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At least 937 records · Page 52Linked to original sources
PubMed2002

Effectiveness of rheolytic coronary thrombectomy with the AngioJet catheter.

Thrombus-filled lesions are associated with a higher rate of acute complications and long-term restenosis following conventional coronary or saphenous vein graft (SVG) intervention. To evaluate the clinical effectiveness of rheolytic thrombectomy in a nonselected population in the glycoprotein IIb/IIIa blockade era, we reviewed clinical, angiographic, and procedural data on 119 patients who underwent 126 consecutive coronary AngioJet procedures (29% in SVGs, and 71% in native coronary arteries) from July 1998 to August 2000. Glycoprotein IIb/IIIa blockers were used in 88%. Most vessels (68% of SVGs, 74% of native coronary arteries) were occluded initially. Complete or substantial removal of filling defects was achieved in 76% of SVGs and 66% of native coronary cases. The AngioJet rheolytic thrombectomy device led to significant improvement in lumen diameter and Thrombolysis In Myocardial Infarction (TIMI) flow, with reduction in the thrombotic lesion length (p <0.05). Angiographic success (<30% residual stenosis, TIMI-3) was attained in 73% of SVGs and 87% of native coronary procedures. Distal embolization occurred in 13 cases, and was less likely to occur in patients treated with abciximab (0%) compared with patients treated with other glycoprotein IIb/IIIa blockers or heparin alone (17%, p = 0.02). A favorable response to the AngioJet (odds ratio 3.9) and freedom from embolization (odds ratio 14.6) were associated with a higher procedural success rate. In-hospital and long-term clinical outcomes were favorable. Thus, rheolytic thrombectomy resulted in significant reduction of the thrombus burden in most patients, restored TIMI-3 flow, and led to favorable short- and long-term outcomes.

Age Factors↗
PubMed2002

Left ventricular assist device for right side assistance in patients with transposition.

Right (systemic) ventricular dysfunction is well described after Senning operations for transposition of the great arteries, and patients with congenitally corrected transposition of the great arteries. Transplantation remains the only definitive therapy for refractory heart failure, however patients may deteriorate clinically prior to the availability of a donor heart. This report details the implantation of a TCI Heartmate (Thoratec Corp., Pleaston, CA) as a morphologic right ventricular assist device to bridge these patients to transplantation.

Adolescent↗
PubMed2002

Complications and strategies for salvage of intervertebral fixation devices.

The recent evolution of interbody fixation devices, known as threaded interbody fusion cages, is a significant new form of segmental fixation for application to the lumbar and lumbosacral spine. This article discusses the construction, biomechanics, and use of these devices, which serve as carriers for autogenous graft material while restoring segmental stability to the involved motion segment. The biomechanics of these devices greatly surpasses those of the interbody spacers used historically. Interbody spacers have traditionally been utilized as a component of an overall construct that also employed segmental posterior instrumentation. Threaded interbody cages, on the other hand, are able to confer a degree of stability to the diseased motion segment as stand-alone constructs.

Device Removal↗
PubMed2006

Preliminary experience with the MicroMed DeBakey pediatric ventricular assist device.

Mechanical circulatory support for both acute and chronic heart failure is a widely applied therapeutic option in the adult population with a variety of devices clinically available. Technology in this field has advanced sufficiently such that long-term support or "destination therapy" has become a generally accepted reality. Similar progress has not occurred in the field of device support for heart failure in children. While the number of potential patients is significantly lower in the pediatric population, the clinical relevance and poignancy of individual need are nonetheless real. Until recently, children with heart failure have been largely disadvantaged in comparison to their adult counterparts. The DeBakey VAD Child (MicroMed Technology, Inc, Houston, TX) represents a hopeful initial step in the direction of reducing the technological gap between adults and children. While the clinical experience with this device is limited at present, preliminary results are encouraging. This report will provide an overview of the DeBakey VAD Child, including device specifications, indications for clinical use, surgical and postoperative considerations, and updated clinical experience.

Adolescent↗
PubMed1986

Colostomy control device.

Temporary or permanent colostomy produces many difficulties such as continuous fecal flow, odor, skin irritation, rash, edema, and uncleanliness. Efforts to resolve these difficulties have not had much success. The present work describes the development of a new colostomy control device and its successful application to eight patients. The device is removable and allows the patients to empty their bowels naturally. Following the bowel movement and cleaning of the stoma, the device is reapplied. The patient remains continent and experiences a psychological uplift from being able to feel the urge for bowel movements. The application of the device is easy and leads to no complications.

Adult↗
PubMed2005

Gene profiling changes in cytoskeletal proteins during clinical recovery after left ventricular-assist device support.

BACKGROUND: After left ventricular-assist device (LVAD) support, a proportion of patients recover sufficient ventricular function to enable explantation of the device. The exact molecular mechanisms involved in myocardial recovery remain unknown. Cytoskeletal proteins are essential for the structure and function of the cardiac myocyte and might play a major role. METHODS AND RESULTS: A total of 15 patients with nonischemic cardiomyopathy who required LVAD implantation were studied; 6 recovered sufficiently to allow explantation of the device compared with 9 who did not recover and required transplantation. LV myocardial samples were collected at implantation and explantation/transplantation. Affymetrix microarray analysis was performed on the paired samples and analyzed with reference to sarcomeric and nonsarcomeric cytoskeletal proteins. In the recovery group, of the nonsarcomeric proteins, lamin A/C increased 1.5-fold (P<0.05) and spectrin 1.6-fold (P<0.05) between the times of implantation and explantation. Integrins beta1, beta6, and alpha7 decreased 1.7-fold (P<0.05), 2.4-fold (P<0.05), and 1.5-fold (P<0.05), respectively, but integrins alpha5 and beta5 increased 2.3-fold (P<0.01) and 1.2-fold (P<0.01) at explantation. The following sarcomeric proteins changed in the recovered group only: beta-actin increased 1.4-fold (P<0.05); alpha-tropomyosin, 1.3-fold (P<0.05); alpha1-actinin, 1.8-fold (P<0.01); and alpha-filamin A, 1.6-fold (P<0.05). Both troponin T3 and alpha2-actinin decreased by 1.6-fold at the time of explantation (P<0.05). Vinculin decreased 1.7-fold (P=0.001) in the recovered group but increased by 1.7-fold (P<0.05) in the nonrecovered group. Vinculin protein levels decreased 4.1-fold in the recovered group. CONCLUSIONS: Myocardial recovery was associated with a specific pattern of changes in sarcomeric, nonsarcomeric, and membrane-associated proteins, which could have important implications in understanding the mechanisms involved.

Adrenergic beta-2 Receptor Agonists↗
PubMed2005

[Video-assisted thoracoscopic surgery for migration of an orthopedic fixation wire in the mediastinum: report of a case].

Migration of an orthopedic fixation wire into the thoracic cavity is an uncommon complication. We present a 64-year-old male undergoing intra-thoracic migration of a Kirschner wire. The patient had undergone the treatment of sternoclavicular joint dislocation due to clavicular fracture. Four months after the operation, a chest X-ray revealed a metallic foreign body in the mediastinum. A chest computed tomography (CT) showed the object in the anterior mediastinum adjacent to the aortic arch. An emergency video-assisted thoracoscopic surgery was successfully performed to remove a 60-mm-long Kirschner wire migrated from the mediastinum to the thoracic cavity. The operating time was 45 minutes, and the blood loss was less than 50 ml. His postoperative course was uneventful and he was discharged at the 6th day after surgery. Prompt diagnosis and surgical removal are necessary to prevent serious complications.

Bone Wires↗
PubMed2006

Management of cardiac device infections: A retrospective survey of a non-surgical approach combining antibiotic therapy with transvenous removal.

Pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have become life-saving therapeutic tools for patients with cardiac arrhythmia. Complications include thrombosis, embolism and infections at a highly variable rate. Surgical removal of the infected device has been perceived as the only way to guarantee a successful outcome and to reduce the high risk of mortality. Recently, a transvenous extraction method has been developed to remove infected intracardiac leads without sternotomy. This survey was designed to evaluate the outcome of an approach combining antibiotic therapy with non-surgical transvenous complete removal for the management of cardiac device infections (CDIs). We reviewed case-histories of 121 patients (105 with PM and 16 with ICD infections). The aim of our retrospective survey was to ascertain that a non-invasive transvenous complete removal of the infected devices is safe and effective when associated with appropriate antibiotic therapy starting 10 days before the procedure and extending to at least three weeks after. The infected devices were successfully removed in all patients with a non-surgical transvenous technique. The infections were most frequently caused by coagulase-negative staphylococci (70%), Staphylococcus aureus (14%), and Gram-negative rods (12%). Polymicrobial infections were documented in 19 patients and represent 16% of all device-related infections. The removal of the devices was done during antibiotic therapy, administered for a median of 26 days (range 23 to 45 days). Neither fatalities nor relapse of infections were recorded in the patient population during the one-year follow-up visits. According to our experience, CDIs can be treated with antibiotic therapy and non-surgical removal of the entire infected device, thus allowing a successful reimplantation. This procedure prevents recurrent infections and operative mortality.

Anti-Bacterial Agents↗