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At least 253 records · Page 14Linked to original sources
PubMed1987

Experiences with the use of the Port-a-Cath in children.

Over a period of 18 months, we have inserted 20 Port-a-Caths in 19 children between the ages of 8 1/2 months and 18 years. The smallest child weighed 7 k. Three others weighed less than 12 k. The indication in all cases except two was the administration of cancer chemotherapy. The devices have been in use for periods ranging from 2 to 70 weeks (total of 517 patient weeks, average 27 weeks). Four patients had the device removed electively at termination of chemotherapy. Five patients died with the device in place and functioning well. Three patients required removal for complications. The eight others still have functioning catheters. The only significant "nuisance" problem is the occasional inability to withdraw blood. Patient tolerance and parent acceptance is good. In particular, we are impressed with the fact that ease of insertion and of use, as well as durability, do not seem to be limited by patient size or age, as long as a vessel large enough to accommodate the catheter can be found.

Adolescent↗
PubMedDate not supplied

Safety and efficacy of midface-lifts with an absorbable soft tissue suspension device.

OBJECTIVE: To evaluate the safety and efficacy of midface-lifting using an absorbable suspension device (Endotine ST). DESIGN: Prospective cohort of 10 consecutive adult female patients seen in a private practice who underwent isolated midface-lift without accompanying eyelid surgery or volume augmentation procedures in the setting of an accredited ambulatory surgical center. All patients underwent endoscopic-assisted midface-lifts with general anesthesia or intravenous sedation. Subperiosteal dissections of the midface were performed with fixation of the Endotine ST device to temporalis fascia. Objective and subjective criteria were recorded and photodocumented during the postoperative period at 1 week and 1, 3, and 6 months. Patient characteristics of erythema, tenderness, and pain were recorded with a visual analog scale. The patients and surgeon rated changes from the baseline condition and overall satisfaction with the procedure at 1, 3, and 6 months. RESULTS: All 10 patients completed the 6-month postoperative follow-up. Nine of the 10 patients had significant improvements in their aesthetic outcome. The most common objective symptom of malar sensitivity diminished significantly between the 1- and 3-month visits. One patient experienced a temporary paresis of the zygomaticofacial nerve that resolved at 3 months. There were no major complications of infection, extrusion, skin irregularities, or device removals. CONCLUSIONS: Midface-lifting with the Endotine ST device provided significant elevation of the malar fat pad with improvement in facial contour. Safety of this surgical technique was comparable to that of midface-lifts in other published studies. Patient acceptance of the midface-lift using the Endotine ST device was favorable. Temporary tenderness over the malar area can be expected during the early postoperative period.

Absorbable Implants↗
PubMed2006

Anterior exposure of the spine for removal of lumbar interbody devices and implants.

STUDY DESIGN: A retrospective review of a consecutive series of 14 patients operated on between March 1998 and April 2005. OBJECTIVES: To report on patients having undergone revision lumbar surgery anteriorly to remove interbody devices placed anteriorly or posteriorly and to determine the incidence of associated complications. SUMMARY OF BACKGROUND DATA: The popularity of interbody lumbar surgery has grown in recent years. Consequently, the number of anterior revision procedures has increased. The risks associated with anterior approach for revision procedures and interbody device removal, in particular, have not been reported. METHODS: The results of 13 consecutive patients who had removal of interbody devices through an anterior approach and 1 patient with removal of anterior fixation (7 males, 7 females; mean age 43 years) were reviewed. The procedure during which the original implant was placed was a posterior lumbar interbody fusion in 4, transforaminal lumbar interbody fusion in 5, and anterior lumbar interbody fusion in 5 patients. Four attending spine surgeons performed the procedures with the assistance of 4 experienced access surgeons. RESULTS: Ten of 14 (71%) patients had complications associated with anterior exposure of revision surgery. Vascular injury is the most common complication (57%). Vascular complications occurred in 100% (4/4) of the revisions of previous posterior lumbar interbody fusions and 80% (4/5) of previous anterior lumbar interbody fusions. The complication rate at L4-5 and L5-S1 was 89% and 40%, respectively. There was 1 postoperative mortality. CONCLUSIONS: Anterior removal of lumbar interbody devices placed anteriorly or posteriorly has a high incidence of complication. Average blood loss and hospital stay are increased with revision anterior surgery. The vascular complication rate is 2-fold higher at L4-L5 level compared to L5-S1.

Adult↗
PubMed2004

Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale.

Percutaneous closure of patent foramen ovale (PFO) in patients with presumed paradoxical embolism yields complete occlusion in > 90% of patients using contemporary closure devices. Patients with a residual shunt after percutaneous PFO closure have been found at increased risk for recurrent paradoxical events. Treatment options for such patients include medical treatment using antiplatelet drugs or oral anticoagulation, surgical device removal and patch closure, and percutaneous implantation of a second closure device. We report our experience with implantation of a second closure device in 10 patients with more than a minimal residual shunt < or = 6 months after percutaneous PFO closure. Procedure and fluoroscopy times were similar for the initial and repeat intervention (32 vs. 30 min and 5 vs. 6 min, respectively; P = NS). There were no procedural complications during implantation of the second closure device. Follow-up transesophageal echocardiography 6 months after the second percutaneous intervention revealed complete PFO closure in nine (90%) patients. Therefore, implantation of a second closure device in patients with persistence of more than a residual shunt after percutaneous PFO closure appears safe and effective.

Adult↗
PubMed1998

Early clinical experience with use of the 'Amplatzer Septal Occluder' device for atrial septal defect.

Device closure of oval fossa atrial septal defects with the Amplatzer Septal Occluder was performed in 26 patients ranging in age from 0.89 to 60.44 years. In eight additional patients no device implant was performed because of the presence of multiple defects or because the defect was of a size unsuitable for closure with the devices currently available. The stretched diameter of the defects that were closed ranged from 4 to 23 mm (mean 14+/-5.4 mm) and device sizes ranged from 4 to 24 mm. Two devices were unstable, of which one embolized to the right atrium after release. Both devices were retrieved at the same procedure. One of these patients subsequently underwent a successful device closure of his defect using a larger (24-mm) device. Three patients had multiple defects, which were successfully closed with a single device. At 1-month follow-up 23/26 (88%) and at 3-month follow-up 22/24 (92%) patients had complete closure of their defects, while two had residual shunts. One further patient who had complete closure of his defect at 1-month post-implant had his device removed and his atrial septal defect patched surgically 8 weeks after device closure. This was done as a result of the development of a vegetation affecting the device after an episode of septicaemia, which was not related to the cardiac problems. There was no procedure-related morbidity or mortality and all patients remain well at the present time.

Adolescent↗
PubMed2002

A comparison of in vitro enamel demineralization potential of 3 orthodontic cements.

The objective of this in vitro study was to compare resistance to enamel demineralization after banding with 3 orthodontic cements. The 3 orthodontic cement groups and the nonbanded control group were evaluated for cariopreventive potential. One hundred twenty extracted human molars were selected for banding, embedded in resin blocks, and randomly assigned to the following 4 groups: zinc phosphate cement, zinc polycarboxylate cement, resin-modified glass ionomer (RMGI), and nonbanded control. Orthodontic bands were placed and cemented; specimens were stored in artificial saliva at 37 degrees C for 30 days, thermocycled for 24 hours, and then debanded with a customized band-removal device attached to a universal testing machine. The cement was hand removed, and 2 coats of nail varnish were applied to the teeth, leaving a 2 x 2-mm window exposed on the buccal surface of the mesiobuccal cusp. The teeth were stored in lactic acid-gelatin solution for 4 weeks at 37 degrees C to develop simulated white spot decalcification in the window. The teeth were subjected to dye (10% methylene blue) for 24 hours and then sectioned through the window. The depth of dye penetration was determined and used as a measure of the cariopreventive effect of the banding cement. Data were analyzed with a 1-way ANOVA and a Tukey test for the multiple comparisons. Dye penetration occurred as follows: the zinc phosphate and control groups were about the same; there was less dye penetration with the zinc polycarboxylate, and the least with the resin-modified glass ionomer. The 2 fluoride-releasing cements (zinc polycarboxylate and RMGI) demonstrated less demineralization than the zinc phosphate in vitro and might provide greater protection from demineralization around a band periphery in clinical settings.

Analysis of Variance↗
PubMedDate not supplied

Are selective macromolecule removal plasmapheresis systems useful for autoimmune diseases or hyperlipidemia?

Although technical limitations exist with existing selective removal systems, very few products are available and no major clinical trials have demonstrated the superiority or equivalence of selective removal systems over plasma exchange. It is generally recognized that selective removal systems are preferable, and that selective macromolecule removal plasmapheresis systems are useful for autoimmune diseases or hyperlipidemia. In the treatment of a disease with a selective removal device, the disease pathogen should be identified and the efficacy of removal demonstrated. In general, for plasmapheresis applications, there is a need to better understand the pathophysiology of the disease states and to identify the pathogenic molecules. With such information, development of the optimal selective removal method will be possible. There is the need for clinical studies to compare selective removal and plasma exchange for specific disease states. Incentives for the development of improved selective removal technologies where cost effectiveness could be demonstrated should be encouraged.

Autoimmune Diseases↗
PubMed2002

[Infections in surgery of idiopathic scoliosis].

PURPOSE OF THE STUDY: In this retrospective study, we evaluated infectious complications in the patients undergoing surgical treatment for idiopathic scolions in order to identify risk factors for postoperative infections. MATERIAL: A total of 786 patients with idiopathic scoliosis were operated on during 24 years. In 754 (96%) cases, we used the posterior approach, involving posterior fusion and internal fixation, and subsequent immobilization in a brace. During that period, we recorded 15 (1.9%) deep wound infections in the area of fusion. Early infections were treated by debridement and lavage, with targeted administration of antibiotics, while instrumentation was kept in place. In late und recurrent infections, instrumentation was always removed. METHODS: We investigated a relationship between the infectious agent and the device used, the length of period between surgery and the onset of infection, the effect of device removal on curve progression, the agent causing infection and the effect of allergy to metal or infectious lesions at other body sites on the outbreak of infection. RESULTS: Early infections (within 6 weeks) were observed in six, late in nine patients. Repeat operations were necessary on average after 487 days. Staphylococcus aureus, the most frequent infectious agent, was isolated from four patients; on four occasions, cultivation was negative. Allergy to nickel was found in four patients. Infection was most often associated with the most frequently used Harrington Instrumentation (six cases, 1.1%). However, in relation to the number of patients treated, infection frequency was highest in TSRH (5.0%) and Isola (4.8%) devices. When Miami Moss fixation or the anterior approach was used, no infection was recorded. In comparison with the non-infected cases, the patients with infectious complications showed the same average values for the curve before and after surgery. At a check up, however, the loss of correction increased to 6 degrees and, after instrumentation removal, to 10 degrees as against 3 degrees in the non-infected patients. Pseudoarthrosis developed in two cases. DISCUSSION: The incidence of deep wound infections in patients who had surgery for idiopathic scoliosis was comparable with the data in the relevant literature. A higher number of infections, particularly late ones, in patients treated with the use of modern instrumentation is probably related to a higher volume of these implants. Early infections are a rare feature and their cause is known (allergy, sepsis). Treatment involves surgical intervention; in early infections, instrumentation is retained but is removed in late infections. CONCLUSIONS: Even though our group included a low number of patients with infections, we can conclude that risk factors for the development of infectious complications associated with surgical treatment of idiopathic scoliosis are as follows: allergy, higher age, large volume of metal used for stabilization and the presence of another infectious lesion.

Adolescent↗
PubMed1998

Do physical restraints prevent patients from removing invasive therapeutic devices?

Many critical care nurses have cared for patients who have removed invasive therapeutic devices such as endotracheal tubes or intravenous lines despite secure physical restraints. Recently medical and nursing authors have begun to question the effectiveness and appropriateness of physical restraints. Through a literature review, this article explores the question: "Do physical restraints prevent patients from removing invasive therapeutic devices?" and identifies some alternatives to restraints that may be appropriate for use in critical care areas.

Confusion↗
PubMed2004

Candida biofilms: antifungal resistance and emerging therapeutic options.

Intravascular catheter infections are a major cause of morbidity and mortality in hospitalized patients, accounting for the majority of the 200,000 nosocomial bloodstream infections occurring in the US annually. Of the intravenous lines that are culture-positive for Candida, 40% actually represent fungemia, which generally necessitates systemic treatment and line removal to affect cure. Until recently, the reason for the need for device removal was unclear. However, our research group and others have demonstrated a near-total resistance to antifungals by biofilm-associated Candida. Similar to bacterial species, Candida biofilm formation proceeds through early, intermediate and maturation phases. This process is associated with the generation of a polysaccharide extracellular matrix (ECM). Mature C. albicans biofilms have a heterogeneous architecture, in terms of distribution of fungal cells and ECM, and exhibit broad antimicrobial resistance. The mechanisms causing such profound antifungal resistance are beginning to be understood. Recent data indicate that resistance is phase-specific and multifactorial, involving efflux pumps and sterol synthesis (at early and mature biofilm phases, respectively). Neither metabolic quiescence nor the ECM appear to contribute substantially. Susceptibility testing and confocal scanning laser microscopy demonstrated that azoles failed to exert activity against mature Candida biofilms. However, sub-inhibitory concentrations of voriconazole impaired biofilm formation and caused cell morphological aberrations. In contrast, lipid-formulation amphotericins and the echinocandins uniquely exhibited activity against mature biofilms. The mechanisms underlying this ability are unknown. The role of other pharmacological (eg, catheter coatings, antimicrobial peptides and antibiotic locks) and non-pharmacological methods in the prevention and treatment of device-related biofilms is discussed in this review.

Animals↗
PubMed2001

Cement removal with an endoscopically controlled ballistically driven chiselling system. A new device for cement removal and preliminary clinical results.

In this paper, we introduce a newly developed miniaturised chiselling system (Swiss OrthoClast) which allows endoscopically controlled cement removal even from deep within the femur in hip revision arthroplasty. The intraoperative handling is demonstrated and illustrated. The device consists of a control unit, a handpiece, a set of chisels of different lengths, shape, and tip geometry, a set of plug extraction tools, and a special intrafemoral endoscope. It uses simple ballistic principles to effect fracturing of the bone cement. Inside the handpiece the projectile is accelerated and strikes the chisel head. The tip moves at high speed and with a small excursion towards the cement, which is fragmented mechanically by the movement of the chisel tip without generating heat. The device is being validated in a prospective, international, multicenter study, and we include here the results of the first 28 clinical procedures of cement removal. The duration of the procedure varied from 13 to 75 min, with an average of 32 min. In all but one case, the cement was completely removed. We noted one case of cortical fissuring.

Aged↗
PubMed1987

Salvage of the eroded inflatable penile prosthesis: a new concept.

Most surgeons consider erosion of any component of an inflatable penile prosthesis as an indication for total device removal. However, it has been our contention that in selected cases conservative management can be used and the device can be salvaged. In 32 patients with erosion of various device components we performed conservative salvage techniques, consisting of immediate component replacement, repositioning of the eroded component or removal of only the eroded component in conjunction with closed drainage and antibiotic irrigation. Early success with device salvage resulted in the development of a rigid protocol for patient selection and management. Salvage techniques were successful in 16 of 22 cases of scrotal pump erosion and in all 8 cases of reservoir erosion. In 2 cases of cylinder erosion salvage attempts failed.

Adult↗
PubMed2005

Effects of unisegmental disc compression on adjacent segments: an in vivo animal model.

It is controversial whether fusion of discs in the spine leads to increased degeneration on the remaining discs or whether the degenerative changes are merely a part of the inevitable natural history process. To determine the effects of unisegmental compression and subsequent recovery on adjacent segments, we studied histology, radiology and intradiscal pressure using an in vivo rabbit model. Fifteen New Zealand rabbits were divided in to three groups of five. In the first group, the intervertebral disc L4-L5 of the lumbar spine was axially loaded for 28 days with an external loading device. In the second group, the intervertebral disc was compressed for 28 days and allowed to recover for an equal amount of time, with the loading device removed. Five animals underwent a sham operation, in which the external loading device was situated, but their discs remained unloaded for 28 days. The intradiscal pressure was determined in the loaded discs as well as in the cranial and caudal adjacent discs. Lateral radiographs were taken from each subjected intervertebral disc with adjacent vertebral bodies and the cranial and caudal adjacent segments. The compressed discs showed lower intradiscal pressure in comparison with the control group, which remained unloaded. In the cranial and caudal discs adjacent to the loaded discs the average intradiscal pressure was similar to the unloaded controls. The loaded discs demonstrated a significant decrease in disc space. No discs adjacent to the loaded discs changed in height. The lamellar architecture of the inner, middle, and outer annulus became more disorganized in the loaded discs. The nucleus pulposus showed increase of mucoid degeneration and increased cell death. Intervertebral discs from the control group and the adjacent discs to the compressed discs maintained their normal morphology. This study shows that mechanical loading of discs in the spine can cause rapid degeneration. Adjacent discs, however, did not change in terms of radiology, intradiscal pressure, or histology.

Animals↗
PubMed2005

Reproductive performance in anestrous dairy cows following treatment with two protocols and two doses of progesterone.

The objectives of this study were to evaluate the effect using two doses of progesterone (P4) releasing devices in two different programs on reproductive performance of anestrous dairy cows. Cows (n = 1555) not detected in estrus by 10 d before the planned start of the seasonal breeding program and in which no CL was palpable were treated with an intravaginal P4-releasing device ('Single'; approximately 1.56 g of P4) or a modified device with triple the normal P4 dose ('Triple'; approximately 4.7 g of P4). The devices were in place for either 6 d ('Short') or 8 d ('Long'), with 1mg estradiol benzoate (EB) given 24 h after device removal. The 'Long' program also included treatment with 2 mg EB at device insertion. The Long program resulted in a higher first service conception rate (RR = 1.18 (95% CI = 1.03-1.33); P = 0.02), but had no effect on the 28-d, 56-d or final pregnancy rate compared to the Short program. There were no effects of dose of P4 on any outcome. In conclusion, the Long compared to the Short program, but not the dose of P4, improved first service conception rates in anestrous cows.

Administration, Intravaginal↗
PubMed1992

Intravascular membrane oxygenation and carbon dioxide removal--a new application for permissive hypercapnia?

Pressure limited ventilation or "lung rest" may prevent further exacerbation of acute lung injury from high airway pressures. A therapeutic goal of an intracorporeal oxygenation and carbon dioxide removal device (IVOX) is reduction of airway pressures. We noted increased IVOX CO2 removal as mixed venous CO2 increased in experimental animals. However, we recognize the limited clinical utility of removing approximately 30% of venous CO2. Therefore, intentional hypoventilation to limit airway pressures (mild permissive hypercapnia) was used in 5 patients with respiratory failure, and again we noted improved CO2 removal with increasing mixed venous CO2 concentrations. Preliminary calculations demonstrate that a CO2 gradient of approximately 70 mm Hg is needed to remove 100 ml CO2/min. The use of more aggressive permissive hypercapnia protocols with IVOX may permit further reduction in airway pressure without problems of severe respiratory acidosis.

Adolescent↗
PubMed2006

The adsorptive capacity of vapor-phase mercury chloride onto powdered activated carbon derived from waste tires.

Injection of powdered activated carbon (PAC) upstream of particulate removal devices (such as electrostatic precipitator and baghouses) has been used effectively to remove hazardous air pollutants, particularly mercury-containing pollutants, emitted from combustors and incinerators. Compared with commercial PACs (CPACs), an alternative PAC derived from waste tires (WPAC) was prepared for this study. The equilibrium adsorptive capacity of mercury chloride (HgCl2) vapor onto the WPAC was further evaluated with a self-designed bench-scale adsorption column system. The adsorption temperatures investigated in the adsorption column were controlled at 25 and 150 degrees C. The superficial velocity and residence time of the flow were 0.01 m/sec and 4 sec, respectively. The adsorption column tests were run under nitrogen gas flow. Experimental results showed that WPAC with higher Brunauer-Emmett-Teller (BET) surface area could adsorb more HgCl2 at room temperature. The equilibrium adsorptive capacity of HgCl2 for WPAC measured in this study was 1.49 x 10(-1) mg HgCl2/g PAC at 25 degrees C with an initial HgCI2 concentration of 25 microg/m3. With the increase of adsorption temperature < or = 150 degrees C, the equilibrium adsorptive capacity of HgCl2 for WPAC was decreased to 1.34 x 10(-1) mg HgCl2/g PAC. Furthermore, WPAC with higher sulfur contents could adsorb even more HgCl2 because of the reactions between sulfur and Hg2+ at 150 degrees C. It was demonstrated that the mechanisms for adsorbing HgCl2 onto WPAC were physical adsorption and chemisorption at 25 and 150 degrees C, respectively. Experimental results also indicated that the apparent overall driving force model appeared to have the good correlation with correlation coefficients (r) > 0.998 for HgCl2 adsorption at 25 and 150 degrees C. Moreover, the equilibrium adsorptive capacity of HgCl2 for virgin WPAC was similar to that for CPAC at 25 degrees C, whereas it was slightly higher for sulfurized WPAC than for CPAC at 150 degrees C.

Adsorption↗