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PubMedDate not supplied

An evaluation of the effectiveness of four mechanical plaque-removal devices when used by a trained care-provider.

Many care-dependent elderly individuals live in nursing homes and must depend on nursing home aides for oral hygiene care. It is generally agreed that the level of oral hygiene care among care-dependent nursing home residents is less than optimal. Two reasons are time constraints and the difficulty involved in brushing other individuals' teeth. The identification of effective and efficient plaque-removal devices for use by care-providers should make it easier for nursing home aides to incorporate effective oral hygiene care into their daily routines. This pilot study was undertaken to determine the relative effectiveness of four plaque removal devices with different basic designs when used by a non-professional care-provider on 10 healthy volunteers. A brush with curved bristles on the lateral aspect of the brush head and short straight bristles in the center (Collis-curve) and an electric toothbrush with tufts that rotate reciprocally (Interplak) were the most effective, a conventional brush (Oral-B) was somewhat less effective, and a disposable foam brush (Abco) was least effective and similar to the prebrushing plaque score (baseline). All the volunteers reported that the Collis-curve was the most comfortable brush, and the care-provider reported that it was the easiest to use.

Adult↗
PubMedDate not supplied

Intravascular membrane oxygenator and carbon dioxide removal devices: a review of performance and improvements.

The first intravascular oxygenator and carbon dioxide (CO2) removal device (IVOX), conceived by Mortensen, was capable of removing 30% of CO2 production of an adult at normocapnia with a measurable reduction in ventilator requirements. Through studies of mathematical modeling, an ex vivo venovenous bypass circuit to model the human vena cava, animal models of severe smoke inhalation injury, and patients with acute respiratory failure, the practice of permissive hypercapnia has been established to enhance CO2 removal by IVOX. By allowing the blood pCO2 to rise gradually, the CO2 excretion by IVOX can be linearly increased in a 1:1 relationship. Experimental and clinical studies have shown that CO2 removal by IVOX can increase from 30 to 40 ml/min at a normal blood pCO2 to 80 to 90 ml/min at a pCO2 of 90 mm Hg. In addition, IVOX with permissive hypercapnia allows a significant reduction in minute ventilation and peak airway pressure. Active blood mixing to decrease the boundary layer resistance in the blood can significantly improve O2 transfer by up to 49% and CO2 removal by up to 35%. Design changes can also improve the performance of IVOX. Increased surface area with more fibers and enhanced mixing by increased fiber crimping in new prototypes of IVOX significantly increased CO2 removal. Other groups have used alternative designs to address the limited performance of intravascular gas exchange devices. With improved design and patient management, clinically meaningful gas exchange and reduction in mechanical ventilatory support may be achieved during treatment of severe respiratory failure.

Adult↗
PubMedDate not supplied

Use of an intravascular oxygenator/carbon dioxide removal device in an ovine smoke inhalation injury model.

The intravascular oxygenator/carbon dioxide removal device (IVOX) is a hollow fiber, implantable membrane oxygenator that lies in the vena cavae and is designed to augment gas exchange during acute respiratory failure. An ovine model of smoke inhalation injury (lethal dose for 50% of animals at 48 hr) was used in eight ewes to test the safety and efficacy of this device. The IVOX was placed in the vena cavae through a right internal jugular vein cut-down. A vacuum pump withdrew O2 through the hollow fiber membrane, and IVOX gas flow was measured with a flow meter. Outlet gas was analyzed for CO2 concentration. Changes in O2 exchange were calculated as changes in mixed venous O2 content with the IVOX on compared with the IVOX off, multiplied by the cardiac output. The IVOX did not significantly change cardiac output, mean arterial pressure, pulmonary artery pressure, or hemoglobin concentration measured every 6 hr for 48 hr. The maximum CO2 exchange averaged 40.2 +/- 10.5 ml CO2/min. The average change in oxygen exchange was 98.4 +/- 76.0 ml O2/min. Iliac vein injury from attempted IVOX placement without fluoroscopic guidance resulted in one death. The authors concluded that the IVOX was safe when properly inserted and provided approximately 25-30% of the gas exchange requirements in this model.

Animals↗
PubMed1998

Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device--an alternative to protamine.

OBJECTIVES: To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). DESIGN: A prospective study. SETTING: University research laboratory. SUBJECTS: Adult female swine (n=7). INTERVENTIONS: Female Yorkshire swine (n=7, 67.3+/-3.5 [SEM] kg) were subjected to 60 mins of right atrium-to-aortic, hypothermic (28 degrees C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual-lumen cannula which was connected to an HRD via extracorporeal circulation. Blood flow was drained at 1431.2+/-25.4 mL/min from the inferior vena cava, through the plasma separation chamber of the HRD (where heparin was bound to PLL), and reinfused into the right atrium. The HRD run time was determined by a previously established mathematical model of first-order exponential depletion. MEASUREMENTS AND MAIN RESULTS: Heart rate, mean arterial pressure, pulmonary arterial pressure, central venous pressure, kaolin and celite activated clotting time (ACT), activated partial thromboplastin time (APTT), heparin concentration, and plasma free hemoglobin were obtained before, during, and after the use of the HRD. Pre-CPB ACT was 167+/-89 secs (kaolin) and 99+/-7 secs (celite), and APTT was 34+/-5 secs. The HRD run time averaged 27.4 +/-1.5 mins targeted to remove 90% total body heparin. Use of the HRD was not associated with any adverse hemodynamic reactions or increases in plasma free hemoglobin. The heparin concentration immediately following CPB was 4.85+/-0.24 units/mL, with ACT >1000 secs and APTT >150 secs in all animals. During heparin removal, total body heparin content followed first-order exponential depletion kinetics. At the end of the HRD run, heparin concentration decreased to 0.51+/-0.09 units/mL, with kaolin ACT returning to 177+/-22 secs, celite ACT returning to 179+/-17 secs, and APTT returning to 27+/-3 secs (p > .05 vs. pre-CPB baseline for all variables). CONCLUSIONS: The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes in hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.

Adsorption↗
PubMed2006

Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen.

BACKGROUND: Increased menstrual bleeding and pain are the primary side effects that lead to early removal of the copper intrauterine device (IUD). Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) are proven treatments for such IUD-induced problems, but their effect on early IUD removal is unknown. METHODS: A total of 2019 first-time IUD users were recruited in Chile for this double-blind, randomized, placebo-controlled trial. Half of the participants were given ibuprofen and instructions to take 1200 mg daily during menses (for up to 5 days each cycle) for the first 6 months of IUD use. The other half were asked to take an identical appearing placebo in the same manner. The primary outcome was IUD removal within 12 months of insertion. RESULTS: A total of 1011 and 1008 women were randomly assigned to ibuprofen and placebo, respectively. During 12 months of observation, 190 had the device removed because of dysmenorrhoea and/or increased menstrual bleeding: 85 in the placebo group and 105 in the ibuprofen group. For ibuprofen users, the hazard ratio for removal for these IUD-induced side effects was 1.0 and 1.2 at 6 and 12 months, respectively (both not significant). CONCLUSION: Although increased menstrual bleeding and pain are common reasons for early IUD removal, prophylactic use of ibuprofen, at the dosage used here, does not reduce removal rates.

Adolescent↗
PubMed1982

Evaluation of the antimicrobial removal device when used with the BACTEC blood culture system.

A study to determine the value of the Antimicrobial Removal Device (ARD) used in conjunction with radiometric detection of bacteremia using three media was conducted. During a 12-month period, 622 duplicate ARD/BACTEC blood-culture sets were collected. There were 88 positive cultures that yielded 68 pathogenic isolates and 28 probable contaminant isolates. When all patients were considered, 31 pathogenic isolates were detected by both systems, 25 pathogenic isolates were detected faster or only by the BACTEC system, and 12 pathogenic isolates were detected faster or only when the ARD was employed. This difference is statistically significant (P less than 0.05). Thus, the standard BACTEC blood-culture system using three different media was superior to the same BACTEC system using ARD-processed blood specimens. When only patients receiving antimicrobial therapy were considered, there were more pathogenic isolates detected from unprocessed blood than from blood processed in the ARD; however, this difference was not statistically significant. In conclusion, there appears to be no advantage to using the ARD system in conjunction with the three-bottle BACTEC blood-culture system.

Adult↗
PubMed1984

Effectiveness of the antimicrobial removal device, BACTEC 16B medium, and thiol broth in neutralizing antibacterial activities of imipenem, norfloxacin, and related agents.

The Antimicrobial Removal Device (ARD), BACTEC 16B medium, and Thiol broth were evaluated for their effectiveness in reducing the activity of imipenem (IPM), cefoxitin, moxalactam, and ceftazidime in blood samples. In addition, the capability of the ARD and Thiol broth to bind norfloxacin and the ARD to bind oxolinic and nalidixic acids in urine samples was investigated. At the highest concentrations of the drugs tested (32 micrograms/ml for the four beta-lactams and 256 micrograms/ml for the three quinolinecarboxylic acids), there was at least a 95% reduction in the in vitro activity of each of the antibacterial agents for treated versus untreated samples. Of the compounds tested in the ARD system, the organic acids were more completely removed than were the beta-lactams. The Thiol broth was more effective than the ARD and the BACTEC 16B medium in inactivating imipenem, but it had no effect on the antibacterial activity of norfloxacin.

Anti-Bacterial Agents↗
PubMed1982

The antimicrobial removal device. A microbiological and clinical evaluation.

A parallel study of blood cultured conventionally and following processing in an Antimicrobial Removal Device (ARD) was conducted with patients suspected of being clinically bacteremic. Cultures yielded 205 isolates from 87 clinically bacteremic patients, of whom 28 were receiving antibiotics at the time their cultures were performed. Overall, ARD processing neither increased the isolation rate nor decreased the time interval required for detection of organisms compared with conventional processing. ARD processing was the only means of isolation of organisms from only seven of the 87 patients and three of the 28 receiving antibiotics, whereas conventional processing accounted for the only means of isolation of organisms from 17 of the 87 patients and nine of the 28 receiving antibiotics. ARD processing demonstrated no advantages over conventional processing of blood cultures.

Anti-Bacterial Agents↗
PubMed1984

[An evaluation of antimicrobial removal device to isolate bacteria from bacteremic patients with hematological disorders].

Antibiotics contained in blood specimens often inhibit bacterial growth in culture media. Recently, the antimicrobial removal device (ARD) containing resins to absorb antibiotics has been made available. To evaluate the effectiveness of the ARD, we investigated how much the antibiotics were removed by the ARD. The ARD method was compared to the conventional culturing method in isolating organisms from blood specimens of patients with hematological disorders receiving antimicrobial agents. The antibiotics, including cefotiam, cefsulodin, cefmenoxime, cefazolin and sulbenicillin, were proved to be almost completely removed by the ARD. Bacteria were detected only by use of the ARD in the blood cultures from 2 of 21 blood specimens (11 patients) entered in the study, while all of the blood cultures were negative by the conventional method. These isolated bacteria were S. aureus and P. aeruginosa, of which septicemias were cured by intensive antibiotic therapy for these bacteria. It is suggested that pretreatment with the ARD makes detection of bacteria easier in blood from the patients receiving antibiotics. Literatures were reviewed concerning improvement and shortened time for isolation of organisms by using the ARD.

Adult↗
PubMedDate not supplied

Efficacy of a heparin removal device in comparison with protamine after hypothermic cardiopulmonary bypass.

To reduce the risks of protamine reactions after cardiopulmonary bypass (CPB), a heparin removal device (HRD) with plasma separation and poly-L-lysine (PLL) affinity adsorption was developed. To compare the efficacy of HRD with that of protamine, blood coagulation variables were evaluated in a swine model of CPB. Female Yorkshire swine were randomly divided into the HRD group (n = 6, weight 79.7 +/- 7.0 kg) and the protamine group (n = 6, weight 79.3 +/- 6.8 kg), and subjected to 60 min of right atrium-to-aortic, hypothermic (28 degrees C) CPB. After weaning from CPB, the right atrium was recannulated with a two-stage, dual lumen cannula in the HRD group. Blood flow was drained from the inferior vena cava, through the plasma separation chamber of the HRD where heparin was bound to PLL, and re-infused into the right atrium. The HRD run time was determined by an established mathematical model of first-order exponential depletion targeted to 90% heparin removal. In the protamine group, protamine was given in a 100 U heparin to 1 mg protamine ratio after CPB in a slow intravenous infusion. Hemodynamics, activated clotting time (ACT), activated partial thromboplastin time (APTT), and heparin concentration were obtained before, every 5 min during, and after the use of the HRD or before and after protamine administration, and 1 and 3 hours after HRD or protamine. Heparin concentration immediately after CPB was 4.90 +/- 0.19 U/ml in the HRD group and 3.94 +/- 0.63 U/ml in the protamine group, respectively (p > 0.05 between groups). The ACT was 994 +/- 7 sec in the HRD group and 768 +/- 55 sec in the protamine group, and APTT was greater than 150 sec in both groups (p > 0.05 between groups). In the HRD group, the HRD run time was determined to be 31.5 +/- 2.4 min for the targeted 90% heparin removal, and the plasma heparin concentration followed first-order depletion kinetics. In the protamine group, the full dose of protamine was administered over 15 min. Immediately after the HRD run or protamine administration, plasma heparin concentration decreased to 0.48 +/- 0.09 U/ml in the HRD group and 0.13 +/- 0.02 U/ml in the protamine group (p < 0.01 between groups); likewise, ACT decreased to 188 +/- 25 sec in the HRD group and 101 +/- 5 in the protamine group (p < 0.01 between groups). The APTT was not significantly different between the groups at any time during the experiment. Plasma heparin concentration and ACT were not significantly different three hours after the HRD run or protamine administration. The authors conclude that the HRD is capable of predictable reversal of systemic heparinization after CPB, and is an alternative to achieve heparin clearance in subjects who may develop adverse reactions to protamine.

Animals↗
PubMed1984

Is the antimicrobial removal device a cost-effective addition to conventional blood cultures?

Two hundred and thirty-four blood cultures from 140 patients receiving antibiotics were processed using the antimicrobial removal device (ARD) in parallel with conventional blood cultures. One hundred and seventy cultures were obtained from patients suspected to have bacteraemia and 64 from patients known to have a positive conventional blood culture within the preceding three days. A total of 38 (16.2%) ARD-processed cultures were positive, compared with 21 (8.9%) conventional cultures (p less than 0.0001, Fisher's exact test). No instances of positive conventional cultures and negative ARD-processed cultures were identified. Thirty-three of 38 ARD-processed cultures became positive within 24 h, compared with 14 parallel conventional cultures (p less than 0.0001 Fisher's exact test). Although the yield and rapidity of isolation of bacteria from blood were improved by ARD processing, in only one of 140 patients did this information alter treatment. As the use of an ARD is associated with a sixfold increase in the cost of blood cultures, we conclude that, in our hands, general use of the device in patients receiving antibiotics is not cost-effective. Considerable care should be taken in selecting patients for ARD-processing of blood cultures.

Anti-Bacterial Agents↗
PubMed2002

Totally implanted venous access device removal in interventional radiology.

PURPOSE: To demonstrate that totally implanted venous access device (TIVAD) removal in the out-patient interventional radiology (IR) recovery room is safe and effective. MATERIALS AND METHODS: Fifty-seven TIVADs were removed in 56 patients using a standard cut-down technique. Forty-one devices (72%) in 40 patients without signs of pocket infection were closed with primary intention with sub-cuticular absorbable or simple non-absorbable sutures, depending on operator preference. All patients were followed up to assess for bleeding or infection. Sixteen devices (28%) in 16 patients with suspected pocket infection were allowed to heal by secondary intention. These patients were managed with antibiotics and dressing changes until healing was complete. Catheter tips were sent for culture and sensitivity. RESULTS: TIVADs were removed intact in all 57 cases. There were no cases of air embolism, uncontrolled hemorrhage, retained foreign body or catheter fragmentation. No bleeding or infectious complications were noted in those patients who were allowed to heal with primary intention. Wound closure was accomplished in all patients who were allowed to heal with primary or secondary intention. CONCLUSION: TIVAD removal in an out-patient recovery room by an interventional radiology team is safe and feasible, providing a possible alternative venue for this procedure.

Adult↗
PubMed1983

Improved recovery of microorganisms from patients receiving antibiotics with the antimicrobial removal device.

Three hundred thirty-seven paired sets of blood cultures and ten sets of body fluid cultures from patients receiving antimicrobials were processed simultaneously by conventional methods with and without the use of an antimicrobial removal device (ARD) over a 13-month period of time in order to compare recovery rates. Forty-two significant pathogens were recovered: 19 by ARD processing only, four by conventional testing only, and the remaining 19 by both methods of processing. (P less than 0.001). Seventeen patient samples contained antimicrobics not active against the blood isolate (mainly Candida albicans). There was no difference (P greater than 0.1) between ARD-assisted and conventional methods in rate (frequency of cultures that were ultimately positive) or rapidity of detection of these microorganisms. In 17 subjects receiving antimicrobials active, in vitro, against the isolated microorganism, use of the ARD displayed a superior rate of recovery compared with conventional processing (P less than 0.001) and more rapidly detected organisms found both with and without ARD processing (P less than 0.04). Contamination rate was 3.7% for use of ARD compared with 0.6% without ARD (P less than 0.01). The ARD is a useful addition to conventional blood culture processing when used in a population of patients already receiving antimicrobial agents.

Adult↗
PubMed2001

Safety and efficacy of a heparin removal device: a prospective randomized preclinical outcomes study.

BACKGROUND: Systemic protamine sulfate for heparin reversal after cardiopulmonary bypass (CPB) is associated with uncommon, but life-threatening adverse reactions. METHODS: In a prospective randomized 3-day outcomes study, a heparin removal device (HRD) group (n = 12; 60-, 80-, 100-kg subgroups) was compared with a matched systemic Protamine group (Protamine; n = 6) for safety and efficacy using an adult swine model of CPB (60 minutes, 28 degrees C). RESULTS: HRD run time was 25 to 38 minutes depending on weight without complications. After HRD, heparin concentration decreased from 4.77 +/- 0.17 to 0.45 +/- 0.06 U/mL (activated clotting time [ACT] 776 +/- 83 to 180 +/- 12 seconds), and in Protamine, 3.94 +/- 0.63 to 0.13 +/- 0.02 U/mL (ACT 694 +/- 132 to 101 +/- 5 seconds) (p = 0.01 between groups, but no significant differences 60 minutes later). No significant difference between HRD and Protamine to 72 hours was seen in plasma-free hemoglobin C3a, heparin concentration, thromboelastogram index, platelet count, activated partial thromboplastin time, anti-thrombin III, fibrinogen, ACT, and tissue histology. CONCLUSIONS: In a prospective randomized outcomes study, HRD achieved predictable reversal of systemic heparinization after CPB with no difference in safety or outcomes compared with protamine.

Adsorption↗
PubMed2000

Assembly of the Heparin Removal Device for patients with suspected adverse reaction to protamine sulphate.

Protamine sulphate is routinely used after cardiopulmonary bypass (CPB) to restore the patient's baseline coagulatory state. However, adverse reactions are encountered, and alternative means to neutralize heparin are, therefore, necessary. The Heparin Removal Device (HRD) constitutes an extracorporeal circuit that allows ex vivo deheparinization by mean of a polycationic ligand that binds heparin molecules. This paper presents the setup of the HRD circuit. It is illustrated by the report of a 68-year-old man with a known severe crustacean allergy. The patient (78 kg, 170 cm) was admitted for elective coronary artery bypass graft surgery. It was decided that the HRD would be used as a precaution in order to avoid the risks of using protamine sulphate. The CPB time and aortic crossclamp time were 70 and 40 min, respectively. At the end of CPB, the device was inserted and processing started. Activated coagulation time values were monitored over a 130 min period and diminished from 480 to 300 s after 45 min, 220 s after 90 min, and settled at 150 s. Haemostasis was acceptable and processing stopped. The operation was terminated and the patient transferred to the intensive care unit. Clinical evolution was excellent, with minimal postoperative bleeding. The HRD presents an alternative to protamine sulphate when this drug is contraindicated for a certain patient population who might have a suspected, known or emergency adverse reaction.

Aged↗
PubMed2006

Efficacy and safety of a low-flow veno-venous carbon dioxide removal device: results of an experimental study in adult sheep.

INTRODUCTION: Extracorporeal lung assist, an extreme resource in patients with acute respiratory failure (ARF), is expanding its indications since knowledge about ventilator-induced lung injury has increased and protective ventilation has become the standard in ARF. METHODS: A prospective study on seven adult sheep was conducted to quantify carbon dioxide (CO2) removal and evaluate the safety of an extracorporeal membrane gas exchanger placed in a veno-venous pump-driven bypass. Animals were anaesthetised, intubated, ventilated in order to reach hypercapnia, and then connected to the CO2 removal device. Five animals were treated for three hours, one for nine hours, and one for 12 hours. At the end of the experiment, general anaesthesia was discontinued and animals were extubated. All of them survived. RESULTS: No significant haemodynamic variations occurred during the experiment. Maintaining an extracorporeal blood flow of 300 ml/minute (4.5% to 5.3% of the mean cardiac output), a constant removal of arterial CO2, with an average reduction of 17% to 22%, was observed. Arterial partial pressure of carbon dioxide (PaCO2) returned to baseline after treatment discontinuation. No adverse events were observed. CONCLUSION: We obtained a significant reduction of PaCO2 using low blood flow rates, if compared with other techniques. Percutaneous venous access, simplicity of circuit, minimal anticoagulation requirements, blood flow rate, and haemodynamic impact of this device are more similar to renal replacement therapy than to common extracorporeal respiratory assistance, making it feasible not only in just a few dedicated centres but in a large number of intensive care units as well.

Aging↗
PubMed1985

Increased detection of staphylococcal bacteremia using an anti-microbial removal device.

During the period of August 16, 1981, through December 16, 1982, 15-mL blood culture specimens collected at the Seattle Veterans Administration Medical Center (SVAMC) were divided into two aliquots. The first 10-mL aliquot was inoculated directly into aerobic and anaerobic BACTEC (Johnston Laboratories, Towson, MD) vials (DIR); the remaining 5 mL was processed in an resin-containing Antimicrobial Removal Device (Marion Scientific, Kansas City, MO) before transfer to a second, identical set of aerobic and anaerobic vials (ARD). The final volume of inoculated blood from the ARD specimen was half that of the DIR specimen. Both sets of vials were processed using the BACTEC radiometric detection system. One hundred fifty specimen pairs grew 161 significant pathogens; 43 isolates were recovered only from the ARD sample, 39 only from the DIR samples, and 79 from both. Of the 35 isolates recovered from patients receiving anti-microbial agents active against the isolated pathogens, 21 were recovered only from the ARD specimen and 5 only from the DIR specimen (P less than 0.005). Of the 15 S. aureus strains isolated from patients on therapy, 12 were recovered only from the ARD specimen, 2 only from the DIR sample, and 1 from both samples (P less than 0.01). Ten of the 32 isolates of S. aureus recovered from antibiotic-free patients were found only in the ARD specimen and three only in the DIR specimen (P = 0.05). The ARD specimens recovered significantly more S. aureus from all patients regardless of antibiotic status.

Bacteriological Techniques↗
PubMed1995

Ultrasonographically guided intrauterine contraceptive device removal before chorionic villus sampling.

OBJECTIVE: Management of a retained intrauterine contraceptive device with no visible string during early pregnancy presents a dilemma. Because these devices are frequently used by multiparous women, it is not unusual that many women with retained devices are also of advanced maternal age. We describe our experience with ultrasonographically guided first-trimester retrieval of an intrauterine contraceptive device in conjunction with chorionic villus sampling. STUDY DESIGN: Patients with a first-trimester pregnancy and a retained intrauterine contraceptive device where no string was visible were offered ultrasonographically guided retrieval of the device. If the patient had genetic risks and desired prenatal diagnosis, chorionic villus sampling was offered at the same office visit. RESULTS: Six patients underwent intrauterine contraceptive device retrieval, under continuous ultrasonographic guidance, by use of an intrauterine contraceptive device hook. All patients had a posterior or fundal device. One patient had two in situ: a Lippes Loop (Ortho Pharmaceutical Corp., Raritan, N.J.) removed by its string and a Cu-7 (G.D. Searle & Co., Chicago) removed under ultrasonographic guidance. The remaining five patients had a Cu-7. Four of six patients had chorionic villus sampling performed immediately after the intrauterine contraceptive device removal and one patient had chorionic villus sampling 3 weeks later. There were two losses in our series: one after a lengthy procedure and one before documented viability. All infants were structurally normal and born at term. CONCLUSION: First-trimester ultrasonographically guided retrieval of a retained intrauterine contraceptive device may be safely performed in conjunction with chorionic villus sampling.

Adult↗