Recognizing and preventing complications regarding bioresorbable scaffolds during coronary interventions

The evolution of coronary intervention techniques and equipment has led to more sophisticated procedures for the treatment of highly complex lesions.However,as a result,the risk of complications has increased,which are mostly iatrogenic and often include equipment failure.Stent dislodgement warrants vigilance for the early diagnosis and a stepwise management approach is required to either expand or retrieve the lost stent.In the era of bioresorbable scaffolds that are not radiopaque,increased caution is required.Intravascular imaging may assist in detecting the lost scaffold in cases of no visibility fluoroscopically.Adequate lesion preparation is the key to minimizing the possibility of equipment loss;however,in the case that it occurs,commercially available and improvised devices and techniques may be applied.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Technical problems produced by the Bravo pH test in nonerosive reflux disease patients

AIM: To evaluate the technical failures of the Bravo pH test in a population with nonerosive gastroesophageal reflux disease. METHODS: Over the course of a year, we prospectively studied a population of 66 nonerosive reflux disease patients who received a Bravo pH test. The number and frequency of all technical failures were documented, quantified and analyzed. RESULTS: A total of 66 patients, with a mean age of 41.7 years, were studied. Technical failures occurred in 15.15% of the sample. The most frequent failures were due to poor data reception (4.5%), early dislodgement (4.5%) and capsule removal (6.1%). CONCLUSION: The Bravo capsule pH test involves a low but non-negligible rate of technical problems, a fact that must always be considered by physicians.

Unreported complication of Bravo p H capsule dislodged into the pyriform sinus

We report an unexpected, previously unreported complication of Bravo p H capsule dislodgement. During Bravo p H testing of a 44-year-old man with gastroesophageal reflux disease, we were unable to endoscopically visualize the capsule attached to the esophageal wall after deployment. After multiple attempts to detect the capsule, it was visualized in the left pyriform sinus. As there was significant risk for pulmonary dislodgement, ENT and pulmonary physicians were immediately consulted to review options for safe removal. Ultimately, ENT successfully retrieved the capsule with a foreign body removal forceps. The Bravo p H test is generally a well-tolerated diagnostic tool used to confirm the presence of abnormal esophageal acid reflux. While few complications have been reported, technical difficulties can occur, including poor data reception, misplacement, and early dislodgement. Rarely, more serious complications can occur, ranging from esophageal wall trauma to capsule aspiration. Gastroenterologists performing this procedure should be aware of the low, but nontrivial, risk of complications.

Unique presentation of Twiddler's syndrome

We present a rare case of Twiddler's syndrome diagnosed in an asymptomatic patient on a routine follow up.This case reiterates the need for frequent monitoring of the implanted device.In addition,it was detected 4 years after implantation of an automatic implantable cardioverter defibrillator.This late representation is extremely uncommon.

Characterisation of Geomechanical Properties of Bentonite Clay Used for Plug and Abandonment Operations of Coal Seam Gas Wells

Compressed bentonite in the form of pellets or plugs is used for the abandonment of production wells for the oil and gas industry. The design of the abandonment systems is based on the hydro-mechanical behaviour of the compressed bentonite defined by mechanical parameters that are used from published data rather than quantified for the used material by laboratory investigations. This paper presents an experimental study on characterising the swelling and shear strength behaviour of raw and polymer (polyvinylpyrrolidone, PVP) treated bentonite. Dislodgement tests consist of three hydrated bentonite plugs inserted in steel casings with the failure mechanism characterised. The bentonite used comes from a local mine (in Queensland, Australia) and is comparable to other bentonites usually used for the abandonment of wells or for other problems where mineral sealing is required (e.g. basal clay barriers of landfills). The experiments have shown that polymer treated bentonite shows significantly larger shear strengths than raw bentonite with simultaneously less swelling. More compressed samples also showed higher shear strengths and less swelling. The dislodgement tests have characterised for the first time the cascaded failure mechanism of a series of plugs forming an abandonment system. This investigation is the first step towards the development of an improved design for abandonment systems for wells using bentonite plugs.