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The Science of the Total Environment Jan 2023Procida Island, located in the Gulf of Naples (southern Italy), is characterized by steep cliffed coasts, articulated in a succession of headlands and small embayments...
Procida Island, located in the Gulf of Naples (southern Italy), is characterized by steep cliffed coasts, articulated in a succession of headlands and small embayments with narrow pocket beaches, such as Ciraccio and Chiaia, often characterized by instability. In this study, a methodology for coastal cliff susceptibility assessment has been conceived based on hydraulic and geomorphological characteristics, which supported the construction of a Cliff Stability Index (CSI). The geomorphological characteristics are related to the whole cliff face, the cliff material resistance, and the cliff failure mechanisms. The hydraulic actions on the cliff are related to the wave impact which is exerted by the breaking waves once the wave run-up distance exceeds the beach width. The index takes into account the slope of the cliff, the rock strength, the wave energy at the cliff base produced by the broken wave and the presence of defence structures at the cliff base. The resulting index classification, obtained by addition of the partial sub-indices, has been compared with the observed coastal cliff evolution from 1954 to 2021.
Topics: Italy; Conservation of Natural Resources
PubMed: 36122713
DOI: 10.1016/j.scitotenv.2022.158759 -
Journal of Clinical Orthopaedics and... Sep 2022Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as... (Review)
Review
UNLABELLED
Textilomas, gossypibomas, muslinomas and gauzomas, otherwise collectively known as Retained Non-absorbable Hemostatic Material (RNHM), are surgical materials such as cotton or gauze pads that are accidentally retained in the surgical bed post-operatively. They may present acutely with signs of infection or may rarely remain chronic and asymptomatic; the latter posing a significant challenge to clinical and imaging diagnosis. Textilomas are not routinely reported due to their medicolegal implications and are usually encountered fortuitously. Here, we report a case of an individual who presented with a non-specific lower backache, had a remote history of lumbar discectomy and in whom a textiloma at the postoperative site was seen to mimic a soft-tissue mass on imaging. In addition, we review current, up-to-date literature on delayed presentations of such retained materials after surgery of the lumbar spine.
CASE REPORT
A 43-year-old male presented with pain in his right lower back and gluteal region. He had undergone an L4-L5 discectomy 11 years ago, remained asymptomatic since, and noticed an insidious, worsening pain a week before presentation. Mild tenderness was elicited over the region of pain. A clinical diagnosis of L4-L5 extraforaminal disc prolapse with deep surgical site infection was made. Ultrasound showed an iso-to-hyperechogenic lesion in the right lower paraspinal region. MRI showed a very well-defined, ovoid T1-hypointense and T2-iso-hypointense lesion in the deep posterior paraspinal region of the L4/5 level adjacent to right laminar process of L4 vertebra. The lesion caused scalloping and chronic erosion of the laminar process. No obvious air pockets were present. The features of infection, like soft tissue oedema and collection, were absent. Based on imaging, differentials of nerve sheath tumour and gossipybomas was made. Open wound exploration was performed, which showed a wad of gauze within the right L4-L5 interlaminar space, with thin surrounding granulation tissue The L4-L5 disc and exiting nerve root were normal. The mass was removed, local washing was done and wound was closed.
CONCLUSION
Though unfortunate and relatively rare, the possibility of a textiloma must be considered among the differential diagnoses of a mass in the spinal region in the event of prior surgery, no matter how remote the history. Clinical presentation may vary, but the imaging appearance is largely consistent and can be relied upon to prevent unnecessary investigation and facilitate early surgical removal of the offending retained material.
PubMed: 36051862
DOI: 10.1016/j.jcot.2022.101967 -
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 -
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 -
Journal of Interventional Cardiac... Aug 2022The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of... (Review)
Review
BACKGROUND
The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them.
METHODS
The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our "shift and cover" approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia.
RESULTS
Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit.
CONCLUSIONS
The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.
PubMed: 35927601
DOI: 10.1007/s10840-022-01312-y -
Journal of Interventional Cardiac... Jul 2022Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead...
BACKGROUND
Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD.
METHODS
The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD.
RESULTS
Indications for TLE were infection (63.9%) and lead malfunction (36.1%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n = 4; 11.1%), isolated pocket erosion (n = 2; 5.5%), and ineffective therapy (n = 1; 2.8%). No lead/hardware dysfunction was reported. Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF). There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥ 2 (HR 5.05; 95% CI 1.00-26.38; p = 0.04), hypertension (HR 22.72; 95% CI 1.05-26.31; p = 0.02), diabetes (HR 10.64; 95% CI 2.05-55.60; p = 0.001) and ischemic heart disease (HR 5.92; 95% CI 1.17-30.30; p = 0.01).
CONCLUSION
Our study provides evidences on the use of S-ICD as an alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidities.
PubMed: 35831772
DOI: 10.1007/s10840-022-01293-y -
Journal of Cardiovascular... Aug 2022
Topics: Defibrillators, Implantable; Device Removal; Electronics; Heart; Humans; Pacemaker, Artificial; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome
PubMed: 35761750
DOI: 10.1111/jce.15612 -
Journal of Cardiovascular... Aug 2022The skin overlying cardiovascular implantable electronic devices (CIEDs) sometimes becomes very thin after implantations, which could cause a device erosion. The factors...
INTRODUCTION
The skin overlying cardiovascular implantable electronic devices (CIEDs) sometimes becomes very thin after implantations, which could cause a device erosion. The factors related to the skin thickness of device pockets have not been elucidated. This study aimed to evaluate the skin thickness of CIED pockets and search for the factors associated with the thickness.
METHODS
Seventeen skin thickness points around the CIED pocket were measured through ultrasonography in each patient.
RESULTS
A total of 101 patients (76 ± 11 years, 26 female) were enrolled. The median duration from the implantation to the examination was 95 months (quartile: 52.5-147.5). The median skin thickness overlying the device was 4.1 mm (3.3-5.9). Patients with heart failure and malignancy had thinner skin overlying the CIED than those without. A significant correlation existed between skin thickness and body mass index (BMI), hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction. In contrast, age, gender, and device size did not exhibit a significant correlation with skin thickness. A multivariate logistic regression analysis revealed that chronic heart failure and a decrease in the eGFR and BMI were independent predictive factors of "very thin (≦3.3 mm)" skin of the CIED pocket late after an implantation.
CONCLUSION
Aside from a low BMI, the comorbidities (low hemoglobin, heart failure, and renal dysfunction) had a stronger impact on the skin thickness overlying the device than the device size. A careful observation of the device pocket should be performed in patients with those risk factors.
Topics: Defibrillators, Implantable; Electronics; Female; Heart Failure; Humans; Pacemaker, Artificial; Prosthesis-Related Infections; Retrospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 35761749
DOI: 10.1111/jce.15613 -
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 -
Health Economics Aug 2022We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic...
We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic damages for health care services. Small chain and unaffiliated nursing homes enjoyed "judgment proof standing" and were less apt to be sued, prior to reform. We find that the managers of such homes were relatively unresponsive to the implementation of state caps on noneconomic damages. Large "deep-pocketed" chain-affiliated homes lacked judgment proof standing and implemented greater reductions in their nursing inputs in the aftermath of tort relief. However, we find little evidence of service quality erosion across four measured dimensions of care outcomes. Our findings are consistent with a "defensive care" model in which large chain homes employ unproductive inputs in an effort to meet a negligence standard of care.
Topics: Humans; Liability, Legal; Malpractice; Nursing Homes; United States
PubMed: 35607270
DOI: 10.1002/hec.4528