When a revision surgery related with removal of failed interbody cage is required, going through the previous passage can lead to a higher risk of neurological deficits or incidental dural injuries. Recently, the lateral approach has become a popular method instead of the conventional anterior or posterior approaches. The lateral approach is also useful method to remove failed interbody cage previously placed and re-do interbody fusion with lower risks compared to revision surgery via previous passage. However, there is still some difficulty in retrieving the interbody cage from the intervertebral space because of no spacious passage, subsidence, and uncontrolled movable cage. In this study, we introduce our experience that we removed failed interbody cage more easily with only the simple additional steps of making a taphole and fixing the cage using a thread-tipped stick.
Device Removal ; Methods ; Reoperation

OBJECTIVETo investigate the technique of repeated operation for removement of polyacrylamide hydrogel from breast.

METHODS17 cases after uncomplete removement of PHG were reoperated through inferior periareolar incision. The PHG and affected denatured muscle and gland tissue were removed.

RESULTSPreoperative MRI or CT showed PHG distributed diffusely in muscle and gland. There was only minimal residual PHG after operation. Histological examination showed PHG distributed in the denatured and proliferative fibrous tissue, including giant cells, many neutrophilic cells infiltration, and foreign body granuloma. The symptoms, such as intramammary pump or nodule, chest and back pain, infection, were relieved after operation.

CONCLUSIONSBlinded suction technique can not remove PHG completely and can also result in malposition of PHG and make the tissue denaturation worse. We suggest open approach to remove the PHG and denatured tissue completely through periareolar incision.

Acrylic Resins ; Adult ; Breast Implants ; Device Removal ; methods ; Female ; Humans ; Mammaplasty ; instrumentation ; Middle Aged ; Young Adult

Bone Screws ; Child ; Device Removal ; methods ; Epiphyses, Slipped ; surgery ; Female ; Humans

Adult ; Device Removal ; methods ; Ductus Arteriosus, Patent ; Heart Septal Defects, Atrial ; therapy ; Humans ; Male

Embolization of the occlusion device after percutaneous closure of atrial septal defect (ASD) is a potential disastrous complication. The usual site of embolization is the right side of the heart including pulmonary artery, but the device embolization to the extracardiac aorta is extremely rare. Here, we report a successful percutaneous retrieval case of the embolized Amplatzer Septal Occluder (ASO) to the descending thoracic aorta after the successful deployment of two ASO devices in a patient with double ASD. Competition between the two devices to obtain a stable position may be an explanation for the migration of ASO.
Adult ; Device Removal/*methods ; Embolism/*etiology/*surgery ; Heart Septal Defects, Atrial/*complications/surgery ; Humans ; Male ; Septal Occluder Device/*adverse effects ; Treatment Outcome

PURPOSE: Supraglottic airway devices have been widely utilized as an alternative to tracheal intubation in various clinical situations. The rotation technique has been proposed to improve the insertion success rate of supraglottic airways. However, the clinical efficacy of this technique remains uncertain as previous results have been inconsistent, depending on the variable evaluated. MATERIALS AND METHODS: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials in April 2015 for randomized controlled trials that compared the rotation and standard techniques for inserting supraglottic airways. RESULTS: Thirteen randomized controlled trials (1505 patients, 753 with the rotation technique) were included. The success rate at the first attempt was significantly higher with the rotation technique than with the standard technique [relative risk (RR): 1.13; 95% confidence interval (CI): 1.05 to 1.23; p=0.002]. The rotation technique provided significantly higher overall success rates (RR: 1.06; 95% CI: 1.04 to 1.09; p<0.001). Device insertion was completed faster with the rotation technique (mean difference: -4.6 seconds; 95% CI: -7.37 to -1.74; p=0.002). The incidence of blood staining on the removed device (RR: 0.36; 95% CI: 0.27 to 0.47; p<0.001) was significantly lower with the rotation technique. CONCLUSION: The rotation technique provided higher first-attempt and overall success rates, faster insertion, and a lower incidence of blood on the removed device, reflecting less mucosal trauma. Thus, it may be considered as an alternative to the standard technique when predicting or encountering difficulty in inserting supraglottic airways.
Device Removal ; Humans ; Intubation, Intratracheal/instrumentation/*methods/standards ; *Laryngeal Masks ; Randomized Controlled Trials as Topic ; Reference Standards ; Risk ; *Rotation

Summary of Event: A transjugular intrahepatic portosystemic shunt (TIPS) stent (Viatorr) was misplaced into main portal vein and superior mesenteric vein. This misplaced covered stent was then successfully retrieved using the rigid endobronchial forceps. Teaching Point: Before release the covered portion of the TIPS stent (Viatorr), it is necessary to confirm the position of uncovered portion in portal vein and covered portion in parenchymal tract. The endobronchial forceps technique is a safe and efficient method for retrieving a misplaced TIPS stent.
Device Removal ; Mesenteric Veins ; Methods ; Portal Vein ; Portasystemic Shunt, Surgical* ; Portasystemic Shunt, Transjugular Intrahepatic ; Stents* ; Surgical Instruments*

Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmHO in the Air-Q group and (22.2±5.0) cmHO in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmHO in the Air-Q group and (33.9±15.9) cmHO in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.
Anesthesia, General ; Child ; Device Removal ; Elective Surgical Procedures ; Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; methods ; Laryngeal Masks ; Pressure ; Prospective Studies

OBJECTIVETo investigate the effect of exchange of tracheal tube for a laryngeal mask airway (LMA) on intratracheal extubation stress response under deep anesthesia level after surgery in elderly patients with hypertension.

METHODSFrom October 2008 to June 2009, 40 hypertension patients aged from 65 to 78 years scheduled for upper abdominal surgery were randomly divided into 2 groups, one was extubated intratracheal tube when being awake (group TT, n = 20) and the other was extubated and exchanged for LMA under deep anesthesia (group LM, n = 20). The American Society of Anesthesiologists (ASA) of the patients were I o rII. The data of mean arterial pressure (MAP), heart rate(HR), pulse oxygen saturation (SPO(2)), end-tidal carbon dioxide tension (P(ET)CO(2)) and rate pressure product(RPP) were recorded before induction of anesthesia (T(0)), suction (T(1)) and at 0 (T(2)), 5(T(3)), and 10 (T(4)) and 15 min (T(5)) after extubation tracheal tube or LMA in two groups. The indices mentioned above also were recorded before and after extubation in group LM. Blood samples were taken at T(0), skin incision, T(2), T(3), for determination of serum concentrations of blood glucose and cortisol. The airway adverse events in the recovery period were recorded.

RESULTSCompared with group LM, MAP, HR and RPP were significantly higher at T(1), T(2), T(3) than T(0) in group TT (P < 0.05). There was no significant difference in the indices mentioned above during extubated intratracheal tube and exchanged for LMA under deep anesthesia in group LM (P > 0.05). The incidence rate of glossoptosis in group TT was significantly higher than those in group LM (P < 0.01), while complications, such as cough, bucking, breath holding during the recovery stage in group TT were more than those in group LM (P < 0.05). Compared with the baseline value, blood glucose and cortisol concentration level were significantly increased in group TT than in group LM (P < 0.01).

CONCLUSIONSExchange of tracheal tube for LMA under deep anesthesia during recovery stage can decrease the stress response during the recovery stage and attenuate the harmful response of respiratory tract. It is suitable for the elderly patients with hypertension.

Aged ; Anesthesia, General ; Device Removal ; methods ; Female ; Humans ; Hypertension ; physiopathology ; Intubation, Intratracheal ; Laryngeal Masks ; Male ; Postanesthesia Nursing ; Stress, Physiological

OBJECTIVETo explore the relationship between mammaplasty and results after polyacrylamide hydrophilic gel (PAHG) removal from breast.

METHODSFrom Feb. 2003 to Aug. 2009, 130 patients with bilateral breast augmentation by PAHG injection were treated. Preoperative ultrasound examination and MRI were performed to know the distribution of PAHG and infiltration at the surrounding tissue. According to the conditions after removal, the patients were received implant augmentation immediately, or at the second stage, or no implant.

RESULTSThe patients were followed up for 3 months at the most with a very satisfactory rate of 63.84% (83/120), a satisfactory rate of 31.53% (41/120) and a unsatisfactory rate of 4.63% (6/120). Slight capsular contracture (Baker I) occurred in 5 cases with 6 breasts in satisfactory group. All the patients in unsatisfactory groups who selected unsuitable implants by themselves were re-operated to take out the implants. 3 cases with much residue PAHG insisted to receive breast implants. Among them, 2 cases achieved acceptable results even the surface of the breasts were not smooth. No other complication happened.

CONCLUSIONSThe breast reaugmentation after PAHG removal should be performed based on the deformity and condition of breast. Both cosmetic result and psychological relief could be obtained after mammaplasty.

Acrylic Resins ; adverse effects ; Adult ; Breast Implants ; adverse effects ; Device Removal ; Female ; Follow-Up Studies ; Humans ; Mammaplasty ; methods ; Middle Aged