Transcatheter Retrieval of Embolized AMPLATZER Septal Occluder

In selected patients, transcatheter closure of atrial septal defects with the AMPLATZER Septal Occluder has yielded excellent results. However, there is a slight risk of device embolization after deployment. We report the case of a 26-year-old woman in whom an embolized AMPLATZER device was retrieved percutaneously from the right pulmonary artery. We also discuss important technical principles for managing this uncommon but potentially severe complication.Key words: Device removal/methods, embolization, therapeutic/instrumentation, heart catheterization/instrumentation, heart septal defects, atrial/ultrasonography, patient selection, prosthesis implantation/adverse effects, prostheses and implants, septal occluder device/adverse effects, treatment outcomeTranscatheter closure of atrial septal defects (ASDs) with use of the AMPLATZER® Septal Occluder (St. Jude Medical, Inc.; St. Paul, Minn) has yielded excellent results in properly selected patients.^1,2 The major advantage of the AMPLATZER occluder is its easy retrieval at all stages of deployment before its final release from the delivery cable. Although embolization of AMPLATZER ASD occluders is rare, it can occur even when interventional cardiologists are experienced. Despite an earlier belief that the transcatheter retrieval of embolized AMPLATZER devices would be difficult, success rates from 50% to 75% have been reported.^3,4 We describe the retrieval of an embolized AMPLATZER device in a young woman. In addition, we present some technical principles with which operators practicing device closure should be familiar.     

Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion

ObjectiveTo evaluate the efficacy and complications of lower eyelid suspension with the modified Safdarjung hospital technique using 5:0 polypropylene suture for punctal ectropion.Study designProspective case series.MethodThirty one eyelids in 19 patients with mild and moderate ectropion and all types of laxity including involutional and paralytic were included. All patients underwent lower eyelid suspension with the modified Safdarjung hospital technique. A 5:0 polypropylene suture was passed in the pre-tarsal plane between the attachments of the lateral and medial canthal tendons near their insertion at the orbital rim. Successful outcome was judged by the anatomical restoration of the apposition of the punctum to the globe in the upward gaze and the physiological relief of epiphora. The recurrence of lid laxity, overall lid/globe apposition and complications were also noted.ResultsAt 1 year follow up anatomical success was achieved in 28 (90%) patients and functional success noted in 27 (87%) patients. Recurrence of lid laxity was noted in 2 patients. There was a suture exposure in one case and a suture granuloma in another case. The results did not correlate to the degree of ectropion and type of laxity.ConclusionLower eyelid suspension using 5:0 polypropylene suture is a useful procedure for the treatment of involutional and paralytic punctal ectropion. It is simple and effective with minimal complications. However, the effect on scleral show and the concern related to suture material biodegradation over years needs to be further evaluated.     

Newer oral anticoagulant agents: a new era in medicine

After a gap of almost 60 years following the development of warfarin, 2 new categories of oral anticoagulant agents have been approved for clinical use - the direct thrombin inhibitors and factor Xa inhibitors. These agents promise to be more convenient to administer with fixed dosing but still have equivalent efficacy and improved bleeding risk compared to warfarin. The clinical community is looking forward to the widespread usage of these agents but there is also some apprehension regarding bleeding risks, non-availability of specific reversal strategies and lack of specific monitoring parameters. This review article will attempt to educate the reader about three representative drugs from these classes: Dabigatran, Rivaroxaban and Apixaban. We will discuss the historical perspective to the development of these drugs, available research data and pharmacology of these agents. The best strategies for monitoring and reversal of these drugs in special situations will also be touched upon.     

Single-port endo-laparoscopic surgery (SPES) for totally extraperitoneal inguinal hernia: a critical appraisal of the chopstick repair

Purpose

Developments in minimal access surgery brought a new concept: single-port endolaparoscopic surgery (SPES). The aim of our study is to verify the safety and feasibility of SPES TEP hernia repair and report our initial clinical outcome.

Methods

We prospectively collected data of all patients who underwent SPES TEP repair from May 2009 to December 2010. Data regarding patient demographics, type, size and location of hernia, port devices used, type of mesh and fixation, operative time, complications, length of stay and cosmetic results were collected and analyzed.

Results

A total of 47 patients (36 M, 11 F) underwent 70 SPES TEP hernia repairs; median age was 53 years (range 22–80). 60 % had indirect hernia, 27.5 % direct, 8.5 % pantaloon, 2 % femoral and 2 % recurrent hernias. Mean hernia size was 1.91 ± 0.67 cm. Port devices used include 33 Triport, 12 SILS and 2 SSL. We used anatomical mesh in 20; flat polypropylene in 10 and titanium-coated polypropylene mesh in 17 patients. Fixation of mesh was achieved in 18 patients with absorbable tacks, 8 with titanium tacks, 1 with fibrin glue, and no tack in 20 with anatomical mesh. No conversions occurred and small seroma was reported in 3 (6.3 %) patients. Mean operative time was 96.48 min (range: 50–150). Average hospital stay was 11.8 h (range: 9–26). Median follow-up was 11 months (range 6–18), and no recurrence was noted. 82.6 % patients were very satisfied, and 17.4 % were satisfied with the procedure.

Conclusion

SPES TEP repair is a safe and feasible technique with good patient satisfaction.     

Fertility preservation through gonadal cryopreservation

Fertility preservation is an area of immense interest in today's society. The most effective and established means of fertility preservation is cryopreservation of gametes (sperm and oocytes) and embryos. Gonadal cryopreservation is yet another means for fertility preservation, especially if the gonadal function is threatened by premature menopause, gonadotoxic cancer treatment, surgical castration, or diseases. It can also aid in the preservation of germplasm of animals that die before attaining sexual maturity. This is especially of significance for valuable, rare, and endangered animals whose population is affected by high neonatal/juvenile mortality because of diseases, poor management practices, or inbreeding depression. Establishing genome resource banks to conserve the genetic status of wild animals will provide a critical interface between ex-situ and in-situ conservation strategies. Cryopreservation of gonads effectively lengthens the genetic lifespan of individuals in a breeding program even after their death and contributes towards germplasm conservation of prized animals. Although the studies on domestic animals are quite promising, there are limitations for developing cryopreservation strategies in wild animals. In this review, we discuss different options for gonadal tissue cryopreservation with respect to humans and to laboratory, domestic, and wild animals. This review also covers recent developments in gonadal tissue cryopreservation and transplantation, providing a systematic view and the advances in the field with the possibility for its application in fertility preservation and for the conservation of germplasm in domestic and wild species.     

Propoxur-induced oxidative DNA damage in human peripheral blood mononuclear cells: protective effects of curcumin and α-tocopherol

The present study enumerates the attenuating effects of curcumin and α-tocopherol against propoxur induced oxidative DNA damage in human peripheral blood mononuclear cells (PBMC). Cultured cells were isolated from peripheral blood of healthy volunteers, and were exposed to varying concentrations of propoxur (0–21?μg/ml) for 6, 12, and 24?h, and in combination with curcumin (9.2?μg/ml) or α-tocopherol (4.3?μg/ml) or both. Cytotoxic effect of propoxur was examined by MTT assay. The role of oxidative stress beneath the cytotoxicity of propoxur was evaluated by the measurement of reduced glutathione (GSH), malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OH-dG) levels in cell lysate. A concentration-dependent cell death, depletion of GSH, an increase in the level of both MDA and 8-OH-dG were observed. Co-treatment with curcumin or α-tocopherol significantly attenuates depleted GSH, decrease in MDA and 8-OH-dG levels in propoxur exposed cells (p?相似文献