The "chemical" approach to removal of Miragel scleral explants.
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Animals↗
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Results for “Device Removal”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Percutaneous removal of migrated nitinol stents from the right ventricle.
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Adult↗
Procedures nurses use to remove central venous catheters and complications they observe: a pilot study.
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Catheterization, Central Venous↗
A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease.
OBJECTIVE: To evaluate the effects of removing coils on the treatment of mild and moderate pelvic inflammatory disease (PID). METHODS: Of 126 women who had mild to moderate PID during coil usage, 60 were treated following coil removal and 66 without. Clinical symptoms, findings of gynecologic examination, erythrocyte sedimentation rates (mm/h), leukocyte counts (mm(-3)) were recorded before and after treatment and recovery rates of symptoms and findings were compared with Chi-square and Fisher's absolute Chi-square tests. Student's t-test was used for the comparison of mean sedimentation rates and leukocyte counts. RESULTS: Recovery rates of pelvic pain, purulent vaginal discharge, dysuria/frequency and dyspareunia and clinical improvements in abdominal and cervical tenderness were significantly higher (P<0.05) in the coil removed group. CONCLUSIONS: Removing the coil before medical therapy, increases the rates of clinical improvement in mild to moderate PID.
Anti-Bacterial Agents↗
Prediction of cardiac function after weaning from ventricular assist devices.
OBJECTIVE: We analyzed the factors influencing the cardiac function of patients after weaning from ventricular assist devices and established a prognostic index. METHOD: A multivariate analysis was performed using the Cox proportional hazards model of the clinical parameters of 28 patients with end-stage heart failure before implantation of a ventricular assist device and directly before weaning from the device. RESULTS: After weaning from the ventricular assist devices, 14 of the 28 investigated patients showed stable cardiac function, and 12 had recurrent heart failure, but only 1 of them died before transplantation or implantation of another ventricular assist device, and 2 patients died of causes unrelated to heart failure. In addition to left ventricular ejection fraction, the duration of symptomatic heart failure and left ventricular intracavitary dimensions in diastole measured before ventricular assist devices weaning were the major factors influencing cardiac function after weaning. In the group of patients with heart failure duration less than 3 years, only 2 of 13 cases were recurrent, but in the group with heart failure duration more than 3 years, 10 of 15 cases were recurrent. In 10 patients with 40 to 50 mm left ventricular intracavitary dimensions in diastole before weaning, only 1 case was recurrent. In 10 patients with 51 to 55 mm left ventricular intracavitary dimensions in diastole, 3 cases were recurrent. In the group with left ventricular intracavitary dimensions in diastole more than 56 mm, all 8 cases were recurrent. A prognostic index was calculated using the following formula: prognostic index = -10.10 + 0.208 (heart failure duration in years) + 0.173 (pre-explantation left ventricular intracavitary dimensions in diastole in millimeters). In the group with a prognostic index less than 0, only 2 of 16 cases were recurrent, and the rate of stable cardiac function in the 51st month after weaning was 83.6%. In the group with a prognostic index greater than 0, 10 of 12 cases were recurrent, and the rate of stable function in the 57th month was 0.0%. CONCLUSION: In patients with off-pump left ventricular ejection fraction greater than 40%, the duration of symptomatic heart failure and the left ventricular intracavitary dimensions in diastole measured before weaning yield a useful index to predict long-term cardiac function after weaning from ventricular assist devices.
Device Removal↗
Biventricular assist device utilization for patients with morbid congestive heart failure: a justifiable strategy.
BACKGROUND: The rationale for the use of a biventricular assist device (BiVAD) for morbid congestive heart failure (MCHF) has been questioned because of historically unacceptable rates of postimplant and post-transplant mortality as well as perceived barriers to their outpatient management. METHODS AND RESULTS: All patients who received a Thoratec BiVAD from January 1990 to December 2003 at the University of Pittsburgh were studied retrospectively. There were a total of 73 patients (32% ischemic, 21% idiopathic, and 47% other) who had a BiVAD implanted. Before implantation, 100% were on > or =1 inotropic agent, and 77% had an intra-aortic balloon pump. Overall survival was 69%; 42 patients (84%) received cardiac transplantation, 5 patients (10%) were weaned, and 3 (6%) remained supported on BiVAD. If the 14 patients with postcardiotomy failure and acute myocardial infarction with shock are excluded, the overall survival improves to 75%. Five-year actuarial survival after heart transplantation was 58%. Of the 29 patients implanted before 2000, the 4-month actuarial freedom from driveline infections, bloodstream infections, and neurological events was 10%, 54%, and 48%, respectively, whereas the rates of these events for the 44 patients implanted after 2000 improved to 70%, 79%, and 80%, respectively. Since 2000, 21 (48%) patients were discharged from the hospital, of whom 38% went to an outpatient residence, 33% to a skilled nursing facility, and 29% to home. Once discharged, > or =1 readmission occurred in 45% and > or =2 readmissions in 48%. CONCLUSIONS: BiVAD support for MCHF has an acceptable overall mortality and survival to transplantation. Morbidity has been significantly reduced in the past 4 years, and management as an outpatient is achievable.
Adult↗
[Technical principles for removal of femoral bone cements in hip prosthesis implant revision].
As the removal of femoral bone cement is one of the most challenging tasks in cemented total Hip Revision, a lot of different technical devices have been developed to aid the surgeon. All of their pros and cons are partly consequences of the specific system-design but mainly arise from the basic physical principles used. The known methods and devices as well as their data-handling have therefore been analysed, reduced to their principles according to the criteria of systematic engineering design and systematized in order to provide a better comparability and starting point for the development of new devices.
Arthroplasty, Replacement, Hip↗
Long-term follow-up of Thoratec ventricular assist device bridge-to-recovery patients successfully removed from support after recovery of ventricular function.
BACKGROUND: In certain forms of severe heart failure there is sufficient improvement in cardiac function during ventricular assist device (VAD) support to allow removal of the device. However, it is critical to know whether there is sustained recovery of the heart and long-term patient survival if VAD bridging to recovery is to be considered over the option of transplantation. METHODS: To determine long-term outcome of survivors of VAD bridge-to-recovery procedures, we retrospectively evaluated 22 patients with non-ischemic heart failure successfully weaned from the Thoratec left ventricular assist device (LVAD) or biventricular assist device (BVAD) after recovery of ventricular function at 14 medical centers. All patients were in imminent risk of dying and were selected for VAD support using standard bridge-to-transplant requirements. There were 12 females and 10 males with an average age of 32 (range, 12-49). The etiologies were 12 with myocarditis, 7 with cardiomyopathies (4 post-partum [PPCM], 1 viral [VCM], and 2 idiopathic [IDCM]), and 3 with a combination of myocarditis and cardiomyopathy. BVADs were used in 13 patients and isolated LVADs in 9 patients, for an average duration of 57 days (range, 11-190 days), before return of ventricular function and successful weaning from the device. Post-VAD survival was compared with 43 VAD bridge-to-transplant patients with the same etiologies who underwent cardiac transplantation instead of device weaning. RESULTS: Nineteen of the 22 patients are currently alive. Three patients required heart transplantation, 1 within 1 day, 2 at 12 and 13 months post-weaning, and 2 died at 2.5 and 6 months. The remaining 17 patients are alive with their native hearts after an average of 3.2 years (range, 1.2-10 years). The actuarial survival of native hearts (transplant-free survival) post-VAD support is 86% at 1 year and 77% at 5 years, which was not significantly different (p = 0.94) from that of post-VAD transplanted patients, also at 86% and 77%, respectively. CONCLUSIONS: Long-term survival for bridge-to-recovery with VADs for acute cardiomyopathies and myocarditis is equivalent to that for cardiac transplantation. Recovery of the native heart, which can take weeks to months of VAD support, is the most desirable clinical outcome and should be actively sought, with transplantation used only after recovery of ventricular function has been ruled out.
Adolescent↗
The cardiovascular response to insertion of the intubating laryngeal mask airway.
Sixty-one patients received a standardised anaesthetic and were randomly assigned to three groups: tracheal intubation via direct laryngoscopy, tracheal intubation via an intubating laryngeal mask airway with immediate removal of the device, and tracheal intubation via an intubating laryngeal mask airway with delayed removal. The cardiovascular response to intubation was of a similar magnitude in all groups, although delayed removal of the intubating laryngeal mask airway was associated with a second pressor response. Norepinephrine changed significantly over time following direct laryngoscopy and following immediate removal of the intubating laryngeal mask airway, but not after delayed removal. The findings of this study do not support using the intubating laryngeal mask instead of direct laryngoscopy purely to decrease the response to intubation.
Adult↗
Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases.
A retrospective follow-up study of patients who, having undergone instrumented posterior spinal fusion for scoliosis, experienced late infection and then underwent either implant removal alone or implant removal and instrumented refusion. We conducted this study to determine whether it is possible to avoid loss of correction by a single-stage implant removal and reinstrumentation procedure. There have been a few reports of late-appearing infections after spinal instrumentation. Implant bulk, metallurgic reactions, and contamination with low-virulence microorganisms have been suggested as possible etiologic factors. The clinical symptoms include pain, swelling, redness, and spontaneous drainage of fluid. Complete instrumentation removal and systemic antibiotics is usually curative. We retrospectively reviewed 45 patients who underwent instrumented posterior spinal fusion for scoliosis and experienced development of late infections and, after a mean of 3 years after the initial procedure, either underwent implant removal alone [ n=35, instrumentation removal (HR) group] or additionally underwent reinstrumentation and fusion [ n=10, reinstrumentation and fusion (RI&F) group]. Three patients were reinstrumented 1.5 years after instrumentation removal, and seven underwent a one-stage rod removal and reinstrumentation/refusion procedure. Allergic predisposition, protracted postoperative fever, and pseudarthrosis appear to increase the risk of late-developing infection after posterior spinal fusion. All wounds in both groups healed uneventfully. Preoperative radiographic Cobb measurements showed no statistically significant between-group differences. At follow-up, however, outcome was clearly better in the RI&F group: Loss of correction was significantly smaller in reinstrumented patients. Thus, the thoracic Cobb angle was 28+/-16 degrees (range 0-55 degrees ) in the RI&F group versus 42+/-15 degrees (21-80 degrees ) in the HR group, and the lumbar Cobb angle was 22+/-11 degrees (10-36 degrees ) in the RI&F group versus 29+/-12 degrees (13-54 degrees ) in the HR group. The results of our study demonstrate that wound healing is usually uneventful after instrumentation removal for late infection, also when patients undergo instrumented refusion in a one-stage procedure. Reinstrumentation appears to achieve permanent correction of scoliosis.
Adolescent↗
Use of the laryngeal tube in 100 patients.
BACKGROUND: The laryngeal tube has a potential role during anaesthesia, but there have been only a few studies assessing its efficacy during the entire course of anaesthesia, and all previous studies used prototypes. We studied 100 patients to assess the efficacy of a new laryngeal tube during the entire course of anaesthesia. METHODS: After induction of anaesthesia, the laryngeal tube was inserted (up to two times) and adequacy of ventilation was assessed. The airway pressure at which gas leaked around the device was measured. The device was used during anaesthesia, while ventilation was controlled. The device was removed after the patient had opened the mouth to verbal command. Any complications during and after anaesthesia were recorded. RESULTS: Ventilation was possible at the first attempt in 90 patients, at the second attempt in another seven patients, and adequate ventilation failed after two attempts in three patients. Median (interquartile range) leak pressure was 28 (22-30) cmH2O. In all 97 patients, the laryngeal tube was used until the end of surgery. However, in two of the 97 patients the airway was partially obstructed during anaesthesia and it was necessary to reposition the device. The laryngeal tube was tolerated well during emergence from anaesthesia. No hypoxia, regurgitation, vomiting or laryngospasm occurred in any patient. On removal of the laryngeal tube, no blood was detected on the device and no apparent ischaemic changes to the tongue were observed in any patient. Post-operatively, six patients complained of a mild sore throat, and no patient complained of difficulty in swallowing or numbness of the oropharynx. CONCLUSION: The laryngeal tube can be useful for maintaining a patent airway during anaesthesia.
Adolescent↗
Suprapubic-assisted cystoscopic excision of intravesical tension-free vaginal tape.
We report on a 56-year-old woman with irritative voiding symptoms, which started 4 months after undergoing a TVT procedure for stress incontinence (SI). Evidence of the mesh coming through the left bladder wall did not emerge until cysto-urethroscopic examination 2 years after surgery. Excision was done via transurethral cystoscopy with the aid of endoscopic scissors placed through a 5-mm suprapubic port inserted into the dome of the bladder, thus avoiding laparotomy. A Foley catheter was left in for 3 days, and after removal, the patient's symptoms disappeared almost completely.
Cystoscopy↗
Modified technique for suprapubic catheter insertion that avoids urinary leakage.
When a large bore suprapubic catheter, such as a Foley catheter, is required for postoperative drainage of the bladder, nearly 10% of patients experience urinary leakage. We describe a novel technique involving the tubularization of the bladder during large bore suprapubic catheter placement to prevent urinary leakage while the catheter is in place and after its removal.
Catheters, Indwelling↗
Alcaligenes xylosoxidans and Propionibacterium acnes postoperative endophthalmitis in a pseudophakic eye.
PURPOSE: To report a case of persistent polymicrobial postoperative endophthalmitis caused by Alcaligenes xylosoxidans and Propionibacterium acnes in a pseudophakic eye. A. xylosoxidans is a gram-negative bacteria resistant to most antibiotics. METHODS: Case report. RESULTS: A 72-year-old man presented with clinical signs of endophthalmitis on the first postoperative day after a phacoemulsification procedure with posterior chamber intraocular lens, left eye. Initial treatment included topical, subconjunctival, and oral antibiotics. After initial clearing, there was recrudescence of infection on postoperative day 37 that prompted referral of the patient to the Cullen Eye Institute. Treatment at that time included anterior chamber and vitreous taps with intravitreal antibiotic injections. Complete pars plana vitrectomy and intraocular lens explantation were eventually required because of persistent infection with a resistant organism. Cultures from the first procedure grew A. xylosoxidans and P. acnes. Cultures from the vitrectomy grew only A. xylosoxidans. At the final follow-up visit 6 months after the initial procedure. The eye was without inflammation with best-corrected visual acuity of 20/40. CONCLUSION: Both A. xylosoxidans and P. acnes can cause chronic progressive endophthalmitis after cataract extraction often resistant to corrective antibiotic therapy. Successful intervention may require complete vitrectomy with intraocular lens and capsule removal.
Aged↗
"Pop-out" method of levonorgestrel implant removal.
The "pop-out" technique is a method of levonorgestrel implant removal that uses digital pressure to direct implants through a small skin incision. This technique was developed, theoretically, to cause less bruising and patient discomfort by avoiding the use of instruments. The pop-out technique is the primary method used for levonorgestrel implant removal in the Magee-Womens Hospital resident clinic. We performed a retrospective analysis of levonorgestrel implant removals performed between July 1, 1995, and December 31, 1998. Of the 168 removals included in this analysis, 38 were performed by one of two attending physicians, and 130 were performed by the residents with attending supervision. The average time for removal was 12 +/- 5 min (range 2.25-27 min) when the "pop-out" method could be used to remove all six implants, and 14 +/- 7 min (range 2.25-59 min) for all removals. The removal time for residents was inversely proportional to the anticipated level of difficulty of the removal and to the number of previous removals performed. The removal time was significantly faster when residents were supervised by one of the attending physicians as compared with the other attending physician. Only 0.7% (7/1,008) of levonorgestrel implants were fragmented during removal. This review shows that the "pop-out" method is a reasonable alternative to other proposed methods of primary implant removal. The difference in the level of expertise of the attending physician may significantly influence removal time when training clinicians in levonorgestrel implant removal.
Adolescent↗
Component removal in revision total hip arthroplasty.
One of the primary steps in revision hip arthroplasty is the extraction of retained components before surgical reconstruction. In revision arthroplasty, the removal of well-fixed components and cement can be extremely demanding, time consuming, and damaging to the remaining host bone. The aims of the current study were to examine the numerous operative techniques used during extraction of acetabular and femoral components and review the results of revision hip arthroplasty after cementless component removal. A review of 157 acetabular components and 113 femoral components removed from 219 patients during hip revision arthroplasty between 1985 and 2000 was done. The average age of the patients was 64.3 years. The average followup was 5 years (range, 0.7-12.5 years). An extended proximal femoral osteotomy was done in 37 (33%) of the femoral revisions. There were 14 (5%) acetabular failures for which the patients required reoperation. There were no femoral rerevisions. Complications included dislocation (6% after acetabular revision and 9% after femoral revision), infection (6%), femoral fracture (6%), hematoma (3.5%), acetabular fixation failure (2.5%), and femoral osteolysis (1%). The removal of cemented and well-fixed porous-coated implants can be done with adequate preoperative planning and a thorough knowledge of numerous implant removal techniques.
Acetabulum↗
Agrobacterium radiobacter bacteremia in pediatric patients: case report and review.
Agrobacterium radiobacter is an opportunistic pathogen often associated with indwelling catheters. We report five children with central venous catheter-associated A. radiobacter bacteremia and review the characteristics of pediatric Agrobacterium infections. Cure was achieved with appropriate antibiotics, often ticarcillin-clavulanate and gentamicin, and removal of the catheter.
Bacteremia↗
Intravesical holmium laser fragmentation and removal of detached resectoscope sheath tip.
PURPOSE: We describe a case in which the tip of a resectoscope sheath broke off in the bladder during transurethral resection of the prostate. MATERIALS AND METHODS: A holmium laser was used to fragment a detached ceramic 26Fr resectoscope sheath tip, which was dislodged into the bladder during transurethral resection of the prostate. The fragments were then retrieved using grasping forceps. RESULTS: This procedure caused minimal trauma. CONCLUSIONS: The procedure represents a novel and safe approach to the intravesical fragmentation and subsequent removal of an iatrogenic foreign body from the bladder.
Aged↗