manifestion as acuphagia, or the ingestion of sharp objects, it considers the possibility that at least some of the witchcraft cases involved deliberate ingestion of sharp metallic objects.

Liaison psychiatry: Its impact in an intrahospital treatment for a psychotic patient

Different manners of non-suicidal self-injuries are common ways to deliberately hurt oneself in order to aliviate suffering. It can be seen in various psychiatric affections. The ingestion of bizarre objects in psychotic patients is part of aggressive behaviour as a reaction to massive anxiety. We hereby present the case of a schizophrenic patient who presented to the Emergency Department for a second episode of ingestion of numerous metallic objects (screws, coins, knives, spoon, handles, …). Physical examination showed no abdominal guarding. CT scan revealed the presence of multiple metallic objects, which seemed impossible to go through the pylorus. Surgical transgastric extraction was performed. Outcome was uneventful. Patient was discharged and followed-up in a private structure. Three months later, the patient was readmitted for the same reason. Flexible endoscopy allowed this time complete extraction of the ingested objects. He recovered rapidly and was allowed to discharge from the surgical ward. The psychiatrist took decision with family to transfer him into a psychiatric hospital for the first time. His treatment was: chlorpromazine, Proton pump inhibitor, pain killers. Patient was treated by means of medication, psychotherapy, daily activities and family, preparation him for a day hospital.ConclusionWe discuss here the beneficial multifocal treatment of a 42-year-old man suffering from schizophrenia. The life threatening ingestion of sharp and other metallic objects three times in a year was treated surgically with success. The psychiatric affection including invalidating acoustic-verbal delusions and severe negative signs were treated in pcychiatric hospital. The definite results will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey.

To evaluate the epidemiologic, anatomic, and clinical features of open globe injuries in children. The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital's Department of Ophthalmology were retrospectively evaluated. A total of 90 patients were evaluated in this study. Among these patients, 26 (28.9%) were female and 64 (71.1%) were male. The mean age of the patients was 7.7±4.2 years. The male/female ratio was observed to increase with increasing age (P=0.006, r=7.48). Injuries were most likely to occur in spring and autumn (P=0.028). The time interval between the injury and the surgical repair was 9.36±27.4h. Forty (44.4%) of the injuries occurred in the home, 27 (30%) occurred in the yard, and 21 (23.3%) happened while playing in the street. The most common causes of injury were sharp metal objects (P<0.001). Injury to the cornea occurred in 47 (52.2%) of the patients (P<0.001). The most common complication to occur was cataract formation. Additional operations were necessary for 37 (41.1%) of the patients. The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound (P<0.001, r=0.502 and P<0.001, r=-0.442, respectively). Open globe injuries that are suffered in childhood generally occur either at home, in the yard, or on the street, with sharp metal objects being the most common cause of injury. The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.

Pediatric traumatic cataract and surgery outcomes in eastern China: a hospital-based study.

To evaluate the etiologies, management, and outcomes of pediatric traumatic cataract in eastern China. Pediatric traumatic cataract were reviewed for demographic information, type of injury, mode of injury, time of injury, interval between injury and first visiting doctors, hospital of first visiting, surgeries, complications and prognosis. A total of 117 eyes of 117 patients (96 boys and 21 girls) with unilateral injuries (66 right and 51 left eyes) were included in the study. The mean (SEM) age at diagnosis was (6.6±3.2) years (range, 1.3-13.8 years). Each cataract was categorized according to the type of trauma: closed-globe (n=26) or open-globe (n=91) injuries. The most common injuring objects were sharp metal objects (37.61%). The most common complication in open-globe injuries was corneal laceration, whereas traumatic mydriasis was most common in closed-globe injuries. Of 68 eyes in patients with open-globe injuries who received cataract extraction, intraocular lens (IOLs) were primarily implanted in 47 eyes (68.12%), whereas 18 eyes with closed-globe injuries received cataract extraction, and IOLs were primarily implanted in 17 eyes (94.4%). The surgical procedures included reconstruction of the anterior segment, synechiolysis, excision of the membrane, lensectomy, vitrectomy and related techniques. Postoperative vision was significantly improved compared with preoperative vision. Pediatric traumatic cataract should be treated in time to attenuate the complications, and education on pediatric traumatic cataract and improvements in pediatric health care are needed for the early detection of cataract in children.