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Results for “Device Removal”

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PubMed1995

Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure.

We reviewed pre-closure echocardiograms on all patients undergoing transcatheter atrial septal defect (ASD) closure with the Bard double-umbrella occluder device aided by simultaneous transesophageal echocardiography to determine precatheterization predictors of outcome. Transesophageal echocardiograms were performed on 28 of 132 patients (22%) undergoing device closure (age = 3-72 years, mean = 14 years; weight = 15-68 kg, mean = 35 kg). Three devices were removed because of unstable position. Of the remaining 25 patients, 21 had effective closure (residual flow diameter < or = 3 mm) and 18 had favorable arm position (device arm on proper side of the septum and not in contact with an atrioventricular valve leaflet). Only ASD size predicted effective closure. All patients with a maximum defect size of < 13 mm had effective closure. Among the 17 patients with defects > or = 13 mm, 10 had effective closure, 4 had significant residual flow, and 3 had devices removed for unstable position. Atrial dimensions and rim size did not predict effective closure. There were no pre-closure predictors of favorable arm position which was associated only with the size of the device implanted.

Adolescent↗

PubMed1980

The use of a modified copper intrauterine device in nulliparous women with small uterine axial length.

In a preliminary study a highly selected group of 31 nulliparous patients with uterine axial length less than 6 cm underwent 32 insertions of a modified Gravigard device with reduced vertical and horizontal arms. After at least six months of use 26 patients (81%) continued to use this method of contraception. The six patients who discontinued are accounted for as follows: one became pregnant, two expelled the device, two requested removal of their devices because of pain and bleeding, and one device was removed accidentally. There was one further pregnancy at nine months of use. It is concluded that provided that the dimensions of the Gravigard are reduced, it is an acceptable method of contraception in nulliparae with small uterine axial length.

Adolescent↗

PubMed2006

Retrieval of Gunther Tulip optional vena cava filters 30 days after implantation: a prospective clinical study.

PURPOSE: To report on the feasibility and safety of retrieval of the Günther Tulip optional vena cava filter 30 days after initial implantation. MATERIALS AND METHODS: From March 2004 to September 2005, a single-center prospective study was undertaken in 35 patients who required inferior vena cava (IVC) filtration. All the Günther Tulip filters (GTFs) were implanted with the intention to be removed 30 days after initial implantation. A modified commercial dynamometer was used to measure the force required to remove the device. The degree of difficulty to remove the GTF was classified into four levels: N (no difficulty, force of 0-4.41 N), M (medium difficulty, force of 4.41-5.88 N), G (great difficulty, force of 5.88-9.8 N), and U (unable to remove). Clinical follow-up was performed 1, 3, 6, and 12 months after filter retrieval by review of medical records and imaging. RESULTS: Two of the 35 patients experienced extensive thrombosis in the IVC as revealed by abdominal computed tomography, and their filters were left in place on a permanent basis. One patient died of respiratory and cardiac failure during follow-up within the first 30 days after GTF insertion. Filter retrieval was attempted in the remaining 32 patients, and 31 of these attempts were successful (98%). The force necessary to disengage the GTF from the caval wall was less than 9.8 N (N, 79%; M, 13%; G, 6%). Attempts to remove the GTF failed in only one patient (2%). On follow-up times ranging between 14 and 640 days (mean, 342.5 d), no complications or cases of recurrent pulmonary embolism were observed in this patient population. CONCLUSION: The Günther Tulip optional IVC filter can be safely placed and retrieved percutaneously 30 days after initial implantation.

Adult↗

PubMed1987

Effects of progesterone intravaginal devices on synchronization of estrus in postpartum dairy cows.

Effects of two intravaginal treatments of progesterone on the synchronization of behavioral estrus were compared in three groups of lactating dairy cows at 7 to 8 wk postpartum. Group 1 had progesterone-releasing intravaginal devices with attached estradiol benzoate capsules inserted for 12 d. Groups 2 and 3 had controlled internal drug release devices, containing progesterone alone, inserted for 9 or 12 d. Behavioral estrus was detected as early as 24, 32, and 36 h after removal of the devices in groups 1, 2, and 3, respectively. Estrus was better synchronized and the proportion of cows showing estrus after device removal was greater in group 1 than in groups 2 and 3. After removal of devices, mean milk progesterone of all cows that did not show estrus was higher than that of cows that showed estrus. In groups 1, 2, and 3, 1 of 7, 7 of 12, and 4 of 12 cows not showing estrus had high milk progesterone after removal of the devices, indicating the presence of functional corpora lutea. In cows not displaying estrus milk progesterone concentrations decreased, indicating these cows were cyclic, although behavioral estrus was absent.

Administration, Intravaginal↗

PubMed1999

[Intravascular hemolysis following percutaneous occlusion of the ductus arteriosus].

Transcatheter occlusion of patent ductus arteriosus has become a safe and successful technique, but it's not free of complications. We present the case of a two-year-old boy who underwent routine transcatheter closure of his patent ductus arteriosus, using a "coil" device. Twenty hours later he developed severe persistent hemolysis in association with residual ductal flow. Patient's clinical situation became stable when the device was removed. Pulmonary embolization of the device and hemolysis are the main complications of percutaneous closure of the patent ductus arteriosus. Hemolysis occurs rarely (0.5%) and is always associated with the presence of residual ductal flow. Several approaches to this problem have been described. Mild cases may require no intervention; however, when severe hemolysis is present, removal of the device may be needed, proceeding with surgical repair of the patent ductus arteriosus.

Catheter Ablation↗

PubMed2002

Posterior capsule folds and removal of ophthalmic viscosurgical devices.

PURPOSE: To evaluate the relationship between posterior capsule folds and an ophthalmic viscosurgical device (OVD) during cataract surgery. SETTING: Parkland Memorial Hospital, Dallas, Texas, USA. METHODS: A prospective observational study of 91 consecutive uneventful cataract extractions by phacoemulsification was performed. The presence or absence of posterior capsule folds was noted immediately after intraocular lens (IOL) implantation and after OVD removal. RESULTS: Posterior capsule folds were present in 21 of 49 cases (43%) with an MA60BM lens (Alcon Laboratories) and in 1 of 42 cases (2%) with an SA30AL lens. In the MA60BM group with folds, the folds were noted before OVD removal in 14 cases and after OVD removal in 16 cases. There was no significant difference in age, sex, axial length, horizontal corneal diameter, or IOL power between groups with and without posterior capsule folds. CONCLUSIONS: The presence of posterior capsule folds does not reliably signify the complete removal of OVDs.

Aged↗

PubMed1988

A comparative study of the ease of removal of intrauterine contraceptive devices.

This study compares the rates of easy and difficult removals of various types of IUDs. Eight-hundred-sixteen IUDs were removed in Auckland Family Planning Clinics in an 8-month period. Nearly 80% were the standard Multiload Copper 250. Eight-eight percent of all IUDs were easy to remove with another 7% requiring a hard pull. Of the remaining 5%, 3.5% required simple intracervical exploration, 1% required intrauterine exploration and 0.5% were referred to hospital. When compared with the standard Multiload, no IUD was statistically easier and only the Mini-Copper 7 was harder to remove at the 5% level of significance.

Family Planning Services↗

PubMed1996

A new procedure for removal of a "lost" intrauterine device.

OBJECTIVE: To evaluate the efficacy of removal of a "lost" intrauterine device (IUD) with the use of a cylindrical brush. METHODS: Women aged 25-43 years with so-called "lost" IUD, in whom the string was indiscernible, were enrolled in the study. During gynecologic examination, a cylindrical brush was rotated in the cervical canal until the device was extracted by a rotating motion. No antibiotics were used after removal of the IUD with the cylindrical brush. RESULTS: Twenty-seven women whose IUD could not be removed from the uterine cavity because of an indiscernible string were referred for a trial of IUD removal. All patients had used a plastic, copper-releasing IUD. Before admission, they had undergone an attempt at IUD removal by their physician using either a hook or clamp. In 24 patients who were referred to our center, the IUD was removed by using a cylindrical brush to view the string. The IUD was removed by hysteroscopy in three cases, in two of which no string was found. CONCLUSION: A cylindrical brush can be used safely as an adjunct to remove an IUD and is a simple method that may be performed before another invasive procedure is attempted.

Adult↗

PubMed1989

Laparoscopic removal of translocated intrauterine contraceptive devices.

Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper 'T' 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.

Adult↗

PubMed1982

Intrauterine contraceptive devices in diabetic women.

11 of 30 (36.6%) insulin-dependent diabetic women fitted with intrauterine contraceptive devices (IUCDs) became pregnant within 1 year, whereas the pregnancy rate for non-diabetic women fitted with the same types of IUCD by the same consultant gynaecologists over a similar time period was 4 per 100 women years (4%). As soon as the high risk was recognised, devices were removed (2 from diabetic women who were pregnant and 19 from non-pregnant diabetic women), and patients were advised about other methods of contraception. The IUCDs were examined in a scanning electron microscope with X-ray microprobe analysis to measure the amount of copper eroded from the wire, the extent of the encrustation (if any) deposited on the wire, and the composition of the deposit, and the data were compared with those for 111 devices removed from non-diabetic women, 40% of the IUCDs from diabetic women had sulphur and chloride in the deposit, compared with 15.3% of IUCDs from normal women, and fewer IUCDs from diabetic women had calcareous deposits. In devices from normal women, erosion and deposition seemed to occur independently, but in IUCDs from diabetic women, there was high erosion, there were also large deposits, and where there was little deposit, the erosion was slight. 7 of 14 IUCDs taken from normal women who had become pregnant with an IUCD in situ had a high sulphur plus chloride deposit; none of these IUCDs had a predominantly calcareous deposit compared with 19.8% of the IUCDs from non-pregnant normal women. The evidence militates against the insertion of IUCDs in diabetic patients and indicated that, even in non-diabetic women, there may be small groups for whom the risk of becoming pregnant is very high.

Adult↗

PubMed2002

Removal of knotted intravascular devices. Case report and review of the literature.

OBJECTIVE: to review published reports on knotted intravascular devices/catheters. METHOD: report of two cases and systematic review of the literature. RESULTS: a total of 113 reported cases of knotted intravascular devices/catheters were located. Pulmonary artery catheters (Swan-Ganz) were responsible for more than two thirds of the total reported intravascular knots. In 62% (70/113) of the cases withdrawal of the knotted catheters was achieved successfully with different interventional radiological techniques, avoiding the need for surgical exploration. In 32% (36/113) of the patients surgical removal was favoured. Capture with one of the interventional techniques and pulling down the knot into an easily accessible vein to be removed through an open venotomy, was the most common surgical procedure. However, in five cases, an open cardiotomy was required. In seven cases the patient's condition was critical and precluded any surgical procedure, so the knotted catheter was left in situ. The mortality of this event was 8% (9/113). CONCLUSIONS: interventional radiological techniques have largely replaced open surgical removal. Knotted catheters may need to be surgically removed when (a) the knot is large in size with many loops, or (b) intracardiac fixing of the knot is encountered.

Aged↗

PubMed1993

The peri-operative management of surgical insertion and removal of the intravenous oxygenator device (IVOX). A report of nine cases.

Intravenous oxygenation (IVOX) is a new technique for augmentation of gas exchange in patients who require near maximal conventional ventilatory support. Patients who require IVOX are, by definition, critically ill with a high expected mortality. At present, these high risk patients must be transferred to the operating theatre for the IVOX device to be inserted. This report describes the anaesthetic problems associated with nine patients in whom an IVOX device was inserted and removed in our institution. The mortality was six out of nine patients; all deaths occurred with the IVOX device in situ. Three patients died within 6 h of insertion. Four patients were female. The patients' ages ranged from 14 to 76 years. There were few immediate ventilation changes in the first 4 h after IVOX insertion. Inspired oxygenation concentration was reduced in only one patient. Positive end-expiratory pressure was not reduced. Peak inspiratory pressure decreased in four patients. Arterial oxygen tension increased in four patients (range 0.1-2.5 kPa) and decreased in five (range 0.1-3.4 kPa). Arterial carbon dioxide tension increased in one patient (0.3 kPa) and decreased in eight (range 0.1-2.7 kPa). Inotropic support with adrenaline, dobutamine and noradrenaline needed to be initiated or increased in eight patients. Eight patients required 2-4 units of blood to be transfused during IVOX insertion or in the following 2 h. One patient suffered an asystolic cardiac arrest during the operation, but was resuscitated successfully. Three patients survived to have the IVOX removed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1997

Medical devices; reports of corrections and removals--FDA. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to establish procedures for implementing the reports of corrections and removals provisions of the Safe Medical Devices Act of 1990 (the SMDA) by requiring that manufacturers, importers, and distributors report promptly to FDA any corrections or removals of a device undertaken to reduce a risk to health posed by the device or to remedy a violation of the Federal Food, Drug, and Cosmetic Act (the act) caused by the device which may present a risk to health. FDA believes that this action is necessary to protect the public health by ensuring that the agency has current and complete information regarding those actions taken to reduce risks to health caused by the devices. Reports of such actions will improve the agency's ability to evaluate device-related problems and to take prompt action against potentially dangerous devices.

Communication↗

PubMed2002

Removal of intra-abdominal intrauterine device by laparoscopy.

OBJECTIVE: In this study, we aimed to evaluate the cases in which intra-abdominal intrauterine devices (IUDs) were removed by laparoscopy. METHODS: A retrospective study, from 1994 to 2000 was carried out with eight patients who underwent laparoscopy for the removal of an IUD. The patients admitted to our clinic with 'lost IUD' were examined by pelvic ultrasonography, X-ray and hysteroscopy. IUDs were found to be extrauterine but within the abdominal cavity. The IUDs were removed by operative laparoscopy. RESULTS: The mean age of the patients was 31.5 years. The mean duration of usage of IUD was 5.5 years. The IUD was located in the cavity of Douglas in four cases, in the posterior wall of the uterus (perimetrium) in one case and in the conglomerated mass bordered by the intestines in three cases. The types of the IUDs were Cu-T 380A (n = 5), Multiload (n = 1) and Lippes-Loop (n = 2). The mean laparoscopic operation time was 25 min. No major complications (intestinal or vessel injuries) or minor problems occurred. Laparotomy was not necessary in any of the eight cases. All cases were treated as out-patients and discharged on the same day. After counselling, three women requested sterilization, which was performed at the same laparoscopy session by the administration of bilateral Yoon rings, and other family planning methods were chosen by five women. There were no problems when cases were followed at the 10th and 30th postoperative days. DISCUSSION: Our results support the idea that, in cases of extrauterine but intra-abdominal IUD, laparoscopic removal of the IUD must be the first choice of therapy.

Adult↗

PubMed2004

Development of protamine hollow-fiber device for extracorporeal heparin removal.

Protamine was covalently coupled to a cellulose hollow fiber (cuprophan membrane) through epichlorohydrin-activated hydroxyl groups on the hollow fiber. An immobilization efficiency of as much as 15 mg protamine/g fiber could be achieved under optimal reacting conditions. Compared to a protamine hollow-fiber device produced using cyanogen bromide as an activator, the protamine hollow-fiber device using epichlorohydrin as an activator shows very high resistance to hydrolysis. Both in vitro and in vivo experiments showed that such a protamine hollow-fiber device had high heparin-removal capacity and efficiency, suggesting that this device may be suitable for various clinical applications in extracorporeal heparin removal.

Adsorption↗

PubMed2003

Histological findings of the femoral bone after cement removal in hip revision. An experimental study of cadaver femurs with two different cement removal procedures.

Cement removal in hip revision arthroplasty is often a time-consuming procedure, lengthy and tedious. Intraoperative bone damage is one of the more common complications. In the present study, the conventional cement removal method is compared with a new method by means of a histological study concerning potential negative effects to cortical or spongious bone. Histological studies on human cadaver femurs demonstrate no deleterious effects on the endosteal bone when cement was removed with this new device. The ballistically driven chiselling system (OrthoClast) is safe to the bone stock and shows no increased risk of bone damage over the conventional technique with mallet and chisel.

Arthroplasty, Replacement, Hip↗

PubMed2006

Post-surgical enterococcal meningitis: clinical and epidemiological study of 20 cases.

Enterococcal post-surgical meningitis is an uncommon disease. 20 episodes of nosocomial post-surgical enterococcal meningitis diagnosed between 1994 and 2003 were retrospectively studied. During the period of study 20 cases of post-surgical enterococcal meningitis (60% female, mean age 55+/-18 y, range 16-78 y) were reviewed. The mean time between admission at the hospital and surgery was 26 (SD = 15) d (range 7-61 d). The most frequent underlying diseases were: intracerebral haemorrhage (55%), brain neoplasms (25%), head trauma (15%) and hydrocephalus (5%). 11 patients had previously received antibiotic treatment. The isolates identified were Enterococcus faecalis (n = 18) (90%), E. faecium (1) and E. durans (1). 11 patients had polymicrobial infections. The treatment most frequently used was vancomycin alone or with other antibiotics (11). In 5 patients intrathecal vancomycin (20 mg/d) was also added. The mortality rate was not different in intrathecally treated patients. Cerebrospinal fluid (CSF) devices were removed in 8 patients. Four patients died due to the infection. Mortality was significantly associated with lack of removal of the CSF devices (p = 0.04). Enterococcal spp. are a cause of nosocomial meningitis associated with neurosurgical procedures and the presence of neurological devices.

Adolescent↗

PubMed2001

Spinal cord stimulation--a long-term evaluation in patients with chronic pain.

Spinal cord stimulation (SCS) is an established treatment modality for chronic pain, angina pectoris, and peripheral vascular disease. This study evaluates experience with SCS over a 13-year period with emphasis on surgical complications, revisions and pain relief. It took the form of a retrospective study of medical/surgical records coupled with a postal/telephone questionnaire. The subjects consisted of seventy patients, aged from 21 to 76 years (mean 47; median 46), with severe, chronic pain refractory to conventional treatment, who underwent SCS implantation between 1984 and 1997. It investigated surgical revisions, complications and pain relief. There were 72 surgical revisions comprising electrode replacement/repositioning (32), generator replacement (22), cable failure (6) and implant removal (12). Half the devices were revised within 3 years (95% confidence interval: 2-5 years) of implantation. Six (8.6%) implants became infected. Sixty per cent of patients reported substantial relief of pain. This study shows that the majority of patients undergoing SCS derive significant benefit in terms of pain relief, but commonly require surgical revisions due to both technical and biological factors. These devices require systematic evaluation to determine optimal usage, clinical effectiveness and cost-benefit analysis.

Adult↗