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

Catheterization, Central Venous ; adverse effects ; instrumentation ; Catheters, Indwelling ; adverse effects ; Central Venous Catheters ; adverse effects ; Device Removal ; Humans

A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.
*Bone Screws ; Device Removal/instrumentation/*methods ; Equipment Design ; Female ; *Femur Head ; Fracture Fixation, Intramedullary/*instrumentation ; Hip Fractures/*surgery ; Humans ; Middle Aged ; *Prosthesis Failure

PURPOSE: The aim of this study was to investigate noninfectious complications of peritoneal dialysis (PD), including mechanical and metabolic complications, at a single center in Korea. MATERIALS AND METHODS: We analyzed data from 60 PD patients aged < or =18 years (40 boys and 20 girls) during the period between 1986 and 2012. The collected data included gender, age, causes of PD, incidence of noninfectious complications, and treatment for the complications. RESULTS: The mean duration of PD therapy was 28.7+/-42.1 months (range 1-240 months). The most common cause of end-stage renal disease was glomerular disease (43.3%). There were no statistically significant differences between patients with and without mechanical complications regarding gender, age at the start of PD, and total duration of PD. Outflow failure was the most common catheter-related complication (14.3%), followed by leakage (10.0%) and hernia (8.6%). Metabolic complications, such as hyperglycemia and hypokalemia, were observed in three of 16 patients. The frequency of noninfectious complications of PD in our study was comparable with those in previous pediatric studies. PD was switched to hemodialysis (HD) in only three patients. CONCLUSION: Our results indicate that noninfectious complications of PD are common, though they hardly lead to catheter removal or HD in pediatric patients on PD.
Adolescent ; Asian Continental Ancestry Group ; Catheterization/*adverse effects ; Child ; Child, Preschool ; Device Removal ; Female ; Humans ; Incidence ; Kidney Failure, Chronic/*therapy ; Male ; *Outcome and Process Assessment (Health Care) ; Peritoneal Dialysis/*adverse effects/instrumentation/*methods ; Renal Dialysis/adverse effects ; Republic of Korea ; Treatment Outcome

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.
Angioplasty, Balloon, Coronary/*adverse effects/*instrumentation ; *Aorta, Thoracic/radiography ; Cardiac Catheterization/*adverse effects/*instrumentation ; Coronary Angiography ; Device Removal/*instrumentation ; Foreign Bodies/etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; *Stents ; Treatment Outcome

OBJECTIVE: To determine whether the introducer curving technique is useful in decreasing the degree of tilting of transfemoral Tulip filters. MATERIALS AND METHODS: The study sample group consisted of 108 patients with deep vein thrombosis who were enrolled and planned to undergo thrombolysis, and who accepted transfemoral Tulip filter insertion procedure. The patients were randomly divided into Group C and Group T. The introducer curving technique was Adopted in Group T. The post-implantation filter tilting angle (ACF) was measured in an anteroposterior projection. The retrieval hook adhering to the vascular wall was measured via tangential cavogram during retrieval. RESULTS: The overall average ACF was 5.8 +/- 4.14 degrees. In Group C, the average ACF was 7.1 +/- 4.52 degrees. In Group T, the average ACF was 4.4 +/- 3.20 degrees. The groups displayed a statistically significant difference (t = 3.573, p = 0.001) in ACF. Additionally, the difference of ACF between the left and right approaches turned out to be statistically significant (7.1 +/- 4.59 vs. 5.1 +/- 3.82, t = 2.301, p = 0.023). The proportion of severe tilt (ACF > or = 10degrees) in Group T was significantly lower than that in Group C (9.3% vs. 24.1%, chi2 = 4.267, p = 0.039). Between the groups, the difference in the rate of the retrieval hook adhering to the vascular wall was also statistically significant (2.9% vs. 24.2%, chi2 = 5.030, p = 0.025). CONCLUSION: The introducer curving technique appears to minimize the incidence and extent of transfemoral Tulip filter tilting.
Blood Vessel Prosthesis Implantation/instrumentation/*methods ; Chi-Square Distribution ; Device Removal ; Double-Blind Method ; Female ; Femoral Vein ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Pulmonary Embolism/*prevention & control ; Statistics, Nonparametric ; Thrombolytic Therapy ; Treatment Outcome ; *Vena Cava Filters ; Venous Thrombosis/*complications

OBJECTIVETo study the impact of screw orientation on the pullout strength of OsteoMed M3 titanium screws in expansive unilateral open-door laminoplasty of the cervical spine.

METHODSSix fresh human cervical spine specimens were randomly numbered and OsteoMed M3 plate and screws were used for an expansive unilateral open-door laminoplasty. The screws were inserted in the lateral mass at different extraversion angles (0°, 30° and 45°). The maximum pullout strength was tested on the ElectroForce material testing machine.

RESULTSThe maximum pullout strength was 81.60∓7.33 N, 150.05∓15.57 N, and 160.08∓17.77 N in extraversion angle 0°, 30°, and 45° groups, respectively. The maximum pullout strength was significantly less in extraversion angle 0° group than in 30° and 45° groups (P<0.05), but similar in the latter two groups.

CONCLUSIONThe pullout strength of the screws inserted at an extraversion angle over 30° provides stronger fixation than an angle of 0° in the unilateral open-door laminoplasty using OsteoMed M3 titanium plate and screws.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Cervical Vertebrae ; surgery ; Cervicoplasty ; instrumentation ; Device Removal ; Fracture Fixation, Internal ; instrumentation ; Humans ; Internal Fixators ; Male ; Materials Testing ; Young Adult

PURPOSE: To compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex. METHODS: A randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups. RESULTS: In both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups. CONCLUSIONS: Compared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.
Aged ; Anterior Chamber/*surgery ; Cataract Extraction ; Device Removal ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular/*methods ; Middle Aged ; Phacoemulsification/*instrumentation/*methods ; Prospective Studies ; Therapeutic Irrigation/*methods

We report on two cases of microguidewire breakage that occurred during endovascular treatment of intracranial aneurysms. The microguidewire can be broken when a part of the wire is stuck due to vascular tortuosity, and, subsequently, application of excessive rotational movement. The mechanical and physical properties of a microguidewire are also important factors in microguidewire breakage. We also suggest technical tips for avoidance of this problem.
Aged ; *Catheters ; Device Removal ; Embolization, Therapeutic/*instrumentation ; *Equipment Failure ; Female ; Humans ; Intracranial Aneurysm/*therapy ; Middle Aged ; Radiography, Interventional/*instrumentation

In a patient with a distal common bile duct stone, a fracture of the traction wire of the basket occurring during the performance of mechanical lithotripsy resulted in the impaction of the lithotripter basket with a stone. The impacted lithotripter basket combined with a fracture of the traction wire is a rare complication of endoscopic stone removal. We were able to pull the impacted basket using an Amplatz goose-neck snare inserted via the percutaneous transhepatic route, which resulted in the freeing of the entrapped stone into the dilated supra-ampullary bile duct. The fractured traction wire and basket could be safely removed by pulling the traction wire from the mouth. The present report is the first to describe the safe and effective use of an Amplatz goose-neck snare for the management of a lithotripter basket impacted with a stone and a fractured traction wire.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Device Removal/*methods ; Diagnosis, Differential ; Equipment Failure ; Gallstones/radiography/*therapy ; Humans ; Lithotripsy/*instrumentation ; Male ; Radiography, Interventional ; Tomography, X-Ray Computed ; Traction/instrumentation