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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 -
Clinical Case Reports May 2018Totally implantable venous access ports are valuable invention for oncological patients. Erroneous arterial malposition rate is estimated from 1.1% to 3.7% (Bowen et al....
Totally implantable venous access ports are valuable invention for oncological patients. Erroneous arterial malposition rate is estimated from 1.1% to 3.7% (Bowen et al. 2014, 208, 937). Early recognition and management are crucial to prevent further complications.
PubMed: 29744099
DOI: 10.1002/ccr3.1496 -
Cardiovascular Diagnosis and Therapy Dec 2020There is a plethora of cardiovascular devices used for therapy and monitoring, and newer devices are being introduced constantly. As a result of advancement of medical... (Review)
Review
There is a plethora of cardiovascular devices used for therapy and monitoring, and newer devices are being introduced constantly. As a result of advancement of medical technology and rapid development of such technology to address unmet needs across cardiovascular care, multiple conditions which were previously treated surgically or with medications now benefit from trans-catheter device-based evaluation and management. Moreover, innovation to existing technology has transformed the structural design of many traditional cardiovascular devices, making them safer and enabling easier deployment within the chest (catheter-based versus surgical). A post-procedure chest radiography (CXR) is often the first routine imaging test ordered in these patients. A CXR is a relatively inexpensive and noninvasive imaging tool, which can be obtained at the patient's bedside if needed. Commonly implanted cardiovascular devices can be quite easily checked for appropriate positioning on routine CXRs. Potential complications associated with mal-positioning of such devices may be life-threatening. Such complications often manifest early on CXRs and may not be readily apparent on clinical examination. Prompt recognition of such abnormal radiographic appearances is critical for timely diagnosis and effective management. Clinicians need to be familiar with new devices in order to assess proper placement and identify complications related to mal-positioning. This pictorial essay aims to describe the radiologic appearances of contemporary cardiovascular devices, review indications for their usage and potential complications, and discuss magnetic resonance imaging (MRI) compatibility.
PubMed: 33381431
DOI: 10.21037/cdt-20-617 -
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 -
Experimental and Therapeutic Medicine Jun 2021Pseudoexfoliation syndrome (PEX) is characterized by the deposition of proteinaceous material in the anterior ocular segment (resulting in ophthalmic pathologies such as... (Review)
Review
Pseudoexfoliation syndrome (PEX) is characterized by the deposition of proteinaceous material in the anterior ocular segment (resulting in ophthalmic pathologies such as glaucoma and increased risk of complications in cataract surgery), but also by several systemic manifestations. The involvement of peri-ocular tissues in PEX, including the eyelid skin, lacrimal gland, conjunctiva, orbital fat and vessels, as well as the optic nerve, has been reported by several previous studies. The peri-ocular effects of PEX include the development of eyelid laxity, conjunctival chalasis, tear film abnormalities, pronounced orbital fat atrophy in response to the administration of prostaglandin analogues in pseudoexfoliative glaucoma, deficient orbital vascular supply and biomechanical changes in both the eyeball and the optic nerve. These effects may have important clinical implications, including increased difficulty in cataract surgery, ocular surface disease and eyelid margin malpositions.
PubMed: 33968180
DOI: 10.3892/etm.2021.10082 -
European Journal of Midwifery 2022Evidence of safe and effective maternal interventions to improve fetal malposition in labor is inconclusive. A contemporary, randomized controlled trial of maternal...
Midwives' views on the acceptability of a future trial of the Sims posture for fetal malposition in labor in the context of their knowledge and practice: A mixed-methods study.
INTRODUCTION
Evidence of safe and effective maternal interventions to improve fetal malposition in labor is inconclusive. A contemporary, randomized controlled trial of maternal posture would expand this evidence, however, collaboration with midwives will be critical. The aim of this study is to assess midwives' views on the acceptability of a trial of the Sims posture for fetal malposition in labor and identify current midwifery knowledge and practice surrounding fetal malposition.
METHODS
A mixed-methods study incorporating a web-based survey and guided focus groups with midwives was conducted in New Zealand during 2020. Midwives serving Auckland Hospital and Māori and Pasifika midwives serving South Auckland (n=136) were invited to participate in the study. Data were descriptively analyzed using chi-squared and cross-tabulation. Collaboration with a trial was contextualized by thematic content from survey and focus-group data.
RESULTS
Fifty (36%) midwives from primary and secondary/tertiary settings responded to the survey, and 19 participated in four focus groups. Most midwives thought maternal posture affects malposition, utilize changes of posture often with the peanut ball, would recommend a posture if cesareans were reduced by 20%, and would definitely or probably collaborate with a labor trial of posture. Fetal monitoring with women in the Sims posture was difficult for nearly one-fifth of midwives. Seven themes emerged regarding trial participation: trial design, relevance, practice, diagnosis, knowledge and skills, and trial compliance.
CONCLUSIONS
Current practice concerning malposition utilizes flexibility of posture. Provision of some free movement and reassurance surrounding trial equipoise may enhance trial collaboration.
PubMed: 35974715
DOI: 10.18332/ejm/150377 -
Medicina (Kaunas, Lithuania) 2006Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful... (Review)
Review
Correcting entropion and ectropion successfully requires knowledge of the eyelid problems, because understanding of these abnormalities is a key to planning a successful surgical procedure. Entropion is a condition in which the eyelid margin turns inwards against the globe. It is divided into following categories: congenital and acquired, which may be involutional or cicatricial. Ectropion is a malposition in which the lid falls away or is pulled away from its normal apposition to the globe. The condition is classified as congenital and acquired, which is divided into following categories: involutional, cicatricial, paralytic, and mechanical. Therefore, there are some common anatomic changes for both entropion and ectropion as well as specific changes that are unique to each eyelid malposition. Typically, instability of the eyelid is caused by either horizontal laxity or disinsertion or attenuation of the lower eyelid retractors to the inferior tarsal border, so surgical procedures should be directed at correcting the horizontal and vertical instability of the lid. Classification, etiology, underlying anatomic changes in the lid, principles of surgical treatment of entropion and ectropion are reviewed in this article.
Topics: Blepharoplasty; Diagnosis, Differential; Ectropion; Entropion; Humans
PubMed: 17172788
DOI: No ID Found -
European Journal of Midwifery 2022Fetal malposition in labor results in adverse maternal and infant health. Whilst evidence for effective interventions is inconclusive, based on the hypothesis that...
INTRODUCTION
Fetal malposition in labor results in adverse maternal and infant health. Whilst evidence for effective interventions is inconclusive, based on the hypothesis that gravity corrects malposition, the feasibility and design of a randomized controlled trial (RCT) to improve maternal and infant health outcomes should be considered. The aim was to assess pregnant women's views on the acceptability, enablers, and barriers of participation in an RCT of maternal posture for fetal malposition in labor.
METHODS
A web-based anonymous survey of pregnant women was conducted in Auckland during 2020. Quantitative data were summarized descriptively using a chi-squared test to assess differences in proportions. Maternal characteristics influence on women's responses was assessed using cross-tabulation. A thematic content analysis of free text responses was undertaken.
RESULTS
Most of the 206 respondents were aged 26-35 years (75%), 29-38 weeks pregnant (71%), of European (40%) or Asian (36%) ethnicity, and similarly nulliparous or multiparous. Most women (76%) knew of fetal malposition in labor; however, only 28% were aware of maternal posture to correct this. Most women (86%) were interested in labor research and although 37% would participate in an RCT, almost half (47%) were unsure and a 15% would not participate. Concerns mostly related to comfort (22%). Nearly half of women (49%) would need to consult their partner regarding participation in an RCT.
CONCLUSIONS
Enablers for participation in a posture trial in labor include measures to enhance maternal comfort, increasing awareness of malposition and the role of posture, and involving partners in pre-trial counselling and recruitment.
PubMed: 35128346
DOI: 10.18332/ejm/144057 -
Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction.The Western Journal of Emergency... Sep 2015Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended... (Review)
Review
Despite the level of skill of the operator and the use of ultrasound guidance, central venous catheter (CVC) placement can result in CVC malpositioning, an unintended placement of the catheter tip in an inadequate vessel. CVC malpositioning is not a complication of central line insertion; however, undiagnosed CVC malpositioning can be associated with significant morbidity and mortality. The objectives of this review were to describe factors associated with intravascular malpositioning of CVCs inserted via the neck and chest and to offer ways of preventing, identifying, and correcting such malpositioning. A literature search of PubMed, Cochrane Library, and MD Consult was performed in June 2014. By searching for "Central line malposition" and then for "Central venous catheters intravascular malposition," we found 178 articles written in English. Of those, we found that 39 were relevant to our objectives and included them in our review. According to those articles, intravascular CVC malpositioning is associated with the presence of congenital and acquired anatomical variants, catheter insertion in left thoracic venous system, inappropriate bevel orientation upon needle insertion, and patient's body habitus variants. Although plain chest radiography is the standard imaging modality for confirming catheter tip location, signs and symptoms of CVC malpositioning even in presence of normal or inconclusive conventional radiography findings should prompt the use of additional diagnostic methods to confirm or rule out CVC malpositioning. With very few exceptions, the recommendation in cases of intravascular CVC malpositioning is to remove and relocate the catheter. Knowing the mechanisms of CVC malpositioning and how to prevent, identify, and correct CVC malpositioning could decrease harm to patients with this condition.
Topics: Catheterization, Central Venous; Central Venous Catheters; Humans; Medical Errors
PubMed: 26587087
DOI: 10.5811/westjem.2015.7.26248