[Cement removal in changing hip prosthesis implants. Search for a conservative method].
Explore the source record for details and available documents.
Aged↗
SEARCH · PubMed Health
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.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Artificial urinary sphincter for post-radical prostatectomy urinary incontinence: long-term subjective results.
PURPOSE: Incontinence affects between 3% and 60% of patients after radical prostatectomy. Insertion of an artificial urinary sphincter is a mainstay therapeutic option available to these patients. We assessed patient satisfaction, outcome and complications long after artificial urinary sphincter implantation. MATERIALS AND METHODS: From a data bank of 131 patients who underwent artificial urinary sphincter prosthesis insertion we identified 71 with a mean age of 72 years who had also undergone radical prostatectomy and were available for evaluation. This group included 29 patients (40.8%) who received an earlier version of the AMS-800 (American Medical Systems, Minnetonka, Minnesota) and 42 (59.2%) who received the newer narrow back cuff device. Information on surgical procedures and followup were obtained from a computerized database. Patients were also contacted by an impartial reviewer who administered a standard telephone questionnaire on the degree of continence, complications, other means used to help with urinary continence, proficiency in device operation and satisfaction. RESULTS: At a mean followup of 7.7 years (range 0.5 to 16) 19 patients (27%) used 0, 23 (32%) used 1, 11 (15%) used 1 to 3 and 18 (25%) used more than 3 daily, while 1 used an external catheter. Surgical revision in 21 cases (29%) was required due to mechanical failure in 18 (25%), device erosion in 3 (4%) and infection in 1 (1.4%). The need for revision correlated significantly with the design of the sphincter (p = 0.005). Only 7 of the 42 patients in whom a narrow cuff AMS-800 was implanted needed revision versus 18 of the 23 with a previous design. Mean time to revision was 2.5 years (range 0.5 to 8). The device was removed in 2 cases (2.8%). Of the patients 41 (58%) are very satisfied, 14 (19%) are satisfied and 16 (23%) are unsatisfied with the device. The degree of satisfaction correlated with the number of pads used (p = 0.0005) and sphincter design (0.028) but not with the number of surgical revisions (p = 0.521) or patient age. CONCLUSIONS: The artificial urinary sphincter is a viable treatment option for post-radical prostatectomy incontinence with a high rate of continence and satisfaction for a long period after the procedure. Patients should be informed that complications necessitating device revision and explantation may appear late in followup. A standard definition of treatment success and studies of homogenous groups of patients with an artificial urinary sphincter would enable better understanding and patient education in the future.
Aged↗
UroLume stents: lessons learned.
PURPOSE: The UroLume (American Medical Systems, Minnetonka, Minnesota) endoprosthesis has been commercially available since 1990 and has been advocated for use in men with urethral stricture disease and detrusor-sphincter dyssynergia due to spinal cord injury. Despite reports of its success and ease of removal, we have noted management problems in several complex cases. MATERIALS AND METHODS: We retrospectively analyzed the outcome of 10 men who required several additional procedures or experienced complications following UroLume placement. RESULTS: Of the patients 4 had detrusor-sphincter dyssynergia and 6 had urethral stricture disease. All patients with detrusor-sphincter dyssynergia required hospitalization for management of urosepsis within 4 to 10 months of stent placement, and all 4 experienced stent migration requiring placement of a tandem stent (3), bladder neck resection (3) or sphincterotomy (1). Two men were in retention following placement of a second stent and required stent explantation. Of the other 6 men 2 had bulbar and 3 had membranous urethral disease, and 1 had a severe bladder neck contracture following radical retropubic prostatectomy. Strictures recurred within the stent lumen in all 6 men and/or adjacent to it in 3. At least 1 repeat procedure was required in all 6 men (within 6 months in 5), and 1 experienced significant bleeding during open explantation which required perineal urethrostomy. CONCLUSIONS: In our referral experience stent migration and recurrent stenosis were noted following UroLume insertion. Placement of a tandem stent was associated with urethral obstruction. In many cases these adverse outcomes may be secondary to improper patient selection. Therefore, judicious use of the UroLume stent and proper case selection are essential since stent removal is not always straightforward.
Adult↗
Does endoluminal brushing eliminate the need for catheter removal in peritoneal dialysis patients with persistent peritonitis?
Recurrent and persistent peritonitis episodes are exhausting problems in children on chronic peritoneal dialysis (PD) and can lead to discontinuation of treatment. In the present report, we describe our clinical experience with endoluminal brushing (EB) in 3 pediatric patients with refractory peritonitis episodes maintained on chronic PD. The EB was performed on 4 occasions in 3 patients. Peritonitis resolved in 2 of the patients. The remaining patient required removal of the PD catheter. No adverse events have since been observed. Endoluminal brushing should be considered an option for the management of persistent peritonitis before catheter removal.
Adolescent↗
Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.
Peritoneal catheter removal may be clinically indicated in the management of peritonitis. The data on the course of patients undergoing peritoneal catheter reinsertion after removal for peritonitis are limited. The present study was designed to examine what happens to patients on chronic peritoneal dialysis (CPD) after peritoneal catheter removal for peritonitis. We retrospectively reviewed the charts of patients who developed peritonitis between January 1, 1990, and September 1, 2002. We identified 1146 episodes of peritonitis; in 189 of the episodes (16%), the peritoneal catheter was removed. Catheters were reinserted in 88 of those patients (47%). Reasons for peritoneal catheter removal among the 88 patients who underwent peritoneal catheter reinsertion included unit protocol (51%), poor response to antibiotics (46%), and exit-site or tunnel infection (3%). Reasons for peritoneal catheter removal among the 101 patients in whom the peritoneal catheter was not reinserted included unit protocol (62%), poor response to antibiotics (20%), and extensive history of peritonitis (18%). After reinsertion, the new peritoneal catheter remained in place for a mean of 15.4 +/- 15.4 months (range: 1-75 months). In 37 of the 88 patients with reinserted peritoneal catheters (42%), the catheters remained in place for longer than 1 year. The remaining 6 patients underwent transplantation or were transferred to another facility. Of the remaining 51 patients whose new peritoneal catheters lastedfor less than I year, 13 (25.5%) died, and 32 (63%) were transferred permanently to hemodialysis. Of the 101 patients who did not have a peritoneal catheter reinserted, 23 (23%) died within the 2-week period following the onset of peritonitis. The rest were transferred to hemodialysis. The reasons noted for not reinserting the peritoneal catheter included frequent episodes of peritonitis, patient unwillingness to retry CPD therapy, psychosocial reasons, bowel perforation, or transfer to an institution unable to perform CPD therapy. We conclude that, among patients who medically require peritoneal catheter removal because of peritonitis, few will successfully return to long-term CPD therapy. Of the patients who required peritoneal catheter removal in our study, 23% died within the first 2 weeks after the onset of peritonitis, before catheter reinsertion could be considered. Only 47% of the patients underwent a successful catheter reinsertion; and, of those, only 34% remained on CPD therapy I year later Thus, only 20% of patients undergoing PD catheter removal remain on CPD therapy 1 year after catheter removal.
Anti-Bacterial Agents↗
Use of the ALN permanent/removable vena cava filter. A multi-centre experience.
AIM: Vena cava filters are used for the prevention of pulmonary embolism in cases of contraindication, failure or complications of the anticoagulant therapy. There are no certain data in the literature concerning the effectiveness of vena cava filters and, above all, the possible long-term complications are not known. For this reason increasing attention is paid to permanent/removable filters that permit exploitation of the short-term advantages of vena cava interruption, eliminating the possible long-term complications. We have reported the results of a multicentre experience concerning ALN permanent/removable vena cava filters in a total of 276 patients. METHODS: Vena cava filters were placed in 276 patients via the jugular, femoral and brachial vein. The filter was removed in 43 patients after 3 months and in 28 patients after 6 months. RESULTS: In 1 case, due to incomplete opening of the filter, immediate percutaneous removal was performed and another filter was positioned. In 5 cases it was not possible to remove the filter, in 1 case due to inexperience and in the remaining cases due to adhesion of the head or claws of the filter to the wall of the vein. No problems occurred in the other cases. CONCLUSIONS: The ALN vena cava filter is safe, easy to position and remove even a long time after placement. Currently permanent filters should be used only for patients with poor survival expectancy whereas in all other cases the use of removable filters is preferable.
Device Removal↗
The complications of central venous access systems: a study of 218 patients.
OBJECTIVE: To evaluate the safety and usefulness of systems for obtaining central venous access. DESIGN: Prospective open study. SETTING: Clinica Universitaria de Navarra, Spain. SUBJECTS: 218 consecutive patients who required long term venous access either for chemotherapy or for total parenteral nutrition, and who had no evidence of infection, a platelet count of over 40 x 10(9)/l, and a life expectancy of three months or more, had 234 devices inserted. INTERVENTIONS: Insertion of either a silicone rubber (Port-A-Cath) or a polyurethane (Implantofix) catheter into the cephalic, jugular or subclavian vein, leaving the tip in the superior vena cava. RESULTS: Between February 1985 and December 1990, 234 devices were implanted in 218 patients aged from 0.9 to 78 years. The median (range) length of time that the catheters functioned was 277 (7-1887) days. The overall incidence of complications was 0.09/100 days inserted, and the complication rates for infection and thrombosis were 0.02 and 0.03/100 days, respectively. Thirty two devices were removed because of complications, and 19 because the treatment had finished. Five of the 218 patients (2%) were lost to follow up. CONCLUSIONS: These devices have a long working life, and a low rate of complications, and are of great value to patients who require long term or cyclical intravenous treatment.
Adolescent↗
Displaying radiologic images on personal computers: image storage and compression: Part 1.
This is the third article of our series for radiologists and imaging scientists on displaying, manipulating, and analyzing radiologic images on personal computers. Part 1 of this article discusses image storage and reviews the basic concepts of information theory and image compression; part 2 will discuss specific methods of image compression. There are a wide variety of removable storage devices available to users who need to archive radiologic images on their personal computers. Tape drives have potentially very large storage capacity but slow performance. Removable SyQuest (SyQuest Technology, Femont, CA) and Bernoulli disks have near hard disk performance and can store from 100 to 150 Mbytes. Magneto-optical drives can store nearly 1 Gb on a 5.25" disk, with somewhat slower performance. Selecting the most appropriate storage solution requires a careful balance of the user's requirements, including performance, storage needs, cost and compatibility with other users. Despite the advances in low cost high capacity storage technology, image compression remains a crucial technology for modern diagnostic radiology because digital images require such large amounts of storage. Image compression is possible because radiologic images have relatively low entropy (high information content) compared with random noise. Image compression is classified as lossless (nondestructive) or lossy (destructive). Lossless image compression commonly achieve compression ratios of 1.5:1 to 3:1 (33% to 67%), whereas lossy compression can compresses images from 3:1 to 30:1 (67% to 97%).(ABSTRACT TRUNCATED AT 250 WORDS)
Computer Storage Devices↗
Endoscopic management of foreign bodies in the upper-GI tract: experience with 1088 cases in China.
BACKGROUND: Reports on endoscopic management of ingested foreign bodies of the upper-GI tract in China are scarce. OBJECTIVE: To report our experience and outcome in the management of ingestion of foreign bodies in Chinese patients. SETTING AND PATIENTS: Between January 1980 and January 2005, a total of 1088 patients (685 men and 403 women; age range, 1 day to 96 years old) with suspected foreign bodies were admitted to our endoscopy center. INTERVENTIONS: All patients underwent endoscopic procedure after admission. MAIN OUTCOME MEASUREMENTS: Demographic and endoscopic data, including age, sex, and referral sources of patients, types, number and location of foreign bodies, associated upper-GI diseases, endoscopic methods, and accessory devices for removal of foreign bodies were collected and analyzed. RESULTS: A total of 1090 foreign bodies were found in 988 (90.8%) patients. The types of foreign bodies varied greatly: mainly food boluses, coins, fish bones, dental prostheses, or chicken bones. The foreign bodies were located in the pharynx (n = 12), the esophagus (n = 577), the stomach (n = 441), the duodenum (n = 50), and the surgical anastomosis (n = 10). The associated GI diseases (n = 88) included esophageal carcinoma (33.0%), stricture (23.9%), diverticulum (15.9%), postgastrectomy (11.4%), hiatal hernia (10.2%), and achalasia (5.7%). A rat-tooth forceps and a snare were the most frequently used accessory devices. The success rate for foreign-body removal was 94.1% (930/988). CONCLUSIONS: Ingestion of foreign bodies is a common clinic problem in China. Endoscopy procedures are frequently performed, and a high proportion of patients with foreign bodies require endoscopic intervention.
Adolescent↗
Removal of selected fracture fixation implants under local anaesthesia.
AIMS AND OBJECTIVES: This study was undertaken to evaluate the feasibility and tolerability of fracture fixation implants (FFI) removal under local anaesthesia. MATERIALS AND METHODS: We reviewed 176 patients who had osteosynthetic materials inserted for the treatment of fractures and whose implants were removed under local anaesthesia. Pain and tolerance were determined using a pain severity score determined by the patients. About 60% of the implants were Kuntcher nails while 31% were Krischner wires. In 171 (97.2% ) patients the implants were removed under local anaesthesia while in 5 (2.8% ) patients with Kuntcher nails the procedures were difficult and painful which necessitated the use of intravenous ketamine. RESULTS: About 89% of patients felt no pain during the procedures while 8.5% felt mild to moderate pain, which was easily tolerated. CONCLUSION: The use of local anaesthesia for fracture fixation implants removal is recommended because it is simple and safe and reduced the cost and complications of treatment.
Adolescent↗
Successful percutaneous extraction of an inadvertently placed left ventricular pacing lead.
A 74-year-old patient was referred for a rapidly increasing pacing threshold 9 months after DDD pacemaker implantation because of symptomatic total atrioventricular (AV) block. She had a history of hypertension, diabetes with micro-angiopathy and a recent transient ischaemic attack. The paced electrocardiogram on admission had a right bundle branch block pattern and 3-dimensional transoesophageal echocardiography demonstrated passage of the lead through an atrial septal defect with a left ventricular position in addition to moderate atherosclerosis of the ascending aorta. No thrombus could be detected on the lead. Percutaneous extraction is usually not recommended because of the risk of mobilization of thrombus material. However, the risk of stroke during removal using cardiopulmonary bypass in this patient was considerably increased because of the presence of multiple independent risk factors. Therefore, percutaneous extraction using a locking device was selected and performed without complications: follow-up was uneventful.
Aged↗
The capture of heavy metals from incineration using a spray dryer integrated with a fabric filter using various additives.
This study investigated the effects of feedstock additives [polyvinyl chloride (PVC) and NaCl] and spray dryer additives (SiO2, CaCl2, NaHCO3) on heavy metal and fly ash removal efficiencies, and on particle size distribution of heavy metals. A spray dryer with an integrated fabric filter was used as an air pollution control device (APCD). Removal efficiencies for fly ash and heavy metals were greater than 95 and 90%, respectively. When additives of PVC or NaCl were used, the concentration of heavy metals distributed in fly ash apparently varied when the particle diameter was <1 microm. Although the effects of the additives SiO2, CaCl2, and NaHCO3 on the elemental size distribution of Cr were insignificant, these additives did slightly increase concentrations of Cd, Zn, and Pb partitioning in coarser particles (>1 microm).
Air Pollutants↗
Automatic filter placement device for region of interest (ROI) fluoroscopy.
In Region of Interest (ROI) Fluoroscopy, an ROI filter is inserted into the x-ray beam in order to decrease the patient exposure in the peripheral part of the field of view. A filter placement device has been designed and constructed for the practical implementation of ROI fluoroscopy. When unmodified spot films are required during fluoroscopic procedures, an electronic signal from the high voltage generator triggers the filter placement device to remove the ROI filter automatically from the field of view and to reinsert it after the conclusion of the spot film exposure. The filter placement device is easily fastened to existing tracks on undertable tube fluoroscopic collimators. A transmission ionization chamber may be placed above the filter assembly so that radiation to the patient may be monitored during ROI fluoroscopic procedures. The mechanical design is compact and involves only one miniature gear-head motor. The filter placement device allows rapid filter positioning in 200 ms so that there is no interference with spot filming. A simple electronic circuit provides 8 volts for rapid motion of the filter support arm and 4 volts for holding the filter in place. This device demonstrates that ROI fluoroscopy with its associated large reduction in patient integral dose can be practically implemented in standard fluoroscopic equipment.
Filtration↗
Continence and quality of life assessment after artificial urinary sphincter implantation.
BACKGROUND: Sphincter-related incontinence after radical prostatectomy, benign prostatectomy or due to neurogenic disease has a considerable negative impact on quality of life. Artificial urinary sphincter implantation is a mainstay therapeutic option for these patients. OBJECTIVES: To assess patient satisfaction, subjective long-term continence and complications after AMS 800 artificial urinary sphincter implantation. METHODS: The medical records of 34 patients who underwent artificial urinary sphincter implantation for radical prostatectomy (n = 23), simple prostatectomy (n = 9) or neurogenic disease (n = 2) between 1995 and 2003 were studied retrospectively. Median follow-up was 49 months (range 3-102 months). Records were analyzed for urinary sphincter survival and complications. Quality of life and continence assessment was done by mailing an impact questionnaire. RESULTS: In 4 of the 34 patients (11.7%) the device was removed due to infection. One of the four had surgical revision elsewhere, and the other three were not interested in re-implantation of the device. Two patients (5.9%) underwent revisions due to mechanical failure. One patient died and three patients were not located. Twenty-seven out of a possible 30 patients (88%) completed the questionnaire; 22 (85%) achieved social continence (0-2 pads daily), and one patient had subjective difficulty activating the device. Subjective improvement and patient satisfaction was rated as 4.22 and 4.11, respectively (scale 0 to 5). CONCLUSIONS: Artificial urinary sphincter implantation is an efficacious option for sphincter-related incontinence. This study documents the positive impact of artificial urinary sphincter implantation on quality of life with acceptable complications; these results are comparable to other published studies.
Aged↗
Clinical performance of the levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report.
OBJECTIVES: This study was undertaken to determine the performance of the levonorgestrel intrauterine system (LNG IUS) in British women in routine clinical use. DESIGN: Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 678 LNG IUSs. RESULTS: Gross cumulative event rates at 5 years per 100 women were pregnancy 1.0, expulsion 5.9, removal for bleeding problems 16.7, removal for pain 4.3, and removal for pelvic inflammatory disease (PID) 1.2. Removals were also required for side effects that may be due to absorbed levonorgestrel. Positive effects include effective contraception and considerably reduced quantity of bleeding for most participants. CONCLUSIONS: A need was identified to counsel women about the early bleeding problems including the possibility of oligomenorrhoea or amenorrhoea. This is considered to be very important as it will help women to persevere so that they can enjoy the longer-term benefits.
Adult↗
Multimodal analgesia for chest tube removal after cardiac surgery.
Explore the source record for details and available documents.
Analgesia↗
Laparoscopic therapy in a CAPD patient with perforated appendicitis without removal of the peritoneal catheter.
Explore the source record for details and available documents.
Adult↗
Minimally invasive removal or revision of lumbar spinal fixation.
BACKGROUND CONTEXT: There are both absolute and relative indications for the removal of pedicle screw fixation in the lumbar spine. Whatever the reasons are, removal of this hardware has required a surgical dissection that has been generally as extensive as the one used for their initial placement. These dissections are always disabling in the short term. In fact, the magnitude of this disabling pain can be significant enough so as to effectively eliminate screw removal as a logical treatment option for many conditions where indications for removal are only relative. Percutaneous pedicle screw fixation has served to amplify the stakes associated with this dilemma. In fact, this new technique makes the need for a less invasive method of pedicle screw removal greater now than ever. PURPOSE: This paper describes a minimal access surgical technique for pedicle screw construct removal that employs the tubular retractor system that was originally developed for microendoscopic discectomy. STUDY DESIGN: This case study represents a summary of the surgical experience gained from the first 10 patients to have undergone removal or revision of pedicle screw constructs by this minimally invasive method. METHODS: A retrospective analysis of pre- and postoperative clinical data was gathered from the hospital records. Surgical times and blood loss were also extracted from these records. The procedure is described in detail. Interpretation of the surgical parameters and clinical effects are discussed. RESULTS: Six patients presented with a radiculopathy secondary to a misdirected pedicle screw. Two of these patients were admitted for simple removal. The four remaining patients who had undergone percutaneous pedicle screw fixation developed acute radicular pain from a misdirected screw. These patients underwent revision of their constructs by this method. Screws were also removed unilaterally in four other patients as the initial phase to revision or additional surgery. All procedures were performed through 16 mm tubular retractors. Operative time averaged 33 minutes for the group,and it ranged between 22 and 40 minutes. Hospital length of stay averaged I day for the group. Hospital stay averaged only 0.8 hospital days for the patients in whom screw removal was the primary goal. At 1 month after surgery no patient felt limited by incisional pain. No complications occurred. CONCLUSIONS: Unlike most other minimal access surgical procedures, the learning curve for this procedure appears to be relatively flat. Removal of pedicle screw fixation in the manner described proved to be simple and straightforward. The benefits are dramatic and immediate. It is possible to complete the procedure within minutes, and the pain produced is best described as inconsequential. This minimally invasive technique radically alters both the intraoperative and postoperative courses for those who face pedicle screw removal. The disadvantages associated with the standard open approach are reduced to the production of mild short-term discomfort and an exposure to the potential risks of brief anesthesia and the possibility of a surgical infection. Considering that hospital stay should be limited to I day or less and that surgical times are less than I hour, minimally invasive removal or revision of hardware should reduce overall costs significantly.
Adult↗