Laparoscopic removal of a large laparotomy pad forgotten in situ

Objects forgotten during surgery are still an important complication with ethical and forensic implications. This case report describes a splenectomized patient with type II Hodgkin's disease. A large laparotomy pad (68 x 48 cm) forgotten in situ during a staging operation 6 months previously was removed laparoscopically. In asplenic patients with a permanent immune deficiency it is especially advantageous to perform surgery via the "closed" route whenever possible.

Percutaneous retrieval of a surgical laparotomy sponge from the peritoneal cavity

Percutaneous retrieval of an extravascular foreign body is an uncommon procedure. This report describes the successful retrieval of a 46 x 46-cm laparotomy sponge from the peritoneal cavity using a Nitinol Gooseneck Snare system. This technique can eliminate the need for exploratory surgery and may be particularly useful in poor operative candidates.

[A case of gauzeoma with recurrent massive hemoptysis mimicking aspergilloma]

A 52-year-old woman who had received a right upper lobectomy and thoracoplasty for the treatment of pulmonary tuberculosis 30 years prior to the present disorder, was admitted to out hospital with massive hemoptysis. We diagnosed aspergilloma clinically because chest X-ray showed a fungus ball-like mass with meniscus sign. Right middle and lower lobectomies were performed after the 7th bronchial arterial embolization for recurrent hemoptysis. The resected specimen showed a mass of old gauze, a so-called "gauzeoma". We have found no previous reports of gauzeoma with both meniscus sign and recurrent massive hemoptysis mimicking aspergilloma.

Gossypibomas mimicking echinococcal cyst disease of the lung

Gossypibomas, masses of retained cotton materials, may produce a variety of postoperative complications. This case report of hemoptysis of 18 months' duration and cavitating chest masses in a 62-year-old man with previous cardiac operations illustrates several salient features about the presentation, differential diagnosis, and management of gossypibomas.

[Value of silicone sponge in retinal detachment surgery]

Lincoff's development of silicone sponge and substitution cryosurgery for diathermy in the mid-1960s, was the beginning of the minimized surgery for retinal detachment, limited to the surgery of the breaks. The aim of this paper is to present our experiences with these kinds of operations, with special attention to the complications causing the necessity of removing the sponge. Our studies concerned the patients who underwent retinal detachment surgery, in the Ophthalmological Clinic in Cracow in the years 1983-1992, using scleral buckling procedures with silicone sponge. In 152 cases circumferential and in 36 radial local scleral buckling procedures were performed; in 30 cases local buckling was added to encirclement with silicone band. The complications, attributed to the sponge, were observed in 9.7% of cases. Anterior segment inflammatory reactions, often sterile were found in 15 eyes, in 7 of them it was necessary to remove the sponge. In 13 eyes the sponge was removed on account of its extrusion. In none of the cases removal of the sponge influenced the retinal attachment. Our studies confirmed, that silicone sponge is a very good material for scleral buckling procedures.

Case report 736: Retained surgical sponge (gossypiboma) with a foreign body reaction and remote and organizing hematoma

This 50-year-old woman presented with progressive pain in the left thigh. Radiographs showed a 9 x 6 cm soft-tissue mass located at the lateral border of the left femur. Magnetic resonance (MR) examination showed an eccentric, nonhomogeneous, soft-tissue mass abutting the femur. The preoperative differential diagnosis was schwannoma, low-grade neurogenic tumor, large periosteal ganglion, or fibroma. At operation, the cut surface of the specimen had features of an organizing hematoma with recent remote hemorrhage and areas of fibrosis. Histopathological examination confirmed the presence of polarizable foreign body material in a background of foreign body reaction. The specimen represented a retained surgical sponge which had been present since the patient's surgery for a comminuted fracture 35 years earlier. Gossypiboma, or cotton balloma, is a term used to describe a mass within the body composed of cotton matrix. Radiopaque markers are now present on surgical sponges, and their appearances have been well documented. The gossypiboma, however, may still present a diagnostic problem if the marker is distorted by folding, twisting, or disintegration over a period of time. Without the radiopaque markers, retained sponges are difficult, if not impossible, to diagnose, as was the situation in this case.

Haemolysis following mitral valve repair

We report the unusual occurrence of severe intra-vascular haemolysis following mitral valve repair. Mild to moderate mitral regurgitation was detected after repair, but severe haemolysis was the only indication for re-operation. Following prosthetic valve replacement there was an immediate cessation of haemolysis. We postulate that a small regurgitant jet directed against the teflon pledgets used in the repair was the reason for the haemolysis.

Contact dermatitis in the dog and cat

OBJECTIVE

The purpose of our study was to describe the MRI features of gossypiboma and correlate the MRI findings with the pathologic findings in four patients.

CONCLUSION

On MRI, gossypiboma in the abdomen and pelvis manifested as a well-defined mass that showed a peripheral wall of low signal intensity at T1- and T2-weighted imaging and enhancement at contrast-enhanced T1-weighted imaging. The whorled stripes within the central portion were characteristically shown as low signal at T2-weighted imaging, and the serrated contour in the inner border of the peripheral wall was shown at contrast-enhanced T1-weighted imaging. Histopathologically, the peripheral wall showed granulomatous inflammation with massive fibrosis and foam cell and multinucleated giant cell infiltrations, whereas the whorled stripes within the central portion were gauze fibers. If a patient has a history of a previous operation, the possibility of gossypiboma should be suggested when the central whorled stripes or serrated contour in the inner border of the peripheral wall is present at MRI.

Tissue reaction to subcutaneous implantation of a collagen sponge. A histological, ultrastructural, and immunological study

The biocompatibility of a subcutaneously implanted bovine collagen sponge (Haemostagen) was studied in rats by analyzing tissue reactions up to 3 months by histological and ultrastructural methods; in addition, the level of serum antibodies to bovine type I collagen (the major implant collagen) was measured by solid-phase radioimmunoassay. By 8 h after implantation, the implant was completely filled with polymorphonuclear cells (PMNs). After 8 days, fibroblasts had developed a granulation tissue within the sponge and the PMNs had almost disappeared. The small residue that remained after 1 month consisted of some densely packed collagen fibrils containing giant cells, which had disappeared by 3 months. No antibodies to bovine type I collagen were found in the sera of implanted rats.

Development and testing of a human collagen graft material

Human Type I collagen was extracted from placenta using pepsin and salt fractionation. The collagen was characterized by SDS-PAG electrophoresis dispersed in acidic medium, freeze-dried, and cross-linked in an 0.25% glutaraldehyde solution pH 4.5 for 2 days. After washing for 7 days and freeze drying the resultant collagen sponge was tested with regard to mechanical, physical, enzymatic degradation properties and biological responses. The modulus of elasticity was found to be 289 +/- 10 g/mm2 and the sponge was insoluble in water, buffered saline, or tissue culture medium over a period of 6 weeks with swelling occurring at less than 5% of volume. The sponge had a high fluid binding capacity, amounting to 56 +/- 5 mL tissue culture medium per gram of dry weight. Bacterial collagenase produced slow degradation of the sponge with complete disappearance by 24 h only when high concentrations (200 units enzyme per mg of the collagen sponge) were used. Cytotoxicity studies using human gingival and periodontal ligament fibroblasts revealed less than 5% apparent cytotoxicity or proliferation. Subcutaneous implantation was followed by resorption and vascularization over a period of 6-8 weeks. It was concluded that the collagen sponge prepared from human Type I collagen has potential as a graft material in oral surgical procedures.

[CT and US findings of gauzeoma]

We described the CT and US findings of gauzeoma in 7 patients, in which the masses were histologically proved. In the wide range of the CT findings, whirl-like spongiform pattern and the wavy striped high density area were characteristic of gauzeomas. The typical US features of gauzeomas were a cystic mass with the distinct internal echoes and strong acoustic shadows. The internal echo were occasionally curve-linear in shape. Gauzeomas are not common disease. However, when the findings described above are seen in the patients who have previously had an abdominal surgery, gauzeomas should be suspected.

In vivo evaluation and comparison of collagen, acetylated collagen and collagen/glycosaminoglycan composite films and sponges as candidate biomaterials

Native collagen, acetylated collagen, collagen/10% chondroitin sulphate, collagen/2.5% hyaluronic acid and collagen/20% hyaluronic acid were implanted both as film and as sponge into rat lumbar muscle for 7 and 14 d. After 7 d implantation, all materials elicited an acute inflammatory cell response characterized by numerous polymorphs and histocytes. The cell population after 14 d was principally mononuclear, i.e. leucocytes, neutrophils, macrophages, lymphocytes and fibroblasts. Both films and sponges followed a similar pattern. Native collagen elicited a subacute inflammatory response after 7 d. However, 14 d after implantation, a marked infiltration by neutrophils was apparent with subsequent degradation of existing collagen material. Acetylated collagen film evoked a much greater inflammatory cell response than native collagen. Both collagen/hyaluronic acid composites elicited a similar response. The collagen/10% chondroitin sulphate composite elicited the least inflammatory cell response at 7 d, whereas infiltration by host fibroblasts after 14 d implantation was clearly seen.

The retained surgical sponge following intra-abdominal surgery. A continuing problem

The surgical sponge retained following intra-abdominal surgery is a continuing problem. Despite precautions, the incidence of this problem is grossly underestimated. During the past 10 years, we have treated four patients with this problem. The presentation of a retained surgical sponge is highly variable, as is the time before the onset of symptoms. The clinical presentation, predisposing factors, and management are presented as well as guidelines for prevention.

Complications of retropubic bladder neck suspension

Seven women who underwent the Stamey endoscopic bladder neck suspension performed by different urologists at a variety of institutions were evaluated at the Lahey Clinic Medical Center. Two to 36 months after operation, each woman sought medical attention because of complaints of pain in the lower abdomen, pelvis, or groin with or without urinary frequency and urgency. Endoscopic examination revealed an acute mucosal inflammatory reaction, perforating sutures or Dacron pledgets, and formation of calculi around a suture. In each patient, sutures or pledgets were removed endoscopically with resolution of presenting complaints.

A remarkable subhepatic tumour

Although foreign-body pseudotumours are not particularly rare, the diagnosis is not often considered. The case history is presented of a patient with a surgical gauze left after a cholecystectomy performed 23 years before. The incidence of these pseudotumours and the variety of clinical pictures in relation to the condition are described.