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Introduction: The ingestion of foreign bodies is a frequently observed problem in daily clinical practice. In order to avoid complications such as perforation, endoscopic removal of potentially penetrating foreign bodies should be attempted quickly. The use of various endoscopic techniques has been reported for this purpose. However, extraction of foreign bodies from the mid gastrointestinal tract has rarely been reported., Case Report: We present the case of a patient who had swallowed a safety needle which could safely be removed from the jejunum by means of double-balloon enteroscopy (DBE). The combination of a thin p-type enteroscope with a thick t-type overtube was used in order to improve the manoeuvrability of the endoscope. The needle was pulled into the overtube which served as a protective shield during the retrieval of the endoscope., Conclusion: Our case report describes the potential of removing foreign bodies from the deep small bowel by pulling them into the overtube of a double-balloon enteroscope. If the suspicion of foreign body impaction in the small bowel is made, it may be advisable to primarily choose a balloon enteroscopy system. Through this, quick and deep insertion can be combined with a safe removal of the foreign body., (© Georg Thieme Verlag KG Stuttgart · New York.)

All dermal fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of these risks and be prepared to accept them. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., the implantation of a long-lasting filler substance was too superficial). Such adverse events can be treated with intradermal 5-fluorouracil and steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunological phenomena such as late-onset allergy and non-allergic foreign body granulomas. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions should remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granulomas in the subcutaneous fat.

6 years after introduction of the police ammunition QD-P.E.P. (9 mm caliber), 9 bullet wounds are presented from forensic investigations along with the results of experimental shots at pig carcasses. The evaluation reveals the characteristic pattern of such bullet wounds: a skin defect which is almost as large as the caliber and has a sharp-edged border thus looking like it has been punched out; the contusion ring ("abrasion ring") is conspicuously narrow. These findings can be explained by the shape and design of the projectile. In regular police work immediate incapacitation has not always been achieved, depending on the entry location of the bullet. Experimental shots at pig carcasses showed that in the case of shots at extremities, the residual energy of the exiting bullet may be sufficient to generate another penetrating bullet wound.

Introduction: Over 75% of ingested foreign bodies pass the gastrointestinal tract without any complications. Blunt foreign bodies may lead to a disruption of the intestinal passage, mainly in the area of the ileocoecal opening. The size of the reported foreign bodies varies considerably. The aim of this study was the anatomic investigation to clarify the possible causes of obstruction and its influence on the diameter of the ileocoecal opening., Material and Method: We investigate anatomically and describe the ileocoecal opening on the basis of 27 specimens., Results: We found not a flap mechanism but a valve mechanism in the ileocoecal junction. The median diameter of the formalin-fixated specimens was 10.9 mm respectively 21.8 mm according to an assumed correction factor of 2. The cause for intestinal obstruction most probably is the ingestion of blunt, angular foreign bodies in the ostium ileale., Conclusion: The intraindividual differences as well as the considerable size of foreign bodies that pass the ileoceocal opening support the hypothesis, that the complications described are more a consequence of an ingestion of blunt, cornered foreign bodies in the ostium ileale independent ofn the size of the ileocoecal opening itself.

Aim: In urology, single cases of lethal pulmonary embolism following extracorporeal shock wave application to renal concrements have been reported. Therefore, lungs of rabbits were histopathologically investigated following extracorporeal shock wave application to the femur., Method: In 8 mature Chinchilla-Bastard rabbits, shock wave application to one distal femur was performed with energy flux density of 0.9 mJ/mm2. In another 6 rabbits, sham-treatment (0 mJ/mm2) to one distal femur was performed. 6 weeks later, the animals were sacrificed and their lungs were blindly investigated by an independent pathologist., Results: In 7 out of the 8 treated animals (0.9 mJ/mm2) but in none of the sham-treated controls, patchy discolorations of the surface of the lung were observed. Furthermore, in 6 out of the 8 treated animals but in none of the sham-treated controls, bony fragments with signs of resorption were observed in lung vessels., Conclusion: Application of extracorporeal shock waves with energy flux densities higher than 0.9 mJ/mm2 has been recommended in the literature for the treatment of aseptic non-unions. In this procedure, the possibility of the occurrence of bone fragments in the lung with the potential risk of pulmonary embolism should be regarded.

Background: A patient with intraocular silicone oildeposits underwent paracentral corneal incision but the corneal sutures were never removed and 7 years later a perforating corneal transplantation was performed due to corneal opacification., Methods: The corneal button was fixed in 10% buffered paraformaldehyde, embedded in celloidin and sections 200 microns thick were cut and stained with van Gieson. Some of these sections were embedded in paraffin and 5 microns thick sections were cut., Results: Celloidin sections showed intrastromal silicone oil droplets located adjacent to defects in Descemets' membrane and corneal sutures but the endothelial cells contained no silicone oil droplets., Conclusion: Silicone oil can penetrate the corneal stroma in cases of defects in Descemets' membrane.

Background: Perossoeus intracranial translocation or passive intracranial transmission of titanium osteosynthesis plates and screws in the growing skull following surgical craniosynostosis corrections, also referred to as the PIT effect, has been described in the literature since 1995. It is a phenomenon which has not received due attention until recently and is explained by appositional and resorptional remodeling processes in the growing skull., Case Report and Discussion: An impressive case of the PIT effect with a total intracranial dislocation of titanium plates and screws is used to demonstrate the problems associated with this phenomenon and to discuss the few clinical case reports in the English-language literature. The obvious advantages of a resorbable material are pointed out; however, it is still uncertain as to whether the resorption process is fast enough to avoid the PIT effect if used clinically.

Despite highly developed scanning methods there is no absolute certainty of delineating malignant pancreatic tumor from chronic pancreatitis. Pancreatitis caused by foreign bodies has occasionally been mentioned in literature. Our report is on the first case of a foreign body granuloma of the pancreatic head caused by a fish-bone transduodenally perforating the pancreas. On preoperative CT and ultrasound as well as by intraoperative inspection and palpation the lesion appeared malignant, so we saw the indication for Whipple's operation. Although the histological examination showed a benign state, taking into account the generally bad prognosis, in case of suspected malignant pancreatic tumor we plead for resection as the only possible form of curative therapy.

Purpose: To demonstrate a rare complication in contactology., Case Report: A 26-year-old female had "lost" her hard contact lens in the right eye 2 years previously. Afterwards, new contact lenses were not tolerated. The patient had a slight intermittent epiphora but no further complaints. She consulted her ophthalmologist for new spectacles. At presentation, there was a firm tumour without signs of inflammation in the right upper lid area. When the lid was everted a hard contact lens was found within the tarsal plate which could be easily removed in the operating room. Microbiologic investigation disclosed no bacteria. Histology showed a circumscribed papillary reaction and a chronic non-specific inflammation with few eosinophils and no giant cells. Two weeks later the lens-related cavity was only slightly filled up by granulation tissue., Conclusions: After "loss" of a contact lens superior dislocation and finally tarsal implantation should be kept in mind. The process of contact lens migration reveals some interesting features: 1. Generally, it causes only minor symptoms though it may last for years. 2. Bacterial contamination rarely occurs. 3. Histologically, the inflammation is often mild or even absent. Eosinophils and giant cells are of minor or no importance indicating that allergy and giant-cell reaction play no significant role. 4. The lens related cavity probably heals slowly, possibly because of a (partial) epithelialization.

Intra-abdominally retained gallstones following laparoscopic cholecystectomy only rarely cause related morbidity. A patient is reported, in whom aseptic foreign body reaction lead to formation of a big intra-abdominal granuloma. Because of troubling symptoms laparotomy and exstirpation were required one year postoperatively.

Acute mechanical failure of prosthetic heart valves is rare, but associated with high mortality when occurring. For convexo-concave Björk-Shiley prostheses only fractures of the outlet strut are reported. We present a case of lethal mechanical complication 5 years after implantation. By additional metallurgic analysis we were able to identify a sequential course of the outlet strut fracture. This could lead to new approaches for early detection of this complication.

Pulmonary embolism usually is due to natural causes, most often to obstruction of pulmonary arteries by blood clots breaking loose from venous thrombi forming in the leg or pelvis. Clots of other cellular material such as tumor fragments or fatty tissue (this especially in case of severe soft tissue and skeletal trauma), but also foreign material can give rise to this- often times lethal-condition. This is a report of foreign-body pulmonary embolism with obstruction of mainly the right lower lobe pulmonary arteries due to white vaseline embolism, probably responsible for the patient's premature surmise. Clinical history, therapeutic measures and course of disease--including radiographic and laboratory findings are being presented. Autopsy revealed massive pulmonary embolism to the right lower lobe due to a whitish greasy substance, which was chemically identified to be white vaseline. Additionally, this zone of infarction also showed signs of severe pneumonia with abscess formation resembling that of necrotizing infarction and therefore felt to be related to the foreign body embolism. Histology showed evidence of pneumonia and also inflammatory changes of the pulmonary arteries in form of additional formation of endothelium with involvement of the internal elastic layer. Finally, several possible causes for this case of pulmonary vaseline embolism are being discussed. The exact mechanism remains unclear; but in view of the course of disease, some radiographic findings as well as those of autopsy and histology, it seems most likely that the vaseline embolism was connected to transjugular catheterization rather than to the two other mechanisms also described.

Two cases of dislocation of the sternoclavicular joint are reported in which migrating nails caused fatal heart tamponade. In both cases death occurred due to fracture nails which had not been bent or secured against migration in some way, and X-ray control had been inadequate. The doctors were charged with manslaughter by negligence since they had not exercised reasonable care as would have been required in those circumstances. As a result of the two attending physicians, trials, it is concluded when that operative osteosynthesis techniques are applied in order to affix dislocations of the sternoclavicular joint, migration of the osteosynthesis material must be prevented by adequate measures and that X-rays have to be taken within short intervals from different planes. Osteosynthesis material should be removed as soon as possible.

The right eye of a 17-year-old patient had been injured by a metallic, nonmagnetic foreign body which had perforated the eye at the limbus at 6 o'clock and become lodged in the posterior part of the ciliary body near the ora serrata. The operation to remove the foreign body was unsuccessful. After three months without any inflammatory reaction the patient noticed it in the conjunctiva. The splinter had been spontaneously rejected via the same route by which it had entered the eye; it was removed from the point of entry under local anesthesia. The special circumstances which, in the authors' opinion, led to spontaneous rejection of this foreign body are discussed.

Gilded molybdenum-wire remains in the sclera and episclera without any reaction of the tissue. Adjacent eye muscles are not involved. In two cases the loops penetrated slowly the sclera and choroid but not the retina.

The hazard involved in MR tomography if there are foreign parts in the body made of metal, is assessed. There are certain hazard-influencing factors. As far as the foreign body is concerned, these are: ability to become magnetized, size, length, elasticity, sharp edges or ends, and sharp surfaces. In the human body itself, risk factors are determined by the position of the foreign body in or near sensitive organs such as cerebrum, nerves, vessels, lungs, eyes, ears and the heart; other factors are the fixation to bones or lack of fixation in hollow organs. One should assume when assessing the risk that the foreign body consists of iron that is capable of complete magnetisation. In that case the attacking forces will not exceed the 25 to 36 fold value of the foreign body's own weight. It is thus possible to predict with some measure of probability whether the position of the foreign body will shift during MR examination and whether the examination can result in injury.