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A disadvantage of stent use after ureteroscopy is the need to remove the stent cystoscopically. We describe a modification that avoids the discomfort of a transurethral suture and allows easy cystoscopic extraction. This modification may also facilitate repositioning or removal of a migrated stent.
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A constricting band causing tourniquet syndrome is a common problem that can cause much frustration and pain for both the patient and practitioner. The following review classifies and describes the different aspects of the treatment of this condition. We also describe a policy and procedure for the motorized removal of large bands by using a high revolutions per minute cutting device.
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Surgical correction of pectus excavatum deformity with the use of a metal bar strut provides a good cosmetic result with a low complication rate. Reports of pectus bar migration are rare but we report three cases of bar migration which required thoracoscopic removal.
A prospective phase II trial was conducted to assess the feasibility, tolerance, and efficacy of a device designed for selective removal of rheumatoid factor from the plasma of rheumatoid arthritis patients. The device contained terpolymer hydrogel-coated plates with chemically attached, aggregated human immunoglobulin G, and it operated as an immunoaffinity column. Sixty-one patients aged 25 to 73 underwent weekly plasmapheresis treatments (the primary therapy phase). During the trial, patients continued current rheumatoid arthritis medications without dose adjustments. All patients received two to six treatments (primary therapy). Responding patients were eligible to continue apheresis treatment every 2 to 6 weeks (maintenance therapy). No serious, untoward side effects were noted in the course of this study; of 640 treatments, only 2 (in different patients) were aborted, one because of complaints of dizziness and angioedema and the other because of chest tightness and shortness of breath. Except for a significant (p less than 0.05) decrease in serum iron, no significant changes in complete blood count, serum electrolytes, renal and hepatic function tests, or serum C3 and C4 were noted. Although the trial was not designed to determine clinical efficacy, patients noted less morning stiffness, longer time to onset of fatigue, and improved global pain assessment (p less than 0.004); significant objective improvements were noted in joint pain, tenderness, swelling, and the number of affected joints (p less than 0.001). One-half of the treated patients had at least a 50 percent improvement in objective measures of antirheumatic activity.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND: Endoscopic extraction of intrahepatic ductal stones with conventional stone retrieval baskets sometimes is difficult when the stones are deep in the segmental ducts or in a tortuous duct. We evaluated the use of a new wire-guided basket for endoscopic bile duct stone extraction. METHODS: The new wire-guided basket has a separate lumen for the guidewire on one side of the catheter. It is rail-loaded and advanced over a guidewire into the desired segmental duct. After they are engaged, the stones are dragged into the duodenum and the guidewire is left in the segmental duct. The basket then can be reinserted into that particular ductal segment over the wire for further stone extraction. RESULTS: The basket was used to treat three patients. Two patients had multiple intrahepatic stones. Repeated passage of the basket back to the desired location was accomplished without difficulty. All stones were removed successfully. CONCLUSION: The new wire-guided basket is a useful device for removing intrahepatic stones, particularly from patients with multiple ductal stones.
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The effectiveness of solute removal of a hemodialyzer may be judged by the ability of the device to remove solutes over the clinical range of blood flow rates. The expression of solute removal characteristics of hemodialyzers at standard or specific blood flow rates is important for clinical use and comparison. The solute removal at a specific blood flow rate is derived mathematically, usually by the fitting of a curve to the blood flow solute removal characteristics established experimentally over a range of blood flow rates. The commonly used methods of obtaining such a relationship are discussed and a new method of curve fitting is described. This method is derived from the mathematical theory defining the overall dialyzer mass transport relationship which governs the clearance blood flow relationship in any dialyzer. The derived relationship between the blood flow rate and the clearance has been validated using data generated for a commercially produced hemodialyzer.
PURPOSE: To evaluate in an in vitro bench-top model the efficacy of 4 filtration devices designed for cerebral protection during carotid angioplasty. METHODS: Embolization during carotid angioplasty was simulated with human plaque material (8 to 12 particles weighing 6.02 +/- 0.10 mg) in an open flow model with the aortic arch and carotid bifurcation made from elastic silicone tubes and saline used as the fluid medium. The 500 to 1500-microm particles were injected into the internal carotid artery (ICA) in front of the test protection device, which was deployed 5 cm distal to the bifurcation. Particles getting past the protection device or flowing into the external carotid artery (ECA) were caught in 100-microm filters and weighed. Ten trials were made on each of 4 devices: Angioguard, FilterWire EX, TRAP, and NeuroShield. All were deployed according to the manufacturers' directions except the FilterWire, which was manually repositioned in all tests to eliminate a gap between the filter and the tube wall. RESULTS: The lowest weight of missed particles in the effluent was obtained with the NeuroShield (0.05 +/- 0.04 mg, 0.8% of injected particle weight) and FilterWire (0.08 +/- 0.05 mg, 1.3%; p=0.254 compared to NeuroShield, p=0.006 versus TRAP). The weight of particles missed by the TRAP device (0.16 +/- 0.06 mg, 2.6%; p<0.001 versus NeuroShield and Angioguard, p<0.05 compared to FilterWire) was higher, and the largest amount of missed particles was observed with the Angioguard filter (0.27 +/- 0.06 mg, 4.4%; p<0.001 compared to all). NeuroShield and FilterWire were significantly different (p<0.001) compared to Angioguard and TRAP in a pairwise analysis. No embolization into the ECA occurred. CONCLUSIONS: In vitro, none of the tested devices had the ability to completely prevent embolization into the ICA. Comparing current designs, the NeuroShield filter and the FilterWire EX captured the highest percentage of human particles in this in vitro model, probably due to their larger filter volume.
A 30-year-old woman was operated for ovarian teratoma and repeatedly for adhesive ileus during 1995-1999. A partial left ovarectomy, extirpation of an intrauterine device (IUD) in malposition (greater omentum) and appendectomy were performed during the first operation. Early adhesive ileus developed on the fourth postoperative day. Adhesectomy was performed in the region of the terminal jejunum. A new adhesive ileus developed after twenty seven months when patient underwent laparoscopy for gynaecological problems with conversion to laparotomy because of greater adhesions intraperitoneally another adhesectomy was performed. During the next eleven months new adhesive obstructions of the bowel developed and a third operation had to be performed incl. resection of the dolichosigmoideum on account of chronic problems during defaecation. A special tube as a intraluminal splint was inserted as prophylaxis of mechanical ileus in the postoperative period. But during next thirteen months subileous conditions and mechanical ileus developed again (up to now). The picture of intraperitoneal conditions was disastrous: almost total fibrotic changes allowed only partial adhesectomy. The passage through bowel is limited and is restricted to dietetic and medicamentous preparations. This case-report demonstrates postoperative adhesions a very old and very serious problem at the beginning of the third millennium.
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OBJECTIVE: Assessment of the prognostic value of the FDD test (fluorescein dye disappearance test) for treatment of congenital occlusion of the lacrimal pathways by means of silicone intubation and for assessment of the time of removal of the cannula. METHOD: The drainage function of the lacrimal pathways was evaluated perspectively in a group of 46 children with inborn occlusion of the lacrimal pathways, aged 1-3 years, treated by means of silicone intubation. The evaluation was made before insertion of the cannula, one week, one month after the operation, during removal of the cannula, one month and one year after its removal. The results of FDDT were compared with the clinical condition and the therapeutic results. RESULTS: In all instances (36 children) where shortly after surgery regression of the signs and symptoms of occlusion occurred and FDDT was 0-1 the long-term result (one year after removal of the cannula) of treatment was favourable. Nine of 11 cases where FDDT 2-3 and signs of occlusion persisted also when the cannula was removed after its removal marked improvement of the symptoms of occlusion occurred or they disappeared and the drainage of the lacrimal pathways was normal. If FDDT suggests during the period with the inserted cannula a satisfactory function of the lacrimal pathways, the prognosis of cure is good and the cannula can be removed already after 6-8 weeks. If during the time with the cannula the impaired drainage function of the lacrimal pathways persists, i.e. FDDT 2-3, it is better to remove the cannula not sooner than after 5-6 months. CONCLUSION: FDDT can serve as a prognostic factor in the treatment of congenital occlusion of the lacrimal pathways by means of a silicone cannula and for assessment of the time of its removal.
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PURPOSE: The aim of this report was to describe the initial 8-month healing events of 8 consecutive cases of placement of an onplant device for orthodontic anchorage and to report the results of a questionnaire evaluating subjective patient experience. METHODS: At 2 weeks and at 4 and 8 months after placement of the device, presence or absence of exposure of the device, mobility using gentle finger palpation, and signs of possible inflammation were evaluated. At 8 months, the inflammatory status of the tissue-abutment interface was determined from presence or absence of bleeding and/or suppuration on probing. Patients' experience of pain, discomfort, and acceptance of the treatment were evaluated by the use of visual analog scales. RESULTS: In 7 of the 8 patients, the device became stable and could be used for orthodontic anchorage. In 1 case, infection occurred, and the device was removed. At the 8-month time point, none of the 7 successful devices showed any plaque or any bleeding or suppuration on stimulation with a periodontal probe. Most patients reported little pain/discomfort from the various treatment procedures and indicated that they felt that opting for the onplant treatment had been the right choice. CONCLUSION: The results of this pilot study suggest that placement of the onplant can lead to uneventful healing and stability of the device. Further studies with larger numbers of subjects are necessary to substantiate these findings and to determine the usefulness of this device for orthodontic anchorage.
Many patients require the administration of therapy via intravenous lines, which increases their risk of acquiring an infection in hospital. It it vital for nurses to be aware of such risks and to minimise them by taking precautions when inserting and removing i.v. devices, as well as in removing or changing dressings. Nurses should also be able to recognise signs of infection should this occur.
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