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Journal of Intensive Care Medicine Sep 2022Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention....
Over 5 million central venous catheters (CVCs) are placed annually. Pneumothorax and catheter malpositioning are common adverse events (AE) that requires attention. This study aims to evaluate local practices of mechanical complication frequency, type, and subsequent intervention(s) related to mechanical AE with an emphasis on catheter malpositioning. This is a retrospective review of CVC placements in a tertiary hospital setting from 1/2013 to 12/2013. Pneumothorax and CVC positioning were evaluated on post-insertion chest x-ray (CXR). Malposition was defined as unintended placement of the catheter in a vessel other than the intended superior vena cava on CXR. Catheter reposition was defined as radiographic evidence of a new catheter with removal of the old catheter less than 24hrs after initial placement. Data points analyzed included pneumothorax and thoracostomy rate, CVC malposition frequency, catheter reposition rate, catheter duration, and incidence of complications such as catheter associated venous thrombosis. Among 2045 eligible CVC insertions, pneumothoraces occurred in 14 (0.7%; 95%CI 0.38, 1.17) and malpositions were identified in 275 (13.4%; 95% CI 12.3, 15.3). The proportion of pneumothoraces that required tube thoracostomy was 57%. The proportion of CVCs with malposition that were removed or replaced within 24h was 32.7%. "Malpositioned" catheters that were left in place by the clinical team (n = 185) had an average catheter duration of 8.2 days (95% CI 7.2, 9.3) versus 7.2 days (95% CI 6.17, 8.23) for catheters that were replaced after initial malposition (p = 0.14, t test). The incidence of venous thrombosis in repositioned "malpositioned" catheters was 7.8% versus 4.9% for "malpositioned" catheters that were left in place. Clinically significant catheter malposition and pneumothorax after CVC insertion are low. In this study, replaced and non-replaced "malpositioned" catheters had similar catheter duration and rates of complications, challenging the current dogma of CVC malposition practice.
Topics: Catheterization, Central Venous; Central Venous Catheters; Humans; Pneumothorax; Radiography, Thoracic; Vena Cava, Superior
PubMed: 35723623
DOI: 10.1177/08850666221076798 -
Aesthetic Surgery Journal. Open Forum 2022Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon...
BACKGROUND
Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants.
OBJECTIVES
Prophylactic use of a polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control.
METHODS
In total, 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants alone; 49 patients received micro-textured implants; and 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared.
RESULTS
No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone and 2.04% for textured devices [ = 0.62; 95% CI -0.06 to 0.01]). There were zero complications in the smooth plus mesh study arm. A comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [ = 0.23; 95% CI -0.12 to 0.01]). The smooth implant group with the prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared with the smooth devices alone ( = 0.03; 95% CI -0.21 to -0.01).
CONCLUSIONS
Micro-textured devices show a trend toward decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition.
PubMed: 35592182
DOI: 10.1093/asjof/ojac021 -
Plastic and Reconstructive Surgery Feb 2020Current goals in lower eyelid blepharoplasty include blending the lower eyelid-cheek junction, which is highlighted in the authors' six-step lower lid blepharoplasty...
Current goals in lower eyelid blepharoplasty include blending the lower eyelid-cheek junction, which is highlighted in the authors' six-step lower lid blepharoplasty technique. One major question in lower lid blepharoplasty is how to prevent lower lid malposition and ectropion, because these are untoward outcomes after an aesthetic procedure. In the authors' technique, they perform a superficial lateral retinacular canthopexy that is effective and safe and also prevents lower lid malposition or ectropion. A retrospective review of 104 patients who underwent six-step lower lid blepharoplasty was performed. In the authors' series, there was no significant difference between preoperative and postoperative intercanthal angles (p < 0.05), and the lateral canthal position did not change significantly from its preoperative position. The authors' six-step blepharoplasty technique addresses signs of midfacial aging, and the lateral canthopexy technique has been shown to have a minimal complication rate and maintains canthal position. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
Topics: Adult; Aged; Blepharoplasty; Ectropion; Eyelids; Female; Humans; Male; Middle Aged
PubMed: 31985628
DOI: 10.1097/PRS.0000000000006468 -
Frontiers in Medicine 2022Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine... (Review)
Review
Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.
PubMed: 36590949
DOI: 10.3389/fmed.2022.1071254 -
Cardiology in the Young Feb 2022DiGeorge syndrome has heterogeneous clinical presentation, and for this reason, its diagnosis can be challenging and may be missed. Since CHDs are very common in this... (Review)
Review
DiGeorge syndrome has heterogeneous clinical presentation, and for this reason, its diagnosis can be challenging and may be missed. Since CHDs are very common in this patients, they can be considered pillars of clinical diagnosis of the syndrome. Therefore, accurate echocardiography is needed to detect even minor cardiac anomalies, as some specific malformation like crossed pulmonary arteries can be associated with 22q11 syndrome. We report two cases of newborns where the diagnosis of DiGeorge syndrome was suspected after finding crossed pulmonary arteries on echocardiography. In order to reach a timely diagnosis of DiGeorge syndrome, we suggest a careful echocardiographic examination of the pulmonary arteries position in all patients and genetic analysis for 22q11.2 microdeletion in patients in whom malposition has been detected.
PubMed: 35193728
DOI: 10.1017/S1047951122000221 -
Insights Into Imaging Aug 2019Central venous port devices are indicated for patients, who need long-term intravenous therapy. Oncologic patients may require intermittent administration of... (Review)
Review
Central venous port devices are indicated for patients, who need long-term intravenous therapy. Oncologic patients may require intermittent administration of chemotherapy, parenteral nutrition, infusions, or blood transfusions. A venous port system is composed of a port chamber attached to a central catheter, which is implanted into the central venous system. The subcutaneous location of the catheter chamber improves the patients' quality of life and the infection rate is lower than in non-totally implantable central venous devices. However, proper implantation, use, and care of a port system are important to prevent short- and long-term complications. Most common early complications (< 30 days) include venous malpositioning of catheter and perforation with arterial injury, pneumothorax, hemothorax, thoracic duct injury, or even cardiac tamponade. Delayed complications include infection, catheter thrombosis, vessel thrombosis and stenosis, catheter fracture with extravasation, or fracture with migration or embolization of catheter material. Radiologic imaging has become highly relevant in intra-procedural assessment and postoperative follow-up, for detection of possible complications and to plan intervention, e.g., in case of catheter migration. This pictorial review presents the normal imaging appearance of central venous port systems and demonstrates imaging features of short- and long-term complications.
PubMed: 31463643
DOI: 10.1186/s13244-019-0770-2 -
Retina (Philadelphia, Pa.) Jan 2022To introduce cases of intraocular lens (IOL) malposition after sutureless intrascleral fixation.
PURPOSE
To introduce cases of intraocular lens (IOL) malposition after sutureless intrascleral fixation.
METHODS
We retrospectively analyzed the medical records of patients who underwent sutureless intrascleral fixation. Cases with postoperative IOL requiring reoperation were analyzed further.
RESULTS
Of the 48 eyes that underwent sutureless intrascleral fixation of their IOL, seven eyes had postoperative IOL malposition and underwent reoperation (14.6%). There was no difference in the clinical results between the intravitreal (33 eyes) and intracameral (15 eyes) techniques, but IOL malposition requiring reoperation was more frequent in the latter (2 cases [6.1%] vs. 5 cases [33.3%], P = 0.024). In the 7 eyes that required reoperation, the visual acuity before reoperation was 0.9 ± 0.6 logMAR (20/159), whereas astigmatism was -4.8 ± 3.2 diopters. The visual acuity and cylindrical error improved to 0.1 ± 0.2 logMAR (20/25) and -2.4 ± 2.3 diopters, respectively, at 6 months after the secondary operation.
CONCLUSION
In 14.6% of the patients who underwent sutureless intrascleral fixation of the IOL, IOL malposition developed and reoperation was performed. With the intravitreal technique, which uses a wider space than the intracameral technique, the frequency of postoperative IOL malposition could be reduced.
Topics: Female; Follow-Up Studies; Foreign-Body Migration; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Refraction, Ocular; Retrospective Studies; Sclera; Sutureless Surgical Procedures; Visual Acuity
PubMed: 34369438
DOI: 10.1097/IAE.0000000000003279 -
American Journal of Ophthalmology Case... Mar 2022Intraocular implants, specifically those used in the treatment of glaucoma, are each associated with various implant related risks and complications of which surgeons...
Intraocular implants, specifically those used in the treatment of glaucoma, are each associated with various implant related risks and complications of which surgeons placing these devices must be aware. Here we present a case of uveitis-glaucoma-hyphema (UGH) syndrome associated with the Hydrus Microstent.
PubMed: 35198823
DOI: 10.1016/j.ajoc.2022.101405 -
Revista Brasileira de Medicina Do... 2019Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain,...
BACKGROUND
Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain, numbness and paresthesia which may reach severe and disabling levels and thus significantly interfere with the performance of work and daily living activities. Computer use at work considerably increased in recent years, being attended with a substantial elevation of the prevalence of CANS among individuals who use computers at work.
OBJECTIVE
To investigate biomechanical and psychosocial risk factors, scapular static imbalance and functional impact on work and daily living activities of upper limb complaints among workers who use computers.
METHODS
We analyzed ergonomic and psychosocial risk factors by means of MUEQ-Br, scapular static malposition with the SICK-scapula protocol, and functional impairment in work and daily living activities with DASH. The sample comprised 109 employees of a private institution who use computers at work.
RESULTS
The average scores on body posture and control over tasks were significantly higher among the symptomatic participants. Scapular malposition did not differ between the symptomatic and asymptomatic participants, but functional impairment did.
CONCLUSION
Awkward posture at work and poor control over tasks seem to contribute to the occurrence of CANS among office workers who use computers. Scapular malposition is not systematically present among individuals with CANS, but the opposite is true. Individuals with CANS exhibited functional impairments.
PubMed: 32685744
DOI: 10.5327/Z1679443520190329 -
The American Journal of Sports Medicine Feb 2023Bone tunnel-related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning,... (Review)
Review
Bone tunnel-related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning, enlargement, containment, and hardware interference may complicate surgery and compromise outcomes. As a result, several strategies have emerged to address these issues and optimize results. However, a systematic, unified approach to tunnel pathology in revision ACLR is lacking. The purpose of this review is to highlight the current state of the literature on bone tunnel complications and, although extensive literature on the subject is lacking, present an updated approach to the evaluation and management of tunnel-related issues in revision ACLR.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Reoperation
PubMed: 34766840
DOI: 10.1177/03635465211045705