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PubMed2003

Infections of intracardiac devices.

Intracardiac devices are increasingly used to correct hemodynamically dysfunctional valves and electrophysiologic abnormalities. These devices become infected at relatively low rates. Nevertheless, when these low rates are applied to widely used devices, significant numbers of infections result. Additionally, these infections have been associated with high degrees of morbidity and high mortality rates. This article reviews the epidemiology, microbiology, clinical presentation, and medical as well as surgical therapy of intracardiac device infections.

Defibrillators, Implantable↗
PubMed2001

Long-term follow-up of Intacs from a single center.

PURPOSE: To evaluate the long-term visual results in patients having Intacs placement for the correction of mild myopia. SETTING: Department of Ophthalmology, Mount Sinai School of Medicine and the Mount Sinai Hospital of Mount Sinai NYU Health, New York, New York, USA. METHODS: Patients with mild myopia (spherical equivalent between -0.75 and -4.50 diopters [D]) were enrolled to have Intacs placement between May 1995 and March 1999 under United States Food and Drug Administration Phase II and Phase III clinical trials for intrastromal corneal ring segments (ICRS). Six insert thicknesses were evaluated: 0.21, 0.25, 0.30, 0.35, 0.40, and 0.45 mm. The long-term results evaluated were uncorrected visual acuity (UCVA), maintenance of best spectacle-corrected visual acuity (BSCVA), predictability and stability of the refractive effect, induced manifest refraction cylinder, slitlamp findings, self-reported visual symptoms, and maintenance of mesopic contrast sensitivity. RESULTS: One hundred fourteen eyes of 73 patients were enrolled; 113 eyes of 72 patients received Intacs. There were no serious intraoperative or postoperative complications. The mean follow-up was 17.5 months +/- 8.9 (SD). At the end of this period (number of eyes evaluated = 100), the UCVA was 20/40 or better in 95 eyes (95.0%), 20/20 or better in 72 (72%), and 20/16 or better in 41 (41%). None of the 113 eyes lost 10 or more letters or 2 or more lines of preoperative BSCVA. The mean change in the cycloplegic refraction spherical equivalent for the 6 insert thicknesses was as follows: -0.75 +/- 0.00 D for 0.21 mm; -1.17 +/- 0.42 D for 0.25 mm; -2.00 +/- 0.54 D for 0.30 mm; -2.59 +/- 0.53 D for 0.35 mm; -3.09 +/- 0.54 D for 0.40 mm; and -3.82+/-0.80 D for 0.45 mm. The refractive correction was within +/-1.0 D of the predicted outcome in 103 eyes (92.0%) and within +/-0.5 D in 72 eyes (63.7%). Intacs were removed from 6 eyes (5.3%). All 4 eyes for which data were available 3 months after removal returned to within +/-0.5 D of their preoperative manifest refraction spherical equivalent. Intacs were exchanged because of undercorrection in 2 eyes (1.8%). These eyes gained 3 and 5 lines of UCVA 12 months and 18 months, respectively, after the exchange procedure. Overall, 85.7% (36/42) of the patients were satisfied with the results of the Intacs procedure. CONCLUSION: Intacs safely and effectively corrected mild myopia. Placement is a brief, easy outpatient procedure. The refractive effect was predictable and stable over long-term follow-up. Results from a limited number of removal and exchange procedures indicate that Intacs are removable and adjustable.

Adult↗
PubMed2003

LVAD bloodstream infections: therapeutic rationale for transplantation after LVAD infection.

INTRODUCTION: Patients who have ventricular assist devices (VADs) and experience bloodstream infection (BSI) have high mortality. We addressed 2 questions raised by the United Network for Organ Sharing (UNOS) priority policy for this problem: 1) Are organs wasted on this ultra-high-risk group? 2) Can device-related BSI be differentiated from transient BSI? METHODS: Patients with VADs who underwent heart transplantation from 1987 to 2001, who had BSI during VAD support, and who had positive cultures at VAD explant (device-related BSI, n = 10) were compared with those with negative cultures at explant (non-device-related BSI, n = 11). RESULTS: Patients with device-related BSI had an 80% (8/10) rate of persistent bacteremia; 30 days and 1 year after transplantation, mortality was 14% and 26%, respectively. Non-device-related BSI (n = 11) persisted in 18% (2/11); peri-operative and 1-year mortalities were 9% and 13%. Duration of VAD support predicted infection (132 vs 48 days, p < 0.001); hypo-albuminemia (2.9 +/- 0.5 mg/dl vs 3.3 +/- 0.8 mg/dl, p < 0.05), and a resistant organism predicted a device-related BSI. These patients had increased intubation requirements and had increased creatinine concentration during the first post-operative week, with no difference in liver function, blood loss, transfusions (packed red blood cells, fresh frozen plasma, or platelets), or hemodynamic stability vs patients with non-device BSI. Despite decreased immunosuppression, we found no difference in acute rejection events with device-related BSI. Re-infection with the pre-operative organism occurred in only 1 patient per group. CONCLUSIONS: These data suggest that urgent (Status 1A) cardiac transplantation is effective in stable patients with device-related BSI, and these data support the current UNOS policy. However, an extra-device source of BSI should be excluded by considering the isolated organism, the baseline nutritional status, and other risk factors.

Bacteremia↗
PubMed2002

Holmium: YAG laser rescue for a stuck stone basket.

A 35-year-old man with left lower ureteric stone underwent ureteroscopic stone removal. Holmium: YAG laser lithotripsy was used to break the stone and to remove a larger fragment a 3 Fr. steel wire stone basket was introduced through the ureteroscope. However, during removal the basket with the stone became impacted in the intramural part of the ureter. All attempts to dislodge the stone and the basket failed. Laser fiber was introduced through the second channel of the ureteroscope bridge and the laser activated at settings of 0.5J and 10Hz. Pulverization of the stone did not free the basket and hence 2 wires of the stuck basket were cut with the laser. This enabled the basket to be freed and easily removed.

Adult↗
PubMed2000

Efficacy of removal of buckle after scleral buckling surgery for retinopathy of prematurity.

UNLABELLED: BACKGROUND OR PURPOSE: A series of encouraging reports over the past decade indicate that scleral buckling (SB) surgery may lessen or eliminate vitreoretinal traction in advanced retinopathy of prematurity (ROP). The effects of SB surgery on refraction and ocular growth, however, have not been demonstrated. We investigated the effects of postoperative removal of buckle in infants whose retinas were reattached in stage 4 ROP. METHODS: Selected for study were 6 eyes of 3 patients whose retinas had been reattached by placing an encircling buckle, 2.5 mm in width, around the eye and whose buckles were subsequently removed. Axial lengths and refractive errors were compared before and after removal of the buckles. The patients were examined for at least 3 years after removal. RESULTS: There was high myopia in all eyes treated for stage 4 ROP with SB. All retinas remained attached after removal of the buckle. Although there was a variable degree of increase in axial length, myopic refractive error tended to decrease after removal of the buckle. CONCLUSIONS: There was some decrease in degree of myopia without resulting in retinal detachment or continued vitreous traction after buckle removal following SB surgery for ROP.

Device Removal↗
PubMed2006

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan.

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

Adolescent↗
PubMed2006

Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal.

BACKGROUND: Cosmetic results after skin surgery are a key component of patient satisfaction and self-image. Various lasers have been used to attempt scar improvement, without consistent results. The optimal time to initiate laser treatment has not been determined. A recent study using a noncooled 585 nm pulsed dye laser starting on the day of suture removal demonstrated substantial improvement in scar appearance. OBJECTIVE: To determine the efficacy of the 595 nm cryogen-cooled pulsed dye laser in the treatment of surgical scars starting on the day of suture removal. METHODS: Sixteen patients with postoperative linear scars of greater than 2 cm were treated three times at 4- to 8-week intervals with a 595 nm cryogen-cooled pulsed dye laser. All patients had Fitzpatrick skin types I to IV. Each scar was divided at the midline into two fields, with half receiving treatment using a 7 mm spot size at 1.5 ms with 8 J/cm2 and a 30 ms spray duration with a 10 ms delay. The other half was not treated. Scars were evaluated for pigmentation, vascularity, pliability, and height by a blinded examiner using the Vancouver Scar Scale (VSS). In addition, the same blinded examiner evaluated the cosmetic appearance using a scale from 0 (worst) to 10 (best) prior to the second treatment and 1 month after the final treatment. RESULT: SThe average sum of all parameters in the VSS showed significant improvement from 1-month post-treatment to the final evaluation of 60% compared with the control of -3%. Also, scars in the treated portions scored an average of 2 points higher in the overall cosmetic appearance by the same blinded examiner based on a scale of 0 (worst) to 10 (best). Among the individual parameters in the VSS, the most significant improvements were found in vascularity and pliability. CONCLUSION: The cryogen-cooled 595 nm pulsed dye laser is a safe and effective option to improve the cosmetic appearance of surgical scars in skin types I to IV starting on the day of suture removal.

Adult↗
PubMed2006

Tuboovarian abscess caused by Candida in a woman with an intrauterine device.

Candida infection should be considered in an individual with a pelvic abscess that is unresponsive to conventional antibiotic therapy, particularly in the presence of an intrauterine device. We present a case of a tuboovarian abscess caused by Candida species in a woman with an intrauterine device for >10 years. Surgical intervention followed by antifungal therapy resulted in a favorable outcome.

Abdominal Pain↗
PubMed2005

Irradiated polyglactin 910 (Vicryl Rapide) for placement of full-thickness skin grafts.

BACKGROUND: The "unsuture" technique originally reported with the use of fast-absorbing gut for the placement of full-thickness skin grafts has provided years of successful full-thickness graft placement without the need for suture removal. OBJECTIVE: The objective was to explore another option for successful graft placement and survival using irradiated polyglactin 910 (Vicryl Rapide, Ethicon Inc, Somerville, NJ, USA), with its longer tensile strength of 7 to 10 days. METHODS: Irradiated polyglactin 910 was used to suture the edges and place basting sutures in full-thickness skin grafts. RESULTS: In our experience, we have found that the use of irradiated polyglactin 910 for the placement of full-thickness skin grafts provides an alternative to the "unsuture" technique with fast-absorbing gut. It provides excellent graft survival, easy workability, low inflammation, and good long-term cosmesis, without the need for suture removal. CONCLUSION: Irradiated polyglactin 910 provides another option for the placement of full-thickness skin grafts without the need for suture removal.

Biocompatible Materials↗
PubMed2002

Removal of a femoral sheath following PTCA in cardiac patients.

Patients with coronary heart disease may require a percutaneous transluminal coronary angioplasty, involving the use of a balloon catheter to dilate the arteries introduced via a sheath. It is now increasingly common for the removal of the sheath to be a nursing procedure. This paper reviews the literature, best practice, potential complications and post-removal nursing care.

Angioplasty, Balloon, Coronary↗
PubMed2003

Physical restraint use in a Korean ICU.

This descriptive study investigated the patterns of use of physical restraints in a Korean Intensive Care Unit (ICU) with the aim of identifying the factors that would best discriminate the times of application and removal of restraints in the same patients. The subjects of the study were 23 physically restrained patients out of 51 patients who were admitted to a medical ICU in a university hospital admitted during a 6-week period, and the 29 nurses who applied or removed the restraints. Ninety-four incidents of restraint application and removal on the 23 patients were analysed. Data were collected using a self-reporting questionnaire of attitudes towards restraint application for nurses, restraint document sheets, ICU flowsheets and patient chart reviews. Restraint-related patient data were collected on a restraint document sheet by the nurse in charge at each instance of application and removal of restraint. The most common type of restraint was the bilateral wrist restraint. The mean number of restraint applications per patient was 3.62 +/- 3.56 (mean +/- SD), and the mean restrained period per incident was 22.64 +/- 58 hours. There were no significant differences in the frequency of restraint use during the day, evening and night shifts. The most significant discriminators for restraint application and removal were the restless-behaviour score and the presence of a nasogastric tube - the classification accuracy by these two factors was 70.2%. More than 90% of the decisions to apply restraints were made by nurses. Nurses reported that preventing the patient from removing medical devices (48.6%) was the primary reason for application, and improvement of cognitive status (29.3%) was the primary reason for removal of restraint. In conclusion, as the most discriminating factor of application or removal of restraints was the patient's restless behaviour, providing nurses with tools for the accurate evaluation of patient restlessness will shorten restraint application periods in ICUs.

Adult↗