Crystal jelly balls are used for decorative purpose in homes and offices. They swell on contact with water. We managed a patient with a clinical diagnosis of acute abdomen. At surgery, there was fecal peritonitis and three ileal perforations caused by previously ingested decorative crystal balls.
Acute abdomen; crystal balls; generalized peritonitis; intestinal perforation; missing foreign body
Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a one-way valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.
blood clot; airway obstruction; suction; tracheostomy
We report a case of a male patient who received an implantation of a Starr-Edwards-caged-ball-valve-prosthesis in 1967. The surgery and postoperative course were without complications and the patient recovered well after the operation. For the next four decades, the patient remained asymptomatic - no restrictions on his lifestyle and without any complications. In 2006, 39 years after the initial operation, we performed a Bentall-Procedure to treat an aortic ascendens aneurysm with diameters of 6.0 × 6.5 cm: we explanted the old Starr-Edwards-aortic-caged-ball-valve-prosthesis and replaced the ascending aorta with a 29 mm St.Jude Medical aortic-valve-composite-graft and re-implanted the coronary arteries.
This case represents the longest time period between Starr-Edwards-caged-ball-valve-prothesis-implantation and Bentall-reoperation, thereby confirming the excellent durability of this valve.
A necrotic lung ball is a rare radiological feature that is sometimes seen in cases of pulmonary aspergillosis. This paper reports a rare occurrence of a necrotic lung ball in a young male caused by Candida and Streptococcus pneumoniae.
A 28-year-old male with pulmonary candidiasis was found to have a lung ball on computed tomography (CT) of the chest. The patient was treated with β-lactams and itraconazole and then fluconazole, which improved his condition (as found on a following chest CT scan) and serum β-D-glucan level. The necrotic lung ball was suspected to have been caused by coinfection with Candida and S. pneumoniae.
A necrotic lung ball can result from infection by Candida and/or S. pneumoniae, indicating that physicians should be aware that patients may still have a fungal infection of the lungs that could result in a lung ball, even when they do not have either Aspergillus antibodies or antigens.
lung ball; necrotic lung ball; Candida; Streptococcus pneumoniae
Gallstone ileus (GI) is characterized by occlusion of the intestinal lumen as a result of one or more gallstones. GI is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. The mortality associated with GI ranges between 12% and 27%. Classical findings on plain abdominal radiography include: (1) pneumobilia; (2) intestinal obstruction; (3) an aberrantly located gallstone; and (4) change of location of a previously observed stone. The optimal management of acute GI is controversial and can be: (1) enterotomy with stone extraction alone; (2) enterotomy, stone extraction, cholecystectomy and fistula closure; (3) bowel resection alone; and (4) bowel resection with fistula closure. We describe a case to highlight some of the pertinent issues involved in GI management, and propose a scheme to minimize recurrent disease and postoperative complications. We conclude that GI is a rare condition affecting mainly the older population with a female predominance. The advent of computed tomography and magnetic resonance imaging has made it easier to diagnose GI. Enterotomy with stone extraction alone remains the most common surgical method because of its low incidence of complications.
Gallstone ileus; Fistula closure; Intestinal obstruction; Bowel obstruction; Enterolithotomy
A 50–year old female presented with the chief complaint of a discharge per vaginum, which was there for the past 15 days. A routine PAP smear was received in the Department of Pathology, Government Medical College, Patiala, India. After its fixation and staining, it was examined under the microscope. It showed the Trichomonas vaginalis infection, with the neutrophils forming cannon balls at places. Neutrophils in the PAP smear are a nonspecific finding, particularly if they are low in numbers or if they are seen in the premenstrual and the menstrual phases. The neutrophils which are adherent to the squamous cells are called “cannon balls” or “pus balls”, which are common in the Chlamydia infection. This case is being presented because of the presence of these rare morphological structures i.e. “cannon balls” or “pus balls”.
PAP; Cannon ball; Trichomonas vaginalis
Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.
We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.
The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.
Recurrent gallstone ileus; enterotomy; fistulectomy
A patient is reported who had biliary tract obstruction secondary to infection of the common bile duct with Candida albicans, with the formation of a fungus ball. Treatment consisted of surgical removal of the fungus ball and drainage. Chemotherapy was not necessary. Ureteral obstruction through fungus ball formation, and even pulmonary fungus ball formation, has been attributed to candida, but this is the first case reported, to our knowledge, of bile duct obstruction.
Very few cases of small bowel obstruction due to ingested fruits have been described in literature, and most of these have managed by a laparotomy. Laparoscopic assisted surgery can effectively deal with such impacted foreign bodies, thereby avoiding a formal laparotomy.
A 75 years old lady was admitted via the Accident and Emergency to the surgical ward with a three-day history of abdominal pain and vomiting. Investigations were suggestive of acute small bowel obstruction. On laparoscopy, there was an area of sudden change in calibre of small bowel with dilated proximal and collapsed distal segment in distal jejunum. A foreign body, dried undigested apricot, was extracted by mini-laparotomy.
Small bowel obstruction is a frequent cause of emergency surgery, and aetiology may include food bolus obstruction. Diagnosis is usually confirmed intra-operatively. Foreign body impacted in small bowel can be removed by open or laparoscopic methods.
Generally, laparotomy is performed for diagnosis and management in acute bowel obstruction, but with increasing expertise, laparoscopy can be equally effective with all the other advantages of minimal access approach.
During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (± SE) were 78 ± 4%, 62 ± 4%, and 29 ± 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 ± 5% and 72 ± 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of ≥ 0.56, cardiac index of < 3.0 L/min/m2, age > 55 years, previous myocardial infarction, systemic pulse pressure of ≤ 40 mm Hg, mean left atrial pressure of ≥ 15 mm Hg, and mean pulmonary artery pressure of ≥ 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age ≥ 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise. (Texas Heart Institute Journal 1987; 14:144-153)
Aortic valve insufficiency; aortic valve stenosis; heart valve prosthesis
A case of isolated candidal fungal balls in the
common bile duct causing obstructive jaundice and
cholangitis is described. There were no predisposing
factors. The fungal balls were removed from the
common bile duct and a transduodenal sphincteroplasty
was performed. Microscopic analysis yielded
colonies of candida. Postoperative period was uneventful.
At follow-up no evidence of candida
infection was evident. He is now 3 years post-surgery
and is well.
The popularity of the gym ball has led to its increased use in programs designed for fitness, rehabilitation and prevention. Some people are using the gym ball to replace the office chair and others are sitting on it at home, which has created some controversy among therapists, researchers, ergonomics experts and the general public. The controversy is due in part to a lack of knowledge and experience with this application for the gym ball. Both patients in this report were suffering with low back pain, and both improved when they began consistently using the gym ball. There are two reasons for case presentations, to document a treatment of a condition and to promote discussion that may lead to research. This presentation will hopefully accomplish this.
gym ball; back pain; Gymball; mal de dos
Pica is an eating disorder typically defined as the persistent eating of nonnutritive substances for a period of at least 1 month at an age in which this behavior is developmentally inappropriate. Acuphagia being consumption of sharp objects and Hyalophagia consumption of glass materials. Majority of the foreign bodies ingested into the gastrointestinal tract pass through the rectum asymptomatically, where as objects which are sharp, long, jagged may not be able to pass through. These types of objects may cause complications like impaction, leading to intestinal obstruction, ulceration, perforation and bleeding, thus need surgical exploration. In this case of young female with impacted bunch of bangles in the stomach and few in the small and large bowel, who was completely asymptomatic, needed gastrotomy with enterotomy for complete and successful retrieval of glass bangles.
Pica; Acuphagia; Hyalophagia
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.
Foreign body ingestion in children is common. Most items pass spontaneously, however rarer cases may result in obstruction and or perforation. Ingestion of multiple magnetic items can be more troublesome, as a consequence of the ability of the items to attract across different sections of bowel, or by coalescing to form a larger foreign body. Very few cases of foreign body ingestion have led to the presentation of a complicated Meckel's diverticulum. We present of a case of an adolescent boy with intestinal obstruction secondary to multiple magnetic foreign body ingestion and sequestration within a Meckel's diverticulum.
Three eye-tracking experiments investigated the role of pitch accents during online discourse comprehension. Participants faced a grid with ornaments, and followed pre-recorded instructions such as “Next, hang the blue ball” to decorate holiday trees. Experiment 1 demonstrated a processing advantage for felicitous as compared to infelicitous uses of L+H* on the adjective noun pair (e.g. blue ball followed by GREEN ball vs. green BALL). Experiment 2 confirmed that L+H* on a contrastive adjective led to ‘anticipatory’ fixations, and demonstrated a “garden path” effect for infelicitous L+H* in sequences with no discourse contrast (e.g. blue angel followed by GREEN ball resulted in erroneous fixations to the cell of angels). Experiment 3 examined listeners’ sensitivity to coherence between pitch accents assigned to discourse markers such as ‘And then,’ and those assigned to the target object noun phrase.
Heterotopic ossification (HO) is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.
We describe the very unusual case of a patient with a large, free-floating left-atrial thrombus secondary to severe mitral stenosis, in whom the peculiar symptoms and complications of a ball thrombus were absent. The patient's only symptom before the episode reported here was mild dyspnea, which was attributed to mitral stenosis. She experienced neither embolism nor syncope. While even her clinical signs did not indicate a left-atrial ball thrombus, both echocardiography and angiography showed a free-floating thrombus. Because of the risk of stroke and acute obstruction of the mitral valve, emergency surgery was performed upon diagnosis of the ball thrombus. The surgery, which consisted of removing the thrombus and replacing the mitral valve with a mechanical prosthesis, was uneventful. A computed tomographic brain scan prior to discharge did not detect any cerebral infarction.
We have treated a total of 16 cases of advanced Kienböck's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienböck's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienböck's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienböck's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienböck's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.
Jejunal diverticuli are rare and usually asymptomatic. More commonly, they are seen as incidental findings on CT images, enteroclysis, or during surgery. Complications such as bleeding, perforation, obstruction, malabsorption, diverticulitis, blind loop syndrome, volvulus, and intussusceptions may warrant surgical intervention.
We report a case of 47-year old woman who had suffered from intestinal obstruction for 3 days. The symptoms did not improve after conservative treatment. An exploratory laparotomy found small bowel obstruction due to proximal jejunal diverticulum with an adhesion epiploic band. Strangulation of the jejunum resulted from the internal hernia caused by the band. The band was removed and the proximal jejunum segmentally resected. The postoperative course was uneventful.
Although this phenomenon is rare, we should keep in mind that intestinal diverticulosis may induce intestinal obstructions of different kinds, repeat physical examinations and X-ray films are needed and enteroclysis studies or CT scan are helpful in diagnosis. Surgery is indicated for acute abdominal or repeated intestinal obstruction.
Jejunal diverticula; gastrointestinal obstruction; jejunal resection
Umbilical discharge in adult is rare and is usually induced by foreign material, most commonly hair. Rarely, it may be due to embryonal anomalies. We are reporting an unusual case of umbilical discharge in adult secondary to an impacted lint ball.
A 55-year-old obese woman presented with a 4-month history of hemorrhagic discharge from the umbilicus. Deep from the base of the umbilicus, a 0.8 cm gray-tan mass was removed that on microscopic examination revealed a lint ball.
An impacted lint ball may be a rare cause of umbilical discharge in adult.
This paper is focused on the template-free synthesis of nanosized ferric oxide (nano-Fe2O3) and its application in quartz crystal microbalance (QCM) resonators to detect dimethyl methylphosphonate (DMMP), a simulant of Sarin. The X-ray diffraction (XRD) patterns confirm that the synthesized samples are made of Fe2O3 and the scanning electron microscopy (SEM) pictures show that the samples have ball-like shapes. The DMMP sensors with a sensing film of hollow ball-like and solid ball-like Fe2O3 are fabricated and their sensing characteristics are compared. The sensitivity of the hollow ball-like Fe2O3 sensor is more than 500% higher than the one of the solid ball-like Fe2O3 sensor. The hollow ball-like nano-Fe2O3 can be synthesized by a novel low temperature hydrothermal method. The sensors with the hollow ball-like Fe2O3 film perform well in a range of 1 to 6 ppm, with a sensitivity of 29 Hz/ppm at room temperature, while the appropriate recoverability and selectivity are maintained. In addition, the performance of different thicknesses of the sensing film of the hollow ball-like nano-Fe2O3 is investigated and the optimized relative film thickness of the hollow ball-like nano-Fe2O3 is found to be 20 μg/mm2.
nano-Fe2O3; quartz crystal microbalance (QCM); dimethyl methylphosphonate (DMMP); gas sensor
Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.
Bezoars; Diospyros kaki; Persimmon; Intestinal obstruction; Operative surgical procedure
Bezoars are concretions of undigested material in the gastrointestinal tract, most commonly in the stomach. Duodenojejunal localization of bezoars is exceptional. We report a case of a 27-year-old woman who experienced nausea, vomiting and severe abdominal pain for one week. By palpation a mobile and sensitive mass, 15 × 15 cm, was detected, which filled the upper quadrant. Results of gastric endoscopy were normal. X-ray and ultrasonography suggested a bezoar. A laparotomy revealed that the jejunum was fissured by the trichobezoar ball. This trichobezoar mass was totally excised by intestinal resection.
To our knowledge, this is the first reported case of duodenojejunal fissuration caused by trichobezoar in an adult. Among patients with high subocclusif syndrome, duodenojejunal bezoar should remain a possibility in differential diagnosis.
Duodenojejunal flexure; intestinal partial obstruction; surgery; trichobezoar
The susceptibility of laboratory reared Zimbabwean Amblyomma hebraeum and A. variegatum ticks to infection with geographically distinct Cowdria ruminantium strains was investigated by feeding both species simultaneously on individual sheep infected with one of the four strains (Crystal Springs [Zimbabwe], Ball 3 [South Africa], Gardel [Guadeloupe] and Nigeria [Nigeria]). A. hebraeum ticks demonstrated a high susceptibility to infection with all four C. ruminantium strains. In comparison, A. variegatum were less susceptible to infection with the Crystal Springs and Ball 3 strains (P < 0.001), but showed a similar susceptibility to the Gardel and Nigeria strains. The differences in susceptibility of A. variegatum to infection with the four strains of C. ruminantium correlated with the origin of these strains. The consistently higher susceptibility of A. hebraeum ticks to infection with geographically different C. ruminantium strains may be one explanation for the observation that heartwater is a more serious problem where A. hebraeum is the vector of the disease.