Early Device Removal Research Articles

Pregnancy outcome in women with an intrauterine contraceptive device

To investigate pregnancy outcome in patients who conceived with an intrauterine contraceptive device. A retrospective study comparing the pregnancy outcome of women with retained intrauterine device (n = 98), patients after intrauterine device removal in early pregnancy (n = 194), and pregnancies without an intrauterine device (n = 141,191) was performed. A significant linear association was documented among the 3 groups and adverse outcomes such as preterm delivery (18.4% in the retained intrauterine device, 14.4 % in removed intrauterine device, and 7.3% in the no-intrauterine device group; P < .001) and chorioamnionitis (7.1% in the retained intrauterine device, 4.1% in removed intrauterine device and 0.7% in the no-intrauterine device group; P < .001). The presence of retained or removed intrauterine device was found as an independent risk factor for both preterm delivery and chorioamnionitis in multivariable models. Women conceiving with an intrauterine device are at increased risk for adverse obstetric outcomes, whereas the risk is higher for pregnancies with retained intrauterine device compared with early intrauterine device removal.

Progression to Late Complete Atrioventricular Block Following Amplatzer Device Closure of Atrial Septal Defect in a Child

Atrial septal defect (ASD) closure by interventional catheterization techniques has been widely accepted and is considered a standard treatment for this congenital heart defect. We report the case of a 6-year-old girl who presented with progression of first-degree atrio-ventricular (AV) block to symptomatic, complete heart block after ASD closure with an Amplatzer septal occluder (ASO). Although she received steroids immediately after the procedure when second-degree AV block was seen, her AV conduction slowly deteriorated over 4 years, requiring permanent pacemaker implantation. We can only speculate that the injury to the conduction system was the result of persistent trauma, ischemia, or progressive scarring caused by the ASO on the AV nodal region. It is uncertain if early device removal would have prevented this complication. This case highlights the importance of cardiac rhythm monitoring following ASO implantation for ASD closure on long-term follow-up.

LAPAROSCOPICALLY IMPLANTED TISSUE EXPANDER RADIOTHERAPY IN CANINE TRANSITIONAL CELL CARCINOMA

Organ motion and injury to adjacent structures limit curative treatment of intraabdominal tumors with external beam radiotherapy. We evaluated the use of Laparoscopically Implanted Tissue Expander Radiotherapy (LITE-RT) to exclude critical structures during irradiation of the urinary bladder in two dogs with transitional cell carcinoma (TCC) using helical tomotherapy. Dogs had histologically confirmed bladder TCC with no metastasis. A custom-shaped tissue expander was placed between the colon and bladder laparoscopically in one dog and during laparotomy in the other. The prescribed radiation dose was 45 Gy to 98% volume of the bladder in 18 fractions of 2.5 Gy. Tumor response and normal tissue effects were monitored with cystoscopy and colonic biopsies before treatment and 3, 6, and 15 months after treatment. Based on treatment plans from inflated vs. deflated tissue expander CT images, there was a mean dose reduction to the colon of 53% and 31% for the two dogs. Interfractional target repositioning was possible by using volumetric megavoltage computed tomography helical tomotherapy. Both dogs had no clinical signs of chronic colitis but did experience mild cystitis during treatment. Tissue expanders became detached, requiring an additional surgery for reattachment, in both dogs. One dog developed a fibrous adhesion resulting in bladder rupture during inflation, which necessitated early device removal. One dog was euthanized for tumor-associated ureteral obstruction at 8 months while the other is alive at 21 months. We conclude that LITE-RT shows promise in treatment of canine bladder TCC due to lack of acute colitis and enteritis.

Persistent Staphylococcus aureus Bacteremia&lt;subtitle&gt;An Analysis of Risk Factors and Outcomes&lt;/subtitle&gt;

Persistent Staphylococcus aureus bacteremia (pSAB) is an emerging problem among hospitalized patients. We studied key clinical characteristics and outcomes associated with pSAB to better define the epidemiological features of this increasingly recognized clinical entity. A retrospective case-control study of patients hospitalized with SAB between January 1, 2001, and September 30, 2004, was conducted to compare the clinical characteristics, management, and outcomes of patients with pSAB (> 7 days of bacteremia) with those of a cohort of patients with nonpersistent SAB (< 3 days of bacteremia). Patients with 4 to 6 days of bacteremia were excluded from the analysis. To detect a potential association between reduced susceptibility to vancomycin and persistent methicillin-resistant SAB, vancomycin susceptibilities were confirmed using standard dilution methods. Eighty-four patients with pSAB and 152 patients with nonpersistent SAB were included in the analysis. Methicillin resistance (odds ratio [OR], 5.22; 95% confidence interval [CI], 2.63-10.38), intravascular catheter or other foreign body use (OR, 2.37; 95% CI, 1.11-3.96), chronic renal failure (OR, 2.08; 95% CI, 1.09-3.96), more than 2 sites of infection (OR, 3.31; 95% CI, 1.17-9.38), and infective endocarditis (OR, 10.30; 95% CI, 2.98-35.64) were independently associated with pSAB. The mean time to device removal was significantly longer in patients with pSAB than in patients with nonpersistent SAB (4.94 vs 1.64 days; P < .01). There was no evidence of reduced vancomycin susceptibility among persistent methicillin-resistant S aureus isolates. Clinical outcomes were significantly worse among patients with pSAB. Many hospitalized patients may be at risk for pSAB. Aggressive attempts to minimize the risk of complications and poor outcomes associated with pSAB, such as early device removal, should be encouraged.