351
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Peskin B, Levin D. [A rare cause of urinary frequency]. HAREFUAH 1998; 134:157-8. [PMID: 9517307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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352
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Abstract
PURPOSE It is generally thought that the Greenfield filter should not be placed in inferior venae cavae (IVCs) that are larger than 28 mm in diameter because of its base diameter. However, the newer versions have larger base diameters. The purpose of this study was to evaluate fixation of the three currently available Greenfield filters in large IVCs. MATERIALS AND METHODS Filter fixation was tested in an ex vivo perfusion system with a 34-mm-diameter equine IVC. Greenfield filters with base diameters of 30 mm (original 24-F version [24-F GF]), 38 mm (percutaneous titanium [TGF]), and 32 mm (percutaneous stainless steel [SGF]) were deployed. Increasing force was then applied in a cephalic direction and the resultant movement was measured. RESULTS In a 34-mm-diameter IVC, the TGF and SGF demonstrated significantly less movement than did the 24-F GF (P < .001). None of the TGFs or SGFs moved above the renal veins with a 480-g pull. Three of the seven 24-F GFs moved above the renal veins at 30 g. No significant difference in fixation was demonstrated between the TGF and the SGF (P = .6). CONCLUSIONS In a 34-mm-diameter IVC, fixation of the TGF and SGF was significantly better than the 24-F GF. The TGF and SGF may not be subject to the same 28-mm-diameter IVC size limitation as the 24-F GF.
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353
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Dardik A, Campbell KA, Yeo CJ, Lipsett PA. Vena cava filter ensnarement and delayed migration: an unusual series of cases. J Vasc Surg 1997; 26:869-74. [PMID: 9372827 DOI: 10.1016/s0741-5214(97)70102-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To review delayed and guidewire-induced morbidity associated with vena cava filters. METHODS The records from the Johns Hopkins Hospital, a tertiary care referral center, of all patients who had vena cava filter complications from August 1993 through July 1996 were retrospectively reviewed. RESULTS Five patients had filter migration or ensnarement with a guidewire. One patient had delayed extrusion of a filter strut into the duodenum. Four patients had filters ensnared by guidewires, including one during initial filter placement and one several years after placement. CONCLUSIONS Delayed complications of vena cava filters should be considered whenever unusual patient signs or symptoms cannot be easily explained, even in the absence of a history of filter placement. To prevent guidewire ensnarement of filters, simple techniques should modify endovascular procedures when vena cava filters are present.
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354
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Garby KB, King TS, Tsai FY. Recurrence of pseudoaneurysm after successful embolization. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1997; 4:385-8. [PMID: 9418204 DOI: 10.1583/1074-6218(1997)004<0385:ropase>2.0.co;2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To report the initial successful treatment of a hepatic pseudoaneurysm by a partially formed coil and subsequent recurrence secondary to coil migration and configuration change. METHODS AND RESULTS A 22-year-old man suffered a gunshot wound in the abdomen; a grade 4 liver laceration was identified and repaired. Eight days later, abdominal pain developed, and pseudoaneurysms were noted off both the superior and inferior branches of the right hepatic artery. Coil embolization was successful in occluding both defects; however, the inferior branch coil was incompletely formed. Twenty days later, symptom recurrence prompted angiography. The inferior branch coil had changed position and configuration, resulting in a larger pseudoaneurysm. Repeat embolotherapy was successful. CONCLUSIONS The possible sequelae to maldeployed occluding coils must be considered even if the procedure appears successful. It may be advisable to place additional coils to more confidently occlude the pseudoaneurysm.
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355
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Stenberg AM, Sundin A, Larsson BS, Läckgren G, Stenberg A. Lack of distant migration after injection of a 125iodine labeled dextranomer based implant into the rabbit bladder. J Urol 1997; 158:1937-41. [PMID: 9334643 DOI: 10.1016/s0022-5347(01)64185-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE In recent years endoscopic treatment of stress incontinence and vesicoureteral reflux has been introduced. Reports of possible particle migration of the injected material to distant organs in humans and experimental animals have led to a search for biological nonmigration products. An implant found to have a good clinical effect in these conditions is dextranomer in hyaluronan. We performed this study in rabbits to investigate the possible migration of dextranomer particles. MATERIALS AND METHODS 125Iodine labeled dextranomer particles were injected into the submucosal space of rabbit bladders, and samples of blood and various tissues were examined for radioactivity at scheduled intervals during a 28-day period. Furthermore, whole body autoradiography was performed 1 day, and 1 and 4 weeks after injection. RESULTS Radioactivity was found in blood samples and in all tissues but it remained at the background activity level except in the thyroid, where uptake representing free 125iodine was detected. In the bladder 41 and 45% of the injected dose remained within the bladder wall 1 day and 4 weeks, respectively, after injection. The remainder of the dose probably disappeared from the bladder wall by leakage into the urine shortly after deposition, as indicated by the finding of 10-fold higher urine radioactivity levels at day 1 than at day 28 after injection. CONCLUSIONS No distant migration of dextranomer particles occurs after submucosal injection of such an implant in the rabbit bladder wall.
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356
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Gilchrist BF, Valerie EP, Nguyen M, Coren C, Klotz D, Ramenofsky ML. Pearls and perils in the management of prolonged, peculiar, penetrating esophageal foreign bodies in children. J Pediatr Surg 1997; 32:1429-31. [PMID: 9349761 DOI: 10.1016/s0022-3468(97)90554-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND/PURPOSE Most retained esophageal foreign bodies (FB) are identified soon after ingestion and are easily extracted. A minority of FB ingestions are not identified for weeks to years and present significant problems for retrieval. The purpose of this study was to describe the diagnostic and therapeutic strategies needed to care for children who have chronic esophageal FBs. METHODS Five children were identified as having retained esophageal FBs 2 months to 2 years after ingestion. During the same 3-year period, 100 children who had acute FBs were identified and had their foreign bodies removed endoscopically. The average age of the children was 3 years (range, 2.4 to 3.5). RESULTS The average age of the five children identified in this study was 3 years. The items ingested included coins, a heart pendant, a clothespin spring, and a toy soldier. Complications from chronically retained foreign bodies were bronchoesophageal fistula, mediastinitis, esophageal diverticulum, and lobar atelectasis. One patient died from an aortoesophageal fistula. In all children, endoscopic removal was attempted. Barium esophagram was then performed, and foreign bodies were eventually removed via right thoracotomy. CONCLUSIONS Long-retained esophageal FBs are extremely morbid and life threatening. History most often identifies excess salivation, new onset asthma, and/or recurrent upper respiratory infections. Three diagnostic adjuncts are helpful in identifying the presence of a long retained FB: (1) Chest x-ray (PA and lateral), (2) barium swallow, and (3) esophagoscopy. Indications for thoracotomy for removal of foreign body include (1) Poor endoscopic visualization of FB because of inflammatory tissue and (2) Herald bleeding during endoscopy.
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357
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358
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Kotsakis A, Tan KH, Jackson G. Is MRI a safe procedure in patients with coronary stents in situ? Int J Clin Pract 1997; 51:349. [PMID: 9489059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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359
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Bovyn G, Gory P, Reynaud P, Ricco JB. The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks. Ann Vasc Surg 1997; 11:520-8. [PMID: 9302065 DOI: 10.1007/s100169900084] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A multicenter study was conducted to evaluate a new temporary caval filter (Tempofilter) designed to be implanted for up to 6 weeks. A total of 66 patients with a mean age of 51.8 years were enrolled in the study. All had documented high risk of pulmonary embolism: severe deep venous thrombosis in 89.5% of cases and previous symptomatic pulmonary embolism in 65% of cases. Filter placement was performed in association with a surgical or obstetrical procedure in 68.5% of cases. The indication for filter placement was contraindication to or failure of anticoagulant therapy in 85% of the cases. The mean duration of implantation was 29.9 days. Pulmonary embolism was not observed during the implantation period. Partial thrombosis of the filter was observed in 15% of cases due to trapping of clots by the filter. Thrombosis did not hinder filter removal when attempted. Filter-related complications were minor. Filter migration occurred in only 7.5% of cases. Migration never led to complications and did not hinder filter removal. In all cases migration was due to specific, preventable causes. The results of this study show that the Tempofilter is not only safe and easy to use but also effective in preventing pulmonary embolism. A significantly longer maximum implantation time is a major advantage of the Tempofilter over conventional temporary filters. We believe that this filter can be used for temporary protection against the risk of pulmonary embolism particularly in young patients and in a surgical setting.
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360
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Abstract
The majority of foreign bodies (FBs) swallowed by children are passed spontaneously without event. Perforation of the intestine with migration to the liver is rare. A child with a needle in the right lobe of the liver is reported.
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361
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Conn KS, Dunning JJ, Pillai R. Extrusion of Teflon aortic pledgets from a sternal wound six years after cardiac surgery. Eur J Cardiothorac Surg 1997; 12:150-1; discussion 152-3. [PMID: 9262099 DOI: 10.1016/s1010-7940(97)00110-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We present a case of a cardiac surgery patient with a persistent low-grade discharge from his sternal wound for over six years. It finally healed when some suture material and Teflon felt pledgets were extruded. These had been used intraoperatively to close the aortic cannulation site. The extrusion of prosthetic material from this site after this length of time has never been described.
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362
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Swana HS, Foster HE. Erosion of malleable penile prosthesis into bladder. J Urol 1997; 157:2259-60. [PMID: 9146640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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363
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Bradfield H, Granke D. Surgical clip as a nidus for a common bile duct stone: radiographic demonstration. ABDOMINAL IMAGING 1997; 22:293-4. [PMID: 9107653 DOI: 10.1007/s002619900192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Surgical clips can migrate into the biliary tract and act as a nidus for stone formation. We present a case of a surgical clip within a common bile duct stone. This diagnosis was suggested by clip movement on serial abdominal radiographs and metallic density within the common duct stone on computed tomography. Confirmation was made by retrograde cholangiogram.
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364
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Beekman WH, Feitz R, van Diest PJ, Hage JJ. Migration of silicone through the fibrous capsules of mammary prostheses. Ann Plast Surg 1997; 38:441-5. [PMID: 9160123 DOI: 10.1097/00000637-199705000-00001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The usual reaction of the human body to implantation of a silicone prosthesis is formation of a fibrous capsule. Local reactions to silicone outside this fibrous capsule and distant migration of silicone particles have been described. So far, transcapsular migration of silicone particles from the mammary implant through the fibrous capsule of mammary prostheses has not been studied. In this prospective study 71 capsules found in 40 patients were histologically studied. The chi-squared test was applied to evaluate a possible correlation between silicone migration on the one hand and implant age and integrity of the prostheses on the other. The degree of silicone migration was discerned in four stages. Stage 1 represents no silicone particles in the capsule, stage 2 represents migration up to less than half of the capsule thickness, stage 3 shows migration confined to the outer half of the capsule thickness, and stage 4 means transcapsular silicone migration. In only 4 of 71 capsules no migration into or through the capsule was observed. The degree of silicone migration was significantly less in patients in whom the capsule was calcified and was significantly more in patients in whom implantation exceeded 12 years. There was no significant correlation between the status of the prosthesis (intact, bleeding, or ruptured) and the degree of silicone migration.
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365
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Sievert T, Skalej M, Heiss E. [Migration of an aneurysm clip in the ventricular system]. ROFO-FORTSCHR RONTG 1997; 166:451-3. [PMID: 9198520 DOI: 10.1055/s-2007-1015457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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366
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367
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Symbas PN, Symbas PJ. Missiles in the cardiovascular system. CHEST SURGERY CLINICS OF NORTH AMERICA 1997; 7:343-56. [PMID: 9156296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A missile in the cardiovascular system is a rare complication of a projectile wound. A missile in the heart should be suspected in the patient with a projectile wound of the thorax and in whom, on chest radiography, a missile is seen in the cardiac silhouette. A missile should be suspected in the patient with a projectile wound elsewhere with similar radiographic findings, no exit wound, and no missile in the area of injury. A missile in the arterial system should be suspected when no exit wound and no projectile are seen in the traumatized area. In such a case, radiography of the entire body should be done. The diagnosis of a suspected missile in the cardiovascular system is confirmed by echocardiography or angiography. Treatment should be individualized according to the clinical manifestations of the patient and the site of the missile.
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368
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Kozarek RA, Brandabur JJ, Raltz SL. Expandable stents: unusual locations. Am J Gastroenterol 1997; 92:812-5. [PMID: 9149191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Expandable metallic prostheses have been used widely for malignant biliary stenoses and are being used increasingly for malignant dysphagia and esophago-airway fistulas. Potentially, such prostheses can be placed for gut neoplasms obstructing beyond the esophagus or gastric cardia. This series reports our experience with expandable metallic stents in the stomach, jejunum, and colon. METHODS All patients with expandable gastrointestinal stents (other than biliary tree or esophagus) were reviewed. Indications for stent placement, type and location of prosthesis, patient demographics, procedural problems, and data with regard to outcome were defined. RESULTS Over a 6-yr period, expandable prostheses (Z stent, Esophacoil, and Ultraflex) were placed in nine patients with widespread malignancy (afferent loop obstruction, three; colon obstruction, three; gastric outlet obstruction, two; and esophagojejunal interposition stricture, one). There was one colon perforation as a consequence of dilation prior to placement of the prosthesis. Subsequent problems included migration (one), occlusion by food bolus (one), and tumor overgrowths/ingrowths (three) which were treated with laser. Median survival approximated 9 months. CONCLUSIONS Expandable metallic prostheses have the potential to palliate malignant gastrointestinal stenoses that have traditionally been treated with surgical bypass or comfort care measures only.
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369
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Sharafuddin MJ, Gu X, Titus JL, Urness M, Cervera-Ceballos JJ, Amplatz K. Transvenous closure of secundum atrial septal defects: preliminary results with a new self-expanding nitinol prosthesis in a swine model. Circulation 1997; 95:2162-8. [PMID: 9133527 DOI: 10.1161/01.cir.95.8.2162] [Citation(s) in RCA: 162] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our purpose was to evaluate a new prosthesis for percutaneous closure of secundum atrial septal defects (ASDs). METHODS AND RESULTS Percutaneous closure of surgically created fossa ovalis ASD was attempted in 15 minipigs. The mean balloon-stretched ASD diameter was 12.3+/-2.3 mm (range, 10 to 16 mm). The self-expanding prosthesis was braided from 0.005-in Nitinol wires in the shape of two flat buttons with a short connecting waist with a diameter corresponding to that of the defect to be closed. Polyester filling was added to enhance thrombogenicity. Pulmonary arteriography with levo-phase was obtained before placement; immediately after placement; and at 1-week, 1-month, and 3-month follow-ups. Four animals were killed at 1 week, 1 month, and 3 months for histopathological correlation. Three deaths resulted from ventricular fibrillation (one during anesthesia and two during the placement procedure). Successful placement of the prosthesis was achieved in the remaining 12 animals. Overall immediate ASD closure on angiography occurred in 7 of 12 animals (all polyester-filled prostheses). Absent or trace shunt by angiography was present in 11 of 12 devices at 1 week, with the remaining one demonstrating a small shunt. All septal defects were completely closed at 1 month with the exception of one case in which delayed partial dislodgment of an undersized prosthesis into the right atrium had developed. Closure rate at 3 months was 100%. Neoendothelialization and fibrous incorporation of the prosthesis were completed within 1 to 3 months. CONCLUSIONS Effective and permanent occlusion of secundum ASDs is feasible with a device that offers the advantages of easy placement, self-centering, and repositionability.
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370
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Plant G. A migrating biliary wallstent. Clin Radiol 1997; 52:322. [PMID: 9112958 DOI: 10.1016/s0009-9260(97)80067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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371
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Cordonnier C, Sevestre H, Gontier MF. [Foreign bodies after total hip prosthesis]. Ann Pathol 1997; 17:100-8. [PMID: 9220998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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372
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Sandu KB, Shah NJ, Kirtane MV. Foreign body in the maxillary antrum. A case report. Int J Oral Maxillofac Surg 1997; 26:110-1. [PMID: 9151164 DOI: 10.1016/s0901-5027(05)80828-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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373
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Maskey CP, Rahman M, Sigdar TK, Johnsen R. Vesical calculus around an intra-uterine contraceptive device. BRITISH JOURNAL OF UROLOGY 1997; 79:654-5. [PMID: 9126106 DOI: 10.1046/j.1464-410x.1997.00165.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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374
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Leonelli FM, Salley R, Szabo TS, Kuo CS. The vanishing defibrillator syndrome: incidence, mechanism, and clinical relevance. Pacing Clin Electrophysiol 1997; 20:960-5. [PMID: 9127402 DOI: 10.1111/j.1540-8159.1997.tb05500.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intraperitoneal migration of an abdominally implanted cardioverter defibrillator is a complication not yet fully described. In a consecutive series of 195 patients, migration occurred between 1 and 20 months in 5 (8%) of the 63 patients in whom a subrectus abdomini placement of the generator was chosen. It was unrelated to the patients' clinical characteristics or the defibrillator model. Dysuria and inability to interrogate the device were present in every subject, and the diagnosis was confirmed by the characteristic abdominal x-ray appearance and the findings at the time of surgery. Adhesions involving the omentum, and in one case, the small bowels, were present in three patients and seem to be related to the length of intraabdominal permanence of the generator. Because this complication may be due to specific anatomical characteristics of the aponeurosis of the abdominal muscles, it is likely that its incidence will be unchanged by the use of smaller devices. A close follow-up of the generators implanted deep to the rectus fascia is therefore advisable.
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375
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Kesby GJ, Korda AR. Migration of a Filshie clip into the urinary bladder seven years after laparoscopic sterilisation. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1997; 104:379-82. [PMID: 9091021 DOI: 10.1111/j.1471-0528.1997.tb11473.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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