Detection of glass foreign bodies by radiography

Protection from β-cell apoptosis by inhibition of TGF-β/Smad3 signaling

Prevailing insulin resistance and the resultant hyperglycemia elicits a compensatory response from pancreatic islet beta cells (β-cells) that involves increases in β-cell function and β-cell mass. However, the sustained metabolic stress eventually leads to β-cell failure characterized by severe β-cell dysfunction and progressive loss of β-cell mass. Whereas, β-cell dysfunction is relatively well understood at the mechanistic level, the avenues leading to loss of β-cell mass are less clear with reduced proliferation, dedifferentiation, and apoptosis all potential mechanisms. Butler and colleagues documented increased β-cell apoptosis in pancreas from lean and obese human Type 2 diabetes (T2D) subjects, with no changes in rates of β-cell replication or neogenesis, strongly suggesting a role for apoptosis in β-cell failure. Here, we describe a permissive role for TGF-β/Smad3 in β-cell apoptosis. Human islets undergoing β-cell apoptosis release increased levels of TGF-β1 ligand and phosphorylation levels of TGF-β's chief transcription factor, Smad3, are increased in human T2D islets suggestive of an autocrine role for TGF-β/Smad3 signaling in β-cell apoptosis. Smad3 phosphorylation is similarly increased in diabetic mouse islets undergoing β-cell apoptosis. In mice, β-cell-specific activation of Smad3 promotes apoptosis and loss of β-cell mass in association with β-cell dysfunction, glucose intolerance, and diabetes. In contrast, inactive Smad3 protects from apoptosis and preserves β-cell mass while improving β-cell function and glucose tolerance. At the molecular level, Smad3 associates with Foxo1 to propagate TGF-β-dependent β-cell apoptosis. Indeed, genetic or pharmacologic inhibition of TGF-β/Smad3 signals or knocking down Foxo1 protects from β-cell apoptosis. These findings reveal the importance of TGF-β/Smad3 in promoting β-cell apoptosis and demonstrate the therapeutic potential of TGF-β/Smad3 antagonism to restore β-cell mass lost in diabetes.

Evaluation of patients undergoing removal of glass fragments from injured hands: a retrospective study

The hand is the body part most frequently injured by broken glass. Glass fragments lodged in soft tissues may result in numerous complications, such as infection, delayed healing, persistent pain, and late injury as a result of migration. Between 2005 and 2010, we removed 46 glass particles from the hands of 26 patients. The injuries were caused by the following: car windows broken during motor vehicle accidents in 11 patients (42%); fragments from broken glasses, dishes, or bottles in 9 (35%); the hand passing through glass in 5 (19%); and a fragment from a broken fluorescent lamp in 1 (4%) patient. Despite the efficacy of plain radiographs in detecting glass fragments, these are sometimes not obtained. Given the relatively low cost, accessibility, and efficacy of radiographs, and the adverse consequences of retained foreign bodies, the objections to obtaining radiographs should be few in diagnosing glass-related injuries of the hand.

High-risk chief complaints III: abdomen and extremities

Abdominal and extremity complaints are a frequent reason for presentation to the emergency department. Although these are common complaints, several abdominal and extremity disease entities may be missed or may be subject to delayed diagnosis. This article provides an overview of the diagnosis and management of several high-risk abdominal and extremity complaints, including appendicitis, abdominal aortic aneurysm, mesenteric ischemia, bowel obstruction, retained foreign body, hand and finger lacerations, fractures, and compartment syndrome. Each section focuses primarily on the pitfalls in diagnosis by highlighting the limitations of history, physical examination findings, and diagnostic testing and provides specific risk management strategies.

Treatment of scattered glass foreign bodies in both the superficial and deep neck: A case report

There have not been any reports about scattered glass foreign bodies in the neck, while injuries of the head and neck region as a result of traffic accidents have been frequently reported. We report the case of a 17-year-old male injured in a traffic accident, with scattered glass foreign bodies in both the superficial and deep neck. A CT scan indicated the existence of numerous glass foreign bodies in the various layers of the neck. Most of the foreign bodies were very fine or sand-like. The wounded skin was keloidal and expected to lead to remarkable facial edema of the left side. The foreign bodies and cervical keloidal lesions with small pieces of glass were carefully removed, and then reconstruction was conducted in stages using tissue expanders. The facial edema was reversed and the aesthetic reconstruction satisfied the patient.

Glass foreign body in the spinal canal of a child: case report and review of the literature

Retained foreign bodies pose a risk to the patient from the perspective of potential morbidity. We describe a previously healthy 8-year-old boy with head and back trauma from a glass picture frame that fell off the wall. He sustained a closed head injury and a back laceration several centimeters lateral to the spine. A persistent drainage from the back laceration contained glucose and protein levels consistent with cerebral spinal fluid. A foreign body was easily visible on subsequent plain radiograph. The glass foreign body was removed by neurosurgeons after computed tomography and magnetic resonance imaging clarified the exact location of the glass fragment. Physicians should have a low threshold for obtaining plain radiographs in patients with glass foreign bodies and consider that projectiles may rest some distance from the laceration site.

Is glass visible on plain radiographs? A cadaver study

Eighteen randomly selected pieces of nonleaded glass from a collection of 30 pieces from broken bottles of four known color types found on the streets of Houston were sorted into four sets with one control. The purpose of this study was to determine if regular glass is visible on plain radiographs and whether color, location, or volume of these fragments had any effect on the detection of nonleaded glass. These sets were then placed into a fresh-frozen cadaver foot and ankle with a history of insulin-dependent diabetes and peripheral vascular disease. This foot was radiographed utilizing four standard foot projections. Five examiners read these five sets of radiographs twice and recorded the number seen. Overall sensitivity for all of the examiners was 90% with an overall false-positive rate of 10%. Intraobserver and interobserver Pearson's correlation coefficients showed that there was reliability between the first and second readings and between observers. The authors concluded that regular nonleaded glass is radiographically visible and that factors such as color and location of the glass have no effect on its detection, while a volume of less than 15 mm3 may have an effect on the detection of glass.

Retained glass foreign bodies in wounds: predictive value of wound characteristics, patient perception, and wound exploration

A convenience sample of 164 adult patients with 185 glass-caused wounds who presented to an emergency department (ED) and consented to a radiograph was prospectively studied. The purpose was to determine the characteristics of wounds at high risk for foreign body (FB) and the predictive value of patient FB sensation and probing wound exploration for FB retention. Retained glass was located in 28 (15%) wounds. Motor vehicle as a mechanism of injury (P=.003), head as a location (P=.035), and puncture as wound type (P=.002) were more likely to be associated with retained FBs (chi2 analysis). Patients with wounds with glass were more likely to have a positive perception of a foreign body (41%) than those with no glass (17%) (P=.005). The positive predictive value of patient perception was 31%; negative predictive value was 89%. In five cases, wound exploration was negative and subsequent radiograph was positive for FB. In one of these cases, a 4-mm glass FB was removed; in the other four, no FB was found. In conclusion, head wounds resulting from motor vehicle accidents or puncture wounds are more likely to harbor retained glass FBs. Patients with glass FB in wounds are more likely to have a positive perception of FB; however, a positive perception has a low predictive value of glass FB. In this series, a negative wound exploration made the presence of retained FB greater than 2 mm less likely but did not rule out the presence of retained glass.

Foreign body removal with fine-nosed forceps and assistance of image intensification

Foreign body removal has been developed as a routine radiology department service. Techniques, indications and hazards are described.

Foreign body retention in glass-caused wounds

STUDY OBJECTIVE

To describe patient and wound characteristics that are clinically useful in identifying wounds that were caused by glass and retained a foreign body.

DESIGN

Retrospective consecutive case review.

SETTING

Urban, university-affiliated teaching hospital.

TYPE OF PARTICIPANTS

Four hundred thirty consecutive patients with a total of 578 evaluable wounds caused by glass during a 12-month period.

MEASUREMENTS AND RESULTS

Medical records were reviewed to determine patient demographics, primary wound data (eg, location, type, description), mechanism of injury, type of glass involved, and presence of foreign body sensation. Glass was found by examination in 7% of wounds. Eight percent of 137 radiographs were positive. Wounds with the highest prevalence of retained glass were puncture wounds (P < .0005), those caused by stepping on glass or by a motor vehicle accident (P < .005), and those of the head or foot (P < .003).

CONCLUSION

Characteristics of wounds most likely to retain glass were identified in this retrospective study. The presence of these factors should increase the clinician's suspicion of a retained glass foreign body. The indications for radiography for the detection of retained glass in wounds should be clarified with prospective studies.

Detection of foreign particles in traumatized skin

The aims of the medico-legal investigation of wounds are a description of the wound morphology, the characterization of the force used and finally identification of the weapon. The demonstration of foreign particles, such as wood particles, paint fragments, synthetic materials, sand or gravel particles, powder residues and rust particles, in the depth of a wound or in the surrounding area can be of great value. In the present series of experiments the suitability of imaging methods (low energy X-ray imaging, direct X-ray magnification, nuclear magnetic resonance) for the detection of relevant foreign particles has been investigated.