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At least 235 records · Page 13Linked to original sources
PubMed2006

Intravascular ultrasound identification of intraluminal embolic plaque material during carotid angioplasty with stenting.

INTRODUCTION: Carotid angioplasty with stenting (CAS) has evolved as a viable method for treating patients at high risk for carotid endarterectomy. Strokes complicating CAS are most commonly caused by the liberation and distal embolization of embolic material from plaque during the procedure. METHODS: CAS with distal embolic protection (DEP) was performed using the assistance of intravascular ultrasound (IVUS) in a 68-year-old man with asymptomatic carotid artery stenosis. Evaluation of the plaque pretreatment was performed using virtual histology software. IVUS evaluation was also performed after prestent angioplasty, stenting, and poststent angioplasty. RESULTS: Initial degree of angiographic stenosis was 78.9%. Final degree of stenosis was 15.7%. By IVUS, stenosis by minimum lumen diameter and minimum lumen area were 75.6% and 93.4% pretreatment, respectively, and 42.2% and 47.1% posttreatment, respectively. An intraluminal lesion was noted in the distal aspect of the stent after poststent angioplasty but before DEP device removal. Ultrasonographic characteristics of the intraluminal defect were consistent with ruptured plaque material. Angiographic runs failed to demonstrate the lesion. A repeat IVUS run performed approximately 10 min later failed to depict the lesion, suggesting that distal embolization had occurred. Embolic material was noticed in the DEP device after removal. The patient did not experience any ischemic neurological symptoms. CONCLUSIONS: IVUS can identify intraluminal plaque material, which may be a precursor for embolism and delayed ischemic events after CAS. IVUS may allow for treatment before distal embolization of plaque material. Virtual histology IVUS software may help to identify carotid lesions at higher risk for significant embolization during CAS.

Aged↗
PubMed1993

Outcome of removal of intrauterine devices with flexible hysteroscopy in early pregnancy.

Removal of intrauterine devices (IUDs) in early pregnancy, when the IUDs threads are not visible at the cervical canal and the patient wishes to continue her pregnancy, remains a problem. Thirty-three patients using IUDs with nonvisible filaments on examination underwent flexible hysteroscopy for retrieval of the devices and follow-up until delivery. In all cases, hysteroscopies were performed without cervical dilatation and anesthesia. In 30 patients, the devices were found within the uterine cavity, and 28 IUDs were removed. In the remaining 3 patients, no IUD was observed. Twenty-four healthy children have been born. Six other patients requested a dilatation and curettage (D & C) about 1-2 weeks later after successful IUD removal. In 2 women, examinations were done at 22 and 29 weeks antepartum, and these 2 patients were lost to follow up. Operative fiberoptic hysteroscopy is proposed as a useful and effective method of retrieval of IUDs in early pregnancy when the filaments of the IUD are absent.

Female↗
PubMed2004

Cerebral oximetry in out-of-hospital cardiac arrest: standard CPR rarely provides detectable hemoglobin-oxygen saturation to the frontal cortex.

Favorable neurological survival in out-of-hospital cardiac arrest (OOHCA) may be influenced by cerebral perfusion during resuscitation. Cerebral oximetry (COx) provides a portable, noninvasive, real-time index of cerebral perfusion that has not been studied in OOHCA. This study examined the feasibility of using COx to measure cerebral perfusion during OOHCA. As a secondary aim, we tested the hypothesis that cerebral perfusion, measured by COx, would decrease with hyperventilation. Subjects were patients with medical OOHCA. A physician responded to the scene of cardiac arrest calls and applied an INVOS 3000 COx probe (Somanetics) to the frontal skull. In a cross-over design, readings were recorded for 2 min while ventilation rate was maintained at 10/min, then for 2 min at 24/min. COx readings were recorded by the oximeter and manually by the investigator. Statistical analyses were done using a paired t-test. Sixteen subjects were enrolled, four had return of pulses. COx reliably detected cortical oxygenation in only one subject during cardiac arrest. None of 16 patients exhibited consistently detectable levels of oxygen during cardiac arrest. In three subjects with ROSC, readings increased with return of pulses and with increasing blood pressure. In a fourth subject the protocol was completed and the device removed, subsequently ROSC was noted and the device re-applied. No patient exhibited any change in oxygen levels with variation of ventilation rates during CPR. The use of cerebral oximetry during OOHCA is feasible. In our sample of OOHCA patients, cerebral perfusion is rarely detectable using an oximeter during CPR. Ventilation rate does not alter the oximeter readings. It is possible that the current standard mechanical method of cardiopulmonary resuscitation provides little or no cerebral oxygenation during OOHCA.

Cardiopulmonary Resuscitation↗
PubMed2002

Multicenter clinical trial results with the LifeSite hemodialysis access system.

BACKGROUND: The LifeSite Hemodialysis Access System is a subcutaneous access device designed to maximize blood flow while minimizing access-related complications. The purpose of this study was to compare the efficacy and safety of the LifeSite System to a similar but transcutaneous access device, the Tesio-Cath Hemodialysis Catheter. METHODS: The study was conducted in two phases. A multi-center randomized prospective design was utilized for the first phase (Phase 1) where thirty-four patients were enrolled in the Tesio-Cath group and 36 patients into the LifeSite group where 0.2% sodium oxychlorosene was used as an antimicrobial solution for the LifeSite. A nonrandomized, but otherwise identical, second phase of the study followed where a 70% isopropyl alcohol solution was utilized as the antimicrobial solution for 34 additional LifeSite patients (Phase 2). RESULTS: Device function was evaluated in Phase 1 of the trial. Actual blood flow (determined by ultrasound dilution) was greater in the LifeSite versus the Tesio-Cath group (358.7 vs. 331.8 mL/min, P < 0.001 for machine-indicated blood flow of 400 mL/min). Infection comparisons were performed for all three groups encompassing Phase 1 and 2 of the trial; Tesio-Catheter, LifeSite System with oxychlorosene, and LifeSite System with 70% isopropyl alcohol. Device-related infections were defined as systemic bacteremia without another obvious site of origin and exit site infections requiring systemic antibiotics or device removal. This revealed infection rates per 1000 device use days of 1.3 for the LifeSite alcohol group, 3.3 for the Tesio-Cath group, and 3.4 per for the LifeSite oxychlorosene group. There was no statistically significant difference in device related infection rates between the Tesio-Cath and the LifeSite oxychlorosene groups. There were significant differences in infection rate between LifeSite alcohol group and the other two groups (P < 0.05). Device thrombosis was defined by the need for instillation of thrombolytic agents to maintain blood flow>300 mL/min. There was no difference in the need for thrombolytic infusions between the LifeSite oxychlorosene group and the Tesio-Cath group (P = 0.1496); however, the LifeSite alcohol group required significantly fewer thrombolytic infusions than the Tesio-Cath group (P = 0.0295) to maintain adequate blood flow. Device survival at 6 months after stratification by diabetic status and adjusting for age was significantly better in the LifeSite alcohol group (89.9%) than in the LifeSite oxychlorosene group (64.8%, P = 0.0286) and in the Tesio-Cath (69.1%, P = 0.0292) group. CONCLUSIONS: The LifeSite Hemodialysis Access System, when used with 70% isopropyl alcohol as an antimicrobial solution, provides superior performance with a lower infection rate and better device survival than a standard cuffed tunneled hemodialysis catheter.

Adult↗
PubMed1995

Internal fixation (pedicle screw fixation) for fusions of the lumbar spine.

STUDY DESIGN: Literature review. OBJECTIVES: To illustrate the indications and potential complications of pedicle screw application in the lumbar spine. SUMMARY OF BACKGROUND DATA: Except for the treatment of severe spondylolisthesis (grades 3 and 4) at L5-S1, using autogenous bone graft and with device removal often fusion is obtained. Pedicle screw devices labeled for stabilizing the lumbar spine or correcting deformities in fusion procedures are currently considered Class III medical devices by the Food and Drug Administration, that is, investigational or experimental forms of spinal fixation. Recent clinical studies have attested to their usefulness and safety by qualified surgeons for selected surgical indications. METHODS: Literature synthesis. RESULTS: Segmental fixation increases the fusion rate and clinical success of indicated patients undergoing the procedure in lumbar spine operations, as it does in the treatment of fusion of long bone injuries, scoliosis, and other comparable surgeries. CONCLUSION: With this technology, surgeons can effectively reduce the pseudarthrosis rate, improve patient satisfaction and results of functional studies, and ultimately reduce the long-term cost to society as a result of effective initial posterior lumbar spine surgery.

Bone Screws↗
PubMed2004

Management of long-term catheter-related Brevibacterium bacteraemia.

Brevibacterium has been reported as a rare cause of implanted-device infection. In two cases of recurrent Brevibacterium casei bacteraemia associated with infection of surgically implanted intravascular devices, relapse occurred 2 and 5 months, respectively, after completion of therapy with vancomycin via the infected catheter. A second intravenous antibiotic therapy course by the antibiotic-lock technique led to bacteriological cure in one patient. Molecular typing results demonstrated that the recurrent bacteraemia was caused by the same strain. Implanted-device removal may be necessary, in addition to appropriate antibiotics, for successful management of such infections.

Actinomycetales Infections↗
PubMed1993

Synchronization of estrus in embryo transfer recipients after using a combination of PRID or CIDR-B plus PGF2alpha.

The use of CIDR-B or PRID in combination with prostaglandin F2alpha (PGF2alpha) for synchronizing estrus in embryo transfer recipients was evaluated in 2 experiments. In Experiment 1, virgin heifers (n=263) were synchronized using either a PRID (including estradiol benzoate capsule) or a CIDR-B in a combined program in which devices were inserted on Day 1, an injection of prostaglandin was given on Day 6, and devices were withdrawn on Day 7. The interval from device removal to the onset of estrus was significantly shorter for CIDR-B than for PRID-treated animals (50.44 vs 55.50 hours; P<0.003). The CIDR-B treatment resulted in a similar degree of synchrony to the PRID treatment (74.0 vs 70.4%; P=0.68). InExperiment 2, cows (n=95) and heifers (n=93) were allocated at random to be synchronized using a PRID (excluding estradiol benzoate capsule) plus PGF2alpha or a CIDR-B device plus PGF2alpha. The devices were inserted on Day 1, an injection of prostaglandin was given on Day 10 and the devices were removed on Day 12. Estrus was observed earlier following the CIDR-B treatment (43.50 vs 47.04 hours; P=0.01), but the degree of synchrony was similar (76.2 vs 76.3%; P>0.10) for the CIDR-B and PRID-treated animals. In both experiments, there were no significant differences in the proportions of animals observed in estrus, selected as embryo transfer recipients, or which achieved pregnancy consequent on embryo transfer between those synchronized using CIDR-B or PRID regimens. We conclude that the CIDR-B is a suitable device for synchronizing estrus in embryo transfer recipients.

Journal Article↗
PubMedDate not supplied

Intracorporeal CO2 removal and permissive hypercapnia to reduce airway pressure in acute respiratory failure. The theoretical basis for permissive hypercapnia with IVOX.

Initial studies have shown that the intravascular oxygenator and carbon dioxide removal device (IVOX, Cardiopulmonics, Inc., Salt Lake City, UT) removes approximately 30% of VCO2. After noting increased CO2 removal with increased venous CO2, we developed a conceptual analytical model based on data obtained from patients and laboratory experiments. Increasing the CO2 gradient across the hollow fiber membranes of IVOX increases the operating efficiency of the device. Using the patient management technique of permissive hypercapnia (limiting tidal volumes, respiratory rates, and airway pressures) serves to increase the CO2 gradient across the membrane. The conceptual analytical model predicts that a PaCO2 of 75-80 mm Hg is required to obtain a CO2 gradient that results in IVOX CO2 removal of approximately 90-100 ml CO2/min. This technique may allow a broader application of both permissive hypercapnia and IVOX in acute respiratory failure.

Acute Disease↗
PubMed2003

Activity of moxifloxacin in combination with vancomycin or teicoplanin against Staphylococcus aureus isolated from device-associated infections unresponsive to glycopeptide therapy.

We tested the in vitro bactericidal activity of moxifloxacin, a new 8-methoxyquinolone, alone and in combination with vancomycin or teicoplanin at different multiples of minimum inhibitory concentration (MIC) against 8 methicillin-ciprofloxacin-resistant Staphylococcus aureus (M-C-RSA) and 1 methicillin-ciprofloxacin susceptible S. aureus (M-C-SSA) recently isolated from device-associated infections unresponsive to or relapsing after glycopeptide therapy, despite device removal. MICs of vancomycin ranged from 1 to 4 microg/ml, MICs of teicoplanin ranged from 2 to 8 microg/ml; MICs of moxifloxacin were always 2 microg/ml against M-C-RSA isolates and 0.125 microg/ml against the M-C-SSA isolate. The 9 strains resulted tolerant when tested for vancomycin, teicoplanin, and moxifloxacin used alone at 2 x MIC. In all cases the combination of moxifloxacin and teicoplanin or vancomycin appeared to be bactericidal already at MIC concentration for glycopeptides plus 0.5 x MIC concentration for moxifloxacin. If these results are confirmed in vivo in animal experiments, the combination of moxifloxacin with glycopeptides might be useful for treating device-associated infections, and in preventing the frightening phenomenon of increasing MICs for glycopeptides.

Anti-Infective Agents↗
PubMed1996

A new adjustable temporary stent catheter for management of acute dissection during balloon angioplasty.

Acute coronary dissection remains a limitation of percutaneous transluminal coronary angioplasty. For the management of acute coronary dissection, a new adjustable temporary stent catheter that can be positioned to the lesion, deployed, and retrieved at a later stage was developed. This catheter has at its distal end a spiral stent that can be reduced and expanded in a controlled fashion by external manipulations. The adjustable temporary stent catheter was applied in three clinical cases with acute coronary dissection during balloon angioplasty. In all cases, the adjustable temporary stent catheter restored blood flow when it was expanded to the lesion for 60 min and this restoration was maintained after device removal. It is envisioned that this temporary stent device may prove a useful means for the treatment of acute coronary dissection during percutaneous transluminal coronary angioplasty.

Angina Pectoris↗
PubMedDate not supplied

Closure of atrial septal defects: is there still a place for surgery?

BACKGROUND: The purpose of this study is to assess the current management of atrial septal defect closure in an era of increasing feasibility of transcatheter device occlusion. METHODS: Atrial septal defect (ASD) closure was performed surgically through complete sternotomy in 165 patients (group 1) and through partial inferior sternotomy in 53 patients (group 2). Transcatheter device occlusion was achieved in 82 patients with only ASD type II and patent foramen ovale (group 3). RESULTS: Overall complications were minor and more frequent in group 1: 26.7% versus 13.2% in group 2 and 14.6% in group 3 (p = 0.04). Compared to complete sternotomy, a partial sternotomy led to less chest tube loss (7.1 +/- 2.9 versus 11.6 +/- 14.5 ml/kg) (p < 0.05) and less postoperative pericardial effusion (11.3% versus 13.5%)(p = 0.55). ASD closure was effective in 99.4% in group 1, 100% in group 2 but only in 86.6% in group 3 (p < 0.05). Two major complications of device implantation required early surgery: 1 femoral arteriovenous fistula and 1 device embolization. Hospital stay was significantly shorter in group 3, as well as in group 2 compared to group 1 (8.3 +/- 4.2 versus 5.9 +/- 1.1 versus 2.1 +/- 7.3 days) (p < 0.05). Midterm results were excellent, with only 1 non-cardiac death and 1 re-operation for residual shunt in group 1, and 1 device removal for thrombosis in group 3. CONCLUSION: Transcatheter device occlusion has become an established treatment for ASD closure, achieving optimal results in older children and adults with anatomically suited ASD type II and PFO. However, a partial inferior sternotomy offers a valuable and complementary operative approach for all ASD variants, maintaining the predictable success of surgery, with the obvious advantages of minimal access in terms of morbidity, cosmetics and hospital stay.

Adolescent↗
PubMed1998

Early bacterial accumulation on guided tissue regeneration membrane materials. An in vivo study.

The aim of the study was to compare the in vivo early bacterial plaque colonization of 3 different guided tissue regeneration (GTR) membrane materials using a morphological (scanning electron microscope) method. Rectangular-shaped strips were cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) and glued to the buccal aspect of removable acrylic devices, which were applied to the molar-premolar region of the upper quadrants in 8 dental students. Each device held 3 strips: one ePTFE, one polyglactin 910, and one polylactic acid. The surface roughness of each membrane material was measured by means of a laser profilometer. During a 24-hour period, the students had to refrain from any oral hygiene procedures and did not use chlorhexidine mouthrinses. In each subject, one device was removed after 4 hours and the other after 24 hours. After removal, the devices were placed in a 2.5% gluteraldehyde solution to fix the membranes, which were then processed for SEM analysis. Fifty-four microscopic fields (at 200x magnification) were randomly selected and analyzed in each strip. Magnification was increased to determine the presence of bacterial morphotypes. The presence or absence of bacteria was assessed in a binomial fashion. In such a system, the field was bacteria-positive when bacteria constituted the deposits covering the surface of the membrane. The microscopic field was considered bacteria-negative when no bacteria were present. Bacteria-positive fields showing rods and filaments as prevalent bacterial morphotypes were recorded as rod-positive fields. A different pattern of plaque accumulation was demonstrated on different membrane materials. The 4-hour results indicated a statistically significant difference (P = 0.008, ANOVA) in the proportion of bacteria-positive fields among the 3 membranes; a greater amount of bacteria was demonstrated on the ePTFE membrane compared to the other 2 membranes. At 24 hours, the difference in the proportion of bacteria-positive fields was statistically significant (P = 0.002, ANOVA); a lesser amount of bacterial plaque was present on the polylactic acid membrane compared to the ePTFE and polyglactin 910 membranes. No difference in the proportion of rod/bacteria-positive fields was demonstrated among the 3 membranes at either 4 or 24 hours. It was concluded that quantitative differences in early plaque accumulation on various membranes seem to be related to the textural and structural characteristics of the surface, which is not adequately represented by the surface Ra value measured with a profilometric instrument.

Absorbable Implants↗
PubMed1990

Excimer laser coronary angioplasty: American multicenter experience.

Second generation angioplasty devices remove rather than displace atherosclerotic plaque. For such devices to be useful they must be capable of addressing the major problems not solved by balloon catheters: difficult anatomy, abrupt reclosure, and restenosis. Laser angioplasty systems have proven difficult to adapt to treatment of coronary artery disease, because of heat generation, problems with perforation, and inflexibility of optical fibers. The AIS excimer laser coronary angioplasty system couples a 308 nm pulsed excimer laser to multifiber over-the-wire catheters of 1.3 mm, 1.6 mm, and 2.0 mm diameters. The laser's uniquely long pulse width (250 ns) allows delivery of higher energies through smaller fibers. Because the catheter system is front firing, risk of perforation is reduced. The Excimer Laser Coronary Angioplasty Registry involves six institutions investigating the AIS excimer system. This report deals with 255 lesions in the first 210 patients in the registry. The study cohort resembles a standard angioplasty population in terms of demographics, symptomatology, vessels dilated, and complications. Unlike a standard PTCA cohort, the ELCA patients had a higher prevalence of chronic total occlusions, calcified lesions, long lesions and diffuse disease. Both very distal lesions and those that had previously failed PTCA were successfully treated with ELCA. The laser was successful in 85% of cases, but adjunctive balloon angioplasty was required in the majority. There were no instances of perforation.

Adult↗
PubMed1998

A new device for selective removal of CD4+ T cells.

To control antigen (Ag)-specific immune cells is important in the treatment of autoimmune diseases. In particular, a direct solution may be obtained by controlling the CD4+ cell function that controls the immune response of autoimmune T cells. Thus, a technique to selectively remove CD4+ cells has been developed, based on the consideration that the immune system may possibly be modified by selectively removing the CD4+ cells by means of extracorporeal circulation. The currently developed device to selectively remove CD4+ cells uses a material made of nonwoven fabric with monoclonal antibodies immobilized on the surface. With this device, removal of only CD4+ cells from human mononuclear cells suspension can be accomplished. Moreover, CD4+ cells can be specifically removed from peripheral whole blood by direct perfusion. This review outlines a series of procedures for selective cell removal and the results of our research.

Animals↗
PubMed1996

Oestradiol potentiates a prolonged progesterone-induced suppression of LH release in ovariectomised cows.

Our working hypothesis was that the negative feedback effect of progesterone on LH secretion in ovariectomised cows is greatly enhanced by oestradiol when both hormones are administered intravaginally. Each of eight ovariectomised cows had a progesterone releasing device ('CIDR-1'; Eazi-breed CIDR-B. InterAg, Hamilton, New Zealand) inserted into the vagina for 3 days, followed by an injection of 1 mg oestradiol benzoate (ODB) in peanut oil 24 h after device removal. The timing of this injection was designated as Day 0. The CIDR-1 was reinserted concurrently with an injection of 0.4 mg ODB on Day 5. An additional device ('CIDR-2') was inserted 4 days later (Day 9). In four of the cows, an ODB capsule (CIDIROL), Douglas Pharmaceuticals. Auckland, New Zealand) was placed into a groove on the surface of CIDR-2 preceding insertion. CIDR-2 was withdrawn after 5 days (Day 14) and CIDR-1 was withdrawn 2 days later (Day 16). The treatment regimen was repeated in a cross-over design where each cow received CIDR-2 with or without an ODB capsule. Blood samples were collected at intervals of 15 min for a period of 16 h beginning 8 h before insertion of CIDR-2 to determine changes in LH secretion pattern, and then at intervals of 8 h until 48 h after removal of CIDR-1 to determine mean LH and steroid concentrations. Concentrations of progesterone in plasma reflected the effects of inserting and removing each CIDR device. The insertion of CIDR-2 elevated progesterone from 2.0 +/- 0.1 ng ml-1 to 4.9 +/- 0.1 ng ml-1 within 30 min (P < 0.01) and maintained levels > 3 ng ml-1. Withdrawal of CIDR-2 produced a new baseline level of 1.8 +/- 0.1 ng ml-1 within 4 h (P < 0.01). Concentrations of oestradiol-17 beta in plasma increased from a baseline of < 1 pg ml-1 to-a-maximum of 12.6 +/- 2.2 pg ml-1 at 22 h after insertion of an ODB capsule. Initial pulse frequency of LH (1.2 +/- 0.05 pulses h-1) and mean concentration of LH (1.6 +/- 0.1 ng ml-1) declined (P < 0.05) to 0.2 +/- 0.1 pulses h-1 and 0.5 +/- 0.1 ng ml-1 during the period from 2 to 8 h following insertion of CIDR-2. Mean concentrations recovered to pre-treatment levels (> 1 ng ml-1) within 48 h if CIDR-2 was inserted without an ODB capsule. In contrast, LH levels remained less than 0.7 ng ml-1 for 5 days following this form of ODB treatment. A subsequent increase in mean LH of 1.4 +/- 0.2 ng ml-1 (P < 0.05) was inversely synchronised with the precipitous decline in progesterone of 1.2 +/- 0.1 ng ml-1, following removal of CIDR-2. The inclusion of an ODB capsule with insertion of CIDR-2 reduced concentrations of FSH from 166 +/- 17 ng ml-1 to a new baseline of 105 +/- 16 ng ml-1 within 24 h (P < 0.05). In conclusion, an acute increase in progesterone induced a transient suppression of LH lasting less than 48 h. This suppression was prolonged to 5 days by the concurrent insertion of a capsule containing 10 mg ODB. The subsequent recovery of LH was coincident with the decline in progesterone following removal of CIDR-2.

Administration, Intravaginal↗