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Kurt Amplatz MD University of Minnesota Hospital and Clinics Minneapolis, MN presents

Nickel toxicity: what is the issue?. Soci

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Kurt Amplatz MD University of Minnesota Hospital and Clinics Minneapolis, MN presents

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    1. Kurt Amplatz MD University of Minnesota Hospital and Clinics Minneapolis, MN presents

    2. Nickel toxicity: what is the issue?

    3. Société Française de Cardiologie Conclusions: CardioSEAL 1. no nickel 2. less bulky 3. better endothelialization

    4. CardioSEAL metal

    5. Amplatzer® devices from Felix Berger MD

    6. Nickel allergy Nine percent of the population is allergic to nickel. However implantation of nickel-containing prostheses and devices virtually never causes problems.

    7. Allergy and nickel-containing implants Dear Dr. Amplatz, Many thanks for answering about percutaneous closure of ASD with the Amplatzer device in patients with allergy to nickel. As you know, I decided to perform the procedure in this young lady that presented with a cutaneous allergic reaction to nickel: The procedure was uneventful and at one month follow-up, no shunt was detected by Echo and she is doing fine…

    8. An essential element Nickel is an essential element for nutrition. Lack of nickel results in retarded body growth, anemia, and increased neonatal mortality in experimental animals.

    9. Toxicity Paracelsus (1493–1541): The factor determining whether a compound is toxic or not depends on the dose

    10. Intake of nickel Daily intake of nickel in the United States ranges from 300 to 600 micrograms per day. Most of the ingested nickel is excreted via feces, urine, bile, and sweat.

    11. Exposure to nickel Nickel-containing alloys used in: coins (quarters, nickels, euros) knives, forks, spoons, etc implants: wires, clips, coils, stents, nails, cava filters, prostheses, heart valves, pacemakers, etc

    12. Anodic corrosion test

    13. Explanted orthodontal arch wires

    14. Implanted Amplatzer devices

    15. Follow-up at 1 week

    16. Follow-up at 1, 14, and 18 months

    17. Cardioscopy of right disks

    18. Cardioscopy of the left disks and valves

    19. Explanted Amplatzer devices

    20. Human experience September 1995: first implant in a patient November 1998: device is intact and shows only total heart motion

    21. Nickel toxicity Nickel toxicity occurs exclusively in nickel refineries due to inhalation of nickel carbonyl, Ni(CO)4, being part of the Mond process.

    22. Explanted devices under light microscopy

    23. Explanted devices under scanning electromicroscopy

    24. Explanted devices at x3000 magnification

    25. Nickel corrosion in a biologic environment A corrosion of 10% would produce a huge crater at 3000 times magnification and the daily dose of nickel would have been 15.4 micrograms, 33 times less than the daily intake.

    26. Conclusion “In conclusion, the results reported here suggest that there is no reason to believe that Nitinol wires are any more subject to corrosion than stainless steel wires in an environment that is typical of clinical service.”

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