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At least 55 records · Page 3Linked to original sources
PubMed2003

Standardization of occupational dose to patient DAP enables reliable assessment of radiation-protection devices in invasive cardiology.

PURPOSE: With the aim of assessing the effectiveness of radiation-protection devices in invasive cardiology, the goal of this study was to validate relative parameters for operator occupational exposure, standardized to the patient's primary dose. MATERIAL AND METHODS: One of these parameters was the local dose, measured in air at the operator's position per dose area product (DAP), applied to a male anthropomorphic Alderson-Rando phantom for simulation of coronary angiography. The second parameter was personal occupational dose to the operator per DAP, measured by thermoluminescence dosimeter stripes during 121 procedures in routine clinical work. RESULTS: The local and personal doses per unit DAP - using typical 0.5-mm lead overcouch and undercouch protection - were comparable (left eye 180 vs. 360, thyroid 260 vs. 260, left shoulder 280 vs. 150, chest 400 vs. 500, hands 400 vs. 550, waist 900 vs. 400 nSv/Gy x cm (2)). The results, however, were far lower than typically reported values. Our findings therefore disclose a typically inadequate use or acceptance by individual operators of available table-attached lead protection devices, and of ceiling-attached lead-glass screens. The additional use of individual 1.0-mm lead-equivalent garments reduced local doses to levels between 1. 10 %. CONCLUSIONS: DAP-standardized dose parameters - determined experimentally (phantom measurements), or in routine clinical work - are not appreciably influenced by the equipment age and type, or by the image-intensifier entrance dose rate of the respective catheterization system. They are consequently best suited for obtaining eloquent comparisons of various radiation-protection devices, and for reliable estimation of local scatter radiation exposure by simple documentation of intervention DAP.

Computer Simulation↗
PubMed2006

Association between health information, use of protective devices and occurrence of acute health problems in the Prestige oil spill clean-up in Asturias and Cantabria (Spain): a cross-sectional study.

BACKGROUND: This paper examines the association between use of protective devices, frequency of acute health problems and health-protection information received by participants engaged in the Prestige oil spill clean-up in Asturias and Cantabria, Spain. METHODS: We studied 133 seamen, 135 bird cleaners, 266 volunteers and 265 paid workers selected by random sampling, stratified by type of worker and number of working days. Information was collected by telephone interview conducted in June 2003. The association of interest was summarized, using odds ratios (OR) obtained from logistic regression. RESULTS: Health-protection briefing was associated with use of protective devices and clothing. Uninformed subjects registered a significant excess risk of itchy eyes (OR:2.89; 95%CI:1.21-6.90), nausea/vomiting/dizziness (OR:2.25; 95%CI:1.17-4.32) and throat and respiratory problems (OR:2.30; 95%CI:1.15-4.61). There was a noteworthy significant excess risk of headaches (OR:3.86: 95%CI:1.74-8.54) and respiratory problems (OR:2.43; 95%CI:1.02-5.79) among uninformed paid workers. Seamen, the group most exposed to the fuel-oil, were the worst informed and registered the highest frequency of toxicological problems. CONCLUSION: Proper health-protection briefing was associated with greater use of protective devices and lower frequency of health problems. Among seamen, however, the results indicate poorer dissemination of information and the need of specific guidelines for removing fuel-oil at sea.

Acute Disease↗
PubMed2005

Usefulness of embolic protection devices during saphenous vein graft intervention in a nonselected population.

Distal embolic protection devices have been shown to reduce the risk of peri-procedural complications associated with saphenous vein graft intervention. However, there are several important anatomic limitations that may preclude routine device use. We analyzed the angiograms of 624 consecutive saphenous vein graft interventions to determine eligibility for use of a proximal or distal embolic protection system. Overall, 483 (77%) of cases had anatomic and lesion characteristics suitable for an embolic protection device, including 59% eligible for proximal protection and 57% for distal protection.

Angioplasty, Balloon↗
PubMed2003

[Percutaneous carotid angioplasty with stent implantation and protection device against embolism--a prospective study of 100 consecutive cases].

BACKGROUND AND OBJECTIVE: Percutaneous transluminal angioplasty and stenting of internal carotid artery stenosis has been increasingly practiced as an alternative to carotid embolectomy, particularly since the development of cerebral protection devices. 100 consecutive elective percutaneous carotid stenting procedures were carried out in our centre. We here present the clinical outcome and follow-up of these patients. PATIENTS AND METHODS: 69 men and 22 women, average age 69 +/- 10 years with symptomatic (41 %) or asymptomatic and progressive (59 %) > 80 % stenosis of the internal carotid artery were treated. There was a high rate of co-morbidity and a high vascular risk. 64 % would have been excluded from the NASCET trial because of one, 31 % because of two or more contraindications. In 84 % of the patients symptomatic coronary artery disease was present, in 13 % a significantly reduced left ventricular function (LVEF < 40 %).Pre- and post-procedure all patients were given aspirin and clopidogrel and examined by an independent neurologist. 99 stents were placed with the use of an embolic protection device (28 times with distal balloon occlusion, 72 times with a filter device).The follow-up period averaged 10.4 +/- 8.2.(1 - 29 months). RESULTS: The angiographic success rate was 99 %. During the procedure transient neurological symptoms were experienced by 4 % of patients (2x TIA,2x PRIND) and a minor stroke resulted in two. In 90 % of the interventions debris was collected from the embolic protection device. The maximum diameter of particles was 311+/-431 (30 - 1850) micro m. There was some correlation between patients' symptoms prior to stent implantation and maximum particle size (p < 0,04),but none with any other angiographic or clinical parameters. The combined endpoint (death and any stroke) after 30 days occurred 5 times (5 %). A subacute stent thrombosis occurred once, restenosis in two patients. CONCLUSION: Carotid artery stenting with use of a distal embolic protection device is a feasible new alternative to carotid endarterectomy. Our results indicate high success rate and low complication rates, even in patients with severe co-morbidity. The results compare well with surgical figures. Our favourable results are supported by data emerging from current randomized multicenter trials and a large therapy registry. However, long-term follow-up will still be required.

Adult↗
PubMed2004

Embolic protection devices for carotid artery stenting: better results than stenting without protection?

AIMS: Carotid artery stenting (CAS) for carotid artery stenoses has become an alternative to carotid endarterectomy. However, CAS itself can cause cerebral ischaemic events. Embolic protection devices (PD) promise to reduce the incidence of these events. METHODS AND RESULTS: From July 1996 to March 2003, 1483 patients from 26 hospitals were included in the prospective CAS Registry of the ALKK study group. A PD was used in 668 of 1483 patients (45%). The use of a PD has grown rapidly over the years and reached 100% in 2003. Patients treated with a PD had prior carotid artery dilatation more often (3.5% versus 1%, p < 0.001), a prior myocardial infarction (34% versus 27.4%, p = 0.007) and a history of arterial hypertension (89.9% versus 78.6%, p = 0.007) compared to patients treated without a PD. A thrombus was more often visible in patients treated under distal protection (16.5% versus 8%, p < 0.001). The use of a PD led to a 10-min longer intervention (45 min versus 35 min median, p < 0.001). Patients treated with a PD had a lower rate of ipsilateral stroke (1.7% versus 4.1%, p = 0.007) and a lower rate of all non-fatal strokes and all deaths (2.1% versus 4.9%, p = 0.004) during the hospital stay. This was confirmed by multiple logistic regression analysis (adjusted OR = 0.45, 95% CI: 0.23-0.91, p = 0.026). A similar reduction could be found for symptomatic as well as asymptomatic carotid artery stenoses. CONCLUSION: Since 1996 there has been a steady increase in the use of PDs for CAS, with a 100% use in 2003. The use of a PD may lower the rate of ipsilateral strokes during CAS.

Aged↗
PubMed2005

Renal angioplasty and stenting: long-term results and the potential role of protection devices.

Renal angioplasty and stenting have become the first treatments to be proposed to patients presenting with renal artery stenosis. The immediate technical success rate is high, with a low complication rate and good long-term patency. In most reports, renal stenting has been proven to improve blood pressure. However, despite good immediate- and long-term results, postprocedural deterioration of renal function is a concern, and may occur after renal artery angioplasty and stenting in 20 to 40% of patients, which limits the immediate benefits of this technique. Of the causes of this deterioration in renal function, atheroembolism seems to play an important role. Contrary to earlier beliefs that atheroembolization is not an issue during percutaneous catheter interventions, there is now mounting evidence that distal atherosclerotic debris commonly embolizes from lesions in many vascular territories during percutaneous interventions. Atheroembolism seems to be the root cause of many procedural complications wherever atherosclerotic lesions are treated. Distal embolization was first demonstrated in saphenous vein grafts and now, clinical data are proving that similar embolization and distal-organ complications also occur during catheter treatment in certain native coronary lesions, carotid stenting and renal artery stenting, demonstrating the role and efficacy of protection devices to reduce the incidence of end-organ complications. The same protection devices (protection balloon and filters) utilized for coronary or carotid procedures may be used to protect the kidney from atheroembolism. In this review, the authors discuss recently published data concerning the techniques and results of renal angioplasty and stenting procedures performed under protection, and evaluate the benefits of this technique on renal function and its role in the future. Indications for this technique need to be discussed.

Angioplasty↗
PubMed2005

Procedure complications of carotid angioplasty and stent placement without cerebral protection devices.

OBJECT: The goal in this retrospective study was to examine the procedural complication rate for carotid angioplasty and stent placement performed without cerebral protection devices. METHODS: Between March 1996 and December 2003, 167 carotid angioplasty and/or stent placement procedures were performed without cerebral protection devices in 152 patients (57 women and 95 men whose mean age was 64 years, range 19-92 years). Seven of these patients underwent angioplasty alone. Eighty-nine patients presented with focal neurological symptoms. Indications for surgery included atherosclerosis, radiation-associated stenosis, dissection, pseudoaneurysm, and stretched endovascular coils from aneurysm treatment. In this study, the patients' medical records were reviewed for clinical characteristics, techniques used, and resulting intraprocedural and 30-day complication rates. The intraprocedural stroke rate was four (2.4%) of 167; this included three hemispheric strokes and one retinal embolus. All events occurred in patients who had symptomatic stenosis. The procedural transient ischemic complication rate was six (3.6%) of 167, as was the procedural nonneurological complication rate. During the 30 days postprocedure, one patient had died and three had suffered permanent ischemic events (two cerebral and one ocular). The composite 30-day postprocedural stroke and death rate was eight (5%) of 160. The rate of asymptomatic angiographically confirmed abnormalities was 0.6% (one treated vessel that was occluded but asymptomatic). The 30-day rate of nonneurological complications was 2.5%. A strong association between intraprocedural thromboembolic events (eight cases) and prior ischemic symptoms was found (p = 0.01). CONCLUSIONS: Carotid angioplasty and stent placement without cerebral protection devices is safe, particularly in patients without symptomatic stenosis.

Adult↗
PubMed2005

Eligibility for use of proximal or distal embolic protection devices during percutaneous intervention for acute myocardial infarction.

Although there has been enthusiasm for using embolic protection devices in acute myocardial infarction, it is unclear how often these devices can be used in nonselected patients. The aim of this study was to evaluate potential eligibility for use of either proximal or distal embolic protection during primary or rescue percutaneous coronary intervention in a consecutive, nonselected population. We analyzed the angiograms of 259 consecutive patients with ST-segment elevation myocardial infarction to determine eligibility for use of either type of protection device. Overall, 202 (78%) patients had anatomy suitable for embolic protection, including 154 (59%) who were eligible for proximal protection, 128 (49%) who were eligible for distal protection, and 80 (31%) who were eligible for both devices. Patients eligible for proximal protection were more likely to have a right coronary culprit, whereas patients eligible for distal protection were more likely to have a lesion in the left anterior descending coronary artery.

Aged↗
PubMed2001

Facial fractures in a level I trauma centre: the importance of protective devices and alcohol abuse.

Urban trauma centres have recently noted a shift in the causative mechanism of facial fractures away from motor vehicle crashes (MVC) to blunt assaults (BA). This study was conducted to examine the incidence and aetiology of facial fractures at our institution as well as the relationship with alcohol and protective device use. Trauma registry records of all patients admitted to a level I trauma centre from 1 January 1988 to 1 January 1999 were reviewed. There were 13594 trauma admissions during the 11-year period. Facial fractures were sustained by 1429 patients (10.5%) and this group forms the subject of this study. MVC was the predominant aetiology (59.9%) followed by BA (18.8%). Facial fractures were found in 9.5% of restrained MVC patients compared to 15.4% of unrestrained patients (P<0.00l). Non-helmeted motorcyclists were four times more likely to sustain facial fractures (4.3% vs. 18.4%) than helmeted patients (P<0.00l). 39.6% of patients in the MVC group were legally intoxicated compared to 73.5% in the BA group (P<0.00l). 45.4% of unrestrained patients with facial fractures were intoxicated compared to 11.8% of restrained MVC patients with facial fractures (P<0.001). MVC continue to be the primary aetiology of facial fractures in our trauma population. Protective devices decrease the incidence of facial fractures. Lack of protective device use and the consumption of alcohol correlate with sustaining facial fractures.

Accidents, Traffic↗
PubMed1987

A protective device for pacemaker generators in children.

A protective device comprised of a pad and a holster was devised for the external protection of a pacemaker generator implanted in the left infraclavicular position in children. The device was accepted by the child and their caretakers and presented no problems during sports activities. The psychological side effects were beneficial and encouraged the child to normal activity and participation in organized sports.

Child↗
PubMed2001

Carotid artery stenting: utility of cerebral protection devices.

Neurologic deficits secondary to embolic events have been the most significant concern regarding carotid bifurcation stenting. Experimental studies utilizing human carotid plaques have shown that embolic particles were released from all specimens. In addition, transcranial Doppler studies have confirmed the fact that multiple emboli are released during each case. Preliminary experiences with the use of cerebral protection devices for carotid stenting have shown encouraging results with embolic particles recovered from each case, although these experiences have also revealed some of the down sides of its use. The present article provides the rationale for routine use of these protection devices and also reviews various protection devices, some of which are currently undergoing clinical trials.

Blood Vessel Prosthesis Implantation↗
PubMed1982

Physiological and psychological adaptation to respiratory protective devices.

This study was conducted to investigate the adaptation process to respiratory protective devices (RPD). Twenty healthy subjects were tested at 80% of their Vo2 max for 6 consecutive days with a fitted RPD with an airway resistance of 2.80 +/- 0.07 cm H2O s/1. It was concluded that working with RPD at a work capacity close to maximum for several minutes per day induces a rapid adaptation process. This is demonstrated by an improvement in physiological parameters rather than in subjective sensations.

Adaptation, Physiological↗
PubMed1993

The noise exposed factory workers: the prevalence of sensori-neural hearing loss and their use of personal hearing protection devices.

A total of 524 industrial workers were studied. They consisted of 442 noise exposed and 82 non-noise exposed workers. The purpose was to compare the prevalence of sensori-neural hearing loss among the noise exposed and the non-noise exposed workers, to study their knowledge on the hazard of noise to hearing and the workers' attitude towards the hearing protection devices. The prevalence of sensori-neural hearing loss was significantly higher among the noise exposed workers, i.e., 83% versus 31.7% (p < 0.01). However, the prevalence of hearing impairment was much lower for both groups, being 30.1% for the noise exposed and 3.7% for the non-noise exposed group. Although hearing protection devices were provided to 80.5% of the workers, only 5.1% were wearing them regularly. The possibility of developing hearing loss due to exposure to excessive noise was only known by 35.5% of the noise exposed workers. This awareness was found to have a positive correlation with the workers' compliance to the hearing protection devices. Our findings highlight the need for workers to be educated on the hazards of excessive noise exposure to hearing.

Auditory Threshold↗
PubMed2002

Comparison and modification of two cerebral protection devices used for carotid angioplasty: in vitro experiment.

The effectiveness of two basic cerebral protection devices designed for carotid angioplasty with and without additional aspiration techniques was compared in an in vitro model. During carotid angioplasty, embolization was simulated by injecting polyvinyl alcohol particles of different sizes into the model system. None of the tested devices, all of which were positioned in the internal carotid artery, was able to completely prevent embolization. In the internal carotid artery, the rate of particle capture did not vary among protection devices. However, embolization into the external carotid artery was more frequent with use of the GuideWire, as compared with that with use of the Angioguard.

Angioplasty, Balloon↗
PubMed1990

Adaptation to discomfort in personal protective devices: an example with safety helmets.

Discomfort in the use of personal protective devices (PPD) has been one of the chief causes of their non-use. A field trial using industrial helmets was carried out to ascertain whether by training and repeated wearing subjects could experience a significant adaptation to discomfort. Ten subjects took part in the trial in a tropical environment by wearing helmets repeatedly (6 h a day) for one month. Subjective evaluations of discomfort were made at the end of the 1st, 3rd, 5th, 14th and 30th day. It was revealed that complaints of discomfort, viz. hotness, heaviness, bad fit, etc., decreased markedly throughout the 30 day period. Though positive responses of adaptation to discomfort seem to reach an optimum towards 30 days, it is difficult to draw any conclusions on the optimum period of adaptation for each discomfort factor. In relation to inherent discomforts that are extremely difficult to overcome without compromising the protection efficiency of a PPD, the principle of adaptation seems to be a very important facet which has to be developed for an effective PPD programme.

Adult↗