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2.
Chirurgia (Bucur) ; 115(4): 526-529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876027

RESUMO

Surgical clip migration in the common bile duct with consecutive stone formation is a rare occurrence after laparoscopic cholecystectomy, less than 100 cases being reported so far. We report a case of a 55-year-old woman with obstructive jaundice due to bile duct stone formed around a migrated surgical clip 9 years after laparoscopic cholecystectomy. The patient presented with pain in the upper abdomen and jaundice. Abdominal ultrasound diagnosed dilation of the common bile duct and intrahepatic bile ducts. The diagnosis was confirmed by computed tomography which revealed a metal clip in the distal part of the common bile duct. The patient was managed successfully by endoscopic retrograde cholangiopancreatography (ERCP) and the surgical clip was retrieved using the Dormia basket. The exact mechanism of clip migration is not fully understood but may be explained by local inflammation and ineffective clipping. Although a rare occurrence, clip migration should not be excluded when considering the differential diagnosis of patients presenting with obstructive jaundice or cholangitis after laparoscopic cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips related complications but surgical common bile duct exploration may be necessary.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/etiologia , Ducto Colédoco/cirurgia , Migração de Corpo Estranho/etiologia , Icterícia Obstrutiva/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/instrumentação , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/diagnóstico por imagem , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
3.
J Vasc Access ; 21(5): 795-798, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32886031

RESUMO

INTRODUCTION: Breakage and fragment embolization is a rare but feared complication of peripherally inserted central catheter use. While chest radiographs are no longer the gold standard for determining peripherally inserted central catheter tip position, their use in diagnosing complications is still warranted. We report a case of occult catheter embolization discovered by routine chest X-ray. CASE DESCRIPTION: A patient with a right brachial vein peripherally inserted central catheter was admitted to our Emergency Department for palpitations and dyspnea. The peripherally inserted central catheter was not visible at presentation, and she was unclear as to what had happened; she left the Emergency Department before workup was performed. Catheter embolization was discovered upon implantation of a new peripherally inserted central catheter. CONCLUSION: Although routine chest radiographs are no longer necessary after peripherally inserted central catheter implantation, they are in diagnosing peripherally inserted central catheter-related complications even in asymptomatic patients. We discuss their use and the possible role of securement devices in preventing some instances of catheter embolization.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Migração de Corpo Estranho/diagnóstico por imagem , Radiografia Torácica , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Remoção de Dispositivo , Falha de Equipamento , Feminino , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/terapia , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
4.
N Engl J Med ; 383(11): 1009-1017, 2020 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-32905673

RESUMO

BACKGROUND: When patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear. METHODS: In five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital. RESULTS: The trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups. CONCLUSIONS: Basing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.).


Assuntos
Remoção de Dispositivo , Oxigenoterapia , Sucção , Traqueostomia , Estado Terminal , Feminino , Humanos , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Fatores de Tempo , Desmame do Respirador
5.
Internist (Berl) ; 61(10): 1055-1058, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32757047

RESUMO

Central venous port systems are an integral part of chemotherapy. Early recognition and management of arterial malposition are crucial to prevent further complications. A 67-year-old female with breast cancer underwent central venous port implantation for adjuvant chemotherapy. After administration of the first chemotherapy the patient developed acute bihemispheric cerebral infarction and myocardial ischemia due to arterio-arterial emboli with a toxic encephalopathic component. After systemic lysis and surgical removal of the central venous port system, the patient showed a complete recovery.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres de Demora/efeitos adversos , Quimioterapia Adjuvante/métodos , Dor , Veias , Abdome , Doença Aguda , Idoso , Infarto Cerebral/complicações , Remoção de Dispositivo , Feminino , Humanos , Isquemia Miocárdica/complicações , Fatores de Risco , Resultado do Tratamento
7.
J Card Surg ; 35(8): 1885-1890, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32643849

RESUMO

BACKGROUND: Device complications in complex percutaneous coronary interventions are rare but potentially deadly. Surgical removal is often required. However, an evaluation of surgical therapy beyond case reports is practically not existent. METHODS: We prospectively followed all cases of retained guide wires and/or other devices referred to us for surgical removal between 2015 and 2019 and retrospectively searched our database for such cases between 2010 and 2014. RESULTS: From 2015 on, eight cases were referred for surgical removal from six different cardiology departments. In the 5 years before, there was not a single case. Six patients were operated emergently. Patients were 60.5 ± 5.42 years old, overweight (body mass index 30.1 ± 3.77) and except for one case (left ventricular-assist device) showed preserved ejection fraction (EF) (mean EF 57 ± 18.01). The retained devices were mostly located in the right coronary artery (50%), followed by the circumflex artery (37.5%) and diagonal branch (12.5%). The devices were remnants of guide wires (n = 4), balloon catheters (n = 3), and in one case a rotablator. Full sternotomy was performed in six patients and two received a left-sided minithoracotomy (n = 2). The operations were performed on-pump in five (62.5%) and off-pump in three patients. Complete extraction of the foreign bodies was possible in all patients. Two patients died; one in unrelated multiorgan failure and one due to retained-device-related right heart failure. The other patients survived and had uneventful postoperative courses. CONCLUSIONS: Retained foreign bodies from cardiac interventions can be completely removed surgically using individualized approaches. There appears to be a trend toward a rising incidence of such interventional complications.


Assuntos
Remoção de Dispositivo , Falha de Equipamento , Intervenção Coronária Percutânea , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
PLoS One ; 15(7): e0236093, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706784

RESUMO

INTRODUCTION: Surgical and percutaneous tracheostomy remains a commonly performed procedure in the intensive care unit (ICU). Given the unique patient population in the Middle East we decided to perform a review of the procedures performed in our hospital over a two-year period. METHODS: Single centre, retrospective observational study. All tracheostomies performed between January 2016 and January 2018 were included in the study. The primary outcome was the rate of tracheostomy complications. Multivariate logistic regression analysis was used to identify the independent factors associated with complications and decannulations. RESULTS: One hundred sixty-four patients were included in the study. Percutaneous tracheostomy was performed in 99 patients (60.4%). Complications occurred in thirty-eight patients (23%). Higher Left ventricular ejection fraction (OR = 0.94, 95%CI: [0.898-0.985]) and percutaneous tracheostomy (OR = 0.107, 95%CI: [0.029-0.401]) were associated with lower complications. Good Eastern Cooperative Oncology Group (ECOG) performance status (OR = 4.1, 95%CI: [1.3-13.3]) and downsized tracheostomy tube (OR = 6.5, 95%CI: [2.0-21.0]) were associated with successful decannulations. Successful decannulation was associated with lower hospital mortality when compated to those who could not be decannulated (3.2% vs 33.3% p < 0.0001). CONCLUSION: In our older population with high comorbidities, percutaneous tracheostomies were associated with less complications than surgical tracheostomies. Patients with poor premorbid functional status and those who could not have their tracheostomy tube sucessfuly downsized were less likely to be decannulated, and had a higher mortality. This data enables physicians to inform the families of the added risks involved with tracheostomy in this patient group.


Assuntos
Remoção de Dispositivo/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Traqueostomia/efeitos adversos , Desmame do Respirador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Retrospectivos
10.
BMC Infect Dis ; 20(1): 438, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571233

RESUMO

BACKGROUND: Candida sp. osteoarticular infection is rare and most often due to hematogenous seeding during an episode of candidemia in immunocompromised patients. However, the diagnosis can be delayed in patients with subtle symptoms and signs of joint infection without a concurrent episode of candidemia. CASE PRESENTATION: A 75-year-old woman presented with a three-year history of pain and swelling of the left knee. Candida pelliculosa was detected from the intraoperative tissue when the patient had undergone left total knee arthroplasty 32 months ago, but no antifungal treatment was performed. One year after the total knee arthroplasty, C. pelliculosa was repeatedly isolated from the left knee synovial fluid and antifungal treatment comprising amphotericin B deoxycholate and fluconazole was administered. However, joint infection had extended to the adjacent bone and led to progressive joint destruction. The patient underwent surgery for prosthesis removal and received prolonged antifungal treatment with micafungin and fluconazole. CONCLUSIONS: This case shows that C. pelliculosa, an extremely rare non-Candida albicans sp., can cause fungal arthritis and lead to irreversible joint destruction owing to delayed diagnosis and treatment.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Candida/patogenicidade , Candidíase/microbiologia , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/etiologia , Candidíase/tratamento farmacológico , Ácido Desoxicólico/uso terapêutico , Remoção de Dispositivo , Combinação de Medicamentos , Feminino , Fluconazol/uso terapêutico , Humanos , Cuidados Intraoperatórios , Prótese Articular , Joelho/microbiologia , Joelho/cirurgia , Micafungina/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia
13.
World Neurosurg ; 142: e183-e194, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32599201

RESUMO

OBJECTIVE: In the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center. METHODS: Neurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods. RESULTS: A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72-80; median during, 45; IQR, 43-47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54-70; median during, 36; IQR, 34-39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12-14; median during, 9; IQR, 8-10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94-114; median during, 75; IQR, 68-84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326-374; median during, 29; IQR, 26-39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0-0) before to a median of 151 (IQR, 126-156) during COVID-19 (P < 0.001). CONCLUSIONS: Significant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.


Assuntos
Assistência Ambulatorial/tendências , Infecções por Coronavirus , Neurocirurgia , Procedimentos Neurocirúrgicos/tendências , Pandemias , Pneumonia Viral , Encaminhamento e Consulta/tendências , Telemedicina/tendências , Centros Médicos Acadêmicos , Adolescente , Idoso , Betacoronavirus , Neoplasias Encefálicas/cirurgia , Criança , Pré-Escolar , Craniotomia/tendências , Remoção de Dispositivo , Procedimentos Endovasculares/tendências , Epilepsia/cirurgia , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/tendências , Doenças da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Tennessee , Procedimentos Cirúrgicos Vasculares/tendências
14.
Spine (Phila Pa 1976) ; 45(13): 872-876, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32539289

RESUMO

STUDY DESIGN: Analysis of explanted MAGnetic Expansion Control (MAGEC) growing rods. OBJECTIVE: The aim of this study was to quantify the rate of locking pin breakage in explanted MAGEC rods and compare with the manufacturer's data. SUMMARY OF BACKGROUND DATA: On June 25, 2019, NuVasive released an Urgent Field Safety Notice stating that MAGEC rods manufactured before March 26, 2015 had a higher than expected locking pin breakage rate of 5%. For rods made on or after that date, no pin breakages had occurred. METHODS: From our independent explant database of 139 explanted MAGEC rods supplied from 10 UK spinal centers (Belfast, Bristol, Birmingham, Edinburgh, Exeter, Leeds, Newcastle, Nottingham, Oxford, and Sheffield) and one Danish center (Aarhus), we divided the rods into those manufactured before March 26, 2015, and those manufactured on or after that date. MAGEC rods were cut open to fully assess internal components including locking pins. From each of the two cohorts, 10 locking pins were selected at random and their diameters were measured using a micrometer. RESULTS: One hundred and five explanted MAGEC rods were made before March 26, 2015 and could be disassembled to allow the locking pin to be examined. Fifty-nine percent (62/105) of these locking pins had fractured. For the MAGEC rods manufactured on or after March 26, 2015, 21% (6/29) were found to have fractured locking pins. Locking pins in MAGEC rods made on or after March 26, 2015 were of a stronger material and a larger diameter. CONCLUSION: Fifty-nine percent of the locking pins in MAGEC rods manufactured before March 26, 2015 had fractured, far greater than the 5% stated in the Urgent Field Safety Notice. Locking pin fracture still occurred in MAGEC rods manufactured on or after that date, in 21% of cases. This contrasted with the 0% reported by the manufacturer. LEVEL OF EVIDENCE: 4.


Assuntos
Dispositivos de Fixação Ortopédica/estatística & dados numéricos , Próteses e Implantes/estatística & dados numéricos , Falha de Prótese , Escoliose/cirurgia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Remoção de Dispositivo , Feminino , Humanos , Masculino , Indústria Manufatureira/estatística & dados numéricos , Dispositivos de Fixação Ortopédica/efeitos adversos , Próteses e Implantes/efeitos adversos
16.
Bone Joint J ; 102-B(6_Supple_A): 19-23, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475276

RESUMO

AIMS: The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. METHODS: We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as 'outpatient' and 'inpatient' TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018. RESULTS: Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme. CONCLUSIONS: Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19-23.


Assuntos
Artroplastia do Joelho/economia , Remoção de Dispositivo/economia , Mecanismo de Reembolso , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Medicare , Estudos Retrospectivos , Estados Unidos
17.
Bone Joint J ; 102-B(6_Supple_A): 129-137, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475284

RESUMO

AIMS: A retrospective longitudinal study was conducted to compare directly volumetric wear of retrieved polyethylene inserts to predicted volumetric wear modelled from individual gait mechanics of total knee arthroplasty (TKA) patients. METHODS: In total, 11 retrieved polyethylene tibial inserts were matched with gait analysis testing performed on those patients. Volumetric wear on the articular surfaces was measured using a laser coordinate measure machine and autonomous reconstruction. Knee kinematics and kinetics from individual gait trials drove computational models to calculate medial and lateral tibiofemoral contact paths and forces. Sliding distance along the contact path, normal forces and implantation time were used as inputs to Archard's equation of wear to predict volumetric wear from gait mechanics. Measured and modelled wear were compared for each component. RESULTS: Volumetric wear rates on eight non-delaminated components measured 15.9 mm3/year (standard error (SE) ± 7.7) on the total part, 11.4 mm3/year (SE ± 6.4) on the medial side and 4.4 (SE ± 2.6) mm3/year on the lateral side. Volumetric wear rates modelled from patient gait mechanics predicted 16.4 mm3/year (SE 2.4) on the total part, 11.7 mm3/year (SE 2.1) on the medial side and 4.7 mm3/year (SE 0.4) on the lateral side. Measured and modelled wear volumes correlated significantly on the total part (p = 0.017) and the medial side (p = 0.012) but not on the lateral side (p = 0.154). CONCLUSION: In the absence of delamination, patient-specific knee mechanics during gait directly affect wear of the tibial component in TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):129-137.


Assuntos
Artroplastia do Joelho , Remoção de Dispositivo , Marcha , Prótese do Joelho , Modelos Teóricos , Falha de Prótese , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Previsões , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Polietileno , Estudos Retrospectivos
18.
J Vasc Interv Radiol ; 31(5): 754-758, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32359522

RESUMO

This brief report describes 3 patients with infected extrahepatic splanchnic venous stents or stent grafts. These devices had been placed to treat prehepatic portal hypertension 4 wk, 3 mo, and 31 mo, respectively, before readmission for fever. Blood cultures and fluorine-18 fludeoxyglucose positron emission tomography/CT were positive in all. With systemic antibiotic treatment, 2 patients showed a clinical recovery. In the third patient, antibiotic treatment failed. Therefore, the infected stent graft was surgically removed and a splenorenal shunt was created. No recurrent splanchnic venous infection was observed in these 3 patients.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/instrumentação , Hipertensão Portal/cirurgia , Infecções Relacionadas à Prótese/terapia , Stents/efeitos adversos , Resultado do Tratamento , Adolescente , Idoso , Implante de Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Pressão na Veia Porta , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Circulação Esplâncnica
19.
Artigo em Inglês | MEDLINE | ID: mdl-32459076

RESUMO

As the number of young and relatively low-risk patients undergoing transcatheter aortic valve implantation increases, the number who will require open heart surgery months or years later will also increase. Only a few cases of late transcatheter heart valve explantation (without root replacement) have been reported in the literature, and this rare procedure can be surgically very challenging. In this video tutorial we present the case of a patient with a valve-in-valve subacute thrombosis, and we describe the surgical technique for valve explantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica , Remoção de Dispositivo/métodos , Reoperação/métodos , Trombose , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Trombose/etiologia , Trombose/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-32349262

RESUMO

BACKGROUND: Optimal care of patients treated with a central tunneled catheter (CTC) as vascular access for hemodialysis requires a number of procedures. One of them is CTC removal, usually carried out using mostly the cut-down method (CDM) and the traction method (TM). The procedure seems to be simple and safe; however, occasionally, serious complications may occur. To eliminate the risk of such events, we have introduced a modified cut-down method (MCDM). METHODS: The study included the analysis of retrospective results of 143 CTC removal procedures, 76 of which were performed using the standard cut-down method (CDM), and in 67 cases, the modified cut-down method (MCDM) was applied. RESULTS: As minor side effects occurred in patients treated with both methods with comparable frequency, serious complications were observed only in the CDM patients group. CONCLUSIONS: In our opinion, the new MCDM procedure is the simplest and safest method of CTC removal.


Assuntos
Cateterismo Venoso Central , Cateteres de Demora , Remoção de Dispositivo , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
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