1/5. Pediatric eye injury due to Avena fatua (wild oats).OBJECTIVE: We report on florid and unusual ophthalmic physical signs in three children where the trauma was caused by seeds from Avena fatua, a grass common in western north america. DESIGN: Case series and literature review. SETTING: Three local emergency departments (ED) during the fall of 1998. patients OR PARTICIPANTS: Three children reporting to an ED with an acutely painful eye from which the foreign body was identified botanically as Avena fatua. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Symptoms, interventions, duration of problem. RESULTS: Three male children (6, 10, 14 years) presented separately following incidents in which they had sustained direct eye injury. Each child immediately experienced severe pain and profuse watering of the eye. Severe localized edema of the conjunctiva and inflammation was evident with conjunctival vessel injection leading to bleeding, reminiscent of a chemical "burn." Initially, two children appeared to have an eyelash caught behind the lower lid. In both instances, the emergency physicians initially dismissed the possibility of there being a significant foreign body, but because of the severity of the pain, conjunctival vessel injection, and edema, they attempted to remove the "lash." Removal of the foreign body proved difficult in all three cases, requiring far greater traction than anticipated. Intact seedpods had become embedded in the subconjunctival space. Ophthalmic analgesia relieved the pain immediately, but in one child who was treated with topical antibiotic alone, significant pain was experienced for 18 hours, until steroid-antibiotic therapy was instituted. All injuries occurred in late summer when the grass propagates. CONCLUSIONS: The physical signs of scleral vasculitis and conjunctival edema can be mistaken for chemical injury or allergic chemosis, but where a foreign body resembling a hair or eyelash is visible, the presence of a seed-pod retained in the subconjunctival space must be considered, particularly if the patient reports exposure to wild grass. Application of local analgesia, foreign body removal, and steroid-antibiotic treatment is recommended.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Synovial metaplasia, a specialized form of repair.Synovial metaplasia is a change seen most frequently in the tissues surrounding silicone breast prostheses and in healing tissue adjacent to joint prostheses. It has also been described in skin and soft tissues, most frequently in healing or healed traumatic or surgical wounds. We report a case of synovial metaplasia occurring in a hitherto unreported location, namely, adjacent to a silicone low-pressure voice prosthesis. A review of cases of synovial metaplasia reported in the literature revealed that in most cases, spaces that form adjacent to foreign material (most commonly silicone breast prostheses) and the smooth gliding surfaces of the foreign material that resist penetration by fibroblast processes are frequent associated findings that precede the occurrence of synovial metaplasia. Thus, synovial metaplasia might represent a specialized form of healing in cases that have this combination of physical features.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
3/5. meningitis caused by mycobacterium fortuitum.A previously healthy 16-yr-old Caucasian male developed a relapsing purulent meningitis shortly after a motor accident in venezuela, in which he received a small wound with a retained foreign body in the sacral region. Repeated initial physical examinations, radiographs of lumbar and sacral regions, and contrast myelography failed to demonstrate a cerebrospinal fluid leak or bone involvement, and mycobacterium fortuitum was repeatedly isolated from the cerebrospinal fluid. Finally, from the originally "cured" lumbar wound a purulent material was obtained from which M. fortuitum was also isolated. A retained foreign body was removed, and an abscess and fistulous tract were incised and drained. The patient responded dramatically to the combination of isoniazid plus co-trimoxazole and surgery.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/5. Thorn-induced non-specific granulomatous left biceps myositis with left subareolar lymphadenopathy.In surveying the pediatric and orthopedic literature, very little has been written about foreign bodies in skeletal muscle or muscle tissue inflammation in response to foreign bodies. When it is known that a foreign body has penetrated the muscle or if it is externally visible, there is no diagnostic problem. However, this can become a perplexing problem when history and physical examination are not clearly diagnostic. We present a case in which a thorn penetrated the left biceps muscle of a 10-year-old girl. The thorn remained there for 3 weeks without disturbing the child. It produced a local sterile granulomatous reaction in the muscle. Two weeks later, left subareolar lymphadenopathy appeared with no involvement of the axillary lymph nodes.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
5/5. Unilateral axillary adenopathy secondary to a silicone wrist implant: report of a case detected at screening mammography.At routine screening mammography, asymmetrically enlarged left axillary lymph nodes were seen in a healthy 70-year-old woman. Ultrasound (US)-guided fine-needle aspiration biopsy of the largest node revealed a foreign body reaction. The patient recalled a previous silicone implantation in her wrist. On the basis of cytologic study, normal findings of physical examination, and clinical history, a benign foreign body reaction to silicone implant material was diagnosed. Consideration of regional silicone lymphadenopathy is recommended in the differential diagnosis of unilateral enlarged lymph nodes noted on mammograms. US-guided fine-needle aspiration biopsy is a simple, rapid, inexpensive, and relatively nontraumatic means of ruling out malignancy.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |