Main Reason For Removal Research Articles

Early removal of the etonogestrel contraceptive implant in Spanish women: a prospective cohort study.

To know the discontinuation rate and characterize predictors and reasons of contraceptive implant removal within 12 months of insertion in our community setting. This prospective cohort study included women receiving the etonogestrel contraceptive implant at sexual and reproductive health centers between September 2019 and September 2020. The variables collected were implanted insertion timing, reproductive and demographic characteristics, medical conditions, sexual activity and counseling. Our primary outcome was implant discontinuation. Kaplan-Meier survival curves were used to show the cumulative discontinuation rate of implants contraceptive within the first year of insertion. We also identified factors that increased the risk of implant removal using the log-rank test and the Cox regression model. Reasons for discontinuation were documented. 199 women were followed up. Implant discontinuation was documented in 17.1% of implant users prior to 12 months. Factors that increase the risk of implant removal are living with a partner, being aged 25-34 years and not receiving comprehensive and structured counseling from the midwife. The main reason for removal was unsatisfactory bleeding (97.1%), but this was combined with other reasons such as cessation of sexual intercourse (58.8%), worsening mood (58.8%), weight gain (55.9%) or decreased libido (50.0%). The rate of discontinuous implant uses in the first year is relevant in relation to cost-effectiveness, there is room for improvement that should not be overlooked. Comprehensive and structured midwife-led counseling can reduce early implant abandonment removal. The development in different countries of the role of midwives in the management of contraceptives can contribute to the economic benefit of health services and the satisfaction of women.

The relationship between plate prominence and need for removal after volar plate osteosynthesis of distal radius fractures.

This study aimed to assess the incidence of plate-related complications and the need for plate removal after volar plate osteosynthesis of the distal radius in relation to Soong classification. All consecutive patients (age > 16years) in our level II trauma center treated with plate osteosynthesis for distal radius fractures from January 2017 until June 2019 were retrospectively evaluated. The main outcome measures were volar plate positioning according to Soong classification and incidence of plate removal. In addition, the incidence of tendon ruptures, reasons for volar plate removal, and improvement of complaints after removal were evaluated. The overall incidence of plate removal in the 336 included patients was 16.9% (n = 57). Removal incidence in Soong 2 plates (28.2%) was significantly higher compared to Soong 0 and 1 plates (8.0% and 14.4%, respectively), P = 0.003. Multivariable binary logistic regression analysis showed Soong grade 2 as an independent predictor for plate removal, OR 4.3 (95% CI 1.4-13.7, P = 0.013). Four cases of flexor and four cases of extensor tendon rupture were reported, all in Soong 2 grade plating. The main reasons for volar plate removal were pain (42%) and reduced functionality (12%). In cases where pain was the main reason for removal, 81% of patients reported a decrease in pain during follow-up after surgery. This study suggests an association between plate prominence graded by Soong and plate removal using a single plating system. Plate prominence should be reduced in volar plating whenever technically feasible.

Intrauterine contraceptive discontinuation reasons among female trial participants living with HIV in Cape Town, South Africa: A qualitative analysis.

While young women in South Africa may navigate both HIV infection and pregnancy risks, intrauterine contraceptive (IUC) use is low. Though IUCs have low failure rates, concerns exist about whether the IUC is an appropriate method choice for women living with HIV (WLHIV). In this qualitative study, we explore WLHIVs' experiences of using IUC and reasons for discontinuation. This qualitative study included in-depth interviews (IDIs) with 17 WLHIV who electively discontinued their allocated IUC while participating in a randomized controlled trial comparing the safety of the levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (C-IUD) in Cape Town, South Africa. The transcripts were coded and emergent themes were grouped to examine women's experiences with IUC use and reasons for discontinuation, highlighting experiential differences between the two methods. Women's experience with the allocated IUC related most commonly to bleeding and/or abdominal pain just after insertion. Most C-IUD discontinuers, but only one LNG-IUS discontinuer, complained of pain and/or increased bleeding as the main reason for removal. Three women (two LNG-IUS, one C-IUD) requested removal because they desired pregnancy, while two others discontinued due to fears the IUC was exacerbating non-gynecologic conditions (hypertension, diabetes). Generally, women acknowledged advantages of IUC use and many expressed their desire to continue use if not for the side effects. In the South African context, IUC use for WLHIV should be promoted with specific counseling considerations. Both providers and potential users should receive specific information about potential menstrual-related side effects and countering common misperceptions to enable informed contraceptive decision-making.

Acceptability and Complications of Postpartum Intrauterine Device Insertion in Tertiary Care Hospital in Eastern Nepal

The modern intrauterine contraceptive device (PPIUCD) is a safe, effective and long term reversible, coitus independent method of contraception with fewer side effects. The immediate postpartum insertion is considered to be an ideal time as patients need not have to return to the facility for the same. The aim of the study was to see the acceptance of PPIUCD and study its related complications. This is a hospital based prospective observational study done in a tertiary hospital at Eastern Nepal over a period of Six months from August 2019 to January 2020. All the women who delivered during the study period were counseled for family planning methods and those who opted for PPIUCD were enrolled. Data was validated and analyzed using SPSS version 17. Acceptance of PPIUCD in the study was only 6.3% despite the method being very effective, safe, long acting and reversible with fewer side effects. The main reason for declining the method being misbelief about the method and husband’s refusal. Forty percent of the acceptors were in the age group of 21-25 years and 33.6% of them were multigravida. Insertion was high in post placental vaginal delivery (61%) as compared to trans cesarean (28%). The main reason for removal was psychosocial aspects followed by pelvic pain and abnormal uterine bleeding. Few complications like UTI (4.4%), fever (4%) were noted during hospital stay and at three month follow up pelvic pain was the most common problem reported. Though the overall acceptance of PPIUCD is in rising trend but in this study it is very low. Awareness of the method, improving health education, active participation of the partner in the counseling process will definitely change the recent scenario. It should be incorporated in the government schemes like Safe Motherhood to cover the high unmet need of contraception in Nepal.

PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy.

The increasing use of arm totally implantable vascular access devices for breast cancer patients who require chemotherapy has led to a greater risk of complications and failures and, in particular, to upper extremity deep vein thrombosis. This study aims to investigate the outcomes of the arm peripherally inserted central catheter-PORT technique in breast cancer patients. The peripherally inserted central catheter-PORT technique is an evolution of the standard arm-totally implantable vascular access device implant based on guided ultrasound venous access in the proximal third of the upper limb with subsequent placement of the reservoir at the middle third of the arm. A prospective study was conducted on 418 adult female breast cancer patients undergoing chemotherapy. The primary study outcome was peripherally inserted central catheter-PORT failure. Median follow-up was 215 days. Complications occurred in 29 patients (6.9%) and failure resulting in removal of the device in 11 patients (2.6%). The main complication we observed was upper extremity deep vein thrombosis, 10 (2.4%); all patients were rescued by anticoagulant treatment without peripherally inserted central catheter-PORT removal. The main reason for removal was reservoir pocket infection: 4 (0.9%) with an infection rate of 0.012 per 1000 catheter days. Cumulative 1-year risk of failure was 3.6% (95% confidence interval, 1.3%-7.1%). With regard to the patients' characteristics, body mass index <22.5 was the only significant risk for failure (p = 0.027). The peripherally inserted central catheter-PORT is a safe vascular device for chemotherapy delivery that achieves similar clinical results as traditional long-term vascular access devices (peripherally inserted central catheter and arm totally implantable vascular access device, in particular) in breast cancer patients.

A Decade of Jadelle Subdermal Implant Contraception in a Tertiary Health Institution in Port Harcourt, Southern Nigeria

Background: Jadelle, a long acting reversible progesterone contraceptive, has been in use in our centre for over 10 years and has not been comprehensively evaluated. Objectives: To determine the acceptance, efficacy, and safety profile associated with the use of Jadelle contraceptive implant in the University of Port Harcourt Teaching hospital, Port Harcourt. Methods: This is a 10-year retrospective study of clients who accepted and used Jadelle for contraception in the university of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. The case files were retrieved and information on their socio demographic profile, source of information, side effects, failures and reason for removal were extracted using a proforma. Data were filled into a spread sheet, analyzed using SPSS version 21.0 and presented in tables of frequencies and percentages. Results: Within the period under review, March 2007 to February 2017, 569 clients used Jadelle out of the 3829 women who accepted and used modern contraceptive in the UPTH. The mean age of users was 33.7 ± 4.2, 536 (94.2%) were multipara with a mean parity of 4.5 ± 3.8 while 541 (95.1%) had secondary education and above. The major side effect was irregular vaginal bleeding 36 (60.9%) while the main reason for removal of the device was expiration of method 272 (53.9%). A pregnancy was recorded during this period giving a pearl index of 0.002. Conclusion: Jadelle is a popular and a very effective means of contraception with increasing acceptance among our clients. The safety profile is high.

Revisional bariatric surgery after failed laparoscopic adjustable gastric banding - a single-center, long-term retrospective study.

IntroductionLaparoscopic adjustable gastric banding (LAGB) used to be one of the most popular bariatric procedures.AimTo present our institution’s experience with LAGB, its complications, causes of failure and revisional bariatric procedures, in a long-term follow-up.Material and methodsRecords of patients who underwent pars flaccida LAGB from 2003 to 2006 were gathered. We selected data on patients with a history of additional bariatric procedures. Their initial demographic data, body mass index and causes of revision were gathered. We analyzed length of stay and early perioperative complications.Results60% of patients (n = 57) who underwent LAGB in our institution between 2003 and 2006 had their band removed (out of 107, 11% lost to follow-up). Median time to revisional surgery was 50 months. The main reasons for removal were: weight regain (n = 23; 40%), band slippage (n = 14; 25%), and pouch dilatation (n = 9; 16%). Thirty (53%) patients required additional bariatric surgery, 10 (33%) of which were simultaneous with band removal. The most popular procedures were: laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 15; 50%), open gastric bypass (n = 8; 27%), and laparoscopic sleeve gastrectomy (LSG) – (n = 3; 10%). Mean length of stay (LOS) was 5.4 ±2.0. One (3%) perioperative complication was reported.ConclusionsThe results show that LAGB is not an effective bariatric procedure in long-term follow-up due to the high rate of complications causing band removal and the high rate of obesity recurrence. Revisional bariatric surgery after failed LAGB may be performed in a one-stage approach with band removal.

Outcome of penile prosthesis implantation: are malleable prostheses an appropriate treatment option in patients with erectile dysfunction caused by prior radical surgery?

The aim of our study was to evaluate the outcome of penile prosthesis implantation in patients with various comorbidities as a cause of erectile dysfunction (ED). The data of 181 patients who underwent surgery between 1998 and 2012 in two centers were evaluated. The mean age of the patients was 52.2 years (range: 31–71 years). The study group contained 162 patients (89.5%) with malleable prostheses and 19 (10.5%) with inflatable implants. All patients were re-evaluated 1 month later to assess prosthesis function and complications, and further re-examinations were performed if needed. Satisfaction was defined as having satisfactory intercourse and happiness with the device in general. The follow-up period was at least 12 months for each patient. The postoperative complication rate was 32% (n = 58). The number of complications with inflatable and malleable prostheses was 7 (3.9%) and 51 (28.1%), respectively. Overall, 21 prostheses (11.6%) had to be removed because of various complications and patient dissatisfaction. Patients with prior radical surgery had higher extraction rates (ƛ = 14.606, P < 0.05, Chi-square test). The main reasons for removal were erosion (n = 11; 6.1%) and infection (n = 3; 2.1%). With respect to satisfaction during intercourse, we found that 104 (57.5%) patients described themselves as very satisfied with the prosthesis, while 21 (11.6%) were unsatisfied. The high explantation rate in patients with prior surgery was remarkable in our study. Our results revealed that a malleable prosthesis should not be the preferred type of implant for patients with prior surgery.

Jordanian Women's Experience with Etonogestrel Subdermal Contraceptive Implant in Two Family Planning Clinics = تجربة النساء الأردنيات مع غرسة منع الحمل التحت جلدية في اثنتين من عيادات تنظيم الأسرة

Objective: Etonogestrel subdermal hormonal contraceptive implant (Implanon®) is a popular and effective contraceptive. However, some users discontinue it for a variety of reasons. To explore the experience of Jordanian women with Implanon. Methods: This survey was undertaken with 69 women who had used or were using Implanon. Data was obtained through telephone interviews and by examining the women’s medical records. Results: The mean age of participants was 30.9 (± 4.99) years. All users had pre-insertion counseling by family planning nurses. No pregnancies occurred while on Implanon. At the time of the survey, 37 women had Implanon in situ and 32 women had Implanon removed due to side effects. Thus, the discontinuation rate was 46.4%. The main reason for discontinuation was bleeding problems. The other main reasons for removal were: weight gain (34.4%), mood change (50%), headache (34.4%), nausea (21.9%), reduced libido (40.6%), acne (15.6%) and hirsutism (3.1%). Of those who discontinued the implant (n=32), 20 women (40.8%) experienced a period duration of 8 days (Chi square 7.9, p value = 0.005). Moreover, 62% of current implant users reported higher satisfactory pre-insertion knowledge of the advantages and disadvantages than those who removed it (chi-square=5.12, p=0.024). Conclusions: The discontinuation rate of Implanon was rather high compared to other countries. The main reason for discontinuation was abnormal bleeding pattern. This is the first report about discontinuation rate of Implanon in Jordan.

PP258-SUN PERCUTANEOUS ENDOSCOPIC GASTROSTOMY EXPERIENCE IN A UNIVERSITY HOSPITAL

respectively). The period of PRG use until it was removed was 104 days (cancer) and 117 (ALS). The main reason for removal was death due to disease progression. Weight after 8 weeks was 5% higher in cancer and was almost unchanged in ALS patients (p = 0.043). All cancer patients used enteral nutrition though PRG straight after placement whereas 30.5% ALS patients use only to ensure hydration initially. Conclusion: PRG placement is frequently performed in our centers as a safe and useful technique to guarantee an enteral access for feeding and/or hydration for patients with dysphagia or difficulties to meet nutritional requirements.

The Angelchik anti-reflux prosthesis--some reservations.

A prospective study has been made of the use of the Angelchik prosthesis in the treatment of hiatus hernia and gastro-oesophageal reflux. Forty-one patients under the care of one surgeon were studied over a 3-year period. The operation is simple and safe to perform. Twelve patients suffered transient dysphagia which spontaneously resolved within 3 months. Satisfactory results were obtained thereafter in 80.9 per cent. Seven of the prostheses have been removed (17.1 per cent), all within 18 months of performing the operation. Dysphagia and recurrent symptoms were the main reasons for removal and in two of these stricturing was present pre-operatively. We feel the presence of an established stricture is a contraindication to the use of the device. We have, however, been impressed by its use as a second procedure when previous surgery has failed and when revisional surgery for recurrent hiatus hernia is difficult due to dense adhesion formation. While it is still early to assess the legacy that the use of this prosthesis might incur, we would recommend conservatism if not abandonment of its use until longer-term evaluation is available.

The treatment of dysfunctional uterine bleeding with the Mirena IUS: a survival analysis

A questionnaire was sent to 124 women with dysfunctional uterine bleeding (DUB) who had been treated with the Mirena IUS. Prior to treatment, the women had received advice about the side effects of the Mirena IUS. There was a 71% response rate of which 21% had the Mirena IUS removed prematurely. The main reasons for removal were pelvic pain and irregular vaginal bleeding. The projected Kaplan–Meier survival rate for the device over the 5-year therapeutic lifetime was 55%. The amenorrhoea rate was 38% and the oligomenorrhoea rate was 72%. The Mirena IUCD is an effective form of treatment for DUB and the majority of women are likely to continue with this treatment at 5 years.

Acceptabilité de l’implant contraceptif à l’étonogestrel (Implanon ®)

To estimate the exact satisfaction of women toward Implanon, the sole contraceptive implant available in France. To clarify the indications of this type of contraception. Among a population of 182 women with Implanon" inserted in a same family planning service between May 22, 2001 and February 14, 2003, 108 women agreed to answer a questionnaire of satisfaction. Implants were inserted in one third of cases after childbirth, in another third after abortion. The average duration of use of the implant was of 16 months (2 in 24 months). Twenty-nine removals among the 108 insertions (27%) were recorded. Possibility of a long-term and easy -to-use contraception was the most common reason for choosing Implanon (74% of the women). Eighty-one percent of the women were globally satisfied with Implanon but one out of two women had side-effects. Only 62% of the women were ready to use it again. Adverse events were first, menstrual disturbance in 83% of the women, mainly amenorrhea (26%) and bleeding irregularity (40%). Bleeding irregularity was one of the main motives for discontinuing the implant in 41% of cases. Except weight gain present for 37% of patients, the other side-effects, even though they were frequent, were less often the reason for removal. Headache, acne, breast pain, mood and decreased libido were the main reasons for removal. Implanon has certainly a place among current contraceptive methods. Because of the frequency raised by adverse events and by their lower tolerance in Europe, this place has to remain limited to the incapacity of classic methods. Preinsertion counseling announcing Implanon's benefit and risk effects is necessary to minimize the early discontinuation rates.

Pattern of tooth loss in recipients of free dental treatment at the University Hospital of Amman, Jordan.

The aim of this study is to document reasons for tooth loss in disadvantaged Jordanians who seek free dental care at the University Hospital/Dental Clinics. A 4-year (1998-2001) prospective study was undertaken involving 2200 randomly selected patients from this subpopulation. Of their 3069 lost teeth, 46.9% were lost due to caries and its sequel; 18% were lost because of periodontal disease; 8% were lost for a combination of caries and periodontal disease; 19.4% for pre-prosthetic reasons; 4% for orthodontic reasons; 2.8% for eruption problems and 0.7% due to trauma. Logistic regression analysis for reasons of tooth loss in this sector revealed that caries and its sequel was the predominant cause of tooth loss in patients <or=40 years of age whereas periodontal extractions were predominant for the above 40-year-old group. In addition, the most frequently extracted teeth, due to caries, were lower first and second molars while lower incisors were most commonly extracted for periodontal disease. Premolars were extracted for orthodontic reasons, upper incisors for trauma, third molars for eruption problems and canines for pre-prosthetic reasons. In conclusion, dental caries was the main reason for removal of teeth in adults attending the University of Jordan free dental casualty clinic. Therefore, in order to reduce the rate of dental extractions in this sector of the Jordanian population, efforts should focus on prevention and treatment of caries. Efforts should also be made to change the values and beliefs of this sector towards the importance of natural dentition.

Complications of the intrauterine device in nulliparous and parous women

Objectives: The intrauterine device (IUD) is still related to pelvic inflammatory disease (PID), pregnancy, expulsion, perforation and menstrual problems, particularly in nulliparous women. We aimed to study the complications and symptoms of the intrauterine device in general practice, particularly in nulliparous women.Methods: We used a retrospective cohort study in four general practices participating in the Nijmegen Continuous Morbidity Registration. Selected women had one or more IUDs inserted between 1981 and 2000. Data on complications, symptoms and removal of the IUD were obtained from the medical records.Results: 461 women were included, 129 nulliparous and 332 parous women. Users of copper IUDs had a rate of PID of 3.5 per 1000 women-years, rates of (ectopic) pregnancy of 0.6 to 1.1% per year and rates of expulsion of 0 to 1.2% per year. Rates of expulsion for the levonorgestrel-releasing IUDs were 0 to 0.2% per year. Nulliparous women did not show more complications than parous women. Menstrual problems were frequent among users of copper and levonorgestrel-releasing IUDs. One third of the IUDs were removed within the first year after insertion. There was no significant excess of IUD removal among nulliparous women compared with parous women. Main reasons for removal were ‘menstrual problems’ and ‘contraception no longer necessary’.Conclusion: Both copper and levonorgestrel-releasing IUDs are safe and highly effective contraceptives, which can adequately be inserted and monitored by general practitioners in nulliparous and parous women.

An assessment of the use of Implanon® in three community services

AimsThe aims of the study were three-fold, namely to assess continuation rates with Implanon® fitted in clients from three contraception and sexual health services; to identify factors associated with early...

Reasons for requesting laser removal of unwanted tattoos.

Laser removal of tattoos is not generally or readily available on the National Health Service and removal in privately run clinics is expensive. For those seeking removal of their tattoo this can create significant financial hardship. We investigated the psychological, social and financial impact of tattoos on the lives of those patients requesting laser removal. Sixty-eight patients with a mean age of 36 years participated. Twenty-seven (40%) had one tattoo, whereas eight (12%) possessed 10 or more; 54% had an amateur tattoo. Only 18% had received an explanation of the procedure or side-effects. The mean age at application of the first tattoo was 16 years; 48 (71%) were tattooed below the legal age limit of 18 years. Most tattoos were applied for the sake of fashion. The median duration of regret was 14 years before seeking removal. The main reasons for removal were enhancement of self-esteem and social, domestic and family reasons. In those patients attending for removal, most tattoos are applied impulsively and inexpensively in youth. They are often regretted for decades and create significant psychological, social and financial burdens.

Bleeding complaints during the first year of Norplant ® implants use and their impact on removal rate

The frequency of bleeding complaints during the first year of use and their influence on removal rate were analyzed in a retrospective cohort study of 491 Norplant ® implants acceptors. Removal rates were significantly higher in women having menstrual complaints (1.98% and 29.23% in the first and fourth trimester) than in those who did not mention them (0.79 and 5.07% in the same periods). In all periods of observation, most women who mentioned menstrual problems decided to continue using the method. Two possible explanations for this are that 1) the complaints did not persist for very long, and 2) the most frequent complaint mentioned was bleeding irregularity, which was not as strongly associated with removals as increased or decreased bleeding. The authors conclude that bleeding problems are the most important factor limiting the acceptability of Norplant ® implants, either being the main reason for removal (3.9 per 100 women) or influencing the rate of removal for other reasons. Adequate counseling appears to be critical for reducing the impact of bleeding problems on removal rates, and thereby increasing the acceptability of the method. The importance of research aimed at preventing or treating menstrual problems to improve the acceptability of the method is emphasized.

Responses of dairy cows to treatment with sometribove (r-BST) during three consecutive years

Cows were treated with sometribove to study long-term effects. In the first year, 64 cows were randomly assigned to two treatments, placebo (C) or 500 mg sometribove (S), and injected every 14 days for 32 weeks (first 2 years) or for 28 weeks (third year), starting at Week 9 (first 2 years) or Week 13 (last year) post partum. Diets were totally mixed rations (TMR), fed individually and ad libitum, with energy densities targeted to production level. Milk yields, feed intakes and body weights were recorded daily. Milk composition was determined at four consecutive milkings per week. Somatic cell counts in milk (SCC) were recorded regularly. Number of cows in the second year was 20 (C) and 20 (S) and in the third year 14 (C) and 10 (S). The main reasons for removal were: barren cows (6 C, 7 S); unsuitable lactation period particularly after the first year (1 C, 6 S); serious mastitis (0 C, 3 S); teat injury by hooftrapping (0 C, 2 S). Main effects of S during treatment periods for the 14 C and 10 S cows in the first, second and third year, respectively, were: kg 4% FCM, + 19, + 15, −17; NE intake, + 9, + 9, + 6; 4% FCM kVEM −1, + 9, + 7, + 8; body weight, −1, + 5, + 6. There were no significant differences in milk composition between C and S. SCC tended to be higher in S but the difference was not significant. After the first lactation only, sets of twins were higher in S (7) than in C (1). During the pretreatment periods of the second and third year feed intake was higher but feed efficiency was lower in S. The study supports the continual efficacy and safety of sometribove over 3 years of treatment.

A three-year clinical evaluation of Norplant-2 rods in Singapore

A three-year clinical evaluation of Norplant-2 rods in Singapore shows that no pregnancy occurred during the three years of use. The continuation rate at the end of three years was 74%. Desire for planned pregnancy was the main reason for removal during the three years. The post-removal conception rate in women desiring planned pregnancy was 50.0% at the end of one year. This low rate could be attributed to the four women deciding against a pregnancy after removal. However, despite this apparent reason one needs to monitor the post-removal return of fertility closely in the years to come.