Faculty Bibliography

PURPOSE: To assess the retrievability of the G2 inferior vena cava (IVC) filter and factors influencing the safety and technical success of retrieval. MATERIALS AND METHODS: From October 2006 through June 2008, G2 IVC filters were placed in 140 consecutive patients who needed prophylaxis against pulmonary embolism (PE). General indications for filter placement included history of thromboembolic disease (n = 98) and high risk for PE (n = 42); specific indications included contraindication to anticoagulation (n = 120), prophylaxis in addition to anticoagulation (n = 16), and failure of anticoagulation (n = 4). Filter dwell time, technical success of filter retrieval, and complications related to placement or retrieval were retrospectively evaluated in patients who underwent filter removal. RESULTS: Twenty-seven attempts at G2 filter removal were made in 26 patients (12 men; age range, 24-88 years; mean age, 55.4 y) after a mean period of 122 days (range, 11-260 d). Data were collected retrospectively with institutional review board approval. Filter removal was successful in all 27 attempts (100%). Tilting of the filter (> or =15 degrees ) occurred in five cases (18.5%), with probable filter incorporation into the right lateral wall of the IVC in one. Other complications of retrieval such as filter thrombosis, significant filter migration, filter fracture, and caval occlusion were not observed. CONCLUSIONS: G2 IVC filter retrieval has a high technical success rate and a low complication rate. Technical success appears to be unaffected by the dwell time within the reported range

This study was undertaken to evaluate the safety and efficacy of retrievable inferior vena cava filters in high-risk orthopaedic patients. A total of 58 patients had a retrievable inferior vena cava filter placed as an adjunct to chemical and mechanical prophylaxis, most commonly for a history of previous deep-vein thrombosis or pulmonary embolism, polytrauma, or expected prolonged immobilisation. In total 56 patients (96.6%) had an uncomplicated post-operative course. Two patients (3.4%) died in the peri-operative period for unrelated reasons. Of the 56 surviving patients, 50 (89%) were available for follow-up. A total of 32 filters (64%) were removed without complication at a mean of 37.8 days (4 to 238) after placement. There were four filters (8%) which were retained because of thrombosis at the filter site, and four (8%) were retained because of incorporation of the filter into the wall of the inferior vena cava. In ten cases (20%) the retrievable filter was left in place to continue as primary prophylaxis. No patient had post-removal thromboembolic complications. A retrievable inferior vena cava filter, as an adjunct to chemical and mechanical prophylaxis, was a safe and effective means of reducing the acute risk of pulmonary embolism in this high-risk group of patients. Although most filters were removed without complications, thereby avoiding the long-term complications that have plagued permanent indwelling filters, a relatively high percentage of filters had to be left in situ

STUDY OBJECTIVES: To investigate the characteristics of tuberculosis infection in diabetic patients at Bellevue Hospital. DESIGN: We conducted a case-control study retrospectively reviewing the records of patients at Bellevue Hospital Center from 1987 to 1997 with a discharge diagnosis of tuberculosis and diabetes mellitus. SETTING: Bellevue Hospital Center is a 1,200-bed, inner-city municipal hospital located in the Lower East Side of New York City. PATIENTS: Fifty-three identified patients had verified tuberculosis infection and diabetes; of these, 50 charts were available for review. One hundred five control cases were selected from nondiabetic patients with a discharge diagnosis of tuberculosis during the same time period. MEASUREMENTS AND RESULTS: Thirty-six percent (18 cases) of the patients with diabetes and tuberculosis had multidrug-resistant tuberculosis (MDR-TB) compared to only 10% (10 cases) in the control group (p < 0.01) Controlling for homelessness, HIV status, and directly observed therapy, the relative risk of MDR-TB was calculated to be 8.6 (confidence interval, 3.1 to 23.6) in the diabetic group compared to the control group. CONCLUSIONS: There was a significant association between diabetes and MDR-TB. Diabetes continues to be a risk factor for tuberculosis and was associated with MDR-TB in our patients