Cases reported "Foreign-Body Reaction"

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1/8. 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.
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2/8. Localized argyria 20-years after embedding of acupuncture needles.

    We report a 66-year-old woman with localized argyria caused by embedding of acupuncture needles. Ten years after she had received acupuncture, she noticed two asymptomatic bluish macules on her right arm. A biopsied specimen from the macule revealed many brownish-black granules mainly located around the sweat glands and the blood vessels in the dermis. The X-ray examination of the extremities revealed numerous needle-like fragments around her extremities. "Embedding of needles" induces some serious adverse events. We should know the adverse events for the safety and health of patients.
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3/8. Progressive visual loss due to a muslinoma--report of a case and review of the literature.

    Intracranial internal carotid artery (ICA) aneurysms are frequently treated either by microsurgical clipping of the aneurysm neck, by endovascular coiling of the aneurysm sac or by balloon occlusion of the parent vessel. For some broad-based aneurysms that may not be suitable for any of these options, microsurgical wrapping of the aneurysm wall with muslin or gauze rarely is applied. We report the case of a patient who suffered from a minor stroke because of arterio-arterial embolism from an intracranial ICA aneurysm. The aneurysm was treated by wrapping muslin material. After 12 months, he experienced progressive visual loss. Cranial magnetic resonance testing magnetic resonance tomography (MRT) revealed a granulomatous inflammation surrounding the site of the aneurysm and affecting optochiasmatic structures. A muslin-induced optic neuropathy is a rare but serious complication of a chronic inflammatory reaction in response to muslin or gauze used in intracranial aneurysm wrapping. If the foreign body inflammatory reaction to muslin or gauze leads to a mass formation, the term muslinoma or gauzoma is applied. Various treatment strategies include surgery, steroids and cyclophosphamide, but recovery of the vision is not predictable. As a consequence, muslin or cotton gauze should only be applied with great caution in neurovascular surgery.
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4/8. A case of implantation dermatosis that formed a tumor.

    A 51-year-old man visited our hospital complaining of a tumor located above his lip. He had been hit on his upper left lip by a chopstick holder 2 months previously. The lesion turned into a tumor and gradually enlarged. The tumor was well circumscribed, smooth and covered with reddish, partially milk-white skin. During surgery to remove the tumor, a piece of a chopstick was found in the subcutaneous tissue, and a diagnosis of implantation dermatosis (ID) was made. On histology, the tumor appeared as an abscess that had increased fibroblasts, small vessels and a large number of neutrophils. In the Japanese published work, we found 86 cases of ID; three were similar to our case and had been clinically diagnosed as adnexal tumors. There were also six cases that showed abscess formation similar to our case on histology. In a survey of the published work from other countries, there were 44 ID cases. There were no common features found among the cases reported in the published work.
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5/8. 'Foreign' particles in encephalic vascular malformations.

    Among 84 surgically resected arteriovenous malformations (AVMs), four were found to have refractile foreign particles lined by endothelium in the vessel walls. In three cases, this was associated with granuloma formation. The particles were probably introduced during cerebral angiography. They represent a not unusual pathologic finding, are relatively more common in AVMs than in other neurosurgically excised lesions, and may have clinical significance, especially if abundant.
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6/8. Unusual pulmonary vascular lesions after intravenous injections of microcrystalline cellulose. A complication of pentazocine tablet abuse.

    We present the morphological features of a case of fatal pulmonary granulomatosis from illicit intravenous injections of microcrystalline cellulose derived from pentazocine tablets. Extensive foreign body granulomas were found in the lumena and walls of pulmonary vessels and in the pulmonary interstitium. Previously unreported gaps containing foreign material were found in the walls of medium-sized muscular pulmonary arteries. This peculiar finding is discussed in the light of the possible mechanisms involved in the removal of embolized foreign material.
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7/8. Retained surgical sponge.

    Surgical foreign bodies are retained more commonly than is suspected. About 50% will become symptomatic in the form of erosion into the bowel or vessels, fistulae, abscesses, obstruction, bleeding, or chronic pain. Expeditious removal is recommended. Laparoscopic retrieval is feasible especially if discovered early.
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8/8. Cervical thorium dioxide granuloma ('thorotrastoma').

    An elderly woman had an expanding cervical mass that entrapped and compressed the adjacent cranial nerves, blood vessels, and muscles. The mass was dense on radiographs, extended from the skull base to low neck in the prevertebral and parapharyngeal tissues, and showed mixed intensity on MR. A previous direct carotid arteriogram with thorium dioxide as the contrast agent suggested the histologically proved diagnosis of a cervical thorium dioxide granuloma ("thorotrastoma").
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