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Biomedical subjects

Michael G Tal

Publications and source records attributed to Michael G Tal.

9 recordsLinked to original sources
PubMed2006

Comparison of side hole versus non side hole high flow hemodialysis catheters.

Current literature suggests that side holes may be detrimental to dialysis catheter performance. Today, these catheters are primarily available with side holes. The purpose of this study was to compare flow rates, infection rate, and survival of side hole vs. non side hole hemodialysis catheters. Over a 16-month period patients were arbitrarily assigned to either a 14.5 F MAHURKAR MAXID cuffed dual lumen tunneled catheter with side holes or a 14.5 F MAHURKAR MAXID cuffed dual lumen tunneled catheter without side holes ("non side hole catheters"). We performed a retrospective analysis of catheter flow rates, patency, catheter survival, and catheter-related infections. Information was gathered for the life of the catheter or up to 28 weeks. A total of 54 patients were enrolled in the study. Thirty-seven of 54 (68%) patients received a catheter with side holes for a total of 3,930 catheter days and 17/54 (32%) received a similar catheter without side holes for a total of 2,188 catheter days. Catheter infection necessitating removal of the catheter occurred in 10/37 catheters with side holes and 1/17 without side holes. Infection rates per 1,000 catheter days were 2.545 with side holes and 0.254 without side holes (p<0.001). Slightly improved catheter survival (p<0.05) was recorded with the non side hole catheters. No insertion complication (e.g., air embolization, bleeding, or kinking) occurred with either catheter. One catheter without side holes had to be repositioned 5 days after insertion because of poor flows. No significant difference was recorded in mean blood flow rates between the catheters. Results indicate reduced catheter infection rate in hemodialysis patients with the use of non side hole dual lumen tunneled cuffed catheters.

Catheters, Indwelling↗
PubMed2005

Comparison of recirculation percentage of the palindrome catheter and standard hemodialysis catheters in a swine model.

PURPOSE: The purpose of this study was to evaluate in vivo recirculation of a new bi-directional dialysis catheter with a symmetric tip design and compare it to currently marketed staggered and split tip catheters. MATERIALS AND METHODS: Twelve catheters were placed in three 70-kg male swine. The catheters were connected to a roller type peristaltic pump. Blood flow and recirculation rates were measured with ultrasound (US) dilution. Recirculation was measured in blood flow rates of 300 mL/min, 400 mL/min, and 500 mL/min. The dialysis lines were then reversed and recirculation was measured in flow rate of 400 mL/min. Measurements were conducted with the catheter tip in the right atrium (RA) and repeated with the catheter tip in the superior vena cava (SVC). RESULTS: Recirculation rates measured with the Palindrome catheter tip (Tyco Healthcare Group LP, Mansfield, MA) in the SVC and in the RA were 0%. When the dialysis lines were reversed, the Palindrome catheter average recirculation was 0% with the tip in the SVC and 1% (0%-3%) with the tip in the RA. The average recirculation rates measured with the split tip catheter were 1% (0%-10%) in the SVC and 0% when the catheter tip was in the RA. When the dialysis lines were reversed split tip catheter recirculation was 11% (9%-16%) with the tip in the SVC and 13% (7%-18%) with the tip in the RA. With the staggered tip catheter, 1% (0%-5%) recirculation was measured. When the dialysis lines were reversed, the average recirculation in the staggered tip catheter measured 23% (18%-30%). Recirculation rate with reversal of dialysis lines was significantly lower with the Palindrome catheter when compared to the split tip and staggered tip designs (P < .05). CONCLUSIONS: Preliminary results in vivo indicate that the Palindrome catheter demonstrates minimal recirculation with reversal of the dialysis lines compared to currently marketed split tip and staggered tip catheters.

Animals↗
PubMed2004

Pulmonary angiography for the diagnosis of thromboembolic events in the non-human primate.

BACKGROUND: Evaluating possible thromboembolic events in the non-human primate has traditionally required euthanasia, significantly limiting the ability to conduct longitudinal studies. We hypothesized that pulmonary angiography could offer a safe, reproducible, and non-lethal means to assess for pulmonary embolus in the non-human primate. METHODS: Eleven rhesus primates were studied using standard pulmonary angiography techniques. Five animals studied had previously received humanized anti-CD154 antibodies (associated with thromboembolism risk) in the context of skin transplantation 2 years before the angiography study. Four primates were studied after receiving mouse anti-human CD154 antibody following allogeneic islet or skin transplantation. RESULTS: Angiography was successful in all primates. We observed no complications, and all animals promptly recovered from the procedure. Angiographic findings consistent with thromboembolism were demonstrated in the three primates actively receiving anti-CD154 antibody and in one primate that last received anti-CD154 nearly 2 years before the study. The study was normal in both the streptozotocin-induced diabetic control animals. Histopathology of the lungs confirmed thrombus in two of the four primates, but no thromboembolus was identified in the other two. The first had limited pathologic evaluation without fine slices, and in the second (treated 2 years before with a humanized anti-CD154), ascariasis was found in the area identified as abnormal by the angiogram. CONCLUSIONS: Minimally invasive pulmonary angiography is a safe, reproducible, and inexpensive method to assess possible thromboembolic events in the non-human primate. This method may allow for the longitudinal assessment of non-human primates given novel agents that may promote thromboembolism.

Angiography, Digital Subtraction↗
PubMed2004

Induction of diabetes in nonhuman primates by means of temporary arterial embolization and selective arterial injection of streptozotocin.

PURPOSE: To develop and assess a technique for induction of C peptide-negative diabetes in adult nonhuman primates in preparation for preclinical investigation of type 1 diabetes treatments. MATERIALS AND METHODS: First, temporary embolization of the hepatic and gastric arteries was performed in 14 adult nonhuman primates (six cynomolgus, five rhesus, and three pigtail macaques). After embolization was confirmed with angiography, streptozotocin was injected at a dose of 50-70 mg/kg into the celiac artery and branches supplying the pancreas. The macaques then were given intravenous injections of arginine and glucose, and blood levels of insulin and C peptide were measured with an enzyme-linked immunosorbent assay to determine whether diabetes had been induced. RESULTS: All but one of the macaques developed persistent long-term C peptide-negative diabetes after the streptozotocin injection. One macaque did not develop diabetes after the initial injection and was given a second dose of streoptozotocin, which did induce diabetes. None of the macaques showed any symptoms of hepatic or renal injury, and only one died (of gastric dilatation 5 days after the procedure). CONCLUSION: Streptozotocin injection after temporary embolization of the hepatic and gastric arteries is a safe and reproducible method for inducing C peptide-negative diabetes in adult nonhuman primates in preparation for preclinical investigation of type 1 diabetes treatments.

Animals↗
PubMed2003

Right atrial migration and percutaneous retrieval of a Günther Tulip inferior vena cava filter.

This report describes a 67-year-old trauma victim in whom a retrievable Günther Tulip (Cook, Bloomington, IN) inferior vena cava filter was placed. The filter migrated to the right atrium immediately after placement. Initial attempts to retrieve the filter with Amplatz Goose Neck snares (Microvena, White Bear Lake, MN) were unsuccessful. A second attempt performed a week later with the addition of the new EnSnare (MDTech, Gainesville, FL) was successful. Possible causes of the migration are discussed and the difficulties encountered while removing this retrievable filter are described.

Aged↗
PubMed2003

Changing trends in gynecologists' opinions of uterine artery embolization for fibroids: the patient's perspective.

This study's purpose was to survey patients' perceptions of gynecologists' opinions of uterine artery embolization (UAE) for fibroids. Twenty-one women who underwent UAE between July 2000 and April 2002 and 21 women who underwent UAE between September 1998 and July 2000 completed questionnaires. Each woman was asked what her gynecologist's initial opinion was toward UAE, what treatment options were offered, who initiated discussion of UAE, and whether she returned to the same gynecologist after UAE. As of 2002, more gynecologists had a favorable opinion of UAE and were offering UAE versus in the year 2000. The majority of patients whose gynecologists initially opposed UAE did not return to the same gynecologists, reflecting a similar trend noted 2 years earlier.

Adult↗
PubMed2002

Vein of Galen technique for occluding the aneurysmal sac of pulmonary arteriovenous malformations.

In seven of 255 consecutive patients (2.7%) who underwent pulmonary arteriovenous malformation (PAVM) embolization at our center between July 1, 1996, and July 1, 2000, the feeding artery was considered too short for safe occlusion with use of standard stainless-steel coils or detachable balloons. These patients were successfully treated with use of a modified vein of Galen technique similar to the one used for managing intracranial vein of Galen aneurysms. In this article, the authors report their experience with this technique in safely occluding the aneurysmal sacs of PAVMs in patients with short (<2 cm) feeding pulmonary arteries.

Adult↗