Unsuccessful Retrieval Attempts Research Articles

B-PO01-029 CHRONIC RETRIEVABILITY OF A LEADLESS PACEMAKER: WORLDWIDE EXPERIENCE OUT TO 7 YEARS

Nanostim leadless pacemaker (LP; Abbott Inc) clinical trials were halted after 1,423 implants in 10/2016 due to premature battery depletion and a docking button detachment vulnerability. To describe the long-term worldwide experience with LP retrieval. Patients enrolled in multicenter LP clinical trials in the US, Canada, Europe, Japan, and Australia, and who underwent an LP retrieval attempt were included. Data were collected for each retrieval attempt and any adverse events were adjudicated by a clinical events committee. The overall success of chronic LP retrieval was 87.6% (176 of 201 LPs). The mean time from implant to retrieval attempt was 2.6 ± 1.5 years (range 0 to 7.2); the mean times from implant to retrieval for the 176 successful and 25 unsuccessful attempts were 2.6 ± 1.5 years (range 0 to 7.2) and 2.5 ± 1.4 years (range 0.3 to 5.1), respectively. The retrieval success rate was above 80% over time, regardless of implant duration (Figure). Most unsuccessful retrieval attempts (21 of 25; 84%) were attributed to an inability to access the docking button, an inability to deliver the retrieval catheter, or detachment of the docking button. The device and/or procedure complication rate associated with attempted retrievals was 5.0% (10 of 201 attempts). The most common of these were tricuspid valve injury (n=3) or an inability to release the snare from the docking button (n=2). There were no deaths related to attempted retrieval. There is a high chronic LP retrieval success rate out to 7 years post-implant, accompanied by a low complication rate. Retrieval success rates remained above 80%, regardless of the LP implant duration.

Inferior Vena Cava Filter Utilization at Kingston Health Sciences Centre: A Comparison of Practice with Guidelines

Background: Inferior vena cava (IVC) filters offer mechanical protection against pulmonary embolism in high risk patients. Guidelines have recommended their use be limited. “Don't use inferior IVC filters routinely in patients with acute venous thromboembolism” (ASH Choosing Wisely, 2013). “For patients with acute VTE who are treated with anticoagulation, the guideline recommends against the use of an inferior vena cava filter.” (CHEST Antithrombotic Therapy and Prevention of Thrombosis, 2016) IVC filters implanted for longer than 100 days confer a significantly higher risk of complications (Odds Ratio 2.3, Dinglasan et al. 2013). We sought to determine compliance with these recommendations at Kingston Health Sciences Center (KHSC), an academic tertiary referral center with 440 inpatient beds at Queen's University in Kingston, Ontario, Canada.Methods: Approval was obtained from the Queen's Health Services Research Ethics Board.Consecutive patients with IVC filter implantation at KHSC from August 1st, 2013 to August 1st, 2016 were identified through Interventional Radiology records. All charts were retrospectively reviewed in depth by one investigator followed by review and discussion. Data extracted included: patient demographics and disposition, details surrounding IVC filter insertion and removal, and IVC filter related complications. The indication for filter implantation was classified as clearly consistent or not clearly consistent with CHEST guidelines. The category ‘lesser indication’ was subsequently added for cases of a more subjective nature where definitive categorization was challenging.Results: Between August 2013 and August 2016, 95 IVC filters were implanted at KHSC. Among these, 42 (44.2%) patients were male and the median age was 67 (ages ranged from 17 to 91). The most responsible services ordering IVC filter implantation were Critical Care Medicine (37.9%), Internal Medicine (32.6%), Surgery (12.6%) and other services such as Neurology, Family Medicine and Emergency Medicine (16.9%).Complications arose in 21 patients (22.1%) including filter-associated thrombosis (11), filter migration or tilt (8), IVC penetration (5), IVC perforation (2), and one instance of suspected IVC filter seeding with methicillin sensitive Staphylococcus aureus (MSSA) leading to bacteremia. The mean dwell time of filters that were successfully removed (n=52, 54.7%) was 69.2 days, with thirteen (18.1%) remaining indwelling beyond 100 days. Of those in whom the filter was not removed (n=43), unsuccessful retrieval attempts were made in eight, 23 patients died with their filters in situ within 100 days of implantation, and in 12 patients no record of an attempt to retrieve the device was found.Indication for IVC filter insertion was clearly consistent with CHEST guidelines in 58 (61.1%) patients. Insertion alongside therapeutic anticoagulation/thrombolysis or for prophylaxis in patients without VTE occurred in 26 patients (27.4%) and was considered not consistent with current recommendations. In 8 (8.4%) patients, a ‘lesser indication’ was identified. Lesser indications included cases where there was a need to withhold anticoagulation for less than 24 hours for procedures or surgeries, such as endoscopic retrograde cholangiopancreatography (ERCPs) or ankle open reduction internal fixations (ORIFs). Three charts had insufficient information to determine compliance.Discussion: The main limitation of this study is its retrospective nature with reliance on chart documentation. In addition, it is recognized that guidelines surrounding IVC filter use do not apply to all possible clinical scenarios. Nonetheless, restricting the use of IVC filters to appropriate indications is an important endeavour. These devices are costly, can cause harm, and do not have a strong evidentiary basis. Educational initiatives are underway to optimize use of IVC filters at KHSC. Additional interventions under consideration include development of a specific requisition form listing recommended indications, and creation of an IVC filter insertion database as a prompt for timely removal. DisclosuresHay:Celgene: Research Funding; Roche: Research Funding; Abbvie: Research Funding; Kite: Research Funding; Amgen: Research Funding; Janssen: Research Funding; Novartis: Research Funding.

Effects of making errors in learning a foreign language

ABSTRACT Kornell, Hays, and Bjork ([2009]. Unsuccessful retrieval attempts enhance subsequent learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 35, 989–998) showed that incorrect guesses do not necessarily harm and might even improve the retention of information on a subsequent test. We sought to replicate the finding using educationally relevant stimuli. In two experiments, our participants either translated sentences in a foreign language receiving immediate feedback (errorful condition), or copied and studied the correct translation (errorless condition). After this training phase, a final test with the same sentences showed that translating sentences wrongly during training did not lower the accuracy of the errorful as compared to the errorless condition. Overall there was evidence that errorful training produced superior learning of the meaning and grammar of the foreign language sentences. The results support the idea that search processes activate a greater network of related knowledge in the errorful than in the errorless condition.

재인방식을 통한 틀린인출시도가 추후의 기억에 미치는 영향

본 연구는 학습과정에서 재인방식의 시험을 이용할 경우에도 틀린인출에 의한 기억촉진효과가 발생하는지, 그리고 그 효과가 최종기억검사방식에 따라 다르게 나타나는지를 알아보기 위해 수행되었다. 이를 위해 학습방법에 따라 단순읽기집단, 단서제시집단 그리고 틀린인출집단으로 세분화하고, 최종기억검사방식에 따라 재인시험방식 집단과 회상시험방식 집단으로 구분하였다. 모든 집단의 실험참여자들은 재인방식으로 이루어진 단어쌍 학습과정과 2분 간 방해과제를 수행하였으며, 최종적으로 재인 및 회상기억검사를 통해 정확기억률을 측정하였다. 그 결과, 회상방식에 비해 재인방식의 최종기억검사의 정확기억률이 높은 것으로 나타났으며, 단순학습집단과 틀린인출집단에 비해 단서제시집단의 정확기억률이 높은 것으로 나타났다. 이러한 결과는 회상방식의 틀린인출의 시험효과를 검증한 다수의 선행연구들과 상반되는 결과로 학습과정에서 틀린인출의 효과가 재인방식과 회상방식에서 서로 다른 영향을 미칠 수 있음을 시사한다.

Abstract No. 654 Fibrin cap disruption using the hangman technique for retrieval of apex embedded conical IVC filters: a highly effective technique even in filters with long dwell times

Hangman technique is an advanced retrieval technique described for conical inferior vena cava (IVC) filters with endothelialized or embedded apex. It uses a subapical guide wire loop for disruption of fibrin cap attaching the filter apex to the IVC wall. Although efficient, the literature on this technique is scant. This study aims to demonstrate the efficacy and reproducibility of the Hangman technique for the retrieval of IVC filters with embedded apex, even the ones with long dwell times. Retrospective review of IVC filter retrieval attempts between Jan 2014 and Aug 2017 yielded 319 cases. Hangman technique was used in 29 of these cases. Two filters were suprarenal and the rest were infrarenal. Filter types were Celect Platinum™ (Cook Inc., Bloomington, Indiana) (n = 11), Celect™ (Cook Inc., Bloomington, Indiana) (n = 6), Option™ELITE (Argon Medical Devices, Inc. Athens, Texas) (n = 6), Denali® (Bard Peripheral Vascular, Tempe, Arizona) (n = 2), Gunther Tulip® (Cook Inc., Bloomington, Indiana) (n = 2), Meridian® (Bard Peripheral Vascular, Tempe, Arizona) (n = 1) and ALN (ALN Implants Chirurgicaux, Ghisonaccia, France) (n = 1). Mean dwell time was 658 days (SD 974 days, range 68-4,753 days, N = 27). The technical success rate was 90% (26/29). Seven patients had prior unsuccessful retrieval attempts. There were no procedure related complications. Mean total procedure time was 81.7 min (27-210 min, N = 29). Mean fluoroscopy time was 37.4 min (10.3-96.3 min, N = 11). Amongst three failures, two Celect™ filters were successfully removed using standard loop-snare technique through the struts, and one Denali® filter was left in situ. The Hangman technique is a safe, highly effective and reproducible technique for retrieving conical filters with embedded apices even after prolonged dwell times.

Surgical retrieval of a swallowed denture in a schizophrenic patient: a case report

BackgroundAccidental foreign body ingestion is a common phenomenon in children between 6 months to 6 years of age. In adults, foreign body ingestion is commonly observed in the geriatric population and in patients with psychiatric disorders. Over 80% of ingested foreign bodies pass uneventfully through the intestinal tract. Endoscopic retrieval is needed in about 20% while surgical intervention is indicated in less than 1%. Herein we report an extremely rare case of esophagocutaneous fistula following operative retrival of an impacted denture in the esophagus with spontaneous healing within 3 weeks. A similar case to the best of our knowledge has so far not been reported previously.Case presentationA case of accidental ingestion of a dental prosthesis in a 35-year old schizophrenic patient is presented. The patient was referred to our department after accidentally swallowing one of his dental prosthesis. Surgical retrieval was indicated after two unsuccessful endoscopic retrieval attempts. The denture was retrieved following a longitudinal incision of the esophagus via a left cervical approach. The postoperative course was complicated by a clinically suspected esophagocutaneous fistula which was managed conservatively via nothing per os with enteral feeding via a nasogastric tube. Secretion ceased 3 weeks later and a fistula could not be found on contrast enhanced radiographic examination with gastrographin®.ConclusionEsophagocutaneous fistula represents a rare but serious complication following foreign body ingestion. An interdisciplinary management including an early surgical consultation should be considered in patients with foreign body impaction in the esophagus following failure of endoscopic retrieval.

Transfemoral Filter Eversion Technique following Unsuccessful Retrieval of Option Inferior Vena Cava Filters: A Single Center Experience

This report describes the technical feasibility of using the filter eversion technique after unsuccessful retrieval attempts of Option and Option ELITE (Argon Medical Devices, Inc, Athens, Texas) inferior vena cava (IVC) filters. This technique entails the use of endoscopic forceps to evert this specific brand of IVC filter into a sheath inserted into the common femoral vein, in the opposite direction in which the filter is designed to be removed. Filter eversion was attempted in 25 cases with a median dwell time of 134 days (range, 44–2,124 d). Retrieval success was 100% (25/25 cases), with an overall complication rate of 8%. This technique warrants further study.

Memory Enhancement Effect of Unsuccessful Retrieval Attempts according to Connectivity between Memory Materials

Memory Enhancement Effect of Unsuccessful Retrieval Attempts according to Connectivity between Memory Materials

Factors affecting Cook Gunther Tulip and Cook Celect inferior vena cava filter retrieval success.

Success rates vary for the retrieval of inferior vena cava filters (IVCFs). The optimal retrieval time and factors influencing retrieval success remain unproven. This study aims to determine optimal time and evaluate factors related to successful IVCF retrieval. An institutional prospectively maintained database was reviewed for all IVCF retrieval attempts from 2006 to 2012. Patient demographics, comorbidities, indications for procedure, placement technique, IVCF type, presence of angulation, and time to retrieval were evaluated with respect to success or failure of retrieval. Statistical analyses (t-test, χ(2), correlations, and Kaplan-Meier plots) were performed comparing successful and unsuccessful retrievals. Of 121 attempted IVCF retrievals, 92 (76%) were successful and 29 (24%) were unsuccessful. There were no significant differences between the successful and unsuccessful attempts in terms of patient demographics, comorbidities, indications for procedure, placement technique, or IVCF type, which included 93 Celect (77%) and 28 Gunther Tulip (23%). Time since IVCF placement was significantly different (P= .025) between the successful and unsuccessful retrieval groups (medians were 105 [7-368] and 162 [43-379] days, respectively). Time since IVCF placement greater than 117days correlated significantly with unsuccessful IVCF retrieval (R=0.218; P= .017; odds ratio, 2.88; P= .02). Angulation greater than 20 degrees on anteroposterior radiograph was noted in seven of 29 (24%) unsuccessful retrievals compared with sevenof 92 (8%) successful retrievals and was significant (P= .012). Cook Gunther Tulip and Celect IVCF retrieval is most likely to be successful within 3 to 4months of placement. Unsuccessful retrieval attempts are more likely to occur when IVCF position is angulated.

Factors Affecting Inferior Vena Cava Filter (IVCF) Retrieval Success

Success rates vary for the retrieval of IVCF. Optimal retrieval time and factors influencing success remain unproven. This study aims to evaluate factors related to successful IVCF retrieval. An institutional prospectively maintained database was reviewed for all IVCF retrieval attempts 2007-12. Patient demographics, comorbidities, indications for procedure, placement technique, IVCF type, presence of angulation, and time to retrieval were evaluated. Statistical analyses performed using SPSS (IBM). Of 121 attempted IVCF retrievals, 92 (76%) were successful. There were no significant differences between the successful and unsuccessful attempts in terms of patient demographics, comorbidities, indications for procedure, placement technique, or IVCF type. Time since IVCF placement was significantly different (P = .025) between the successful and unsuccessful retrieval groups, medians were 105 (7-368) and 162 (43-379) days respectively. Time since IVCF placement greater than 117 days correlated significantly with unsuccessful IVCF retrieval (R = .218 P = .017, OR = 2.88 P = .02). Angulation greater than 20 degrees on AP radiograph was noted in 7 of 29 (24%) unsuccessful retrievals compared with 7 of 92 (7.6%) successful retrievals, this difference was significant (P = .015). IVCF retrieval is 90% successful within 117 days of placement. Unsuccessful retrieval attempts are most likely to occur in IVCF which are angulated.

Indications, Complications, and Management of Inferior Vena Cava Filters

Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely. To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy. A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England. In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records. Placement of retrievable IVC filter. In total, 952 medical records were included in the analysis. Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy. Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.

Test-potentiated learning: distinguishing between direct and indirect effects of tests.

The facilitative effect of retrieval practice, or testing, on the probability of later retrieval has been the focus of much recent empirical research. A lesser known benefit of retrieval practice is that it may also enhance the ability of a learner to benefit from a subsequent restudy opportunity. This facilitative effect of retrieval practice on subsequent encoding is known as test-potentiated learning. Thus far, however, the literature has not isolated the indirect effect of retrieval practice on subsequent memory (via enhancing the effectiveness of restudy) from the direct effects of retrieval on subsequent memory. The experiment presented here uses conditional probability to disentangle test-potentiated learning from the direct effects of retrieval practice. The results indicate that unsuccessful retrieval attempts enhance the effectiveness of subsequent restudy, demonstrating that tests do potentiate subsequent learning.

Neural correlates of source memory retrieval in young, middle-aged and elderly adults

Event-related potentials (ERPs) were recorded in young (21–27 years old), middle-aged (50–57 years old) and older adults (70–77 years old) to determine whether the decline in source memory that occurs with advancing age coincides with contemporaneous neurophysiological changes. Source memory for the spatial location (quadrant on the screen) of images presented during encoding was examined. The images were shown in the center of the screen during the retrieval task. Retrieval success for source information was characterized by different scalp topographies at frontal electrode sites in young adults relative to middle-aged and older adults. The right frontal effect during unsuccessful retrieval attempts showed amplitude and latency differences across age groups and was related to the ability to discriminate between old and new images only in young adults. These results suggest that the neural correlates of the retrieval success and attempt were affected by age and these effects were present by middle-age.

When and why do retrieval attempts enhance subsequent encoding?

Unsuccessful retrieval attempts can enhance subsequent encoding and learning. In three experiments, subjects either attempted to retrieve word pairs prior to studying them (e.g., attempting to recall tide-? before studying tide-beach) or did not attempt retrieval and retention of the studied targets was assessed on a subsequent cued recall test. Experiment 1 showed that attempting retrieval enhanced subsequent encoding and recall relative to not attempting retrieval when the word pairs were semantically related, but not when the pairs were unrelated. In Experiment 2, studying a different word pair prior to the correct pair (e.g., studying tide-wave prior to tide-beach) did not produce the same effect as attempting retrieval prior to studying. Constraining retrieval to a particular candidate word prior to study (e.g., recalling tide-wa__ before studying tide-beach) produced a negative effect on subsequent recall. Experiment 3 showed that attempting retrieval did not enhance encoding when a brief delay occurred between the retrieval attempt and the subsequent study trial. The results support the idea that a search set of candidates related to the retrieval cue is activated during retrieval and that this retrieval-specific activation can enhance subsequent encoding of those candidates.

Testing unsuccessfully: A specification of the underlying mechanisms supporting its influence on retention

Five experiments were conducted to examine how unsuccessful retrieval influences learning and subsequent memory. We used a cued-recall paradigm that produces many unsuccessful retrieval attempts (followed by feedback) and allows comparisons to be made between later memory for these trials and trials that only required reading or studying the pairs. On read trials participants studied cue–target pairs that were either weakly associated (DOOR–EXIT) or unrelated but identical in length (DOOR–SHOE). On test trials participants were given only the cue (either without [Exps. 1–3] or with [Exps. 4–5] prior experience with the pair items) and asked to guess the target which they were told was either semantically related or identical in length to the cue; then they received the correct cue–target pair to study. Unsuccessful retrieval attempts (i.e., guessing) relative to studying benefited retention for weakly associated pairs but impaired retention for unrelated pairs. This pattern of results occurred regardless of study duration (Experiments 1A and 1B), level of processing of the cue (Experiment 2), whether relatedness was manipulated between or within subjects (Experiment 5), and when guessing involved episodic as opposed to semantic retrieval (Experiments 4 and 5). However, this pattern was partly mediated by the ability to retrieve incorrect guesses during a final cued-recall test which may provide a link between the cue and target (Experiment 3). The current study demonstrates that unsuccessful retrieval attempts with immediate feedback not only enhance, but also can impair learning. This effect is robust and depends on elaborative semantic activation related to the answer and the effectiveness of incorrect guesses as mediating cues.

Short- and Long-term Retrievability of the Celect Vena Cava Filter: Results from a Multi-institutional Registry

To evaluate retrievability of the Celect vena cava filter over time and to assess the safety of the retrieval procedure in a prospective multicenter registry. Between October 2005 and March 2008, Celect filters were placed in 95 patients (61 men; mean age, 51 years +/- 18.5) with a temporary need for an inferior vena cava (IVC) filter. All patients satisfied requirements for filter placement; the primary indications for placement were pulmonary embolism (PE) with a contraindication to or failure of anticoagulation (n = 40), high risk for further PE (n = 29), trauma (n = 23), or massive PE with residual deep vein thrombosis and risk for further PE (n = 3). Filter orientation, vena cava injury, and other device-related incidents were evaluated at implantation and retrieval. The degree of difficulty associated with retrieval was also assessed. Filter retrieval was attempted in 58 patients (mean indwell time of 179 days; median, 168.5 d; range, 5-466 d). Fifty-six filters (96.6%) were successfully retrieved. Unsuccessful retrieval attempts were attributed to filter tilt (n = 1) or excessive tissue growth with the hook embedded in the endothelium (n = 1). No adverse events were associated with the inability to retrieve these filters. A Kaplan-Meier product-limit survival estimate revealed that the probability of successful filter retrieval remained at 100% at 50 weeks and at more than 74% at 55 weeks after implantation. No adverse events were related to the retrieval procedures. Retrieval of the Celect filter was performed safely as long as 466 days after implantation.

Unsuccessful retrieval attempts enhance subsequent learning.

Taking tests enhances learning. But what happens when one cannot answer a test question-does an unsuccessful retrieval attempt impede future learning or enhance it? The authors examined this question using materials that ensured that retrieval attempts would be unsuccessful. In Experiments 1 and 2, participants were asked fictional general-knowledge questions (e.g., "What peace treaty ended the Calumet War?"). In Experiments 3-6, participants were shown a cue word (e.g., whale) and were asked to guess a weak associate (e.g., mammal); the rare trials on which participants guessed the correct response were excluded from the analyses. In the test condition, participants attempted to answer the question before being shown the answer; in the read-only condition, the question and answer were presented together. Unsuccessful retrieval attempts enhanced learning with both types of materials. These results demonstrate that retrieval attempts enhance future learning; they also suggest that taking challenging tests-instead of avoiding errors-may be one key to effective learning.

The pretesting effect: Do unsuccessful retrieval attempts enhance learning?

Testing previously studied information enhances long-term memory, particularly when the information is successfully retrieved from memory. The authors examined the effect of unsuccessful retrieval attempts on learning. Participants in 5 experiments read an essay about vision. In the test condition, they were asked about embedded concepts before reading the passage; in the extended study condition, they were given a longer time to read the passage. To distinguish the effects of testing from attention direction, the authors emphasized the tested concepts in both conditions, using italics or bolded keywords or, in Experiment 5, by presenting the questions but not asking participants to answer them before reading the passage. Posttest performance was better in the test condition than in the extended study condition in all experiments--a pretesting effect--even though only items that were not successfully retrieved on the pretest were analyzed. The testing effect appears to be attributable, in part, to the role unsuccessful tests play in enhancing future learning.

Non-asphyxiating tracheobronchial foreign bodies in adults

The presentations of 47 adult patients with a non-asphyxiating tracheobronchial foreign body were reviewed. The duration of residence of the foreign body was 1 week or less in nine ("acute group"); 1 month or more in 29 ("chronic group"), uncertain in four ("uncertain group"); and the foreign body was a broncholith in five patients ("broncholith group"). In the chronic and uncertain groups, no precipitating factor was found and bone was the most common foreign body. In the chronic group, a choking history was obtained before bronchoscopy in only 15 patient. Clinical manifestations and roentgenograms were nonspecific in most cases, except in the acute group. In the chronic group, the mean duration of residence of the foreign body was 25.8 months. The diagnosis was delayed due to absence of a choking history and invisibility of the foreign body on chest films in 12, due to patient's ignorance in 14, due to physician's ignorance in 1, and due to previous unsuccessful retrieval attempts in 2 patients. The main indication for bronchoscopy in the acute group was a choking history or a visible foreign body on the chest film. In the chronic group, a choking history or conditions leading to "suspicion of an endobronchial lesion" were the main indications. The foreign body was removed with a fibreoptic bronchoscope in over 90% of patients. It is concluded that the most important diagnostic factor is a high clinical index of suspicion and that flexible fibreoptic bronchoscopy provides a valuable therapeutic option in selected conditions.

Evaluation of current techniques for nonsurgical removal of intravascular iatrogenic foreign bodies

Intravascular embolization of polyethylene catheter fragments continues to occur, the majority from intravenous indwelling catheters. Sixty-nine nonsurgical retrievals of embolized fragments have been reported. The various recorded retrieval techniques are reviewed as well as their respective successes and limitations. Complications of snare techniques, unsuccessful retrieval attempts, and factors influencing the choice of local surgical removal versus snare techniques are discussed. The fate of patients from whom embolized catheter fragments were not removed is reviewed in depth. Our figures indicate a 71% incidence of death or serious complication, which is significantly higher than previously reported.