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PubMed2002

Treatment of idiopathic subfoveal choroidal neovascular lesions using photodynamic therapy with verteporfin.

PURPOSE: To report the effects of photodynamic therapy using verteporfin in the treatment of patients with subfoveal idiopathic choroidal vascularization (CNV). DESIGN: Interventional case series. METHODS: In a retrospective study, eight eyes of eight consecutive patients aged 55 years or younger with subfoveal idiopathic CNV treated with photodynamic therapy using verteporfin were evaluated. Visual acuity was considered to be improved if the visual angle was halved, while acuity was thought to be worse if the visual angle doubled. RESULTS: The eight patients included three men and five women with a mean (+/- SD) age of 34.6 (+/- 9.7) years (range 25-53 years). The mean follow-up time was 13.5 months. At the end of the follow-up period the visual acuity improved in five eyes (62.5%), remained unchanged in one (12.5%), and decreased in two (25%). The mean acuity improvement was 3.6 lines of Snellen acuity by the end of the follow-up period, a change that was statistically significant (P =.027, Wilcoxon signed-rank test). No patient had any complication from the treatment. CONCLUSIONS: There is no widely accepted method for treating subfoveal idiopathic CNV and all previously investigated methods have had a significant number of serious side effects. Although the follow-up time and the number of patients in this pilot study were limited, the encouraging results and lack of complications suggest that further study is indicated.

Adult↗
PubMed1997

1-Methylxanthine derived from caffeine as a pharmacodynamic probe of oxypurinol effect.

AIMS: In the present study we have investigated the use of caffeine, administered in the form of instant coffee, as a prodrug for 1MX to validate the use of the 1MU:1MX ratio following caffeine administration as a pharmacodynamic measure of oxypurinol effect on xanthine oxidase. METHODS: Five healthy volunteers took caffeine 75 mg 8 hourly administered as instant coffee over a 7 day period. They were given allopurinol 600 mg on day 4. Urine was collected in 8 h aliquots from day 1-day 7. The ratio of 1-methyluric acid (1MU) to 1-methylxanthuric (1MX) was determined. RESULTS: The relationship between the plasma oxypurinol (the active metabolite of allopurinol) concentration at the midpoint of each caffeine dosage interval and the decrement in the urinary 1MX to 1MU ratio fitted well by a sigmoid Emax model. Mean (+/-s.d.) values of the oxypurinol EC50(3.9 +/- 1.4 mg l-1), EC90(8.7 +/- 1.8 mgl-1) and the exponent, n (3.0 +/- 1.2) were similar to those obtained previously following either the direct administration of 1MX or the use of theophylline as a prodrug for 1MX. CONCLUSIONS: These data indicate that the use of caffeine as a source of 1MX could provide a simple and ethically acceptable method for monitoring oxypurinol effect in patients taking allopurinol for the treatment of gout.

Adult↗
PubMed2006

Attitudes of Roma toward smoking: qualitative study in Slovenia.

AIM: To understand the reasons for widespread smoking behavior among Roma in Slovenia for the purpose of developing successful smoking cessation interventions. METHOD: A qualitative focus group approach using a combination of pre-structured and open-ended questions was applied to collect the data from the representative members of the Roma community in southern Slovenia. The discussions were audiotaped and transcribed, and the collected data analyzed according to qualitative content analysis theory. RESULTS: The content analysis revealed that smoking was a strong part of the cultural, ethnic, and individual identity of the Roma. Even children smoked. Doctor's advice to quit smoking was usually not followed and the attempts to quit were usually unsuccessful. Difficult financial situation was never mentioned as a possible motive to quit. Roma held a tenacious belief that the harmful effects of smoking were in the hands of destiny and did not associate the smoking-related illness with the habit. CONCLUSIONS: Traditional strategies for smoking cessation are largely ineffective among the Roma because of their different attitudes toward smoking. Therefore, innovative and culturally acceptable methods need to be developed.

Adolescent↗
PubMed1997

Helper T-lymphocyte count. TRAx CD4 test kit versus conventional flow cytometry.

BACKGROUND: We evaluated a newly developed enzyme-linked immunosorbent assay system for measuring helper T-lymphocyte count. METHODS: Data from 111 human immunodeficiency virus-infected injection drug users in a cohort study were analyzed by flow cytometry and independent duplicate runs of the TRAx enzyme-linked immunosorbent assay. RESULTS: The mean helper T-cell counts were 470, 480, and 506 per microliter by flow cytometry and TRAx runs 1 and 2, respectively. The correlation coefficients for TRAx runs 1 and 2 with the flow cytometry results as the dependent variable were .93 and .91, respectively. A cross-tabulation of the enzyme-linked immunosorbent assay helper T-lymphocyte counts with flow cytometry counts showed agreement of 71% and 76% when the flow count was between 201 and 500, and 88% and 90% when it was greater than 500 cells per microliter. In those samples with 200 or fewer helper T cells, agreement was 73% and 41% for each TRAx run. CONCLUSIONS: The TRAx enzyme-linked immunosorbent assay system is an acceptable method for measuring helper T-lymphocyte count, but should be recalibrated for better performance at helper T-cell counts below 200 per microliter.

CD4 Lymphocyte Count↗
PubMed2004

[25 years review of vascular microsurgery evaluation--perspectives].

Free-tissue transfer has become an accepted method for reconstructing complex surgical defects. We review 25 years' experience of this approach. In France, microsurgery was first performed in 1974. I myself constructed 839 consecutive free flaps in 821 patients during a 25-year period. Here we distinguish between two different indications, namely malignant and benign lesions. In oncology, the patient recovers good quality of life even if the prognosis is poor. In contrast, the transplant offers permanent cure for patients with benign lesions. Microvascular anastomoses were constructed with separated stitches (90% of anastomoses); end-to-end anastomoses were preferred (85%). Manual suture with thread is the best technique. Post-operative flap monitoring included clinical observation, Doppler sonography, thermic probing, and endoscopy. The overall success rate of free flap reconstruction was 95.5%. In cancer patients, surviving flaps resulted in wound healing and did not delay post-operative irradiation or chemotherapy. The incidence of major complications (death 0.36%, necrosis 4.5%) and minor post operative complications (27.1%) was acceptable. The mean hospital stay was 20 days. Careful selection of the transplants yielded good reliability. Six donor sites were sufficient to reconstruct the majority of defects. Teaching of microsurgery is one of our main preoccupations. This is an indispensable technique in all fields of reconstruction. Rigorous training is necessary and much time must be spent before reaching a high level of reliability.

Anastomosis, Surgical↗
PubMed2005

[Evaluation of calf muscle pump function after subfascial endoscopic perforator dissection].

INTRODUCTION: Perforating vein incompetence can be demonstrated in many cases of chronic venous insufficiency. Subfascial endoscopic perforating vein surgery has become an accepted method in the treatment of perforator insufficiency over the past decade. However, what the hemodynamic consequences of perforating vein interruption are, is not clear. OBJECTIVE: To analyse the results of endoscopic perforating vein surgery performed in the authors' department over the past four years. To compare the outcome of the operation in patients with deep venous reflux with those who only had superficial and perforating vein reflux. To analyze the changes in calf muscle pump function with photoplethysmography carried out before and after the operation. METHODS: Subfascial endoscopic perforator dissection was performed on 53 patients who suffered from severe chronic venous insufficiency mainly with active ulcer. With the follow-up of 51 patients, a prospective clinical trial was carried out which consisted of physical examination and Doppler ultrasound, six weeks after the operation and every three months thereafter. The data were analyzed with standard statistical methods. RESULTS: Clinical symptoms improved and proved to be durable in 33 (64%) of 51 patients during the follow-up. The healing rate of 40 patients with venous ulcer was 82% after the operation. 62% of the patients were ulcer-free on a long term. While of the 33 patients with deep venous reflux 17 (52%) showed durable improvement, of the 18 patient who had only superficial and perforating vein insufficiency only 2 patients did not experience improvement. Average venous refilling time of the 33 patients who underwent photoplethysmography increased from 12.5 sec to 14.6 sec after endoscopic perforating vein surgery although significant improvement was demonstrated only on patients who had only superficial venous reflux together with perforating vein insufficiency. CONCLUSIONS: Subfascial endoscopic perforating vein surgery proved to be a successful alternative in the authors' clinical trial in treating patients with severe chronic venous insufficiency. Mid-term evaluation showed excellent results with patients without deep venous reflux and acceptably good outcome with patients with deep venous insufficiency. Improvement of clinical symptoms after endoscopic perforator dissection was followed by significant improvement of calf muscle pump function only on patients without deep venous reflux.

Adult↗
PubMed1985

Radiological sampling and analytical methods for National Primary Drinking Water Regulations.

Radiological sampling and analysis performed under the National Interim Primary Drinking Water Regulations were evaluated for the U.S. Environmental Protection Agency (EPA) Office of Drinking Water to consider whether any changes should be recommended. The authors reviewed the analytical screening scheme; sample collection, storage and analysis procedures; selection of analytical methods; reliability of results; and possible future needs. The main problem in the program has been dependence on a screening scheme of gross alpha-particle activity measurement and 226Ra analysis for predicting elevated 228Ra levels to determine compliance with the maximum contaminant level (MCL) for Ra. In some aquifers, 228Ra levels have been found to be unrelated to 226Ra levels. Several alternatives are discussed to eliminate this problem. A secondary problem is that the measurement for assuring compliance with the MCL for gross alpha-particle activity minus Ra, Rn and U uses chemical U analysis and assumes equilibrium of 238U and 234U. Because some ground waters are known to be at disequilibrium, radiometric U analysis is needed for those gross alpha-particle activities and chemical U values that could result in an erroneous conclusion relative to the MCL. In addition, studies were recommended for determining analytical uncertainties and assuring reliable sampling and sample maintenance; improvements in the system for accepting methods were suggested; and methods were identified for several radionuclides not currently in the analytical program that may be needed to assure absence of elevated radiation doses and could be useful for identifying trace contaminants.

Alpha Particles↗
PubMed2002

Postoperative administration of donor B cells induces rat kidney allograft acceptance: lack of association with Th2 cytokine expression in long-term accepted grafts.

BACKGROUND: Although donor leukocytes are only thought to prolong survival when administered before transplantation, recent evidence shows that they are effective at transplantation. This study aims to identify the leukocyte subset that is most active in prolonging kidney allograft survival and examine the cytokine expression in long-term acceptance. METHODS: PVG rat kidneys were transplanted to completely MHC class I and class II-mismatched DA recipients. Donor B cells or T cells, purified by negative selection, were injected i.v. at the time of transplantation. Expression of interleukin (IL)-2, IL-4, IL-10, interferon (IFN)-gamma, and transforming growth factor-beta mRNA was measured by quantitative real-time polymerase chain reaction (PCR). Immunohistochemical analysis and terminal deoxynucleotide transferase-mediated dUTP nick-end labelling (TUNEL) staining was used to identify infiltrating cells and apoptotic cells, respectively, in sections of kidney allografts. RESULTS: Median kidney graft survival time (MST) of B cell-treated animals (n=5) was >300 days, compared with 7 days in untreated animals (n=7) (P=0.003), whereas animals treated with the same number of T cells (n=6) had a MST of 17 days (P=0.1 vs. untreated, P=0.03 vs. B cell-treated). Examination of the long-term (>300 days) accepted grafts from B cell-treated recipients showed little evidence of kidney damage but a moderate perivascular infiltrate consisting of T and B cells. This infiltrate seemed to be quiescent because there was no detectable expression of IL-2 receptors or of apoptotic cells. It produced little or no cytokine mRNA, because expression in the long-term accepted grafts was similar to levels in normal kidneys or syngeneic transplants. There was a marked increase of cytokine mRNA early after transplantation in both leukocyte-treated and untreated grafts, with more rapid appearance of IFN-gamma and IL-10 in leukocyte-treated grafts. CONCLUSIONS: Donor B cells efficiently induce long-term acceptance of transplanted kidneys in a fully MHC-mismatched rat model when administered at transplantation, by a mechanism that seems to be independent of Th2 cytokine expression within the long-term accepted graft.

Animals↗
PubMed1999

Serial colour flow duplex scanning of the veins of the lower limb throughout pregnancy.

OBJECTIVE: To examine changes in diameter and reflux in normal veins of the lower limb throughout pregnancy. METHODS: Fifty-seven women were recruited into the study and 43 completed the full assessment to six weeks postpartum. Thirteen had pre-existing venous disease and are reported elsewhere. The veins were assessed in both lower limbs using colour flow duplex scanning. This was performed at a 75 degree tilt measuring vein diameter and the presence or absence of reflux. Measurements were made at 12, 20, 26, 34, 38 weeks of gestation and 6 weeks postpartum. RESULTS: No new reflux developed in any of the veins studied. In the superficial system the maximum change was seen in the long saphenous vein at 34 weeks, on the left side the vein diameter failed to return to baseline size. Significant change also occurred in the superficial femoral vein. Dilatation of the deep veins of the calf was observed being greater in the left posterior tibial and the left peroneal at the mid-calf point. CONCLUSION: Colour flow duplex scanning is an acceptable method of assessing the lower limb veins in pregnancy. Maximum diameter changes were seen in the long saphenous vein and in the deep veins at mid-calf. No new reflux developed during the gestation period in veins which were previously normal.

Adult↗
PubMed2006

Investigation of unexplained infant deaths in Jerusalem, Israel 1996-2003.

BACKGROUND: Sudden infant death syndrome (SIDS) is a diagnosis of exclusion that may be assigned only after investigations including a forensic autopsy are performed to exclude possible organic and environmental causes of death. Israeli society is influenced by the Jewish and Islamic faiths, which permit autopsy only under selected circumstances. Against this background, we carried out a study to determine what examinations are performed to investigate unexplained infant deaths in Jerusalem, Israel. METHODS: We examined hospital, Ministry of Health and Ministry of Interior records of unexplained infant deaths in the Jerusalem district from the years 1996-2003. RESULTS: Ninety six cases were identified from all sources. Forty nine (51%) infants were brought to a hospital at or near the time of death. Studies to determine the cause of death were performed in 54% of cases for which medical records were available for review. These studies included bacterial cultures (44%), skeletal surveys (12%), computerised tomography (3%) and metabolic studies (3%). Only one forensic autopsy was performed, and in no instance was the death site examined by medical personnel. There was a high rate of retrospective review by district health physicians. The most frequently assigned cause of death was SIDS. CONCLUSIONS: : The capacity of public health officials and forensic pathologists to investigate unexplained infant deaths is strongly affected by the legal, religious and political milieu in which they work. Efforts should be made to develop socially acceptable methods of improving the quality of infant death investigations in Jerusalem.

Autopsy↗
PubMed2003

Minimally invasive, endoscopically assisted colostomy can be performed without general anesthesia or laparotomy.

PURPOSE: Fecal diversion is frequently required in critically ill patients who may not be able to tolerate a laparotomy. Laparoscopic-assisted and trephine colostomies are alternative methods for colostomy without laparotomy, but require general anesthetic. The objective of this study was to evaluate the possibility of performing fecal diversion with the assistance of a colonoscope and without the additional morbidity of abdominal exploration or general anesthesia. METHODS: Patients were diverted using a colonoscope to identify a site of the sigmoid colon that could easily be approximated to the anterior abdominal wall as confirmed by transillumination of the abdominal wall. A small skin disc was then removed at this location and a loop colostomy was made. The colonoscope was also used as a guide to identify the proximal and distal limbs of the loop colostomy. Four patients were considered to be critically ill and local or regional anesthetic with sedation was used in these patients. RESULTS: A total of 15 patients were reviewed during the past five years. All 15 patients were successfully diverted using minimally invasive techniques with the aid of the colonoscope. Four of these patients were diverted using local or regional anesthetic without complication, thus avoiding the morbidity associated with a general anesthetic in critically ill patients. CONCLUSION: No complications related to this technique were noted in this five-year review. Endoscopically assisted colostomy is an acceptable method for fecal diversion without the need for laparotomy and can be accomplished using a local or regional anesthetic with sedation.

Adult↗
PubMed2006

Removing barriers to knowing HIV status: same-day mobile HIV testing in Zimbabwe.

OBJECTIVES: We developed a mobile HIV voluntary counseling testing (VCT) strategy. Our aims were (1) to describe those using the services, (2) to assess the acceptability of such services, (3) to assess reasons for not testing previously, and (4) to compare those who used the services with those who did not to determine how to increase acceptability. METHODS: We provided free anonymous mobile VCT using 2 rapid HIV tests in 12 marketplaces in Epworth and Seke, Zimbabwe. Qualitative interviews were conducted to assess motivations for and barriers to testing. A subsample of HIV testers and individuals near testing vans who declined testing (nontesters) completed a questionnaire. RESULTS: A total of 1099 individuals participated in mobile VCT between March 2002 and August 2003. The proportion of participants infected with HIV was 29.2%. Overall, 98.8% of participants elected to receive HIV test results the same day. Reasons for not testing previously were often logistic (eg, inconvenience of hours [25.6%] and location [20.7%] or cost [8%]). Those who used the same-day mobile testing services (testers vs. nontesters) perceived themselves at higher risk for HIV infection (adjusted odds ratio [AOR] = 1.8) but were less likely to have known people with HIV (AOR = 0.49) or where to get tested (AOR = 0.57). CONCLUSIONS: Same-day HIV testing in community settings seems to be acceptable in sub-Saharan Africa. Barriers to HIV testing are often logistic and can be overcome with community-based strategies. These strategies need to be refined to address the needs of those not using mobile testing services.

AIDS Serodiagnosis↗
PubMed2001

T cell and B cell tolerance to GALalpha1,3GAL-expressing heart xenografts is achieved in alpha1,3-galactosyltransferase-deficient mice by nonmyeloablative induction of mixed chimerism.

BACKGROUND: We have previously demonstrated that mixed xenogeneic chimerism and donor-specific T-cell tolerance can be induced in the rat-to-mouse species combination by using a relatively nontoxic, nonmyeloablative conditioning regimen. However, natural antibodies (NAbs) against Galalpha1,3Gal (Gal) pose an additional major barrier to pig-to-human vascularized xenograft acceptance. METHODS: To determine whether the mixed chimerism approach could also overcome this humoral barrier, T cell-depleted rat (GalT+/+) bone marrow cells (BMC) were transplanted to alpha1,3-galactosyltransferase deficient (GalT-/-) mice conditioned with a nonmyeloablative regimen, consisting of transient T cell and natural killer (NK) cell depletion, 3 Gy whole body irradiation, and 7 Gy thymic irradiation. RESULTS: By giving a high dose (180x106) of rat BMC, persistent mixed chimerism could be induced in GalT-/- mice, although the level of donor-type hematopoietic repopulation declined over time. Induction of mixed chimerism was associated with a rapid disappearance of anti-Gal and anti-rat NAb in the sera. Both anti-Gal Ab-producing cells and B cells with receptors recognizing Gal were undetectable in mixed chimeras, even when the chimerism levels declined, suggesting that a very low level of chimerism could effectively maintain B-cell tolerance to Gal, probably by clonal deletion and/or receptor editing. Mixed chimeras accepted subsequently transplanted donor-type rat hearts (>100 days) without immunosuppressive therapy, whereas delayed vascular and even hyperacute rejection of rat hearts occurred in conditioned control GalT-/- mice. Cellular rejection occurred by 5-6 days in conditioned control wild-type mice. CONCLUSIONS: These findings demonstrate that induction of mixed chimerism with a nonmyeloablative regimen can prevent vascularized xenograft rejection by cellular and anti-Gal Ab-dependent pathways in GalT+/+-to-GalT-/- species combinations.

Animals↗
PubMed1994

A short survey for assessing health and social problems of adolescents. Dartmouth Primary Care Cooperative Information Project (The COOP).

BACKGROUND: Many significant problems of adolescents are undetected and untreated. To aid in the discovery of these problems, we have developed and tested picture-and-word charts for use in the classroom or the physician's office. This report presents the results of these tests and describes how the charts may be used. METHODS: We assessed test-retest reliability of the picture-and-word charts. We also compared picture-and-word chart scores with corresponding multi-item questionnaires. Six charts were determined to be the most effective in measuring mutually exclusive dimensions of health and social problems. We used these six charts to examine factors that might affect the distribution of chart scores. RESULTS: We administered the picture-and-word charts to a diverse population of 658 adolescents whose median age was 15 years. Compared with multi-item questionnaires, respondents found the charts easier to understand and less likely to induce dishonest replies. Girls scored significantly worse (P < .001) than boys on the Physical Fitness and Emotional Feelings charts but better on the (at-risk) Health Habits chart (P < .001). The scores of teenagers known to have behavioral problems were worse on the Health Habits chart than were those of other adolescents (P < .001). CONCLUSIONS: The charts are an efficient and acceptable method for detecting health and social problems of adolescents.

Adolescent↗
PubMed2006

Severity staging by early features of age-related maculopathy exhibits weak relationships with functional deficits on SWS grating acuity.

PURPOSE: To examine the relationship between short-wavelength-sensitive (SWS) resolution acuity and epidemiologically defined stages of early age-related maculopathy (ARM). METHODS: Subjects consisted of 88 adults aged 51 to 87 years. Psychophysical testing was undertaken in only one eye of each subject (the study eye). All study eyes had a LogMAR acuity of 0.30 (20/40 Snellen) or better. SWS and achromatic grating resolution acuity were measured at 6 degrees eccentricity from the fovea. Stereoscopic color fundus photographs centered on the macula were taken on both eyes of each subject and were graded using the Wisconsin Age-Related Maculopathy Grading System (WARMGS). After grading, features of ARM were combined to assign a severity stage from 0 to 5 using the methods described by the Rotterdam Eye Study. Relationships between visual function, study eye ARM stage, and fellow eye status were examined with the use of standard statistical analysis. RESULTS: Although SWS resolution acuity was significantly reduced in eyes classified as having any ARM compared with eyes classified as having no ARM (P = 0.002), there was no relationship between the severity of functional deficits and the morphologic severity from stage 1 to stage 4. On reassigning subject eyes to a revised severity staging (stage 0, stages 1 to 4 combined, and stage 5), SWS acuity was significantly different among these three groups (P < 0.001). No significant relationship was found between achromatic resolution acuity and ARM staging. The status of the fellow eye (advanced macular degeneration present or absent) was not significantly related to visual function in the study eye. CONCLUSIONS: Significant functional deficits in SWS resolution acuity were found in eyes with ARM features, but the severity of functional loss did not correlate well with the currently accepted method of assigning a morphologic severity stage. Longitudinal studies may reveal further information on the relationships between functional deficits, ARM status, disease progression, and outcome.

Aged↗
PubMed2003

Comparison of two methods of delivering continuously nebulized albuterol.

OBJECTIVE: To compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer. DESIGN: An open, randomized comparison of 3 hours of CNA administration using an in vitro lung model with a follow-up particle size assessment of the large-volume nebulizer. METHODS: Six different nebulizers of each type were connected to a lung model via a volume-limited mechanical ventilator and infant ventilator circuitry. Albuterol was nebulized at 10 mg/h for 3 hours in random order. The small-volume nebulizer used was the Airlife Misty Neb (Baxter, Valencia, CA); the large-volume nebulizer was the HEART Nebulizer (Vortran Medical, Orangevale, CA). One large-volume nebulizer was operated over 8 hours for the output and particle sizing study. RESULTS: The small-volume nebulizer delivered a greater amount of albuterol (mean +/- SD percentage of total nebulized) to the model lung (5.75 +/- 1.38% vs. 4.12 +/- 0.67%; p < 0.025) than the large-volume nebulizer, but demonstrated greater variability. Although total output was not maintained after 8 hours of nebulization with the large-volume nebulizer, the percent of particles in the respirable range remained consistent. CONCLUSIONS: The large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.

Administration, Inhalation↗
PubMed1997

A prospective comparison of two expanded polytetrafluoroethylene grafts for linear forearm hemodialysis access: does the manufacturer matter?

BACKGROUND: The function and patency of standard 6-mm Goretex (W.L. Gore and Associates, Flagstaff, AZ) and Impra (Impra, Inc., Tempe, AZ) expanded polytetrafluoroethylene (e-PTFE) grafts for hemodialysis as radial-antecubital linear arteriovenous fistulae for dialysis are compared. STUDY DESIGN: A randomized clinical trial was conducted in two community dialysis centers and in one hospital-based center serviced by one vascular surgical practice, that performed the access surgery. Selection of linear forearm access, as opposed to other hemodialysis graft configurations, was at the discretion of the surgeon. Candidates for linear grafts had palpable radial pulses with a normal Allen test and normal digital Doppler flow in the hand. Linear grafts were placed using end-to-side anastomoses to the artery and vein, and the graft type was determined by randomization. Primary patency was determined by first episode of thrombosis, first revision, or angioplasty of the graft. Secondary patency after thrombectomy, revision, or angioplasty was determined when the graft was no longer clinically usable, and a new graft needed to be placed as a parallel conduit in the forearm or in another site. Statistical analysis was by actuarial life-table methods. RESULTS: There were 131 linear forearm grafts in 117 patients. The Impra and Goretex groups were equally matched for gender and major risk factors, except for smoking, which was more common in the Goretex group. Minimum followup was 24 months. Life table primary patencies at 1 year (Impra 43%, Goretex 47%) and at 2 years (Impra 30%, Goretex 26%) were not statistically different (p = 0.78); secondary patency was also equal at 1 year (Impra 49%, Goretex 69%) and at 2 years (Impra 33%, Goretex 41%) (p = 0.15). Discontinuance of use of a patent graft, complications, episodes of thrombosis, and the need to replace the original graft occurred in the two groups without a statistically significant difference. CONCLUSIONS: In the linear forearm position from the radial artery to an antecubital vein, there is no difference in the performance of 6-mm standard e-PTFE grafts on the basis of manufacturer, whether Goretex or Impra. On the basis of performance, linear forearm dialysis grafts are an acceptable method for hemodialysis access.

Adult↗
PubMed1997

The success rate of free flaps after preoperative irradiation in head and neck reconstruction.

BACKGROUND AND AIMS: The reconstructive treatment of large head and neck tumours involves serious problems. Preoperative irradiation increases the risk of postoperative complications. Microvascular free flaps offer definite advantages over conventional reconstruction techniques and permit immediate preoperative high-dose radiation therapy. MATERIAL AND METHODS: In 1985-1996, at the Turku University Central Hospital, 101 patients, 61 (60%) men and 40 (40%) women (age range 15-79 years, mean 61 years), with head and neck tumours, underwent microvascular reconstructions, and 90 of them were irradiated before surgery. All irradiated patients underwent primary reconstruction immediately after resection. The total irradiation dose was about 60 Gy, usual range 50 to 65 Gy. The patients were operated on 3 to 5 weeks after discontinuation of irradiation therapy. RESULTS: Of the whole material of 101 free flaps, 89 (88%) were transferred successfully. The success rate in irradiated patients was 88% and in nonirradiated patients 91%. Reoperation had to be performed within twelve hours in three cases, with good results. Only two hernias occurred as donor complications (2%). Two of the patients died postoperatively (2%). Partial flap necrosis occurred in five patients and five patients underwent another reconstruction using a new free flap or with conventional reconstruction techniques. CONCLUSIONS: Free flaps are often the only acceptable choice in extensive head and neck primary reconstructions after irradiation. Microvascular free tissue transfers to the head and neck after preoperative irradiation has become the accepted method of reconstruction as a result of increased success rates with superior aesthetic and functional results.

Adolescent↗