Late Erosion Research Articles

Late erosion of an Adjustable Transobturator Male System (ATOMS®) device

IntroductionThis report describes late erosion of an Adjustable Transobturator Male System device which was inserted for post‐prostatectomy incontinence. The Adjustable Transobturator Male System device eroded the bulbar urethra 5 years post insertion, despite initial improvement of symptoms.Case presentationFollowing an open radical retropubic prostatectomy, a 64 year‐old male patient developed post‐prostatectomy incontinence. He had a known urethral stricture and had also undergone salvage radiotherapy for biochemical recurrence of prostate cancer. His incontinence was initially successfully treated with an Adjustable Transobturator Male System device, yet this eroded his bulbar urethra 5 years post insertion, which was deemed to be a late erosion.ConclusionUrologists should be aware that late erosion of the Adjustable Transobturator Male System device can occur, and risk stratification of patients undergoing Adjustable Transobturator Male System device insertion may help to minimize erosion rates.

Late erosion of Amplatzer septal occluder device 9 years after the implantation. A case report.

Cardiac erosion is a rare but life-threatening complication after the interventional closure of an atrial septal defect. We present the case of a patient who developed cardiac erosion 9 years after the placement of an Amplatzer Septal Occluder. The patient presented to our hospital with symptoms of tamponade. Surgical exploration revealed a tear in the roof of the left atrium. To our knowledge, this is one of the most delayed presentations reported. In these cases, diagnosis is difficult and a level of clinical suspicion is demanded.

Late erosion pulse triggered by rapid melt in the cold‐based interior of the last Fennoscandian Ice Sheet, an example from Rogen

AbstractIce sheet interiors are conventionally regarded as non‐erosive. Yet subglacial conditions may be transformed during deglaciation by the arrival of large volumes of meltwater at the ice sheet bed. The development of a dynamic meltwater drainage system and the onset of basal sliding have potential to increase erosion rates in bedrock and sediment. Here, we examine the impact of late deglacial thawing on the Rogen plateau, located near the former ice divide of the Fennoscandian Ice Sheet. We provide new maps of glacial and glacifluvial landforms which we combine with existing data on Quaternary sediments and landforms. Cross‐cutting and overlapping relations allow for an event sequence to be established of the deglaciation period. In the Early Holocene (< 11 ka), an ice lobe onset zone developed at the Rogen plateau. In places where meltwater reached the bed and where pressures rose to overpressure, it caused fracture dilation in horizontally bedded sandstones and rock brecciation. The onset of sliding and application of drag resulted in the mobilization of bedrock sheets. The establishment of meltwater corridors led to fluidization of sediments at the bed, dissection and modification of ribbed moraines and formation of murtoos and hummock corridors. During final stagnation of the ice sheet, meltwater drained through channels forming axial eskers. Bedrock erosion during deglaciation reached depths up to 4 m, and in conjunction with some recycling of till, generated 317 km2 of boulder cover. The average erosion depths by removal and reworking of sediment are 0.9–1.1 m across areas below 900 m elevation. This study shows that when the cold‐based interiors of ice sheets become briefly activated by large subglacial meltwater delivery late in deglaciation, there can be significant reworking and erosion of rock and sediment.

Late Erosion of Percutaneous ASD Occlusion Device.

As the number of patients undergoing percutaneous atrial septal defect closure increases, so too will the volume presenting with late complications.Early recognition and intervention in cases of device erosion is critical to prevent death.

Long-term Outcomes in Children Treated via Transcatheter Approach for Mild Congenital Heart Defects

Abstract Background: Transcatheter interventions in children with mild congenital heart defects (CHD), such as isolated patent ductus arteriosus (PDA) and atrial septal defect (ASD), have become a common practice in the US in contrast to surgical procedures. Such patients may be exposed to unique risks such as late tissue erosion and arrhythmias. However, data regarding the long term outcomes of patients treated by transcatheter approach compared to those treated surgically for similar lesions are …

Cardiac erosion causing an aortic dissection after a catheter closure of an atrial septal defect: first late erosion case with the Figulla Flex II septal occluder.

Cardiac erosion causing an aortic dissection after a catheter closure of an atrial septal defect: first late erosion case with the Figulla Flex II septal occluder.

Time Effect of Chloride Erosion on Physical and Mechanical Properties of High‐Water‐Content Materials

In order to study the characteristics of high water‐content materials (HWC) undergoing chloride erosion, we analyzed and summarized changes in strength, elastic modulus, and mass of HWC materials during chloride erosion using specific experimental research, and we also described the compression failure morphologies of HWC materials after erosion. The cuboid specimens developed a horizontal crack between the top and bottom, and the cylindrical specimens developed irregular encryption cracks at the top during increasing pressure. The erosion of HWC materials exposed to calcium chloride (CaCl2) solutions was relatively serious, and the erosion of the cuboid specimens was lower than that of the cylindrical specimens. The strength of HWC materials increased during prolonged erosion, and the strength of the cylindrical specimens in water was the highest, followed by the CaCl2 and sodium chloride (NaCl) solutions. However, the strength change of the cuboid specimens after 28 d was contrary to the above order. In late erosion stages, the HWC materials had better compactness and experienced smaller compressive deformation in water than the other two solutions. In the NaCl solution, the high‐water filling material had more pores and a larger deformation than the other solutions.

A Case Report of Late Atrial Septal Defect Occlusion Device Erosion into the Aorta

A Case Report of Late Atrial Septal Defect Occlusion Device Erosion into the Aorta

Artificial urinary sphincter urethral erosions: Temporal patterns, management, and incidence of preventable erosions

Introduction:The artificial urinary sphincter (AUS) is the mainstay of surgical treatment for male stress urinary incontinence. Although urethral erosions are a known complication, their temporal distribution and optimal management have not been well characterized. We seek to evaluate the timing, etiologies, and management of urethral erosions in primary AUS implantations.Materials and Methods:1802 male patients underwent AUS procedure at Mayo Clinic (Rochester) from 1983 to 2011, including 1082 primary placements. Of primary placements, 63 had a urethral erosion of their device requiring explanation and were included in our analysis. All cases of urethral erosion were confirmed at the time of explantation through cystoscopy and direct visualization. At our institution, explantation is typically performed without primary urethral repair.Results:There were 63 cases (5.8%) of urethral erosions of primary AUS devices during the study time frame. The median age at AUS implantation was 74 years (interquartile range [IQR] 68–77 years) and median time to explantation was 21 months (IQR 5–59 months). The temporal trend of AUS erosions demonstrates a peak in the 1st year, with a gradual tapering of cases thereafter, persisting beyond 10 years. Three of 36 (8.3%) patients with follow-up developed a urethral stricture. Overall, 32/63 patients (51%) underwent salvage AUS reimplantation at a median of 7.1 months (IQR 3.1–12.9 months).Conclusions:Urethral erosions tend to occur early (within 1–2 years), with gradual tapering over time. However, continued vigilance is needed after AUS placement to decrease late erosions. These data can be used for counseling and to help guide follow-up care of patients with AUS.

Delayed Erosion of a Pelvic Reconstruction Plate into the Bladder Causing Recurrent Urinary Tract Infections: A Case Report.

A forty-seven-year-old woman presented with recurrent urinary tract infections eleven years after open fixation of a pelvic ring injury. Cystoscopy revealed that the pelvic reconstruction plate had eroded into the bladder, likely the source of the recurrent infections. Following removal of the involved pelvic hardware and repair of the bladder, the patient had no further urinary tract infections. Operative fixation of osseous pelvic injuries places metal implants in proximity to the bladder. Late erosion of hardware into the bladder can occur. A low threshold for urological work-up should be maintained for recurrent genitourinary symptoms in these patients.

An Unusual Complication of the Ventricular Septal Defect Closure by Device: Late Right Aortic Cusp Perforation

Aortic regurgitation (AR) is a rare complication of transcatheter closure of perimembranous ventricular septal defects (pmVSD). It results from iatrogenic pinching of the aortic valve by the VSD occluder or perforation by the catheter. It is usually detected during control echocardiography (ECHO). The current study reports the first case of a late AR, which resulted from late right coronary cusp perforation by the VSD occluder. The current manuscript discusses the possible causes of late cusp erosion due to occluder, advantages of early operation in such cases, and an alternative treatment method where the occluder removal is not possible at the operation.

Evaluation of Valsalva sinus wall deformation due to compression by the Amplatzer septal occluder and the potential for erosion development.

We studied whether the pressure exerted by the Amplatzer septal occluder (ASO) disk on the Valsalva sinus wall (VW) is a risk factor for erosion and attempted to determine the pressure that may trigger erosion. The causes and mechanisms of erosion after ASO placement remain unclear. We reviewed 665 consecutive patients with atrial septal defects who underwent ASO closure at our hospital from 2005 to 2012. We used transesophageal echocardiography and other tests to evaluate disk-related VW deformation as a risk factor for erosion. Immediately after ASO placement, intermittent VW deformation from either disk was determined in 54 of the 665 patients (8%). Of these 54 patients, only 1 exhibited late erosion (0.15%) during a follow-up of more than 4 years (0.035% a year). The maximum VW deformation depth relative to the standard curve, or dent, was 2.6 mm in this patient, whereas that in the remaining patients ranged from 0.5 to 2.0 mm. The dent values were significantly deeper in patients with contact between the left atrial disk and posterior atrial wall than in those without contact (P = 0.03). There was a significant negative correlation between dent and the aortic side-maximum device thickness (DT)/middle part-DT ratio (P = 0.04). Although VW deformation, particularly deep VW deformation caused by pressure from either disk after ASO placement must be a recognized risk for erosion, which deformation level carries a stronger risk for erosion could not be concluded.

Management of ostium secundum atrial septal defect in the era of percutaneous trans-catheter device closure: 7-Year experience at a single institution

ObjectivesThis study aimed to review the single institutional experience of the repair of secundum atrial septal defect (ASD) after the initiation of percutaneous trans-catheter device closure, to confirm the current management strategy and outcomes. MethodsFrom August 2005 to December 2012, a total of 1026 (659 females, age 27±21 years) consecutive patients underwent the repair of ASD. Including eight patients who converted to surgical repair, 317 patients (31%) underwent surgical repair and 709 (69%) underwent trans-catheter device closure. ResultsAn embolized device into the left atrium was surgically retrieved in one patient soon after trans-catheter device closure without any postoperative complications. The other patient developed left atrium to aorta fistula due to late erosion, and required the removal of implanted device and patch closure of fistula and ASD 3 months after trans-catheter device closure. Whereas serious central nerve system complications occurred in three patients after the surgical repair including a 75-year-old patient with postoperative transient atrial fibrillation who subsequently developed aspiration pneumonia and died; there were no mortalities and no morbidities associated with cranial nerve function after trans-catheter device closure. A number of patients approached through partial sternotomy with limited skin incision have increased per year, and the length of skin incision was 5.1±1.2cm in pediatric patients weighing less than 15kg (n=40), 6.9±1.9cm in the remaining pediatric patients (n=91), and 10.0±2.5cm in young adult females (n=10). ConclusionPercutaneous trans-catheter ASD closure was safely performed under the support of a surgical team. The cosmetic outcome of surgical closure is improving after initiation of partial sternotomy via limited skin incision for the pediatric population and young adult females. Prior to the treatment, the physicians must thoroughly inform patients and families of the advantages and disadvantages of both treatment options.

Tube versus Trabekulektomie (TVT)-Studie

Epibulbar glaucoma drainage devices have been only slightly modified since their introduction more than 40 years ago. Having been used primarily in only difficult cases with a poor prognosis (and therefore with poor clinical results) the recently published trabeculectomy versus tube study (TVT) led to a change in our understanding of these devices. In this study epibulbar glaucoma drainage devices (here the Baerveldt device) were employed for early implantation (in some cases as primary glaucoma surgery intervention). Being sceptically monitored the results over the first 5 year clearly showed an almost equal or even better outcome in comparison to trabeculectomy. Despite these good results a critical evaluation seems mandatory mainly because of the unsolved problems concerning late complications. Late tube erosion with subsequent blebitis and enophthalmitis as well as late base plate encapsulation need to be mentioned here. The latter leads to thick fibrous tissue around the base plate resulting in an increase of intraocular pressure (IOP). Late corneal decompensation is also a late complication the pathomechanism of which is only poorly understood. Solving and treating such late complications are often troublesome and time consuming. Future experiments should lead to development of new drainage implant designs and the bulk material should be enhanced and optimized to increase clinical surgical results.

Connecting tube colonic erosion and gastrocolic fistula formation following late gastric band erosion.

Band erosion is a rare complication of laparoscopic adjustable gastric banding (LAGB) with a reported prevalence varying from 0.3% to 14%. Intraluminal colonic erosion of the connecting tube is very rare, as only isolated cases have been described. Consequently, simultaneous gastric band erosion and connecting tube colonic erosion is an extremely rare event. Herein, we present a case of a woman with morbid obesity, who submitted to LABG 4 years ago. The patient presented with symptoms and signs of right lower quadrant peritonitis. Computed tomography (CT) demonstrated migration of the band into the gastric lumen, inflammation around the intra-abdominal course of the connecting tube and an inflammatory mass surrounding the tube at the right lower quadrant. Laparotomy revealed the eroded band, the eroded transverse colon from the connecting tube, a gastrocolic fistula along the course of the tube and a right lower quadrant phlegmon. The connecting tube was mobilized from the surrounding adherent tissues, the gastric band removed, the stomach and colon walls closed, and the gastrocolic fistula excised. To our knowledge this is the second case of concurrent band erosion and connecting tube colonic erosion along with gastrocolic fistula formation in a patient with morbid obesity treated with LAGB.

Very late erosion of amplatzer septal occluder device presenting as pericardial pain and effusion 8 years after placement

We report the case of a very late erosion of an Amplatzer septal occluder (ASO) device more than 8 years after implant, presenting without signs of cardiac tamponade. To date, this case represents the longest period between ASO device implantation and clinical presentation following erosion. The overall rate of device erosion remains low, and the majority reported so far has occurred early, but clinicians should remain alert to the possibility of very late erosion in patients with ASO devices.

Late Bladder Erosion Complications and Vesical Stone Formations of Synthetic Graft Materials Used in Mid-Urethral Sling Procedures

We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings.

Quantification of late Holocene Soil Erosion – An Example from the Southern Forelands of the Harz Mountains, Germany

Quantification of late Holocene Soil Erosion – An Example from the Southern Forelands of the Harz Mountains, Germany

Intragastric gastric band migration: erosion: an analysis of multicenter experience on 177 patients

Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consistent information regarding this complication is still lacking. Treatment for migration is still being debated as well. Most of the inconsistencies of these data stem from the very low number of patients reported in single-center experiences or case reports. Lack of multicenter experience is evident. The aim of this study was to perform a retrospective analysis of data on intragastric migration in a large multicenter cohort of patients who underwent LAGB. A retrospective multicenter study on LAGB patients was performed. Data had been entered into a prospective database of the Italian Group for LapBand(®) (GILB) since January 1997. Pars flaccida and perigastric positioning were considered along with different kinds of gastric bands by the same manufacturer. Time of diagnosis, mean body mass index (BMI), presentation symptoms, and conservative and surgical therapy of intragastric migration were considered. From January 1997 to December 2009, a total of 6,839 patients underwent LAGB and their data were recorded [5,660 females, 1,179 males; mean age 38.5 ± 18.2 years (range 21-62 years); mean BMI = 46.7 ± 7.7 kg/m(2) (range 37.3-68.3); excess weight (EW) 61.8 ± 25.4 kg (range 36-130); %EW 91.1 ± 32.4 % (range 21-112 %)]. A total of 177 of 6,839 (2.5 %) intragastric erosions were observed. According to the postoperative time of follow-up, the diagnosis of intragastric migration was made in 74 (41.8 %), 14 (7.9 %), 38 (21.4 %), 40 (22.6 %), 6 (3.4 %), and 4 (2.2 %) banded patients at 6-12, 24, 36, 48, 60, and 72 months after banding, respectively. Most of intragastric band migration during the first 2 years occurred in bands with no or a few milliliters of filling. In patients with late erosion, the bands were adjusted several times; no band was overfilled but one was filled to the maximum or submaximum with a maximum of two adjustments. Erosions diagnosed during the first 24 months were related to the experience of the surgical staff, while late erosions were not. Intragastric band migration or band erosion is a rare, disturbing, and usually not life-threatening complication of gastric banding. Its pathogenesis is probably linked to different mechanisms in early (technical failure in retrogastric passage) or late (band management) presentation. It is usually asymptomatic and there is no pathognomonic presentation. A wide range of therapeutic options are available, from simple endoscopic or laparoscopic removal to early or late band replacement or other bariatric procedure. More experience and more studies are needed to lower its presentation rate and definitively clarify its pathogenesis to address the right therapeutic option.

Influence of Sulfate Attack and Drying-Wetting Cycle on Properties of Mortar

This paper presents the study on mortar specimens exposed to three kinds of Na2SO4 solution(0.5%,5%and10%)and different drying-wetting cycles(20,30,40and75). Influence of cycle number and solution concentration on mechanical behavior, mass and appearance of mortar specimen was analysis. The results show that surface of specimen in 5% and 10% solution shows obvious desizing, sandiness and some crack at 75 drying-wetting cycles. In different solution concentration, mass of specimen shows a trend to increase firstly then decrease lately. The increasing and declining separately of specimen mass are more obvious in high concentration solution. In three kinds concentration of solution, peak stress and modulus of elasticity of specimen show the same trend to increase in early erosion stage and decrease in late erosion stage. Change rate of mechanical behavior of specimen in high concentration solution is larger than that of in low concentration solution at early and later stage separately. On the contrary, peak strain show a trend to decline firstly then increase lately.