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At least 811 records · Page 45Linked to original sources
PubMed1995

Management of infected penile implants.

Penile prosthesis implantation is associated with a relatively low wound infection rate (3%). Proper adherence to antiseptic principles has kept the incidence low. When an infection does occur, one has the option of removing the device, allowing the infection to clear and possibly returning at a later date for reimplantation, or a salvage procedure, i.e., removing all foreign material, cleansing the wound, and reinserting a new device. The experience with salvage has resulted in approximately 80-90% success in saving the erectile abilities in a number of series.

Anti-Bacterial Agents↗
PubMed1988

Rotational atherectomy in atherosclerotic rabbit iliac arteries.

PTCA is not technically possible in many patients with symptoms of coronary artery disease. In addition, atheroma is not physically removed by PTCA, and restenosis of the treated vessel is common. We have tested a new, rotating, abrasive-tipped angioplasty device in vivo in 13 atherosclerotic rabbit iliac vessels. Atherosclerosis was generated in rabbit iliac vessels by a 2% cholesterol diet combined with balloon endothelial injury for 10 weeks. The diseased vessels were then treated with the rotational atherectomy device. Before treatment, contrast angiograms demonstrated that initial percent diameter stenosis was 81% +/- 9%. After atherectomy, there was significant improvement, with residual 38% +/- 22% narrowing (p less than 0.001). One perforation resulted from distal guidewire manipulation, and one vessel was occluded by the device. Histologic examination demonstrated loss of portions of the diseased intima in all cases. Particles were produced for analysis in vitro by operating the atherectomy device in atherosclerotic rabbit aortas perfused with saline solution. Ninety-eight percent of the particles produced by the device were less than 10 micron in diameter. We conclude that this new rotational device can remove atheromatous material from diseased arteries in rabbits. Such a device may complement other angioplasty techniques and lead to wider application of catheter-based therapeutic interventions.

Animals↗
PubMed2000

Transcatheter occlusion of complex atrial septal defects.

Percutaneous device occlusion of secundum atrial septal defects (ASDs) is becoming an accepted alternative to surgical closure. This method allows us to evaluate patients with complex conditions for treatment. From a total of 70 patients with ASD evaluated for percutaneous closure, we selected for analysis 28 who had complex conditions. The mean age was 36+/-23 yr (range, 4-72). Six had heart failure, and of these six, three had atrial fibrillation. At cardiac catheterization, the pulmonary pressure was 47+/-24 mm Hg, and the QP/QS was 1.7+/-0.4; two patients had bidirectional shunt and systemic pulmonary pressure. Two patients received a buttoned device and 26 an Amplatzer septal occluder. The groups of patients with complex conditions were separated into the following groups. Group I (n = 4) underwent combined treatment of associated anomalies. Two patients had pulmonary stenosis, one had mitral stenosis, and one had an aortic root-left atrium fistula. They were treated in or during with the same procedure by combined transcatheter techniques (balloon valvuloplasty and fistula occlusion) before ASD occlusion. Group II (n = 9) had multiple defects (cribiform or two separate holes). They were treated with a single device in five instances and with two separate devices in four cases. Group III (n = 14) had large (32+/-3 mm) single defects. Nine of them underwent successful implantation using a device 33+/-3 mm in diameter; in the remaining five patients the device was removed because of instability. Group IV (n = 3) had residual defects after previous partial device occlusion. All three defects were successfully occluded with a second device. No movement or interference with the first device was observed. Group V (n = 6) had severe pulmonary hypertension (86+/-16 mm Hg). Immediately after ASD occlusion we observed significant relief in these patients (67+/-14 mm Hg; P<0.01). There were no major complications; all 23 patients with successful implants were discharged without symptoms 2-7 days later; one patient with atrial fibrillation recovered sinus rhythm. The follow-up (8+/-5 mo) Doppler echo study showed complete ASD occlusion in 22 patients and a peak pulmonary pressure of 30+/-14 mm Hg. We conclude that transcatheter occlusion of ASDs is an effective and safe treatment for patients with complex anatomic or physiopathologic conditions, as evaluated by short-term follow-up.

Adolescent↗
PubMed1999

[Interventional catheter occlusion of the atrial septal defect of the secundum type--experiences with "CardioSeal" and "Angel Wings"].

Between July 1996 and July 1998, 34 patients (female n = 16, male n = 18) were scheduled for catheter--interventional occlusion (ASDO) of an atrium septum defect of secundum type (ASD II). Median age was 7.9 years (2.5-54.6), weight 23.1 kg (9-97). 9 defects were closed with "Angel Wings" (AW) and 25 ASD occlusions were attempted with "CardioSeal" (CS). 30 patients had simple ASD II, 3 persisting foramen ovale with suspected paradoxal cerebral embolization and 1 significant residual shunt at atrial level after corrective heart surgery for interrupted aortic arch type B. ASDO was successful in 31/34 cases (91%). One CS was removed surgically due to significant left to right shunt after release and two CS devices were withdrawn back into the sheath. Median ASD diameter was 11.9 mm (6-16), balloon occlusive diameter was 15 mm (6-20) and median left to right shunt was 40% (6-64%). On follow up minimal left to right shunt was seen in 5/31 patients (16%). In selected patients catheter--interventional ASDO may be a good alternative to surgical ASD closure.

Adolescent↗
PubMed2004

Ovarian pregnancy with intrauterine device in situ.

INTRODUCTION: Since some reports have already suggested a higher rate of ovarian pregnancies in women using intrauterine device and some have not, an additional case report may be of interest for the literature purposes. CASE REPORT: In this case report we present an ovarian pregnancy in a patient with an intrauterine device in situ.

Adult↗
PubMed2005

Successful bridge to resynchronization therapy with a left ventricular assist system in a patient with idiopathic dilated cardiomyopathy.

Implantation of a left ventricular assist system (LVAS) in patients with idiopathic dilated cardiomyopathy (DCM) may improve cardiac function and allow explantation of the device. Generally, an ejection fraction of more than 40% is considered necessary for successful weaning from an LVAS, but less than 10% of DCM patients with an LVAS can achieve such a significant recovery of cardiac function. Cardiac resynchronization therapy, or atrial-synchronized biventricular pacing, has been found to treat congestive heart failure and ventricular dyssynchrony effectively. Here we report on a patient with an LVAS, in whom enough functional recovery could be obtained with resynchronization therapy for the device to be explanted successfully. A 32-year-old man was implanted with a Toyobo-NCVC paracorporeal LVAS to treat his intractable heart failure caused by idiopathic dilated cardiomyopathy. While on the LVAS for 8 months, his cardiac function recovered to some extent. The ejection fraction of his left ventricle (LVEF) improved from 9% to 41%. He chose explantation of the device rather than heart transplantation. Because he occasionally showed a wide QRS pattern on his ECG, epicardial biventricular pacing leads as well as a biventricular pacemaker were implanted on LVAS explantation surgery. An echocardiogram 2 weeks after explantation showed a marked difference in his LVEF by switching his biventricular pacing on and off (40% with biventricular pacing on and 29% with it off). Biventricular pacing may help recovery of cardiac function in selected LVAS patients and contribute to the increase in bridge to recovery cases.

Adult↗
PubMed2004

Diaphragmatic hernias associated with ventricular assist devices and heart transplantation.

BACKGROUND: Diaphragmatic hernias in heart transplant recipients with prior left ventricular assist device (LVAD) placement are a potentially life-threatening complication. This review examined the incidence, diagnostic strategies, surgical management, and prevention of diaphragmatic hernias in these patients. METHODS: A retrospective review of patients receiving a Thoratec HeartMate (Thoratec Laboratories Corp, Pleasanton, CA) LVAD who developed a diaphragmatic hernia after VAD explantation and orthotopic heart transplantation (OHT). Two groups were identified and their results compared. In the early group, the diaphragmatic defect was not closed at the time of OHT and VAD explantation, while in the late group the defect was closed. RESULTS: In the early group, between September 1995 and November 1999, a total of 61 HeartMate LVADs were placed intraperitoneally as a bridge to transplantation, and 44 of those patients went on to OHT. Of these patients, 7 of 44 (15.9%) developed a diaphragmatic hernia after transplantation. Five of the patients underwent successful surgery by laparotomy without recurrence. Two patients with asymptomatic diaphragmatic hernia await repair. After a modification in diaphragmatic closure after VAD explantation at the time of OHT, in the late group between November 1999 and July 2002, 29 HeartMate LVADs were placed and 23 patients went on to OHT. There has been one diaphragmatic hernia (1 of 23, 4.3%) in this group. CONCLUSIONS: Diaphragmatic hernia following VAD placement and heart transplantation requires an aggressive diagnostic and therapeutic approach in this immunosuppressed patient population. We recommend primary closure of all diaphragmatic defects at the time of OHT and VAD explantation to reduce the incidence of this complication.

Adolescent↗
PubMed2003

Assessment of myocardial recovery in a patient with acute myocarditis supported with a left ventricular assist device: a case report.

Acute myocarditis may present with profound hemodynamic compromise; however, spontaneous resolution of the inflammatory process may occur in up to half of such patients. In patients with fulminant myocarditis, mechanical circulatory support may serve as a bridge to myocardial recovery. In this report we describe a 35-year-old man with acute myocarditis who required left ventricular assist device support as a bridge to recovery, and suggest a method for determining the suitability and timing of device explantation. A combination of echocardiography, right heart catheterization, exercise testing and serial endomyocardial biopsies was used to determine the resolution of myocarditis, recovery of myocardial function and timing for device explantation. Successful device explantation was performed after 37 days of device support. Further study is required to assess the role of ventricular assist devices in combination with immunosuppressive therapy in the management of fulminant myocarditis.

Acute Disease↗
PubMed2004

FFPRHC Guidance (January 2004). The copper intrauterine device as long-term contraception.

This Guidance provides information for clinicians providing women with copper-bearing intrauterine devices as long-term contraception. A key to the grades of recommendations, based on levels of evidence, is given at the end of this document. Details of the methods used by the Clinical Effectiveness Unit (CEU) in developing this Guidance and evidence tables summarising the research basis of the recommendations are available on the Faculty website (www.ffprhc.org.uk). Abbreviations (in alphabetical order) used include: acquired immune deficiency syndrome (AIDS); actinomyces-like organisms (ALOs); automated external defibrillator (AED); blood pressure (BP); British National Formulary (BNF); confidence interval (CI); copper-bearing intrauterine contraceptive device (IUD); emergency contraception (EC); Faculty Aid to Continuing Professional Development Topic (FACT); levonorgestrel-releasing intrauterine system (IUS); human immunodeficiency virus (HIV); Medicines and Healthcare products Regulatory Agency (MHRA); non-steroidal antiinflammatory drugs (NSAIDs); odds ratio (OR); pelvic inflammatory disease (PID); relative risk (RR); Royal College of Obstetricians and Gynaecologists (RCOG); Scottish Intercollegiate Guidelines Network (SIGN); sexually transmitted infection (STI); termination of pregnancy (TOP); World Health Organization (WHO); WHO Medical Eligibility Criteria (WHOMEC); WHO Selected Practice Recommendations (WHOSPR).

Consumer Product Safety↗
PubMed1998

[Insertion and management of long-term central venous devices: role of radiologic imaging techniques].

INTRODUCTION: Anticancer chemotherapy causes irreversible damage to the endothelial wall of small vessels. This is the reason why long-term (more than 3 months) central venous devices are essential to administer chemotherapy drugs to cancer patients and antibiotics for chronic or severe infections and in patients requiring long-term parenteral nutrition. We report our experience with the percutaneous implantation of central venous devices in a radiology department. MATERIAL AND METHODS: March, 1993, to August, 1997, eighty-seven consecutive patients (26 men and 61 women, mean age: 55 years) were examined. The indications for central venous catheter placement included anticancer chemotherapy in 82 cancer patients, repeated blood transfusion in one patient with bone marrow aplasia and nutritional support in four cancer patients. Eighty-four central venous devices (75 totally subcutaneous systems--Port-a-cath Dome--, and 9 partially tunneled catheters--Groshong) were inserted. The average follow-up was 6.5 months (range: 1-18). All procedures were performed in the radiology department and venous access was achieved with fluoroscopy using the Seldinger technique. Chest radiography with the patient standing was routinely performed after the procedure and repeated the day after to assess the catheter position and the presence of pneumothorax. The venous catheters were placed in the subclavian vein in 68 cases (12 in the right side and 56 in the left side), internal jugular vein in 12 cases (9 in the right side and 3 in the left side) and right femoral vein in 4 cases. We prefer the subclavian vein (80.9%) for better cosmetic results, wider catheter angulation and easier fixation to the deep plane. RESULTS: The first access failed in 6 cases (6.8%). A pneumothorax occurred in 4 patients (4.7%) and late complications were seen in 15 patients (17.8%) after a mean of 15.7 weeks (range: 2-48). Catheter-related infections developed in 6 patients (7.1%) after a mean of 20 weeks (range: 5-48). The microorganisms cultured from these catheters was the Staphylococcus epidermidis. After two weeks' specific antibiotic therapy, all the devices were removed. Deep venous thrombosis occurred only in one patient after 10 months and was successfully treated with direct thrombolytic infusion. The catheter was displaced in the right atrium in two patients after 11 and 12 weeks, respectively: both catheters were removed by transfemoral catheterization. CONCLUSIONS: The percutaneous implantation of--long-term central venous devices is a safe and tolerable procedure. In our experience, the radiology-assisted placement of these devices offers many advantages over surgical implantation. In particular, fluoroscopy allows direct visualization of the catheter position while insertion and positioning are essentially "blind" at surgery, which complicates venous access and increases the risk of catheter malpositioning. Radiologic follow-up is also useful to depict and correct complications.

Adult↗
PubMed1993

Laparoscopic ablation of endometriosis using the cavitational ultrasonic surgical aspirator.

Surgical modalities such as electrosurgery and lasers have been used for many years to treat endometriosis. They are relatively unselective with wide scatter, however, leading to the potential for significant tissue damage and injury. As an alternative, a technique for performing laparoscopic excision and adhesiolysis using a cavitational ultrasonic surgical aspirator (CUSA) was developed and studied in 15 patients. Endometriosis was removed using a prototype titanium probe developed for a 10-mm laparoscopic port. The ultrasonic laparoscopic probe consisted of an acoustic vibrator, a coupling device, a removable tip, and a protective flue. Vibrations from the acoustic vibrator (magnetostrictive device) were conveyed to the operating tip through a coupling piece. The magnetostrictive device consisted of nickel alloy laminations 10.8 cm in length that transformed electrical energy into mechanical motion at the hollow titanium tip, vibrating at a frequency of 23 kHz. The excursion of the tip (amplitude setting) was arbitrarily set, with a fixed stroke of 200 microm in all cases to remove tissue with a 1- to 2-mm radius of the vibrating tip. The tip was tapered to obtain greater amplitude and ablation efficiency. When placed in contact with the endometriotic implants and adhesions, it destroyed and emulsified the cell membranes, which were irrigated and removed through a built-in suction tube. The resulting debris and irrigating fluid were removed through the hollow central portion of the probe. The vibrating tip was moved over the surgical site in a back-and-forth motion to allow continuous, controlled removal. Vessels larger than 0.5 mm in diameter, nerves, and fibrous tissue capsules rebounded with the ultrasonic vibration waves emitted by the CUSA, and thus were unimpaired by the procedure. The consistency of tissues was sensed accurately when the tip of the device was in contact with them. This tactile feedback was helpful in enabling the surgeon to differentiate target tissues. The future application of this instrument awaits the outcome of research.

Adult↗