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PubMed1999

Effects of earplugs and protective headgear on auditory localization ability in the horizontal plane.

The purpose of this study was to determine how well humans localize sound sources in the horizontal plane while wearing protective headgear with and without hearing protection. In a source identification task, a stimulus was presented from 1 of 20 loudspeakers arrayed in a semicircular arc, and participants stated which loudspeaker emitted the sound. Each participant was tested in 8 conditions involving various combinations of wearing a Kevlar army helmet and two types of earplugs. Testing was conducted at each of 2 orientations (frontal and lateral). In the frontal orientation, overall error was slightly greater in all protected conditions than in the bare-head control condition. In the lateral orientation, overall error score in the protected conditions was substantially and significantly greater than in the bare-head control conditions. Most errors in the lateral orientation were accounted for by front-back confusions, indicating that the protective devices disrupted high-frequency spectral cues that are the basis for discriminating front from back sound sources. The results have practical implications for the use of protective headgear and earplugs in industrial or military environments where localization of critical sounds is important.

Adult↗
PubMed2006

An increased platelet-leukocytes interaction at the culprit site of coronary artery occlusion in acute myocardial infarction: a pathogenic role for "no-reflow" phenomenon?

BACKGROUND: Distal protection devices have been shown to reduce the incidence of "no flow" phenomenon during primary percutaneous coronary intervention (PCI). So far, it has not been well clarified which mechanism is mainly involved in distal coronary protection. AIM: To investigate the activation state of leukocytes and platelets locally present within the blood from the site of coronary occlusion. METHODS: Ten patients with acute myocardial infarction (AMI) underwent primary PCI with an embolization protection device and aspiration catheter (PercuSurge GuardWire) were included. The following functional parameters: a) monocyte and neutrophils surface molecules; b) platelet surface activatory antigens; c) leukocytes-platelet conjugates were studied by flow cytometry in blood obtained from the site of coronary occlusion and from peripheral femoral artery. RESULTS: The leukocyte-platelet adhesion index was significantly higher in the aspirated blood at the site of coronary occlusion than in the peripheral arterial blood for both monocytes (0.226+/-0.04 vs. 0.084+/-0.01; p=0.004) and neutrophils (1.372+/-0.3 vs. 0.524+/-0.1; p=0.02). Moreover, the volume of coaggregates exhibited a significant increase in coronary blood for both populations (p=0.02 for monocytes and for neutrophils). Interestingly, a significant up-regulation of the adhesive molecule CD18 was observed in coronary blood respect to systemic circulation either in monocytes (p=0.01) than in neutrophils (p=0.003). A significant up-regulation of monocyte (HLA-DR) and neutrophil (CD66b) activatory molecules expression was also observed in the aspirated coronary compared to peripheral artery blood (p=0.02 and p=0.03 for HLA-DR and CD66b, respectively). CONCLUSIONS: These data indicate an increased leukocyte-platelet functional interaction in AMI at the site of plaque rupture relative to the systemic circulation, which may be one of the pathogenetic mechanisms responsible for myocardial "no-reflow" phenomenon.

Angioplasty, Balloon, Coronary↗
PubMed2003

A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study.

Hub colonization and subsequent intraluminal progression due to frequent opening and manipulation of intravenous systems is the cause of many catheter-related infections (CRI). A prospective, comparative, randomized study was performed to assess a new closed-needleless hub device (CLAVE) compared with conventional open systems (COS). End-points were hub and skin colonization, catheter tip colonization, catheter-related bloodstream infection (CRBSI) and number of accidental needlesticks. All cultures were processed following standard semiquantitative microbiological techniques. The study involved patients who underwent heart surgery over an 11-month period in a post-surgical ICU. During the study period, 352 patients underwent major heart surgery and 1774 catheters were inserted. Overall, 865 catheters in 178 patients were allocated to the CLAVE system and 909 catheters in 174 patients to COS. The groups were similar regarding underlying conditions and risk factors for infection. Comparison of endpoint results in CLAVE and COS groups was as follows: incidence density per 1000 catheter-days of tip colonization: 59.2 versus 83.6 (P=0.003); of hub colonization: 7.56 versus 24.66 (P=0.0017); of skin colonization: 41.5 versus 58.9 (P=0.038); and of CRBSI 3.78 versus 5.89 (P=0.4). There was one accidental needlestick and one catheter-related prosthetic endocarditis in the COS group. Multivariate analysis showed that CLAVE use was an independent protective factor for tip colonization. CLAVE offered significant protection from catheter-tip and hub colonization.

Aged↗
PubMed2000

The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men.

PURPOSE: We report our experience with 166 patients who underwent radical cystectomy and orthotopic bladder substitution with the ileal Kock neobladder between February 1990 and January 1999. MATERIALS AND METHODS: We classified complications as early (3 months or less postoperatively) and late. Continence was assessed by patient interview, the need to use protective devices and provocative incontinence testing. Neobladder function was evaluated by uroflowmetry, post-void residual urine volume measurement and enterocystometry, and renal function was assessed by 51creatinine ethylenediaminetetraacetic acid clearance. RESULTS: There were no perioperative deaths. However, 52 early complications developed in 39 patients (23.5%) and 73 late complications in 62 (37.4%). The rate of early and late complications associated with the urinary tract was 11.5% and 23.5% with abdominal reoperation rates of 1.8% and 2.4%, respectively, due to these complications. At 3 and 5 years the risk of stone formation on the metallic staples was 18% and 34%, and the risk of B12 deficiency was 30% and 33%, respectively. One patient (0.6%) underwent reoperation for ureteral anastomotic stricture. Anterior urethral stricture in 5 cases (3%) was caused by recurrence in 1 and urethral anastomotic stricture in 1 also resulted from recurrent disease. Daytime continence was reported by 97% and 100% of our patients at 1 and 5 years, respectively. Provocative incontinence testing confirmed this level of daytime continence. Overall 75% of patients reported nighttime continence at 1 year and 94% at 5 years. The need for a nighttime protective device decreased with time. At 1 versus 3 years 39.8% versus 45.9% of patients used no protection, 29.7% versus 39.2% used a sanitary pad and 30.5% versus 14.9% used a condom device. Enterocystometric capacity and subtracted maximum reservoir pressure remained remarkably uniform at 456 versus 411 ml. and 47 versus 50 cm. water 6 months and 5 years postoperatively, respectively. Nevertheless, median post-void residual urine volume increased from 20 ml. at 6 months to 40 ml. at 5 years with an increased prevalence of patients requiring intermittent catheterization due to post-void residual urine greater than 100 ml. from 16% at 6 months to 44% at 5 years. 51Creatinine ethylenediaminetetraacetic acid clearance remained unchanged. There was a substantial 5-year survival advantage for the subpopulation with stage pT3a or less, pN0 tumors (94% versus 51%, p <0.001). CONCLUSIONS: Radical cystectomy and orthotopic bladder substitution with the Kock ileal neobladder may be performed with an acceptable complication rate and good functional results. The probability of survival was considerably higher for patients with tumor confined to the bladder. Consequently we believe that early aggressive treatment should be considered in those with invasive disease, and reconstruction with orthotopic bladder substitution may encourage patients to accept radical surgery.

Adult↗
PubMed1996

Technology advancements in hearing protection circa 1995: active noise reduction, frequency/amplitude-sensitivity, and uniform attenuation.

Conventional hearing protection devices represent a mature technology that has been widely used since the late 1950s. When worn consistently and correctly such devices can provide suitable hearing protection in many, if not most noise-hazardous or aurally annoying situations. However, such devices have often been implicated in compromised auditory perception, degraded signal detection, and reduced speech communication abilities. In some instances this can create hazards for the wearer, or at the very least, resistance to use by those in need of hearing protection. Recent technological developments have been used to augment hearing protectors in an attempt to alleviate these problems for the user while providing adequate attenuation. Operational characteristics, design alternatives, performance data, and applications for active noise reduction, active sound transmission, frequency selectively, adjustable attenuation, amplitude sensitivity, and uniform attenuation features in hearing protectors are discussed, and recommendations are provided.

Acoustics↗
PubMed2005

Angioplasty and stenting of the cervical carotid bifurcation under filter protection: a prospective study in a series of 53 patients.

The aim of this study is to assess safety, reliability, ease of use and usefulness of filter protection devices during angioplasty and stenting of stenotic lesions of the cervical carotid bifurcation. Over a period of 42 months, 53 patients harboring a cervical carotid bifurcation stenotic lesion were treated, by angioplasty and/or stenting using filter protection devices of different kinds. The stenosis was atherosclerotic in 48 cases, post-surgical in four and post-radiation in one case. In all cases, the treatment was successful, with good restoration of the luminal diameter. There were three major strokes (5.6%) and one minor stroke (1.9%). Two of these (one major, one minor) occurred a few hours after the stenting procedure and both seemed by all evidence due to a hemorrhagic hyperperfusion syndrome. One hemiparesis and dysphasia occurred two days after the procedure, secondary to subacute thrombosis with occlusion of the stent. One patient complained of three episodes of decrease in visual acuity of the eye ipsilateral to the stenting in the two weeks following treatment. In conclusion, in our experience, use of the devices adds only few minutes to the procedure time; direct lesions of the arterial wall, such as dissections or intraluminal thrombi, related to the use of filters were never observed, and spasm of the distal I.C.A. also proved rapidly regressive. The content of all filters, if any, was histologically examined, but plaque material was found only in one case, probably owing to our primary stenting technique without use of pre-dilation. The major technical drawback is in-filter coagulation, which occurred in 16 cases, occluding the membrane of the filter and thus slowing or blocking intracranial flow. Such an event can be counteracted by a more aggressive anti-coagulation protocol, which could, however, be responsible for the two complications with hemorrhagic brain infarction. Furthermore, we observed two other major neurological events, which bring the incidence of neurological complications in this series as high as 7.5%. Therefore, it is our opinion that safety of filters is not yet proven, and consequently great care must be taken in their use.

Aged↗
PubMed2005

What is the latest in inventory for carotid stenting and cerebral protection?

Carotid angioplasty is fast being incorporated into the treatment options for patients with carotid occlusive disease. The results of the SAPPHIRE and ARCHER trials have demonstrated that carotid angioplasty and stenting with the use of cerebral protection devices is not inferior to open surgical endarterectomy in high-risk patients. The limiting step for percutaneous carotid interventions was the potential for cerebral embolization during the intervention. However, the ready availability of several embolic protection devices has placed this technology into the hands of many endovascular specialists. A brief outline of the basic inventory necessary for a carotid stent program is presented.

Angioplasty, Balloon↗
PubMed1984

Guidelines for radiation protection in the cardiac catheterization laboratory.

Even though radiation levels in the catheterization laboratory are the highest encountered during any commonly performed diagnostic study, dose levels to laboratory personnel should not approach the maximum permissible. A certain minimum amount of radiation is necessary to produce optimal diagnostic images. Therefore, optimum use of radiation protection devices and measures is essential. The goal should be dose minimization, keeping personnel radiation dose as low as reasonably achievable. In the cardiac angiographic suite this goal can be assumed to have been accomplished if: (1) maximum use is made of suitable radiation protection devices, (2) film-and video-imaging chains are optimized, (3) good radiographic technique is employed, (4) strict ongoing quality control programs are maintained for radiographic equipment and cine processor, and (5) there is compliance with all federal, state and local regulations for the safe use of ionizing radiation.

Allied Health Personnel↗
PubMed2006

Distal embolic protection during percutaneous coronary intervention in patients with acute coronary syndromes: the RUBY study.

OBJECTIVE: To assess the safety and feasibility of the GuardWire system as an embolic protection device during percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). BACKGROUND: Distal embolization occurs in approximately 15% of patients after primary angioplasty and is associated with reduced myocardial reperfusion, more extensive myocardial damage and a poor prognosis. Distal embolic protection could reduce the rate of embolic complications and improve outcome. METHODS: 329 patients (mean age 60+/-12 years) were included: 278 (84.5%) with ST-elevation myocardial infarction (STEMI), 50 (15.2%) with unstable angina/non-STEMI and 1 (0.3%) with post-infarction angina. Primary endpoint was the incidence of major adverse cardiac events (MACE) at 30 days. Secondary endpoints were the magnitude of ST-segment resolution at 90 and 180 min post-procedure, myocardial blush grade, and angiographically visible distal emboli. RESULTS: The GuardWire system was successfully positioned in 99% of patients. Complete ST-elevation resolution (>70%) was observed in 28.5% immediately post-procedure, and in 35.4% and 41.6% at 90 and 180 min post-procedure. TIMI-3 flow grade was achieved by 89.8% of patients after intervention and mean corrected TIMI frame count was 20.2+/-13.2. Grade-3 myocardial blush was seen in 47.7% of patients and distal emboli were angiographically visible in 7.4%. Incidence of MACE at 30 days was 3.3% (death 1.2%; Q-wave MI 0.3%; non-Q-wave MI 0.3%; coronary artery bypass graft 0.6%; repeat PCI 0.9%). CONCLUSION: The GuardWire system was successfully positioned in nearly all patients without complications. The use of this embolic protection device in ACS patients undergoing PCI was associated with low rates of distal embolization and 30-day MACE.

Angioplasty, Balloon, Coronary↗
PubMed2000

New developments in endovascular interventions for extracranial carotid stenosis.

We provide an overview of recent developments in carotid interventional technique and equipment, including new stents and emboli protection devices. The newer self-expanding stents lessen the problem of external stent compression associated with balloon expandable stents, but precise deployment and the matching (by length) of stents to lesions remain problematic. We also discuss emerging pharmacologic strategies for cerebral protection in stroke. Multiple randomized clinical trials and multicenter registries are under way to compare percutaneous with surgical strategies for the treatment of carotid stenosis. These include the evaluation of emboli protection devices, and, to a lesser degree, intravenous glycoprotein IIb/IIIa antagonists. Other clinical trials are aimed towards refining the ability to stratify patients by risk, in order to identify the subsets that would benefit most from these complex and expensive procedures.

Angioplasty, Balloon↗
PubMed1987

Neurologic aspects of boxing.

The assessment and prevention of potentially adverse neurologic consequences of boxing requires two important considerations. Acute neurologic injuries should be distinguished from chronic brain injuries and the level of competitive boxing (ie, amateur vs professional) must also be taken into account. Acute neurologic injuries such as concussion, post-concussion syndrome, intracranial hemorrhage, and brain contusion are more readily identified than chronic neurologic injuries because of their immediate devastation of the nervous system. In contrast, chronic neurologic injuries differ in their pathophysiologic mechanisms that are exemplified by an insidious onset and progression after the cessation of boxing. Accordingly, the chronic traumatic encephalopathy of boxing poses the most serious neurologic threat of boxing. Amateur boxing differs from professional boxing in the duration of fights, rules and regulatory policies, medical evaluation, and protective devices. These factors could produce a differential effect on the risk of injury to the brain. The prevention of neurologic injuries in boxing requires the integration of proper neurologic evaluation by qualified ring-side physicians, the design and utilization of effective protective devices, and the establishment of national regulatory agencies.

Athletic Injuries↗
PubMed1994

Environmental control of tuberculosis: continuing controversy.

The incidence of tuberculosis--and, more important, that of multidrug-resistant tuberculosis--have risen drastically in the past decade. Nosocomial outbreaks have alerted health-care workers to the hazards of the spread of tuberculosis. The use of environmental control modalities (e.g., ventilation, air filtration, and ultraviolet irradiation) and personal protective devices has been explored in the medical, legislative, and public forums. New regulations and legislation have created controversy over the recommendations and their interpretation. In this review we present the theory behind the rational selection of environmental-control modalities and personal protective devices. We also offer suggestions about the application of specific control techniques and the revision of existing facilities to comply with new standards.

Air Microbiology↗
PubMed2004

"No-reflow" phenomenon during percutaneous carotid angioplasty in a scleroderma patient.

Atherosclerosis remains the most common etiology of carotid artery stenosis, but other systemic diseases can also cause this disease. Percutaneous carotid angioplasty and stenting (CAS) with and without distal embolic protection devices is gaining acceptance as the treatment of choice. No-reflow phenomenon due to distal embolization has been previously described mainly during percutaneous intervention of degenerated saphenous vein graft. We describe a patient with systemic sclerosis who underwent CAS with distal embolic protection device with occurrence of no-reflow phenomenon during the procedure that resolved after retrieval of the filter device.

Aged↗
PubMedDate not supplied

Limitations to the value of the Sapphire trial.

The Sapphire trial was organised as a randomised trial to compare carotid endarterectomy (CEA) with carotid angioplasty and stenting (CAS) using a protection device in so called high risk patients. The trial concluded that CEA and CAS were similar as far as stroke and death are concerned but CAS was superior when other complications were taken into account. The trial was flawed for several reasons. It was commercially funded and the inventor of the protection device was one of the investigators and therefore not in equipoise. The end points of the trial favoured CAS by making a biochemical myocardial event an end point. The surgeons doing CEA in the trial did relatively few CEA'S per year and had a high stroke and death rate. These surgeons also excluded over 400 patients from the trial because they were said to be too difficult or risky to operate on. The precise reasons for this exclusion have never been made clear except that the surgeons were probably inexperienced. Finally the patients were heterogeneous, more than 70% being asymptomatic or suffering from recurrent stenosis. For all of these reasons the Sapphire trial's conclusions that CAS is equivalent to CEA in high risk patients cannot be scientifically justified.

Angioplasty↗
PubMed2004

Routine use of cerebral protection during carotid artery stenting: results of a multicenter registry of 753 patients.

PURPOSE: To evaluate the short-term outcome of patients who underwent carotid stenting with the routine use of cerebral protection devices. METHODS: In five centers, 808 successful stent procedures (of 815 attempted) were performed in 753 patients (557 [74%] men; mean [+/- SD] age, 70 +/- 8 years). Cerebral protection involved distal filter devices (n=640), occlusive distal balloons (n=144), or proximal balloon protection (n=24). RESULTS: The protection device was positioned successfully in 793 (98.2%) of the 808 attempted vessels. Neurologic complications occurred within 30 days after 46 procedures (5.6%), including seven major strokes, 17 minor strokes, and 22 transient ischemic attacks. There were four deaths (one following a major stroke). The 30-day incidence of stroke and death was 3.3% (27/815). The rate of stroke or death was 3.8% (8/213) for symptomatic lesions and 3.2% (19/602) for asymptomatic lesions (P=0.87), and 3.4% (25/729) in patients aged <80 years and 2% (2/86) in those aged > or =80 years (P=0.81). Protection device-related vascular complications, none of which led to neurologic symptoms, occurred after nine procedures (1.1%). CONCLUSION: In this uncontrolled study, routine cerebral protection during carotid artery stenting was technically feasible and clinically safe. The incidence of major neurologic complications in this study was lower than in previous reports of carotid artery stenting without cerebral protection.

Aged↗
PubMedDate not supplied

Field study of subjective assessment of negative pressure half-masks. Influence of the work conditions on comfort and efficiency.

The aim of this study was to assess the effects of work conditions on the acceptability and efficiency of respiratory protective devices (RPD). The subjective evaluation of comfort, protection, respiratory and visual constraint, and the acceptable duration of wear of six RPDs against dust was achieved by 30 workers during their actual work. Metabolic rate was evaluated for each worker, and dry and wet air temperatures measured in the work area. RPDs objective protection factor was measured during each of the 180 test periods. In the conditions of this study, the acceptable duration of wear was about 1 h. This duration and the comfort parameters were reduced when the air temperature increased. The younger workers and/or smokers were less sensitive to mask discomfort. Objective protection factors of the RPDs are reduced under warmer conditions, and when the metabolic rate is low. Finally, the results of this study also show the poor capacity of standardized leakage tests to assess the objective respiratory protection of workers in the field. Some hypotheses which can explain this fact are discussed.

Adult↗
PubMed1992

Blood lead levels in incinerator workers.

Questions have been raised concerning the safety of mass burn incineration and its role in solid waste management. In 1989, the New York City Office of Occupational Safety and Health examined air levels of metals in New York City incinerators and found that workers were exposed to air lead levels as high as 2500 micrograms/m3 while cleaning the electrostatic precipitators in the plant. In order to determine the biologic significance of these exposures to the workers, blood samples were taken from 56 incinerator workers and 25 controls and analyzed for lead and erythrocyte protoporphyrin levels. Incinerator workers were found to have a mean blood lead of 11.0 micrograms/dl as compared to the control group level of 7.4 micrograms/dl. Risk factors for increased blood lead levels were analyzed using multiple regression analyses. Wearing a personal protective device "always" or not and the interaction of smoking and cleaning the precipitator more than seven times in the past year were found to be significant predictors for blood lead. These results indicate that lead in municipal incinerator ash from electrostatic precipitators is bioavailable and that the effects of such exposure can be minimized by wearing personal protective devices, not smoking, and rotating the work force to minimize precipitator ash contact.

Air Pollutants, Occupational↗