1/18. Infusion port dislodgement of bilateral breast tissue expanders after MRI.Tissue expanders are placed routinely for breast reconstruction, and magnetic resonance imaging (MRI) is a common diagnostic procedure. Many studies have reported on the safety of MRI in patients with nonferromagnetic implants; however, many tissue expanders contain ferromagnetic components. The authors present a case of bilateral tissue expander infusion port dislodgment after MRI. A 56-year-old woman underwent bilateral mastectomy and immediate reconstruction with McGhan BIOSPAN tissue expanders. These implants contain integral nonferromagnetic infusion ports, as well as small, powerful Magna-Site magnets. Several weeks postoperatively the patient underwent MRI of her spine, which was ordered by her primary physician for back pain. Subsequently, the infusion ports could not be located with the finder magnet. A chest radiograph was obtained, which demonstrated bilateral dislodgment of the infusion ports. Surgical removal and replacement of the tissue expanders were required. safety considerations of MRI have been discussed extensively in the literature, and data on MRI with various implanted devices have been obtained. The potential risks of performing MRI on patients with metallic implants include conduction of electrical currents, heating of the implant, misinterpretation resulting from artifact, and the possibility of movement or dislodgment of the implant. The small magnet integral to many tissue expanders may be overlooked by patients and physicians during pre-MRI screening. All patients undergoing tissue expansion with implants that contain integral ports should be thoroughly warned about the potential hazards of MRI.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Complications associated with silicone intracanalicular plugs.PURPOSE: To assess American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) member physicians' experiences with complications associated with silicone intracanalicular plugs and publicize risks associated with this device. methods: Two case reports are presented. A survey was sent to 420 ASOPRS member physicians, questioning them on their experiences with complications associated with silicone intracanalicular plugs. RESULTS: We present two case reports of complications associated with migration of intracanalicular plugs. In the first case, a 41-year-old man underwent serial insertion of seven intracanalicular plugs in one eye over several years, he had a 3-month relapsing course of nocardia asteroides canaliculitis, dacryocystitis, and cellulitis requiring systemic antibiotics and multiple surgeries. In the second case, a 72-year-old woman had acute dacryocystitis, eventually necessitating dacryocystorhinostomy; at surgery, an intracanalicular plug was discovered in the lacrimal sac. One hundred fifty-nine usable survey responses were obtained. Sixty-one percent of respondents reported various complications including tearing, canaliculitis, and dacryocystitis. Fifty-one percent of respondents performed surgery to treat complications associated with silicone intracanalicular plugs. CONCLUSIONS: Silicone intracanalicular plugs may be difficult to remove and may be associated with significant lacrimal complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/18. An unusual intrapleural foreign body: ignored aspiration.A 54-year-old male patient was admitted to our department with fever, dyspnea and chest pain. Left pleural effusion and destroyed left lower lobe was noticed in his computerized chest tomography. After chest tube drainage, massive hemoptysis developed. An emergency thoracotomy was performed. A bronchopleural fistula, destroyed left lower lobe and the head of an oat were detected in the pleural space. Left lower lobectomy and perioperative pneumoperitoneum were performed. The patient had an uneventful postoperative (p.o.) course and was discharged on p.o. day 6. We present this case because of the rarity and to emphasize the clinical presentation. The physicians should be aware of life threatening complications of oat head aspiration.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/18. Misplacement of a right internal jugular vein haemodialysis catheter into the mediastinum.A 69-year-old woman with end-stage renal failure discontinued continuous ambulatory peritoneal dialysis and commenced temporary haemodialysis because of resistant peritonitis. Right internal jugular vein haemodialysis catheter placement was performed. The cuffed, tunnelled haemodialysis catheter was inserted using the modified Seldinger technique. When haemodialysis was initiated the following day, blood could not be aspirated from the catheter and the patient complained of central chest pain during the aspiration. Subsequent venography and computed tomography scan of the thorax showed that the catheter was placed extraluminally into the posterior mediastinum. The importance of a chest radiograph after placement of a central venous catheter is highlighted by this case report. Subtle deviations in catheter position from normal should alert the physician to the possibility of catheter misplacement and lead to further investigation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/18. ascites, pleural effusion, and CA 125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-meigs syndrome.BACKGROUND: The combination ascites, pleural effusion, and elevated CA 125 are usually associated with a malignancy. CASE: A 38-year-old SLE patient consulted her physician for shortness of breath. On clinical examination, she had a tender abdomen and reduced breathing sounds. X-ray and computed tomography of the chest showed pleural effusion. An adjustment of her SLE maintenance therapy was performed. Vaginal ultrasound and computed tomography of the abdomen revealed massive ascites and an intracavitair myoma of 2 cm, but no obvious mass in the pelvis. CA 125 was 887 U/ml. A laparoscopy was performed showing ascites and 2 Filshie clips embedded in the peritoneum of the vesicouterine pouch, but no sign of malignancy. Both clips were removed. The cytology of the aspirated ascites showed sings of acute inflammation. Within 10 weeks, the pleural effusion was resolved and the CA 125 normalized. CONCLUSION: The combination of ascites, pleural effusion, CA 125 elevation, and no tumor in an SLE patient is either a Tjalma syndrome or due to the migrated Filshie clips a pseudo-meigs syndrome.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/18. Christmas surprise: the unnoticed journey of a needle-from bronchus to intestine.We report on a 14-year-old Arabian girl who suddenly developed coughing after having aspirated a needle used for fixing her headscarf. The chest X-ray showed the needle located in the right main bronchus. However, subsequent flexible bronchoscopy could not detect any foreign body. A further X-ray of the abdomen showed the needle now behind the diaphragm. Gastro-oesophageal endoscopy was also uneventful. On the third day, the needle was excreted naturally. Astonishingly, this journey of the wandering needle from bronchus to intestine was not realised by the patient at any time. Our case highlights that children and adolescents should be warned repeatedly about the risks of putting needles between their teeth. It also reminds the physician to diagnose aspirated foreign bodies as early as possible to prevent wandering and migrating, which may induce new risks and unnecessary diagnostic and therapeutic procedures.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/18. Catheter embolism.With the increasing utilization of intravenous catheters, complications from their use may be anticipated. We report the case of one such complication, a venous catheter fragment embolization. A review of the literature addressing catheter embolization is provided. Specific recommendations are offered to the emergency physician in an effort to minimize such untoward occurrences.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/18. Taser dart ingestion.The Taser is a relatively new electronic self-defense and immobilization weapon used by the public and by law enforcement agencies. Taser victims characteristically have an altered mental status due to drug ingestion or primary psychiatric illness. An unexpected case of Taser-associated morbidity, that of voluntary Taser dart ingestion in a patient with paranoid delusions, is reported. Near mismanagement due to unfamiliarity with the Taser occurred. Recommendations for diagnosis and management are discussed. The emergency physician should be aware of the potential of this unusual ingestion.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/18. Peanut shell colitis.A 40-year-old physician experienced abdominal pain, loose stools, hematochezia, and anal discomfort with defecation associated with the daily consumption of 15 to 30 whole peanuts, including the shells. Thorough evaluation revealed only nonspecific colitis of the distal portion of the sigmoid colon and inflamed hemorrhoids. Discontinuation of whole peanut ingestion was associated with symptomatic, endoscopic, and histological resolution. In this patient, undigested peanut shells seem to have caused a nonspecific colitis, perhaps as the result of mechanical abrasion of the colonic mucosa.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/18. Occult foreign bodies of the foot.This article illustrates several case reports of occult foreign bodies of the foot. The patients came for treatment from weeks to years after the inciting incident with chronic, sterile, draining wounds. The diagnosis of these foreign bodies can be quite difficult. Several radiographic and clinical clues are included, yet the single most valuable tool for the physician remains a high index of suspicion.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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