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At least 55 records · Page 3Linked to original sources
PubMed1988

Role of laser and thermal ablation devices in the treatment of vascular diseases.

Since the first coronary angioplasty in 1977, both the number and complexity of interventional procedures have grown dramatically. Continuous-wave and pulsed lasers may further extend the capabilities of balloon angioplasty. Fiberoptic catheters may be used to transmit continuous-wave laser energy to ablate plaque via thermal mechanisms. Pulsed laser systems (such as the excimer) are technologically more complex than the continuous-wave systems, but may prove superior in small vessels given their ability to ablate plaque with minimal associated effects. On the other hand, modifications of the fiber-optic tip, such as the placement of a metal cap, have yielded even better results than current bare fiber systems. Such laser thermal techniques have proved a useful adjunct to balloon dilatation in peripheral vessels, but further research is necessary to determine their effect on coronary arteries. New, nonlaser technologies, however, may provide simpler power sources for thermal angioplasty. Although balloon angioplasty remains the cornerstone of interventional vascular therapy, new technologies should help to further expand the indications for nonsurgical interventions.

Angioplasty, Balloon↗
PubMed1991

Penetrating keratoplasty for severe complications of radial keratotomy.

Severe sight-threatening complications were seen in five eyes of three patients following improperly performed radial keratotomy. All patients exhibited neovascularization of the incision sites, severe stromal scarring or ulceration involving the visual axis, loss of the anterior chamber, and iridocorneal adhesions. These complications necessitated multiple and complex surgical interventions, including penetrating keratoplasty and anterior segment reconstruction. Final visual acuity was decreased to light perception in four eyes while one eye achieved 6/60 vision following repeated penetrating keratoplasty. The success and safety of radial keratotomy rely on careful case selection, appropriate instrumentation, specialized training, and the ability to perform complex secondary procedures to correct surgical complications.

Adult↗
PubMed1992

Provision of services for the diagnosis and treatment of heart disease. Fourth report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England.

The principal conclusions of the fourth report of the Joint Cardiology Committee are: 1 Cardiovascular disease remains a major cause of death and morbidity in the population and of utilisation of medical services. 2 Reduction in the risk of cardiovascular disease is feasible, and better co-ordination is required of strategies most likely to be effective. 3 Pre-hospital care of cardiac emergencies, in particular the provision of facilities for defibrillation, should continue to be developed. 4 There remains a large shortfall in provision of cardiological services with almost one in five district hospitals in England and Wales having no physician with the appropriate training. Few of the larger districts have two cardiologists to meet the recommendation for populations of over 250,000. One hundred and fifty extra consultant posts (in both district and regional centres) together with adequate supporting staff and facilities are urgently needed to provide modest cover for existing requirements. 5 The provision of coronary bypass grafting has expanded since 1985, but few regions have fulfilled the unambitious objectives stated in the Third Joint Cardiology Report. 6 The development of coronary angioplasty has been slow and haphazard. All regional centres should have at least two cardiologists trained in coronary angioplasty and there should be a designated budget. Surgical cover is still required for most procedures and is best provided on site. 7 Advances in the management of arrhythmias, including the use of specialised pacemakers, implantable defibrillators, and percutaneous or surgical ablation of parts of the cardiac conducting system have resulted in great benefit to patients. Planned development of the emerging sub-specialty of arrhythmology is required. 8 Strategies must be developed to limit the increased exposure of cardiologists to ionising radiation which will result from the expansion and increasing complexity of interventional procedures. 9 Supra-regional funding for infant cardiac surgery and transplantation has been successful and should be continued. 10 Despite advances in non-invasive diagnosis of congenital heart disease the amount of cardiac catheterisation of children has risen due to the increase in number of interventional procedures. Vacant consultant posts in paediatric cardiology and the need for an increase in the number of such posts cannot be filled from existing senior registrar posts. All paediatric cardiac units should have a senior registrar and in the meantime it may be necessary to make proleptic appointments to consultant posts with arrangements for the appointees to complete their training. 11 Provision of care for the increasing number of adolescent and adult survivors of complex congenital heart disease is urgently required. The management of these patients is specialised, and the committee recommends that it should ultimately be undertaken by either adult or pediatric cardiologists with appropriate additional training working in supra-regionally funded centers alongside specially trained surgeons. 12 Cardiac rehabilitation should be available to all patients in the United Kingdom. 13 New recommendations for training in cardiology are for a total of at least five years in the specialty after general professional training, plus a year as senior registrar in general medicine. An additional year may be required for those wishing to work in interventional cardiology and adequate provision must be made for those with an academic interest. 14 It is essential that both basic and clinical research is carried out in cardiac centres but these activities are becoming increasingly limited by the lack of properly funded posts in the basic sciences and restriction in the number of honorary posts for clinical research workers. 15 A joint audit committee of the Royal College of Physicians and the British Cardiac Society has been established to coordinate audit in the specialty. All district and regional cardiac centres should cooperate with the work of the committee, in addition to their participation in local audit activities.

Cardiac Surgical Procedures↗
PubMed2026

Process evaluation of a nurse-led transitional care model (Cardiolotse) within a randomized controlled trial aiming to improve care coordination for patients with cardiovascular diseases in Germany.

BACKGROUND: Patients with higher age suffering from cardiovascular disease discharged from hospital are at greater risk of readmission within 30 days. We evaluated an innovative care program providing post-discharge support and helping patients to navigate through the healthcare system. This paper reports the findings of the process evaluation of the randomized controlled trial Cardiolotse, a nurse-led transitional care model improving care coordination for patients with cardiovascular diseases in Germany. METHODS: A process evaluation, following the guidelines of the Medical Research Council (MRC) Framework, was performed. Semi-structured interviews with all relevant target groups were conducted to gain more insight about implementation processes. Questionnaires and medical records were used to explore mechanisms of impact and understand how change was produced in the intervention. Qualitative data were analysed using content analysis with deductive and inductive categories. Descriptive statistics and subgroup analyses were utilized to explore quantitative data. RESULTS: Overall, the designed training programme was perceived positively by the study nurses, so called Cardiolotsen (CLs). Patients receiving support by the CLs reported positive satisfaction ratings. Interactions between CLs and patients were reported as trustworthy and reliable. A total of approximately 12,500 contacts were made over the course of the intervention. However, changes in satisfaction scores between intervention and control groups in terms of medical treatment or the interaction between medical health providers involved in the treatment could not be determined. Furthermore, data suggested reach issues with respect to office-based physicians, as regular CL contact could not be achieved with 90% of the participating general practitioners and cardiologists. CONCLUSIONS: The CLs served as an important source of support for the participating patients throughout the intervention. At regular intervals, they checked a patient's health status and their adherence to therapies after discharge. However, the process evaluation identified cross-sectoral communication and information exchange between CLs and office-based physicians as an implementation challenge. TRIAL REGISTRATION: The study was retrospectively registered at German Clinical Trial Register, http://www.drks.de/DRKS00020424 (Trial Registration Number DRKS00020424) on 18 June 2020.

Humans↗
PubMed1992

A novel treatment of global cerebral ischaemia with a glycine partial agonist.

Chronic treatment of gerbils with 1-aminocyclopropanecarboxylic acid (a high affinity, partial agonist at strychnine-insensitive glycine receptors) resulted in a 3-fold increase in survival, a significant improvement in neurological status, and an extensive protection of vulnerable brain regions following severe forebrain ischaemia. A bolus of 1-aminocyclopropanecarboxylic acid 30 min prior to ischaemia did not further improve outcome compared to gerbils receiving their last injection 24 h prior to ischaemia. These findings are consistent with the hypothesis that chronic treatment with a glycine partial agonist desensitizes the N-methyl-D-aspartate receptor complex. Pharmacological intervention at the strychnine-insensitive glycine receptor may be an effective means of ameliorating the consequences of neuronal degeneration caused by excitotoxic phenomena.

Amino Acids↗
PubMed1991

Tumors of the central nervous system. Improvement in outcome through a multimodality approach.

More children with CNS tumors will continue to be cured of their neoplasms as a result of improved surgical, radiotherapeutic, and chemotherapeutic intervention. The complex problems seen in these patients mandate their treatment at academic centers actively involved in therapeutic investigations and capable of providing comprehensive multidisciplinary care.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2025

OctopuSV and TentacleSV: a one-stop toolkit for multi-sample, cross-platform structural variant comparison and analysis.

MOTIVATION: Structural variants (SVs) influence gene regulation, disease progression, and diagnostics, yet integrating SV calls across platforms remains difficult due to inconsistent annotations, limited merging flexibility, and fragmented workflows. Ambiguous breakend (BND) annotations, which comprise many variant calls, are often discarded or misclassified, hindering variant characterization. Existing tools lack advanced merging operations essential for precise identification of disease-specific or somatic variants across samples or patient groups. Additionally, current SV analysis pipelines require extensive manual intervention and complex parameter tuning, compromising reproducibility and scalability. Addressing these gaps is crucial for improving the accuracy, interpretability, and clinical utility of SV analyses. RESULTS: We developed OctopuSV and TentacleSV to address these long-standing challenges in SV analysis. OctopuSV features a specialized BND correction module that converts ambiguous BND annotations into canonical SV types, recovering important variants that are often overlooked by existing tools. Additionally, it provides advanced set operations (difference, complement, custom-defined) that enable sophisticated variant filtering without programming expertise, critical for identifying tumor-specific SVs or variants unique to specific sample groups. TentacleSV completes our solution by automating the entire SV analysis process from raw sequencing data to high-confidence callsets, ensuring consistency and reproducibility across projects. Benchmarking across short-read and long-read platforms showed superior F1 score, complete SV type consistency compared to existing tools. Our framework enables experimental biologists and clinical researchers to perform sophisticated analyses ranging from cancer subtype-specific SV identification to multi-sample comparative studies without requiring specialized programming skills. AVAILABILITY AND IMPLEMENTATION: All codes are available at https://github.com/ylab-hi/OctopuSV; https://github.com/ylab-hi/TentacleSV.

Software↗
PubMed1991

Intermediate-term effectiveness of balloon valvuloplasty for congenital aortic stenosis. A prospective follow-up study.

BACKGROUND: Percutaneous balloon valvuloplasty has proven to be acutely effective in the treatment of congenital valvar aortic stenosis; however, the intermediate- and long-term effectiveness of the procedure remain to be documented. METHODS AND RESULTS: To assess the intermediate-term effectiveness of balloon valvuloplasty, repeat catheterization was performed in 27 of 30 children 1.7 +/- 0.1 years after balloon valvuloplasty for congenital aortic stenosis (AS). In 33 children the peak AS gradient was reduced acutely by 55% from 77 +/- 4 to 35 +/- 3 mm Hg (p less than 0.001), and left ventricular systolic pressure was reduced from 176 +/- 4 to 138 +/- 4 mm Hg (p less than 0.001). Despite a technically adequate valvuloplasty procedure, three patients had inadequate relief of obstruction and required complex surgical intervention. Twenty-seven of the 30 patients available for late reevaluation (90%) enrolled in the follow-up study. The peak AS gradient remained significantly reduced compared with that present before valvuloplasty (29 +/- 3 versus 77 +/- 4 mm Hg, p less than 0.001). Furthermore, there was no difference in peak AS gradient at follow-up compared with that immediately after valvuloplasty. The greatest increase in gradient at reevaluation was 14 mm Hg. Twenty of 27 patients (74%) had no change in the degree of aortic insufficiency at follow-up compared with that present before valvuloplasty. At follow-up, 16 patients had no aortic insufficiency at all, and only two had moderate-to-severe (3-4+) insufficiency. Femoral artery injury was documented in four patients, three of whom were under 12 months of age at valvuloplasty. CONCLUSIONS: Balloon aortic valvuloplasty provides safe and effective intermediate-term gradient relief without early restenosis in children and adolescents with congenital AS.

Adolescent↗
PubMedDate not supplied

Percutaneous alternatives in nutritional support: a radiologic perspective.

As alternatives to per os feeding and nutritional support increase in number and complexity, the interventional radiologist has come to play a more significant role in the creation and maintenance of nutritional access. In very difficult access cases, the concerted effort of the nutritional surgeon and the radiologist is often required. We describe several such situations which have been successfully managed at our institution. The indications for and techniques of percutaneous reestablishment of surgically placed jejunostomy tubes, the percutaneous conversion of gastrostomy to jejunostomy tubes with retention of the gastrostomy tube, and percutaneous placement of an inferior vena caval Hickman catheter are all described in detail.

Adult↗
PubMed1992

The dependence of the scattered radiation dose to personnel on technique factors in diagnostic radiology.

The measurement and prediction of scattered radiation dose to staff in diagnostic radiology is particularly important, owing to the increased use and complexity of interventional radiology. The air kerma-area product and scattered radiation dose in the vicinity of the patient couch, for both overcouch and undercouch X-ray tube geometries, were simultaneously monitored. The scattered radiation distribution at the couchside was deduced at a range of tube potentials for both overcouch and undercouch X-ray tube geometries. The variation of scattered radiation with field size on both geometries was investigated, as well as the variation with focus-table distance on an overcouch tube geometry. It was discovered that the scattered radiation dose at a point correlated with the air kerma-area product and the result may be used for radiation protection purposes. A method of predicting the scattered radiation dose at a given position is described.

Humans↗
PubMed1977

[Pain-sensation following classic neck-dissection (author's transl)].

Resulting neck-dissection surgery (including curative or conservative intervention) very complex pain-syndromes are next to losses of function at the top of complaints stated. The discussion of the case-reports of 242 patients with unilateral neck-dissection and the reexamination of 28 patients free of recurrence revealed several causes of head- and facial pain. The close relationship of functional disability and pain-sensation is discussed. The recommendation of elective neck-dissection - by critical indication - is supported. Resection of nervus accessorius may be necessary in some cases, immediate reconstruction by nerve sutures is recommended. By post-operative treatment the complaints often can be relieved.

Accessory Nerve↗
PubMed1992

Process measures in interventions for drug-abusing women: from coping to competence.

As a guide to the selection of process and outcome measurement in interventions with drug-abusing women, we have offered a model of fundamental coping processes. Three coping processes--reinforcer management, challenge management, and affect management--appear critical to women's competence and physical hardiness. When these processes go awry, substance abuse is a likely result. For successful recovery from substance abuse, good fortune or purposeful intervention must promote these coping processes. To measure the impact of any intervention with drug-abusing women, methods of assessing fundamental coping processes during intervention (process measures) and repeatedly after intervention (outcome measures) are needed. We have described multiple methods of measuring fundamental coping processes from diverse vantage points: self-report, behavioral observation, biochemistry, and physiology. We have discussed how these measures relate to the theoretical model. Finally, we have indicated measures favored and used in our longitudinal and intervention research on adolescent and perinatal substance abuse. The final set of measures, as summarized in the list of recommended process and outcome measures on pages 324-325, is somewhat lengthy because the process of intervention is complex. Given the financial and structural limitations of research in drug treatment settings, it may not be possible for a single investigator to employ all the recommended measures. An adequate research design would employ two measures from each of the domains outlined. If resources allow, more extensive measurement procedures would be possible.

Adaptation, Psychological↗
PubMed1991

[Value of studying pain in objective assessment of the clinical status of patients after spinal surgery].

The author demonstrates the role of algologic studies (projective Stewart's test scale), scales of verbal and visual analogs) in objective evaluation of the clinical status of patients who underwent spinal surgery for lumbar pains. Differences have been revealed in the algologic status of patients who suffered restricted interventions and complex decompression stabilizing operations with posterior spondylodesis.

Back Pain↗
PubMed1991

[Management of radiation-induced injuries of the intestine].

Radiation-induced injury of the intestine (RII) is a chronic iatrogenic disorder which often necessitates complex surgical intervention. We describe our experience with the surgical management of 9 patients with RII, 8 of whom suffered injuries of the small bowel and 1 of the rectosigmoid. There were 3 deaths, 2 from postoperative complications of ongoing RII and 1 from recurrence of the original tumor. 3 of the survivors continued to suffer from complications attributed to active RII, while only 3 remained symptom-free during follow-up. Our study emphasizes the fundamental role of good nutritional support during the perioperative period in these patients. It also indicates the desirability of using nonirradiated bowel for the anastomosis, and of a bypass procedure instead of resection and primary anastomosis in cases of radiation-induced frozen pelvis. Creating a barrier between the peritoneal cavity and the lower pelvis by an omental flap or other means, should be considered in patients operated on for pelvic cancer who might need adjuvant radiotherapy. This procedure shields the bowel from the radiation field, thus hopefully reducing the incidence of RII.

Humans↗
PubMed1990

[Methods to improve the delivery of hospital ophthalmological care to children in the Ukrainian SSR].

On the material of Children Eye Department the Filatov Institute, changes in the structure of eye pathology for the period of 1947-1989 are analysed. It is shown that for the last years, among all eye diseases, the incidence of inflammatory eye diseases fell to 7.5%. The incidence of eye traumas and their outcomes reaching 26.2% remained stable. The incidence of congenital pathology (35.4%) and new-formations in the eye (10.8%) with predominance of malignant tumors, complex pathology of oculomotor apparatus (23.5%) reached high values. Organization of centers, of ophthalmic microsurgery in children allowed to introduce into ophthalmological practice complex surgical interventions requiring special devices and instruments. Surgical activity of the Center of Ophthalmic microsurgery in Children on the basis of the Filatov Institute made up 84.5% in the last five years. In order to optimize the rendering of stationary ophthalmological aid to children, the authors consider it necessary to improve continuity between a microsurgical center and regional children eye hospitals, to increase qualification of children ophthalmologists, to create a Republic Center for Rehabilitation of Children with eye diseases on the basis of a sanatorium with a good ophthalmological equipment.

Child↗
PubMed1988

Future growth and development of hysteroscopy.

In less than two decades, hysteroscopy has evolved into a practical technique for the evaluation of the uterine cavity, with well-established indications such as evaluation of abnormal uterine bleeding and abnormal hysterograms as well as the treatment of intrauterine adhesions or the septate uterus, the removal of misplaced or embedded intrauterine devices, and the removal of submucous leiomyomas. As the use of hysteroscopy increases and more practitioners utilize it, new instrumentation and techniques are beginning to evolve, simplifying and facilitating not only a diagnostic examination, but also the more difficult and complex surgical interventions. Flexible endoscopes are being tested for possible use in the uterine cavity, and operative hysteroscopes with practical inflow and outflow accessory channels have been introduced. The accessory operative instrumentation has also been expanded and refined, and portable units for office examinations have been developed. The trend in the development of instrumentation is toward simplicity, effectiveness, and refinement in lenses with wider fields of view and accessory channels without compromising the total outer diameter of the endoscopes. As clinical applications expand as a result of increased use and proficiency in hysteroscopy, new applications undoubtedly will follow, such as closer study of the endometrium with and without additional magnification. This latter may permit a better understanding of the receptivity of the endometrium to the embryo, which may help in predicting successful nidations. Portable laser units with the capability to use the CO2 fiber undoubtedly will increase laser use through hysteroscopy, and in the near future, photodynamic therapy may become the best approach to the selective treatment of intrauterine lesions. The uterotubal junction will remain an attractive area for endoscopists to approach the fallopian tubes transcervically and eventually to accomplish tubal closure safely and effectively with the possibility of future reversibility. The hysteroscope will play an important role in new reproductive technologies, particularly those related to the gamete intrafallopian transfer via the uterine side and perhaps also for direct embryo transfers under visual control. The future of hysteroscopy thus is promising. The present diagnostic and therapeutic applications will not only become a standard of treatment but will expand as gynecologists will gain proficiency and confidence in this endoscopic method.

Endoscopes↗
PubMed1979

[Treatment of peritonitis in abdominal injuries].

According to the author's data, peritonitis occurred in 250 (20.8%) out of 1200 cases of abdominal injuries, 69 of these 250 patients died (27.6%). The main means combating this complication was an early surgical intervention. A complex of postoperative therapeutic procedures, aimed at the prophylaxis and treatment of peritonitis in these patients, is described.

Abdominal Injuries↗