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At least 1,081 records · Page 60Linked to original sources
PubMed1977

Intrauterine deposition of calcium on copper-bearing intrauterine contraceptive devices.

Copper-bearing intrauterine contraceptive devices (IUDs) removed after various times in utero were examined by scanning electron microscopy and x-ray microanalysis of the elements present. As time in utero increased these devices became increasingly calcified. This calcification may limit the release of copper from the devices and decrease the specific contraceptive effectiveness of copper over an enert plastic device. Conversely, any teratogenic effects attributable to the copper may decrease with time in utero and depend on the extent of calcification. Even though the amount of copper in the device is not significantly diminished after two years, devices should not remain in situ for over two years because calcium accumulation probably prevents further diffusion of copper. Calcification can begin as early as six months after insertion. Consequently a careful review of the amount of time a copper-containing IUD should be left in situ should be undertaken.

Abnormalities, Drug-Induced↗
PubMed2006

Repositioning and removal of an intra-renal migrated ureteric Memokath stent.

The increasing use of ureteric stents including permanent ones is not without their own set of problems. The authors describe the difficulties encountered and a novel technique to reposition a permanent ureteric stent migrated into the kidney with an illustrated case. The same technique can also be applied to a-traumatically remove the stent if required.

Device Removal↗
PubMed2005

A sonography assisted technique for the removal of a femoral interlocking nail--a technical note.

BACKGROUND: Open methods for removal of femoral interlocking nails involve an incision (up to 10 cm) over the trochanter to find the tip of the nail. The distal locking screws are some times difficult to palpate and an incision (up to about 5 cm) is often needed for exposure. Intra-operative fluoroscopy is often used as an adjunct technique to minimize the surgical wound. However, patients and surgeons are exposed to a radiation hazard. Sonography can provide a real-time and efficient alternative to fluoroscopy. METHODS: Sonography of soft tissue has been established to identify a foreign body. A metallic implant has a hyperechoic image; therefore, we can identify the correct position of the screws preoperatively and intraoperatively. RESULTS: We have developed a technique using sonography and minimal incisions for the removal of a femoral interlocking nail. The proximal wound is 2.5 cm in length and the wound is 0.5 cm in length for each distal locking screw. CONCLUSION: The sonography can be used to minimize the length of incision and prevent radiation exposure in the removal of intramedullary femoral nails.

Bone Nails↗
PubMedDate not supplied

Clinical skills: how to remove and change a suprapubic cathether.

Suprapubic catheterization is becoming more widely used to drain the urinary bladder either short or long term or is inserted where initial urethral or recatheterization is problematic. No matter where you work as a nurse, either in the hospital, community, hospice or nursing care home, sooner or later you will have to deal with a patient with a suprapubic catheter in situ. One of the concerns nurses encounter when changing the suprapubic catheter is what action to take when the catheter appears to have become stuck when removing it. The main cause of this problem is owing to a 'cuffing' effect occurring to the deflated catheter balloon, especially if using 100% silicone catheters. This article looks at the problem of removing a suprapubic catheter that has become stuck and how to change such catheters safely.

Catheterization↗
PubMed2006

Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance.

BACKGROUND: Implanon insertion appears to be an easy procedure, but in a small minority of cases difficulties have been encountered with removal if the rod is impalpable. METHODS: Patients were referred to the contraceptive and sexual health service with non-palpable Implanon. Following a clinical assessment and examination of the arm where the implant had been inserted, an ultrasound examination was carried out to identify and locate the implant. These implants were subsequently removed, some under general anaesthesia and others under local anaesthesia. RESULTS: Twenty-seven patients were referred to the unit with impalpable Implanon rods. In four cases the rods were palpable and were removed in the clinic setting without the need for further intervention. Positive identification of the implants was achieved in 21 of the remaining 23 cases using ultrasound. No implant was detected in two cases and etonogestrel was not demonstrated serologically in either woman, suggesting non-insertion. All 21 Implanon rods identified by ultrasound were successfully removed. In just over 52% of women a previous attempt at removal had been undertaken prior to referral. CONCLUSIONS: It is possible to identify and locate impalpable Implanon rods with the aid of ultrasound, facilitating their subsequent safe removal. Although previous reports have identified the position of 'lost' implants using ultrasound, this is the first case series to discuss measuring the skin/implant depth. This parameter, together with the precise position of the implant (in muscle or fat), aids removal. All health professionals inserting and removing contraceptive implants should have been appropriately trained.

Adult↗
PubMed2001

Corporoscopic-assisted removal of ruptured inflatable penile prosthesis.

Despite the recent availability of effective oral agents for treatment of erectile dysfunction, many patients do not respond to oral therapy and do not desire injection therapy. For some of these patients, inflatable prostheses remain an effective form of treatment for erectile dysfunction; however, prostheses are not without their own set of complications. The most common complications are infection and mechanical failure. We present the case of mechanical failure of a prosthesis and the use of corporoscopy to assist in the removal and subsequent successful reimplantation of a new inflatable prosthesis.

Device Removal↗
PubMed2002

[Removal of osteosynthetic implants].

BACKGROUND: Removals of fracture implants constitute a considerable share of orthopaedic operations and take up significant hospital resources. In the Norwegian basic fracture course, guidelines are given on indications for removal as well as minimum function time for implants. Indications for implant removal are, however, relative, and we wanted to study actual practice in this field in Norway. MATERIAL AND METHODS: An inquiry was made to Norwegian hospitals in spring 2000 concerning their current practice for implant removal. RESULTS: Most hospitals follow the suggestions given but there is still great variation, especially in age limits for routine removal of all implants, which range from 15 to 70 years. INTERPRETATION: Implant removal is desirable after fracture healing but it requires a surgical procedure with a certain morbidity and incidence of complications. Lack of strict criteria for removal may explain varying practice. We conclude that there should be a uniform practice for implant removal in Norwegian hospitals. More research is warranted on the possible systemic and local long-term effects of implants remaining in situ in order to give more evidence-based indications for implant removal.

Adolescent↗
PubMed1990

[Closure of the persistent ductus arteriosus (Botalli) using a catheter procedure; the initial 50 patients treated in The Netherlands].

Experience gained with non-surgical catheter occlusion of patent ductus arteriosus in 50 patients (1-65 years) is described. Embolisation of the Rashkind device into the right pulmonary artery occurred in 1 patient. In another patient the device was removed because the prongs of the proximal umbrella could not be visualized. In 4 patients a considerable residual shunt was successfully treated with implantation of a second device. In 1 of these 4 patients this resulted in disappearance of considerable haemolysis as well. Five patients, however, still have a--haemodynamically insignificant--residual shunt. In 43 patients catheter occlusion of the ductus arteriosus was 100% successful. The advantages and disadvantages of this method are briefly compared with those of surgical treatment.

Adolescent↗
PubMed2004

Extended-interval aminoglycoside dosing for treatment of enterococcal and staphylococcal osteomyelitis.

BACKGROUND: Gram-positive osteomyelitis requires long-term antibiotic therapy, much of which is often administered in the outpatient setting. Historically, synergistic aminoglycoside use in these infections requires multiple daily doses, which can be inconvenient. Data regarding extended-interval aminoglycoside dosing (EIAD), also known as once-daily dosing, in this setting are lacking. OBJECTIVE: To evaluate the safety and efficacy of EIAD in the treatment of gram-positive osteomyelitis. METHODS: Retrospective chart review of adult patients treated for documented, gram-positive osteomyelitis with EIAD at the University of New Mexico Home IV Antibiotic Clinic was conducted. The patients' medical records were reviewed by an infectious diseases clinical pharmacist. Clinical and microbiologic outcomes and the incidence of nephrotoxicity and ototoxicity were the main outcome measures. RESULTS: Fifteen patients (16 events) were included. Enterococcus spp. was the most common organism isolated. Nine patients had infected equipment or devices; 6 of these had removal of these devices in conjunction with antibiotic therapy. The median duration of antibiotic therapy was 6 weeks (range 6-31). The median duration of aminoglycoside therapy was 28 days (range 6-43). Seven patients developed nephrotoxicity, 5 of whom received an aminoglycoside in combination with vancomycin. Male patients had a higher risk of developing nephrotoxicity compared with females (p = 0.04). The mean +/- SD duration of EIAD before the development of nephrotoxicity was 34 +/- 8 days. Clinical cure was achieved in 12 (75%) patients. Three patients achieved clinical cure without hardware removal. CONCLUSIONS: Most of the patients with gram-positive osteomyelitis were successfully managed with EIAD. However, nephrotoxicity developed in a high proportion of patients and was likely related to prolonged aminoglycoside use.

Adult↗
PubMed2006

Access strategies for revision or explantation of the Charité lumbar artificial disc replacement.

BACKGROUND: Several lumbar disc prostheses are being developed with the goal of preserving mobility in patients with degenerative disc disease. The disadvantage of lumbar artificial disc replacement (ADR) compared with anterior interbody fusion (ALIF) is the increased potential for displacement or component failure. Revision or removal of the device is complicated by adherence of the aorta, iliac vessels, and the ureter to the operative site. Because of these risks of anterior lumbar procedures, vascular surgeons usually provide access to the spine. We report our experience with secondary exposure of the lumbar spine for revision or explantation of the Charité disc prosthesis. METHODS: Between January 2001 and May 2006, 19 patients with prior implantation of Charité Artificial Discs required 21 operations for repositioning or removal of the device. Two patients had staged removal of prostheses at two levels. One patient had simultaneous explantation at two levels. The mean age was 49 years (range, 31 to 69 years; 56% men, 42% women). The initial ADR was performed at our institution in 14 patients (74%). The mean time from implantation to reoperation was 7 months (range, 9 days to 4 years). The levels of failure were L3-4 in one, L4-5 in nine, and L5-S1 in 12. RESULTS: The ADR was successfully removed or revised in all patients that underwent reoperation. Three of the 12 procedures at L5-S1 were performed through the same retroperitoneal approach as the initial access. One of these three, performed after a 3-week interval, was converted to a transperitoneal approach because of adhesions. The rest of the L5-S1 prostheses were exposed from a contralateral retroperitoneal approach. Four of the L4-5 prostheses were accessed from the original approach and five from a lateral, transpsoas exposure (four left, one right). The only explantation at L3-4 was from a left lateral transpsoas approach. Nineteen of the 22 ADR were converted to ALIF. Two revisions at L5-S1 involved replacement of the entire prosthesis. One revision at L4-5 required only repositioning of an endplate. Access-related complications included, in one patient each, iliac vein injury, temporary retrograde ejaculation, small-bowel obstruction requiring lysis, and symptomatic, large retroperitoneal lymphocele. There were no permanent neurologic deficits, deep vein thromboses, or deaths. CONCLUSIONS: Owing to vascular and ureteral fixation, anterior exposure of the lumbar spine for revision or explantation of the Charité disc replacement should be performed through an alternative approach unless the procedure is performed < or = 2 weeks of the index procedure. The L5-S1 level can be accessed through the contralateral retroperitoneum. Reoperation at L3-4 and L4-5 usually requires explantation and fusion that is best accomplished by way of a lateral transpsoas exposure.

Adult↗
PubMed2004

Analysis of local complications following explantation of silicone breast implants.

A study was undertaken to analyse local complications in patients with breast implants and the total number of implant-related interventions when silicone breast implants were explanted. We studied 53 patients who had received breast implants for cosmetic augmentation or breast reconstruction following surgery for breast cancer at the time of explantation. The clinical records of all these patients were analysed, and clinical information on reason for implantation, implant properties, number and kind of implant-related interventions and reason for explantation was elicited. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture, loss of implant integrity, haematoma or seroma, infection of the implant site, extrusion or wound dehiscence, and dissatisfaction with the result. The mean numbers of implant-related operations were 3.1 in patients who had undergone breast reconstruction and 2.3 in patients who had cosmetic augmentation (P < 0.03). We found a total of 35 complications in 28 patients, 21 patients (75%) each had one complication, five patients (18%) had two and two patients (7%) had three complications. A significantly higher incidence of early complications in patients who had undergone breast reconstruction (P < 0.03) marks the difference from complications in the cosmetic group, most of which arose after a longer time (P < 0.02). A complication analysis is presented. At the time of explantation, 78% of the patients decided to have a new implant, while 12% requested permanent removal of the implant without replacement. In the present study we saw no patients with connective tissue or other autoimmune disorders. When breast reconstruction or augmentation with silicone devices is considered, patients must be informed of the possible complications and of the potential choices in later implant-related revision surgery.

Adult↗
PubMed2006

Mechanical cardiac support in the young with the Berlin Heart EXCOR pulsatile ventricular assist device: 15 years' experience.

The pediatric-size pneumatically driven pulsatile extracorporeal ventricular assist device (VAD) Berlin Heart EXCOR (Berlin Heart Mediprodukt GmbH, Berlin, Germany) was introduced into clinical practice by the German Heart Institute Berlin in 1992. Until July 1, 2005, Berlin Heart EXCOR systems have been used for circulatory support in 68 children up to 18 years of age with severe circulatory failure resistant to pharmacologic therapy. These were patients suffering from cardiomyopathy, fulminant myocarditis, end-stage congenital cardiac defects, and acute heart failure following congenital heart surgery. Mean VAD support time was 35 days (range, 0 to 420 days). Forty-two patients (62%) survived to transplantation or after weaning; 37 patients (54%), including eight infants, were discharged home. These results in patients with very advanced disease have improved significantly in recent years because of technical developments and growing experience in the treatment of patients on the device, in postoperative care and optimal timing for VAD implantation. Timely implantation of the Berlin Heart EXCOR in the course of progressive heart failure now appears to be justified because the system has undergone the necessary modifications and the accumulation of clinical knowledge has made its use highly reliable and safe.

Adolescent↗
PubMed1976

Therapy of Staphylococcus aureus bacteremia associated with a removable focus of infection.

We did a retrospective study of Staphylococcus aureus bacteremia--from removable foci of infection--treated with short course antimicrobial therapy. Patients with S. aureus endocarditis were excluded from our study. The majority of patients had sepsis from intravascular devices. After removal of the focus of bacteremia, antibiotics were administered for a mean period of 15.2 days. There were no relapses, and no patient developed endocarditis. A 10- to 21-day antibiotic regimen can be curative in S. aureus bacteremia associated with a removable focus of infection.

Adolescent↗
PubMed1991

New female intravaginal barrier contraceptive device. Preliminary clinical trial.

The Fem Cap, a silicone rubber cervical cap, is shaped like a sailor's hat. While its dome covers the cervix, its rim fits snugly into the vaginal fornices, and its brim adheres and conforms to the vaginal walls. A spermicidal material is applied to the cap, then it is positioned over the cervix by hand or with a special applicator. The device is removed by hand up to 48 hours after insertion, but no sooner than eight hours after intercourse. Women chosen for the trial had contraindications to or were dissatisfied with the currently available contraceptive methods. Each woman was fitted with a cap of suitable size and instructed in its use. She was then asked to note any side effects and the dates of her menses in a diary. One-hundred-twenty-one women were enrolled in the study. Five became pregnant. Of those, two reported dislodgment of the cap during intercourse; the other three admitted to non-use of the cap on several occasions. This device has proven so far to be safe, effective and acceptable to women and men. It has several advantages over the currently available barrier contraceptive devices. The silicone rubber material from which it is made is non-allergenic, durable and easy to clean. Its design fits the anatomy and accommodates physiological changes. The Fem Cap is easy to insert and remove; an applicator facilitates insertion for some women. Instruction for use of the device requires short time from the health care provider.

Adolescent↗