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Pacing and Clinical Electrophysiology :... Feb 2021The subcutaneous cardioverter-defibrillator (S-ICD) may be a valuable option in patients after successful transvenous lead extraction (TLE) without indication for...
AIMS
The subcutaneous cardioverter-defibrillator (S-ICD) may be a valuable option in patients after successful transvenous lead extraction (TLE) without indication for pacemaker therapy and persistent risk of sudden cardiac death. The aim of this study was to evaluate device performance, postoperative outcome, and safety in patients who received a S-ICD after TLE compared to patients who underwent de-novo S-ICD implantation.
METHODS
A retrospective analysis of all patients included into our institution's S-ICD database between September 2010 and May 2019 was conducted.The patients were divided in two groups, depending on whether they had received their S-ICD after TLE (n = 31) or de-novo (n = 113).
RESULTS
The TLE group was significantly older with a mean age of 54.3 ± 15.7 versus 46.7 ± 14.4 years; p = .007. Leading S-ICD indication in the TLE group was previous infection (50%), whereas in the de-novo group the S-ICD was primarily chosen due to young patient age (74.6%). Median duration of follow-up was 527.0 versus 472.5 days, respectively; p = .576. Most common complication during follow-up was inappropriate ICD therapy (12.9% vs. 13.3%); p = 1.000. Pocket erosion/infection occurred in 3.2% versus 3.5% with no reported cases of systemic (re-)infection in either group; p = 1.000. All-cause mortality was low (6.2% vs. 2.7%) and entirely unrelated to S-ICD implantation or the device itself; p = .293.
CONCLUSION
The S-ICD is a safe and effective alternative for patients after TLE with very similar results regarding device performance and postoperative outcome, when compared to patients who underwent de-novo S-ICD implantation.
Topics: Adult; Aged; Defibrillators, Implantable; Device Removal; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; Veins
PubMed: 33377195
DOI: 10.1111/pace.14157 -
International Journal of Pediatric... Mar 2018The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma...
INTRODUCTION
The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging.
OBJECTIVE
To describe management strategies for cholesteatoma diagnosis, surgical treatment, and post-operative management in children with Down syndrome.
METHODS
Retrospective case series of 14 patients (17 total ears) with Down syndrome diagnosed with cholesteatoma over a 9-year period.
RESULTS
A total of 14 patients with cholesteatoma (3 with bilateral disease) were analyzed. Thirteen ears (76.5%) had ≥2 tympanostomy tubes insertions prior to cholesteatoma diagnosis, and otorrhea and hearing loss were the most common presenting symptoms. Common pre-operative CT scan findings included mastoid sclerosis and ossicular erosion. The average age at first surgery was 9.8 years, and the average follow-up was 4.3 years. For acquired cholesteatoma, most ears were managed with canal wall up (CWU) approaches, but ultimately 6/15 (40.0%) required canal wall down (CWD) approaches. Postoperatively, 3 (20.0%) ears developed new tympanic membrane retraction pockets, but no recurrent cholesteatoma. Four (26.7%) ears developed recurrent disease, and 3 (20.0%) had residual disease at secondary procedures. Ossiculoplasty was performed in 4 ears. Twelve (70.6%) ears were rehabilitated with hearing aids or FM systems.
CONCLUSIONS
The diagnosis of cholesteatoma in Down syndrome was associated with otorrhea, hearing loss, and CT scan findings of ossicular erosion and mastoid sclerosis. Most cases were managed with CWU surgical approaches. Hearing aid use was common post-operatively.
Topics: Adolescent; Child; Child, Preschool; Cholesteatoma, Middle Ear; Down Syndrome; Endoscopy; Female; Hearing Loss; Humans; Infant; Male; Mastoid; Mastoidectomy; Middle Ear Ventilation; Otitis Media; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Tympanic Membrane; Tympanoplasty
PubMed: 29447898
DOI: 10.1016/j.ijporl.2018.01.016 -
Journal of Dentistry Sep 2018To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and...
OBJECTIVES
To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and periodontal pocketing (PPD) in young European adults.
MATERIALS AND METHODS
This is a secondary analysis using data collected from 350 UK participants enrolled in a European cross sectional study of 3187 young adults. GR, BOP, PPD, DH (participant and clinician assessment) and BEWE were recorded. A questionnaire assessed demographics, oral hygiene and lifestyle habits.
RESULTS
349 participants completed the study. GR, BOP and PPD showed the same pattern of distribution, prevalence increasing from incisors to molars in upper and lower arches for buccal and palatal scores. Every participant exhibited recession affecting at least 1 tooth, 42% having a maximum recession of 4-8 mm. There was a significant and linear association demonstrating an increase in maximum recession with age. DH and BEWE produced a similar pattern to buccal periodontal indices, the premolars being most affected. Maximum recession correlated significantly with maximum DH (participant and Schiff), PPD, BOP, BEWE (scores of 2/3), BMI (≥25 kg/m) and unsystematic brushing motion. 94% of the study population exhibited some BOP at one or more sites. 5% of the population had periodontal pocketing ≥4 mm, 46% had DH and 80% BEWE 2/3.
CONCLUSION
Widespread recession and gingivitis with minimal periodontal disease was observed. Every participant exhibited at least one tooth with recession. Many teeth did not exhibit DH despite prevalent recession and severe erosive toothwear. Recession correlates to a number of oral and lifestyle variables.
CLINICAL SIGNIFICANCE
Recession in young adults is multifactorial and highly prevalent. It can result in DH and consequential increase in demand for treatment relating to both pain and aesthetics. Further research is needed to understand the underlying aetiology to prevent recession occurring.
Topics: Cross-Sectional Studies; Gingival Recession; Gingivitis; Humans; Prevalence; United Kingdom; Young Adult
PubMed: 29933005
DOI: 10.1016/j.jdent.2018.06.005 -
Retina (Philadelphia, Pa.) Jul 2023We will describe a minimally invasive technique for the repair of iridodialysis, without conjunctival dissections, using intrasceral fixation of a 6-0 polypropylene...
PURPOSE
We will describe a minimally invasive technique for the repair of iridodialysis, without conjunctival dissections, using intrasceral fixation of a 6-0 polypropylene suture with a flanged tip.
METHODS
A flange was created at the end of the suture with thermoplasticity. An ab interno passing of the needle attached to the suture was performed through the peripheral part of the iris and was further passed out from the eye 1.5 mm to 2 mm behind the limbus. Intrascleral fixation of the exterior suture was performed with the aid of the attached needle. After adjusting the tension of the iris relocation, the externalized end of the suture was cut flush to the sclera with scissors. For a wide dialysis, the same manipulations were repeated until the repair was completed.
RESULTS
The technique was used in three eyes of three patients. No visual impairments of monocular diplopia and glare were observed after surgery. Postoperatively, the irises remained well positioned, with no suture erosion, suture loosening, hypotony, scleral atrophy, or chronic inflammation being observed within the follow-up period. Mild postoperative hyphema was observed in one eye of blunt trauma.
CONCLUSION
The present technique provides minimal surgical invasion for the repair of iridodialysis without creations of scleral flap/groove/pocket and conjunctival dissection.
Topics: Humans; Polypropylenes; Iris; Lens Implantation, Intraocular; Sclera; Surgical Flaps; Sutures; Suture Techniques; Lenses, Intraocular
PubMed: 32649489
DOI: 10.1097/IAE.0000000000002904 -
Indian Journal of Plastic Surgery :... Sep 2021Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free...
Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Twelve patients ( = 10; = 2) with a mean age of 65 years (range, 46-82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8-30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.
PubMed: 34667522
DOI: 10.1055/s-0041-1735417 -
Pain Practice : the Official Journal of... Jul 2022Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part,...
Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part, upon the gate control theory; however, new waveforms may suggest other mechanisms. Although benefits of the SCS technology generally outweigh the complications associated with SCS, some complications such as infection and skin erosion over the implant can result in device removal. Additional reasons for device removal, such as pocket pain and battery depletion, have driven technological innovations including battery-free implants and device miniaturization. The neurostimulation system described here was specifically designed to address complications commonly associated with implantable batteries and/or larger implantable devices. The benefits of the small size are further augmented by a minimally invasive implant procedure. Usability data show that patients found this novel neurostimulation system to be easy to use and comfortable to wear. What is more, clinical data demonstrate that the use of this system provides statistically significant reduction in pain scores with responder rates (defined as ≥50% reduction in pain) of 78% in the low back and 83% in the leg(s). Advances in miniaturization technology arose from the considerable shrinkage of the integrated circuit, with an increase in performance, according to Moore's law (1965). However, commensurate improvements in battery technology have not maintained a similar pace. This has prompted some manufacturers to place the battery outside, against the skin, thereby allowing a massive reduction in the implant volume, with the hopes of fewer device-related complications.
Topics: Chronic Pain; Humans; Pain Management; Spinal Cord; Spinal Cord Stimulation; Treatment Outcome
PubMed: 35509116
DOI: 10.1111/papr.13124 -
International Journal of Pediatric... Dec 20151. To determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) can decrease recurrence of ARPC and...
OBJECTIVE
1. To determine whether intraoperative tympanostomy tubes (TT) during surgery for acquired retraction pocket cholesteatoma (ARPC) can decrease recurrence of ARPC and retraction pockets (RP). 2. To determine the need for subsequent TT in children that did not initially receive TT.
STUDY DESIGN
Retrospective review of children who underwent primary surgery for ARPC.
SETTING
Tertiary care children's hospital.
SUBJECTS AND METHODS
Audiometry, operative reports, office findings, and recurrence of ARPC and RP were analyzed. Univariate analysis with Fisher's exact test, Wilcoxon rank-sum and t test, as well as multivariate analysis with logistical regression, were used for statistical analyses.
RESULTS
21 patients had TT at initial surgery and 34 patients did not. The recurrence of ARPC was 24% for the TT Group versus 44% for the no TT group (p=0.09). The incidence of RP was 33% in the TT group versus 41% in the no TT groups (p=0.35). 35% of the no TT group subsequently required TT. Audiometric outcomes were not different between groups. TT placement did not significantly affect the odds of recurrent ARPC and RP (95% CI 0.12-1.83, p=0.28 for ARPC and 95% CI 0.30-4.60, p=0.82 for RP). However, the odds of recurrent ARPC and RP were significantly increased in children with stapes and malleus erosion by cholesteatoma. Children with stapes and malleus involvement had 5.28 and 11.8 times higher odds of recurrent ARPC compared to those without ossicular erosion (95% CI 1.09-25.6, p=0.04 stapes and 95% CI 1.58-88.3, p=0.02 malleus). Similarly, children with malleus involvement had an 18.6 times higher odds of recurrent RP (95% CI 1.62-214, p=0.02) compared to those who did not. Incus erosion was not a significant predictor for recurrent ARPC and RP.
CONCLUSION
There was no statistical difference in recurrence or audiometric outcomes between patients who underwent TT versus those who did not during initial surgery for ARPC. However malleus and stapes erosion were significantly associated with recurrent ARPC and RP. These findings suggest that TT at initial ARPC surgery did not play a role in preventing recurrence, but malleus and incus erosion, was predictive of recurrent disease. A larger, prospective study of TT at initial surgery for ARPC is needed.
Topics: Adolescent; Audiometry; Child; Child, Preschool; Cholesteatoma, Middle Ear; Ear, Middle; Female; Humans; Logistic Models; Male; Middle Ear Ventilation; Recurrence; Retrospective Studies; Tertiary Care Centers; Treatment Outcome
PubMed: 26518467
DOI: 10.1016/j.ijporl.2015.08.028 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: Investigate structural changes in the tissues of the periodontal complex under the condition of experimental lipopolysaccharide periodontitis combined with...
OBJECTIVE
The aim: Investigate structural changes in the tissues of the periodontal complex under the condition of experimental lipopolysaccharide periodontitis combined with hyper¬thyroidism.
PATIENTS AND METHODS
Materials and methods: The studies were performed on adult white male rats, which simulated periodontitis combined with hyperthyroidism. Periodontal tissues were subjected to morphological examination on the 22nd day of the experiment. Collection of material for microscopic examinations was performed according to the generally accepted method; histological specimens were studied using a light optical microscope.
RESULTS
Results: Morphological studies of the components of the periodontal complex of experimental animals with experimental periodontitis established the reorganization of its structural elements. Damage to the epithelium in the area of attachment of the circular ligament and erosive-ulcerative changes of the gums led to a deepening of the gingival sulcus with the formation of a deep periodontal pocket. Intense hyperkeratosis was observed in the area of the bottom of the periodontal pocket. In the own plate of the mucous membrane of the gums - significant edema, collagen fibers were disorganized, defragmented. There were pronounced destructive-degenerative and inflammatory changes of the epithelial and own plates of all areas of the gums and periodontium, damage to the nuclei and cytoplasm of keratinocytes, fibroblasts, and leukocytes.
CONCLUSION
Conclusions: Experimental periodontitis combined with hyperthyroidism is accompanied by pronounced signs of destructive and inflammatory changes in the soft and dense tissues of the periodontal complex, as well as disruption of stromal-vascular interactions, which progress from reversible to irreversible disruption of periodontal connective tissue.
Topics: Animals; Collagen; Hyperthyroidism; Lipopolysaccharides; Male; Periodontal Pocket; Periodontitis; Rats
PubMed: 36129078
DOI: 10.36740/WLek202208203 -
Retina (Philadelphia, Pa.) Dec 2023To present the flattened flanged polypropylene suture technique developed to obtain round and stable pupils in patients with iridodialysis.
PURPOSE
To present the flattened flanged polypropylene suture technique developed to obtain round and stable pupils in patients with iridodialysis.
METHODS
After performing a fornix-based conjunctival peritomy, a flange was created at the tip of a 6.0 polypropylene suture by cautery. In the quadrant of iridodialysis, an ultrathin 30-gauge needle was inserted into the sclera at a distance of 2 mm from the limbus and advanced 1.5 mm intrasclerally, parallel to the limbus. The needle was directed radially into the eye and easily passed through the edge of the peripheral iris. The polypropylene suture was pushed into the lumen of the needle with the help of forceps. After the needle was externalized, the tip of the suture was flanged by cautery, and the flange was immediately flattened using a needle holder.
RESULTS
Six eyes of six patients with iridodialysis were enrolled in this study. Postoperatively, the irises remained well positioned and the pupils became round in all eyes. None of the patients developed suture erosion, suture loosening or rupture, hyphema, hypotony, chronic iridocyclitis, and angle closure.
CONCLUSION
The present technique provides a minimally invasive surgery and robust iris fixation without the need to create a scleral flap, groove, or pocket.
Topics: Humans; Polypropylenes; Iris; Sclera; Conjunctiva; Sutures; Suture Techniques; Lenses, Intraocular
PubMed: 37983378
DOI: 10.1097/IAE.0000000000003447 -
Archives of Plastic Surgery Jan 2017Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems,...
BACKGROUND
Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition.
METHODS
The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study.
RESULTS
Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage.
CONCLUSIONS
Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.
PubMed: 28194346
DOI: 10.5999/aps.2017.44.1.42