Acute tenosynovitis following an accidental injection of Bacille Calmette-Guérin (BCG) in a health care worker: A case report.

Case: A 36-year-old female healthcare worker with no past medical history, accidentally injected her flexed right middle finger with live attenuated Mycobacterium bovis bacillus Calmette-Guérin (BCG). Swelling and erythema around the injured area appeared two days after the needlestick injury. She was referred to the hospital and presented approximately nine days after self-inoculation. Surgical debridement was immediately performed. After 38 days, colonies were observed on cultures of the removed tissue on Ogawa's medium. This isolate was identified as M. bovis BCG by polymerase chain reaction (PCR) based on RD1 gene deletion. She had a history of BCG vaccination and her skin lesion appeared immediately after the accidental injection of M. bovis BCG. Therefore, in the differential diagnosis, the possibility that the lesion was an allergic reaction to BCG was considered. The subsequent culture results came back positive for M. bovis BCG and acute tenosynovitis caused by M. bovis BCG was diagnosed. The skin lesion was treated with anti-mycobacterial drugs and resolved. Discussion: The allergic reactions to BCG should be considered in the differential diagnosis of skin lesions following BCG vaccination. It is important to promptly submit a specimen for culture as delayed initiation of appropriate treatment can lead to a poor prognosis. In patients with accidental injection of M. bovis BCG, it is important to consider timely surgical excision and appropriate antimycobacterial therapy.

Injection of sodium hypochlorite into soft tissues of the oral cavity: A literature review with clinical preventive recommendations.

Injection of sodium hypochlorite (NaOCl) solution instead of local anaesthetic (LA) solution is an iatrogenic error with serious consequences including medico-legal implications. Such cases have been reported despite recommended precautionary measures. The purpose of this article is to review the literature on such cases and present clinical preventive recommendations. Electronic search was conducted in PubMed/Medline, Google Scholar, Cochrane, Scopus, Lilacs, ScienceDirect, and Crossref databases for articles reporting accidental or mistaken or inadvertent injection of NaOCl instead of LA during dental or endodontic treatment. Articles reporting NaOCl accident due to extrusion or injection of NaOCl beyond root confines were excluded. A total of 11 articles were found and reviewed. Data pertaining to the patient, injected NaOCl, cause, clinical manifestations, management, hospitalization, healing and recovery, and long-term or residual effects were extracted, compiled, and analysed for interpretation and discussion. Injection of NaOCl instead of LA into the soft tissues leads to varying clinical manifestations with unpredictable extent, outcome, and recovery period. The onus lies with the clinician to prevent it. Therefore, a clinician must take all the precautionary measures and confirm the identity of LA and NaOCl solutions before delivering them. The presented clinical recommendations assist clinicians to prevent it, including its potential medico-legal consequences. However, in case of such an unfortunate event, it is crucial to immediately identify and quickly manage it to limit the tissue damage or complications.

Accidental Injection of Chlorhexidine during Endodontic Therapy.

The use of chlorhexidine gluconate (CHX) as an irrigating solution in an anesthesia cartridge is a wrong procedure commonly performed in daily clinical practice. Being an invasive procedure, it is invariably associated with complications. A 47-year-old healthy woman was injected accidentally with 2% CHX in the buccal vestibular area instead of an anesthetic solution during a root canal treatment. After the injection, the patient experienced local side effects, such as a burning sensation on the right cheek area, also a discomfort perception at the injection site and a slight inflammation with a mild extraoral redness especially on the right side cheek. The patient was prescribed with antibiotics and anti-inflammatories to reduce pain and inflammation. The patient complained of upper lip numbness by the second day of the accident. The extraoral swelling reduced gradually and the redness diminished considerably over a period of 6 days. At day 60 of follow-up, the patient recovered satisfactorily from extraoral inflammation but still presented a slight numbness of the upper lip. As a conclusion, we can claim that anesthesia cartridges with irrigant solutions should never be used to irrigate the root canals, and accidental injection of CHX should be carefully assessed by the clinician.

Acidente com hipoclorito de sódio durante tratamento endodôntico: análise de prontuário / Accident injection with sodium hypochlorite during endodontic treatment: case report

O sucesso do tratamento endodôntico está diretamente ligado ao processo de limpeza e modelagem dos canais radiculares. E para se conseguir a limpeza e desinfecção são utilizadas substâncias químicas auxiliares como coadjuvantes ao preparo mecânico, pois são essenciais na redução de microrganismos presentes no sistema de canais radiculares. Dentre as principais substâncias químicas auxiliares empregadas, a que apresenta maior destaque é o Hipoclorito de Sódio. O objetivo do presente estudo é mostrar através de uma análise de prontuário, um relato de um acidente com hipoclorito de sódio durante um atendimento odontológico. Para isso, um prontuário foi selecionado, onde a paciente procurou a clínica do Curso de Odontologia do Centro Universitário da Serra Gaúcha para realizar tratamento endodôntico do dente 16. Durante este procedimento, ocorreu um extravasamento do hipoclorito de sódio aos tecidos periapicais, e partir deste fato foi possível relatar maneiras de como prevenir, tratar e evitar esse tipo situação(AU)

The success of endodontic treatment is directly related to the root canal cleaning and modeling process. In order to achieve cleaning and disinfection, auxiliary chemical substances are used as auxiliaries to the mechanical preparation, since they are essential in the reduction of microorganisms present in the root canal system. Among the main auxiliary chemical substances employed, the most prominent is Sodium Hypochlorite. The objective of the present study is to show through an analysis of medical records, an account of an accident with sodium hypochlorite during a dental care. For this, a chart was selected, where the patient sought the clinic of the Dentistry Course of the University Center of Serra Gaúcha to perform endodontic treatment of the tooth 16. During this procedure, an extravasation of the sodium hypochlorite occurred to the periapical tissues, and from this It was possible to report on ways to prevent, treat and avoid this type of situation(AU)

Intracrystalline Ozurdex®: therapeutic effect maintained for 18 months.

INTRODUCTION: Ozurdex® is a sterile, sustained-release implant of dexamethasone. The device dissolves within the vitreous body and releases dexamethasone. Here we present a clinical case that demonstrates the sustained therapeutic efficacy of Ozurdex® when accidentally injected into the crystalline lens. METHODS: Case report. RESULTS: Sixty-three-year-old male in which we decided to prescribe the intravitreal injection of a dexamethasone implant (Ozurdex®) in the left eye because of macular oedema after branch retinal vein occlusion. Best-corrected visual acuity (BCVA) was 0.4. At 15 days post-implantation, the slit-lamp examination revealed the dexamethasone implant was located in the crystalline lens. Given there was no inflammation in the anterior pole, no cataracts had developed, the intraocular pressure (IOP) was normal and the macular oedema had been resolved, we decided to assess the efficacy and safety of the dexamethasone implant located in the crystalline lens. The BCVA improved until 14 months post-accidental injection. At 18 months post-Ozurdex® injection the BCVA worsened until 0.05 because of the cataract evolution. Phacoemulsification and intraocular lens placement in sulcus was performed. CONCLUSION: Once the complication has occurred, most authors advocate the early withdrawal of the implanted Ozurdex® device by means of crystalline phacoemulsification and then repositioning it in the vitreous body. However, as long as there are no signs of inflammation in the anterior pole, the IOP is within normal limits, the device does not affect the visual axis and there is no cataract development, we can evaluate the potential therapeutic effect of Ozurdex® in this non-indicated, abnormal location.

Hazards of Improper Dispensary: Literature Review and Report of an Accidental Chloroform Injection.

Several clear, transparent solutions are used in endodontics. Inappropriate dispensing methods can lead to accidental injection or accidental irrigation. These accidents can cause permanent tissue damage including damage to the bone, periodontium, nerves, and vasculature. This article reports on the consequences of an accidental chloroform injection. Nonsurgical retreatment of tooth #8 was planned as part of a restorative treatment plan in a 69-year-old woman. The dentist accidentally injected chloroform instead of local anesthesia because chloroform was loaded into the anesthetic syringe. The patient experienced severe pain and swelling and soft tissue necrosis and suffered permanent sensory and motor nerve damage. A review of the literature was performed on accidents caused by improper dispensary, namely accidental injections and accidental irrigations. The data were extracted and summarized. Sodium hypochlorite, chlorhexidine, formalin, formocresol, 1:1000 adrenaline, benzalkonium chloride, and lighter fuel were accidentally injected as an intraoral nerve block or as infiltration injections. Bone and soft tissue necrosis, tooth loss, and sensory nerve damage (anesthesia and paresthesia) were the most common consequences reported. Such disastrous events can be prevented by appropriate labeling and separate dispensing methods for each solution. There is a need for disseminating information on toxicity and biocompatibility of materials/solutions used in endodontics. The authors recommend training dental students and endodontic residents on immediate and long-term therapeutic management of patients when an accidental injection or accidental irrigation occurs.

Accidental Injection of Freund Complete Adjuvant With Mycobacterium Tuberculosis.

Accidental needlestick injuries are common in laboratory and health care workers. Injection of atypical pathogens, such as those encountered in the animal laboratory setting, may pose considerable problems at the site of inoculation. We present the case of an otherwise healthy laboratory worker who accidentally self-injected Freund complete adjuvant with heat-killed Mycobacterium tuberculosis into her hand, requiring multiple debridement operations over a prolonged treatment course.

Accidental injection of 2% chlorhexidine gluconate instead of an anesthetic agent: A case report.

We report a case where 2% chlorhexidine (CHX) gluconate was mistaken for an anesthetic solution and infiltrated into the buccal vestibule during routine root canal treatment. Accidentally, 2% CHX gluconate solution was injected in the right upper buccal vestibule (16) of a 23-year-old male during routine root canal treatment. The patient experienced pain and a burning sensation over the injected area shortly after injection. Swelling with mild extraoral redness over the right cheek area was observed clinically. The patient was immediately administered dexamethasone intramuscularly, and was prescribed antibiotics, analgesics, and antihistamines. The patient complained of a loss of sensation over the right cheek by the 15(th) day. The swelling reduced gradually over a period of 15 days. Reversal of sensation was attained after 35 days.

Death After Accidental Injection of Tranexamic Acid During Spinal Anesthesia / 대한법의학회지

Medication errors such as administration of wrong drugs, wrong dosage and erroneous route of administration are not rare among medical misadventures. We present an autopsy case of accidental injection of tranexamic acid instead of bupivacaine during spinal anesthesia, accompanying the quantitative result of the tranexamic acid in the blood, cerebrospinal fluid and each internal organs. We think that warning signs on syringes and ampoules, simple and unified guideline for drug administration, separative documentation of drug administration and interpersonal communication on drug information should be done to prevent this type of medical errors.

A Case Report of Central Nervous System Toxicity following Accidental Injection of Tranexamic acid into Subarachnoid space / 대한마취과학회지

Neurologic Sequelae after spinal anesthesia are extrenely rare, due in part to use of prepackaged and sterile kits and the small doses of local anesthectics employed. We have experienced 42 years old healthy male developed cental nervous system toxicity due to injection of wrong substance into subarachnoid space. And the patient recovered 3 days later with mild pulmonary edema and about 72 hour anterograde amnesia after symptomatic treatment.