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Indian Pacing and Electrophysiology... 2020Insertable cardiac monitors (ICMs) are often used for long-term monitoring of cardiac rhythm. The Medtronic's LINQ Reveal ™ is a new generation wireless, automated,...
BACKGROUND
Insertable cardiac monitors (ICMs) are often used for long-term monitoring of cardiac rhythm. The Medtronic's LINQ Reveal ™ is a new generation wireless, automated, and patient responsive subcutaneous ECG monitoring device. Despite several advantages to its small size we have noted an unusually high incidence of extrusion at our center.
METHODS
& Results: We conducted a retrospective case analysis to review Reveal LINQs implanted at our center. All devices were inserted using the provided insertion tools. Patients with extruded devices were identified and details regarding the site and technique of insertion, incision closure, use of peri-operative antibiotics, and follow-up details were collected. 81 patients underwent 85 Reveal LINQ implants at a tertiary care University Hospital referral center. The most common reason for implant was suspected arrhythmia with or without structural heart disease or unexplained syncope. There were 4 spontaneous extrusions occurring within 7-24 days after insertion with an incidence rate of 4.7%. One extruded device was anchored to subcutaneous tissue, and no pocket/device infections or hematomas were noted.
CONCLUSIONS
Device migration and erosion through skin are important potential adverse events for the Reveal LINQ implantable loop recorder. This study reports an unexpectedly high rate of extrusion without infection. The authors suggest that the depth of the incision is the main factor impacting extrusions. Larger studies are recommended, however, and a proposed measure to avoid spontaneous extrusion is the design of a longer manufacturer's blade in order to increase the depth of the incision and insertion.
PubMed: 32298763
DOI: 10.1016/j.ipej.2020.04.005 -
International Journal of Cardiology Feb 2022Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a high risk of ventricular arrhythmias. This study aimed to evaluate the safe replacement of TV-ICD with S-ICD based on updated recent evidence.
METHODS
We systematically searched EMBASE, JSTOR, PubMed/MEDLINE, and Cochrane Library on 30 July 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
We identified 26 studies that examined 7542 (58.27%) patients with S-ICD and 5400 (41.72%) with TV-ICD. The findings indicated that, compared to patients with TV-ICD, patients with S-ICD had a lower incidence of defibrillation lead failure (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.98; p = 0.05), lead displacement or fracture (OR, 0.25; 95% CI, 0.12-0.86; p = 0.0003), pneumothorax and/or hemothorax (OR: 0.22, 95% CI 0.05, 0.97, p = 0.05), device failure (OR: 0.70, 95% CI 0.51, 0.95, p = 0.02), all-cause mortality (OR: 0.44 [95% CI 0.32, 0.60], p < 0.001), and lead erosion (OR: 0.01, 95% CI 0.00, 0.05, p < 0.001). Patients with TV-ICD had a higher incidence of pocket complications than patients with S-ICD (OR, 2.13; 95% CI, 1.23-3.69; p = 0.007) and a higher but insignificant incidence of inappropriate sensing (OR, 3.53; 95% CI, 0.97-12.86; p = 0.06).
CONCLUSIONS
The S-ICD algorithm was safer and more effective than the TV-ICD system as it minimized the incidence of pocket complications, lead displacement or fracture, inappropriate sensing, defibrillation lead failure, pneumothorax/hemothorax, device failure, lead erosion, and all-cause mortality. Future studies should explore the scope of integrating novel algorithms with the current S-ICD systems to improve cardiovascular outcomes.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Humans; Incidence; Treatment Outcome
PubMed: 34801615
DOI: 10.1016/j.ijcard.2021.11.029 -
Indian Journal of Otolaryngology and... Dec 2019The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction...
The tympanic membrane retraction pocket is a pathological invagination of tympanic membrane into the middle ear space. The most common sites for formation of retraction pocket are pars flaccida and postero-superior parts. Decision about the procedure and the timing of the treatment of retraction pockets is debatable and depends on the functional and anatomic condition of the ear. To evaluate the results of the technique of two handed endoscopic management of retraction pockets with sliced tragal cartilage. Prospective Non Randomized Clinical Study. The study included 41 ears operated with the technique of two handed endoscopic cartilage tympanoplasty for retraction pockets with endoscope holders from November 2013 to May 2016 with a follow up period ranging from 22 to 53 months. Cases of cholesteatoma and tympanic membrane perforation were excluded from the study. Pre and postoperative symptoms and air-bone gaps were recorded. The average preoperative air-bone gap in the study group was 24.53 ± 4.326 dB. 28 ears were of pars tensa retractions (stage II-4, stage III-15, and stage IV-9) and 13 were pars flaccida retractions (stage III-8 and stage IV-5). 24 ears had ossicular erosion. The follow up revealed that, the results of two handed endoscopic sliced cartilage tympanoplasty for retraction pockets were stable and there was no recurrence of the retraction and the post-operative air-bone-gap closure was achieved to 13.62 ± 4.78, 14.13 ± 5.91 dB, 14.32 ± 3.46 and 14.57 ± 3.88 dB at 6 months, 1 year, 2 years, 3 years respectively. Though, indications for surgery are based mostly on anatomic status and observation of behaviour of retraction pocket over time, we recommend early management of retraction pockets by the technique of endoscopic sliced tragal cartilage tympanoplasty with tragal cartilage of 0.5 mm thickness using endoscope holder. : Level 4.
PubMed: 31750111
DOI: 10.1007/s12070-019-01682-2 -
Frontiers in Cardiovascular Medicine 2022A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and...
BACKGROUND
A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and hospital stay. Patients suffering from atrial fibrillation and undergoing cardiovascular electronic implantable device (CIED) surgery are widely prescribed and treated with direct oral anticoagulants (DOACs). In this study, the use of a novel compression device was evaluated to examine its ability to decrease the incidence of pocket hematomas following device implantation with uninterrupted DOACs.
METHODS
A total of 204 participants who received DOACs and underwent CIED implantation were randomized into an experimental group (novel compression device) and a control group (elastic adhesive tape with a sandbag). The primary outcome was pocket hematoma, and the secondary outcomes were skin erosions and patient comfort score. Grade 3 hematoma was defined as a hematoma that required anticoagulation therapy interruption, re-operation, or prolonged hospital stay.
RESULTS
The baseline characteristics of both groups had no significant differences. The incidence of grades 1 and 2 hematomas was significantly lower in the compression device group than in the conventional pressure dressing group (7.8 vs. 23.5 and 2.0 vs. 5.9%, respectively; < 0.01). Grade 3 hematoma occurred in 2 of 102 patients in the experimental group and 7 of 102 patients in the control group (2.0 vs. 6.9%; = 0.03). The incidence rates of skin erosion were significantly lower, and the patient comfort score was much higher in the compression device group than in the control group ( < 0.01). Multivariable logistic regression analysis showed that the use of novel compression device was a significant protective factor for pocket hematoma (OR = 0.42; 95% CI, 0.29-0.69, = 0.01).
CONCLUSIONS
The incidence of pocket hematomas and skin erosions significantly decreases when the proposed compression device is used for patients undergoing device implantation with uninterrupted DOACs. Thus, the length of hospital stay and re-operation rate can be reduced, and patient comfort can be improved.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn, identifier: ChiCTR2100049430.
PubMed: 35282349
DOI: 10.3389/fcvm.2022.817453 -
Quintessence International (Berlin,... Jan 2024Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and...
OBJECTIVE
Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus.
METHOD AND MATERIALS
108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured.
RESULTS
On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient.
CONCLUSION
Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression.
Topics: Humans; Lichen Planus, Oral; Periodontitis; Gingiva; Periodontal Index; Dental Plaque Index
PubMed: 37724998
DOI: 10.3290/j.qi.b4343127 -
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 -
BMC Ophthalmology Jul 2020This report serves to describe the use of a novel adjustable single 8-0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe...
BACKGROUND
This report serves to describe the use of a novel adjustable single 8-0 polypropylene suture for scleral fixation without conjunctival dissection, and to describe related clinical outcomes associated with this approach.
METHODS
In this study, we retrospectively reviewed 28 eyes from 27 patients that underwent scleral fixation of the intraocular lens (IOL) without conjunctival dissection using an adjustable single 8-0 polypropylene suture at the Beijing Tongren Eye Center between April 2018 and April 2019. For this surgical approach, a 23-gauge infusion cannula was set, after which two Hoffmann scleral pockets were created. Next, 8-0 polypropylene sutures were inserted into the eye guided by 10-0 polypropylene sutures of a long straight needle. The 8-0 suture was then used to fix the haptic IOs. Finally, these 8-0 polypropylene sutures were removed from the scleral pockets, and knots were tightened with the adjustable single suture. Primary outcomes included visual acuity and postoperative complication incidence.
RESULTS
For this study, outcomes for 28 eyes from 27 patients (9 female, 18 male) were assessed. Patients had a mean age of 54 ± 15.11 years-old and were followed for an average of 10.18 ± 2.76 months postoperatively. Uncorrected visual acuity in these patients improved significantly from a preoperative value of 1.269 ± 0.464 logMAR to a 3-month postoperative value of 0.409 ± 0.413 logMAR (p = 0.000). The majority of postoperative complications in these patients were temporary and self-limiting, including corneal edema (35.71%), hypotony (14.29%), elevated intraocular pressure (28.58%), and mild hyphema (7.14%). No evidence of exposure or erosion of the trimmed suture end was detected in any patients. An ultrasound biomicroscope was able to readily detect the IOL and all sutures, and IOLs were found to be well-centered without any dislocation, tilting, or subluxation upon follow-up.
CONCLUSIONS
An adjustable single 8-0 polypropylene suture can reliably and effectively be used for scleral fixation without conjunctival dissection for the treatment of patients with aphakia or inadequate posterior capsule support. The novel procedure described herein may therefore be an effective means of minimizing the risk of suture-related complications in patients undergoing scleral-fixated IOL implantation.
TRIAL REGISTRATION
Retrospective case series study, not applicable. NCT04476264 .
Topics: Adult; Aged; Beijing; Dissection; Female; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Polypropylenes; Postoperative Complications; Retrospective Studies; Sclera; Suture Techniques; Sutures
PubMed: 32711502
DOI: 10.1186/s12886-020-01558-y -
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 -
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