Abortion, Induced ; adverse effects ; Adult ; Device Removal ; Embolization, Therapeutic ; Female ; Humans ; Intrauterine Devices ; Pregnancy ; Uterine Artery ; Uterine Rupture ; etiology

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

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

Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well.
Anterior Cruciate Ligament/injuries/surgery ; Anterior Cruciate Ligament Reconstruction/*adverse effects ; Anti-Bacterial Agents/administration & dosage ; Arthritis, Infectious/etiology/*microbiology ; Arthroscopy ; Coinfection ; Device Removal ; Humans ; Male ; Mycobacterium Infections, Nontuberculous/*microbiology ; Recurrence ; Reoperation ; Staphylococcal Infections/*microbiology ; *Staphylococcus aureus ; Therapeutic Irrigation ; Young Adult

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: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.
Adult ; Airway Management/*methods ; Anesthesia Recovery Period ; Anesthetics, Intravenous/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Humans ; Infusions, Intravenous ; Laryngeal Masks/*adverse effects ; Male ; Middle Aged ; Piperidines/*administration & dosage ; Postoperative Complications/prevention & control ; Psychomotor Agitation ; Vomiting/prevention & control

PURPOSE: This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence. MATERIALS AND METHODS: This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated. RESULTS: The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05). CONCLUSION: Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.
Adult ; Airway Management/*methods ; Anesthesia Recovery Period ; Anesthetics, Intravenous/*administration & dosage ; Cough/prevention & control ; Device Removal ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Humans ; Infusions, Intravenous ; Laryngeal Masks/*adverse effects ; Male ; Middle Aged ; Piperidines/*administration & dosage ; Postoperative Complications/prevention & control ; Psychomotor Agitation ; Vomiting/prevention & control

OBJECTIVETo evaluate the safety and efficiency of acellular dermal matrix combined with implant in correcting the secondary deformity post polyacrylamide hydrogel removal.

METHODSA retrospective study enrolling 23 female patients (42 breasts) who received breast deformity correction from June 2008 to June 2012 with acellular dermal matrix and implant were performed.

RESULTSOne patient suffered bilateral seroma and 1 patient suffered infection in one side. None of the implants were removed. Patients were followed up for (15.0±11.7) months (range: 3-36 months), and the results were satisfactory.

CONCLUSIONAcelluar dermal matrix and implant can be safely used simultaneously in correcting the secondary breast deformity post polyacrylamide hydrogel removal.

Acellular Dermis ; Acrylic Resins ; adverse effects ; Adult ; Allografts ; Breast ; abnormalities ; Breast Implantation ; methods ; Breast Implants ; adverse effects ; Device Removal ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Postoperative Complications ; surgery ; Retrospective Studies

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.
Device Removal/methods ; Dexamethasone/administration & dosage/*adverse effects ; Diagnosis, Differential ; Drug Implants/*adverse effects ; Endophthalmitis/diagnosis/*etiology/surgery ; Eye Infections, Bacterial/diagnosis/*etiology/surgery ; Glucocorticoids/administration & dosage/adverse effects ; Humans ; Intravitreal Injections/adverse effects ; Male ; Middle Aged ; Retinal Vein Occlusion/diagnosis/*drug therapy ; Vitrectomy

BACKGROUND/AIMS: The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS: All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (> or = 7 days) and nonpersistent MRSA bacteremia (< or = 3 days). RESULTS: Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS: High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.
Academic Medical Centers ; Aged ; Anti-Bacterial Agents/therapeutic use ; Catheter-Related Infections/diagnosis/drug therapy/*microbiology/mortality ; Catheters, Indwelling/*adverse effects ; Comorbidity ; Device Removal ; Female ; Hospital Bed Capacity ; Humans ; Logistic Models ; Male ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Middle Aged ; Multivariate Analysis ; Neoplasms/microbiology/mortality ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Factors ; Staphylococcal Infections/diagnosis/drug therapy/*microbiology/mortality ; Time Factors ; Treatment Outcome