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Atayi AA, Omar AM, Floyd MS. Preputial advancement flap for delayed urethrocutaneous fistula of the glans following urethral insertion of an 'AAA' battery. Urologia 2024; 91:226-231. [PMID: 37491907 DOI: 10.1177/03915603231189026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Foreign body insertion associated with sexual gratification is known as polyembolokoilomania. Following removal of the foreign body, long-term complications are infrequently seen. Whilst conservative and endoscopic approaches usually suffice, in extreme cases open surgical approaches are required. We describe an unusual case of polyembolokoilomania in a 25-year-old male involving a single 'AAA' battery who developed a urethrocutaneous fistula requiring delayed reconstructive surgery. CASE PRESENTATION Following an initial successful open extraction of an 'AAA' battery from the mid penile urethra the patient developed a delayed urethrocutaenous fistula of the glans. This was managed using a single stage closure with a preputial graft on its vascular pedicle thereby preserving the foreskin and avoiding a buccal graft. No intra-operative or post-operative complications occurred with a catheter left in situ for 2 weeks. Formal histology confirmed a foreign body type reaction. Following outpatient review successful cosmetic, functional, and sexual outcomes were recorded with questionnaires and medical photography. CONCLUSION Preputial advancement flap with foreskin preservation for distal urethrocutaenous fistula is a successful method of treating delayed urethrocutaenous fistula of the distal urethra in cases of polyembolokoilomania.
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Affiliation(s)
- Andrew A Atayi
- Department of Reconstructive Urology, Whiston Hospital, St Helens & Knowsley Hospital NHS Trust, Merseyside, UK
| | - Ahmad M Omar
- Department of Reconstructive Urology, Whiston Hospital, St Helens & Knowsley Hospital NHS Trust, Merseyside, UK
| | - Michael S Floyd
- Department of Reconstructive Urology, Whiston Hospital, St Helens & Knowsley Hospital NHS Trust, Merseyside, UK
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2
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Management of Incisional Self-Harm of the Upper Limb: A Systematic Review. JPRAS Open 2023; 36:76-84. [PMID: 37197690 PMCID: PMC10184042 DOI: 10.1016/j.jpra.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background The incidence of incisional self-harm of the upper limbs is increasing, and recurrence rates are high. It is not known whether different wound treatment strategies (dressings only vs. surgery) or the operative setting (main theatre vs. non-main theatre) affect wound or mental health-related outcomes. Methods Four electronic databases (Ovid MEDLINE, OVID EMBASE, PsycINFO and CENTRAL) were searched from inception to 14/09/2021 for studies which describe the management of incisional self-harm wounds of the upper limb(s) in adults and children. Dual-author screening and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results In total, 19 studies (1477 patients) were included. Overall, the evidence was limited by a paucity of comparative data on wound management strategy and setting, and poor-quality outcome reporting. Only four studies clearly identified the operative setting for definitive wound management (two in main operating theatres, one in the emergency department and one using both settings, depending on injury severity). Few studies inconsistently reported surgical outcomes (n=9) or mental health outcomes (n=4), hindering evidence synthesis. Conclusion Further investigation is needed to determine the most cost-effective management strategies and settings for these injuries.
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3
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Oakley B, Uzoigwe C, Millward T, O'Brien M, Bainbridge C, Johnson N. Management of self-harm injuries: a review of the evidence and guidance. J Hand Surg Eur Vol 2023; 48:67-70. [PMID: 36437501 DOI: 10.1177/17531934221138433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ben Oakley
- Pulvertaft Hand Unit, Royal Derby Hospital, Derby, UK
| | | | | | - Mary O'Brien
- Pulvertaft Hand Unit, Royal Derby Hospital, Derby, UK
| | | | - Nick Johnson
- Pulvertaft Hand Unit, Royal Derby Hospital, Derby, UK
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4
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Hylenius S, Uldall W, Qvamme G, Kroman N. Radioactive seed localization of foreign body. Acta Radiol Open 2022; 11:20584601221088922. [PMID: 35992728 PMCID: PMC9386870 DOI: 10.1177/20584601221088922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Radioactive seed localization is a method widely used within breast cancer treatment. This case represents a 43-year-old male patient with a foreign body in his left axilla. We used radioactive seed localization for marking the foreign body, which made the subsequent surgery possible, quick, and minimal invasive.
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Affiliation(s)
- Sine Hylenius
- Department of Breast Surgery, Herlev Hospital, Herlev, Denmark
| | - Wei Uldall
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
| | - Gro Qvamme
- Department of Breast Surgery, Herlev Hospital, Herlev, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Herlev Hospital, Herlev, Denmark
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5
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Chen K, Wang M, Su Y. Foreign body removal with the assistance of ultrasound guidance and methylene blue staining in children-a cohort study. INTERNATIONAL ORTHOPAEDICS 2022; 46:1831-1838. [PMID: 35536367 DOI: 10.1007/s00264-022-05427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Soft tissue foreign bodies (FBs) are very commonly observed in paediatric emergency departments. Not all FBs can be removed effectively, even via open surgery and image intensifier guidance. In the current study, we evaluated the efficiency of FB removal with the assistance of ultrasound (US) and methylene blue (MB) staining. METHODS We enrolled 80 patients at our clinical center between May 2016 and December 2020. Eleven patients were operated upon with the assistance of US guidance and MB and were defined as group A; the other 69 patients were defined as group B. For the patients in group A, US was first used to locate the FB; MB was then injected next to the FB. Open surgery was subsequently performed. For group B, the FBs were removed by conventional methods. The surgical outcomes were evaluated according to surgical duration, incision infection rates, radiograph exposure times, and FB residue rates. RESULTS The average surgery time for group A was 0.35 ± 0.10 hours; the corresponding time was 0.49 ± 0.50 hours in group B and there was a significant difference between the groups (p = 0.032). The radiograph exposure times were 1.33 ± 0.34 in group A and 4.65 ± 1.81 times in group B (p = 0.021). CONCLUSIONS This study demonstrates that assistance of US and MB staining is a more efficient approach compared with traditional methods for FB removal, and this surgical method can be used effectively for FB removal in children.
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Affiliation(s)
- Kai Chen
- Orthopedics Department, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China
| | - Menglei Wang
- Orthopedics Department, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China
| | - Yuxi Su
- Orthopedics Department, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China. .,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.
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6
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Rooks VJ, Shiels WE, Murakami JW. Soft tissue foreign bodies: A training manual for sonographic diagnosis and guided removal. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:330-336. [PMID: 32385865 PMCID: PMC7754500 DOI: 10.1002/jcu.22856] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/03/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
Sonography provides excellent detection, localization, and characterization of soft-tissue foreign bodies. Ultrasound guided foreign body removal is a safe and highly successful minimally invasive procedure that facilitates effective treatment and avoidance of complications in patients with soft tissue foreign bodies. Focused laboratory training is critical to successful implementation of a sonographic foreign body management practice.
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Affiliation(s)
| | - William E. Shiels
- Deceased, Prior Active Duty Army, Department of RadiologyNationwide Children's HospitalColumbusOhioUSA
| | - James W. Murakami
- Department of RadiologyNationwide Children's HospitalColumbusOhioUSA
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7
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Floyd Jr. MS, Omar AM, Khattak AQ. Re: unusual intravesical foreign body in a young female migrated from the vagina due to autoerotism. Int Braz J Urol 2017; 43:1196-1197. [PMID: 28853816 PMCID: PMC5734090 DOI: 10.1590/s1677-5538.ibju.2017.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 11/23/2022] Open
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8
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Hiremath R, Reddy H, Ibrahim J, Haritha CH, Shah RS. Soft Tissue Foreign Body: Utility of High Resolution Ultrasonography. J Clin Diagn Res 2017; 11:TC14-TC16. [PMID: 28892999 DOI: 10.7860/jcdr/2017/26384.10269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Minor percentage of wooden foreign bodies is radio-opaque. High Resolution Ultrasonography (HRUSG) though existing is sparsely used as a primary imaging modality for diagnosis and localization of retained foreign body. AIM To evaluate the diagnostic accuracy of High Resolution Ultrasonography (HRUSG) in diagnoses and localization of retained foreign body. MATERIALS AND METHODS A prospective study with registered 46 patients with history of foreign body injury which were initially imaged with conventional radiography was enrolled. Later patients were subjected for high resolution USG of the diseased part with a linear transducer. Surface marking was done for all subjects to assist the surgical exploration. Ultrasound findings were correlated with surgical exploration and histopathological findings. RESULTS Out of 46 patients, forty one showed foreign body with foreign body inflammatory reaction in the form of abscess and/or granulation tissue on high resolution ultrasonography. No foreign body was detected in five patients but they showed focal hypoechogenicity which represented abscess and/or haematoma. On surgical exploration, two out of 41 patients did not reveal foreign body where as rest were found to have foreign body with foreign body inflammatory reaction. Sensitivity and negative predictive value of the current study is 100%. CONCLUSION High resolution USG is not only an efficient modality in diagnosing and localizing the foreign body in soft tissue, but can also be utilized for guiding the foreign body removal.
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Affiliation(s)
- Rudresh Hiremath
- Professor, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Harish Reddy
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Jebin Ibrahim
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - C H Haritha
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
| | - Rushit Sandeep Shah
- Senior Resident, Department of Radiodiagnosis, K V G Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
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9
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Mannarino VS, Pereira DCS, Gurgel WS, Costa CBF, Valença AM, Fontenelle LF, Mendlowicz MV. Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review. J Forensic Sci 2016; 62:953-961. [PMID: 27982450 DOI: 10.1111/1556-4029.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/07/2016] [Accepted: 09/17/2016] [Indexed: 11/27/2022]
Abstract
Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.
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Affiliation(s)
- Victor S Mannarino
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Débora C S Pereira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil
| | - Wagner S Gurgel
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Carolina B F Costa
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.,D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, Brazil.,School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, 3800, Australia
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
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10
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Batejan KL, Swenson LP, Jarvi SM, Muehlenkamp JJ. Perceptions of the Functions of Nonsuicidal Self-Injury in a College Sample. CRISIS 2016; 36:338-44. [PMID: 26502784 DOI: 10.1027/0227-5910/a000332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rates of nonsuicidal self-injury (NSSI) are particularly high on college campuses. Commonly endorsed reasons for NSSI include interpersonal (e.g., seeking support) and intrapersonal (e.g., affect regulation) functions. AIMS This study compared college students with and without a history of NSSI on their views of NSSI functions in order to inform gatekeeper intervention/prevention programs targeting NSSI. METHOD The Inventory of Statements About Self-Injury, which assessed NSSI behavior and functions of NSSI, was completed by 367 college students (73% female, 95% white). RESULTS Ninety-eight participants endorsed lifetime moderate/severe NSSI, 109 endorsed minor NSSI, and 160 denied any history of NSSI. Noninjuring participants' views of NSSI functions were compared with the views held by participants with histories of NSSI. The groups did not differ in their views of the relevance of intrapersonal functions, although noninjuring individuals appeared to stress some interpersonal factors (e.g., influence) slightly more than individuals with a history of NSSI did. CONCLUSION These results suggest that college students generally hold similar perceptions of the functions of NSSI. Our findings suggest intervention/prevention efforts may consider broadening the selection of gatekeepers (e.g., peers with no history of NSSI) in schools and colleges to identify at-risk students and encourage help-seeking behaviors.
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Affiliation(s)
| | - Lance P Swenson
- 1 Psychology Department, Suffolk University, Boston, MA, USA
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11
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Floyd MS, Baird AD. An unusual case of polyembolokoilamania: Urethral avulsion from foreign object use during sexual gratification. Can Urol Assoc J 2016; 10:357-358. [PMID: 27800060 DOI: 10.5489/cuaj.4003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael S Floyd
- Department of Urology, Aintree University Hospital, Liverpool, United Kingdom
| | - Andrew D Baird
- Department of Urology, Aintree University Hospital, Liverpool, United Kingdom
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12
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Cazzato RL, Garnon J, Ramamurthy N, Tsoumakidou G, Caudrelier J, Thénint MA, Rao P, Koch G, Gangi A. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System. Cardiovasc Intervent Radiol 2016; 39:1050-6. [DOI: 10.1007/s00270-016-1302-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
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13
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Brunner J, Russel M, Herr K, Benjamin E, Myers L, Boyko O, Jaffray P, Reddy S. Nonsuicidal self-injury-related foreign bodies in the emergency department. Semin Ultrasound CT MR 2014; 36:80-7. [PMID: 25639181 DOI: 10.1053/j.sult.2014.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nonsuicidal self-injury is a common cause of foreign bodies encountered in emergency departments, resulting in significant morbidity, mortality, and economic costs. We review the role of imaging and frequent imaging findings in nonsuicidal self-injury, illustrated by case examples from a level 1 trauma center with dedicated jail and psychiatric wards in a major US metropolitan teaching hospital.
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Affiliation(s)
- John Brunner
- Department of Radiology, University of Southern California, Los Angeles, CA.
| | - Marie Russel
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Keith Herr
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Elizabeth Benjamin
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Lee Myers
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Orest Boyko
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Paul Jaffray
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Sravanthi Reddy
- Department of Radiology, University of Southern California, Los Angeles, CA
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14
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Multimodality Imaging of Foreign Bodies of the Musculoskeletal System. AJR Am J Roentgenol 2014; 203:W92-102. [DOI: 10.2214/ajr.13.11743] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Baker JC, Hillen TJ, Demertzis JL. The role of imaging in musculoskeletal emergencies. Semin Roentgenol 2014; 49:169-85. [PMID: 24836492 DOI: 10.1053/j.ro.2014.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jonathan C Baker
- Musculoskeletal Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
| | - Travis J Hillen
- Musculoskeletal Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Jennifer L Demertzis
- Musculoskeletal Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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16
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Nwawka OK, Kabutey NK, Locke CM, Castro-Aragon I, Kim D. Ultrasound-guided needle localization to aid foreign body removal in pediatric patients. J Foot Ankle Surg 2013; 53:67-70. [PMID: 24239426 DOI: 10.1053/j.jfas.2013.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Indexed: 02/03/2023]
Abstract
Patients with podiatric foreign body injury commonly present to the emergency department. Often, the foreign object cannot be easily located or removed, and radiographs are frequently obtained to aid in localization. In cases requiring tissue dissection to remove the foreign bodies, accurate localization is required for safe removal of small and difficult to visualize bodies. We present 2 pediatric cases in which an ultrasound-guided needle localization technique was used to facilitate successful removal of small, difficult to visualize foreign bodies from the plantar foot. Ultrasound-guided needle localization reduced the required incision length and depth and helped to minimize the risk of damage to surrounding tissue.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA.
| | - Nii-Kabu Kabutey
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Christopher M Locke
- Department of Surgery, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Ilse Castro-Aragon
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
| | - Ducksoo Kim
- Department of Radiology, Boston Medical Center/Boston University Medical Center, Boston, MA
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17
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Martin G, Linnell JD, Yang SS, Lin J, Camarata PJ, Andrews BT. Ultrasound localization of a tunneled leech beneath a microvascular scalp reconstruction: A case report. Microsurgery 2013; 33:572-4. [PMID: 23996135 DOI: 10.1002/micr.22163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/17/2013] [Accepted: 06/25/2013] [Indexed: 11/09/2022]
Abstract
Medicinal leech therapy is a common adjuvant modality used to treat venous congestion following threatened microvascular anastomosis. Migration and tunneling of a leech beneath a surgical reconstruction is a rare event that is seldom mentioned in the literature and worthy of further discussion. We present a rectus abdominus myocutaneous free tissue transfer that was used to cover a large alloplastic cranioplasty following resection of a previously radiated skull base malignant meningioma. The flap became congested postoperatively and required leech therapy after surgical salvage. Three days after flap salvage, the subject was once again brought back to the operating room for surgical exploration when a leech was witnessed to migrate beneath the threatened free flap. Duplex ultrasound was used intra-operatively to localize the leech 12 cm from its bite and assist with its successful removal. Tunneling of the leech beneath the flap is a rare complication, and localization underneath a myofascial or myocutaneous flap may be difficult. Duplex ultrasound is a simple and reliable method to localize the leech and allow for its removal through a minimal access incision.
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Affiliation(s)
- Garry Martin
- Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Joshua D Linnell
- Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS
| | - Susan S Yang
- Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS
| | - James Lin
- Department of Otolarynoglogy-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS
| | - Brian T Andrews
- Department of Plastic Surgery, University of Kansas Medical Center, University of Kansas Medical Center, Kansas City, KS.,Department of Otolarynoglogy-Head & Neck Surgery, University of Kansas Medical Center, Kansas City, KS
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18
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Strain D, Smith R. Unintended use of a hairbrush: case report of an uncommon foreign body. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1519-1521. [PMID: 23887967 DOI: 10.7863/ultra.32.8.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Thapa M, Vo JN, Shiels WE. Ultrasound-guided musculoskeletal procedures in children. Pediatr Radiol 2013; 43 Suppl 1:S55-60. [PMID: 23478920 DOI: 10.1007/s00247-012-2599-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/16/2012] [Accepted: 11/17/2012] [Indexed: 11/24/2022]
Abstract
Ultrasound is an excellent tool to evaluate many pediatric musculoskeletal conditions. It may be used for both diagnosis and for guidance for therapeutic procedures. With US, the radiologist can readily evaluate the contralateral side for comparison. No sedation is typically required and ionizing radiation is avoided. Real-time information is obtained with US and the portability of US allows for the performance of bedside interventions in children who cannot be transported or are clinically unstable. Limitations of US compared with MRI and CT include limited field of view, inability to evaluate the bone marrow and user dependence of image and exam quality. In this article, we discuss common US-guided musculoskeletal procedures in children, including hip aspiration, joint injection, soft-tissue biopsy and foreign body removal.
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Affiliation(s)
- Mahesh Thapa
- Department of Radiology, Seattle Children's, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Yang XJ, Xing GF, Shi CW, Li W. Value of 3-dimensional CT virtual anatomy imaging in complex foreign body retrieval from soft tissues. Korean J Radiol 2013; 14:269-77. [PMID: 23483807 PMCID: PMC3590339 DOI: 10.3348/kjr.2013.14.2.269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/17/2012] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the value of 3-dimensional (3D) CT virtual anatomy imaging (VAI) in the complex foreign body (FB) retrieval of the soft tissues. Materials and Methods Four hundred and seventy-five patients with radiopaque FB(s) diagnosed by radiograph underwent contrast-enhanced 3D CT examination. VAI was reconstructed by volume-rendering opacity software, by sliding down the lowest threshold from -600 to 100 HU. The imaging was grouped into three groups: A (axial and multi-planar reformation [MPR] images), B (standard 3D imaging with axial and MPR images), and C (VAI with axial and MPR images). They were analyzed to reveal the type, size, number, location, complications, and the interventional removability of the object, with the comparisons in the management and clinical outcomes on the patient follow-up studies. The data were subjected to chi-square tests, with p value < 0.05 indicating significant statistical difference. Results The FB shape, size, number, site distribution and vessels around FB, as well as the FB-associated vascular complications and the FB interventional removability were assessed more accurately in Group C than in Group B or Group A (p < 0.005). There was no significant difference in disclosing the type and depth of the FB among the three groups (p > 0.75). On the basis of the 3D CT, especially the enhanced 3D CT VAI, the followings were processed: the recommendation of interventional removal in 286 (60.47%) and non-intervention in 187 (39.53%) of the 473 patients with soft-tissue FB(s); in 352 (56.50%) of the 623 radiopaque FBs patients, 258 (54.55%) patients accurately detected on 3D CT and the successful removal by intervention (343 FBs) or surgery (9 FBs) without any sequela; and 215 (45.45%) patients with 271 FBs lost in the follow-up, with their departure from the hospital. Conclusion The 3D CT, especially 3D enhanced CT VAI, has great incremental value in further diagnosis and management of complex FB extraction from soft tissues.
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Affiliation(s)
- Xiu-Jun Yang
- Department of Radiology, Shanghai Eighth People's Hospital, Shanghai 200235, China
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Non-suicidal Self-Injury (NSSI): A Case for Using Emotionally Focused Family Therapy. CONTEMPORARY FAMILY THERAPY 2013. [DOI: 10.1007/s10591-013-9236-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kim S, Seo K, Song HT, Suh JS, Yoon CS, Ryu JA, Park JS, Kim AH, Park AY, Kim Y. Determination of optimal imaging mode for ultrasonographic detection of subdermal contraceptive rods: comparison of spatial compound, conventional, and tissue harmonic imaging methods. Korean J Radiol 2012; 13:602-9. [PMID: 22977328 PMCID: PMC3435858 DOI: 10.3348/kjr.2012.13.5.602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/29/2012] [Indexed: 11/26/2022] Open
Abstract
Objective To determine which mode of ultrasonography (US), among the conventional, spatial compound, and tissue-harmonic methods, exhibits the best performance for the detection of Implanon® with respect to generation of posterior acoustic shadowing (PAS). Materials and Methods A total of 21 patients, referred for localization of impalpable Implanon®, underwent US, using the three modes with default settings (i.e., wide focal zone). Representative transverse images of the rods, according to each mode for all patients, were obtained. The resulting 63 images were reviewed by four observers. The observers provided a confidence score for the presence of PAS, using a five-point scale ranging from 1 (definitely absent) to 5 (definitely present), with scores of 4 or 5 for PAS being considered as detection. The average scores of PAS, obtained from the three different modes for each observer, were compared using one-way repeated measure ANOVA. The detection rates were compared using a weighted least square method. Results Statistically, the tissue harmonic mode was significantly superior to the other two modes, when comparing the average scores of PAS for all observers (p < 0.00-1). The detection rate was also highest for the tissue harmonic mode (p < 0.001). Conclusion Tissue harmonic mode in uS appears to be the most suitable in detecting subdermal contraceptive implant rods.
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Affiliation(s)
- Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, Korea
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2012. [PMID: 22474637 DOI: 10.5312/wjo.v2.i7.] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Unruh BT, Nejad SH, Stern TW, Stern TA. Insertion of foreign bodies (polyembolokoilamania): underpinnings and management strategies. Prim Care Companion CNS Disord 2012; 14:11f01192. [PMID: 22690353 DOI: 10.4088/pcc.11f01192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 12/17/2022] Open
Abstract
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Dr Unruh is an attending psychiatrist at McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts. Dr Nejad is an instructor in psychiatry at Harvard Medical School, Boston, Massachusetts, an attending physician on the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and the director of the Burns and Trauma Psychiatric Consultation Service at Massachusetts General Hospital, Boston. Mr Stern is a research assistant in the Department of Psychiatry at Massachusetts General Hospital, Boston. Dr Stern is chief of the Psychiatric Consultation Service at Massachusetts General Hospital, Boston, and a professor of psychiatry at Harvard Medical School, Boston, Massachusetts.Dr Stern is an employee of the Academy of Psychosomatic Medicine, has served on the speaker's board of Reed Elsevier, is a stock shareholder in WiFiMD (Tablet PC), and has received royalties from Mosby/Elsevier and McGraw Hill. Drs Unruh and Nejad and Mr Stern report no financial or other affiliations relevant to the subject of this article.
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Royall NA, Farrin E, Bahner DP, Stawicki SPA. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2011; 2:57-66. [DOI: 10.5312/wjo.v2.i7.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Royall NA, Farrin E, Bahner DP, Stawicki SP. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World J Orthop 2011; 2:57-66. [PMID: 22474637 PMCID: PMC3302042 DOI: 10.5312/wjo.v2.i7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 06/28/2011] [Accepted: 07/05/2011] [Indexed: 02/06/2023] Open
Abstract
Traditionally performed by a small group of highly trained specialists, bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment. Due to this limitation, a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel. The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios. This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures. In-depth discussion of each ultrasound procedure including pertinent technical details, indications and contraindications is provided. Despite the limited amount of prospective, randomized data in this area, a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.
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Affiliation(s)
- Nelson A Royall
- Nelson A Royall, David P Bahner, Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Bennett GH, Shiels WE, Young AS, Lofthouse N, Mihalov L. Self-embedding behavior: a new primary care challenge. Pediatrics 2011; 127:e1386-91. [PMID: 21555492 DOI: 10.1542/peds.2010-2877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to define self-embedding behavior (SEB), develop a clinical profile of adolescents who engage in SEB, and emphasize the importance of rapid, targeted, and effective identification and intervention. METHODS As part of a retrospective study with a database evaluating 600 patients percutaneously treated for soft-tissue foreign body removal, adolescents were identified with self-embedded soft-tissue foreign bodies. We describe patients' gender, age, and psychiatric diagnoses; SEB age of onset, frequency, and self-reported reasons; and the number, type, location of, and removal technique for objects. RESULTS Eleven patients (9 females) who engaged in SEB were identified. Ten of the 11 patients were members of a group home or psychiatric facility at the time they engaged in SEB. All patients had previous and multiple psychiatric diagnoses. SEB mean age-of-onset was 16 years, and mean number of SEB episodes per patient was 1.9. The most common self-reported purpose for SEB was suicidal ideation (6 of 8 [75%]) versus nonsuicidal ideation (2 of 8 [25%]), with 3 cases lacking this documentation. The mean number of objects embedded in a single episode was 2.4, usually composed of metal and embedded in the arm. Seventy-six foreign bodies were percutaneously removed (using ultrasound or fluoroscopic guidance), including metal, glass, wood, plastic, graphite, and crayon. CONCLUSIONS SEB is an extreme form of self-injury requiring aggressive and timely interdisciplinary assessment and treatment. An understanding of SEB allows medical professionals to pursue rapid, targeted, and effective intervention to interrupt the cycle of self-harm and institute appropriate long-term therapy.
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Affiliation(s)
- Gregory H Bennett
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH 43205, USA
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