Transesophageal echocardiographic-guided percutaneous removal of a pigtail catheter from the left atrium.
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Cardiac Catheterization↗
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Results for “Device Removal”
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The "sardine can technique": a method for the removal of internal fixation hardware.
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Bone Plates↗
The use of boric acid solution to help in the removal of biodegraded Miragel episcleral buckles.
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Animals↗
Spontaneous migration of an inferior vena cava filter resulting in cardiac tamponade and percutaneous filter retrieval.
Thromboembolic disease accounts for thousands of hospitalizations every year in the US. Its primary management consists of anticoagulation. However, in certain instances this may be contraindicated or not sufficient. Mechanic occlusion of the inferior vena cava (IVC) becomes then a viable alternative. In this case a 35-year-old man presented with a saddle pulmonary embolus but was unable to be anticoagulated due to intestinal bleed. A removable IVC filter was then placed. The filter spontaneously migrated into the right atrium causing severe tricuspid regurgitation, perforation of the atrial wall, and cardiac tamponade. The device was successfully retrieved percutaneously and the patient discharged from the hospital in stable condition. This case illustrates the potentially lethal complications associated with the use of IVC filters, as well as the possibility to percutaneously recover them from within the right atrium.
Adult↗
Implantation of central venous ports with catheter insertion via the right internal jugular vein in oncology patients: single center experience.
AIM OF WORK: Evaluation of suitability and safety of venous port implantation with catheter insertion via the right internal jugular vein in oncology patients. PATIENTS AND METHODS: One hundred one totally implantable venous ports were placed in 100 patients with malignancies from January 1, 2003 until March 31, 2005. Catheter of venous port was preferably inserted via the right internal jugular vein. We recorded a number of successful implantations using this venous approach and the rate of complications during the procedure and follow-up. MAIN RESULTS: Ninety-seven catheters (96%) of totally implantable venous ports were inserted via the right internal jugular vein in 96 patients, and only in four cases were we not able to access this vein. We had no complications related to catheter insertion via the right internal jugular vein. Follow-up was made in all 96 patients with a total access days of 41 in 151 days (mean: 407 days). Premature catheter removal was required in six (6.2%, 0.144 per 1,000 access days) due to complications: three catheter dislocations/malfunctions (3.1%, 0.072 per 1,000 access days), one port-related sepsis, one pocket port infection, and one decubitus over port (1%, 0.024 per 1,000 access days). Six venous ports were removed after completion of the treatment at the patient's request. CONCLUSION: The placement of totally implantable venous ports with catheter insertion via the right internal jugular vein has a high success rate without any early complications. Follow-up also demonstrates a low incidence of late complications requiring port removal.
Adult↗
The biomechanics of rigid contact lens removal.
The removal of rigid contact lenses from the eye, using the eyelids, is a relatively simple procedure. However, there is a sequence of biomechanical events underlying this procedure which are not well understood. By using high-speed videokeratoscopy (50 Hz), we have shown that during the lid-pull procedure the cornea typically shows a significant increase in with-the-rule astigmatism by an average of 2.19 D (axial power). The average increase in steep K power was 1.22 D (S.D. +/-1.05 D) and the average decrease in flat K power was 0.97 D (S.D. +/-1.05 D). This change in corneal topography increases the edge lift of the lens at 12 and 6 O'clock locations of the lens, enhancing the removal process. When the subject blinks, as the lid margins reach the lens edge, the lens flexes and the eye retracts by an average of 0.66 mm (S.D. +/-0.27 mm). This retraction again enhances the act of lens removal.
Adult↗
Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort.
BACKGROUND: Few patients have significant symptoms during wireless esophageal pH monitoring, and the capsule typically sloughs spontaneously. Severe discomfort during monitoring can occur that requires endoscopic dislodgement of the capsule. OBJECTIVE: To determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention. DESIGN: Chart review. SETTING: University-based outpatient endoscopy facility. PATIENTS: A total of 452 consecutive patients undergoing wireless pH monitoring over a 3.5-year period. INTERVENTIONS: Endoscopic dislodgement of the capsule by using nudging with the endoscope tip and cold snare techniques. RESULTS: Eight subjects (1.8%) required endoscopic capsule dislodgement because of severe chest pain or odynophagia (n = 7) or severe foreign-body sensation (n = 1). Chest pain was the initial indication for pH monitoring in 5 (62.5%) of the subjects. Initial nudging with the endoscope tip successfully dislodged 2 capsules; continued nudging produced mucosal stripping in 3 subjects, which required hemostasis in 1. A cold snare was used successfully, without complication, to separate the capsule from stripped mucosa and as a primary removal method in the remainder of subjects. Capsule removal uniformly resulted in marked improvement of discomfort. CONCLUSIONS: Endoscopic removal of the capsule was required in <2% of subjects who underwent wireless pH monitoring. Separation of the capsule from the mucosa with a cold snare may be the preferred method of accomplishing uncomplicated removal.
Adult↗
Totally laparoscopic explantation of migrated stent graft after endovascular aneurysm repair: a report of two cases.
This report describes the removal of two migrated stent grafts and the repair of abdominal aortic aneurysms by laparoscopic technique. In these two cases, endovascular treatment was not indicated because of device migration into the aneurysm and the presence of thrombus within the endografts. Operative times were 245 and 230 minutes, with aortic clamp times of 95 and 66 minutes. The patients were extubated immediately after the procedure, resumed a normal diet on postoperative day 2, and were discharged home on postoperative days 5 and 6. We believe these are the first reported cases of laparoscopic explantation of migrated aortic stent grafts in the literature.
Aged↗
Removal of the retained fragment of broken solid nails by the intra-medullary route.
The development of solid nails has not eliminated the risk of occasional nail failure. It has been suggested that subsequent intra-medullary removal of solid nail fragment may be virtually impossible and thus major surgery is required for their revision. We report two cases of hardware failure of a solid intra-medullary nail (Synthes solid femoral and tibial nail) and describe their successful intra-medullary removal using the Synthes extraction kit.
Adult↗
Technique for removal of a capsular tension ring from the vitreous.
PURPOSE: To report a new technique for safely and quickly removing a displaced capsular tension ring from the vitreous cavity. DESIGN: Two interventional case reports. PARTICIPANTS: The authors retrospectively reviewed the charts of two patients with displaced capsular tension rings (CTRs). INTERVENTION: Surgical removal of the displaced CTRs was performed in two patients. MAIN OUTCOME MEASURES: Visual and anatomic outcomes. RESULTS: The CTRs were removed surgically, in case 1 by cutting the CTR into two pieces before removal and in case 2 by using the CTR injector to remove the CTR in one piece through a sclerotomy site. Both patients had good visual and anatomic outcomes. CONCLUSIONS: The described technique of removing a displaced CTR in one piece through a sclerotomy site using the CTR injector provides a safe and efficient method of CTR removal. Cutting the CTR into two or more pieces for removal is not recommended.
Aged↗
Transnasal removal of a biliary endoprosthesis with percutaneous transhepatic biliary catheter replacement.
The authors describe a novel fluoroscopically guided transnasal technique for removal of an endoscopically placed endobiliary prosthesis (EBP). A case in which the approach was applied is used to demonstrate its indications, clinical utility and possible benefits. The procedure entails simultaneous percutaneous replacement of the EBP with an internal/external biliary catheter over a through-and-through transhepatic/transnasal access wire. A comparison of the technique's limitations with those of traditional approaches for endoscopic or percutaneous EBP removal and replacement is presented.
Aged↗
A case report: reconstruction of a damaged knee following treatment of giant cell tumor of the proximal tibia with cryosurgery and cementation.
OBJECTIVE: Reconstruction of a knee damaged by cement packed to cure a giant-cell tumor is sometimes difficult. We reconstructed such a knee by removal of the cement, autologous bone transplantation and distraction osteogenesis using the Ilizarov apparatus. In this paper the results 29 months after the salvage surgery are given. PATIENT AND METHODS: We saw a 31-year-old woman's knee joint that showed osteoarthritic change after curettage, cryosurgery and cementation performed 4 years previously for a giant-cell tumor of the proximal tibia. We reconstructed the knee joint. This procedure included cement removal, alignment correction by tibial osteotomy, subchondral bone reconstruction by autologous bone transplantation, and filling the defect after removing the bone cement by elongating the diaphysis using the Ilizarov apparatus. RESULTS: Distraction was terminated 4 months later when 54 mm of elongation was performed. All devices were removed 12 months after the surgery. Seventeen months after the removal of the apparatus, the range of motion of the right knee was 0 degrees extension and 110 degrees flexion, and the patient was able to walk without pain. CONCLUSIONS: Although the treatment period is long and there may be some complications of Ilizarov lengthening and distraction osteogenesis, this procedure has numerous benefits. Bony defects can be soundly reconstructed and, at the same time, the alignment of the knee can be corrected. Also it is not necessary to reconstruct the ligaments because the insertions are intact. If osteoarthritis progresses, a surface type total knee replacement can be performed, not constrained type prosthesis, which would be used if the bony structure had not been reconstructed. This procedure may be one of the candidates for reconstructing such knee joints destroyed by bone cement.
Adult↗
Functional results after operative treatment of olecranon fractures.
In a retrospective, nonrandomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between March 1, 1992 and March 1, 2000. Medical charts and radiographs of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time interval of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, age and comorbidity were analysed. Radiological end result (intraarticular step-offs, gaps, arthrosis), subjective complaints, mobility of the elbow joint and muscle strength were evaluated. Patients with an unstable elbow (Mayo classification type III and Schatzker-Schmeling classification type D) had a higher loss of elbow function than others. There was a correlation between fracture morphology (fractures type C and D in the Schatzker-Schmeling classification) and arthrosis. There also was a correlation between suboptimal osteosynthesis and arthrosis. There was no correlation between suboptimal osteosynthesis, implant loosening and secondary procedures. Patients more often expressed subjective complaints and loss of function in activities of daily life before than after hardware removal. Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures. We therefore recommend the classification systems of the Mayo-clinic or of Schatzker-Schmeling. As many patients have complaints related to the implants, we recommend hardware removal after fracture healing.
Adult↗
The use of Q-switched alexandrite laser (755 nm, 100 ns) for eyeliner tattoo removal.
BACKGROUND: Eyelid tattooing for cosmetic reasons has increased in the past few years, and unsatisfied customers may request pigment removal. Q-switched laser systems have been useful in these cases. OBJECTIVE: To evaluate the clinical result of a patient with a bluish-black eyelid tattoo treated with Q-switched alexandrite laser. METHODS: Threshold fluence was determined and a spot test made on the first visit. Treatment was with QSAL, with a fluence range of 6.75-7.50 J/cm2 (mean fluence 7.125 +/- 0.26) and overlapping +/- 10% at 4-week intervals. RESULTS: The eyeliner tattoo was not completely removed after five treatments with QSAL, but noticeable pigment lightening was obtained. No side effects were seen. CONCLUSIONS: Q-switched alexandrite laser may be a useful device to remove the bluish-black pigment used in cosmetic eyeliner tattoo.
Aged↗
Technique for removal of broken interlocking screws.
Breakage of an interlocking screw is a known complication in tibial fractures treated by intramedullary nailing. This happens most often in delayed union or nonunion because of the lack of progressive load transference from the nail to the healing bone. To treat this problem, the nail and screws need to be removed. This article describes a simple technique for the removal of broken interlocking screws.
Bone Screws↗
Removal of Günther Tulip vena cava filter through femoral vein approach.
The Günther Tulip vena cava filter is designed for removal by the internal jugular vein approach with use of a blunted hook placed at the superior aspect of the filter. Removal of this filter was performed by the femoral approach in a patient with central venous occlusion that precluded removal by the conventional approach.
Anticoagulants↗
Long-term air-exposed functioning hydrocephalus valve with no infection.
One of the reasons for shunt infection is valve erosion through the skin. In such cases, it is common practice to instantly relocate the shunt to avoid infection. We present a 77-year-old female patient with a 15-month history of hydrocephalus valve extrusion. Despite her poor mental status, clinical condition and hygiene, and the prolonged extrusion period, she developed neither a local nor a cerebrospinal fluid (CSF) infection. The patient was ultimately treated with shunt removal and repositioning. An extensive literature review revealed no previous report of such a case. This case indicates that under rare conditions, central nervous system (CNS) implantable devices might not become contaminated and may remain functional, even if they remain exposed for prolonged periods.
Aged↗
Ultrasound localisation and removal of non-palpable Implanon implants.
BACKGROUND: Implanon is the trade name for a contraceptive implant that releases etonogestrel over a 3-year period. The rod is inserted into the subdermis of the upper arm. The implant should be palpable and easily removed through a small incision. AIMS: To determine whether ultrasound is an accurate means of localising and guiding removal of non-palpable Implanon implants. METHODS: All patients referred to The Northern Hospital, between March 2002 and October 2005, for localisation and/or removal of their non-palpable Implanon implants were included in this study. Ultrasound was used to locate the implants, the implant was considered localised when a linear echogenic rod with posterior acoustic shadowing was identified. When removal of the implant was requested and the implant was clear of neurovascular structures, blunt dissection was performed under ultrasound control and the implant was extracted. If the implant was considered too close to major neurovascular structures, the position of the implant was marked and the patient was referred for surgical removal. RESULTS: Thirty-four women were included in the study. In 33 patients the implant was identified. In one patient no implant was found and its absence was confirmed by serum assay. Twenty-four patients were referred for implant removal. In 20 patients the implant was successfully removed under ultrasound guidance. In the other four patients the implant was close to neurovascular structures. The position of the implants was marked and surgical removal was successfully performed. CONCLUSION: Ultrasound is highly accurate at localising and guiding removal of non-palpable Implanon implants.
Adipose Tissue↗