S‐ICD: Is it time for radiological follow‐ups? Rillo, Mariano; Palamà, Zefferino; My, Giulia ...
Journal of cardiovascular electrophysiology,
October 2021, 2021-10-00, 20211001, Letnik:
32, Številka:
10
Journal Article
Lead pollution precaution caused by lead-based anode corrosion is a hot and challenging issue for zinc electrowinning. A novel functional lead-based anode (MnO2 pre-coated anode-MPA) was precisely ...fabricated and its long-term performances were studied compared with typical Pb−1%Ag anode (TPA). Results indicated that MPA posed excellent effects on synergistic inhibiting lead dissolution and reducing hazardous pollutants generation, and decreasing the lead content of zinc products by 81%. Further, the underlying mechanism of film growth and transformation in structure, composition and crystal phase, the migration and distribution of lead and anode slime during electrolytic, were clarified in-depth. Dynamic material flow analysis confirmed that MPA reduced the entire lead migration amount by over 92% compared with TPA. The compact multilayer structure of the MPA film and self-reparation effects of local structure provided better and persistent protection for the lead matrix, which greatly retarded the high-speed corrosion of lead anode. Compared with α-MnO2 in TPA, the formation and maintenance of γ-MnO2 in MPA accelerated the oxygen evolution reaction and inhibited the anode slime generation. This finding provides new insights in pollution precaution and control by designing and tuning new functional anode in hydrometallurgy process.
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•MPA displayed significant superiority in 92% of lead corrosion inhibition and 95% of anode slime reduction than TPA.•The compact MnO2 inner layer structure of MPA retarded the lead corrosion and dissolution by forming physical barrier.•The self-reparation effects played an important role in maintaining the compact film structure during long-term service.•Phase transformation from traditional α-MnO2 to γ-MnO2 contributed the slime generation reduction.
Electrode migration is one of the most common complication of Spinal Cord Stimulation (SCS). Usually the lead migrates cranio-caudally or laterally and in the vast majority of cases occurs during the ...first few months after implantation. One method of preventing lead migration is the use of open-surgical insertion of paddle electrodes.
51-year old woman was admitted for a revision of postoperative wound after implantation of Spinal Cord Stimulator, which was inserted 4 years earlier due to Failed Back Surgery Syndrome (FBSS). Two years after surgery the patient reported severe pain at the site of electrode implantation. After removal of scar tissue pulling on electrode wires the symptoms subsided. In the following months impaired healing of the postoperative wound was observed. For a long time, the patient would not consent to removal of SCS hardware because of good therapeutic effect. When she was finally admitted for surgery, radiological examination demonstrated significant electrode migration out of the vertebral canal. Surgery was performed to remove all of the hardware.
In this case, electrode migration out of the vertebral canal resulted from prolonged infection of SCS hardware. The importance of an infection prevention in neuromodulation procedures should be highlighted. According to our best knowledge, this is the first presented case of paddle type electrode extraspinal migration.
Background:
Lead migration is a complication associated with occipital nerve stimulation (ONS). We present a rare case in which fibrosis in the stress relief loop caused lead migration in the ...treatment of occipital neuralgia.
Case Description:
A 30-year-old woman with a 5-year history of refractory occipital neuralgia, who had been under ONS therapy for 2 months, presented with a sudden onset of typical occipital neuralgia pain associated with cervical muscles spasms and myoclonus. A skull radiography showed lead migration. The patient underwent surgery for lead repositioning. During surgery, we identified extensive fibrosis throughout the stress relief loop that produced several constriction points. The fibrosis in the stress relief loop increased tension on the lead during head-and-neck movement, causing progressive migration of the lead.
Conclusion:
Although lead migration is a common complication of ONS, its association with fibrosis in the stress relief loop has not, to the best of our knowledge, been reported before. Lead migration can directly affect treatment outcome and it is, therefore, important to fully understand the possible mechanisms that can cause it and how to promptly manage them.
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•The migration of Pb during waste incineration was investigated using Pb isotopes.•Source tracing of Pb during incineration by isotopic technology was feasible.•Contributions of MSW ...components were measured to trace Pb sources quantitatively.•Isotopic technology helps understand the migration of Pb during thermal treatment.
Emission of Pb is a significant environmental concern during solid waste incineration. To target Pb emission control strategies effectively, the major sources of Pb in the waste incineration byproducts must be traced and quantified. However, identifying the migration of Pb in each waste component is difficult because of the heterogeneity of the waste. This study used a laboratory-scale incinerator to simulate the incineration of municipal solid waste (MSW). The Pb isotope ratios of the major waste components (207Pb/206Pb=0.8550–0.8627 and 208Pb/206Pb=2.0957–2.1131) and their incineration byproducts were measured to trace sources and quantify the Pb contribution of each component to incineration byproducts. As the proportions of food waste (FW), newspaper (NP), and polyethylene bag (PE) in the artificial MSW changed, the contribution ratios of FW and PE to Pb in fly ash changed accordingly, ranging from 31.2% to 50.6% and from 35.0% to 41.8%, respectively. The replacement of PE by PVC significantly increased the partitioning and migration ratio of Pb. The use of Pb isotope ratios as a quantitative tool for tracing Pb from raw waste to incineration byproducts is a feasible means for improving Pb pollution control.
Lead migration after spinal cord stimulator (SCS) implant is a commonly reported complication and the most common reason for revision surgery in cases of loss of efficacy. The primary aims of this ...study are to describe the incidence and degree of lead migration in the subacute postoperative period after SCS implant and to report potential risk factors for lead migration.
We performed a retrospective chart review of all patients at a single academic center who received an SCS implant from January 1, 2020, to December 31, 2020. Information on patient (age, sex, weight, and height) and operative factors (device manufacturer, epidural access level and method, and implantable pulse generator location) were extracted from medical records. Intraoperative imaging was compared to subacute follow-up imaging obtained less than 20 days postimplant to measure lead migration distance. Regression models were fitted to determine associations between lead migration distance and potential clinical risk factors.
A total of 91 cases (182 leads) were included in the study. Within 20 days of implantation, 88.5% of leads had migrated (86.3% caudal and 2.2% cephalad). Mean migration distance for leads with caudal migration only was 12.34 ± 12.19 mm based on anteroposterior radiographs and 16.95 ± 15.68 mm on lateral radiographs. There was an association of greater caudal lead migration as patient body mass index increased (β-coefficient 0.07 95% confidence interval 0.01-0.13, p = 0.031). Within the entire cohort, one patient (1.1%) required lead revision for loss of efficacy.
In the subacute postoperative period after SCS implant, the majority of SCS leads migrated caudally with an average of two lead contacts. Knowledge of this expected migration and risk factors can better inform implanting physicians intraoperatively when deciding final lead placement location. The finding of high likelihood of caudal lead migration in the subacute postoperative period brings the need for a well-designed prospective study to the forefront of our field. This will allow implanting providers to make well-informed decisions for intraoperative lead placement.
Spinal cord stimulation is an important therapy option for the treatment of chronic neuropathic pain of spinal or peripheral etiology. As with any implantable device, complications may arise. These ...must be promptly identified and managed to maintain patients in successful therapy.
We report an unusual case of cephalad and extraspinal lead migration requiring surgical intervention in order to salvage therapy.
Lead migration is one of the most common complications of spinal cord stimulation, and left untreated can lead to loss of therapy and possible device explant. A strategy for correcting this issue is needed, and we present an unusual case to consider when faced with a loss of therapy from lead migration.
Objectives
Upper airway stimulation (UAS) is an effective treatment for patients with obstructive sleep apnea. The device consists of a stimulating electrode, an internal pulse generator, and a ...respiratory sensing lead. The purpose of this study is to characterize the incidence of sensing lead malfunction necessitating revision surgery in a high‐volume center in conjunction with a review of the FDA Manufacturer and User Facility Device Experience (MAUDE) database reports on adverse events associated with the sensing lead component.
Methods
Patients age ≥18 implanted with the device were reviewed between July 2017 and June 2022. Those determined to have sensing lead malfunction were analyzed. The FDA MAUDE database was reviewed for reports associated with “Inspire Model 4323 Respiratory” and “Inspire Model 4340 Respiratory” between January 2014 and September 2022.
Results
One hundred ninety patients underwent UAS at our institution during the study period and four (2.1%) patients were found to have sensing lead malfunction. Analysis of the MAUDE database revealed 122 reports of adverse events associated with the sensing lead component, with 72% (88/122) of these requiring revision surgery. The most frequently reported adverse event was sensing lead tip separation from lead body, noted in 46% of these reports (56/122).
Conclusion
The functionality of the sensing lead component is vital to the integrity of the UAS device and is measurable through waveform analysis. To provide optimal care after device implantation, it is essential to have a comprehensive understanding of the scenarios in which this component fails, the incidence of such events, and appropriate management.
Level of Evidence
4 Laryngoscope, 134:1479–1484, 2024
This study investigates the incidence of sensing lead malfunction with the Inspire device for obstructive sleep apnea, utilizing a retrospective review of 190 patients from a single institution as well as reviews adverse events associated with the sensing lead component via an analysis of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. Results indicate a 2.1% rate of sensing lead malfunction, with cases demonstrating internal component issues and sensing lead tip separation. Such malfunctions put patients at risk for migration of the isolated tip, emphasizing the importance of understanding failure scenarios for optimal patient management.
Lead Migration in Neuromodulation Mollica, Semira; Awad, Mohammed; Teddy, Peter J.
Journal of clinical neuroscience,
August 2021, 2021-08-00, 20210801, Letnik:
90
Journal Article
Recenzirano
•Lead migration in neuromodulation is common complication.•A simple technique of securing leads.•Lead securing can significantly decrease the occurrence of lead migration.
We describe a simple ...technique of securing surgically implanted leads for spinal cord (SCS), dorsal root ganglion (DRG) and occipital nerve stimulation (ONS), for both primary surgical implantation and correcting lead migration. This technique could also be adapted for securing percutaneously implanted leads. Thirty-nine patients underwent neurosurgical implantation of SCS, DRG, and ONS devices utilizing titanium mini-plates to obtain secure anchorage of leads to adjacent laminae close to their exit point from the epidural space, thereby minimizing the risk of further lead migration or electrode displacement. There were no cases of primary or recurrent lead migration in any patient undergoing lead placement using mini-plate anchorage. The technique appears to offer a reliable means of preventing post-operative lead migration in a variety of spinal and extra-cranial neuromodulation implants.
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