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PubMed2001

Alternatives to unfractionated heparin for anticoagulation in cardiopulmonary bypass.

Despite the progress made in the development of cardiopulmonary bypass (CPB) equipment, systemic anticoagulation with unfractionated heparin and post-bypass neutralization with protamine are still used in most perfusion procedures. However, there are a number of situations where unfractionated heparin, protamine or both cannot be used for various reasons. Intolerance of protamine can be addressed with extracorporeal heparin removal devices, perfusion with (no) low systemic heparinization and, to some degree, by perfusion with alternative anticoagulants. Various alternative anticoagulation regimens have been used in cases of intolerance to unfractionated heparin, including extreme hemodilution, low molecular weight heparins, danaparoid, ancrod, r-hirudin, abciximab, tirofiban, argatroban and others. In the presence of heparin-induced thrombocytopenia (HIT) and thrombosis, the use of r-hirudin appears to be an acceptable solution which has been well studied. The main issue with r-hirudin is the difficulty in monitoring its activity during CPB, despite the fact that ecarin coagulation time assessment is now available. A more recent approach is based on selective blockage of platelet aggregation by means of monoclonal antibodies directed to GPIIb/IIIa receptors (abciximab) or the use of a GPIIb/IIIa inhibitor (tirofiban). An 80% blockage of the GPIIb/IIIa receptors and suppression of platelet aggregation to less than 20% allows the giving of unfractionated heparin and running CPB in a standard fashion despite HIT and thrombosis. Likewise, at the end of the procedure, unfractionated heparin is neutralized with protamine as usual and donor platelets are transfused if necessary. GPIIb/IIIa inhibitors are frequently used in interventional cardiology and, therefore, are available in most hospitals.

Abciximab↗

PubMed1991

Development and current status of a new intracorporeal membrane oxygenator (IVOX).

The IVOX (intravascular oxygenator) is an intracorporeal, hollow-fibre membrane oxygenator and carbon dioxide (CO 2) removal device. The IVOX is surgically placed into the vena cava via a femoral or jugular venotomy. Oxygen (O 2) is pulled through the hollow fibres by a vacuum pump controlled by a flow meter. There is no extracorporeal circulation of blood. Gas exchange occurs as the patient's blood flows over several hundred hollow fibres. Inlet and outlet gas conduits exit a small skin incision for inflow of 0 2 and outflow of CO 2. Studies in sheep show that the IVOX can support approximately 30% of gas exchange requirements. The position of the IVOX in the vena cava does not affect haemodynamics or cause thromboembolic complications. It can remain in place for up to 22 days without affecting haematologic or blood chemistry parameters. The IVOX is currently undergoing clinical trials at selected medical centres in patients with acute respiratory failure.

Animals↗

PubMed1987

The in vivo biodegradation of nylon 6 utilized in a particular IUD.

The particular IUD of this study was composed of a plastic shield and a nylon 6 coated filament tail string. This IUD was unique, in the fact that its tail string was the only one (and has been to date) that consisted of a coated multifilament arrangement. Studies on the tail string have revealed bacteria and debris existing between the outer filaments that are underneath the coating. Other studies have reported that removed devices were found to exhibit an unusually high incidence of breaks in the tail string coating. Studies at the University of Lowell also found that upon examination of devices that had been in vivo for periods of two years or longer, 67% of these devices examined had breaks in the coating of the tail string. Investigations have determined that the design of the tail string was serving as an avenue of transport for the bacteria to bypass the protective cervical mucus barrier and enter the sterile uterine cavity through the breaks in the tail string coating. This mechanism has been suggested to account for the higher frequency of uterine infections associated with this device. Research at the University of Lowell was undertaken to study the degradation of the nylon 6 coating and to determine the in vivo degradation mechanism. The biochemistry of the fluids present in the reproductive tract were carefully documented and the more aggressive ones selected for in vitro trials. The results of the study revealed that the in vivo physical breakdown of the coating may depend upon a series of mechanisms and variables.

Biodegradation, Environmental↗

PubMed2001

Treatment of unstable fractures of the forearm in children. Is plating of a single bone adequate?

Unstable fractures of the forearm in children present problems in management and in the indications for operative treatment. In children, unlike adults, the fractures nearly always unite, and up to 10 degrees of angulation is usually considered to be acceptable. If surgical intervention is required the usual practice in the UK is to plate both bones as in an adult. We studied, retrospectively, 32 unstable fractures of the forearm in children treated by compression plating. Group A (20 children) had conventional plating of both forearm bones and group B (12 children) had plating of the ulna only. The mean age was 11 years in both groups and 23 (71%) of the fractures were in the midshaft. In group B an acceptable position of the radius was regarded as less than 10 degrees of angulation in both anteroposterior (AP) and lateral planes, and with the bone ends hitched. This was achieved by closed means in all except two cases, which were therefore included in group A. Union was achieved in all patients, the mean time being 9.8 weeks in group A and 11.5 weeks in B. After a mean interval of at least 12 months, 14 children in group A and nine in group B had their fixation devices removed. We analysed the results after the initial operation in all 32 children. The 23 who had the plate removed were assessed at final review. The results were graded on the ability to undertake physical activities and an objective assessment of loss of rotation of the forearm. In group A, complications were noted in eight patients (40%) after fixation and in six (42%) in relation to removal of the radial plate. No complications occurred in group B. The final range of movement and radiological appearance were compared in the two groups. There was a greater loss of pronation than supination in both. There was, however, no limitation of function in any patient and no difference in the degree of rotational loss between the two groups. The mean radiological angulation in both was less than 10 degrees in both AP and lateral views, which was consistent with satisfactory function. The final outcome for 23 patients was excellent or good in 12 of 14 (90%) in group A, despite the complications, and in eight of nine in group B (90%). If reduction and fixation of the fracture of the ulna alone restores acceptable alignment of the radius in unstable fractures of the forearm, operation on the radius can be avoided.

Adolescent↗

PubMed1992

Patient maintenance of esthetic restorations.

There are probably as many ways to maintain esthetic restorations as there are restorations. After esthetic treatment is completed, schedule a mandatory postoperative appointment to make certain that whatever technique the patient uses is effective. At the postoperative visit, it should be apparent that the patient's tissue is healthy. If the tissue has not healed, some change in home care or additional periodontal or restorative treatment may be necessary. There are virtually hundreds, perhaps even thousands of home plaque removal devices. The ones mentioned here have worked for us and are therefore discussed. It isn't the type of device that is critical, however, but patient compliance. The described regimens have worked effectively for us in overcoming this obstacle of compliance. Appropriate recall visits with the hygienist should be made at one- to six-month intervals. In the final analysis, your success with esthetic restorations may well depend on your patients' success with esthetic maintenance.

Dental Devices, Home Care↗

PubMed2000

The effect of chlorhexidine mouthrinses on early bacterial colonization of guided tissue regeneration membranes. An in vivo study.

BACKGROUND: Different membrane materials accumulate varying amounts of bacteria when exposed in the oral cavity, due to their textural and structural surface characteristics. The aim of the study was to evaluate the effect of chlorhexidine mouthrinses on the in vivo early bacterial colonization of 3 different guided tissue regeneration membrane materials. METHODS: Rectangular-shaped strips cut from 3 periodontal membranes (expanded polytetrafluoroethylene, polyglactin 910, and polylactic acid) were glued to removable devices adapted to the 2 upper quadrants in 8 dental students. In each student 1 quadrant was randomly selected as test side while the other served as control side. The experiment was divided in 2 phases: in the first phase plaque accumulation was followed for 4 hours while the second accumulation was followed for 24 hours. During the 4-hour experiment, students rinsed the test device twice (immediately following device application and after 2 hours) with 0. 12% chlorhexidine solution. The control device was rinsed with saline. In the second phase, students rinsed the test device with chlorhexidine and the control devices with saline 3 times (after device application and at 8 and 16 hours). Both the 4-hour and the 24-hour specimens were processed for scanning electron microscopy analysis. Fifty-four fields (at 200x magnification) were randomly selected and analyzed on each strip. Magnification was increased to determine the presence and morphotype of bacteria. The presence or absence of bacteria was assessed in a binomial fashion: the field was bacteria-positive when bacteria constituted the deposits covering the membrane surface. The microscopic field was negative (bacteria-negative) when no bacteria were observed. Bacteria-positive fields showing rods and filaments as prevalent morphotypes were recorded as rod-positive fields. RESULTS: The results of data analysis suggest that bacterial contamination of membrane materials is significantly reduced by treatment with chlorhexidine. They also suggest that other variables affect plaque accumulation as well; i.e., the time allowed (4 versus 24 hours) and the different membrane materials. The interaction between these 2 variables is also highly significant, thereby indicating a different rate of plaque accumulation on different materials, irrespective of the treatment with chlorhexidine. CONCLUSIONS: It was concluded that chlorhexidine mouthrinses may be effective in reducing and delaying the early bacterial accumulation on membrane materials although they are not able to fully prevent it. Membrane surface characteristics seem to be a more critical factor than the use of chlorhexidine, in influencing bacterial adhesion and colonization of barrier materials.

Adult↗

PubMed1989

Conception rates and calving intervals after prostaglandin F2 alpha or prebreeding progesterone in dairy cows.

Two experiments were performed in two different herds to determine if utilizing prostaglandin F 2 alpha to induce estrus for first services would be effective in reducing the duration and variability of calving intervals. In Experiment 1, cows were assigned randomly as controls (n = 217) to be inseminated as they were detected in estrus (beginning d 42 to 53 postpartum depending on replicate) or treated with prostaglandin F2 alpha (n = 185). In Experiment 2, the same treatments were utilized, except control cows (n = 124) were inseminated at their first detected estrus after d 40 postpartum, and treated cows received either one injection of prostaglandin F2 alpha between d 54 and 63 (n = 116) or were given progesterone (via a progesterone-releasing intravaginal device) for 7 d, with the device removed 24 h after prostaglandin F2 alpha (n = 116). More cows were inseminated and pregnancy rates were higher within 5 d after treatment with prostaglandin F2 alpha, and interval from prostaglandin F2 alpha to first service was reduced compared with that of control cows. Duration and variation of calving intervals were unaffected in either experiment, despite the fact the elective waiting period was 6 to 23 d longer for treated cows than for controls. Prebreeding treatment with progesterone failed to improve conception rates, but the efficiency of estrous expression increased from 54% in prostaglandin F2 alpha-treated cows to 71% in those cows also receiving prebreeding progesterone. We conclude that prostaglandin F2 alpha was ineffective in improving reproductive performance of these herds under good herd management. However, prostaglandin F2 alpha offers the convenience of inseminating small groups of cows, controlling when breedings occur during the work week, and prolonging the elective waiting period without extending the calving interval.

Animals↗

PubMed2000

Diagnosis and management of infections involving implantable electrophysiologic cardiac devices.

BACKGROUND: Optimal treatment of infections related to implantable electrophysiologic cardiac devices is poorly defined. OBJECTIVE: To describe the clinical presentation, treatment, and outcome of patients with such infections. DESIGN: Retrospective case series. SETTING: The Cleveland Clinic Foundation, Cleveland, Ohio. PATIENTS: 123 patients with infections involving implantable cardiac electrophysiologic devices. MEASUREMENTS: Demographic characteristics, clinical manifestations, time to diagnosis, management, and outcome. RESULTS: 87 patients with permanent pacemakers and 36 patients with implantable cardioverter defibrillators had infections. The most common signs and symptoms were pocket erythema and local pain. The most common pathogens were coagulase-negative staphylococci (68%) and Staphylococcus aureus (23%). In 117 patients (95%), all equipment was extracted and antibiotic therapy lasted a median of 28 days. Operative mortality was zero. Follow-up showed crude mortality and relapse rates of 8% and 3%, respectively. CONCLUSION: For infections related to implantable electrophysiologic devices, complete device removal and antimicrobial therapy allow timely, successful reimplantation at a remote anatomic site without substantial risk for operative mortality or recurrent infection.

Adolescent↗

PubMed2002

[A new locking nail for proximal humerus fractures: the Telegraph nail, technique and preliminary results].

We present a new nail, the telegraph nail, designed for the treatment of proximal fractures of the humerus. This nail has a new locking system providing a self-stabilization of the cancelous screws inserted in small fragments. We discuss the surgical technique and present preliminary results. The anterolateral approach and nail insertion through the medial and well vascularized part of the cuff is described for simple fractures. With the cup and ball technique, this nail can also be used for complex fractures of the proximal humerus with three or four fragments and major displacement. With this method, the nail is inserted before reduction and locked in the distal humerus before fixation of the head and tuberosities around the head once the targeting device removed. We report results for the first 64 nails inserted in our unit during the first year (1998-1999). Outcome was assessed at 11 months mean follow-up using the Constant score. Outcome was favorable, including in patients with complex fractures involving 3 or 4 separate displaced fragments. Besides providing an anatomically stable reconstruction, the telegraph nail has the advantage of allowing early mobilization of the shoulder joint. This method is a useful alternative to prosthetic reconstruction for traumatic fractures of the proximal humerus.

Adolescent↗

PubMed2002

[Tolerance and acceptability of Norplant contraceptive devices].

OBJECTIVES: Norplant implants have been used for long-lasting contraception in Senegal since 1986. The purpose of this work was to assess tolerance and acceptability of the method among Senegalese women. MATERIAL AND METHODS: A prospective non-comparative study including 300 women was undertaken in the Obstetrics and Gynecology Clinic at the University Teaching Hospital A Le Dantec of Dakar between December 1986 and July 1991. Women meeting inclusion criteria were seen at 1 month, 3 months, and 6 months after insertion then every 6-month until device removal. RESULTS: The mean age of women was 31.3+/-5.45 years and mean parity was 4.7+/-2.45. Almost half of the women no longer desired pregnancy and 67.6% of the women who had not used contraceptive method the month before admission decided to use Norplant. During follow-up visits, 45.2% had menstrual side effects mainly amenorrhea 23.4% and irregular bleeding 12.5%. Non-menstrual side effects were local reactions at the implant site (19.9%). The other side effects were dizziness, asthenia, insomnia, anemia, and high blood pressure and weight change. Overall, 58.8% of the women kept their implants and had them removed after 5 years of use. The failure rate was 3.3+/-1.25. At the end of five years of use, satisfaction was 84.8% and nearly two-thirds of the women decided to recommend Norplant to a friend or relative or to use it again. CONCLUSION: Norplant is a method of choice among the range of contraceptive methods available in Senegal. Because of its advantages and its ease of use, Norplant could be a widely used method in Senegal.

Adolescent↗

PubMed1992

Corporeal reconstruction and prosthetic implantation for impotence associated with non-dilatable corporeal cavernosal fibrosis.

Thirty patients with severe cavernosal body fibrosis, secondary to various etiologies, underwent penile prosthetic implantation with cavernosal reconstruction using Gortex grafting material. The overall success rate was 70% (21 of 30 patients). Infection was the most significant postoperative complication and required device removal in 9 patients. This operative procedure was the only option these patients had in hope of restoration of erectile function for satisfactory sexual intercourse. We continue to recommend this procedure to the highly motivated, carefully selected patient.

Adult↗

PubMedDate not supplied

Rapid forced eruption: a case report and review of forced eruption techniques.

This article reviews the infrequently utilized treatment method of forced eruption and how it can serve as an alternative to the sacrifice of the natural root system. Forced eruption can preserve the natural root system and related periodontal architecture, resulting in years of additional service for the patient. It also can maintain adjacent tooth structure while retaining the option for future implant reconstruction. Given the reported success of forced eruption, the technique requires greater attention and increased application among dentists. A case of forced eruption in the anterior maxilla utilizing a removable device is described. An overview of forced eruption technique also is provided.

Adult↗

PubMed2005

Use of physical restraints in adult critical care: a bicultural study.

BACKGROUND: Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices. OBJECTIVES: To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway. METHODS: Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level. RESULTS: Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample. CONCLUSIONS: Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.

Adult↗

PubMed2005

Second generation of minimal invasive extracorporeal circuit: pilot study resting heart system.

Cardiopulmonary bypass (CPB) has evolved from a complex multifunctional system to the minimally invasive extracorporeal circuit (MIEC). Concerns currently exist regarding the technically demanding nature of off-pump coronary artery bypass (OPCAB) procedures, the quality of anastomosis associated with it, and the difficulty in achieving "complete revascularization." Recognizing these issues, the so-called mini-CPB concept has evolved in an effort to offer the perceived benefits of OPCAB with the technical advantages of CPB and at the same time minimize the adverse effects of full-scale CPB. The first generation of MIEC had an inherited risk of gas embolisms. Therefore, there was the introduction of the resting heart system (RHS), the main characteristic of which is the venous air removal device. The aim of this study was to describe our early experience, feasibility, and safety with this system to help others who are considering introducing this technique into their clinical practice. Using this system, we operated on 30 consecutive patients. Moderate hypothermia (33 degrees C) CPB and cold intermittent antegrade cardioplegia was used. No technical incidents were encountered. One death from multiorgan failure occurred in a patient operated on for a thoraco-abdominal aneurysm. Our own short-term experience with the RHS has been very favorable, and we will continue to explore this development in CPB technology.

Cardiopulmonary Bypass↗

PubMed1991

A new intravascular membrane oxygenator to augment blood gas transfer in patients with acute respiratory failure.

The IVOX (intravascular oxygenator) is an intracorporeal, hollow-fibre membrane oxygenator and carbon dioxide (CO2) removal device. The IVOX is surgically placed into the vena cava via a femoral or jugular venotomy. Oxygen (O2) is pulled through the hollow fibers by a vacuum pump controlled by a flow meter. There is no extracorporeal circulation of blood. Gas exchange occurs as the patient's blood flows over several hundred hollow fibers. Inlet and outlet gas conduits exit a small skin incision for inflow of O2 and outflow of CO2. Studies in sheep and humans show that the IVOX can support approximately 30% of gas exchange requirements. The position of the IVOX in the vena cava does not affect hemodynamics or cause thromboembolic complications. It can remain in place for up to 22 days without affecting hematologic or blood chemistry parameters. The IVOX is currently undergoing clinical trials at selected medical centers in patients with acute respiratory failure.

Adolescent↗

PubMed1990

[Methods of treatment of preschool children used in the orthodontics department, Institute of Stomatology, Medical Academy in Warsaw].

The reported analysis was based on 288 clinical cards of patients aged 2 to 6 years, admitted for treatment in the years 1980-1985. The greatest group was that of children aged 3 years (28%), followed by those aged 6 years (25%). Abnormalities from the group of distocclusion prevailed (28%), followed by teeth abnormalities (26%), and cross-bite (16%). In 165 cases functional apparatus was used initially, in 66 cases Schwarz or Adams plates, in 31 cases dental prostheses, and in 22 cases chin sling. Four cases were observed after removal of malocclusion cause. Besides treatment with removable devices myotherapy and spatula exercises were used.

Child↗

PubMed1986

How does the IUD influence subsequent fertility?

Analyzing the data of 649 women, 587 pregnancies and 502 deliveries after discontinuation of IUD use, the return of fertility was investigated in a retrospective study. The non-medicated, Szontágh-type device was removed for planned pregnancy in every case and after removal, the women did not use any kind of contraception until the first conception. Using the life table technique for calculation, the cumulative conception rate was 90.5 at the end of the first year after discontinuation of IUD use. The duration of IUD use did not influence the length of time that had elapsed until the first conception after removal, and the outcome of pregnancies was the same in the study and the local control group. The period of time between discontinuation and first conception did not influence the length of gestation and there were statistically no significant differences in the frequencies of abortion, immature or premature, and mature delivery among the pregnancies conceived in the first, second, third and fourth quarter of the year after removal. The frequency of malformations and the sex ratio of the newborns also were found to be the same in the study and the control group. The birthweight corresponded to that of the local standard values. It is stated that, as for the return of fertility, the Szontágh IUD fulfils the requirement established for all temporary contraceptive methods. After removing the device fertility was restored and no negative effects on conception, course and outcome of pregnancy were observed. In our opinion, the conclusions drawn from these results may apply to other inert IUDs, however, further investigation of the question with more cases and different types of IUD should be made.

Abortion, Spontaneous↗

PubMed1987

Use of an external skeletal fixation device and bone graft for arthrodesis of the metacarpophalangeal joint in horses.

Arthrodesis of the metacarpophalangeal joint was attempted in 9 adult horses, using a new external skeletal fixation device and autogenous cancellous bone graft. Four horses had excellent results, 2 horses had fair results, arthrodesis failed in 2 horses, and 1 horse fractured the third metacarpal bone. The advantages of the technique included minimal surgical trauma to the area of injury, immediate rigid fixation of the metacarpophalangeal joint, and access for treatment of soft-tissue lesions at the site of injury. Although pin loosening and pin-track infection were complications when the device was in place, all pin tracks healed without complications after device removal.

Animals↗