Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective.

There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.

Nuss bar migrations: occurrence and classification.

BACKGROUND: Pectus excavatum results from dorsal deviation of the sternum causing narrowing of the anterior-posterior diameter of the chest. It can result in significant cosmetic deformities and cardiopulmonary compromise if severe. The Nuss procedure is a minimally invasive technique that involves placing a thin horizontally oriented metal bar below the dorsal sternal apex for correction of the pectus deformity. OBJECTIVE: To identify the frequency and types of Nuss bar migrations, to present a new categorization of bar migrations, and to present examples of true migrations and pseudomigrations. MATERIALS AND METHODS: We retrospectively reviewed the electronic medical records and all pertinent radiologic studies of 311 pediatric patients who underwent a Nuss procedure. We evaluated the frequency and type of bar migrations. RESULTS: Bar migration was demonstrated in 23 of 311 patients (7%) and occurred within a mean period of 26 days after surgery. Bar migrations were subjectively defined as deviation of the bar from the position demonstrated on the immediate postoperative radiographs and categorized as superior, inferior, rotation, lateral or flipped using a new classification system. Sixteen of the 23 migrations required re-operation. CONCLUSION: Nuss bar migration can be diagnosed with careful evaluation of serial radiographs. Nuss bar migration has a wide variety of appearances and requires exclusion of pseudomigration resulting from changes in patient positioning between radiologic examinations.

Migration of retrievable expandable metallic stents inserted for malignant esophageal strictures: incidence, management, and prognostic factors in 332 patients.

OBJECTIVE: The purpose of this study was to evaluate the incidence, prognostic factors, and secondary management of stent migration in patients with malignant esophageal strictures. MATERIALS AND METHODS: A retrospective study was performed in a single tertiary referral university hospital to identify the incidence, management, and prognostic factors for stent migration in 332 consecutive patients with placement of a retrievable expandable metallic stent. Stent migration was classified into four patterns as locations of a migrated stent: pattern I, partially migrated in the proximal direction; pattern II, partially migrated in the distal direction; pattern III, completely migrated into the stomach; and pattern IV, completely migrated into the bowel. RESULTS: Stent migration occurred in 42 (12.6%) of 332 patients. Migration was partial (n = 21) or complete (n = 21), and nine (21%), 12 (29%), 11 (26%), and 10 (24%) patients had patterns I, II, III, and IV, respectively. Multivariate analysis identified the following prognostic factors: esophagogastric junction strictures caused by cancer of the gastric cardia (odds ratio 1.330; p = 0.004), patients who underwent anticancer treatment after stent placement (17.514; p < 0.001), and patients with a longer survival time (1.994; p < 0.001). Secondary management was needed for 33 of 42 patients. The strictures in the remaining nine patients improved throughout follow-up. CONCLUSION: Stent migration occurs most commonly in patients with cancer of the gastric cardia, patients with longer survival time, and those who underwent anticancer treatment after stent placement. Stent migration is successfully managed by further intervention. Accurate knowledge of the pattern of stent migration is important for successful management.

[Buried bumper syndrome: A new classification and therapy algorithm]. / Buried-bumper-Syndrom : Eine neue Klassifikation mit Therapiealgorithmus.

BACKGROUND: Buried bumper syndrome (BBS) is a severe complication of percutaneous endoscopic gastrostomy (PEG) based on the overgrowth of gastric mucosa over the inner bumper of a PEG and migration into the gastric or abdominal wall and with a highly variable incidence ranging between 0.9 and > 8 %. However, no classification has yet been described setting the extent of migration of the inner bumper in relation to therapy and the related risk, especially of perforation. OBJECTIVES: In the past 12 years 38 patients presented with BBS. Initially, an attempt was made to treat all BBS patients endoscopically. A structured BBS classification into four types for estimation of the therapy risk was developed. METHOD: BBS classification: IA: inner bumper partially extrakorporeal or subcutaneous with and without fistula; IB: inner bumper completely extrakorporeal, full thickness focal defect; II: partially visible inner bumper inside the stomach, good degree of mobility; IV: deep type., inner bumper not visible, mucosa without mobility. RESULTS: Up to August 2014, examiners with different degrees of experience classified and treated 17 BBS patients according to the algorithm described above (type IA n = 2, type IB n = 2, type II n = 3, type III n = 4 and type IV n = 6). Problem-free endoscopic therapy was possible in all of the patients in whom good mucosa mobilization with or without partial identification of the inner PEG bumper could be previously induced. CONCLUSION: The classification serves as an aid and takes both the therapist's experience and patient safety into consideration. In estimating the risk, it considers the following prevailing circumstances: More stringent obligation for patient information under the Patient Rights Act, with presentation of possibly necessary expansion of therapy; the obligation to cite relative alternative treatments; prior check of the resources available (specialist/surgery available yes/no).

Engasgamento em bebês após busca às cegas com os dedos / Infants choking following blind finger sweep

OBJETIVO: Em situações estressantes, as pessoas geralmente usam os dedos para retirar corpos estranhos de faringe da boca. Este artigo relata três casos de óbito de bebês após o uso dessa técnica. MÉTODOS: Um total de 26 casos de engasgamento causado por aspiração de corpos estranhos nas vias respiratórias superiores e inferiores envolvendo crianças menores de 11 anos submetidas a autopsia no Departamento de Medicina Forense da Universidade da Jordânia entre 1996 e 2006 foram revisados. RESULTADOS: O uso de busca às cegas com os dedos para retirar corpos estranhos de faringe foi relatado em três bebês durante o choro. Todas as crianças eram menores de 1 ano e haviam se engasgado com grãos-de-bico, uma bola de gude e um lápis curto. A diversidade, o tamanho, a forma, e a maciez da superfície são as principais características que fazem com que esses corpos estranhos sejam mais difíceis de ser removidos com os dedos e facilitam sua entrada via respiratória. CONCLUSÃO: Esses casos mostraram que a busca às cegas com os dedos na boca de bebês durante o choro não é somente uma manobra perigosa, mas também pode ser fatal.

OBJECTIVE: In stressful situations, people usually use finger sweep to remove pharyngeal foreign bodies from the mouth. This article reports on three cases of death of infants following the use of this technique. METHODS: A total of 26 cases of choking caused by foreign bodies aspiration in the upper and lower respiratory passages involving children younger than 11 years of age autopsied at the Forensic Department of University of Jordânia between 1996 and 2006 were reviewed. RESULTS: Blind finger sweep to remove pharyngeal foreign bodies were reported in three crying infants. All of these cases were younger than 1 year of age and choked on a chickpea, a marble and a short pencil. Diversity, size, shape and smoothness of the surface are the main characteristics that render the foreign bodies less easily caught by fingers and make them easily enter the respiratory passage. CONCLUSION: These cases showed that blind finger sweep in crying infants is not only dangerous but can be a fatal maneuver.

Infants choking following blind finger sweep.

OBJECTIVES: In stressful situations, people usually use finger sweep to remove pharyngeal foreign bodies from the mouth. This article reports on three cases of death of infants following the use of this technique. METHODS: A total of 26 cases of choking caused by foreign bodies aspiration in the upper and lower respiratory passages involving children younger than 11 years of age autopsied at the Forensic Department of University of Jordan between 1996 and 2006 were reviewed. RESULTS: Blind finger sweep to remove pharyngeal foreign bodies were reported in three crying infants. All of these cases were younger than 1 year of age and choked on a chickpea, a marble and a short pencil. Diversity, size, shape and smoothness of the surface are the main characteristics that render the foreign bodies less easily caught by fingers and make them easily enter the respiratory passage. CONCLUSIONS: These cases showed that blind finger sweep in crying infants is not only dangerous but can be a fatal maneuver.