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Montoya C, Rey J, Polania-Sandoval CA, Bornak A, Shao T, Kenel-Pierre S. Inferior Vena Cava Filter Long Term Complications and Retrieval Techniques: A Case Series and Literature Review. Vasc Endovascular Surg 2024; 58:559-566. [PMID: 38196287 DOI: 10.1177/15385744231226048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
INTRODUCTION AND IMPORTANCE Long-term mechanical complications after inferior vena cava (IVC) filter placement include embedded or tilted filters, erosion of the vena cava, filter thrombosis. In the setting of caval thrombosis, patients may subsequently develop venous hypertension and post-thrombotic syndrome (PTS). Here we present three unique cases of IVC filter complications and surgical management. CASE PRESENTATION A 30-year-old female presented with acute abdominal pain, revealing a duodenal perforation caused by an IVC filter eroding into her duodenum. A 42-year-old female with an IVC filter in place for 20 years due to a prior pulmonary embolism underwent laser-assisted retrieval of the filter due to concerns of caval adherence. A 48-year-old male with a history of DVT, venous stasis ulcer, and an IVC filter presented for filter retrieval. CLINICAL FINDINGS AND INVESTIGATIONS The surgical techniques described in this report include complicated IVC filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis resulting in PTS. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. INTERVENTION AND OUTCOMES The surgical techniques described in this report include complicated inferior vena cava filter retrieval, performed in cases of filter complications including migration, fracture, duodenal perforation and IVC thrombosis. One case, requiring open retrieval, is explained and the surgical technique is provided. There are images and videos of these procedures to enrich the learning experience. RELEVANCE AND IMPACT Endovascular retrieval of long-term complicated IVC filters is challenging, but it can be a safely performed in many patients. However, open surgery may be necessary in selected patients.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jorge Rey
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | | | - Arash Bornak
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Tony Shao
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Stefan Kenel-Pierre
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
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Beal T, Say C, Ghasemi Rad M, Leon D. A Novel Microsnare and Microwire Coil Retrieval Technique. Vasc Endovascular Surg 2024; 58:567-570. [PMID: 38240584 DOI: 10.1177/15385744241229599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Coil migration during endovascular embolization is a complication that can result in thromboembolic occlusion leading to potentially large infarcts if not removed. Microsnares are commonly used to remove migrated coils. Current techniques, however, struggle in cases where the microsnare is unable to loop over and secure a free end of the coil. We present a case in which a microsnare combined with a microwire successfully removed a migrated coil in a patient with a bleeding hepatic pseudoaneurysm post-embolization. This technique proved beneficial when traditional methods were insufficient, especially in small vessels or coil packs that cannot be snared. The synergy of the microsnare and microwire technique presents a promising solution for challenging migrated coil retrievals.
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Affiliation(s)
- Taylor Beal
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | - Conrad Say
- Department of Student Affairs, Baylor College of Medicine, Houston, TX, USA
| | | | - David Leon
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Lee JH, Kim SB, Lee KW, Kim SH. Prognostic factors for tracheostomy early decannulation in acquired brain injury patients. Int J Rehabil Res 2024; 47:97-102. [PMID: 38451479 DOI: 10.1097/mrr.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
After severe brain injuries, a tracheostomy tube is usually inserted for respiratory support. This study aimed to clarify the prognostic factors for tracheostomy early decannulation in patients with acquired brain injuries. We retrospectively reviewed the medical records of inpatients with acquired brain injuries who underwent successful tracheostomy decannulation between March 2021 and June 2022. Fifty-six patients were included; median age was 68 (59-72) years; 28 (50%) were men; 28 (50%) underwent tracheostomy due to stroke. The median time to decannulation was 47 days. The patients were divided into the early and the late decannulation groups based on the median time, and compared. In univariate analysis, the early decannulation group had a higher BMI, peak cough flow, and acquired brain injuries due to trauma, and a lower penetration-aspiration scale score, duration of antibiotic use, and duration of oxygen use. Multivariate Cox regression analysis revealed that a higher initial peak cough flow [hazard ratio (HR) 1.142; 95% confidence interval (CI) 0.912-0.954; P < 0.001] and lower duration of oxygen use (HR 0.930; 95% CI 0.502-0.864; P = 0.016) were independent factors for early tracheostomy decannulation, with each unit increase in peak cough flow corresponding to a 14.2% increase and each additional day of duration of oxygen use corresponding to a 7.0% decrease in the likelihood of early decannulation. In conclusion, key prognostic factors for early tracheostomy decannulation were identified as the initial cough strength and duration of oxygen use. These results could play important role in decannulation plans for patients with tracheostomy tube.
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Affiliation(s)
- Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Seo-gu, Busan, Korea
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Lou Y, Tang S, Sheng Z, Lian H, Yang J, Jin X. Immediate and delayed placement of the intrauterine device after abortion: a systematic review and meta-analysis. Sci Rep 2024; 14:11385. [PMID: 38762680 DOI: 10.1038/s41598-024-62327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/15/2024] [Indexed: 05/20/2024] Open
Abstract
This article aims to report the comprehensive and up-to-date analysis and evidence of the insertion rate, expulsion rate, removal rate, and utilization rate of immediate placement of intrauterine devices (IUDs) versus delayed placement after artificial abortion. PubMed, Embase, Cochrane, Web of Science, CNKI, and Wanfang databases were comprehensively searched up to January 12, 2024 for studies that compared immediate versus delayed insertion of IUDs after abortion. The evaluation metrics included the number of IUD insertion after surgical or medical abortions, the frequency of expulsion and removal at 6 months or 1 year, the number of continued usage, pain intensity scores, the number of infections, the duration of bleeding, and instances of uterine perforation during or after IUD insertion. Ten randomized controlled articles were eligible, comprising 11 research projects, of which 3 projects involved the placement of an IUD after surgical abortion, and 8 projects involved the placement of an IUD after medical abortion. This included 2025 patients (977 in the immediate insertion group and 1,048 in the delayed insertion group). We summarized all the extracted evidence. The meta-analysis results indicated that for post-surgical abortions, the immediate insertion group exhibited a higher IUD placement rate than the delayed insertion group. After medical abortions, the immediate insertion group showed higher rates of IUD placement, utilization, and expulsion at 6 months or 1 year. The two groups showed no statistically significant differences in the removal rate, post-insertion infection rate, pain scores during insertion, and days of bleeding during the follow-up period. Compared to delayed placement, immediate insertion of IUDs can not only increase the usage rate at 6 months or 1 year but also enhance the placement rate.
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Affiliation(s)
- Ying Lou
- Women Healthcare Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Shanshan Tang
- Gynecology Department, Hangzhou Women's Hospital, Hangzhou, 310000, Zhejiang, China
| | - Zhumei Sheng
- Women Healthcare Department, Hangzhou Women's Hospital, Hangzhou, 310000, Zhejiang, China
| | - Hongqin Lian
- Gynecology Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Jingjing Yang
- Medical Department, CiXi Maternity and Child Health Care Hospital, Cixi, 315300, Zhejiang, China
| | - Xuejing Jin
- Reproductive Endocrinology Center, Hangzhou Women's Hospital, 369 Kunpeng Road, Shangcheng District, Hangzhou, 310000, Zhejiang, China.
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Guyer RD, Blumenthal SL, Shellock JL, Zigler JE, Ohnmeiss DD. Lumbar Total Disk Replacement Device Removals and Revisions Performed During a 20-Year Experience with 2141 Patients. Spine (Phila Pa 1976) 2024; 49:671-676. [PMID: 38282440 DOI: 10.1097/brs.0000000000004942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/21/2024] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN This was a retrospective study with prospective patient contact attempted to collect current data. OBJECTIVE The purpose was to investigate the incidence and reasons for lumbar total disk replacement (TDR) removal or revision. SUMMARY OF BACKGROUND DATA A concern regarding lumbar TDR was safety, particularly the need for device removal or revision. This may be particularly important considering removal/revision requires repeat anterior exposure with an increased risk of vascular injury. METHODS Data were collected for a series of 2141 lumbar TDR patients, beginning with the first case experience in 2000. The mean follow-up was 78.6 months. For each case of device removal/revision, the reason, duration from index surgery, and procedure performed were recorded. RESULTS Of 2141 patients, 27 (1.26%) underwent TDR removal or revision. Device removal was performed in 24 patients (1.12%), while three patients underwent revision (0.14%). Of the 24 removals, 12 were due to migration and/or loosening, three developed problems post-trauma, two developed lymphocytic reaction to device materials, two had ongoing pain, and there was one case of each: TDR was too large, vertebral body fracture (osteoporosis), lytic lesion, device subsidence and facet arthrosis, and infection seeded from a chest infection 146 months post-TDR. The three revisions were for Core repositioning (technique error), device repositioning after displacement, and core replacement due to wear/failure. With respect to timing, 37.0% of removals/revisions occurred within one-month postimplantation. Of note, 40.7% of removals/revisions occurred in the first 25 TDR cases performed by individual surgeons. There was one significant vascular complication occurring in a patient whose TDR was removed due to trauma. This was also the only patient among 258 with ≥15-year follow-up who underwent removal/revision. CONCLUSION In this large consecutive series, 1.26% of TDRs were removed/revised. The low rate over a 20 year period supports the safety of these devices.
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Affiliation(s)
- Richard D Guyer
- Center for Disc Replacement at Texas Back Institute; Plano, TX
| | | | | | - Jack E Zigler
- Center for Disc Replacement at Texas Back Institute; Plano, TX
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La Saponara V, Wan S, Nagarkar B, Zwain F, Creinin MD. Understanding the mechanical behavior of intrauterine devices during simulated removal. Contraception 2024; 133:110399. [PMID: 38369271 DOI: 10.1016/j.contraception.2024.110399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate differences based on intrauterine device (IUD) frame geometry in force, and stress, and strain at the stem/arms junction during simulated IUD removal. STUDY DESIGN We manufactured injection-molded frame models for three Nova-T IUDs (Mirena [model M]; Liletta [model L]; Kyleena [model K]) and a Tatum-T IUD (Paragard [model P]) at two-times scaling. We created a custom fixture to simulate the uterus and used a screw-driven machine to pull models at various displacement rates through the 10 cm fixture cavity to measure force and strain and calculate stress at the IUD stem/arms junction. We tested models at 30 mm/min and higher displacement rates for exploratory analyses. We used Mann-Whitney U test for statistical testing. RESULTS We completed testing at 30 mm/min using five of each Nova-T model and nine model P samples. Resistance against the cavity walls created significantly more force on model P (11.83, interquartile range [IQR] 11.61-12.31) than any Nova-T model samples (p < 0.001). The smaller model K created slightly more median stress (MPa) than the larger model M (0.36 [IQR 0.33-0.38] and 0.79 [IQR 0.76-0.80], respectively, p = 0.008); model P samples generated significantly more median stress than other models (1.70 [IQR 1.67-1.77], p < 0.001). Strain plots demonstrated permanent deformation for some samples during IUD removal simulation. We tested 20 samples at various higher displacement rates up to 2500 mm/min, with stress notably increasing for model P samples with increasing rates. No fractures occurred. CONCLUSIONS Force and stress at the stem/arms junction are higher with Tatum-T-shaped compared to Nova-T-shaped IUD models under the same testing conditions, and a higher speed of extraction causes more stress. IMPLICATIONS Sharp corners create vulnerability under static and fatigue loading in structural components due to increased local stresses. Our findings suggest that IUDs with Tatum-T frames should be removed slowly to minimize the stress at the stem/arms junction. Future studies can provide more information if performed with commercially available products.
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Affiliation(s)
- Valeria La Saponara
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Shuhao Wan
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Bhagyashree Nagarkar
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Faress Zwain
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
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Demirok A, Illy DHC, Nagelkerke SQ, Lagerweij MF, Benninga MA, Tabbers MM. Catheter salvage or removal in catheter-related bloodstream infections with Staphylococcus aureus in children with chronic intestinal failure receiving home parenteral nutrition and the use of prophylactic taurolidine catheter lock solution: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:486-494. [PMID: 38605559 DOI: 10.1002/jpen.2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Children with chronic IF require long-term home parenteral nutrition (HPN), administered through a central venous catheter. Catheter-related bloodstream infection (CRBSI) with Staphylococcus aureus is known to be a serious infection with a high mortality rate and risk of complications. A standardized protocol on the management of S aureus CRBSIs in children receiving HPN is lacking. The aim of this study is to evaluate the effectiveness and safety of the current management in an HPN expertise center in the Netherlands. METHODS We performed a retrospective descriptive cohort study between 2013 and 2022 on children 0-18 years of age with chronic IF requiring long-term HPN. Our primary outcomes were the incidence of S aureus CRBSI per 1000 catheter days, catheter salvage attempt rate, and successful catheter salvage rate. Our secondary outcomes included complications and mortality. RESULTS A total of 74 patients (39 male; 53%) were included, covering 327.8 catheter years. Twenty-eight patients (38%) had a total of 52 S aureus CRBSIs, with an incidence rate of 0.4 per 1000 catheter days. The catheter salvage attempt rate was 44% (23/52). The successful catheter salvage rate was 100%. No relapse occurred, and no removal was needed after catheter salvage. All complications that occurred were already present at admission before the decision to remove the catheter or not. No patients died because of an S aureus CRBSI. CONCLUSION Catheter salvage in S aureus CRBSIs in children receiving HPN can be attempted after careful consideration by a multidisciplinary team in an HPN expertise center.
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Affiliation(s)
- Aysenur Demirok
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - David H C Illy
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Sietse Q Nagelkerke
- Pediatric Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel F Lagerweij
- Interventional Radiology, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers University of Amsterdam, Amsterdam, The Netherlands
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Rishiraj N, Taunton JE, Lloyd-Smith R, Regan W, Niven B, Woollard R. Functional knee brace use for 21 h leads to a longer duration to achieve peak vertical ground reaction forces and the removal of the brace after 17.5 h results in faster loading of the knee joint. Knee Surg Sports Traumatol Arthrosc 2024; 32:1096-1104. [PMID: 38461373 DOI: 10.1002/ksa.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To investigate the landing strategies used after discontinuing and continuing the use of a functional knee brace (FKB) while performing a drop jump. METHODS Following published methodology and power analysis, 23 uninjured male athletes, mean age of 19.4 ± 3.0 years, performed seven tests, during three test conditions (nonbraced, braced and removed brace or continued brace use), over 6 days of 12 testing sessions (S) for a total of 38.5 h. Each subject was provided with a custom-fitted FKB. This study focuses on the single leg drop jump kinetics during S12 when subjects were randomly selected to remove the FKB after 17.5 h or continued use of FKB. The time to peak vertical ground reaction forces (PVGRF) and PVGRF were recorded on landing in eight trials. RESULTS After brace removal, a significantly shorter mean time to PVGRF was recorded (9.4 ± 22.9 msec (3.9%), p = 0.005, 95% confidence interval (95% CI): -168.1, 36.1), while continued brace use required a nonsignificant (n.s.) longer mean duration to achieve PVGRF (19.4 ± 53.6 msec (8.9%), n.s., 95% CI: -49.7, 73.4). No significant mean PVGRF difference was found in brace removal (25.3 ± 65.8 N) and continued brace use (25.1 ± 23.0 N). CONCLUSION Removal of FKB after 17.5 h of use led to a significantly shorter time to achieve PVGRF, while continued brace use for 21 h required a longer duration to achieve PVGRF, suggesting faster and slower knee joint loading, respectively. Understanding the concerns associated with the use of FKB and the kinetics of the knee joint will assist clinicians in counselling athletes about the risks and benefits of using an FKB. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Neetu Rishiraj
- High Performance and Rehabilitation, ACTIN Health & Rehabilitation Inc., Vancouver, British Columbia, Canada
| | - Jack E Taunton
- Allan McGavin Sports Medicine Clinic (Primary Care), University of British Columbia, Vancouver, British Columbia, Canada
| | - Rob Lloyd-Smith
- Allan McGavin Sports Medicine Clinic (Primary Care), University of British Columbia, Vancouver, British Columbia, Canada
| | - William Regan
- Allan McGavin Sports Medicine Clinic (Orthopaedics), University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Niven
- Department of Mathematics & Statistics, University of Otago, Otago, New Zealand
| | - Robert Woollard
- Department of Family Practice, University of British Columbia, British Columbia, Canada
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James M, Iftikhar S, Sehgal VS. Revolutionizing inferior vena cava filter retrieval with electromagnetic graspers and gold-coated magnetic beads. J Vasc Surg Venous Lymphat Disord 2024; 12:101819. [PMID: 38631802 DOI: 10.1016/j.jvsv.2024.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 04/19/2024]
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Plant A, Stewart F, Hooks D. Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation. J Cardiovasc Electrophysiol 2024; 35:1050-1054. [PMID: 38501328 DOI: 10.1111/jce.16249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.
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Affiliation(s)
- Allan Plant
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Fergus Stewart
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Darren Hooks
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
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Pinelli F, Muzzi M, Pittiruti M. Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal? J Vasc Access 2024; 25:697-702. [PMID: 36163680 DOI: 10.1177/11297298221125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite several effective preventive strategies peripherally inserted central catheters (PICCs)-as much as centrally inserted central catheters and femorally inserted central catheters-are inevitably associated with the potential development of catheter-related thrombosis. This complication may be symptomatic or-more often-asymptomatic. Even if remote, the chance that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism, is theoretically possible. On the other hand, the diffuse adoption of an ultrasound scan aiming at detecting an asymptomatic catheter-related thrombosis may be logistically difficult and expensive. No clear evidence-based recommendations exist on this issue and whether perform an ultrasound scan before PICC removal in asymptomatic patients remains a matter of debate. For these reasons, the authors propose few common sense recommendations that may help clinicians in weighing the clinical advantages of the exam (optimal safety for the patient) versus its practical disadvantages (logistic cost).
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Affiliation(s)
- Fulvio Pinelli
- AOUC, Anesthesia and Intensive Care, Florence, Tuscany, Italy
| | - Mirko Muzzi
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Agostino Gemelli, Rome, Lazio, Italy
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Lee JZ, Talaei F, Tan MC, Srivathsan K, Sorajja D, Valverde A, Scott L, Asirvatham SJ, Kusumoto F, Mulpuru SK, Cha YM. Long-term outcomes with abandoning versus extracting sterile leads: A 10-year population-based study. Pacing Clin Electrophysiol 2024; 47:626-634. [PMID: 38488756 DOI: 10.1111/pace.14940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Long-term outcomes of sterile lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) remain unclear. METHODS We performed a retrospective study of a population residing in southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE of sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10 years or until their death were included. RESULTS A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. Indications for subsequent lead extraction arose in 9.1% (n = 14) of patients with initial LA and 5.3% (n = 1) in patients with initial TLE, after an average of 7 years. Moreover, 28.6% of patients in the LA cohort who required subsequent extraction did not proceed with the extraction, and among those who proceeded, 60% had clinical success and 40% had a clinical failure. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges (5.2% vs. 5.3%). There was no difference in 10-year survival probability among the LA group and the TLE group (p = .64). CONCLUSION An initial lead abandonment strategy was associated with more complicated subsequent extraction procedures compared to patients with an initial transvenous lead extraction strategy. However, there was no difference in 10-year survival probability between both lead management approaches.
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Affiliation(s)
- Justin Z Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fahimeh Talaei
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Min-Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Arturo Valverde
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Luis Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Fred Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Garner MT, Ibanez K, Erkilinc M, Espina-Rey A, Ilgenfritz RM, Lovejoy JF, Malone JB. No Value Found With Routine Early Postoperative Radiographs after Implant Removal in Pediatric Patients. J Am Acad Orthop Surg 2024; 32:396-400. [PMID: 38261769 DOI: 10.5435/jaaos-d-22-00883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Implants are routinely removed in pediatric patients. Fracture through the prior implant site is a common worry after implant removal. Early post-implant removal radiographs are routinely used to evaluate the prior implant removal sites and to assess when a patient may return to normal activities. To our knowledge, the value of early, routine postoperative radiographs after elective implant removal in pediatric patients has not been studied. METHODS A retrospective patient cohort of pediatric patients who had implant removal from an extremity from 2017 to 2019 was used in this study. Data were collected for patient demographics, implant site, reason for primary surgery, complications, number of postoperative radiographs, radiation exposure, cost of imaging, and whether the postoperative plan was changed by imaging. RESULTS Two hundred ninety patients were included in the study. Postoperative plans were changed only in 0.69% of patients (n = 2) because of abnormal 2-week radiographs and 1.72% (n = 5) because of abnormal 6-week radiographs. However, the event's proportion difference (change of management) was not statically significant ( P = 0.182) between those who had a radiograph obtained and those who did not. The mean follow-up time was 16 months. The mean number of postoperative radiographs obtained was 3.74, the mean cost per radiograph was $103, and the mean postoperative radiation exposure was 1.34 mSv. No fractures were observed after implant removal. DISCUSSION A retrospective review of the value of early, postoperative radiographs after routine orthopaedic implant removal found that postoperative radiographs at 2 and 6 weeks did not change the postoperative plan for most of the patients. Postoperative radiographs have an average cost of $103, and radiation exposure equal to approximately 6 months of natural background radiation. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- M Tyrel Garner
- From the University of Central Florida College of Medicine, Orlando, FL (Garner and Ibanez), Department of Orthopedics, Nemours Children's Hospital Florida, Orlando, FL (Erkilinc, Espina-Rey, Ilgenfritz, Lovejoy, and Malone)
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14
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Munemoto M, Mukai S, Shoji S, Yamakawa T. Delamination of Acuseal arteriovenous graft: Two case reports. J Vasc Access 2024; 25:1015-1019. [PMID: 36883727 DOI: 10.1177/11297298231152630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Acuseal arteriovenous graft is an early cannulation graft having a tri-layered structure with an elastomeric middle layer. However, delamination of Acuseal grafts has been reported recently. This article describes two cases with different characteristics of Acuseal delamination. In case 1, the delamination occurred 1 month after a percutaneous transluminal angioplasty (PTA); therefore, the PTA was suspected to be a trigger. The delamination was located between the outer expanded polytetrafluoroethylene (ePTFE) layer and the elastomeric middle layer. On the other hand, in case 2, the delamination was located between the luminal ePTFE layer and the elastomeric middle layer. A surveillance ultrasound examination detected the delamination unexpectedly in the uneventful course; however, the delaminating location corresponded to the cannulation puncture site and the intraoperative findings suggested the involvement of mis-needling as a possible cause. Interestingly, for the purpose of continued use on hemodialysis, specific treatments were required against the delamination itself in both cases. As we identified Acuseal delamination in 5.6% (2/36) of cases, concerns arise that numerous cases of Acuseal delamination may have been overlooked in general. Understanding and recognizing this phenomenon are important for adequate use of Acuseal graft.
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Affiliation(s)
| | | | - Shigeichi Shoji
- Department of Internal Medicine, Shirasagi Hospital, Osaka, Japan
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15
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Mergen B, Berger T, Hamon L, Daas L, Seitz B. Anterior chamber intraocular lens removal combined with triple DMEK: Quadruple DMEK for bullous keratopathy. Eur J Ophthalmol 2024; 34:NP13-NP17. [PMID: 37941333 DOI: 10.1177/11206721231213684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE To present the outcomes of a patient with anterior chamber intraocular lens (ACIOL) related endothelial decompensation who underwent Descemet membrane endothelial keratoplasty (DMEK) and cataract surgery with intraocular lens (IOL) implantation in the capsular bag (so-called triple DMEK) combined with ACIOL removal (quadruple DMEK) in both eyes. METHODS Case report. RESULTS A 58-year-old female patient was referred due to decreased visual acuity within the last 18 months. She had a history of iris-claw ACIOL implantation 17 years before. The corrected distance visual acuity (CDVA) was 20/40 in both eyes. Due to low endothelial cell density and increased corneal thickness, ACIOL removal combined with triple DMEK (as quadruple DMEK) was performed for both eyes. Despite a graft detachment that was successfully managed with re-bubbling in the first eye, both eyes showed an increase in the CDVA (20/25 and 20/32, respectively) without any other significant complications in the follow-up of the patient. The corneas of both eyes were clear postoperatively. CONCLUSION This case report demonstrated that quadruple DMEK may provide feasible management for chronic endothelial cell decompensation secondary to iris-claw ACIOL implantation.
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Affiliation(s)
- Burak Mergen
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
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16
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Mogil RS, Ferenchak K, Starr MR. GORE-TEX SUTURE-ASSOCIATED ENDOPHTHALMITIS IN A SCLERAL-SUTURED INTRAOCULAR LENS. Retin Cases Brief Rep 2024; 18:293-295. [PMID: 36603161 DOI: 10.1097/icb.0000000000001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To describe a unique case of Gore-Tex (Gore Medical, AZ) suture-associated delayed-onset endophthalmitis in a patient with a history of scleromalacia, pathologic myopia, multiple prior vitrectomies in the setting of a scleral-sutured intraocular lens (IOL). METHODS A 69-year-old man complained of blurry vision and eye pain 21 months after implantation of a scleral-sutured IOL and was found to have an exposed Gore-Tex suture with scleromalacia, vision loss to hand motion, a hypopyon, and vitritis. He was diagnosed with culture-positive endophthalmitis. He had a previous history of a rhegmatogenous retinal detachment repair and subsequent dislocated IOL in this eye treated with a scleral-sutured IOL. A vitreous tap and injection of broad-spectrum antibiotics and suture removal at the slit lamp were performed at the time of presentation. One week later, he underwent pars plana vitrectomy and removal of the IOL. RESULTS After the tap and inject and subsequent lens removal, his vision has returned to his preoperative vision of 20/100 with refraction. DISCUSSION Gore-Tex suture is a nonabsorbable and flexible option with great tensile strength that has emerged as a favored alternative to polypropylene for the use in transscleral fixated IOLs. Although endophthalmitis and suture erosion are known complications of this procedure, this report describes one of the first cases of Gore-Tex suture-associated endophthalmitis.
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Affiliation(s)
- Rachel S Mogil
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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17
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Xu Y, Li X, Cai Z, Chen S, Zhu R, Zhuang H, Wan S, Xu G. Risk factors for migration of retrievable covered expandable metallic stent in patients with persistent benign ureter strictures. World J Urol 2024; 42:273. [PMID: 38689135 PMCID: PMC11061021 DOI: 10.1007/s00345-024-04986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/06/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The purpose of this study is to evaluate the incidence, risk factors, and salvage management of retrievable covered expandable metallic stent (RCEMS) migration in patients with persistent benign ureter strictures. MATERIALS AND METHODS A retrospective study was performed on 117 consecutive patients who underwent implantation of RCEMS. Univariate and multivariate analyses were used to identify prognostic factors for stent migration, including stricture location and length, hydronephrosis-cortex ratio, ureteral dilation, and the diameter of the narrowest portion of the stricture. RESULTS Stent migration occurred in 22 (19.5%) of 113 patients who met inclusion criteria. Of the 22 patients, 16 (72.7%) had ordinary ureteral stricture, 3 (13.6%) had stricture in transplanted kidneys, and 3 patients (13.6%) had ureter stricture in orthotopic neobladders. The mean creatinine for the entire cohorts showed significant improvement (p = 0.038). Multivariate analysis identified the following prognostic factors for migration: distal ureteral stricture (p = 0.006), patients who underwent balloon dilation (p = 0.003), hydronephrosis-cortex ratio ≧10 (p = 0.017), larger diameter of wasting of RCEMS (p < 0.001), and patients with a shorter stricture length (p = 0.006). Salvage management was required in 4 of the 22 patients. The strictures in the remaining 18 patients improved with observation. CONCLUSIONS Stent migration is more likely to occur in patients with the five prognostic factors mentioned above. Our study developed a nomogram to predict stent migration in patients with ureteral strictures treated using RCEMS.
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Affiliation(s)
- Yuyu Xu
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - Xiezhao Li
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - Zhiduan Cai
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - Shuangxing Chen
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - Rui Zhu
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - Haishan Zhuang
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China
| | - ShawPong Wan
- First People's Hospital of Xiaoshan, Hangzhou, 311200, Zhejiang, China
| | - Guibin Xu
- Department of Urology, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, China.
- Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510230, China.
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Eskildsen SJ, Hansen CA, Kallemose T, Curtis DJ, Wessel I, Poulsen I. Factors Associated With Time to Decannulation in Patients With Tracheostomy Following Severe Traumatic Brain Injury. Respir Care 2024; 69:566-574. [PMID: 38649274 DOI: 10.4187/respcare.11376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Prolonged tracheal tube placement following severe traumatic brain injury (TBI) can cause serious complications. Safe removal requires sufficient ability for independent breathing and airway protection. Thus, identifying important factors for time to removal of the tracheal tube (decannulation) is essential for safe and efficient weaning. This study aimed to identify significant factors for time to decannulation in a Danish population of subjects with tracheostomy after TBI. METHODS This was a retrospective register-based cohort study. Subjects with moderate and severe TBI and a tracheal tube were selected from the Danish Head Trauma Database between 2011-2021. Time to decannulation was calculated as time from injury to decannulation. Associations between selected explanatory variables representing demographic and clinical characteristics and time to decannulation were analyzed using linear regression models. RESULTS A total 324 subjects were included with a median of 44 d to decannulation. Primary analysis found that an improvement in swallowing ability during the initial 4 weeks of rehabilitation was associated with an 8.2 d reduction in time to decannulation (95% CI -12.3 to -4.2, P < .001). Change in overall sensorimotor ability reduced time to decannulation by 0.94 (95% CI -0.78 to -0.10, P = .03) d. Change in cognitive abilities from rehab admission to 4-week follow-up did not significantly affect the number of days to decannulation (P = .66). Secondary analysis showed pneumonia was associated with the largest estimated increase of 24.4 (95% CI 15.9-32.9, P < .001) d and that increased cognitive functioning at rehabilitation admission was associated with a significant reduction in time to decannulation. CONCLUSIONS This study found that a change in swallowing ability is a potentially significant factor for reducing time to decannulation. Identifying factors that could explain differences in time to decannulation is essential for patient outcomes, especially if these factors are modifiable and could be targeted in rehabilitation and treatment.
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Affiliation(s)
- Signe J Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and Aarhus University, Health, Department of Public Health, Aarhus, Denmark.
| | - Carrinna A Hansen
- Department of Orthopaedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark; and University of Southern Denmark, the Faculty of Health Sciences, Department of Regional Health Research, Odense, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Derek J Curtis
- Department of Pediatric Rehabilitation, Children's Therapy Center, The Child and Youth Administration, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Denmark; and Aarhus University, Health, Department of Public Health, Aarhus, Denmark
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Yanagino Y, Kawamoto N, Kainuma S, Tadokoro N, Kakuta T, Ikuta A, Tonai K, Fujita T, Fukushima S. Successful Implantation of Rapid Deployment Aortic Valve after TAVR Explantation. J Cardiothorac Surg 2024; 19:211. [PMID: 38616249 PMCID: PMC11017536 DOI: 10.1186/s13019-024-02728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become widely used in recent years, However, there is also an increasing need for removal of TAVR valves due to prosthetic valve dysfunction (PVD) and the development of infective endocarditis. Surgical aortic valve replacement (AVR) for these patients is risky due to the original patient background and anatomic conditions. Intuity rapid deployment aortic valve (Edwards Lifesciences, Irvine, CA) replacement would be useful for such high risk patients to prevent longer cardiac arrest time and obtain good hemodynamic results. However, there are few reports which present Intuity valve replacement after TAVR explantation. Herein, We report two cases in which we have achieved good hemodynamics with shorter cardiac arrest times by using a rapid deployment valve after TAVR explantation. CASE PRESENTATION We present 2 cases of successful implantation of the Intuity rapid deployment valve after TAVR explantation. The 84- and 88-year-old female patients had previously received TAVR for severe aortic stenosis with SAPIEN XT (Edwards Lifesciences, Irvine, CA) and developed PVD during follow-up. The TAVR valve was removed carefully, then an Intuity valve was implanted with cardiac arrest times of 69 and 41 min. Both patients had good echocardiographic results with effective orifice area of 2.0 cm2 and 1.2 cm2 and mean trans-aortic plessure gradient of 9 mmHg and 15 mmHg respectively without aortic regurgitation. They were discharged without major complications. CONCLUSIONS Surgical AVR using a rapid deployment valve is a useful alternative to sutured AVR after TAVR valve explantation. It allows for shorter cardiac arrest times and better postoperative hemodynamics without major complication.
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Affiliation(s)
- Yusuke Yanagino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan.
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Ayumi Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
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20
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Aikawa T, Funayama N, Sunaga D, Minamino T. Retrieval of entrapped coronary balloon catheter with Goose Neck snare. Cardiovasc Revasc Med 2024; 61:116-117. [PMID: 38057211 DOI: 10.1016/j.carrev.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Tadao Aikawa
- Department of Cardiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu 279-0021, Japan.
| | - Naohiro Funayama
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo 064-8622, Japan
| | - Daisuke Sunaga
- Department of Cardiology, Hokkaido Cardiovascular Hospital, 1-30, Minami-27, Nishi-13, Chuo-ku, Sapporo 064-8622, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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21
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Time considerations and outcomes in pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2024; 179:111934. [PMID: 38537449 DOI: 10.1016/j.ijporl.2024.111934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The study objective is to identify factors that impact the time to decannulation in pediatric patients ages 0 through 18 years who are tracheostomy-dependent. METHODS This retrospective chart review from January 1, 2005 through December 31, 2020 identified pediatric tracheostomy patients at a single pediatric institution. Data extracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time with tracheostomy. RESULTS Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with median of 24 months (IQR 12.91-45.71). In the multivariate analysis, patients with bronchopulmonary dysplasia (p = 0.021) and those with Passy-Muir® Valve at discharge (p = 0.015) were significantly associated with decannulation. In contrast, neurologic comorbidities (p = 0.06), presence of gastrostomy tube (p < 0.001), or discharged on a home ventilator (p < 0.001) were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient otolaryngology care, time to decannulation was delayed by 0.5 months (p = 0.010). For each additional outpatient otolaryngology follow-up visit, time to decannulation increased by 3.36 months (p < 0.001). CONCLUSIONS Decannulation in pediatric tracheostomy patients is multifactorial. While timely establishment of outpatient care did correlate with quicker decannulation, factors related to medical complexity may have a greater impact on time to decannulation. Our results can help guide institutional decannulation protocols, as well as provide guidance when counseling families regarding tracheostomy expectations.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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22
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Kihlström C, Hailer NP, Wolf O. Surgical and non-surgical treatment for fully displaced lateral clavicle fractures have similar outcomes: An observational register study of 113 patients. Injury 2024; 55:111422. [PMID: 38408424 DOI: 10.1016/j.injury.2024.111422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Whether displaced lateral clavicle fractures should be treated surgically remains controversial. This study aims to compare outcomes after surgical versus non-surgical treatment of such fractures. PATIENTS AND METHODS 113 patients with lateral clavicle fractures registered in the Swedish Fracture Register (SFR) during 2018 and with complete displacement on radiography were included in this cohort study. Linkage with the National Patient Register provided information on baseline medical comorbidities and further interventions. Patient-reported outcome measures (PROM) were assessed using the European Quality of Life Scale (EQ-5D-3L), the Short Musculoskeletal Function Assessment (SMFA), and the Quick Disabilities of the Arm, Shoulder and Hand (QDASH). The primary outcome was the total number of initial and delayed surgical procedures. The secondary outcome was difference in PROM between surgically and non-surgically treated patient groups. RESULTS At a mean follow-up of 4.4 (range 3.9-4.9) years, 35 (67 %) of the 52 patients initially treated surgically had undergone a secondary procedure, mostly for implant removal. Of the 61 initially non-surgically treated patients, 3 (5 %) underwent delayed surgical treatment due to non- or malunion. 45 (40 %) patients responded to follow-up questionnaires, but no statistically significant differences were found in any PROM between groups. CONCLUSIONS Two thirds of surgically treated patients with displaced lateral clavicle fractures underwent two procedures. The need for delayed surgical treatment in non-surgically treated patients was low and PROM was similar in both treatment groups. Nonsurgical treatment should be considered as an option to surgery for fully displaced lateral fractures of the clavicle more often.
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Affiliation(s)
- Caroline Kihlström
- Department of Surgical Sciences - Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Nils P Hailer
- Department of Surgical Sciences - Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Olof Wolf
- Department of Surgical Sciences - Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
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23
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Cho YJ, Jeong YT, Lee TH, Cho HW. Delayed Implant Fixture Displacement into the Maxillary Sinus Five Years Post-Loading: Unraveling the Causes - A Case Report. J ORAL IMPLANTOL 2024; 50:81-86. [PMID: 38353278 DOI: 10.1563/aaid-joi-d-23-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Reports of implant fixtures dislocating into the maxillary sinus during sinus graft procedures are well-documented. However, cases of fixtures migrating into the sinus long after placement have yet to be reported. This case report details the surgical extraction of a displaced screw and cement-retained prosthesis, including a fixture and its abutment, from the maxillary sinus after a minimum of 5 years under functional load. The extracted implant was subsequently examined using scanning electron microscopy and energy-dispersive x-ray spectroscopy. We found that the migration commenced with peri-implantitis surrounding the implant, replacing the second molar. This was accompanied by a loss of cement from the crown on this implant and concurrent loosening of the abutment screw on the implant, replacing the first molar. We hypothesize that the inability of the bony tissue surrounding the second molar implant to withstand occlusal forces resulted in forming a bony sequestrum. This process ultimately precipitated the migration of the fixture, along with its abutment and adjacent necrotic bone, into the sinus cavity.
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Affiliation(s)
- Young Joon Cho
- Mac Dental Clinic, Daegu, South Korea
- Department of Periodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Yong Tak Jeong
- Mac Dental Clinic, Daegu, South Korea
- Department of Periodontics, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | | | - Hyun Woo Cho
- College of Dentistry, New York University, New York, New York, USA
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24
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Ip JE. Postmortem examination of a dual-chamber leadless pacemaker system: Implications for chronic atrial leadless pacemaker removal. Heart Rhythm 2024; 21:488-489. [PMID: 38184058 DOI: 10.1016/j.hrthm.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Affiliation(s)
- James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York.
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Bulman JC, Ali H, Sikaria D, Ahmed M, Weinstein JL. The Impact of Implementation of a Commercial Inferior Vena Cava Filter Database Program on Filter Retrieval versus Physician Tracking over a 9-Year Period: A Retrospective, Observational Study. J Vasc Interv Radiol 2024; 35:576-582. [PMID: 38142888 DOI: 10.1016/j.jvir.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023] Open
Abstract
PURPOSE To compare the impact of a commercial tracking database on inferior vena cava filter retrievals with that of physician tracking and no tracking. MATERIALS AND METHODS From January 2013 to December 2021, 532 filters were placed at a single institution and followed in 3 phases: (a) Phase 1, pretracking (January 1, 2013, to February 28, 2015); (b) Phase 2, commercial database tracking (March 1, 2015, to June 30, 2019); and (c) Phase 3, commercial database tracking with separate tracking by an interventional radiologist (July 1, 2019, to December 31, 2021). Patients excluded from the commercial database due to human error served as a control group. Outcomes of commercial database entry, 2-year filter retrieval rates, dwell times, and factors contributing to retrieval candidacy were collected. RESULTS Two-year retrieval rates in Phases 1, 2 and 3 were 20%, 31%, and 46%, respectively (Phase 1 vs 2, P = .04; Phase 2 vs 3, P = .009). Median dwell times across Phases 1, 2, and 3 were 168 days (4-1,313 days), 140 days (3-1,988 days), and 188 days (13-734 days) (P = .33), respectively. There was no difference in retrieval rates (P = .86) and dwell times (P = .50) between patients enrolled in the database group and those enrolled in the control group. Across all phases, 48% of patients enrolled in the database were not successfully contacted, and only 6% were categorized as "likely to consult" filter retrieval. During Phase 3, 100% of patients achieved a retrieval disposition. CONCLUSIONS A commercial tracking database had low success rates of contacting patients and did not increase filter retrieval rates relative to those in the control group; however, physician tracking increased retrieval rates.
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Affiliation(s)
- Julie C Bulman
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | - Hamza Ali
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Dhiraj Sikaria
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Jeffrey L Weinstein
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Arslan S, Yıldırım H, Çobanoğlu B, Işık AÜ, Bahadır O. Impact of Intranasal Splint Removal Time on Postoperative Complications after Septoplasty. Niger J Clin Pract 2024; 27:430-434. [PMID: 38679763 DOI: 10.4103/njcp.njcp_381_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/27/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Various types of nasal tampons are used for packing after septoplasty. Intranasal splints are widely used as they are more advantageous than other materials regarding the lower complication rates of synechia, and lesser pain during removal. However, there is no consensus on the timing of intranasal splint removal after septoplasty operations. AIM In this study, we aimed to investigate the effects of removal time of intranasal splints on postoperative complications after septoplasty. METHODS One hundred patients who had septoplasty were randomly divided into two groups according to splint removal time. In group I, the splints were removed on the third postoperative day and in group II, splints were removed on the seventh postoperative day. Pain during splint removal was evaluated by visual analog scale (VAS). Complications of hemorrhage, septal hematoma, crusting, mucosal injury, and infection were recorded during splint removal and compared. In the first postoperative month, hemorrhage, crusting, mucosal injury, infection, synechia, and in the second postoperative month, synechia and perforation rates were compared between two groups. RESULTS Mucosal crusting was significantly higher in group II during splint removal. There was no statistically significant difference between the two groups regarding the complication rates and pain scores. Our findings showed no significant difference in pain scores during splint removal and postoperative complications between the two groups except for mucosal crusting. CONCLUSION Based on our findings, although there is no consensus on the optimal time for splint removal, earlier removal of splints can be considered a favorable option after septoplasty operations.
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Affiliation(s)
- S Arslan
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Head and Neck Surgery, Trabzon, Turkey
| | - H Yıldırım
- Department of Otorhinolaryngology, Palandöken State Hospital, Erzurum, Turkey
| | - B Çobanoğlu
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Head and Neck Surgery, Trabzon, Turkey
| | - A Ü Işık
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Head and Neck Surgery, Trabzon, Turkey
| | - O Bahadır
- Department of Otorhinolaryngology, Karadeniz Technical University, School of Medicine, Head and Neck Surgery, Trabzon, Turkey
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Renschler A, Kelkar N, Eid K, Hawn V, Bundogji N, Werner L, Mamalis N. Complications of foldable intraocular lenses requiring explantation or secondary intervention: 2022 survey with update of long-term trends. J Cataract Refract Surg 2024; 50:394-400. [PMID: 37994083 DOI: 10.1097/j.jcrs.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To assess the complications that resulted in the explantation or secondary intervention with foldable intraocular lenses (IOLs). SETTING University setting, Salt Lake City, Utah. DESIGN Survey study. METHODS For the 25th consecutive year, surgeons were surveyed regarding complications associated with foldable IOLs requiring explantation or secondary intervention over the 2022 calendar year. These forms were made available online using the ASCRS and ESCRS websites and a fax-on-demand service. Surgeons completed 1 survey for each foldable IOL requiring explantation or secondary intervention. Further analysis determined complication trends related to specific IOL styles, materials, and types over the past 16 years (2007 to 2022). RESULTS 103 completed surveys were returned in 2022 contributing to a total of 1627 tabulated surveys since 2007. In the 2022 survey, dislocation/decentration continued to be the most common complication overall. Glare/optical aberrations was a common complication associated with multifocal IOLs continuing a 16-year trend. In addition, hydrophilic acrylic IOLs as well as some silicone lenses in eyes with asteroid hyalosis demonstrated calcification as the most common complication necessitating explantation. CONCLUSIONS Dislocation/decentration remains the leading cause of explantation in most IOL types. Glare/optical aberrations continue to be an associated complication of multifocal IOLs suggesting this ongoing issue has yet to be resolved with this type of IOL. In addition, calcification of hydrophilic acrylic lenses and silicone lenses is a rare event but continues to occur.
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Affiliation(s)
- Andy Renschler
- From the University of Utah School of Medicine, Salt Lake City, Utah (Renschler, Kelkar, Eid, Hawn, Bundogji, Werner, Mamalis); Intermountain Ocular Research Center, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Kelkar, Eid, Hawn, Bundogji, Werner, Mamalis)
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Tayebi P, Ziaie N. Chemotherapy Port Peal Away Sheath Embolisation and Removal With Endovascular Snaring. Vasc Endovascular Surg 2024; 58:335-337. [PMID: 37877688 DOI: 10.1177/15385744231207024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Chemotherapy port implantation is a common procedure for long-term intravenous access in cancer patients. While generally safe, complications can occasionally occur. This case report describes a rare complication of chemotherapy port placement, specifically peel away sheath embolisation, and its successful endovascular removal using snaring techniques. The purpose of this report is to highlight this uncommon complication and discuss the management strategy employed in our case.
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Affiliation(s)
- Pouya Tayebi
- Department of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Naghmeh Ziaie
- Department of Cardiology, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Ragland A, Stevens C, Bai N, Ahuja C, Virk C. Retrieval of an inferior vena cava Greenfield filter 34 years after insertion. BMJ Case Rep 2024; 17:e259053. [PMID: 38514161 PMCID: PMC10961489 DOI: 10.1136/bcr-2023-259053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Inferior vena cava (IVC) filters are engineered medical devices deployed in the IVC primarily to prevent a pulmonary embolism from occurring. In this article, we present a case of an IVC filter that was successfully retrieved from a patient after being in place for 34 years. The patient presented to hospital for trauma in which subsequent imaging showed tines of an IVC filter protruding outside of the vessel with one of the tines penetrating the duodenal wall. The filter was successfully removed with no complications. This report adds to the existing literature by yielding an example of an adverse risk that can be associated with the placement of IVC filters. In addition, to the authors' best knowledge, this is the longest reported length of time that an IVC filter has stayed in a patient before being removed, thus adding another intriguing detail to the case.
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Affiliation(s)
- Amanda Ragland
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Christopher Stevens
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Nancy Bai
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Chaitanya Ahuja
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, Louisiana, USA
| | - Chiranjiv Virk
- Louisiana State University Health Sciences Center Shreveport School of Medicine, Shreveport, Louisiana, USA
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30
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Liapis SC, Perivoliotis K, Moula AI, Christodoulou P, Psarianos K, Stavrou A, Baloyiannis I, Lytras D. Is magnetic anal sphincter augmentation still an option in fecal incontinence treatment: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:98. [PMID: 38499684 DOI: 10.1007/s00423-024-03288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Magnetic anal sphincter (MAS) augmentation is a novel surgical option for the treatment of fecal incontinence. Current clinical evidence is conflicting. The purpose of this meta-analysis was to report the safety profile, potential benefits, and the functional efficacy of this device. METHODS The study followed the PRISMA guidelines. Literature databases (Medline, Scopus, Web of Science, CENTRAL) were screened for eligible articles. The primary endpoint was the pooled effect of MAS in the Cleveland Clinic Incontinence Score (CCIS) score. Quality evaluation was based on the ROBINS-I and Risk of Bias 2 tool. RESULTS Overall, 8 studies with 205 patients were included. MAS resulted in a significant reduction of CCIS values (p = 0.019), and improvement only in the embarrassment domain of FIQoL scores (p = 0.034). The overall morbidity rate was 61.8%. Postoperative adverse events included MAS explantation in 12%, infection in 5.1%, pain in 10% and obstructed defecation in 5.8% of patients. CONCLUSION The application of MAS in patients with fecal incontinence results in the improvement of some clinical parameters with a notable morbidity rate. Due to several study limitations, further, high-quality RCTs are required to delineate the efficacy and safety of MAS.
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Affiliation(s)
| | - Konstantinos Perivoliotis
- Department of Surgery, "Achillopouleion" General Hospital, Volos, Greece
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | - Kyriakos Psarianos
- Department of Surgery, "Achillopouleion" General Hospital, Volos, Greece
| | - Alexios Stavrou
- Department of Surgery, "Achillopouleion" General Hospital, Volos, Greece
| | | | - Dimitrios Lytras
- Department of Surgery, "Achillopouleion" General Hospital, Volos, Greece
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Burnett C, Chandler S, Jegatheesan D, Pearch B, Viecelli A, Mudge DW. The stuck haemodialysis catheter-a case report of a rare but dreaded complication following kidney transplantation. BMC Nephrol 2024; 25:104. [PMID: 38500070 PMCID: PMC10949815 DOI: 10.1186/s12882-024-03507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Tunnelled cuffed haemodialysis catheters are at increased risk of incarceration or becoming 'stuck' via fibrotic adhesion to the central veins when left in situ for prolonged periods of time. Stuck catheters cannot be removed using standard techniques such as bedside dissection of the cuff. Whilst there are several strategies published for the removal of these incarcerated lines, there is no consensus on the best approach. Here we present a challenging case of a stuck haemodialysis catheter in the acute post transplantation period. CASE PRESENTATION A 66-year-old female on haemodialysis presented for kidney transplantation with a tunnelled-cuffed haemodialysis catheter in situ for five years. Following transplantation, removal of the line was unsuccessful despite dissection of the cuff, with traction causing a choking sensation with tracheal movement. Eventually, the line was removed without complications utilising sequential balloon dilatation by interventional radiology and the patient was discharged without complications. CONCLUSIONS This case serves as a timely reminder of the risks of long-term tunnelled haemodialysis catheters and as a caution towards proceeding with kidney transplantation in those with long-term haemodialysis catheters in situ. Greater nephrologist awareness of interventional radiology techniques for this challenging situation will help to avoid more invasive strategies. The risks of a stuck catheter should be included in the discussions about the optimal vascular access and transplantation suitability for a given patient.
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Affiliation(s)
- Cameron Burnett
- Department of Kidney and Transplantation Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
| | - S Chandler
- Department of Kidney and Transplantation Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - D Jegatheesan
- Department of Kidney and Transplantation Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- PA-Southside Clinic Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - B Pearch
- Department of Interventional Radiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - A Viecelli
- Department of Kidney and Transplantation Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- PA-Southside Clinic Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - D W Mudge
- Department of Kidney and Transplantation Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- PA-Southside Clinic Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Kolu AC, Akan S. Spontaneous knot formation complication of double J: two case reports. J Med Case Rep 2024; 18:103. [PMID: 38475904 PMCID: PMC10935823 DOI: 10.1186/s13256-024-04395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Use of ureteral stents has become an integral part of urological practice. However, it also brought with it many complications. Double J (DJ) stent knotting is a rare stent complication, and only a few cases have been reported in the literature. Although the exact cause is unknown and, in the literature, it is generally thought that knots occur due to traction. In this case report we present for the first time that spontaneous knots can occur due to ureteral peristalsis or ureteral anomalies. CASE PRESENTATION Two patients (67 and 35 aged-Caucasian person) with ureteral stones who presented to the emergency department with colicky pain and had no previous history of urological surgery. We observed knot formation in the routine urinary system radiographs taken before stent removal in two patients whose ureters were observed to be narrow during endoscopic ureteral stone treatment. The stents were successfully removed using gentle traction under general anesthesia. CONCLUSIONS We discussed the cause and solution of spontaneous knot formation. We emphasized the importance of the direct urinary system radiograph taken before DJ stent removal.
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Affiliation(s)
- Ahmet Can Kolu
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, 34758, Istanbul, Turkey.
| | - Serkan Akan
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, 34758, Istanbul, Turkey
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Walther M, Krenn V, Pfahl K. Diagnosing and Managing Infection in Total Ankle Replacement. Foot Ankle Clin 2024; 29:145-156. [PMID: 38309798 DOI: 10.1016/j.fcl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Infections after total ankle replacement (TAR) within the first 4 weeks after implantation can be managed successfully with 1 or several debridements, irrigation, and a change of polyethylene inlay. Late infections require implant removal. Low-grade infections might be an underestimated problem so far. Although single-surgery revisions are reported in the literature, the authors' experience with 2-stage revisions using an antibiotics-loaded bone cement spacer is better. Additional antibiotics are used to support the surgical treatment. After antibiotic therapy of 12 weeks, the final treatment includes ankle or tibio-talo-calcaneal fusion and, with limitations, revision TAR.
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Affiliation(s)
- Markus Walther
- Department of Foot and Ankle Surgery, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, Munich 81547, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, München 81377, Germany; Department of Orthopedic Surgery, University of Wuerzburg, Brettreichstrasse 11, Würzburg 97074, Germany; Paracelsus Medical University, Strubergasse 21, Salzburg 5020, Austria.
| | - Veit Krenn
- Pathologie Trier, Max-Planck-Str. 5, Trier 54296, Germany
| | - Kathrin Pfahl
- Department of Foot and Ankle Surgery, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, Munich 81547, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, München 81377, Germany
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Bronswijk M, Christiaens P. A novel device for buried bumper syndrome management: not all roses and sunshine. Gastrointest Endosc 2024; 99:474. [PMID: 38368046 DOI: 10.1016/j.gie.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden; Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven; Imelda Clinical GI Research Center, Bonheiden
| | - Paul Christiaens
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
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Abubeker FA, Tufa TH, Tolu LB, Sium AF, Grentzer JM, Welderufael MB, Prager S. Localization and removal of nonpalpable contraceptive implants: Experience from a teaching hospital in Ethiopia: A case series. Int J Gynaecol Obstet 2024; 164:1125-1131. [PMID: 37787448 DOI: 10.1002/ijgo.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To assess the outcome of women presenting with nonpalpable contraceptive implants to a referral center in Ethiopia. In addition, we discuss our approach and experience with localization and removal of nonpalpable contraceptive implants. METHODS We conducted a facility-based retrospective review of patients evaluated for a nonpalpable contraceptive implant between September 2019 and March 2022 at St. Paul's Hospital Millennium Medical College (SPHMMC) located in Addis Ababa, Ethiopia. SPHMMC is a tertiary teaching hospital with Obstetrics and Gynecology (OBGYN) residency as well as a Family Planning fellowship program. The present study was approved by the institutional review board of SPHMMC. RESULTS Of the 68 patients reviewed, 48 were referred from other facilities. A total of 24 (35.3%) patients had at least one previous failed attempt at removal before referral. On ultrasound examination, 27 (40.3%) implants were found below the muscle fascia. Implant removal procedures were successfully done at the outpatient clinic in 65 (95.6%) patients including 40/40 (100%) suprafascial and 25/27 (92.6%) subfascial implants. Removal of subfascial implants was performed in the operating room in two patients. We failed to localize the device in one patient currently on follow-up. All removals were performed by OBGYNs with subspecialty training in family planning or current fellows supervised by subspecialists. No post-procedure complications have been documented. CONCLUSION Our findings show that with meticulous evaluation and careful patient selection, localization and removal of nonpalpable implants in outpatient settings are successful. Initial ultrasonography minimizes delays and allows for same-day implant localization and removal.
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Affiliation(s)
- Ferid A Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tesfaye H Tufa
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lemi Belay Tolu
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abraham Fessehaye Sium
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Jaclyn M Grentzer
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mekdes Bahru Welderufael
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah Prager
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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36
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Talha KM, Winscott JG, Patel V, Lemor A, Ashley KE, Campbell WF, McMullan MR, Hernandez GA. Using Arterial Recoil for Large Bore Access Closure After Impella Assist Device Removal. Crit Pathw Cardiol 2024; 23:36-38. [PMID: 37944008 DOI: 10.1097/hpc.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The use of Impella assist device for high-risk percutaneous coronary interventions and cardiogenic shock has increased in the last decade and requires a large bore arterial access (LBA). However, LBA closure following Impella removal is associated with significant complications. Herein, we describe the safety and efficacy of a novel method of LBA closure using arterial recoil following Impella removal. We performed a retrospective review of electronic medical records of patients who underwent LBA closure using this method from July 1, 2018 to June 30, 2022. The procedure involves controlled downsizing of the arterial sheath from 12 French (Fr) to 6 Fr catheters with intermittent compression to allow patent hemostasis facilitated by arterial recoil. Baseline characteristics and outcomes including closure success, immediate/delayed bleeding, and access site complications were included. Of 103 patients with Impella placement, 20 (19%) underwent LBA closure with this method. Patients were predominantly male (80%) and White (55%) with a mean age of 65 ± 16 years. After downsizing of the femoral sheath to 6 Fr, 14 patients underwent manual compression, 3 patients had a 6 Fr catheter left in place to maintain access, and 3 patients underwent placement of a Perclose or Vascade device. Successful LBA closure was performed in all patients with no immediate or delayed bleeding complications. Five patients (25%) died inpatient; the deaths were unrelated to complications of Impella removal. In conclusion, LBA closure post-Impella removal with this novel method was safe and effective. Further prospective studies are needed to ascertain its comparative efficacy.
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Affiliation(s)
- Khawaja M Talha
- From the Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - John G Winscott
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Vishal Patel
- From the Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Alejandro Lemor
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Kellan E Ashley
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - William F Campbell
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Michael R McMullan
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Gabriel A Hernandez
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
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Chirpaz N, Elbany S, Rocher A, Rochepeau C, Benyoucef Y, Esminezhad-Limoochi C, Dot C, Burillon C. [Intraoperative opacification of a scleral-fixated Carlevale (Soleko®) intraocular lens]. J Fr Ophtalmol 2024; 47:104095. [PMID: 38382417 DOI: 10.1016/j.jfo.2024.104095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/13/2023] [Indexed: 02/23/2024]
Abstract
Thermal shock can cause intraoperative opacification of a Carlevale (Soleko®) implant. This is a rare phenomenon which resolves spontaneously. It is crucial to recognise this phenomenon in order to avoid unnecessary and potentially harmful explantation decisions for the patient.
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Affiliation(s)
- N Chirpaz
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France.
| | - S Elbany
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France
| | - A Rocher
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France
| | - C Rochepeau
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France
| | - Y Benyoucef
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France
| | - C Esminezhad-Limoochi
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France
| | - C Dot
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France; Académie du service de santé militaire, Val-de-Grâce, Paris, France
| | - C Burillon
- Service d'ophtalmologie, hôpital Edouard-Herriot, hospices civils de Lyon, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France
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Bemtgen X, von Zur Mühlen C, Westermann D, Wengenmayer T, Staudacher DL. A Solution for Distal Femoral Occlusion After Venoarterial Extracorporeal Membrane Oxygenation Decannulation: Distal Femoral Access and Thrombectomy. ASAIO J 2024; 70:e43-e45. [PMID: 38411927 DOI: 10.1097/mat.0000000000002114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
For patients on venoarterial extracorporeal membrane oxygenation support where ready-to-wean criteria are met, complications during the decannulation are quite common. Management of these complications can be challenging as many of the remaining standard arterial access sites are in use or had prior closure by a closure device. In this case report of a 70-year-old patient, explantation of the arterial cannula with the help of a vascular closure device led to thrombotic occlusion of the distal femoral artery. Here, we describe a step-by-step guide outlining our approach on management of this complication. Most relevantly, a distal femoral access via the superficial femoral artery was used, and thrombus aspiration was done with the help of the AngioJet peripheral thrombectomy system.
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Affiliation(s)
- Xavier Bemtgen
- From the Department of Cardiology and Angiology (Heart Center Freiburg-Bad Krozingen), University Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- From the Department of Cardiology and Angiology (Heart Center Freiburg-Bad Krozingen), University Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- From the Department of Cardiology and Angiology (Heart Center Freiburg-Bad Krozingen), University Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Department of Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dawid L Staudacher
- Department of Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Veliev E I, Sokolov E A, Metelev A Y, Aliev E N, Polyakova A S, Ivkin E V. [Antibacterial prophylaxis with fosfomycin at the time of the urethral catheter removal after radical prostatectomy (prospective randomized trial)]. Urologiia 2024:35-40. [PMID: 38650404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
AIM To evaluate the effect of antibacterial prophylaxis using oral fosfomycin during the removal of a urethral catheter after radical prostatectomy on the development of urinary tract infection, severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms. MATERIALS AND METHODS A single-center, non-blind, prospective, randomized controlled trial was carried out. The main group included 40 patients, and the control group included 37 patients. In the group 1, patients received two doses of oral fosfomycin, 3 g, namely in the evening on the day of catheter removal (the first dose) and 48 hours after catheter removal (the second dose). In the group 2, patients did not receive any antibacterial prophylaxis after urethral catheter removal. The endpoints of the study were confirmed episodes of urinary tract infection within 1 month after removal of the urethral catheter, leukocyturia and bacteriuria in urinalysis/urine culture) and severity of the lower urinary tract symptoms assessed by IPSS questionnaire. RESULTS In the group 2, urinary tract infection was noted in 17.1%, while in the group 2 only in 2.6% of patients (p=0.032). Leukocyturia and bacteriuria were significantly less common in the group receiving antibacterial prophylaxis with fosfomycin (18.4% vs. 48.6%, respectively; p=0.006). Positive urine culture was observed in 7.9% vs. 25.7%, respectively (p=0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group 2 (13.2 vs. 9.5 points; p=0.002). There were no cases of allergic reaction and pseudomembranous colitis associated with C. difficile in both groups. Diarrhea cured with sorbents was noted in 2 patients (5.2%) in fosfomycin group. CONCLUSION Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day of urethral catheter removal and 48 hours after catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of urinary tract infection and the severity of lower urinary tract symptoms, and is characterized by a minimal risk of adverse events. It is necessary to carried out further research and develop clear recommendations for antibacterial prevention in urological interventions requiring prolonged urethral catheterization.
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Affiliation(s)
- I Veliev E
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
| | - A Sokolov E
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
| | - Yu Metelev A
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
| | - N Aliev E
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
| | - S Polyakova A
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
| | - V Ivkin E
- Russian Medical Academy of Continuous Professional Education, Department of Urology and Surgical Andrology, Moscow, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
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40
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Koizumi K, Kimura K, Jinushi R. Successful removal of a proximally migrated biliary fully covered self-expandable metal stent using a sphincterotome. Dig Endosc 2024; 36:374-375. [PMID: 38131247 DOI: 10.1111/den.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Watch a video of this article.
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Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa, Japan
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41
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Whittemore BA, Braga BP, Price AV, De Oliveira Sillero R, Sklar FH, Megison SM, Weprin BE, Swift DM. Management of cerebrospinal fluid pseudocysts in the laparoscopic age. J Neurosurg Pediatr 2024; 33:256-267. [PMID: 38100755 DOI: 10.3171/2023.10.peds23174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Abdominal CSF pseudocysts are an uncommon but challenging complication of ventriculoperitoneal shunts. Pseudocysts consist of a loculated intraperitoneal compartment that inadequately absorbs CSF and may be infected or sterile at diagnosis. The treatment goal is to clear infection if present, reduce inflammation, and reestablish long-term function in an absorptive (intraperitoneal) space. This aim of this paper was to study the efficacy of primary laparoscopic repositioning of the distal shunt catheter for treatment of sterile abdominal CSF pseudocysts. METHODS All patients treated for abdominal CSF pseudocysts at Dallas Children's Health from 1991 to 2021 were retrospectively reviewed. Patient history and pseudocyst characteristics were analyzed, with a primary outcome of pseudocyst recurrence at 1 year. RESULTS Of 92 primary pseudocysts, 5 initial treatment strategies (groups) were used depending on culture status, clinical history, and surgeon preference: 1) shunt explant/external ventricular drain (EVD) placement (23/92), 2) distal tubing externalization (13/92), 3) laparoscopic repositioning (35/92), 4) open repositioning (4/92), and 5) other methods such as pseudocyst drainage or direct revision to another terminus (17/92). Seventy pseudocysts underwent shunt reimplantation in the peritoneal space. The 1-year peritoneal shunt survival for groups 1 and 2 combined was 90%, and 62% for group 3. In group 3, 1-year survival was better for those with normal systemic inflammatory markers (100%) than for those with high markers (47%) (p = 0.042). In a univariate Cox proportional hazards model, the risk of pseudocyst recurrence was increased if the most recent abdominal procedure was a nonshunt abdominal surgery (p = 0.012), and it approached statistical significance with male sex (p = 0.054) and elevated inflammatory markers (p = 0.056. Multivariate Cox analysis suggested increased recurrence risk with male sex (p = 0.05) and elevated inflammatory markers (p = 0.06), although the statistical significance threshold was not reached. The length of hospital stay was shorter for laparoscopic repositioning (6 days) than for explantation/EVD placement (21 days) (p < 0.0001). Ultimately, 62% of patients had a peritoneal terminus at the last follow-up, 33% (n = 30) had an extraperitoneal terminus (19 pleura, 8 right heart, and 3 gallbladder), and 5 patients were shunt free. CONCLUSIONS Some sterile pseudocysts with normal systemic inflammatory markers can be effectively treated with laparoscopic repositioning, resulting in a significantly shorter hospitalization and modestly higher recurrence rate than shunt explantation.
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Affiliation(s)
| | - Bruno P Braga
- Departments of1Neurosurgery and
- 3Children's Health, Dallas, Texas
| | - Angela V Price
- Departments of1Neurosurgery and
- 3Children's Health, Dallas, Texas
| | | | | | - Stephen M Megison
- 2Surgery, UT Southwestern Medical Center
- 3Children's Health, Dallas, Texas
| | - Bradley E Weprin
- Departments of1Neurosurgery and
- 3Children's Health, Dallas, Texas
| | - Dale M Swift
- Departments of1Neurosurgery and
- 3Children's Health, Dallas, Texas
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42
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Dibello J, Portal D, Greenstein J, Hahn B. Hidden in Plain Sight. J Emerg Med 2024; 66:e381-e382. [PMID: 38242751 DOI: 10.1016/j.jemermed.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/15/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Jaclyn Dibello
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Daniel Portal
- Department of Radiology, Staten Island University Hospital, Staten Island, New York
| | - Josh Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York
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43
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Gong M, He X, Gu J. A more appropriate modality may be desired for the measurement of inferior vena cava filter position. J Vasc Surg Venous Lymphat Disord 2024; 12:101735. [PMID: 38368021 DOI: 10.1016/j.jvsv.2023.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Jianping Gu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
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44
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Suri K, Billick S. Breast Implant Illness Through a Psychiatric Lens. Aesthetic Plast Surg 2024; 48:559-567. [PMID: 37828367 DOI: 10.1007/s00266-023-03692-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Since their introduction in the 1960's, the safety of silicone breast implants has remained contentious due to concerns regarding carcinogenicity as well as a growing array of adverse psychiatric symptoms, which have now been termed 'Breast Implant Illness.' This article aims to explore the merits of a psychiatric approach to treating Breast Implant Illness by outlining how it is defined by psychiatric symptoms and categorized alongside other psychiatric illnesses. Furthermore, it is unclear whether the pathology of Breast Implant Illness is purely medical or psychiatric. However, the efficacy of the medical approach to treatment through a process called explantation, which involves removal of the implant and surrounding scar tissue, or capsule, is not strongly supported by existing data. A psychiatric approach to treatment, in conjunction with explanation, thus holds potential in remedying the novel and poorly understood Breast Implant Illness.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kashviya Suri
- The University of Pennsylvania, Philadelphia, PA, USA.
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45
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Hicks AC, Sangroula D, Dwivedi AJ, Wayne EJ, Sigdel A. Inferior vena cava perforation during percutaneous filter removal. Vascular 2024; 32:190-194. [PMID: 36269323 DOI: 10.1177/17085381221135268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous Inferior Venacava (IVC) filter retrieval can be challenging when the filter is grossly angulated, embedded in the wall or penetrates through the IVC. When conventional filter removal technique fails, the use of advanced retrieval techniques often improves the chances of percutaneous filter retrieval. These techniques, however, are associated with a high rate of complications. METHODS We report a case of 26-year-old female who had IVC filter placed on postpartum day 4. Attempted percutaneous filter retrieval 3 weeks later with loop snare technique and endobronchial forceps assisted filter removal technique resulted in gross filter deformity, malposition, and IVC perforation. RESULT Open IVC filter removal was performed with midline laparotomy and cavotomy with lateral venorrhapy. The deformed filter along with adherent thrombus was completely removed. The patient had an uneventful recovery with no immediate or long-term complications. CONCLUSION Use of advanced endovascular IVC filter retrieval techniques could result in serious complications like filter fracture, migration and IVC perforation. Since excessive tilt of the filter at the time of placement often results in difficult retrieval, it is important to ensure proper deployment of the filter with minimal tilt. If encountered with excessively tilted or embedded filter, one should refrain from excessive manipulation of the filter and consider open filter removal.
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46
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Gandhi JA, Baig SJ, Gajjar AP, Banker AM. Enhancing mesh explantation reporting: a novel classification system for improved surgical decision-making and patient outcomes. Hernia 2024; 28:277-278. [PMID: 37713141 DOI: 10.1007/s10029-023-02877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Affiliation(s)
- J A Gandhi
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - S J Baig
- Belle Vue Clinic, Kolkata, India
| | - A P Gajjar
- Seth G S Medical College and KEM Hospital, Mumbai, India.
| | - A M Banker
- Fellow in Liver Transplant, Jackson Memorial Hospital, Miami, USA
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47
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Qin L, Gu X, Wang K, Jia Z, Xue T, Li S, Wang K. Characteristics of Option and Denali Inferior Vena Cava Filters. Ann Vasc Surg 2024; 99:349-355. [PMID: 37852367 DOI: 10.1016/j.avsg.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND To assess the characteristics of Option and Denali filters and to identify associations between these characteristics in each filter type. METHODS Consecutive patients who underwent Option or Denali filter placement between August 2019 and August 2022 were included in this retrospective study. RESULTS A total of 119 patients (Option, n = 60; Denali, n = 59) were included. The retrieval rates were 45.0% for Option filters and 40.7% for Denali filters. The incidence of tilt at placement was higher for Option filters (76.7%) than for Denali filters (11.9%; P < 0.001). The tilt angle of Option filters at placement was correlated with the common iliac vein-inferior vena cava (CIV-IVC) angle. The incidence of tilt angle change after placement was higher for Option filters (74.1%) than for Denali filters (8.3%; P = 0.001). The IVC contraction rate after retrieval of Option is less than Denali (22.2% vs. 87.5%, P < 0.001). The median fluoroscopy time during Option filter retrieval was longer than during Denali filter retrieval. The fluoroscopic time was related to tilt angle during retrieval of Option filters. CONCLUSIONS Option filters are more likely than Denali filters to tilt at placement, and the tilt angle of Option filters is more prone to change after placement. The tilt angle at placement in Option filters is related to the CIV-IVC angle. Option filters require a longer fluoroscopic time during retrieval than Denali filters, and this increased fluoroscopic time is related to the tilt angle. Denali is more likely to cause IVC constriction after placement.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Xiaocheng Gu
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huaian City (Huaian Cancer Hospital), Huaian, China.
| | - Shaoqin Li
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.
| | - Ke Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.
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Dieter AA. Support for At-Home Removal of Transurethral Catheters Placed for Acute Postoperative Voiding Dysfunction. Obstet Gynecol 2024; 143:163-164. [PMID: 38237160 DOI: 10.1097/aog.0000000000005494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Alexis A Dieter
- Dr. Dieter is from the Section of Female Pelvic Medicine & Reconstructive Surgery at MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC;
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49
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Gwechenberger M. Leadless Pacemaker Implantation After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device. Am J Cardiol 2024; 212:139-140. [PMID: 38103762 DOI: 10.1016/j.amjcard.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Affiliation(s)
- M Gwechenberger
- Department of Cardiology, Medical University of Vienna, Vienna, Austria.
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Abstract
Gastric band migration, for which abscess of the subcutaneous port is an alarm signal, can in some cases be asymptomatic. Therapeutic options for withdrawal of the migrated band include colonoscopy (if the band is located at the level of the ileo-caecal valve), laparoscopy and mini-laparotomy.
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