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CJC Open Jun 2022The aging population, particularly the thin and frail, has an increased risk of long-term cardiac implantable electronic device complications. This case is that of an...
The aging population, particularly the thin and frail, has an increased risk of long-term cardiac implantable electronic device complications. This case is that of an elderly, thin-skinned patient who presented with a pacemaker pocket erosion 4 years after elective generator change, potentiated by a small pocket size with a superficial suture fixating the generator in the subcutaneous pocket. The risk for device erosion may have been mitigated during the generator change by increasing the size of the pocket, using a submuscular pocket, and potentially an absorbable antibacterial envelope. Fixation of the generator is considered optional.
PubMed: 35734518
DOI: 10.1016/j.cjco.2022.03.002 -
Journal of Otology Sep 2017The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas. (Review)
Review
AIMS
The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas.
METHODS
Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years (from 1 to 17 years). The sample presented a mean age of 47.56 ± 19.11 years (from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10 (40%) underwent tympanoplasty (TPL) type I, 14 (56%) TPL type II and 1 (4%) TPL type V.
RESULTS
Eleven ears (44%) showed cholesteatoma: all these cases were stage III according to Charachon staging, and stage IV or V according to Gersdorff classification. Twelve patients (48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage II or III RP (according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.
CONCLUSIONS
Surgical treatment of stages II and III RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP (stages IV and V, according to Gersdorff) are the real predictors of poor prognosis.
PubMed: 29937845
DOI: 10.1016/j.joto.2017.04.003 -
Cureus Jan 2021Background The CanGaroo® Envelope (Aziyo Biologics, Silver Spring, MD) is intended to securely hold a cardiovascular implantable electronic device (CIED) to create a...
Background The CanGaroo® Envelope (Aziyo Biologics, Silver Spring, MD) is intended to securely hold a cardiovascular implantable electronic device (CIED) to create a stable environment when implanted in the body. Data on the utilization of this newly available product are limited. Objective In this study, our objective was to describe the specific profiles of patients who may benefit from the use of the CanGaroo® Envelope at the time of CIED implantation. Methods The utilization of the CanGaroo® Envelope was assessed from January 2019 to October 2019 among a series of patients who were either undergoing de-novo CIED implantation or replacement. Results Among a total of 50 patients, the CanGaroo® Envelope was utilized in 15 (30%). Three distinct patient profiles were identified: profile 1: elderly patients with poor tissue turgor at risk of wound dehiscence or erosion; profile 2: patients with a history of previous device infection; and profile 3: patients at high risk of device infection having one or more of the following risk factors - chronic kidney disease, immunocompromised state, or diabetes mellitus. At a mean follow-up of 18 ±3 months, no CIED pocket erosion, dehiscence, or infection was noted. Conclusions Three distinct profiles of patients who could potentially benefit from the use of the CanGaroo® Envelope were identified by the implanting physicians. Long-term follow-up data, including infection and wound dehiscence rates, are necessary to further analyze the optimal utilization of the device.
PubMed: 33604224
DOI: 10.7759/cureus.12702 -
Indian Journal of Otolaryngology and... Aug 2022Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves...
Ossicular discontinuity is the most common cause of conductive hearing loss. The use of ossicular graft material in ossicular chain reconstruction significantly improves the result in hearing. This study was conducted to compare and analyze the outcome of ossicular reconstruction using allogenic septal spur cartilage and autologous cortical bone in terms of hearing results and graft uptake rates. Study design: randomized clinical trial. Study included 112 patients visiting our ENT department. Patients between 16 and 50 years of age with history of chronic ear discharge and air-bone-gap (ABG) of > 35 dB and ossicular involvement were included in the study. The patients underwent detailed ENT examination, audiological and radiological assessment of temporal bone and those patients with evidence of ossicular erosion were subjected to ossiculoplasty with allogenic septal spur cartilage (group I) and autologous cortical bone (group II) randomly. The patients were followed up to 6 months to analyze functional and anatomical results. 50 patients out of 56 patients (90%) from group I who underwent allogenic septal cartilage ossicular reconstruction showed significant improvement in hearing as assessed by pure tone audiogram after 3 months and 6 months. Remaining 10% of patients who did not show hearing improvement on PTA were reopened after 6 months. It was observed that the stapes head got necrosed in them. 40 patients (72%) out of 56 patients (50%) from group II who underwent autologous cortical bone reconstruction showed hearing improvement. Remaining 16 patients (28%) showed no hearing improvement. They were reopened and ankylosis, dislocation of ossicle and extrusion were noted. In our study, graft uptake rates, formation of retraction pockets, and hearing improvements were analyzed. Complications like ankylosis formation, dislocation of ossicle and extrusion rates were more in the group II compared to group I. Hearing results of group I are better compared to group II and the allogenic septal cartilage being readily available is a good option for ossicular reconstruction.
PubMed: 36032828
DOI: 10.1007/s12070-020-01924-8 -
Cureus Dec 2020The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases....
The standard of care for device infection is normally a complete removal of the implantable system, including lead extraction in local or systemic infection cases. Despite the importance of lead extraction techniques, these techniques are complex and have some major risks. Success rates were high, but they are less favorable in patients with several comorbidities. An 80-year-old male presented for device erosion. The patient is known to have several cardiac comorbidities: a transcatheter aortic valve replacement (TAVR), mitral clips for severe aortic stenosis, mitral regurgitation, dual-chamber implantable cardioverter defibrillators (ICD) for secondary prevention. Several weeks ago, he noted tenderness and redness at the site of his device pocket, and his physician, after checking his wound, suggested a possible skin irritation with no systemic infection and started antibiotics treatment. Two weeks later, he noted thinning of the skin around the device with a hematoma and ecchymosis, and slight skin erosion. Strategies for assessment of the wound and pocket cleaning were taken. The strategy was to remove the left-sided device and keep the leads since the patient lately has no elevated inflammatory labs, negative cultures, no fever, nor signs of vegetation on transesophageal echocardiography (TEE) and refused any additional examination as positron emission tomography (PET) scan, and reimplant a new system on the contralateral side. The procedure was divided into two sequences: extracting the device and after one-week implantation of a right-sided new system. In this case, chronic antibiotics were discussable to decrease the recurrence rate, but they did increase the severity of the patient's thrombocytopenia. Despite extraction being the gold standard of treatment in most cases of devices with local and systemic infection, there are some frail patients with several comorbidities where extraction is unbearable due to its major risks and complex procedure. In these specific cases with local infection and device erosion with no signs of any systemic infection, conservative therapy could be a viable option.
PubMed: 33457133
DOI: 10.7759/cureus.12032 -
Molecular Pharmaceutics May 2021Except for routine scaling and root planing, there are few effective nonsurgical therapeutic interventions for periodontitis and associated alveolar bone loss....
Except for routine scaling and root planing, there are few effective nonsurgical therapeutic interventions for periodontitis and associated alveolar bone loss. Simvastatin (SIM), one of the 3-hydroxy-3-methylglutaryl-cosenzyme A reductase inhibitors, which is known for its capacity as a lipid-lowering medication, has been proven to be an effective anti-inflammatory and bone anabolic agent that has shown promising benefits in mitigating periodontal bone loss. The local delivery of SIM into the periodontal pocket, however, has been challenging due to SIM's poor water solubility and its lack of osteotropicity. To overcome these issues, we report a novel SIM formulation of a thermoresponsive, osteotropic, injectable hydrogel (PF127) based on pyrophosphorolated pluronic F127 (F127-PPi). After mixing F127-PPi with F127 at a 1:1 ratio, the resulting PF127 was used to dissolve free SIM to generate the SIM-loaded formulation. The thermoresponsive hydrogel's rheologic behavior, erosion and SIM release kinetics, osteotropic property, and biocompatibility were evaluated . The therapeutic efficacy of SIM-loaded PF127 hydrogel on periodontal bone preservation and inflammation resolution was validated in a ligature-induced periodontitis rat model. Given that SIM is already an approved medication for hyperlipidemia, the data presented here support the translational potential of the SIM-loaded PF127 hydrogel for better clinical management of periodontitis and associated pathologies.
Topics: Alveolar Bone Loss; Alveolar Process; Animals; Drug Carriers; Drug Liberation; Female; Humans; Hydrogels; Injections, Intralesional; Mice; Models, Animal; Periodontitis; Poloxamer; RAW 264.7 Cells; Rats; Simvastatin; Solubility; X-Ray Microtomography
PubMed: 33754729
DOI: 10.1021/acs.molpharmaceut.0c01196 -
Journal of Cardiothoracic Surgery Sep 2020Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or...
BACKGROUND
Pocket-related complications following the implantation of cardiovascular implantable electronic devices primarily include pocket hematoma, infection, skin erosion or decubitus, device migration, and Twiddler's syndrome, with other pathologies such as nerve impairment or bone lesions being extremely rarely encountered. We report a case of a 20-year old asthenic, non-athlete female patient presenting with a device-generated fracture of the second rib several months after sub-muscular permanent pacemaker implantation due to repeated bilateral pre-pectoral pocket infections.
CASE PRESENTATION
A 20-year old female patient was readmitted to our institution 9 months following sub-pectoral implantation of a permanent pacemaker, complaining of severe pocket-related pain, which arose spontaneously in the absence of direct trauma, intense physical activity or vigorous coughing, and was associated with normal day-to-day activity. To rule out a pacemaker re-infection, a native computed tomography and a positron emission tomography-computed tomography of the thorax were performed. Both modalities excluded an infection but showed a healing fracture and a focus of enhanced metabolic activity in the anterolateral part of the right second rib, indicating a non-traumatic or stress fracture of the bone. Consequently, a complete extraction of the pulse generator and both leads was performed and the smallest available single-chamber pulse generator with a single atrial electrode was implanted in the sub-fascial, pre-muscular pocket in the now recovered and uninfected left subclavicular region, alleviating patient's severe pain symptoms and significantly enhancing her quality of life.
CONCLUSIONS
In the absence of direct trauma, intense physical activity or vigorous coughing, we assume that in this asthenic girl a normal day-to-day motion of the right shoulder has persistently forced the sub-muscularly placed pulse generator toward thoracic wall, putting increased repetitive pressure force on the underlying bones, finally causing a fatigue stress fracture of the second rib. In asthenic phenotype patients with small thorax and short subclavicular distance, a sub-muscular pacemaker implantation can potentially cause unique and unexpected pocket-related adverse events necessitating advanced diagnostics and timely treatment.
Topics: Diagnosis, Differential; Female; Fractures, Stress; Humans; Pacemaker, Artificial; Postoperative Complications; Quality of Life; Rib Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 32938486
DOI: 10.1186/s13019-020-01303-y -
Health and Human Rights Dec 2019Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms...
Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms that are implemented with neoconservative policies and pressures. The paper builds on original data collected in 2014 and 2015 through focus groups and interviews with health practitioners in family health centers and women receiving reproductive care in Izmir, Diyarbakir, Van, and Gaziantep. The data analysis informed by writings on the debt economy by Maurizio Lazzarato and Bifo Berardi and transnational feminist theory demonstrate that neoliberal mechanisms of "dismantling the public" interact with pronatalist policies and pressures to erode women's reproductive rights in Turkey. This has resulted in (1) indebtedness of women through out-of-pocket payments for contraception and abortion, (2) indebtedness of providers through performance measures, (3) reduction in the quality of reproductive care, and (4) reduction in access to reproductive care itself (contraception, counseling, and abortion). There is a need to pay attention to neoliberal mechanisms and the legal framings of reproductive rights to fully understand the limitations of law and counter the neoliberal and conservative assaults on women's sexual and reproductive rights.
Topics: Abortion, Induced; Adult; Contraception; Female; Focus Groups; Health Expenditures; Health Services Accessibility; Health Surveys; Humans; Interviews as Topic; Politics; Pregnancy; Reproductive Rights; Turkey; Women's Rights
PubMed: 31885436
DOI: No ID Found -
Journal of Cardiology Cases Aug 2022Total extrusion of a pacemaker is rare and may result from skin and/or pocket infection or skin erosion because of fragility caused by actions such as scratching an...
UNLABELLED
Total extrusion of a pacemaker is rare and may result from skin and/or pocket infection or skin erosion because of fragility caused by actions such as scratching an itch. Total extrusion of a pacemaker may cause fatal arrhythmias, exacerbation of heart failure, and infection. We report the case of a 37-year-old man with a pacemaker implanted for complete atrioventricular block who presented with exacerbation of advanced heart failure due to complete extrusion of the pacemaker from the left groin and pacing failure. No fever was observed during the clinical course, but exudate leaked from his abdominal pocket. Electrocardiography showed a complete atrioventricular block. He successfully underwent implantation of a new pacemaker.
LEARNING OBJECTIVE
There are various complications related to permanent pacemaker implantation; however, total extrusion, which is extremely rare, can lead to pacemaker failure, sepsis, and life-threatening arrhythmias. It is essential not only to check the pacemaker pocket and generator but also to educate patients on the importance of pacemaker check-ups and problems.
PubMed: 35949569
DOI: 10.1016/j.jccase.2022.04.002 -
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