Successful Removal Research Articles

Successful removal of a proximally migrated biliary fully covered self-expandable metal stent using a sphincterotome.

Watch a video of this article.

Electrochemical oxidation of reverse osmosis concentrate using a pilot-scale reactive electrochemical membrane filtration system: Performance and mechanisms

Scale-up treatment of real wastewater holds the key to promoting the practical application of electrochemical filtration technology. This work used a pilot-scale Ti/Pd reactive electrochemical membrane (REM) system (12 REM modules with a total REM area of 0.144 m2) to treat high-salinity reverse osmosis concentrate (ROC) from a chemical industry park. The pilot-scale Ti/Pd REM system demonstrated effective electrochemical degradation of ROC wastewater, achieving removal efficiencies of 82.3 ± 1.9% for COD and 46.7 ± 5.6% for TN at a membrane flux of 90 L/(m2·h) and a cell voltage of 5 V, with an energy consumption of 0.045 kWh/g-COD. Singlet oxygen (1O2) and reactive chlorine species were identified as the two primary reactive oxygen species generated in the Ti/Pd REM system. Fluorescence spectroscopy and Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) analysis indicated that the pilot-scale Ti/Pd REM treatment effectively oxidized humic acid-like substance and unsaturated aromatic compounds. Overall, the Ti/Pd REM technology shows a promising application potential for the treatment of high-salinity ROC from the chemical industry.

CASE STUDY: COLONIC LYMPHANGIOMA IN VIETNAMESE CHILDREN

Objectives: We presented a rare case of lymphangioma in the colon with successful surgical removal. Methods: A case report of a 13-year-old female patient who was brought to Vietnam National Children’s Hospital with hematochezia severe normochromic microcytic anemia. Due to nonspecific symptoms, the patient was misdiagnosed with iron deficiency anemia and internal hemorrhoid. After approaching symptoms of lower gastrointestinal bleeding, the patient was done with colonoscopy and abdominal CT scanner, then was diagnosed with a lymphangioma of the sigmoid colon. Surgical resection of the bowel, which contains lymphatic malformation, was successful. Conclusion: Lower gastrointestinal bleeding and microcytic anemia are solitary colonic lymphangioma symptoms. Their diagnosis is established by colonoscopy and abdominal CT scanner. The main therapeutic option is surgical removal of the lesion.

The Use of a Surgical Spoon in the Removal of Substernal Goiter.

Goiter with substernal extension is common, with a reported incidence of up to 20% in patients undergoing thyroidectomy. It has been shown that the vast majority of substernal goiters can be removed through a cervical incision. However, if this is not possible, a sternotomy is usually required, which could add significant morbidity to an otherwise routine operation. During substernal mobilization, the surgeon's finger is typically placed under the strap muscles and against the thyroid capsule, hooking around the inferior aspect of the gland to facilitate separation of the gland from its mediastinal attachments. In cases where the length required for successful substernal mobilization is beyond the reach of a surgeon's fingers, the use of an alternative strategy may be required. A surgical spoon is a blunt, curved instrument that can allow safe substernal mobilization while providing the added length needed when digital mobilization is inadequate. Here, we describe the use of a surgical spoon for the safe and successful removal of a goiter with substernal extension unable to be removed with digital manipulation.

Electrohydrodynamic Nanopatterning: A Novel Solvent-Assisted Technique for Unconventional Substrates.

Electrohydrodynamic (EHD)-driven patterning is a pioneering lithographic technique capable of replicating and modifying micro/nanostructures efficiently. However, this process is currently restricted to conventional substrates, as it necessitates a uniform and robust electric field over a large area. Consequently, the use of nontraditional substrates, such as those that are flexible, nonflat, or have high insulation, has been notably limited. In our study, we extend the applicability of EHD-driven patterning by introducing a solvent-assisted capillary peel-and-transfer method that allows the successful removal of diverse EHD-induced structures from their original substrates. Compared with the traditional route, our process boasts a success rate close to 100%. The detached structures can then be efficiently transferred to nonconventional substrates, overcoming the limitations of the traditional EHD process. Our method exhibits significant versatility, as evidenced by successful transfer of structures with engineered wettability and patterned structures composed of metals and metal oxides onto nonconventional substrates.

A novel method for the bronchial occlusion of prolonged air leakage using customized endobronchial plugs.

The management of prolonged air leakage (PAL) is a significant clinical challenge, particularly for patients who are unfit for surgical treatment. The use of endoscopic interventions with occlusive devices has been reported previously; however, local availability and cost may represent potential hurdles, especially in developing countries. In this study, we presented a conical endobronchial plug of our design and evaluated the efficacy of making use of that in the treatment of PAL as a novel method. This retrospective study included a total of 23 patients with PAL who were not suitable for surgery and underwent bronchial occlusion using customized plugs. The responsible bronchi were identified by the balloon occlusion test or by end-tidal carbon dioxide detection. In each case, the plug was grasped at the knot of the tip with forceps and then inserted into the target bronchus with a flexible bronchoscope. Of the 23 patients with intractable pneumothorax, 1 to 3 plugs (median =1) were successfully inserted into the affected bronchi of each patient for bronchial occlusion. Air leakage showed complete cessation in 13 patients (56.5%) and reduction in seven patients (30.4%). A total of 20 patients (87.0%) experienced successful removal of the drainage tube following plug occlusion or presented with additional pleurodesis. Complications included expectoration of the plug (n=1) and fever (n=1); no other severe complications were observed. Bronchial occlusion using customized endobronchial plugs appears to be an effective and simple option for the management of PAL in patients who are not suitable for surgery, especially in developing countries, as the customized plug is a cost-effective alternative.

Clinical Efficacy, Safety, and Complications of the Arthroscopic Cartilage Shaving Procedure for Secondary Osmidrosis Treatment

Background Axillary osmidrosis is a common disease with negative psychosocial impact on patients. Further, many treatment modalities are not sufficient and result in recurrence. Objective We aimed to evaluate the effectiveness and safety of using a cartilage shaver in patients with recurrent osmidrosis to remove tightly attached apocrine glands and subdermal scars. Methods We retrospectively evaluated 24 patients with secondary axillary osmidrosis who underwent cartilage shaving surgery between January 2013 and May 2022. We analyzed the incidence of complications, including seroma, infection, pigmentation, wound dehiscence, skin necrosis, scarring, shoulder movement limitation, comedones/sebaceous cysts, and nerve injury. Clinical effectiveness was also evaluated. Results Excellent or good efficacy with improved malodor was achieved in 24 patients (47 axillae [100%]). Complications were observed in 16 (36.17%) axillae, including hematomas (n = 2), pigmentation (n = 7), skin necrosis (n = 3), and comedones/sebaceous cysts (n = 4); one patient (2.13%) required local debridement. Mean Vancouver Scar Scale scores were markedly low (5.41 to 4.67). Scar tissue did not interfere with the shaving surgery, allowing for successful removal of the apocrine glands. Conclusions Secondary osmidrosis treatment using a cartilage shaver system yielded satisfactory and better scar results than the patients' previous treatments.

Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

Successful removal of an iatrogenic pleural foreign body—pigtail catheter, using a semi-rigid thoracoscope

Tube thoracostomy stands as the conventional treatment for pleural diseases. Nevertheless, pigtail catheters have gained traction due to their smaller size, potentially resulting in reduced complications. Despite the enhanced safety and ease of insertion associated with pigtail catheters, it is crucial to recognize that procedural complications can arise irrespective of the drainage method employed. Complications related to small-bore pigtail catheters encompass the possibilities of dislodgment, kinking, and, though rarely, breakage. Our case serves as a reminder for medical practitioners to select appropriately sized pleural tubes based on the specific pleural condition. In this instance, we present the utilization of a semi-rigid thoracoscope to extract a broken pigtail catheter from the pleural cavity. To the best of our knowledge, this is the first case report of removing a broken pleural catheter using semi-rigid medical thoracoscopy.

Successful removal of a migrated plastic stent using a new endoscopic sheath

Successful removal of a migrated plastic stent using a new endoscopic sheath

The endoscopic removal of urethral foreign body (a fragment of an artillery shell): a clinical case

Gunshot wounds of the external genitalia are present in two-thirds of all penetrating genitourinary trauma in the military setting with prevailing shrapnel wounds.The reported clinical case is aimed at providing rational and demonstrating benefits of endoscopic removal of a splinter from the urethral lumen.The clinical case presents the successful removal of a splinter from the urethral lumen. A 22-year-old man suffered gunshot shrapnel wound to the scrotum and urethra 7 months ago, а splinter was located in the urethral lumen and was successfully removed using endoscopic approach. In some cases X-ray diagnosis does not allow detecting the exact location of the splinter. Therefore, it is rational to use endourological diagnostic procedures.

Design and field-scale demonstration of the buoyant-kill process for restoring integrity of wells with sustained casing pressure

Sustained Casing Pressure (SCP) is the persistent casinghead pressure resulting from the well’s annular integrity loss and migration of gas above the leaking cement sheath. Downhole—intervention methods for SCP removal employ workover rigs to access and plug off the leaking annulus at depth from within the well. The inexpensive rig-less method of Buoyant Kill involves surface injection of immiscible heavy fluid at the casinghead into the well’s annulus to replace the annular fluid column above the gas-leaking cement and stop gas migration. Laboratory and pilot-size testing have shown feasibility of the method. Presented here, is a field-scale demonstration experiment conducted in a pressurized 2750-foot well with water displaced by an immiscible brominated organic fluid over 20-h long operation. Discussed is experimental design supported by fluid selection study, benchtop and pilot tests, and fluid transport model. Also analyzed is the process performance and operational problems. The results confirm feasibility of the Buoyant Kill technique for SCP removal. The overall change of the wellhead and downhole pressures follows the expected patterns indicating partial removal of the simulated SCP. The removal is incomplete due to pumping pressure pulses and wellhead pressure variations resulting in some emulsification of the two fluids and partial loss of the injection fluid into the overflow. The results show that wellhead pressure control and injection pump operation are critical for successful SCP removal using the Buoyant Kill technique.

Evaluating the opportunities for mainstream P-recovery in anaerobic/anoxic/aerobic systems

Mainstream P-recovery can help wastewater treatment plants (WWTPs) to effectively maintain good enhanced biological phosphorus removal (EBPR) while helping to recover P. In this study, a pilot-scale anaerobic-anoxic-aerobic (A2O) process was operated for simultaneous COD/N/P removal and P-recovery under different operational conditions. The operation with conventional extraction of waste activated sludge (WAS) from the aerobic reactor was compared to the mainstream P-recovery strategy of WAS extraction from the anaerobic reactor. Successful nutrient removal was obtained for both scenarios, but the anaerobic WAS extraction results improved polyphosphate accumulating organisms (PAOs) activity by increasing almost 27 % P concentration in the anaerobic reactor. WAS fermentation was also evaluated, showing that anaerobic WAS required only 3 days to reach a high P concentration, while the aerobic WAS fermentation required up to 7 days. The fermentation process increased the amount of soluble P available for precipitation from 24.4 % up to 51.6 % in the fermented anaerobic WAS scenario. Results obtained by precipitation modelling of these streams showed the limitations for struvite precipitation due to Ca2+ interference and Mg2+ and NH4+ as limiting species. The optimum precipitation scenario showed that P-recovery could reach up to 51 % of the input P, being 90 % struvite.

Polydopamine-functionalized electrospun poly(vinyl alcohol)/chitosan nanofibers for the removal and determination of Cu(II)

Environmentally friendly and recycled polydopamine-functionalized electrospun poly(vinyl alcohol)/chitosan nanofibers (PVA/CS/PDA) were prepared through a low-energy-consumption procedure. The PDA coating endows PVA/CS/PDA nanofibers with good water stability. The PVA/CS/PDA nanofibers have a fibrillar and porous structure that is favorable for Cu(II) to access the active sites of the nanofibers. The adsorption isotherm and kinetics data preferably conform to the Liu isotherm and pseudo-second-order kinetic models, respectively. The maximum adsorption capacity of Cu(II) ions by PVA/CS/PDA nanofibers from the Liu isotherm model is 326.5 mg g−1. The PVA/CS/PDA nanofibers exhibit higher adsorption capacity than some other reported adsorbents. The adsorption mechanism study demonstrates that the Cu(II) adsorption is mainly ascribed to the complexation of Cu(II) with the imino, amino, and hydroxy moieties in PVA/CS/PDA nanofibers. The nanofibers can be employed for 5 cycles without significantly deteriorating performance. More interestingly, a fluorometry method based on the oxidation mimic enzyme activity of Cu(II) was developed to detect low concentrations of Cu(II) using the nanofibers as an adsorbent to preconcentrate Cu(II). The limit of detection is 0.42 mg L−1. The successful removal and detection of Cu(II) in Pearl River and mineral water samples demonstrates the great potential of PVA/CS/PDA nanofibers to remediate Cu(II)-polluted water.

Neodymium long-pulse laser as a monotherapy for unaesthetic vessels of various locations: a series of clinical observations

The article presents a series of clinical cases describing the successful use of the long-pulse neodymium laser in removing unaesthetic reticular veins and telangiectasia of various locations. The first two cases demonstrated reticular varicose veins of the lower limbs in female patients with a fear of injections, which were treated without compression garments and ecchymoses with excellent effect. The outcome of treatment was comparable with that of classical sclerotherapy. The third case showed a successful laser removal of large telangiectasias on the hands, which developed following the long-term use of injection narcotic drugs as part of trophovegetoneurosis. Such pathology is rare for medical practice and approaches to its treatment have not been developed. The fourth case showed large telangiectasias of the buccal and zygomatic regions A good effect after the use of a large diameter spot in that area was demonstrated. The fifth case demonstrated the treatment of the veins in the buccal region, including the vein curving over the mandibular angle. The outcome of the treatment allowed to evaluate not only the aesthetic effect of the procedure, but also the severity of side effects in that area. In the sixth case, the periorbital vein, which divides into two branches, was investigated. The treatment was successful despite the different structure of the vein wall and depth of occurrence. The seventh case demonstrated the removal of large temporal veins. The outcome of treatment was presented on the following day, reflecting the degree of visual discomfort in the early post-procedure period. The final outcome a month after treatment was also demonstrated. In conclusion, the eighth case demonstrated the effectiveness of the treatment of scattered small red telangiectasias on the face using a long-pulse neodymium laser.

Complications of orotracheal intubation in the horse

SummaryDifficulty to extubate any patient is not a problem commonly thought of during general anaesthesia. This case report describes some of the factors that lead to this predicament and the successful surgical removal of the endotracheal tube via a tracheostomy. This case report also highlights some of the deficiencies in the clinical practice of veterinary anaesthesia. Further research is required for the selection size criteria of endotracheal tubes in all species and the monitoring of cuff pressures during general anaesthesia.

Predictors on admission associated with successful weaning and in - hospital mortality in patients with refractory shock undergoing veno - arterial extracorporeal membrane oxygenation

Abstract Introduction In assessment of prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO), considerable data have been focused on predictors just before or after VA-ECMO initiation. The aim of this study is to determine the prognostic factors on admission in patients with refractory shock undergoing VA-ECMO. Methods A total of 307 patients (median age 57; interquartile rate [IQR]: 48-68, male 220 (72%)) who underwent VA-ECMO due to refractory shock from 2015 to 2021 were retrospectively analyzed. Successful weaning was defined as successful removal of VA-ECMO without mechanical support over the following 30 days. In-hospital mortality (IHM) was defined as death occurred during the hospital stay. Results Median duration of weaning and hospital stay was 10 days (IQR: 7-14) and 24 days (IQR: 9-43), respectively. Of all patients, 115 patients (37%) were successfully weaned from VA-ECMO and 191 (62%) died before discharge. Patients with successful weaning and survived before discharge had lower prevalence of sepsis, higher cystatin C based estimated glomerular filtration rate (cyc-eGFR) and total cholesterol, and lower blood urea nitrogen, C-reactive protein and INR on admission than those with failed weaning and those who had died. In multivariate regression analyses, sepsis, cyc-eGFR and INR on admission were independently associated with successful weaning and only cyc-eGFR on admission was remained as independent predictor of IHM. In an incremental model, the addition of cyc-eGFR significantly increased the χ² of the clinical and laboratory data model including creatinine based eGFR (Cr-eGFR), from 22.3 to 33.7 (p<0.001) for prediction of successful weaning and from 22.2 to 33.6 (p<0.001) for prediction of IHM, respectively. Conclusion Cyc-eGFR on admission showed an incremental prognostic value beyond Cr-eGFR on admission for prediction of successful weaning and IHM in patients with refractory shock undergoing VA-ECMO.

Abstract 11430: A Bad Break: Cardiogenic Shock Complicated by an Intracardiac Foreign Body

Introduction: We report a case of cardiogenic shock complicated by an intracardiac foreign body. This is a rare occurrence during a dangerous cardiovascular disease process which necessitated urgent multidisciplinary management. Case: A 54-year-old female with a history of hypertensive cardiomyopathy and breast cancer was not improving during a hospitalization for acutely decompensated CHF and atrial flutter with RVR. Right heart catheterization demonstrated cardiogenic shock, with a foreign body noted in the right atrium favored to be a fragment of the left subclavian port catheter also seen on fluoroscopy. This object was present on admission imaging but likely mistaken as external artifact. Coronary angiography revealed severe multi-vessel CAD. A multidisciplinary team discussed the timing and modality of foreign body removal, electing to prioritize hemodynamic optimization before intervention. Once stable, the patient underwent successful endovascular removal of the catheter fragment with immediate improvement of her heart rhythm. She remained in sinus rhythm until discharge home in stable condition. Discussion: This episode of cardiogenic shock may have been precipitated by an arrhythmogenic intracardiac foreign body. However, medication non-adherence and severe CAD on angiography suggested a multifactorial etiology, justifying a delay in the removal of the foreign body until shock had resolved. Additionally, the catheter fragment present on admission imaging should have been identified earlier as a contributing factor. Timely recognition and removal of the fragment may have prevented the hemodynamic decompensation of the patient. Conclusion: This case demonstrates the efficacy of delaying the removal of an intracardiac foreign body in favor of hemodynamic optimization in patients with cardiogenic shock, while obviating the need for maintaining a broad differential when determining the underlying etiology of decompensated heart failure.

Conversion of seaweed waste to biochar for the removal of heavy metal ions from aqueous solution: A sustainable method to address eutrophication problem in water bodies

The present study investigated the sustainable approach for wastewater treatment using waste algal blooms. The current study investigated the removal of toxic metals namely chromium (Cr), nickel (Ni), and zinc (Zn) from aqueous solutions in batch and column studies using biochar produced by the marine algae Ulva reticulata. SEM/EDX, FTIR, and XRD were used to examine the adsorbents' properties and stability. The removal efficiency of toxic metals in batch operations was investigated by varying the parameters, which included pH, biochar dose, initial metal ion concentration, and contact time. Similarly, in the column study, the removal efficiency of heavy metal ions was investigated by varying bed height, flow rate, and initial metal ion concentration. Response Surface Methodology (Central Composite Design (CCD)) was used to confirm the linearity between the observed and estimated values of the adsorption quantity. The packed bed column demonstrated successful removal rates of 90.38% for Cr, 91.23% for Ni, and 89.92% for Zn heavy metals from aqueous solutions, under a controlled environment. The breakthrough analysis also shows that the Thomas and Adams-Bohart models best fit the regression values, allowing prior breakthroughs in the packed bed column to be predicted. Desorption studies were conducted to understand sorption and elution during different regeneration cycles. Adding 0.3 N sulfuric acid over 40 min resulted in the highest desorption rate of the column and adsorbent used for all three metal ions.

The application value of high-frequency ultrasound in the feasibility assessment of endoscopic retrograde appendicitis therapy in children with appendicitis

Acute appendicitis is one of the common acute abdominal diseases in pediatrics. However, the implementation of radiological examination guided endoscopic retrograde appendicitis therapy (ERAT) in adults is limited in children. Our previous research explored the non-invasive guidance of high-frequency ultrasound (HFUS) for ERAT and achieved good therapeutic effects. This study mainly focuses on exploring the application value of HFUS in the feasibility assessment of ERAT in children with appendicitis. 163 children with appendicitis received ERAT guided by HFUS were analyzed retrospectively. According to the parameters evaluated by HFUS before and during ERAT, the results indicated that the distance between the appendix orifice and the ileocecal valve significantly affected the time required for the guidewire to enter the appendix cavity (P < 0.05). The diameter and the texture of the fecalith, the thickness of the intestinal wall of the appendiceal orifice all had significant effects on the successful removal of the fecalith (P < 0.05). The success rate, treatment time and final flushing effect of the guidewire to reach the blind end of the appendix were significantly affected by the tortuosity of the appendix and whether there was adhesion with surrounding tissues (P < 0.05). HFUS can accurately assess the feasibility of ERAT in children with appendicitis.