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Wideochirurgia I Inne Techniki... Jun 2022Peripherally inserted central catheters (PICC) are a type of deep venipuncture, for which the catheter tip malposition rate is high.
INTRODUCTION
Peripherally inserted central catheters (PICC) are a type of deep venipuncture, for which the catheter tip malposition rate is high.
AIM
To examine the feasibility of preventing catheter tip malposition during PICC placement using an ultrasound-guided finger-pressure method to block the internal jugular vein.
MATERIAL AND METHODS
We conducted a double-blinded randomized controlled trial (RCT) at a tertiary public hospital in Hubei province, China. A total of 600 patients were recruited and randomly allocated to the ultrasound-guided finger compression method (UGFCM) and traditional partial head method (TPHM) group (n = 300/group). Incidence of catheter tip malposition was assessed as the primary outcome of the study. A systematic literature review and meta-analysis was performed. We searched MEDLINE, EMBASE, Cochrane Library, China-National Knowledge Infrastructure, and Chinese Biomedicine Database and performed publication bias and sensitivity analyses on 10 extracted studies.
RESULTS
There were no significant differences in baseline demographic and clinical characteristics between the two groups (p > 0.05). Overall incidence of catheter tip malposition was significantly lower in the UGFCM and TPHM group (1.67% vs. 10.3%) and particularly the incidence of malposition in the internal jugular vein (1% vs. 9%). In the meta-analysis of 10 eligible studies, with 1263 cases using the UGFCM method while 1261 adopted the TPHM method, the results showed that the incidence of catheter tip malposition was significantly lower in the group using the UGFCM method (OR = 0.17, 95% CI: 0.11-0.27, p < 0.01), which is in line with the results of our RCT study.
CONCLUSIONS
This study may add valuable evidence on adopting the finger-pressure method for blocking neck veins to reduce the incidence of catheter tip malposition, particularly in the internal jugular vein.
PubMed: 35707337
DOI: 10.5114/wiitm.2022.115198 -
Journal of the Mechanical Behavior of... Mar 2020Malposition of implant components in total knee arthroplasty (TKA) has consequences on tibiofemoral kinematics, contact forces and ligament tensions. To evaluate the...
PURPOSE
Malposition of implant components in total knee arthroplasty (TKA) has consequences on tibiofemoral kinematics, contact forces and ligament tensions. To evaluate the impact of tibial baseplate malpositioning in the same knee, we conducted a computer simulation.
METHODS
An established weight-bearing finite element model of a fixed bearing TKA was used for the computer simulation. To evaluate the influence of tibial baseplate malposition, calculations were consecutively performed in neutral position, at 3° and 6° of internal and external rotation and at 3 mm and 6 mm of medial and lateral translation.
RESULTS
The highest effect of malposition was observed for ligament tensions, with a tendency of a greater influence for the 6 mm translation compared to 6° of rotation. Changes in contact forces and tibiofemoral kinematics were according to the alterations of ligament tensions. The highest ligament tension, contact force and femoral roll-back were registered for 6 mm medialization of the tibial baseplate.
DISCUSSION
Tibial baseplate malposition effects ligament tensions, tibiofemoral contact forces and kinematics and has a risk of unfavorable clinical results due to postoperative pain, reduced range of motion, instability and a higher rate of early loosening. Therefore, surgeons should aim for a neutral position of the tibial baseplate.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Computer Simulation; Humans; Knee Joint; Knee Prosthesis; Ligaments; Range of Motion, Articular; Rotation; Tibia
PubMed: 32090954
DOI: 10.1016/j.jmbbm.2019.103564 -
Journal of Orthopaedic Surgery and... May 2019Stem malalignment can affect offset reconstruction and may result in gluteal muscle insufficiency. In this retrospective study, a novel geometric angle named 'critical...
INTRODUCTION
Stem malalignment can affect offset reconstruction and may result in gluteal muscle insufficiency. In this retrospective study, a novel geometric angle named 'critical trochanter angle' (CTA) is described and investigated towards the risk of malposition of a collarless straight tapered hydroxyapatite-coated stem in primary total hip arthroplasty (THA).
MATERIAL AND METHODS
A total of 100 cementless THA were implanted in patients with unilateral coxarthrosis via the direct anterior (n = 50) or direct lateral Hardinge approach (n = 50) in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Stem alignment was analysed in postoperative AP pelvic radiographs and correlated to the CTA: the angle crest was defined by the intersection of the femoral shaft and neck axis and the angle was measured between the shaft axis and a leg intersecting the vertex between the lateral and superoposterior facet of the trochanter.
RESULTS
Forty-seven stems were implanted in varus (≥ + 1°), 42 in neutral (< + 1°/> - 1°) and 11 in valgus position (≤ - 1°). The mean critical trochanter angle was 25.0° (SD ± 7.5°), and there was a negative and statistically significant correlation to stem alignment (r = - 0.52; p ≤ 0.001) independent from the surgical approach. For stem malposition of 2° and above (n = 23), mean CTA was 17.2° for varus (n = 20) and 31.6° for valgus (n = 3). A CTA lesser or equal to 22.75° had a sensitivity of 90% and specificity of 80% for varus stem position of 2° or greater. Specificity raised to 100% with a cutoff CTA of 12.5° or lesser.
CONCLUSION
Varus stem alignment in THA is associated with coxa vara deformity and a radiological low CTA. In preoperative planning, the critical trochanter angle can help to evaluate the risk for intraoperative stem malpositioning. If navigation or robotic assistance is not available when using this stem design, we recommend an intraoperative x-ray to verify correct implant positioning in patients with a CTA under 20° or above 30°.
Topics: Arthroplasty, Replacement, Hip; Female; Femur; Humans; Male; Predictive Value of Tests; Prosthesis Design; Retrospective Studies
PubMed: 31146787
DOI: 10.1186/s13018-019-1206-x -
Plastic and Reconstructive Surgery Jan 2017Natrelle 410 silicone breast implants are approved in the United States for breast augmentation, reconstruction, and revision. (Clinical Trial)
Clinical Trial
BACKGROUND
Natrelle 410 silicone breast implants are approved in the United States for breast augmentation, reconstruction, and revision.
METHODS
In two ongoing, prospective, multicenter 10-year studies, 17,656 subjects received Natrelle 410 implants for augmentation (n = 5059), revision-augmentation (n = 2632), reconstruction (n = 7502), or revision-reconstruction (n = 2463). Capsular contracture, implant malposition, and late seroma were documented. Cox proportional hazards regression analyses evaluated potential associations between subject-, implant-, and surgery-related factors and these complications.
RESULTS
Median follow-up was 4.1, 2.6, 2.1, and 2.3 years in the augmentation, revision-augmentation, reconstruction, and revision-reconstruction cohorts, respectively. Incidence of capsular contracture across cohorts ranged from 2.3 to 4.1 percent; malposition, 1.5 to 2.7 percent; and late seroma, 0.1 to 0.2 percent. Significant risk factors for capsular contracture were subglandular implant placement, periareolar incision site, and older device age in the augmentation cohort (p < 0.0001), older subject age in the revision-augmentation cohort (p < 0.0001), and higher body mass index (p = 0.0026) and no povidone-iodine pocket irrigation (p = 0.0006) in the reconstruction cohort. Significant risk factors for malposition were longer incision size in the augmentation cohort (p = 0.0003), capsulectomy at the time of implantation in the reconstruction cohort (p = 0.0028), and implantations performed in physicians' offices versus hospitals or standalone surgical facilities in both revision cohorts (p < 0.0001). The incidence of late seroma was too low to perform risk factor analysis.
CONCLUSIONS
These data reaffirm the safety of Natrelle 410 implants. Knowledge of risk factors for capsular contracture and implant malposition offers guidance for reducing complications and optimizing outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, II.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Implantation; Breast Implants; Female; Follow-Up Studies; Humans; Implant Capsular Contracture; Incidence; Middle Aged; Proportional Hazards Models; Prospective Studies; Risk Factors; Seroma; Silicone Gels; Young Adult
PubMed: 27627058
DOI: 10.1097/PRS.0000000000002837 -
European Radiology Nov 2022Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during...
OBJECTIVES
Cement leakages in soft tissues are a common occurrence during cementoplasty. They may cause chronic pain, and thus treatment failure. Spindle malposition during reinforced cementoplasty may cause vascular, nerve or cartilage injury. Our goal was to evaluate the rate of cement leakage/spindle extraction and describe the techniques used.
METHODS
This retrospective monocentre study included 104 patients who underwent reinforced cementoplasty and 3425 patients who underwent cementoplasty between 2012 and 2020. Operative reports and fluoroscopic images were reviewed to identify extraction attempts and their outcomes.
RESULTS
Six patients (5.8%) had a malpositioned spindle, and all of them underwent spindle extraction during reinforced cementoplasty, with an 80% success rate. A total of 7 attempts were performed, using 2 different techniques. One thousand one hundred thirty patients (32%) had a cement leak in soft tissues, and 7 (0.6%) underwent cement leakage extraction during cementoplasty, with a 100% success rate. A total of 10 attempts were performed, using 3 different techniques. No major complication related to the extraction procedures occurred.
CONCLUSIONS
Spindle malpositions and soft tissue cement leakages are not uncommon. We described 5 different percutaneous techniques that were safe and effective to extract spindles and paravertebral cement fragments.
KEY POINTS
• Soft tissue cement leakages or spindle malpositions are a non-rare occurrence during cementoplasty, and may cause technical failure and/or chronic pain. • Most soft tissue cement fragments and malpositioned spindles can easily be extracted using simple percutaneous techniques.
Topics: Humans; Retrospective Studies; Chronic Pain; Bone Cements; Cementoplasty; Fluoroscopy; Treatment Outcome; Spinal Fractures; Vertebroplasty
PubMed: 35449235
DOI: 10.1007/s00330-022-08787-3 -
JACC. Cardiovascular Interventions Oct 2010We evaluated the anatomic and technical factors predicting stent malposition and embolization in patients undergoing endovascular stent implantation for relief of...
OBJECTIVES
We evaluated the anatomic and technical factors predicting stent malposition and embolization in patients undergoing endovascular stent implantation for relief of noncoronary vascular obstruction.
BACKGROUND
Endovascular stent implantation provides a highly effective, minimally invasive solution to vascular obstruction in patients with structural heart disease. However, stent implantation is technically challenging and stent embolization occurs in up to 5.5% of cases.
METHODS
We reviewed patient and procedural characteristics of all endovascular stent implantations performed for relieving noncoronary vascular obstruction from January 1, 1999, through December 31, 2009. Univariate and multivariate predictors of stent malposition or embolization were explored through logistic regression methods.
RESULTS
During the 10-year study period, 429 stents were implanted. Of these, 399 were placed for relief of vascular obstruction in 267 patients during 322 procedures. Initial implantation failure occurred in 33 patients (8.3%), including stent malposition in 18 (4.5%) and stent embolization in 15 (3.8%). Patient size and vascular obstruction caused by external compression or a vascular fold were independent predictors of stent malposition or embolization. All malpositioned and embolized stents were successfully managed without surgery, and none resulted in death, sustained hemodynamic instability, or important vascular injury.
CONCLUSIONS
Endovascular stent implantation is a highly effective and safe means of relieving noncoronary vascular obstruction in patients with congenital and acquired structural heart disease. Stent embolization occurs in approximately 3.8% of implantation procedures but can be managed successfully without surgical intervention. Anatomic and technical factors predict stent malposition, and consideration of these factors may improve procedural results.
Topics: Adolescent; Adult; Angioplasty, Balloon; Arterial Occlusive Diseases; Child; Child, Preschool; Constriction, Pathologic; Foreign-Body Migration; Heart Defects, Congenital; Heart Diseases; Humans; Infant; Infant, Newborn; Logistic Models; Middle Aged; Odds Ratio; Radiography; Retrospective Studies; Risk Assessment; Risk Factors; San Francisco; Stents; Time Factors; Treatment Outcome; Young Adult
PubMed: 20965468
DOI: 10.1016/j.jcin.2010.07.010 -
Alternative Therapies in Health and... Mar 2024The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical...
OBJECTIVE
The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical efficiency and safety.
METHODS
423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects and enrolled into group A (malposition ligation), group B (selective malposition ligation), and group C (selective malposition ligation and hemorrhoid and fistula I), each with 141 cases.
RESULTS
The scores for visual analogue scale (VAS), edema, and hemorrhage of group C 8h, 1 day, 2 days, 3 days, 5 days, and 7 days after surgery were all inferior to those in groups A and B, while that of group B was inferior to that in group A (P < .05). The duration of wound healing of group C (15.33 ± 2.78 days) was shorter than that of groups A (21.78 ± 3.22 days) and B (18.34 ± 3.01 days), and this duration of group B was shorter than that of group A (P < .05). The total effective rate of group C (96.45%) was superior to that of groups B (96.45%) and A (82.27%). The total effective rate of group B was superior to that of group A. The falling-off rate of the rubber ring in groups C and B was inferior to that in group A. The incidence of total complications in group C (9.93%) was inferior to that in groups B (30.50%) and A (30.50%), while that of group B was inferior to that in group A (P < .05).
CONCLUSION
After selective malposition ligation, the oral intake of hemorrhoid and fistula I could promote the recovery of wounds among patients with complex mixed hemorrhoids and reduce the incidence of postoperative hemorrhage and edema. Hence, it has significant clinical application values.
PubMed: 38518140
DOI: No ID Found -
Turkish Journal of Ophthalmology Jun 2017To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy.
OBJECTIVES
To evaluate patient satisfaction and outcomes of surgical treatment of eyelid malpositions secondary to facial palsy.
MATERIALS AND METHODS
Consecutive patients with facial palsy who underwent surgical treatment by the same surgeon at İzmir Katip Çelebi University Atatürk Training and Research Hospital between Jan 2007 and Dec 2012 were included in the study. Ophthalmic examination findings, surgical approaches, and their outcomes were evaluated. A successful result for upper eyelid position was defined as more than 50% reduction in lagophthalmos and induction of less than 2 mm of ptosis. A successful outcome for lower eyelid position was defined as the lower eyelid residing at or within 1 mm above or below the limbus. Linear visual analog scale 1 (VAS-1) (subjective complaints) and VAS-2 (cosmetic outcome), both ranging from 0 to 10, were used to compare preoperative findings with findings at last postoperative visit.
RESULTS
The mean age of the 14 female and 21 male patients was 54.5±19.9 years. Gold weight implantation (n=31), lateral tarsal strip (n=22), tarsorrhaphy (n=15), suborbicularis oculi fat elevation (n=16), hard palate graft (n=14), and eyebrow ptosis repair (n=6) were performed. Average follow-up time was 17.9±16.9 months (range, 2-60). Surgical success rates were 90% for upper lids and 75% for lower lids. Mean lagophthalmos decreased from 7.1±2.7 mm to 1.6±1.6 mm postoperatively (p=0.000). The use of lubricating drops and gels was reduced from average preoperative daily values of 5.3±2.5 drops and 1.3±0.6 gel applications to 4.4±1.4 and 0.6±0.6, respectively (p=0.003, p=0.001).
CONCLUSION
An individualized surgical approach tailored according to each patient's severity of facial palsy and associated malpositions resulted in both functional and aesthetic improvements in our patients.
PubMed: 28630790
DOI: 10.4274/tjo.13549 -
Aesthetic Plastic Surgery Dec 2011Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as...
BACKGROUND
Although capsule formation is a natural-healing process following breast augmentation using implants, a contracted capsule around a poorly positioned implant can act as an obstacle during the corrective procedure to reposition the implant. The ideal treatment of capsular contracture is removal of the capsule and covering the implant with a healthy envelope without scar tissue. However, total capsulectomy in the submuscular space may be difficult, especially if the capsule is firmly attached to the chest wall. This situation may require a highly skilled technique because aggressive capsulectomy could injure the intercostal muscles and vasculature and cause further complications such as pneumothorax. Therefore, the authors have developed a new, less traumatic method of leaving the capsule behind the new implant.
METHOD
From February 2001 through February 2009, the authors treated 74 patients (139 breasts) using a subpectoral, precapsular implant repositioning technique. These patients suffered from capsular contracture or implant malposition after submuscular breast augmentation. The technique is composed of three parts. First, a plane was developed between the anterior wall of the capsule and the posterior surface of the pectoralis major muscle using a periareolar or inframammary approach. After removing the previous implant, the anterior wall of the capsule was fully released from the posterior surface of the pectoralis major muscle and fixed to the posterior wall of the capsule which adhered to the chest wall. The new implant was inserted into the developed subpectoral space, anterior to the capsule.
RESULTS
The mean age of the patients was 31 years (range = 24-52) and the time between the primary and the secondary augmentation was 42 months (range = 4 months to 12 years). The range for follow-up was from 12 months to 5 years. Median follow-up was 26 months. Postoperative complications included two cases of hematoma but no cases of infection, muscle distortion, or double-bubble deformity.
CONCLUSION
This technique is a valid alternative treatment for capsular contracture or malpositioned implant after breast augmentation surgery. It may be less traumatic than the conventional method of total capsulectomy. In addition, this technique reduces the relapse rate of capsular contracture significantly compared to a partial capsulectomy or capsulotomy as the new implant is inserted into a scar tissue-free environment. Good aesthetic results and patient satisfaction was achieved using this method. In our experience, this novel technique is a good alternative method of correcting complications of submuscular implant augmentation.
Topics: Adult; Breast Implantation; Female; Humans; Implant Capsular Contracture; Middle Aged; Reoperation; Young Adult
PubMed: 21512869
DOI: 10.1007/s00266-011-9714-z -
Stereotactic and Functional Neurosurgery 2021Directional leads are increasingly used in deep brain stimulation. They allow shaping the electrical field in the axial plane. These new possibilities increase the...
BACKGROUND
Directional leads are increasingly used in deep brain stimulation. They allow shaping the electrical field in the axial plane. These new possibilities increase the complexity of programming. Thus, optimized programming approaches are needed to assist clinical testing and to obtain full clinical benefit.
OBJECTIVES
This simulation study investigates to what extent the electrical field can be shaped by directional steering to compensate for lead malposition.
METHOD
Binary volumes of tissue activated (VTA) were simulated, by using a finite element method approach, for different amplitude distributions on the three directional electrodes. VTAs were shifted from 0 to 2 mm at different shift angles with respect to the lead orientation, to determine the best compensation of a target volume.
RESULTS
Malpositions of 1 mm can be compensated with the highest gain of overlap with directional leads. For larger shifts, an improvement of overlap of 10-30% is possible, depending on the stimulation amplitude and shift angle of the lead. Lead orientation and shift determine the amplitude distribution of the electrodes.
CONCLUSION
To get full benefit from directional leads, both the shift angle as well as the shift to target volume are required to choose the correct amplitude distribution on the electrodes. Current directional leads have limitations when compensating malpositions >1 mm; however, they still outperform conventional leads in reducing overstimulation. Further, their main advantage probably lies in the reduction of side effects. Databases like the one from this simulation could serve for optimized lead programming algorithms in the future.
Topics: Algorithms; Computer Simulation; Deep Brain Stimulation; Electrodes, Implanted; Finite Element Analysis; Humans
PubMed: 33080600
DOI: 10.1159/000509781