Long-Term Outcomes of Peripheral Pulmonary Cement Embolism in Patients with Polymethylmethacrylate Augmentation: A Case Series with a Minimum Follow-Up of Five Years.

BACKGROUND: Pulmonary cement embolism (PCE) is a rare but lethal complication. However, few long-term follow-up studies have investigated PCE after polymethylmethacrylate augmentation. This study aimed to investigate both the clinical and imaging outcomes of patients with PCE during a follow-up period of at least 5 years. METHODS: A total of 1460 patients were initially included in this retrospective study. After exclusion, the clinical and imaging data were analyzed for selected patients, including the augmented level, location and length of the PCE, symptoms, therapy, migration and disintegration of the embolism, foreign body reaction, and status at follow-up. RESULTS: Twelve female patients (age range, 56-88 years) with PCE and more than 5 years of follow-up (range, 5-13 years) were eventually included. All emboli were found in subsegment pulmonary arteries and were classified as peripheral PCE. Although 2 patients experienced transient symptoms after surgery, the majority of patients (84.6%) were asymptomatic during follow-up. No other reported emboli were observed during the follow-up period. The imaging data showed that the cement embolus could remain in the initial position throughout the long-term follow-up. In terms of the length of the PCE, there was no statistically significant difference between the values post-operation and at the last follow-up time (P > 0.05). CONCLUSIONS: Patients with peripheral PCE do not develop known late complications. Moreover, polymethylmethacrylate can remain stable and inert in the pulmonary vasculature over the long term. Routine prophylactic anticoagulation may not be necessary for patients with peripheral PCE during follow-up.

Management of button batteries in the upper gastrointestinal tract of children: A case-series study.

Button batteries are the second most frequently-ingested foreign bodies and can lead to serious clinical complications within hours of ingestion. The purpose of this study was to analyze the outcomes of 14 children with button batteries lodged in the upper gastrointestinal tract.Totally 14 children with button batteries lodged in the upper gastrointestinal tract were included. The diagnosis was made primarily by the history of button battery ingestion, physical examination and chest-abdomen X-ray examination.The button batteries lodged in the esophagus were removed by esophagoscope, and those in the gastrointestinal tract were under observation. Among 10 children with batteries in the first esophageal stenosis, 9 were cured and 1 suffered from tracheoesophageal fistula. One case of battery in the second esophageal stenosis was dead due to intercurrent aortoesophageal fistula. Two cases of batteries in the third esophageal stenosis were cured after removal, and 1 case of the battery in the gastrointestinal tract discharged spontaneously.Ingested button batteries are mainly lodged in the esophageal stenoses and are easy to cause esophageal injury and severe complications. Early detection, prompt treatment, strengthening observation and regular follow-up after discharge may help to decrease the incidence of complications and improve the outcomes.

Broncoscopio rígido para la extracción de cuerpo extraño en vías aéreas / Rigid bronchoscope for the extraction of foreign body in airways

INTRODUCCIÓN: La aspiración de cuerpos extraños son incidentes evitables que son comunes en niños entre 1 y 3 años. Cuadro clínico: Los cuerpos extraños en vías aéreas continúan presentando desafíos para su manejo debido a que los síntomas pueden simular diferentes enfermedades pediátricas, como asma, crup o neumonía. La extracción del cuerpo extraño se realiza a través del broncoscopio rígido. Tecnología sanitaria: El broncoscopio rígido es un dispositivo utilizado para propósitos diagnósticos y terapéutico en el caso de presencia de cuerpos extraños en las vías aéreas. El dispositivo cuenta con un tubo rígido que contiene dos canales separados para la óptica y los instrumentos. Este dispositivo permite una visualización constante de las vías aéreas lo que facilita el procedimiento y la intubación del paciente, entre otras. Existen diferentes marcas en el mercado internacional, sin embargo, no se ha podido identificar marcas disponibles en el Perú a través de una fuente oficial. OBJETIVO: Evaluar la eficacia y seguridad, así como documentos relacionados a la decisión de cobertura del broncoscopio rígido para la extracción de cuerpo extraño en vías aéreas. METODOLOGÍA: Se realizó una búsqueda en las principales bases de datos bibliográficas: MEDLINE, LILACS, COCHRANE, así como en buscadores genéricos de Internet incluyendo Google Scholar y TRIPDATABASE. Adicionalmente, se hizo una búsqueda dentro de la información generada por las principales instituciones internacionales de pediatría, otorrinolaringología y agencias de tecnologías sanitarias que realizan revisiones sistemáticas (RS), evaluación de tecnologías sanitarias (ETS) y guías de práctica clínica (GPC). RESULTADOS: Se seleccionaron tres series de casos/registros y un estudio de revisión con búsqueda sistemática. Además, se incluyeron dos guías de práctica clínica. No se encontraron evaluaciones de tecnología sanitaria ni evaluaciones económicas de la región que evaluaran al broncoscopio rígido para la extracción de cuerpo extraños en vías aéreas. CONCLUSIONES: La evidencia con respecto al uso del broncoscopio para la extracción de cuerpo extraño en vías aéreas es escasa. Si bien no se identificó estudios comparativos del uso de esta tecnología, existen series de casos/registros de pacientes que utilizan la tecnología y se evidencia una tasa de éxito de más del 95% para la remoción del cuerpo extraño sin ningún reporte de eventos adversos severos. Las guías de práctica clínica recabadas recomiendan la utilización del broncoscopio rígido para el manejo de cuerpo extraño en vía aérea sin mencionar otra tecnología. No se encontraron evaluaciones de tecnología ni evaluaciones económicas que evaluaran a la tecnología de interés.

Mesotherapy: Safety profile and management of complications.

BACKGROUND: Mesotherapy is a procedure that involves the injection of active substances into the dermis and subcutaneous tissue in order to treat several local medical and cosmetic conditions. Despite being considered as a relatively safe method, a series of adverse reactions can occur due to its wide application and lack of standardization processes. OBJECTIVES: The aim of this paper is to summarize all the mesotherapy-related complications published so far, and to provide an insight into their management. PATIENT/METHODS: Articles derived from the databases, PubMed, EMBASE, and SCOPUS, and published between 1992 and 2018, were analyzed for this review. The study was conducted according to the PRISMA guidelines. RESULTS: In this literature, there is a number of case series and isolated case reports describing various side effects of different severities. The therapeutic management of these complications is-in most cases-individualized. CONCLUSIONS: Larger systematic studies are needed in order to adequately evaluate the safety profile of mesotherapy, and in order to determine standardized therapy parameters, so as to minimize the risk of potential adverse reactions.

Competence in pulmonary endoscopy emergencies.

In clinical practice, interventional pulmonologists face several situations which can lead to dramatic consequences especially regarding ventilation and require immediate intervention. We describe the main pathological conditions where an urgent bronchoscopy is crucial because they act through mechanisms such as airway obstructions or alteration of the anatomic integrity of the tracheobronchial tree. We point out the problems resulting from inhalation of foreign bodies, one of the most dramatic respiratory emergencies typical in childhood which needs not only the appropriate endoscopic equipment suitable for the age, but also great experience in the management of the possible related complications. Massive hemoptysis is then discussed in order to help to choose the right endoscope and to clarify the steps requested to face this dramatic event. Lastly, iatrogenic tracheal injuries are described, in spite of their low occurrence. The correct endoscopic assessment of the lesions enables to select the proper multidisciplinary therapeutic approach together with surgeons and anesthetists. Due to their peculiarities, emergencies do not allow classic training so it is difficult to estimate the procedure volume necessary to achieve an adequate endoscopic experience. We think, in this field, it is advisable to refer to numbers proposed for elections endoscopic procedures. For these reasons, we consider desirable the use of simulators and clinic case discussions during interventional pulmonologist's training.

Eritema postimplantación asociado a implante mamario tratado con láser de colorante pulsado / Post-Implantation Erythema Associated to a Breast Implant Treated With Pulsed-Dye Laser

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The haemostatic efficacy and foreign body reaction of epinephrine-Impregnated polyurethane foam in osseous defects.

The objective of this study was to compare the haemostatic efficacy and foreign body reaction of epinephrine-impregnated cotton pellets with those of epinephrine-impregnated polyurethane (PU) foam cubes in osseous defects created in guinea pigs. Initially, these substances were randomly applied to the osseous defects in guinea pigs for 2 min and blood loss was measured. The animals were then sacrificed 7 weeks later and the degree of foreign body reaction was scored. The data were analysed by the independent-samples Kruskal-Wallis test. Epinephrine-impregnated PU foam cubes showed significantly better haemostatic effect compared to epinephrine-impregnated cotton pellets. The PU foam containing epinephrine specimens elicited significantly less foreign body reaction compared to epinephrine cotton pellets (P < 0.05). Based on the results of this study, it is concluded that epinephrine-impregnated PU foam cubes are a good alternative to epinephrine-impregnated cotton pellets as a local haemostatic agent in endodontic surgery.

Consultas relacionadas con la ingesta de un cuerpo extraño en Urgencias / Emergency department consultations due to foreign body ingestion

INTRODUCCIÓN: La ingesta de un cuerpo extraño (CE) es un motivo de consulta poco frecuente en Urgencias. El objetivo es conocer las características clínico-epidemiológicas de las ingestas de CE y el manejo de estos pacientes. PACIENTES Y MÉTODOS: Estudio retrospectivo incluyendo a los pacientes menores de 14 años que consultaron en un Servicio de Urgencias de Pediatría en relación con la ingesta de un CE entre 2010 y 2013. Se analizaron las circunstancias que rodearon la ingesta del CE, el manejo en Urgencias y la evolución de los pacientes. RESULTADOS: De los 226.666 episodios registrados, 1.608 (0,7%) estuvieron relacionados con un CE, correspondiendo 970 a ingestas, sobre todo espinas de pescado (367, 38,7%) y monedas (181, 18,7%), salvo en menores de un año (objetos de plástico). La mediana de edad fue 4,7 años, siendo mayoritariamente varones a partir de los 4 años (58,5%); 557 pacientes (57,3%) estaban sintomáticos y en 414 (42,7%) se realizó alguna exploración complementaria. Se requirió la participación de otro especialista en 315 (32,4%), fundamentalmente Otorrinolaringología (espinas) o Cirugía (monedas). En 305 (31,4%) se extrajo el CE, fundamentalmente espina o pipa de girasol. Ingresaron 71 pacientes (7,3%), sobre todo por ingestas de espinas o monedas. Ningún paciente falleció. CONCLUSIONES: La ingesta de espinas o monedas por parte de los niños pequeños es un motivo de consulta relativamente frecuente en Urgencias. Aunque el pronóstico global es bueno, se asocia a frecuentes intervenciones médicas. Debe considerarse mejorar la educación sanitaria de la población para disminuir la frecuencia de estos episodios

INTRODUCTION: Foreign body (FB) ingestion is an uncommon reason for going to the Paediatric Emergency Department (PED). The aim of this study was to assess the clinical and epidemiological characteristics of foreign body ingestion and the management of these patients. PATIENTS AND METHODS: Retrospective study, including children under 14 years old with suspected foreign body ingestion seen in the PED between 2010 and 2013. An analysis was made of the circumstances of the FB ingestion, its management in the PED, and patient outcomes. RESULTS: Of the 226,666 presentations recorded, 1,608 (0.7%) were for a FB, 970 corresponding to ingestion of mainly fish bones (367, 38.7%) and coins (181, 18.7%), except in children under 1 year (plastic objects). The median age was 4.7 years, with boys being more common in those older than 4 years (58.5%). A total of 557 patients (57.3%) reported some symptom, and complementary tests were performed in 414 (42.7%). Another specialist was called in 315 (32.4%) cases, mainly from Ear, Nose and Throat (fish bones) or Surgery (coins). The FB was removed in 305 (31.4%) cases, which were mostly fish bones or sunflower seeds. Seventy-one patients (7.3%) were admitted, especially ingestion of fish bones or coins. No patient died. DISCUSSION: Ingestion of fish bones or coins by young children is a relatively common presentation in the PED, and it is associated with frequent medical interventions. Although the overall prognosis is good, and improving the health education of the population should be considered to reduce the frequency of these episodes

Dermal fillers: pathophysiology, prevention and treatment of complications.

Dermal fillers are increasingly used for soft tissue augmentation of the face and hands. The widespread use of dermal fillers for rejuvenation has led to a rise in reports of associated complications. Although the majority of complications are mild and transient, serious and long-lasting complications have been observed. This article discusses the key complications including pigmentary changes, hypersensitivity reactions, infections, nodule formation, granulomatous reactions, vascular occlusion and migration of filler material. A thorough literature review was performed in addition to the combined extensive authors' (GP and FA) experience. Complications from fillers are increasingly being recognized and highlighted in the literature partly reflecting the growth in the market. This article provides a comprehensive overview of the filler complications with mechanisms of prevention and treatment per complication. A thorough understanding of the preventative and management strategies for the associated dermal filler complications will help the physician to prepare the patient well, and deal with complications that may arise effectively.

Tratamiento de la ingesta de cuerpos extraños / Treatment for ingested foreign bodies

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Broncoaspiración de cuerpo extraño odontológico. A propósito de tres casos / Three cases of odontological foreign body bronchoaspiration

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A staging system for gluteal foreign body reaction to injectables.

BACKGROUND: Esthetic augmentation of the gluteal region can lead to complications including debilitating pain, infections, wounds, and scars. To our knowledge, a general consensus of staging and treatment guidelines for managing gluteal foreign body reaction to injectables has not yet been established. OBJECTIVE: The objective of this study was to develop a reliable staging system that can be used to implement a treatment algorithm for gluteal foreign body reactions. METHODS: A retrospective review of 40 patients treated for complications of gluteal injections between September 2010 and May 2014 was performed. Patient symptoms, imaging, and photographs were used to develop a staging system of disease. Institutional review board approval was obtained from the University of Miami Miller School of Medicine. Five independent observers reviewed the patients' documented symptoms and photographs. Using our staging system, the independent observers reviewed the patient cases at two separate time intervals. Intra- and interclass correlation coefficients (ICCs) were computed to assess the reliability for each of the observers. RESULTS: Seven patients were classified as Stage I, fifteen as Stage IIa, nine as Stage IIb, and nine as Stage III. The mean patient age was 34 years (21-50). Analysis of the independent reviewer results revealed ICC for each rater to range from 0.96 to 0.98, demonstrating high indexes of intra-rater reliability. CONCLUSIONS: Based on our statistical analysis, we found an excellent inter- and intra-observer reliability, indicating that the staging system is reproducible and reliable. A treatment strategy dependent on the stage can be implemented as a guideline to optimize functional and esthetic outcomes.

Diagnosis and Management of Adverse Local Tissue Reactions Secondary to Corrosion at the Head-Neck Junction in Patients With Metal on Polyethylene Bearings.

We reviewed 27 patients who underwent revision for an adverse local tissue reaction (ALTR) secondary to corrosion at the head-neck junction with MoP bearings. Serum cobalt and chromium levels were elevated in all cases, with a mean cobalt of 11.2 ppb and chromium of 2.2 ppb. Patients underwent modular bearing exchange, including a ceramic head with a titanium sleeve in 23 of 27 cases with only one recurrence of ALTR in one of the four patients not treated with a ceramic head. The diagnosis of ALTR secondary to corrosion is associated with cobalt levels of >1 ppb with cobalt levels elevated above chromium. Retention of a well-fixed stem and modular exchange to a ceramic head leads to resolution of symptoms and decreases in metal levels.

Macrophage responses to implants: prospects for personalized medicine.

Implants, transplants, and implantable biomedical devices are mainstream solutions for a wide variety of human pathologies. One of the persistent problems around nondegradable metallic and polymeric implants is failure of macrophages to resolve the inflammation and their tendency to stay in a state, named "frustrated phagocytosis." During the initial phase, proinflammatory macrophages induce acute reactions to trauma and foreign materials, whereas tolerogenic anti-inflammatory macrophages control resolution of inflammation and induce the subsequent healing stage. However, implanted materials can induce a mixed pro/anti-inflammatory phenotype, supporting chronic inflammatory reactions accompanied by microbial contamination and resulting in implant failure. Several materials based on natural polymers for improved interaction with host tissue or surfaces that release anti-inflammatory drugs/bioactive agents have been developed for implant coating to reduce implant rejection. However, no definitive, long-term solution to avoid adverse immune responses to the implanted materials is available to date. The prevention of implant-associated infections or chronic inflammation by manipulating the macrophage phenotype is a promising strategy to improve implant acceptance. The immunomodulatory properties of currently available implant coatings need to be improved to develop personalized therapeutic solutions. Human primary macrophages exposed to the implantable materials ex vivo can be used to predict the individual's reactions and allow selection of an optimal coating composition. Our review describes current understanding of the mechanisms of macrophage interactions with implantable materials and outlines the prospects for use of human primary macrophages for diagnostic and therapeutic approaches to personalized implant therapy.

Common bile duct injury by fibrin glue: report of a rare complication.

Fibrin glue is widely used in clinical practice and plays an important role in reducing postoperative complications. We report a case of a 65-year-old man, whose common bile duct was injured by fibrin glue, with a history of failed laparoscopic cholecystectomy and open operation for uncontrolled laparoscopic bleeding. In view of the persistent liver dysfunction, xanthochromia and skin itching, the patient was admitted to us for further management. Ultrasound, computed tomography, and magnetic resonance cholangiopancreatography (MRCP) revealed multiple stones in the common bile duct, and liver function tests confirmed the presence of obstructive jaundice and liver damage. Endoscopic retrograde cholangiopancreatography was unsuccessfully performed to remove choledocholithiasis, but a small amount of tissue was removed and pathologically confirmed as calcified biliary mucosa. This was followed by open surgery for suspicious cholangiocarcinoma. There was no evidence of cholangiocarcinoma, but the common bile duct wall had a defect of 8 mm × 10 mm at Calot's triangle. A hard, grid-like foreign body was removed, which proved to be solid fibrin glue. Subsequently, the residual choledocholithiasis was removed by a choledochoscopic procedure, and the common bile duct deletion was repaired by liver round ligament with T-tube drainage. Six months later, endoscopy was performed through the T-tube fistula and showed a well-repaired bile duct wall. Eight months later, MRCP confirmed no bile duct stenosis. A review of reported cases showed that fibrin glue is widely used in surgery, but it can also cause organ damage. Its mechanism may be related to discharge reactions.