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PubMed2005

Trends in bariatric surgical procedures.

CONTEXT: The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity. OBJECTIVE: To examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States. DESIGN, SETTING, AND PATIENTS: The Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates. MAIN OUTCOME MEASURES: Trends in bariatric surgical procedures, patient characteristics, and complications. RESULTS: The estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002 (P<.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P<.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low. CONCLUSIONS: These findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.

Adult↗

PubMed2005

Procedural success and complications following percutaneous coronary interventions among Asians and Pacific Islanders.

BACKGROUND: Although Asians and Pacific Islanders (PI) make up the fastest growing ethnic group in the United States, little is known about the clinical characteristics, procedural success, and procedure-related complications of those who undergo percutaneous coronary interventions (PCI). HYPOTHESIS: This study investigated PCI procedural success and procedural complications among PI and Asian patients in comparison with Caucasians. METHODS: We examined clinical characteristics, procedural success (post-PCI lesion < 50%) and procedure-related complications (hemorrhage, renal failure, myocardial infarction, stroke, bypass surgery, death) for all patients undergoing PCI at our hospital from January 1999 to June 2003. RESULTS: Overall, 2,598 PCIs were performed--1,058 (39%) in Caucasians, 1,163 (43%) in Asians, and 377 (14%) in PIs. The mean age of PIs (59 +/- 11 years) was significantly lower than that of Caucasians (65 +/- 12 years) and Asians (66 +/- 12 years). The mean body mass index (26 +/- 5) of Asians was significantly lower, while that of PIs (31 +/- 7) was significantly higher than that of Caucasians (28 +/- 6). More Asians (33.3%) and PIs (40.5%) had diabetes mellitus than did Caucasians (19.9%). More Asians (71.6%) and PIs (76.1%) had hypertension than did Caucasians (61.9%). Renal failure was more prevalent in Asians and PIs (6.0 and 7.4%, respectively) than in Caucasians (3.8%). Other than a higher prevalence of disease involving the left anterior descending vessel in Asians (56.4%) compared with Caucasians (50.4%), angiographic features across the three races were similar. There was no significant difference in procedural success (approximately 94%) or procedure-related complications among Caucasians (6.4%), Asians (7.1%), and PIs (4.3%). CONCLUSION: Although PIs and Asians have a substantially higher burden of comorbidities than Caucasians, race does not appear to influence PCI procedural success or procedure-related complications.

Aged↗

PubMed2004

Hepatic delivery of particulates in the submicron range by a hydrodynamics-based procedure: implications for particulate gene delivery systems.

BACKGROUND: A large-volume intravenous (i.v.) injection of DNA, i.e. a hydrodynamics-based transfection procedure, is known to be an efficient and liver-specific method of in vivo gene delivery. However, little is available on an applicable particle size in the procedure. METHODS: We examined the effect of particle size on the hepatic delivery by the hydrodynamics-based procedure, using fluorescein isothiocyanate labeled polystyrene microspheres (MS) of 50, 200 or 500 nm in diameter. MS were injected intravenously to mice by a conventional (normal) or the hydrodynamics-based procedure and their degree of hepatic uptake was determined fluorometrically. RESULTS: For all sizes tested, the two procedures were similar in terms of the apparent degree of hepatic uptake, whereas the intrahepatic localization of MS was apparently different between the procedures as shown by an examination of frozen tissue sections. In mice with gadolinium chloride induced Kupffer cell blockade, the hepatic uptake of MS following the normal procedure was decreased while that of the hydrodynamics-based procedure was less affected. This phenomenon of enhanced hepatic delivery seemed to be more effective for larger particles. Confocal microscopic observation of hepatocyte suspensions indicated that part of the injected MS-50 was delivered intracellularly following the hydrodynamics-based procedure, whereas almost all the observed MS-200 and MS-500 were detected in the extracellular compartment or on the surface of the cells. This was supported by the fact that most of the injected MS existed pericellularly around the transgene-expressing cells. CONCLUSIONS: The hydrodynamics-based procedure facilitated extravasation and hepatic delivery of MS. Larger MS were more efficiently extravasated and trapped by the liver, whereas intracellular delivery hardly occurred with them.

Animals↗

PubMed1997

Is Adam worth more than Eve? The financial impact of gender bias in the federal reimbursement of gynecological procedures.

PURPOSE: On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVU). The RVU multiplied by a dollar conversion factor sets the reimbursement for all procedures covered by Medicare and many other private insurers. This study was undertaken to evaluate discrepancies in federal reimbursement for gender-specific procedures. METHODS: Using the December 1995 Federal Register and the regional Medicare conversion factor ($40.08/RVU), we compared the work RVU and total reimbursement of 24 groups of gender-specific surgical procedures. The groups were matched as carefully as possible so that the amount of work and level of difficulty would be similar, if not identical. Some examples of comparisons are as follows: biopsy of male vs female genitals, hysterectomy vs prostatectomy, staging for ovarian vs testicular cancer, and exenteration for cervical vs prostate cancer. RESULTS: In the 24 matched procedures, the male-specific procedures were reimbursed at a higher amount in 19 (79%) cases. The female-specific procedures were reimbursed at a higher amount in 3 (12%) cases (P = 0.004). There was no difference in reimbursement for two of the comparisons. Overall, we found that male-specific procedures are reimbursed at an amount which is 44% higher than female-specific procedures. Comparison of work RVU revealed that male-specific procedures were assigned higher values in 19 cases and, overall, male gender-related surgeries had work RVU that were 50% higher than female gender-related surgeries. CONCLUSION: There is significant gender bias against the Medicare reimbursement of female-specific services. This results in a lower net reimbursement for gynecologic procedures. In addition, since many private sector insurance carriers now use the resource-based relative value scale system, this gender bias is further potentiated.

Female↗

PubMed1997

Hartmann's procedure vs. abdominoperineal resection for palliation of advanced low rectal cancer.

UNLABELLED: In managing advanced low rectal adenocarcinomas in medically fit patients, surgical resection offers the best palliation. Tenesmus, bleeding per rectum, sacral pain, and sciatic pain are common complaints, which are not relieved by radiotherapy or fulguration. The most appropriate resection, however, remains controversial. Abdominoperineal resection is faster and simpler to perform but leaves behind a perineal wound with associated complications. Hartmann's procedure requires adequate mobilization below the tumor and may be technically more demanding but avoids a perineal wound. Therefore, an analysis of outcome in patients treated by Hartmann's procedure vs. abdominoperineal resection was made. METHOD: Fifty-four symptomatic patients with advanced rectal adenocarcinoma arising within a median of 5 (range, 4-8) cm from the anal verge treated between June 1989 and October 1995 were studied. Twenty-eight patients (17 males; mean age, 67.6 +/- 10.3 years) had Hartmann's procedure, and 26 patients (12 females; mean age, 68.8 +/- 8.3 years) were treated by abdominoperineal resection. Mean follow-up was 23.5 months (+/-17.5) and 18.6 months (+/-12.9) in Hartmann's procedure and abdominoperineal groups, respectively. RESULTS: Mean operative time was 138.4 +/- 26.7 minutes for Hartmann's procedure group and 124.6 +/- 27.1 minutes for the abdominoperineal resection group (P > 0.05; not significant). Postoperatively, Hartmann's procedure group started oral intake at a mean of 2.3 days, and stomas were functioning at a mean of 3.1 days compared with 2.6 days for oral intake and 3 days for stoma functioning in the abdominoperineal resection group. Hartmann's procedure group was ambulant after a mean of 2.4 days vs. a mean of 3.2 days in the abdominoperineal resection group. Postoperative abdominal wound infection occurred in 18 and 19 percent, respectively, in Hartmann's procedure and abdominoperineal resection groups. Forty-six percent of patients had perineal wound sepsis, and 38 percent had perineal wound pain in the abdominoperineal resection group. These complications were absent in Hartmann's procedure group. Postoperative stay was similar in both groups. CONCLUSION: We conclude that Hartmann's procedure offers superior palliation compared with abdominoperineal resection because it provides good symptomatic control without any perineal wound complications and pain.

Abdomen↗

PubMed1999

Initiation of ethanol self-administration in the rat using sucrose substitution in a sipper-tube procedure.

RATIONALE: The concepts of appetitive and consummatory behaviors provide a framework for examining ethanol-drinking behavior. However, traditional studies of ethanol self-administration using dipper procedures make separating the appetitive from the consummatory components difficult. OBJECTIVE: This study compared the ability to initiate ethanol self-administration using a new sipper-tube self-administration procedure with the older established sucrose-substitution initiation model that employed dipper presented reinforcement. The new model was developed to allow for an assessment of the appetitive and consummatory components in ethanol self-administration. METHODS: For the sipper-tube procedure, the rats were initiated to self-administer ethanol using a sucrose-substitution procedure that provided limited access to a sipper tube containing ethanol. This procedure required the completion of a fixed ratio requirement (FR4) in order to gain access to a sipper tube for 20 min. Initially, a 20% sucrose solution with no ethanol was provided in the sipper tube. Over sessions, the concentration of sucrose was reduced and the ethanol concentration increased, until 10% ethanol in water was the solution presented. A second group of animals was initiated to self-administer ethanol using the dipper-presentation procedure employed in our laboratory for many years. This group was used for comparison of the effectiveness of initiation in the sipper-tube procedure. RESULTS: Following initiation, the sipper-tube rats self-administered 10% ethanol in water with intakes averaging 0.75 g/kg during the 20-min drinking period. Increasing the ethanol concentrations as high as 20%, increased intakes as high as 1.5 g/kg. The ethanol intakes observed were similar to those obtained with the dipper initiation procedure but occurred in one-third of the time. CONCLUSIONS: The sipper-tube procedure employed here results in similar ethanol self-administration behavior as has been found with a dipper presentation procedure. More importantly, however, it allows for a separation of the appetitive and consummatory components of ethanol self-administration. This separation may prove useful for examining the strength of ethanol-seeking behaviors without the confound of increasing levels of ethanol interacting with the appetitive seeking behaviors.

Alcohol Drinking↗

PubMed2003

Comparison of three sequential extraction procedures used to study trace metal distribution in an acidic sandy soil.

On an acid sandy soil contaminated with trace metals (Fe, Mn, Cu, Pb and Zn), three sequential extraction procedures were compared to determine the efficiency of the reagents used and the effects of the step order on the fractionation of metal species. In all cases, a magnesium nitrate solution (MgNIT) was previously used to extract exchangeable forms. In the first procedure (I), the next extraction step was performed with sodium acetate buffer (NaOAc), as used on calcareous soils, to dissolve active calcium carbonate. Then trace metals bound to different forms of oxi-hydroxides (NH(2)OH, TAMOx and TAMAs fractions) were extracted before organic matter/sulfide oxidation with hydrogen peroxide at pH 2.0 in nitric acid medium (OMHyd). Finally, residual bound metals (RESID) in each procedure were extracted with a nitric-hydrofluoric-perchloric acid mixture. The second procedure (II) was the same as I, but without the NaOAc step, because of the absence of carbonate in the study soil. In procedure III, the NaOAc step was omitted and the oxidizable organic/sulfide fraction was extracted with sodium hypochlorite at pH 8.5 (OMOCl) before the reducible fractions. This study first showed that NaOAc may remove considerable amounts of metals (especially Mn and Zn) in other forms than exchangeable ones. Procedures II and III give similar results for Fe, Mn and Zn forms, which were mainly found in fractions of inorganic soil components, but not for Cu and Pb. Copper distribution was affected by the position of the oxidation step in the sequence. In procedure II, where the oxidation step (OMHyd) ended the sequence, Cu was mainly recovered in the TAMOx fraction. However, in procedure III, where the oxidation step (OMOCl) preceded the NH(2)OH, TAMOx and TAMAs steps, Cu was found in both OMOCl and TAMOx fractions. Lead distribution varied with oxidation reagent: it was partly removed in the OMHyd fraction of procedures I and II, and to a much lower extent in the OMOCl fraction of procedure III, probably due to the alkaline pH of the reagent in the latter case.

Acids↗

PubMed1999

Comparison of results of laparoscopic and open antegrade continence enema procedures.

Several modifications of the Malone antegrade continence enema (ACE) procedure have now been reported. In this study we have compared the results of our experience with the laparoscopic appendicostomy (LACE procedure) with the published results of previously described open ACE procedures. Children who had the LACE procedure at our institutions were reviewed. Intra- and postoperative problems were identified by review of hospital case notes and from a questionnaire completed by the children's caregivers. These results were compared with the reported results of the original Malone procedure, the Peña modification, and the open appendicostomy as described by Wilcox. Since 1994, 30 children have had LACE procedures performed at our institutions. Two have required conversion to an open procedure because of difficulty locating the appendix. The stoma is being used for regular antegrade colonic washouts in 29 of the 30, compared with 19 of 31 in Malone's series and 16 of 20 in Peña's. Improvement in soiling has been achieved in 27 (90%) of our patients, 15 of whom are completely clean, a rate similar to that of the other types of procedure (61%-78%). Stenosis of the stoma has occurred in 8 children (27%), compared with rates of 10%-33% in other series. Stomal leakage has been troublesome for 2 (6.7%), compared with leak rates between 5.6% and 15% in other series. The LACE procedure is technically the simplest. The laparoscopic approach to the ACE procedure appears to be a simpler and safe alternative to previously described methods. It causes minimal morbidity, has a high long-term viability rate, and resulted in improved control of soiling in 90% of the children with faecal incontinence in whom it has been employed.

Adolescent↗

PubMed2003

Oncological effects of insufflation with different gases and a gasless procedure in rats.

BACKGROUND: The validity of using carbon dioxide (CO2) pneumoperitoneum in laparoscopic tumor surgery has not been investigated thoroughly. The oncologic effects of a gasless procedure and insufflation with different gases were compared in rats. METHODS: In all the experiments, Donryu rats were randomized to receive a gasless procedure; to receive insufflation with CO2, helium, or air at 10 mmHg for 30 min, or to serve as control subjects without insufflation. In experiment 1, involving 60 rats, ascites hepatoma AH130 cells were inoculated intraperitoneally just before the procedures. The S-phase fraction of the intraperitoneal tumor cells was determined using a flow cytometry on day 7. In experiment 2, 60 rats injected intraperitoneally with latex particles received one of the procedures. At the end of the procedure, peritoneal macrophages were harvested to determine the number of phagocytosed particles. In experiment 3, 75 rats inoculated intraperitoneally with AH130 cells received one of the procedures for 5 consecutive days and were followed for survival analysis. RESULTS: EXPERIMENT 1: The S-phase fraction was lower after insufflation with air or helium (p < 0.01) than with the anesthesia control condition. Insufflation with CO2 showed a higher S-phase fraction than the gasless procedure or insufflation with air or helium (p < 0.01). EXPERIMENT 2: The phagocytotic activity of peritoneal macrophages was increased by insufflation with helium and air, as compared with the control condition (p < 0.01). Insufflation with CO2 deteriorated the phagocytotic activity more than the gasless procedure (p < 0.05) or insufflation with air or helium (p < 0.001). EXPERIMENT 3: Insufflation with gases demonstrated shorter survival than the anesthesia control condition or the gasless procedure regardless of the gases used (p < 0.01). CONCLUSIONS: These results suggest that the choice of gases may affect the proliferation of tumor cells and the phagocytotic activity of peritoneal macrophages, insufflation itself may promote tumor spread regardless of the gases used, and the gasless procedure may be oncologically advantageous in this animal model.

Air↗

PubMed2006

Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease.

BACKGROUND: Nissen fundoplication is the most popular laparoscopic operation for the management of gastroesophageal reflux disease (GERD). Partial fundoplications seem to be associated with a lower incidence of postoperative dysphagia, and thus a better quality of life for patients. The aim of this study was to compare the long-term outcome in neurologically normal children who underwent laparoscopic Nissen, Toupet, or Thal procedures in three European centers with a large experience in laparoscopic antireflux procedures. METHODS: This study retrospectively analyzed the data of 300 consecutive patients with GERD who underwent laparoscopic surgery. The first 100 cases were recorded for each team, with the first team using the Toupet, the second team using the Thal, and the third team using the Nissen procedure. The only exclusion criteria for this study was neurologic impairment. For this reason, 66 neurologically impaired children (52 Thal, 10 Nissen, 4 Toupet) were excluded from the study. This evaluation focuses on the data for the remaining 238 neurologically normal children. The patients varied in age from 5 months to 16 years (median, 58 months). The median weight was 20 kg. All the children underwent a complete preoperative workup, and all had well-documented GERD. The position of the trocars and the dissection phase were similar in all the procedures, as was the posterior approximation of the crura. The short gastric vessels were divided in only six patients (2.5%). The only difference in the surgical procedures was the type of antireflux valve created. RESULTS: The median duration of surgery was 70 min. There was no mortality and no conversion in this series. A total of 12 (5%) intraoperative complications (5 Nissen, 5 Toupet, 2 Thal) and 13 (5.4%) postoperative complications (3 Toupet, 4 Nissen, 6 Thal) were recorded. Only six (2.5%) redo procedures (2 Thal, 2 Toupet, 2 Nissen) were performed. After a minimum follow-up period of 5 years, all the children were free of symptoms except nine (3.7%), who sometimes still require medication. The incidence of complications and redo surgery for the three procedures analyzed with the Mann-Whitney U test are not statistically significant. CONCLUSIONS: For pediatric patients with GERD, laparoscopic Nissen, Toupet, and Thal antireflux procedures yielded satisfactory results, and none of the approaches led to increased dysphagia. The 5% rate for intraoperative complications seems linked to the learning curve period. The authors consider the three procedures as extremely effective for the treatment of children with GERD, and they believe that the choice of one procedure over the other depends only on the surgeon's experience. Parental satisfaction with laparoscopic treatment was very high in all the three series.

Adolescent↗

PubMed2005

Effects of hydrogen peroxide cleaning procedures on bone graft osteoinductivity and mechanical properties.

Bone allografts are frequently used during orthopaedic trauma cases or other reconstructive procedures. Most allografts are processed and cleaned before use. Our goals were to determine if an improved cleaning procedure compromises the strength or osteoinductivity of a graft. We compared our improved cleaning procedure to our standard cleaning procedure on cortical bone allograft. The cleaning procedures are generally composed of a series of chemical steps with nonionic detergents, hydrogen peroxide, and alcohol under time and temperature control, subjected to ultrasonic agitation. We tested the compressive strength, impact strength, and shear strength following the standard and improved cleaning procedures. Osteoinductivity was tested in 4 groups, using the improved cleaning procedure with four different hydrogen peroxide cleaning times: 0, 1, 3, and 5 h. Osteoinductivity was evaluated in vivo, using a 28-day implant in the hamstring muscle of an athymic, nude mouse. Results demonstrated that osteoinductivity is maintained with cleaning in hydrogen peroxide for up to 1 h, and that compressive strength, impact strength, and shear strength were all unaffected by the improved cleaning procedure. The improved cleaning procedure therefore did not compromise the strength or osteoinductivity of cortical bone allografts in comparison to the standard procedure.

Adult↗

PubMed1986

Paramedic use of advanced life support procedures: experience and attitude survey.

To gather information about paramedic use of 11 advanced life-support (ALS) procedures, 74 emergency physicians and 171 paramedics practicing in Utah were surveyed. Response was 66% and 65%, respectively. Performance difficulty, frequency of use, and success rate were evaluated. The willingness of physicians to order, and paramedics to perform each procedure were compared. Physicians' and paramedics' difficulty ratings were significantly different (P less than .001) for only 3 of the 11 procedures. During the study period, paramedics successfully performed 455 procedures; 229 were performed by 15 (13%) of the responding paramedics. The reported success rate for all attempted procedures was 82% (455/557). The number of attempts and the success rate was significantly higher (P less than .05) for paramedics with secondary medically affiliated employment. Paramedics were significantly more willing to perform 7 of the 11 procedures (P less than .001) than physicians were willing to order. We conclude that paramedic and physician difficulty ratings were generally similar, that many types of ALS procedures are rarely performed, that a small percentage of paramedics perform the largest number of ALS procedures, that secondary employment increases paramedics' procedural attempts and improves success rates, and that they are more willing to perform ALS procedures than physicians are to order them.

Allied Health Personnel↗

PubMed2005

Practice patterns of nonvascular interventional radiology procedures at academic centers in the United States?

RATIONALE AND OBJECTIVES: To determine and analyze the patterns of practice of nonvascular interventional procedures in academic centers in the United States. MATERIALS AND METHODS: A survey was administered via e-mail to the chief residents of 112 academic radiology departments in the United States. Recipients of the survey were asked to identify which sections within their respective radiology departments performed each of 43 types of nonvascular interventional procedures. An additional entry for performance of procedures by non-radiologists was provided. A total of 66 (59%) recipients responded. The statistical method used was the analysis of contingency tables. RESULTS: Percutaneous abdominal biopsies are performed mainly by abdominal and body imaging sections (43/66, 65%), followed by vascular/interventional sections (21/66, 32%). Percutaneous abdominal drainages are performed mostly by abdominal, body imaging, and computed tomography sections (40/66, 61%), followed by vascular/interventional sections. Fluoroscopically guided procedures were performed most commonly by vascular/interventional sections, including percutaneous gastrostomy (40/66, 61%), percutaneous nephrostomy (42/66, 64%), and biliary interventions such as percutaneous transhepatic cholangiography (47/66, 71%). Breast and musculoskeletal procedures are performed by their respective sections most frequently. Non-radiologists perform a significant portion of certain types of procedures: paracenteses, thoracenteses, biliary interventions (particularly stone extractions), enterostomies (particularly percutaneous jejunostomies and cecostomies), and certain biopsies (kidney and prostate). CONCLUSIONS: Academic US radiology sections perform nonvascular interventional radiology procedures in a complex and nonuniform manner. The vascular/interventional sections and organ system and modality (especially CT) sections perform the bulk of the procedures included in the survey. Breast imaging sections predominate in procedures in their disciplines. A substantial number and amount of interventional radiology procedures are performed by non-radiologists.

Academic Medical Centers↗

PubMed2005

Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity.

BACKGROUND: The radial artery is currently regarded as a useful vascular access site for coronary procedures. Adequate anatomical information of the radial artery should be helpful in performing the transradial coronary procedure. Therefore, we tried to evaluate the size of radial artery, the incidence and clinical significance of anomalous branching patterns and tortuosity of the radial artery related with transradial coronary procedure. MATERIALS AND METHOD: In 1191 cases, mean radial arterial diameter (RAD) was measured before and after the procedure using a two-dimensional ultrasound and retrograde radial artery angiography was performed before the transradial coronary procedure in all patients. Branching anomaly, tortuosity of the radial artery and procedural characteristics including procedure times and local vascular complications were analyzed. RESULTS: The mean RAD was 2.60 +/- 0.41 mm by two-dimensional ultrasound: 2.69 +/- 0.40 mm in men and 2.43 +/- 0.38 mm in women (p < 0.001). Radial artery occlusion occurred in 0.6% in coronary angiography and 1.4% in coronary intervention. In multivariate analysis, coronary intervention was significantly related to the radial artery occlusion (p = 0.048). Anomalous branching of upper extremity artery was found in 38 cases (3.2%); high origin of the radial artery was most frequent in 28 cases (2.4%). Tortuosity of radial and brachial artery was found in 67 of 50 cases (4.2%). Most common forms of tortuosity were S-shape in 21 cases (31.3%) and Omega-shape in 21 cases (31.3%). And most common site of radial artery tortuosity was proximal third of antecubital fossa (35 cases, 52.2%). Prolonged procedure times and cross-overs to other arteries were related with tortuosity of the radial artery, but not with anomalous branching. CONCLUSION: In our study, radial artery diameter was larger than the outer diameter of 5Fr sheath in 82.7% for transradial coronary procedure. Radial artery occlusion was associated with coronary intervention using larger size sheath than diagnostic angiography using 5Fr sheath. The incidence in branching anomaly and tortuosity of radial artery was not rare in our study. Radial artery tortuosity was associated with old age and prolonged procedure time.

Catheterization, Peripheral↗

PubMed2006

Relationship between provider volume and postoperative complications for bariatric procedures in New York State.

BACKGROUND: Although the number of bariatric procedures has grown recently, few studies have focused on the relationship between provider volume and outcomes among patients undergoing a bariatric procedure. STUDY DESIGN: Using New York State's inpatient discharge database, we identified adults undergoing a bariatric procedure in New York State between January 1, 2003 and December 31, 2003 (n=7,868). Separate multivariable statistical models were constructed to examine the relationship between surgeon volume and hospital volume and postoperative complications (using surgeon volume cutpoints of 25, 50, 100, 150 and hospital volume cutpoints of 100, 125, 150, 200) while controlling for demographic characteristics and comorbidity. RESULTS: There was a considerably higher likelihood of postoperative complications among surgeons performing 100 or fewer bariatric procedures compared with those performing more than 100 procedures (odds ratio [OR]: 2.39, 95% CI: 1.59 to 3.59) and for those performing 150 or fewer procedures compared with those performing more than 150 procedures (odds ratio: 2.05, 95% CI: 1.29 to 3.25) after risk adjustment. Likewise, for each of the four hospital volume cutpoints, there was a notably higher likelihood of postoperative complications in the lower volume hospitals. Analyses of the interaction between surgeon and hospital volume indicated a markedly higher likelihood of postoperative complications among patients operated on by a low-volume surgeon (100 procedures or fewer) in a low-volume hospital (150 procedures or fewer) or a low-volume surgeon in a high-volume hospital than among patients operated on by a high-volume surgeon in a high-volume hospital. CONCLUSIONS: The likelihood of postoperative complications from bariatric procedures is greater for patients with low-volume surgeons or in low-volume hospitals.

Adult↗

PubMed2003

Effects of operator experience on the outcome and duration of pulmonary vein isolation procedures for atrial fibrillation.

Segmental, ostial ablation to isolate the pulmonary veins has been shown to be effective for the treatment of atrial fibrillation (AF). The purpose of this study was to determine the effects of operator experience on the outcome and duration of pulmonary vein isolation procedures for AF. One hundred three consecutive patients with AF underwent segmental, ostial ablation to isolate pulmonary veins. The effect of operator experience on the outcome and duration of the procedure was measured. The mean procedure duration was 232 +/- 70 minutes (range 50 to 460). There was an indirect linear relation between the total procedure time and the number of procedures performed (r = -0.68; p <0.001), and between the total fluoroscopic time and the number of procedures performed (r = -0.71; p <0.001). The percentage of patients in whom complete isolation of the pulmonary veins was achieved and the total duration of radiofrequency energy delivered during the procedures remained stable as operator experience increased. Operator experience was not an independent predictor of recurrent AF. The primary effect of operator experience on pulmonary vein isolation procedures for AF was a marked reduction in the duration of the procedure and fluoroscopic time. Long procedure durations and large amounts of radiation exposure may currently limit the widespread application of this therapy. The results of this study suggest that after >75 cases, segmental ablation to isolate the pulmonary veins using fluoroscopy and conventional radiofrequency ablation usually is feasible in <3 hours.

Adult↗

PubMed1999

Acute cerebral redistribution in response to invasive procedures in the human fetus.

OBJECTIVES: We sought to investigate the fetal hemodynamic response to the acute stress of invasive procedures. STUDY DESIGN: The middle cerebral artery pulsatility index was measured by Doppler ultrasonography before and after 136 invasive procedures (fetal blood sampling, transfusion, shunt insertion, tissue biopsy, and ovarian cyst aspiration). The response of fetuses submitted to invasive procedures involving transgression of the fetal body, such as intrahepatic vein blood sampling, was compared with that of control procedures at the placental cord insertion. RESULTS: The middle cerebral artery pulsatility index value fell with fetal blood sampling performed at the intrahepatic vein (median, -0.26; 95% confidence interval, -0.35 to -0.15) but not at the placental cord insertion (median, 0.05; 95% confidence interval, -0.04 to 0.19). With transfusions, the middle cerebral artery pulsatility index also fell with procedures at the intrahepatic vein (mean, -0.51; 95% confidence interval, -0.66 to -0.35) but not at the placental cord insertion (mean, -0.04; 95% confidence interval, -0.23 to 0.14). The magnitude of the response was greater with transfusions than with blood sampling alone. The middle cerebral artery pulsatility index value also fell with non-fetal blood sampling procedures involving transgression of the fetal body (mean, -0.32; 95% confidence interval, -0.56 to -0.09) but not with control non-fetal blood sampling procedures. The change in the middle cerebral artery pulsatility index was not related to gestational age, with the youngest fetus showing a fall in the middle cerebral artery pulsatility index value being at 16 weeks' gestation. Although the degree of response was weakly correlated with the duration of needling (y = -0.21 - 0.00014x; R (2) = 0.08; P =.02), multiple logistic regression demonstrated that this was instead a function of the type of the procedure. A response was seen within 70 seconds of fetal puncture. The fetal heart rate did not change significantly with procedures in any of the above-mentioned groups. CONCLUSIONS: The human fetus mounts a cerebral hemodynamic response to invasive procedures involving transgression of the fetal body, which is consistent with the brain-sparing effect.

Biopsy↗

PubMedDate not supplied

Cumulative vs. acute dose-response procedures produce differential BAC and behavioral functions for ethanol.

The discriminative stimulus attributes of ethanol (ETOH) were characterized in rats trained to discriminate between 1.25 g/kg ETOH and saline. The ETOH generalization functions were assessed using both acute and cumulative dosing procedures. The cumulative procedures differed in the individual incremented doses used to generate the functions. Acute dosing procedures produced discriminative functions that were significantly different from cumulative dose-response curves (DRCs). Similar cumulative DRC's were generated within each cumulative dosing procedure, whereas significant differences were produced between the two dosing incremented procedures. When blood alcohol concentrations (BACs) were quantified, a cumulative testing procedure produced significantly lower BACs than acute testing procedures at every dose above the initial or starting dose. Interestingly, response rate functions did not differ within or between cumulative and acute procedures. These data may suggest that differential ETOH dosing procedures may differentially influence the behavioral choice and BAC functions in rats, and cautions against the use of cumulative procedures to assess shifts in DRCs during chronic treatments without a concomitant assessment of BACs.

Animals↗