Biomedical subjects

R M Fujitani

Publications and source records attributed to R M Fujitani.

At least 37 records · Page 2Linked to original sources

PubMed1993

Combined coronary artery bypass and abdominal aortic aneurysmectomy: appropriate management in selected cases.

Patients with aortic aneurysms frequently have concomitant coronary artery disease, which carries the potential for significantly increased perioperative morbidity. Most cases of severe surgically correctable coronary artery disease can and should be treated by a separate operation before aneurysmectomy to lower operative cardiac morbidity and enhance long-term survival. Infrequently, a patient can have both unstable coronary disease and a large symptomatic aortic aneurysm. In this situation, a single procedure combining coronary artery bypass followed by aneurysmectomy, as illustrated by this case report, is a reasonable option and should be considered in the cases of carefully selected patients.

Aged↗

PubMed1993

Revision of the failing vein graft: outcome of secondary operations.

Infrainguinal vein bypass continues to be widely accepted as providing effective palliation for disabling claudication and limb salvage in patients with arterial insufficiency of the lower extremity. The development of lesions that may threaten vein graft patency are presently an inevitable consequence of arterial reconstruction in the atherosclerotic patient. However, long-term patency has been sustained by detection and intervention for inflow, outflow, or intrinsic graft lesions. The excellent secondary (assisted primary) patency rates achieved for both reversed and in situ vein grafts affirm the importance of a noninvasive surveillance protocol and a low threshold for reintervention before actual graft failure.

Blood Vessel Prosthesis↗

PubMed1993

A reevaluation of intraarterial thrombolytic therapy for acute lower extremity ischemia.

PURPOSE: This study was performed to clarify the role of intraarterial thrombolytic therapy (IATT) in the management of acute lower extremity ischemia. METHODS: A retrospective review of 77 patients undergoing 84 courses of high-dose regional urokinase IATT from July 1981 to June 1991 was performed. The group included patients with acute thrombosis of lower extremity bypass grafts (n = 48) or native arteries (n = 36), presenting with ischemic but viable limbs, minimal or no motor dysfunction, and an absence of muscle rigor or compartment syndrome. The data were then examined individually by site of thrombosis to evaluate patient selection for IATT. RESULTS: Complete lysis, complications (either distal thromboembolism or bleeding), and early limb loss occurred in 59.5%, 11%, and 6% of infusions, respectively. IATT precluded the need for operative intervention in 49% of acutely ischemic limbs. When surgery was required, successful IATT precisely localized responsible lesions and reduced the magnitude of operation. A subset of 13 patients were identified in whom either no intrinsic abnormality or poor runoff were evident after lysis and were treated with anticoagulation alone. CONCLUSIONS: These data show IATT to be especially suitable for thrombosis of native iliac or femoropopliteal arteries and infrainguinal vein grafts. IATT serves primarily as an adjunct in management of acute lower extremity ischemia. After successful IATT, subsequent therapy can be tailored to the anatomic cause of thrombosis.

Femoral Artery↗

PubMed1992

The influence of groin sepsis on extraanatomic bypass patency in patients with prosthetic graft infection.

Twenty-seven vascular prosthetic graft infections in 25 patients were managed from 1981 through 1990 using the principles of extraanatomic bypass through uncontaminated fields and removal of the infected prosthesis. This experience included 18 aortic, three femoral-femoral, three femoral-popliteal, two axillofemoral grafts, and one popliteal endarterectomy patch. The predominant organism was Staphylococcus epidermidis (26%). Mean follow-up was 36 months. There was only one early and one late death, with two late amputations. Extraanatomic bypass grafts were placed in 21 of 25 patients including all 18 infected aortic grafts. Of these 21 patients, 11 (52%) experienced at least one extraanatomic bypass failure within 15 months, resulting directly in two major lower extremity amputations and two graft reinfections. Axillounifemoral bypass had a higher incidence of failure than axillobifemoral bypass (54% versus 29%). More importantly, however, extraanatomic graft failure was also associated with the presence of groin sepsis. The revision rate was 63% when the graft required circuitous tunneling to avoid groin sepsis, in contrast to a revision rate of only 17% when the graft could be anastomosed directly to the common femoral artery. Of extraanatomic bypass grafts that failed once, 63% had multiple failures. Graft removal and extraanatomic revascularization produced excellent overall results when not involving the groin. Late complications occurred more frequently when groin sepsis was present. These results suggest that, to reduce the incidence of late graft failure and amputation, more aggressive early direct reconstruction should be performed in lieu of atypical graft tunneling, especially if the extraanatomic graft has failed once and the causative organism is Staphylococcus epidermidis.

Bacterial Infections↗

PubMed1992

Contribution of routine intraoperative completion arteriography to early infrainguinal bypass patency.

To determine the clinical utility of routine intraoperative completion arteriography, we prospectively evaluated 214 consecutive infrainguinal bypass grafts (209 reversed-vein and 5 polytetrafluoroethylene grafts) performed from July 1987 to August 1991. Visual inspection, pulse palpation, and continuous-wave Doppler examination were performed in all cases. At least 1 completion arteriogram was obtained in 213 cases (99%). The bypasses were to the popliteal artery in 130 cases and to the tibial or pedal arteries in 84 cases. Graft patency was confirmed at 30 days in all patients by ankle-brachial index determinations (greater than 0.2 increase) and duplex scan-derived peak-systolic flow velocities (greater than 45 cm/s). Significant technical problems requiring revision were identified in 18 grafts (8%), including 6% of popliteal grafts and 12% of tibial/pedal grafts. Only three of these problems were suspected by pulse palpation or continuous-wave Doppler examination. The intraoperative angiographic findings leading to revision included distal anastomotic stenoses (n = 6), distal arterial disease requiring sequential bypass (n = 4), mid-graft valvular or branch ligature stenoses (n = 4), distal arterial thrombosis (n = 2), and graft kink or twist (n = 2). Thirty-day primary patency was 99% (129 of 130) for femoropopliteal grafts and 93% (78 of 84) for femorodistal grafts. Secondary patency was 100% (130 of 130) and 96% (81 of 84), respectively. Primary patency was 89% (16 of 18) for those grafts that required intraoperative revision based on arteriographic findings. We conclude that routine completion arteriography is an excellent method of ensuring the intraoperative technical adequacy of infrainguinal bypass. The test is easy to perform, reproducible, and should be considered the "gold standard" for intraoperative bypass assessment. Prior to adopting angioscopy or duplex scanning for intraoperative surveillance, randomized, controlled validation studies against angiography should be performed.

Aged↗

PubMed1992

The effect of unilateral internal carotid arterial occlusion upon contralateral duplex study: criteria for accurate interpretation.

To determine the influence of unilateral internal carotid arterial occlusion (ICO) on Doppler frequency spectral analysis (DFSA) of the patent contralateral carotid artery, a retrospective review of 154 patients between July 1987 and December 1991 with angiographically confirmed ICO was performed, correlating duplex and arteriographic findings in a blinded fashion. Biplane arteriograms and bilateral carotid artery duplex studies that used a 5.0 MHz Doppler probe with a 1.5 mm3 sample volume at a 60 degree angle of insonation were performed on all patients. Each carotid artery was categorized by the severity of stenosis as quantified by arteriography: 1% to 15% (n = 41); 16% to 49% (n = 48), 50% to 79% (n = 21), 80% to 99% (n = 34), and bilateral occlusion (n = 10). DFSA peak systolic frequencies were commonly exaggerated in the presence of contralateral ICO and use of standard criteria for DFSA interpretation overestimated bifurcation stenoses in 43 of 89 lesions (48.3%) when determining nonhemodynamically significant lesions (less than 50% diameter reduction) with a sensitivity of only 57.3% and specificity of 96.9%. Conversely, prediction of hemodynamically significant lesions (greater than 50% diameter reduction) with standard criteria had 96.9% sensitivity but only 57.3% specificity. Modification of these criteria to account for the velocity increase or "jet effect" in the ipsilateral carotid artery system increased the sensitivity and specificity to 97.8% in predicting nonhemodynamically and hemodynamically significant stenoses respectively. A Doppler frequency spectrum with a peak systolic frequency (PSF) greater than 4.0 kHz and end-diastolic frequency (EDF) less than 5 kHz with an "open window" distinguished lesions with less than 50% diameter reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗

PubMed1992

Cryopreserved saphenous vein allogenic homografts: an alternative conduit in lower extremity arterial reconstruction in infected fields.

Autologous saphenous veins are considered the best arterial substitute for lower extremity revascularization in infected fields. The search continues for a vascular conduit in instances when an autologous biologic grafting is not feasible. Herein we report our experience with eight patients in whom cryopreserved saphenous vein allogenic homografts were used in 10 lower extremity arterial reconstructions for limb salvage with coexisting infection. Six patients with eight prosthetic grafts including four femoropopliteal, two femorotibial, a femorofemoral, and a femoroperoneal graft required complete or partial graft excision as a result of overt infection. The two remaining patients included one with an infected femoral pseudoaneurysm and another with extensive chemical burns. All cryopreserved saphenous vein allogenic homografts were of identical match to the ABO/Rh blood groupings of the recipient patients. No immunosuppressive drugs were administered after operation. Mean follow-up was 9.5 months (range, 6.0 to 14.0 months). One patient died 5 weeks after operation with a patent graft. Two grafts occluded during follow-up; in one graft, patency was restored with thrombectomy alone. The remaining seven arterial reconstructions continue to be patent with no evidence of aneurysmal dilation with complete eradication of the primary infection. These preliminary findings suggest that cryopreserved saphenous vein allogenic homografts can serve as interim conduits for lower extremity arterial reconstruction to preserve limb viability when autogenous conduits are unsatisfactory or unavailable. Further definitive reconstruction may thereafter be necessary once sepsis is eradicated and sufficient wound healing is achieved.

Aged↗

PubMed1991

The retroperitoneal, left flank approach to the supraceliac aorta for difficult and repeat aortic reconstructions.

Between 1986 and 1990, 11 patients with relative or absolute contraindications to standard infrarenal reconstructions underwent supraceliac aortofemoral bypass. The operation was performed through a left-flank incision extended into the eleventh intercostal space with retroperitoneal and extrapleural dissection. Indications included multiple failed infrarenal reconstructions in four patients, previous removal of infected aortofemoral bypass graft with failure of extra-anatomic bypass in five patients, prior para-aortic lymph node dissection and radiotherapy in one patient, and aortic aneurysmal disease proximal to the renal arteries in one patient. Bypass conduits included either a bifurcated Dacron graft or a tube graft to the left femoral artery with a femorofemoral cross-over graft; concomitant left renal artery reconstruction was performed in three patients. The mean supraceliac cross-clamp time was 24 minutes, and only one patient experienced transient postoperative acute tubular necrosis. There was no operative mortality. The graft limb patency was 95% after mean follow-up extending to 17 months (range: 5 months to 5 years). We conclude that the supraceliac aorta is a useful inflow source for aortofemoral reconstruction in difficult repeat cases. It can be approached easily without thoracotomy and avoids difficult infrarenal aortic dissection in a scarred field. The tunneling is easier than with descending thoracic aorta or ascending aorta inflow sources. In addition, this bypass is likely to be more durable than inflow reconstructions based on the axillary artery.

Aorta, Abdominal↗

PubMed1990

Experimental and early clinical evaluation of vascular anastomoses with argon laser fusion and the use of absorbable guy sutures: a preliminary report.

This study investigated the feasibility of forming vascular anastomoses by use of argon laser tissue fusion and absorbable, monofilament polydimethylsiloxane guy sutures. In initial animal studies femoral arteriovenous fistulas approximately 1.5 cm in length were created bilaterally in each of 10 dogs and were studied histologically at 2, 4, 8, 16, and 24 weeks (two animals in each interval). In each animal, one anastomosis (control) was formed with continuous 6-0 polypropylene suture, and the contralateral anastomosis (experimental) was performed with an argon laser (0.5 watt, 5 to 7 minutes exposure, energy fluence 1100 to 1500 joules/cm2 per 1 cm length) with stay sutures of 5-0 polydimethylsiloxane at 0.5 to 0.65 cm intervals. At removal, all anastomoses were patent without hematomas, aneurysms, or luminal narrowing. Histologic examination at 2 to 16 weeks demonstrated resorption of the biodegradable suture material by a local inflammatory reaction. By 24 weeks, laser-fused specimens had no evidence of suture material at the anastomotic line, and healing consisted of a bond between artery and vein wall tissues. Control suture specimens at the same intervals exhibited an organized fibrous tissue response to the suture. Clinical adaptability of this technology has subsequently been evaluated in five patients at 10 to 27 months (21.6 +/- 5.8) by physical examination and duplex scanning and demonstrate no evidence of abnormal healing. This study establishes the experimental and preliminary clinical feasibility of laser-fused anastomoses aligned by biodegradable guy sutures and supports further investigation and refinement of the technique.

Adult↗

PubMed1989

Argon laser vascular fusion: venous and arterial bursting pressures.

This study was designed to determine the optimal laser power (watts) for maximal strength of argon laser vascular fusions by measuring bursting pressures of repairs. Longitudinal incisions (n = 105) measuring either 2.5 or 5 mm in length were performed in canine femoral, carotid, and jugular veins and arteries and were fused with the argon laser at 0.3, 0.5, 0.7, or 0.9 W power. Total exposure time for each repair (50 to 80 sec/0.5 cm) was adjusted to yield identical energy fluences of 1,100 J/cm2. Bursting pressure of the fusions was determined by monitored infusion of anticoagulated blood into an isolated segment of the vessel that contained the fusion. Mean bursting pressures for venous and arterial repairs were significantly higher in the 2.5 mm incisions compared with the 5 mm incisions (P less than 0.05). Venous and arterial repairs of equal length performed at each power resulted in equivalent bursting strengths, except that 5 mm venous segments fused with 0.9 W withstood lower pressures than all other venous repairs (P less than 0.05), and 5 mm arterial segments were in turn significantly weaker at 0.3 W (P less than 0.02). We conclude that argon laser fusion is equally suitable for repair of medium-sized veins and arteries and that immediate strength decreases with increasing length of repair. To maximize strength of longer repairs, venotomies should be welded at power settings between 0.3 and 0.7 W while arteriotomies should be fused at power settings between 0.5 and 0.9 W. The differences in optimal power may be explained by variable wall composition and thickness between veins and arteries.

Animals↗

PubMed1989

Initial human evaluation of argon laser-assisted vascular anastomoses.

Forearm Brescia-Cimino arteriovenous fistulas were chosen for the initial clinical evaluation of argon laser-assisted anastomosis of human vessels. Ten patients with chronic renal failure had side-to-side radial artery/cephalic vein fistulas fused by laser. Incisions 1.2 to 1.5 cm in length were made in adjacent segments of artery and vein and were aligned for application of laser energy by four 6-0 polypropylene sutures. The sutures divided each fistula into four segments that were 5.0 to 6.5 mm long. Each segment was sealed satisfactorily in 75 to 100 seconds by use of 0.5 W, 1130 to 1520 joule/cm2 argon laser energy fluence. Seven (17.5%) of 40 bonds required an additional 7-0 biodegradable suture to close small gaps that did not fuse adequately. Serial prospective follow-up studies of the patients by physical examination and duplex scanning for periods of 12 to 20 months (15.4 +/- 2.8, n = 7) postoperatively have shown uniformly patent, compliant anastomoses with no evidence of hematomas, false aneurysms, or luminal narrowing. Histologic examination of two patent fistulas that were excised during revision procedures at 4 and 5 months postoperatively showed healing of the entire circumference of the anastomosis similar to that noted in extensive preclinical canine studies. We conclude from these preliminary results that argon laser vascular tissue fusion is possible in humans when reliable primary sealing of vascular anastomoses is achieved, and that healing occurs without aneurysmal dilatation during follow-up of up to 20 months.

Adult↗

PubMed1988

Mechanism of tissue fusion in argon laser-welded vein-artery anastomoses.

The mechanism of laser vascular tissue welding remains unknown. This study compared the acute tissue response and long-term healing of sutured and laser-welded anastomoses of vein segments used to bypass ligated canine femoral arteries. For each procedure, one anastomosis was formed using running 6-0 polypropylene suture (control), and the other anastomosis was formed using argon laser tissue welding (experimental). The vein grafts were harvested at 4 (n = 2), 8 (n = 1), 12 (n = 1), and 16 (n = 2) weeks, and selected samples were evaluated by histologic examination, electron microscopy, tensile strength testing, and by measuring the formation of [3H]hydroxyproline as an index of collagen synthesis. Examination of successful laser fusions immediately after they were formed showed bonding of collagen to collagen and elastin to collagen. Follow-up evaluations showed that the precision of tissue apposition affected the rate of healing and tensile strength. Laser-welded anastomoses demonstrated a progression of healing similar to sutured repairs, with remodeling of fibrous tissue and collagen being the primary component of weld integrity. This study demonstrates that sutured and argon laser-welded vein-artery anastomoses heal comparably up to 16 weeks postoperatively, and that laser welding is a satisfactory alternative to sutured anastomoses.

Animals↗

PubMed1988

Perioperative suppression of platelet adherence to small-diameter polytetrafluoroethylene (PTFE) grafts.

The perioperative effect of platelet antagonists on small-diameter polytetrafluoroethylene (PTFE) grafts was evaluated in forty-six New Zealand white male rabbits receiving either dipyridamole (DPM) 100 mg/kg/day (n = 10; group 1), aspirin (ASA) 10 mg/kg/day (n = 10; group 2), a combination of ASA 10 mg/kg/day and DPM 10 mg/kg/day (n = 9; group 3) or 100 mg/kg/day (n = 10; group 4), or placebo (n = 7) as single daily doses. All regimens began 72 hr prior to insertion of a 20 x 3-mm internal diameter PTFE interposition aortic graft. Autologous indium-111 labeled platelets were injected immediately after implantation. Graft and an equivalent segment of aorta were harvested after 48 hr. Graft platelet adherence index (GPAI) was calculated as the graft:reference aorta ratio of emissions. The GPAI in the control group was 238 +/- 46 (mean +/- SD). Single regimen antiplatelet agents in groups 1 and 2 reduced mean GPAI to 47 +/- 38 and 40 +/- 12, respectively. The combination regimen in group 3 lowered mean GPAI to 43 +/- 8 and in group 4 to 21 +/- 7. Platelet uptake in PTFE grafts at 48 hr is significantly lowered to 8.8 to 19.7% of control by perioperative antiplatelet agents given as a single daily oral dose (P less than 0.001). ASA alone and DPM alone provided similar suppression of platelet uptake, but combination ASA + low dose or high dose DPM gave significantly greater (P less than 0.001) suppression of early platelet deposition than the single agent regimens. These results support perioperative administration of combination oral antiplatelet agents as adjunctive therapy in small diameter prosthetic graft implantation.

Animals↗

PubMed1988

Thermal studies of in-vivo vascular tissue fusion by argon laser.

There are conflicting opinions regarding the mechanism of welding or fusion of vascular tissue by lasers. In this study, we measured the effects of saline irrigation on tissue temperature and fusion produced by argon laser welding of eight femoral and four carotid arteriovenous fistulas. Temperatures were continuously recorded using a digital thermographic camera. Forty 1-cm. welds were performed using powers of 0.50 (n = 24), 0.75 (n = 8), and 1.00 (n = 8) watt (W), with an energy fluence of 1100 J/cm2 per 1 cm segment, and cooling of the anastomotic site by saline irrigation (3 ml/minute). The "success" of fusions was determined by testing integrity of the repairs by exposure to blood flow. At 0.50 and 0.75 W, successful welds were formed when the temperatures were 44.2 +/- 1.6 (n = 28) and 55.0 +/- 3.6 degrees C (n = 20), with maximum temperatures of 47.9 and 59.9 degrees C respectively. At 1 W, the tissue was desiccated and the welds disrupted when exposed to blood flow with temperatures measured at 63.7 +/- 10.0 degrees C (n = 22) and maximum of 88.0 degrees C. Eight welds were also attempted without saline irrigation at 0.25 (n = 4) and 0.50 W (n = 4). At 0.25 W, tissue fusion was achieved but disrupted when exposed to intraluminal pressures with temperatures 50.3 +/- 2.0 degrees C (n = 10) and maximum of 52.6 degrees C. At 0.50 W, the fusion failed after only minimal exposure to the laser energy because of tissue drying and retraction with temperatures measured at greater than 125 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1988

Canine peripheral vascular arteriosclerosis following myointimal fragmentation and atherogenic diet.

The development of arteriosclerotic peripheral vascular lesions following balloon catheter and mechanical fragmentation of the arterial myointima combined with an atherogenic diet was studied in a canine model. The ileofemoral arteries of five mongrel dogs (mean wt 22 +/- 2 kg) were selectively cannulated and subjected to balloon catheter and mechanical myointimal injury by repeated longitudinal and transverse shearing forces. Twenty grams of hydrogenated coconut oil and a 5.0% cholesterol diet were fed to the animals daily during the study period. Followup angiographic studies obtained at 4 weeks (n = 2), 10 weeks (n = 3), 16 weeks (n = 3), and 24 weeks (n = 2) demonstrated changes of progressive peripheral vascular occlusion. Concurrent duplex Doppler studies correlated well with the angiographic results. At 10 (n = 1), 18 (n = 2), and 24 (n = 2) weeks, the animals were sacrificed and the vessels were perfusion-fixed in situ with 2% glutaraldehyde or formaldehyde solutions and excised. Histological examination demonstrated extensive arteriosclerotic changes including (i) fragmentation and reduplication of the internal elastic membrane, (ii) myointimal hyperplasia with fibroblastic proliferation including the development of fibrous intimal plaques, and (iii) transmigration and proliferation of smooth muscle cells with scattered monohistiocytes. The specimens showed a range of stenotic changes from 25% to total occlusion of the vascular lumen. These preliminary data demonstrate the feasibility of providing intense arteriosclerotic myointimal histologic changes in the canine peripheral vasculature within a 24-week period. Further refinement of this methodology may provide a practical model for studies of localized peripheral vascular occlusive disease.

Animals↗

PubMed1988

Comparison of indium 111 oxine-labeled platelet aggregation between sutured and argon laser-assisted vascular anastomoses.

The thrombogenicity of argon laser-assisted vascular anastomoses (LAVAs) was compared with that of sutured vascular anastomoses (SVAs) by measurement of platelet aggregation at the site of repair in a canine model. Sequential 1 cm longitudinal carotid and femoral arteriotomies (n = 80) or jugular and femoral phlebotomies (n = 80) were performed, with each vessel having two tandem, randomly positioned arteriotomies or phlebotomies separated by a 4 cm length of intact vessel. One incision was repaired by SVA with continuous 6-0 polypropylene sutures and the other by argon LAVA. For the laser fusions, argon laser energy was applied to the adventitial surface of the vessel with a 300 micron fiberoptic probe with 0.5 W power, 1100 joules per square centimeter energy fluence, and 150 second exposure per 1 cm length. The arterial and venous segments of SVAs and LAVAs and an equivalent length of normal vessel were harvested at 48 hours (n = 16, 16, 16), 2 weeks (n = 12, 12, 12), and 4 weeks (n = 12, 12, 12). Autologous indium 111 oxine-labeled platelets were injected intravenously 48 hours before removal of the vascular repairs and the radioactivity of the specimens was determined on removal with a NaI (T1) well-type scintillation counter. Anastomotic platelet adherence index (APAI) was calculated as the ratio of emissions of SVA or LAVA to normal reference vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗

PubMed1988

Preoperative splenic artery occlusion as an adjunct for high risk splenectomy.

High risk splenectomy is often encountered in cases of hypersplenism with massive splenomegaly (10 times usual weight of 150-200 g) resulting from myelophthisic processes. Intra-operative ligation of the splenic artery through the lesser sac is a technically useful method of gaining vascular control prior to mobilizing the challenging spleen. However, a massive or inaccessible spleen imposes mechanical limitations during surgery and may be complicated by torrential intra-operative hemorrhage in the setting of severe thrombocytopenia refractile to platelet transfusions. The authors describe pre-operative intravascular proximal splenic artery control in four adult patients (3 men, 1 woman) with extreme splenomegaly (2,250-10,000 g). The massive splenomegaly in this group resulted from chronic myelogenous leukemia (n = 2), isolated splenic lymphoma (n = 1), and agnogenic myeloid metaplasia (n = 1). Chief symptom manifestations included left upper quadrant abdominal pain, early satiety, post-prandial emesis, dyspnea, petechiae, and associated easy bruising. Prior to surgery, all the patients were taken to the radiology suite where either detachable silastic balloons or stainless steel coils were placed selectively into the splenic artery under fluoroscopic guidance requiring approximately 35 minutes. Splenic artery occlusion aided normalization of thrombocytopenia (average increases 19,000/microliter to 215,000/microliter) with prolongation in survival of platelets. Successful splenectomy was subsequently performed with no additional transfusion requirements and was made technically easier by reducing splenic bulk. There were no adverse consequences of intravascular occlusion and no peri-operative morbidity or mortality. Preoperative intravascular selective splenic artery occlusion, used as an important potential adjunct to anticipated high risk splenectomy, is recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Systemic treatment of venous leg ulcers with high doses of pentoxifylline: efficacy in a randomized, placebo-controlled trial.

Several small studies have indicated that the systemic administration of pentoxifylline may accelerate healing of venous leg ulcers. The goal of this study was to further evaluate these findings in a larger scale placebo controlled trial and to explore the effect of the dose of pentoxifylline on healing. The study used a prospective, randomized, double-blind, parallel group placebo controlled design in a multicenter outpatient setting. Patients with one or more venous ulcer were enrolled, with all patients receiving standardized compression bandaging for treatment for their ulcers. Patients were also randomized to receive either pentoxifylline 400 mg, pentoxifylline 800 mg (two 400 mg tablets), or placebo tablets three times a day for up to 24 weeks. The main outcome measure was time to complete healing of all leg ulcers, using life table analysis. The study was completed as planned in 131 patients. Patients receiving 800 mg three times a day of pentoxifylline healed faster than placebo (p = 0.043, Wilcoxon test). The median time to complete healing was 100, 83, and 71 days for placebo, pentoxifylline 400 mg, and pentoxifylline 800 mg three times a day, respectively. Over half of all patients were ulcer free at week 16 (placebo) and at week 12 in both pentoxifylline groups. Whereas the placebo group had only achieved complete healing in half of the cases by week 16, all of the subjects remaining in the group receiving the high dose of pentoxifylline had healed completely. Treatment with pentoxifylline was well tolerated with similar drop-out rates in all three treatment groups. Complete wound closure occurred at least 4 weeks earlier in the majority of patients treated with pentoxifylline by comparison to placebo. A higher dose of pentoxifylline (800 mg three times a day) was more effective than the lower dose. We conclude that pentoxifylline is effective in accelerating healing of leg ulcers.

Adult↗