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Degradation of triglycidyl isocyanurate as a cause of false-negative patch test reaction.

Triglycidyl isocyanurate (TGIC) is mainly used in polyester-based powder paints, but also in laminates, insulating varnishes, coatings and adhesives. Several cases of contact allergy to TGIC have been reported during the last 10 years. Contact allergy to TGIC has developed in a factory producing the chemical, in a factory producing powder paints containing TGIC, and in industries using powder coating. In this paper, we report a man who developed a work-related dermatitis when working on the painting of metal frames. He was exposed to polyester powder pigments containing TGIC. When patch tested, he was negative to TGIC (prepared in 1988) 3x and positive to polyester powder pigment. Only when a new test preparation of fresh TGIC powder was tested, was a positive reaction obtained. Chemical analyses showed that there was no TGIC in the test preparation from 1988, and that in the TGIC powder from 1988, there was only 30% of the expected amount of TGIC. The investigations, clinical and chemical, strongly indicate degradation of TGIC in the test preparation and powder. Both substances and the test preparations made from them may change over time. Therefore, if a false-negative reaction due to a test preparation is strongly suspected, we recommend a re-test of the patient with a new test preparation of fresh material. As a general rule, patch testing should be performed with fresh substances and test preparations made from them, unless their stability and durability are known.

Adult↗

Ultraviolet protection factor of fabrics: comparison of laboratory and field-based measurements.

BACKGROUND/PURPOSE: Spectrophotometry has become an accepted laboratory-based method for the determination of the ultraviolet protection factor (UPF) of fabrics. However, the validity of the UPF determined in the laboratory has been a controversial issue with regard to its significance in the field. To compare UPF values obtained by spectrophotometry, determination of the minimal erythema dose (MED), and biological dosimetry, we conducted laboratory and field-based measurements on various fabric materials. METHODS: One cotton, two viscose, and two polyester fabrics were enrolled into the study. Spectrophotometric (SP) testing was performed in accordance with the European standard. In vivo "on skin" (IV) testing on human subjects was performed with and without fabric protection. For determination of MED, a solar-simulator was used. In another part of the study, biological dosimetry (BD) testing was employed for laboratory testing with solar-simulated radiation (laboratory BD testing) as well as field-based measurements with natural sunlight in stationary (stationary BD testing) and "real life" exposure situations (mobile subject BD testing). For field-based measurements one light-weight polyester fabric was selected. RESULTS: The differences of the mean UPF values obtained by the laboratory-based methods were significant (MANOVA; P = 0.05), except for fabric no. 2 (MANOVA; P = 0.097). In 4 of the 5 fabrics tested, UPF values obtained by IV testing were significantly lower than those obtained by SP testing (t-test; P = 0.05). In 3 fabrics, SP testing revealed significantly higher UPF values in comparison to laboratory BD testing (t-test; P = 0.05). The differences of UPF values obtained by the laboratory and field-based measurements employed for the light-weight polyester fabric were significant (ANOVA; P = 0.05). In comparison to SP testing (UPF 3.8), stationary BD testing resulted in significantly lower (UPF 3.5) and mobile subject BD testing in a significantly higher UPF of 4.4 (t-test; P = 0.05). The UPF obtained by mobile subject BD testing differed significantly from the UPF obtained by stationary BD testing (t-test; P = 0.05). CONCLUSIONS: Comparison of the presented methods indicates that IV testing generally results in lower UPF values. By contrast BD testing in "real life" exposure situations reveals relatively high UPF values. Although an overestimation of the spectrophotometrically measured UPF has been observed in comparative laboratory testing, UPF values obtained by field-based measurements are in relatively good agreement, or even surpass UPF values obtained by spectrophotometry. It is, therefore, suggested that SP testing provides "safe" UPF values which may be also valid in extreme real exposure situations. Biological UV dosimetry is, however, a promising alternative method for UPF testing: the test is easily performed in realistic exposure situations, the test is relatively inexpensive, and the measurements are valid.

Analysis of Variance↗

Do Mersilene sutures need to be removed after cataract surgery?

A major disadvantage of nylon sutures is the need to remove them post-operatively to prevent suture fracture and irritation. Mersilene (polyester) sutures do not hydrolyse or disintegrate and are in theory superior to nylon. Fifty-two consecutive patients were examined an average of 3 years after uncomplicated extracapsular cataract extraction with corneal sections sutured with interrupted 11/0 polyester. It was found that 29% had suture-related problems and required, or had previously undergone, suture removal for reasons other than high astigmatism. The most common problem was a loose stitch with adherent mucus and corneal vascularisation (17% of patients at review). Sixty-six per cent of patients with loose sutures reported discomfort. We would not advocate prophylactic removal, but patients with polyester sutures should be advised to return if they become symptomatic.

Astigmatism↗

Large area UV casting using diverse polyacrylates of microchannels separated by high aspect ratio microwalls.

Large area molding of long and deep microchannels separated by high aspect ratio microwalls is important for high sensitivity and high throughput microfluidic devices. Ultraviolet (UV) casting is a feasible, economical and convenient method of replication of such microstructures in plastics. It is shown that a wide variety of polyacrylates with diverse properties such as those made from epoxy (EP), polyurethane (UR), polyester (ES), poly (ethylene glycol) (EG) and poly(propylene glycol) (PG) can be used for the high aspect ratio (7-9) UV casting of such linear microstructures over a 100 mm diameter, enlarging the range of applications of the replicated microstructures. Some challenges arise. With the EG formulation, wavy microstructures were observed; this can be overcome by stress relaxation. With non-polar PG formulation, poor adhesion between the polyester substrate and resin can lead to delamination of the casting from the substrate during demolding; this can be overcome by pre-coating a partially cured same resin on the polyester substrate. An optimum UV irradiation time was important for cure at the deepest end of the microstructure without excessive crosslinking leading to much increased demolding forces. The viscosity and wetting capability of the formulations were found to affect replication fidelity.

Acrylates↗

Comparison of the substrate effect on VOC emissions from water based varnish and latex paint.

BACKGROUND, AIMS AND SCOPE: The building materials are recognised to be major contributors to indoor air contamination by volatile organic compounds (VOCs). The improvement of the quality of the environment within buildings is a topic of increasing research and public interest. Legislation in preparation by the European Commission may induce, in the near future, European Union Member States to solicit the industries of paints, varnishes and flooring materials for taking measures, in order to reduce the VOC emissions resulting from the use of their products. Therefore, product characterisation and information about the influence of environmental parameters on the VOC emissions are fundamental for providing the basic scientific information required to allow architects, engineers, builders, and building owners to provide a healthy environment for building occupants. On the other hand, the producers of coating building materials require this information to introduce technological alterations, when necessary, in order to improve the ecological quality of their products, and to make them more competitive. Studies of VOC emissions from wet materials, like paints and varnishes, have usually been conducted after applying the material on inert substrates, due to its non-adsorption and non-porosity properties. However, in real indoor environments, these materials are applied on substrates of a different nature. One aim of this work was to study, for the first time, the VOC emissions from a latex paint applied on concrete. The influence of the substrate (uncoated cork parquet, eucalyptus parquet without finishing and pine parquet with finishing) on the emissions of VOC from a water-based varnish was also studied. For comparison purposes, polyester film (an inert substrate) was used for both wet materials. METHODS: The specific emission rates of the major VOCs were monitored for the first 72 h of material exposure in the atmosphere of a standardized test chamber. The air samples were collected on Tenax TA and analysed using thermal desorption online with gas chromatography provided with both mass selective detection and flame ionisation detection. A double exponential model was applied to the VOC concentrations as a function of time to facilitate the interpretation of the results. RESULTS AND DISCUSSION: The varnish, which was introduced in the test chamber 23 h after the application of the last layer of material, emitted mainly glycolethers. Only primary VOCs were emitted, but their concentrations varied markedly with the nature of the substrate. The higher VOC concentrations were observed for the parquets of cork and eucalyptus, which indicated that they have a much higher porosity and, therefore, a higher power of VOC adsorption than the finished pine parquet (and polyester film). The paint was introduced in the chamber just after its application. Only primary VOCs were emitted (esters, phthalates, glycolethers and white spirit) but some compounds, like 2-(2-butoxyethoxy)ethanol and diethylphthalate, were only observed for paint/polyester, which suggested that they were irreversibly adsorbed by the paint/concrete. Compared with the inert substrate, the rate of VOC emissions was lower for concrete in the wet-stage (first hours after the paint application) but slightly higher later (dry-stage) as a consequence of desorption. CONCLUSIONS: As to varnish, the substrates without finishing, like cork and eucalyptus parquets, displayed a higher power of adsorption of VOCs than the pine parquet with finishing, probably because they have a higher porosity. As concerns paint, the total masses of VOCs emitted were lower for concrete than for polyester, indicating that concrete reduces the global VOC emissions from the latex paint. Concrete is seen to have a strong power of adsorption of VOCs. Some compounds, namely 2-(2-butoxyethoxy)ethanol, diethylphthalate and TEXANOL (this partially), were either irreversibly adsorbed by the concrete or desorbed very slowly (at undetected levels). A similar behaviour had not been reported for gypsum board, a paint substrate studied before. RECOMMENDATIONS AND OUTLOOK: The present data suggest that concrete may be a recommendable substrate for paint in an indoor environment. As the nature of the substrate conditions the rate and nature of VOC emissions from wet materials, it must be explicit when emissions from composite materials are reported, in order to allow comparisons and labelling of the product in terms of indoor air quality.

Air Pollution, Indoor↗

Surgical management of trabecular ventricular septal defects: the sandwich technique.

BACKGROUND: Surgical closure of trabecular ventricular septal defects is difficult and often unsuccessful. OBJECTIVE: We performed closure of trabecular ventricular septal defects by sandwiching the septum between 2 polyester felt patches placed in the left ventricle and right ventricle without ventriculotomy. METHODS: Eleven patients (7 boys and 4 girls) underwent a sandwiching closure at a mean age of 4.7 years (range, 0.4-9.7 years) and a mean weight of 16.7 kg (range, 4.6-52 kg). Associated cardiac malformations were present in 9 of the 11 patients. Seven patients had undergone previous operations. The trabecular ventricular septal defects are exposed through the tricuspid valve and also from the left ventricular side through a coexisting large perimembranous ventricular septal defect or through the mitral valve through an interatrial septostomy. Two forceps, one each from the right and left ventricular side, lead a 3F Nelaton catheter through the trabecular defect. An oversized circular polyester felt patch mounted on a 3-0 Nespolen suture attached to the Nelaton catheter is then passed into the left ventricle. The suture ends are then passed through a slightly smaller polyester felt patch on the right ventricular side of the septum. The Nespolen suture is then tied, thereby sandwiching the septum between the 2 patches. RESULTS: Time required for the procedure was less than 20 minutes in each case. There were no hospital deaths, and the postoperative course was uneventful in all patients. There was no residual shunt in 3 patients, and a minimal residual shunt was observed in 5 patients. Mild residual shunt was observed in 3 patients. Cardiac catheterization was performed 1 month postoperatively in 8 patients in whom residual shunt was noted on echocardiography. Five of 8 patients had a minimal residual shunt (pulmonary blood flow/systemic blood flow ratio = 1.0). Three patients had a residual shunt (pulmonary blood flow/systemic blood flow ratio = 2.0, 1.6, and 1.2). The patient with a pulmonary blood flow/systemic blood flow ratio of 2.0 had a "Swiss cheese" ventricular septal defect, and a residual shunt remained around the patch. However, the residual shunt decreased to a pulmonary blood flow/systemic blood flow ratio of 1.6 at examination 16 months postoperatively. Echocardiography showed that the residual shunt had also decreased in another 2 patients. CONCLUSIONS: We conclude that the sandwich technique is safe and easy. Even in cases with a residual shunt present, the shunt is expected to decrease as time passes. Further experience and longer follow-up of these patients are necessary to conclude whether this technique is applicable to neonates and young infants.

Blood Flow Velocity↗

Expanded application of in situ replacement for prosthetic graft infection.

PURPOSE: The purpose of this study was to analyze the outcome of an individualized treatment algorithm for prosthetic graft infection, including the application of in situ graft replacement, based on clinical presentation, extent of graft infection, and microbiology. METHODS: There was a retrospective review (1991-2000) of 119 patients with 68 aortoiliofemoral or 51 extracavitary (infrainguinal, 19; axillofemoral, 16; femorofemoral, 16) prosthetic graft infections presenting more than 3 months (range, 3-136 months) after implantation/revision. The treatment algorithm consisted of graft excision with or without ex situ bypass grafts for patients presenting with sepsis or graft-enteric erosion, whereas in situ replacement (autogenous vein, rifampin-bonded polyester, polytetrafluoroethylene [PTFE]) was used in patients with less virulent gram-positive graft infection, in particular infections caused by Staphylococcus epidermidis. Outcomes (death, limb loss, recurrent infection) were correlated with treatment type and infecting organism. RESULTS: In situ replacement was used in 52% of aortoiliofemoral (autogenous vein, 10; rifampin-bonded polyester, 6; PTFE, 9) and 80% of extracavitary (autogenous vein, 26; PTFE, 9; rifampin, 6) graft infections. Total graft excision with ex situ bypass was performed in 34 patients, including 21 patients with graft-enteric erosion/fistula, with a 21% operative mortality and 9% amputation rate. In situ graft replacement was used to treat 76 graft infections with a 30-day operative mortality rate of 4% and an amputation rate of 2%. Graft excision alone was performed in nine patients with one 30-day death. Gram-positive cocci were the prevalent infecting organisms of both intracavitary (59% of isolates) and extracavitary (76% of isolates) graft infections. S epidermidis was the infecting organism in 40% of patients, accounting for the expanded application of in situ prosthetic replacement using a rifampin-bonded polyester or PTFE prosthesis. During the mean follow-up interval of 26 months, recurrent graft infection developed in 3% (1 of 34) of patients after conventional treatment, 3% (1 of 36) patients after in situ vein replacement, and 10% (4 of 40) patients after in situ prosthetic graft replacement (P >.05). Failure of in situ replacement procedures was the result of virulent and antibiotic-resistant bacterial strains. CONCLUSIONS: In situ replacement was a safe and durable option in most (64%) patients presenting with prosthetic graft infection. In situ replacement with a rifampin-bonded graft was effective for S epidermidis graft infection, but when the entire prosthesis is involved with either a biofilm or invasive perigraft infection, in situ autogenous vein replacement is preferred. Virulent graft infections presenting with sepsis, anastomotic dehiscence, or graft enteric fistula should continue to be treated with total graft excision, and if feasible, staged ex situ bypass graft.

Aged↗

Advances in male contraception.

The methods devised for male contraception are meager. The authors review the various nonhormonal methods applied for contraception including vas deferens interference and heat. The former comprises the no-scalpel vasectomy, percutaneous vasal injection, the "Shug" method, and the argon laser vasal photocoagulation. Heat methods used wet heat, and artificial cryptorchidism was created by testicular suspension. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitch and ball. Two recently developed methods for male contraception--polyester-induced azoospermia and prolactin injection--are described. The azoospermic effect of the polyester sling seems to be due to (1) creation of an electrostatic field across the intrascrotal structures, and (2) disordered thermoregulation. Prolactin administration as a contraceptive method is efficient and safe and has the potential to be developed as a male contraceptive. The methods, especially testicular suspension and polyester suspensors, are simple and easily applicable and were well accepted by the subjects.

Animals↗

Pyrolysis of composite plastic waste.

Several different composite plastics were pyrolysed in a fixed bed reactor at final temperatures between 350 and 800 degrees C. The composites studied were polyester, phenolic, epoxy, vinylester, polypropylene and PET resins, reinforced with glass and/or carbon fibre. The product yields of oil gas and solid residue were determined together with a detailed composition of the derived gases. There was evidence to suggest that calcium carbonate filler, present in the polyester and phenolic composites, decomposed to form carbon dioxide at 800 degrees C, which was subsequently involved in char gasification reactions. Polyester, phenolic and epoxy composites generated highly aromatic, oxygenated condensable products. There was no noticeable correlation between the composition of these products and the final pyrolysis temperature. The tensile strength of recovered glass fibre was lower than that of virgin fibre and decreased markedly as the final pyrolysis temperature increased from 650 to 800 degrees C.

Conservation of Natural Resources↗

Hyperbranched polymers as drug carriers: microencapsulation and release kinetics.

The aim of this work was to study the feasibility of hyperbranched polymers as drug carriers by employing different microparticle formation methods and the influence of loading methods on release kinetics. Commercially available hyperbranched polyester (Perstorp) and three polyesteramides (DSM) were loaded with the pharmaceutical acetaminophen. The gas antisolvent precipitation (GAS), the coacervation, and the particles from gas saturated solutions (PGSS) are among conventional processes that were used to prepare microparticles of drug-loaded hyperbranched polyesters for the first time. For preparing solid dispersions of drug-loaded hyperbranched polyesteramides the solvent method was applied. Infrared (IR) and differential thermal analysis (DTA) studies suggest that acetaminophen is partly dissolved in the polymer matrix and partly crystallized outside the polymer matrix. For acetaminophen-loaded polyesters prepared by the GAS method, the presence of free drugs is predominant when compared to microparticles prepared by the coacervation method. This event disappears for microparticles prepared by the PGSS method. Moreover, the release of drug from drug-loaded Bol-GAS is biphasic, where the initial burst (48%), indicating the presence of unincorporated drugs, is followed by a slow-release phase, suggesting the diffusion of drug through polymer matrices. The release of drugs from drug-loaded Bol-PGSS do not show this behavior since the drug is better dissolved or dispersed in polymer matrices. In the case of drug-loaded polyesteramides, coevaporates prepared from 3 hyperbranched structures (H1690, H1200, and H1500) using the solvent method result in different release kinetics. The hydrophobic characteristic of hyperbranched polyesteramide H1500 shows the biphasic release kinetic whereas the drug released from hydrophilic matrices H1690 and H1200 exhibits fast release comparable to that of pure drug.

Acetaminophen↗

Deep prosthesis infection in incisional hernia repair: predictive factors and clinical outcome.

OBJECTIVE: To evaluate the incidence of prosthetic infection in incisional hernia repairs, to determine whether there are any factors associated with prosthetic infection and to describe the clinical outcome. DESIGN: Retrospective clinical study. SETTING: Teaching hospital, Germany. SUBJECTS: 121 consecutive patients who underwent incisional hernia repair in our department from December 1994 to December 1999. INTERVENTION: Hernia repair by implantation of an alloplastic prosthesis by the Stoppa-Rives technique. MAIN OUTCOME MEASURES: Postoperative deep prosthetic infection and associated factors. RESULTS: All 121 patients had the mesh implanted in the subfascial plane, 77 had a polypropylene mesh (Prolene) (64%), 7 had a polyester mesh (Mersilene) (6%), and 37 patients had a expanded polytetrafluoroethylene patch (ePTFE, Gore-Tex) (31%). Postoperatively the mesh became infected in 8 patients (7%), a mean of 4.5 months (range 0.5-16) after hernia repair. All three infected ePTFE patches had to be removed whereas drainage was sufficient treatment for the infected polypropylene and polyester meshes. CONCLUSION: Once a mesh infection is verified adequate drainage seems to be sufficient for polypropylene and polyester meshes but ePTFE patches should be removed.

Aged↗

Foreign body reaction to meshes used for the repair of abdominal wall hernias.

OBJECTIVE: To investigate the local tissue reactions to meshes that had been removed from humans. DESIGN: Open study SETTING: Surgical department of the technical University, Aachen, Germany. MATERIAL: Samples of 17 non-absorbable meshes (1 polyester, 10 polypropylene, 2 reduced polypropylene, and 4 polytetrafluorethylene, PTFE) and 1 absorbable mesh (polyglactin 910) that had been implanted for repair of abdominal wall defects. INTERVENTIONS: Light and transmission electron microscopy, immunohistochemistry, and histological examination. MAIN OUTCOME MEASURES: Signs of inflammatory response. RESULTS: Light microscopy showed chronic inflammatory tissue reaction, even after years, with pronounced differences among materials. Partial volume of inflammatory cells (%) varied from 32 in polypropylene, to 12 in expanded PTFE, 8 in polyester, and 7 in reduced polypropylene. Formation of connective tissue correlated significantly with the extent of the inflammatory reaction (p<0.01). In meshes implanted for long periods there were still numerous macrophages at the interface between tissue and polypropylene (45%), polyester (45%), expanded PTFE (25%), and reduced polypropylene (22%). There was no difference in time dependent tissue reactions (p = 0.19). CONCLUSION: Inflammation around alloplastic materials used to repair defects in the abdominal wall persists for many years. There was evidence of long term wound complications as a result of persistent foreign body reactions. Further studies are required to evaluate the long term tissue response to these materials.

Abdominal Muscles↗

Microwave fixation: in situ tick (Acari: Ixodidae) histoanatomy, thin sectioning of tick tissues, and antigen preservation in mouse spleen.

Microwave irradiation was used for the fixation of eggs, nymphs, and adult Boophilus spp. ticks. Although optimal temperatures for fixation of the different tick stages varied, heating to 58 degrees C of adult ticks submerged in either PBS or fixative was found to be sufficient. After microwave fixation, whole adult ticks, hand held, were sectioned with a sharp razor blade. The resulting sections revealed the in situ histoanatomy of the tick. Thin sections of ticks were obtained after either paraffin or polyester wax embedding. Microwave fixation combined with polyester wax embedding made serial thin sections of the different stages of Boophilus ticks possible. The technique preserved antigens as demonstrated by the immunostaining of lymphocytes and erythrocytes infected with Babesia microti in mouse tissues subjected to the same treatment as the ticks. With the microwave fixation-polyester wax technique, the specimen preparation time from fixation to the section on the glass slide was reduced to less than 8 h.

Animals↗

Narrowband impedance matching layer for high efficiency thickness mode ultrasonic transducers.

A new matching layer design concept has been proposed for narrowband continuous wave (CW) devices. Analysis has shown that the mechanical impedance of a resonant-type transducer in thickness mode CW operation does not equal its acoustic impedance rhoVs but roughly equals rhoVs/Q, where p is density, Vs is acoustic velocity, and Q is the mechanical quality factor. The value of rhoVs/Q is much lower than the acoustic impedance of water for any transducer material, including lead zirconium titanate (PZT), single crystals, or polyvinylidene fluoride (PVDF). With this new approach, the impedance of the matching layer must also be between water and pVs/Q, but there are few such practical low impedance materials. To realize equivalent low impedance structure, a novel double layer design is presented: a relatively low impedance material (such as polyethylene or polyurethane) on the inside and a relatively high impedance material (such as polyester or metal) on the outside. A high power CW transducer structure was designed and fabricated with PVDF-TrFE (polyvinylidene fluoride trifluoroethylene) to operate at 1.4 MHz. The basic quarter wavelength resonator structure is 0.7-mm alumina/0.2-mm piezo-polymer/0.25-mm polyester, and the matching section is 0.2-mm polyurethane and 0.25-mm polyester. A maximum power output of 6 to 9 W/cm2 with conversion efficiency of 30 to 35% was observed. For the transducer without matching section, the observed power was 3 to 4 W/cm2. Mason's model analyses (1) predict that the traditional matching layer is for broadband purposes and reduces output power both for PZT and PVDF-TrFE (2); this new matching scheme can be applied to PZT high power transducer. This high efficiency technique has application in various CW systems, such as Doppler sensors, interferometry, phase-sensitive imaging, or high energy focused beam systems.

Aluminum↗

Development of equine models of inflammation. The Ciba-Geigy Prize for Research in Animal Health.

Two experimental models of acute non-immune inflammation have been developed to enable studies of the biochemical composition and cellular content of exudates to be undertaken. Both are based on the creation of a mild, reproducible and reversible inflammatory reaction, which is free from uncontrolled incidental factors and which causes minimal distress to the experimental animals. The polyester sponge model involves the insertion of small polyester sponge strips soaked in sterile carrageenan solution into subcutaneous neck pouches and their serial removal. The tissue-cage model is based on the initial insertion of a spherical tissue-cage subcutaneously in the neck and the subsequent stimulation with carrageenan of the granulation tissue which lines and permeates the cage. The acute inflammatory exudates have been shown to contain eicosanoids with prostaglandin E2 predominant. Polymorphonuclear leucocyte numbers increased progressively in the polyester sponge model, whereas cell numbers were maximal at 12 hours in the tissue-cage model. The relationships between eicosanoid formation at the site of inflammation and leucocyte accumulation, enzyme release, total protein content of exudates and the temperature of the lesions have been investigated.

6-Ketoprostaglandin F1 alpha↗

MR imaging of soft-tissue changes after percutaneous transluminal angioplasty and stent placement.

PURPOSE: To evaluate the different tissue reactions at magnetic resonance (MR) imaging after balloon dilation and placement of covered and uncovered stents. MATERIALS AND METHODS: Contrast material-enhanced MR imaging was performed in 14 patients with polyester-covered nitinol stents, 10 patients with conventional metallic stents, and 12 patients who underwent peripheral percutaneous transluminal angioplasty. Lesions were located in the subclavian, iliac, femoral, and popliteal arteries. RESULTS: MR imaging demonstrated perivascular soft-tissue inflammation in 11 of 14 (79%) patients with polyester-covered stents. Eight (57%) of these patients showed clinical symptoms. No reaction was found among the group with uncovered stents and those who underwent peripheral percutaneous transluminal angioplasty. CONCLUSION: The polyester-covered nitinol stent can induce systemic and severe local reactions. These reactions seem to be specific to this type of stent. No definite cause has been established, although the phenomenon appears to be self-limiting.

Aged↗

History of peritoneal access development.

The first peritoneal accesses were devices that had been used in other fields (general surgery, urology, or gynecology): trocars, rubber catheters, and sump drains. In the period after World War II, numerous papers were published with various modifications of peritoneal dialysis. The majority of cases were treated with the continuous flow technique; rubber catheters for inflow and sump drains for outflow were commonly used. At the end of the 1940s, intermittent peritoneal dialysis started to be more frequently used. Severe complications of peritoneal accesses created incentive to design accesses specifically for peritoneal dialysis. The initial three, in the late 1940s, were modified sump drains; however, Ferris and Odel for the first time designed a soft, polyvinyl intraperitoneal tube with metal weights to keep the catheter tip in the pelvic gutter where the conditions for drain are the best. In the 1950s, intermittent peritoneal dialysis was established as the preferred technique; polyethylene and nylon catheters became commercially available and peritoneal dialysis was established as a valuable method for treatment of acute renal failure. The major breakthrough came in the 1960s. First of all, it was discovered that the silicone rubber was less irritating to the peritoneal membrane than other plastics. Then, it was found that polyester velour allowed an excellent tissue ingrowth creating a firm bond with the tissue. When a polyester cuff was glued to the catheter, it restricted catheter movement and created a closed tunnel between the integument and the peritoneal cavity. In 1968, Tenckhoff and Schechter combined these two features and designed a silicone rubber catheter with a polyester cuff for treatment of acute renal failure and two cuffs for treatment of chronic renal failure. This was the most important development in peritoneal access. Technological evolution never ends. Multiple attempts have been made to eliminate remaining complications of the Tenckhoff catheter such as exit/tunnel infection, external cuff extrusion, migration leading to obstruction, dialysate leaks, recurrent peritonitis, and infusion or pressure pain. New designs combined the best features of the previous ones or incorporated new elements. Not all attempts have been successful, but many have. To prevent catheter migration, Di Paolo and his colleagues applied the old idea of providing weights at the catheter tips to Tenckhoff catheters. In another modification, Twardowski and his collaborators created a permanent bend to the intra-tunnel portion of the silicone catheter to eliminate cuff extrusions. The Tenckhoff catheter continues to be widely used for chronic peritoneal dialysis, although its use is decreasing in favor of swan-neck catheters. Soft, silicone rubber instead of rigid tubing virtually eliminated such early complications as bowel perforation or massive bleeding. Other complications, such as obstruction, pericatheter leaks, and superficial cuff extrusions have been markedly reduced in recent years, particularly with the use of swan-neck catheters and insertion through the rectus muscle instead of the midline. However, these complications still occur, so new designs are being tried.

Animals↗

Does prosthetic covering of nitinol stents alter healing characteristics or hemodynamics?

PURPOSE: To evaluate placement of polyester (Dacron) coverings on nitinol stents implanted in the canine aorta to determine the effect on cross-sectional lumen area, development of intimal hyperplasia, device endothelialization, and flow hemodynamics. METHODS: Ten polyester-covered and 10 uncovered nitinol stents (60-mm length, 10- or 12-mm diameter) were deployed percutaneously in the normal infrarenal aorta of 20 adult mongrel dogs using random assignment. Angiography, intravascular ultrasound (IVUS), and duplex ultrasound performed at device deployment and before explantation at 6 weeks were used to measure aorta/device diameter and cross-sectional area. Pressure-perfusion-fixed aortic segments were compared for surface endothelialization (CD31 staining) and for thickness of neointimal formation. RESULTS: All 20 endoluminal devices were accurately positioned in the infrarenal aorta without early or delayed evidence of device thrombosis, significant lumen narrowing, or device deformity. IVUS and duplex scanning identified no anatomical stenosis in either the covered or the bare devices by duplex ultrasound; peak systolic velocity measurements were similar (106+/-25 cm/s in the covered stent versus 96+/-25 cm/s for bare stents, p > 0.05). Mean neointimal thickness was significantly greater (p < 0.005) in the covered (326+/-145 microm) compared with the bare (219+/-62 microm) stents. Intima-to-media height ratios were greater in the covered stents (3.0+/-1.1 compared with 1.1+/-0.2, p < 0.003). Mean surface area endothelialization in the proximal, middle, and distal sections of each device was similar (p > 0.05) in covered (59%, 56%, and 69%) and bare (59%, 65%, and 53%) stents. CONCLUSIONS: Deployment and balloon dilation of a covered nitinol stent in a nondiseased canine aorta increased neointimal development compared with an uncovered stent, but overall lumen cross-sectional area was preserved. No differences in device patency, intradevice thrombus formation, flow hemodynamics, or luminal endothelialization were demonstrated, despite a thicker intradevice neointima induced by the polyester covering.

Alloys↗