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Device loss or entrapment during percutaneous coronary interventions (PCI) is a rare circumstance whose incidence has decreased over time mainly because of device improvements. Nevertheless, they still represent fearful complications also and above all because the operators may be unfamiliar with rescue and retrieval techniques. The devices that most frequently experience loss or entrapment are stents, followed by angioplasty balloons, burrs for rotational atherectomy, guidewires and microcatheters. In this review we will illustrate the risk factors for device loss and the main retrieval techniques, as described in the literature or stemmed from our experience as high-volume PCI center.

This paper evaluates forensic duties and liabilities for psychiatrists, based on the current literature and based on our experience over several years of forensic medicine practice, involving both criminal and civil cases. We evaluated different scenarios, including cases of patients dangerous to themselves or others. We highlighted the importance to keep adequate and detailed clinical records, both in the inpatient and outpatient setting, given the absence of other objective items (e.g., laboratory records or other instrumental assessments) that may be of help for the judge and his/her counselors.

We present an unusual case of a young patient regularly followed in our Chronic Renal Insufficiency ambulatory with the periodicity of 2-3 visits per year--with stabilization of his residual renal function. The patient came to the emergency department declaring abdominal pain but make a diagnosis turned out to be more complicated than we expected.

Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).

Chronic maxillary sinusitis as an expression of infectious dental disease seemed destined to vanish. On the contrary, during the last years, the frequency of chronic maxillary sinusitis is rising again in relation to several factors, among these bacterial resistance as well as the poor dental hygiene and the limited access to odontologic care by not well-off patients play a key role. Anyway oral rehabilitative surgery (pre-implantologic and implantologic) is nowadays becoming the major cause of chronic maxillary sinusitis. The authors describe a recently observed case that, for its peculiarity, clearly exemplifies the variety of manifestations and the close relation between dental disease and anatomic nasal defects in the genesis of sinusal disease.

The presence of a static magnetic field (Bo), a radiofrequency field (RF), a dynamic gradient which varies in time and loud noises during an MR examination could increase patient risk. Specifically, a magnetic field could interfere with ferromagnetic material leading to one of the following five dangerous interactions: 1) projectile effect, 2) twisting, 3) burning, 4) artefacts and 5) device malfunction. The projectile effect is when an object is attracted by the magnet with the risk, as reported in literature, of hitting the patient, operators and/or the instrument. Objects which typically can undergo this effect are oxygen and helium cylinders, IV stands, cleaning trolleys, chairs, lamp holders, scissors, forceps, clampers, traction weights, monitoring instruments, and especially metallic splinters within the patient. Twisting (torsion) typically occurs with cerebral vascular clamps and cochlear implants. If parts of implants are involved a malfunction may result. Burns can be caused when electrically conductive material is introduced within the magnet, for example, ECG electrodes, monitoring cables and coils which are in contact with the patient's skin, as well as tattoos and eye-liners that contain iron-oxides. Artefacts can be induced by RF emission of implanted devices which can be mistaken for noise of the receiving coil. Implanted devices can induce signal voids which mask or simulate pathologies. Electrical or mechanical malfunction of implanted devices includes pacemakers which can stimulate inappropriately or at an elevated frequency yielding a distorted ECG with altered T-waves. The risk for patients can be reduced by specific educational programs within individual radiology departments which include other specializations and external referring physicians with the aim of developing a standardized safety protocol.

Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event, with very high mortality rates. Most of the cases are due to a complication in endoscopic manouvers and the best treatment, conservative rather than aggressive, remains a controversial topic., Material and Methods: In 1995-2005 period we observed 7 cases of esophageal perforation, 5 women and 2 men mean age 73.2 y (range 60-87). Three cases are due to foreign body ingestion, 2 cases to endoscopic manoeuvres, 2 cases were spontaneous. In 3 cases the lesion was in the cervical tract of the esophagus, in the thoracic tract the others. All the patients were admitted very early to our Unit and presented disphagia, vomiting and dyspnoea, 2 out of them also a pleural effusion. In iatrogenic perforation we performed a cervicotomy and a drainage of mediastinic abscess, while in spontaneous lesions mono (one case) or bipolar esophageal exclusion (one case) with primary suture, jujunostomy and drainage of pleural effusion were the treatment. In foreign body perforation we performed thoracotomic and cervicotomic esophagotomy, extraction of the foreign body, direct suture with pleural or muscle protection. We didn't observe any intra or post-operative mortality. About the complications, we observed a bilateral pleural empyema, a chylous fistula, a digestive bleeding due to gastric ulcer, a laparotomic infection, a parossistic FA and a persistent esophageal fistula. Mean hospital stay was 24.3 days (range 10-43). All the patients were discharged to the hospital in good conditions., Conclusions: In conclusion in most of the cases of esophageal perforation the surgical treatment is the treatment of choice for its lower morbidity and mortality and good functional results.

Purpose: To assess the role CT in the evaluation of traumatic and spontaneous oesophageal perforation., Materials and Methods: From March 2001 to May 2003, we studied 12 patients (7 males and 5 females; age range: 25-66 years, mean age: 43.5 years) with suspected oesophageal perforation due to motor-vehicle accidents (4 cases), stab wound (one case), post-intubation (2 cases), foreign body ingestion (2 cases) and spontaneous (3 cases). Five patients underwent standard chest and cervical radiography; two patients with suspected foreign body ingestion also underwent a gastrografin swallow study; all of the 12 patients underwent CT of the neck, chest and abdomen before and after intravenous, and in four cases oral, administration of contrast material., Results: In 5 patients with cervical, thoracic and abdominal trauma, the CT examination showed the presence of pleuroparenchymal injury (pneumothorax, pleural effusion and subcutaneous emphysema) as well as findings suggestive of oesophageal perforation: peri-oesophageal air (5 cases), peri-oesophageal fluid (4 cases), oesophageal wall thickening (3 cases), oesophageal wall laceration (2 cases) with abnormal course of the nasogastric tube in one of them and extraluminal extravasation of oral contrast material (2 cases). In 2 patients with post-intubation complications, CT showed the presence of a small peri-oesophageal fluid collection containing small gas bubbles in one case, and a gross perioesophageal abscess-like collection in the second case. In the 2 patients with foreign body ingestion, the plain radiography associated with CT showed the presence of a thin metal object in the cervical region (fragment of a dental plate) and a small extraluminal extravasation of gastrografin in one case, whereas in the other case CT showed the presence of a foreign body (chicken bone) in the hypopharynx with oesophageal wall thickening and peri-oesophageal oedema. In the remaining three patients with suspected spontaneous oesophageal perforation, CT showed the presence of a intramural haematoma in one case, oesophageal fluid distension with gas and a small peri-oesophageal fluid effusion (Mallory-Weiss syndrome) in another, and oesophageal rupture (Boerhaave syndrome) in the last case., Conclusions: Our experience shows that in patients with suspected traumatic and spontaneous oesophageal perforation, standard cervical and chest radiography may suggest a suspected oesophageal perforation in only a small proportion of cases, whereas oral contrast oesophagography has a higher sensitivity. Through the careful analysis of suggestive and specific signs of oesophageal perforation, a correct CT examination enables an accurate and timely diagnosis which significantly affects prognosis and provides valuable indications for treatment.

The Authors explain a case of intestinal obstruction due to a gossypiboma. They stress the great importance of the prevention in surgical operations (count of surgical towels, exploration of the surgical site) and the role of the differential diagnosis.

Aim of the Study: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at the Ospedale S. Corona, Pietra Ligure (SV)., Methods: perspective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, aetiology and treatment., Results: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing., Conclusions: spondylodiskitis is more frequently localized at lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic ones often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.

Aim of the Study: to evaluate the episodes of non-tubercular spondylodiskitis diagnosed between 1998 and 2002 at Ospedale S. Corona, Pietra Ligure (SV)., Methods: prospective evaluation of vertebral osteomyelitis classified as spontaneous or iatrogenic if associated with procedures on the spinal cord, with detection of associated risk factors, localization, etiology and treatment., Results: 45 episodes, 71% spontaneous and 29% iatrogenic were observed. Associated risk factors were present in 47% of spontaneous spondylodiskitis. Lumbosacral localization was detected in 68% of spontaneous and 100% of iatrogenic episodes. Other localizations in spontaneous spondylodiskitis were dorsal (25%) or cervical (7%). Methicillin-sensitive staphylococci caused the majority of spontaneous spondylodiskitis, while methicillin-resistant strains were more frequently involved in iatrogenic episodes. Among spontaneous spondylodiskitis, 63% healed with antibiotics for 8 weeks, but surgery was often needed in dorsal localizations. In iatrogenic forms antibacterial therapy for 8 weeks-6 months was effective in cases not associated with foreign bodies but their presence always required surgery for healing., Conclusions: spondylodiskitis is more frequently localized at the lumbosacral level. Beta-lactams are generally effective in spontaneous episodes, while iatrogenic episodes often require associations of drugs. Surgery may be required in the case of dorsal localization or in the presence of foreign bodies.

The authors report on a series of 142 patients who had swallowed foreign bodies over the period 1981-1999. After outlining the various ways in which the foreign bodies were swallowed and the fact that they were eliminated spontaneously by natural routes in 80-90% of cases, the authors deal at some length with the serious complications that occurred in some of these cases, which, as a result of their characteristics and mode of ingestion, may require emergency surgery for their resolution. In particular, the authors describe 6 cases of foreign bodies that were urgently removed by endoscopy and also describe 3 cases in detail (1 perforation and 2 bowel obstructions) in which a laparotomy was required not only to correct the complication but also to definitively clarify the diagnosis.

From June 1987 to April 2000, 167 (74%) of 223 patients suspected of swallowing foreign bodies were treated. Hundred-sixty-three were successfully treated endoscopically. The surgery rate was 2.4%. There was failure to remove a tablespoon, a tooth-brush, a dental prostheses with metallic hook, a knitting-needle. The sharp and pointed foreign bodies were 35 (20.9%). Endoscopic removal of sharp and pointed foreign bodies in the upper gastrointestinal tract can be very difficult to manage. The Authors report iatrogenic perforation of esophagus-gastric-fundus in a patient with hiatus hernia who ingested a big knitting-needle in order to suicide. They think that it is absolutely necessary to use special endoscopic equipment during the taking out of foreign-body procedure, especially when pointed and sharp-edge shaped bodies are involved and when there is high risk of iatrogenic lesions.

A modern cardiology department has very frequent relations with a heart surgery center for the management of stable and unstable patients with coronary artery disease. Therefore, these relations need to be formally defined. This impelling necessity stems from the clinical evidence that a high number of unstable patients need a timely revascularization as well as from the economical pressure to correctly allocate the limited surgical resources available. Thus three main contexts should be clearly defined: 1) surgical support during coronary angioplasty (PTCA), when this activity is performed on-site; 2) timely revascularization of unstable patients admitted to the coronary care unit or the ward; 3) surgical prioritization of stable subjects undergoing diagnostic catheterization. The increased experience in PTCA as well as several technical improvements, namely stents, has dramatically reduced the need for emergency surgical revascularization and has induced an evolution in the stand-by strategy with new concepts such as "surgical back-up" or "next available operating room". Therefore, the role of heart surgery has switched from the emergency treatment of the frequent complications of PTCA to the timely revascularization of subjects not suitable for percutaneous interventions. Thus, PTCA "without on-site" surgical facilities is gaining widespread acceptance. With the aim of defining the requirements to perform PTCA at hospitals without coronary surgery facilities, several aspects are reviewed. Furthermore, the concepts of timely surgical revascularization in unstable patients as well as the management of surgical prioritization for stable subjects submitted to diagnostic catheterization are discussed in detail. Therefore, there is still a tight relation between cardiology and heart surgery in several clinical contexts. However, the main issues of these relations as well as outcomes do not differ significantly whether heart surgery is on-site or off-site.

The aim of the study was the evaluation of emergency surgical treatment of traumatic oesophagus rupture due to the foreign body observed between 1990 and 1999. In three cases there was fortuite ingestion of foreign bodies (metallic money; alimentary particle; dentary prosthesis) and in one case it was a suicide attempt with ingestion of mascellary prosthesis. One case of death (25%) was observed, due to septic mediastinitis with pleuric compromision. The rarity of these lesions with high rate of mortality from septic mediastinitis and importance of early treatment are outlined.

Ureteral endoprostheses can be complicated by incrustations, sometimes making it impossible to withdraw the stent. A case in which the use of cistolithotripsy and of extracorporeal shock-wave lithotripsy (ESWL) allowed withdrawal of a double J ureteral stent with large incrustations is reported. The stent was placed 3 years before. Epidemiology, aetiology and therapeutic aspects of encrusted ureteral stents are discussed.

Aortoesophageal fistula is a rare but fatal cause of upper gastrointestinal bleeding. AEF develop progressively from the esophageal perforation caused by foreign body. Clinically, there is a medial chest pain, followed by hematemesis and finally terminal exsanguination. Diagnosis must be achieved during the free intervals in this triad of often rapidly succeeding signs.

The Authors report a clinical case of a patient endoscopically treated for recurrent oesophageal obstruction by a foreign body. A review of the recent medical literature confirms that immediate endoscopic treatment is the best approach in the oesophageal retention of foreign bodies.

Hepatic abscess is a serious surgical problem with a high mortality rate. The Authors report a case of a liver abscess following the migration of a toothpick from the stomach into the hepatic left lobe. Percutaneous abscess drainage combined with endoscopical removal of the foreign body were the goal treatment. The Authors stress importance of the laparoscopy-guided drainage with placement of intra-hepatic drains.

The case of a 3-year-old female with an atypical presentation of foreign body aspiration is described. Resistance to the therapy, mild radiological signs and a high index of suspicion of the clinician could lead to the right diagnosis.

An entero-vesical fistula due to intestinal foreign body is rare. A case is presented and the clinical diagnostic and therapeutic aspects of this lesion are discussed.

Intestinal injuries are pathologies frequently caused by toothpicks. In literature are reported serious damage to the cardiovascular system, lung and systemic fatal sepsis. In literature are also reported some deaths caused by delayed diagnosis. The authors report two cases of intestinal perforation by toothpick. Both patients had accidentally swallowed the toothpick. The clinical state was compatible with acute abdomen in a 59 year old psychopathic patient and acute appendicitis in a 27 year old patient. The aim of this paper is to emphasize the importance of a careful anamnesis for detecting the swallowing of a toothpick.

Ingestion of foreign bodies (FB) seems to be a relatively common occurrence in certain classes of people. The majority of ingested objects reach the stomach end 80% of these pass spontaneously without complications. However nearly 20% of FB that pass from the stomach result in complication distally such to required a surgical operation. The authors report a case of chicken bone perforation of the ileus, which was diagnosed by surgical operation. The case reported is of interest for several reason. The lack of condition that can predispose patients to accidental ingestion of FB, no specific history of FB ingestion and the impossibility to detect chicken bones on plain radiography.

Dating from October 1987 to January 1995 we have observed 24 patients who swallowed an extraneous object. Tree of them underwent a surgical operation whereas the remaining 21 were monitored endoscopically. Our team use to operate when the extraneous object, for its shape or dimension, comes to a stop along the intestine, causing a potential of existent complication. In 2 of the 3 cases above mentioned, the diagnosis came out from a abdomen x-ray which put into evidence a clothes peg stopped at level with the first jejunal ansa and an open pin which had performed an ileal ansa. As far as concerns the third case, we were compelled to operate without a preoperative diagnosis as the patient, mentally disabled, swallowed a sharpened, not x-rayed extraneous object (a toothpick). When swallowed, a toothpick usually causes lesions in the higher stretch of the digestive system. It is very difficult to spot the toothpick position for it slack x-opacity, even when the lesion caused by it is clearly visible. The sigma perforation, caused by the swallow of an object, rarely happens. Authors have reported a case to be pointed out for its pathogenetic originality.

Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.

After investigation of the international literature on this subject, the authors describe a case report of adhesive-stenotic and retractile peritonitis, very likely caused bt a foreign body reaction (surgical stitches, gloves, rice powder, etc.?). This case-report is interesting both to remember the existence of this pathology and to limit its iatrogenic development. In conclusion, it is advisable to wash surgical gloves with sterile solutions and to limit enlarged bowel resections mostly in young people.

The Authors report a case of cervical esophageal perforation from foreign body. Comparing their experience with data from literature, they point out the diagnostic importance of both X-ray studies, in order to demonstrate the site of the lesion, and CT scans, to have accurate information on perilesional infective complications (abscesses). Early surgical treatment, with primary closure of perforation and adequate drainage, associated with antibiotics and enteral or total parenteral nutrition, allows good results in most cases.

Starting from a case of aortoesophageal fistula caused by a foreign body, some aspects of the treatment of upper gastrointestinal hemorrhage of uncertain etiology are discussed. The time between bleeding and perforation often notes it possible to perform resolutive diagnostic tests (aortography, esophagoscopy, CT).

The authors describe the origin and the physiopathological events in acute appendicitis. They show an uncommon case of acute appendicitis. The aetiology was an opaque radiation foreign body causing a subacute abdominal disease. At operation the authors discovered the above body free in the abdominal cavity; the appendix was not in ischemic phase but completely cut off bycecal plant. They suppose aetiology to be of a decubitus origin.

Perforation of the colon carries a high mortality and morbidity. Perforations caused by foreign bodies are relatively rare and appear to be less often associated with postoperative complications than perforations due to organ disease. Depending upon the extent of the perforation and its anatomical site, as well as on the basis of the presence of diffuse or circumscribed peritonitis, the treatment of foreign-body perforation will vary from simple suturing, with or without a protective colostomy, to exteriorization in the form of a colostomy, and the Hartmann operation.

The Authors describe a case of perforation of the cervical oesophagus by a foreign body (dental prosthesis). After outlining the clinical and instrumental elements which may be useful in the diagnosis, the Authors go on to tackle the topic of the most appropriate choice of therapy in the course of foreign-body perforation and in perforation of the oesophagus in general.

The authors describe a rare complication following total gastrectomy or reconstruction using a Roux-en-Y loop: the presence of a metal mandrel used to insert the nasogastric tube in the end tract was discovered during esophagojejunal anastomosis. The object was extracted by esophagoscopy without damage to the patient.

At first, the authors mention indications and way of placement of the Angelchik prosthesis. Then after a wide review of the literature, they describe the complications and results. Finally a case of penetration into the stomach of an Angelchik prosthesis is reported. It was favourably resolved by an operation.

The possibility of migration of a transvenous electrode bend in the infundibulum of the pulmonary artery is a very rare complication of permanent pacing. The Authors describe the case of a patient whose transvenous electrode, positioned in the pulmonary artery 5 years after implantation, was presumably the cause of a ventricular hyperkinetic arrhythmia (VT) and of cerebral disturbances (sublipothymia, syncope). The re-position of the electrode removed the arrhythmia thus considerably improving the symptoms of the patient.

On the basis of observations made in 69 patients with traumatic lesions and those caused by foreign bodies in the colon and rectum, supplemented by the data emerging from literature, some clinical and therapeutic considerations are expressed on the subject. A tactic of treatment based on the material examined and, in the present state, advisable as a possible plan of treatment for the said lesions is also proposed.

The authors describe a rare case of sigmoidovesical fistula due to a foreign body and giving trouble 30 years after the causative surgical procedure, namely an oopheroctomy. The cause of the fistula was apparently some suture material that had not been reabsorbed. Surgical excision of the fistula produced a complete recovery.

Experimental research designed to provoke subcutaneous granulomas by means of vegetable foreign bodies in animals is reported. The possibility of influencing the ongoing picture by means of anti-inflammatory drugs was also investigated. The findings were similar to those observed in a patient with a similar foreign body responsible for a perineal granuloma. The anti-inflammatory substances employed, however, had no effect on the aspecific granulomatous reaction.