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This case report deals with an unusual complication in the removal of an active fixation implantable cardioverter defibrillator (ICD) lead. We were not able to pass the stylet beyond the point of lead fracture and this was subsequently found to be due to the stylet passing between the electrode and the outer layer of the lead insulation. The lead was removed by rotation extraction of the entire lead.
Surgical extraction of permanent pacemaker leads is performed when noninvasive extraction is felt to be unsafe or has been unsuccessfully attempted. Surgical extraction in patients with previous cardiac surgery presents a particular challenge as re-sternotomy is hazardous and the presence of surgical adhesions makes video-assisted approaches difficult. We report 2 cases of successful deployment of a surgical technique using femorofemoral cardiopulmonary bypass and right anterior thoracotomy for removal of pacemaker leads.
Percutaneous tube nephrostomy (PTN) placement is associated with bleeding complications in a small proportion of cases. We study a case of inadvertent renal vein catheterization during PTN tube change with catheter right atrial migration treated by fluoroscopically monitored catheter removal.
We often experience hepatic metastases after resections for advanced gastrointestinal cancers. Various methods such as resection and hepatic arterial infusion chemotherapy are used when a metastatic tumor is detected on imagings. We have considered postoperative prophylactic hepatic arterial infusion chemotherapy for the prevention of heterochronous hepatic metastases. For this purpose, we conducted experimental trials of temporary insertion of a catheter, which we would be able to remove safely in the near future, into an artery. Laparotomy was done on rabbits under general anesthesia, and a 16 G catheter was inserted into the left renal artery. The proximal site of the artery and the catheter were ligated together with Elastik, and the catheter was fixed with coated VICRYL RAPIDE distal of the insertion point. Upon insertion of the catheters, there was no bleeding, and neither occlusion nor dislocation of the catheter occurred. Two weeks later, the catheters were easily removed without bleeding under laparotomy. At a second-look laparotomy after 2 more weeks, there were no abnormal findings such as hematomas. Therefore, we concluded that our method would be acceptable for the temporary catheter insertion into an artery which could be removed safely and easily when the chemotherapy was finished.
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This study has been carried out to investigate whether the presence of an intra-uterine contraceptive device in pregnancy is a risk factor for the pregnancy, for the fetus and for the mother. We have concerned ourselves with pregnancies that led to a viable fetus. We wanted to know whether early removal of the device altered the bad effects of the device. The same types of pathology such as bleeding, threatened premature labour, premature rupture of the membranes and premature delivery occurred whether the device was removed or not; but the incidence of the various complications was increased if the device remained in place the whole pregnancy. It seems absolutely necessary for every woman who becomes pregnant with an intra-uterine device to have the pregnancy diagnosed as early as possible and for the device to be removed to lessen the risk of complications. When this is not done the pregnancy should be considered a high risk pregnancy.
The use of central venous catheters is associated with many different complications, some of which can be life threatening. Most complications associated with the use of central venous catheters are either immediate and occur around the time of catheter insertion, or are delayed and are related to the duration of catheter use. Complications occurring after removal of central venous catheters are reported infrequently but are still a cause of significant morbidity. The following case report illustrates a serious complication which occurred after a large gauge central venous catheter was removed from a patient and demonstrates the importance of close observation not only at the time of catheter placement but also when such devices are removed.
Despite the widespread use of rigid fixation techniques in craniofacial surgery, there is a paucity of studies in the literature that serve to better define the reasons for the subsequent removal of plates and screws. The current study appears to be the first to attempt to assess these issues among a broad range of craniofacial surgery patients. Fifty-five patients who underwent hardware removal following craniofacial surgery at the University of Michigan Medical Center between 1989 and 1995 were retrospectively studied via an in-depth chart review. Common reasons for hardware removal included palpable/prominent hardware in 19 patients (34.5%), loosening of plates and screws in 14 patients (25.5%), pain in 14 patients (25.5%), infection in 13 patients (23.6%), wound dehiscence/exposure of hardware in 11 patients (20%), and removal at the time of secondary procedures in 5 patients (9.1%). It is hoped that this study will serve as a tool to define more completely the risk of needing subsequent hardware removal among craniofacial surgery patients treated with rigid internal fixation.
A 39 year-old vaginal multipara status postpubovaginal sling in 2002 and a transobturator tape procedure in 2004 presented with persistent stress incontinence and vaginal polypropylene mesh erosion. Ten days later, she presented to the emergency room with severe right groin pain, difficulty walking, fever, and chills. She described shooting pain originating from the right inguinal ligament radiating down her right leg anteriorly. Although her neurologic examination was normal, palpation of the right obturator internus muscle reproduced her pain. MRI clearly revealed the course of the mesh tape through the obturator muscles and marked increase in the size of the right adductor and obturator internus muscles, apparently compressing the adjacent neurovascular fascicle. The patient was taken to the operating room where the polypropylene tape was easily removed through the vaginal erosion. Mesh cultures were positive for bacteroides fragilis. She experienced complete symptom resolution within 1 week of tape removal.
This study investigated the effects, if any, that the presence of a tracheotomy tube has on the incidence of laryngeal penetration and aspiration in patients with a known or suspected dysphagia. This was a prospective, repeated-measure design study. A total of 37 consecutive patients with a tracheotomy tube underwent a fiberoptic endoscopic evaluation of swallowing (FEES). Patients were first provided with pureed food boluses with the tracheotomy tube in place. The tracheotomy tube was then removed and the tracheostoma site was covered with gauze and gentle hand pressure was applied. The patients were then evaluated without the tracheotomy tube in place with additional puree. Aspiration status was in agreement with and without the tracheotomy tube in place in 95% (35/37) of the patients. The two patients who demonstrated a different swallowing pattern with regard to aspiration demonstrated aspiration only when the tracheotomy tube was removed. Laryngeal penetration status was in agreement with and without the tracheotomy tube in place in 78% (29/37) of the patients. For the majority of the patients, the removal of the tracheotomy tube made no difference in the incidence of aspiration and/or laryngeal penetration. Results of this study do not support the clinical notion that the patient's swallowing function will improve once the tracheotomy tube has been removed.
Tension-band wire fixation of olecranon fractures leads to a high re-operation rate because of the need to remove the metalware. This problem has commonly been thought to be related mainly to the backing-out of the Kirschner wires. A retrospective study was carried out in 55 patients with displaced olecranon fractures operated on with the tension-band wiring technique, in whom there was an overall 71.7% re-operation rate. Complications were few and minor in most patients. The main reason for the removal of the metalware was a direct complaint from the patient (in 61.3% of all removals). A literature review analyzing the causes of metalware removal is also presented.