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At least 901 records · Page 50Linked to original sources
PubMed2002

Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting.

We sought to prospectively assess the feasibility and in-hospital efficacy of the PercuSurge GuardWire temporary balloon-occlusive system for neuroprotection during carotid angioplasty and stenting (CAS).Carotid angioplasty and stenting harbors a risk of distal embolization. Cerebral protection devices are currently under clinical investigation.Ninety-six consecutive patients with carotid bifurcation disease underwent a total of 102 CAS procedures with the intention to use the GuardWire for neuroprotection. GuardWire deployment was achieved in 99 procedures performed in 93 patients (97%). Device failure (n = 3) and severe neurologic responses to balloon occlusion of the targeted carotid artery (n = 2) accounted for five additional procedures that were essentially concluded without neuroprotection, for a total of 94 procedures completed as intended in 88 patients (92% procedural feasibility rate). Carotid angioplasty and stenting was performed successfully in 94 patients (100 procedures). There were no in-hospital deaths; but three patients (3.1%) sustained strokes, and two patients experienced transient ischemic attacks, for a total periprocedural complication rate of 5.2%. One major stroke occurred with the GuardWire in place, whereas two minor strokes were observed in patients in whom the device could not be deployed. Thus, successful neuroprotected CAS without major neurologic events was achieved in 87 patients (91%). The GuardWire temporary balloon-occlusive system is feasible as an adjunct to CAS in the majority of patients. It is associated with a 3.1% rate of major periprocedural neurologic complications. Adverse neurologic reactions to balloon occlusion may prohibit effective use of the system in about 2% of patients.

Aged↗
PubMed1996

Delayed pulmonary edema and bronchospasm after accidental lacrimator exposure.

Clinical manifestations of lacrimator exposure can be immediate or significantly delayed. In both phases, the sequelae can be severe and life-threatening. As personal protection devices, these agents have become readily available to the public in many areas of the country. Emergency physicians should gain a firm understanding of the presentation, management, and disposition of the lacrimator-exposed patient. A case of accidental prolonged lacrimator exposure inducing pulmonary edema and bronchospasm is presented.

Adult↗
PubMed2003

Primary injury prevention in an urban EMS system.

Injury prevention is increasingly recognized as an important part of health care delivery. Emergency Medical Services (EMS) personnel may be called upon to deliver primary injury prevention (PIP) by educating both patients and peers about how to avoid future similar injury. The purpose of this study was to determine EMS provider attitudes toward PIP and knowledge and practice of PIP during day-to-day clinical work. A brief survey was administered to a sample of paramedics assessing their attitudes toward primary injury prevention, how often they practice it, and whether or not they have received any PIP education during their training. One hundred sixty-two paramedics completed surveys. Of those surveyed, 70% believe that PIP should be a core mission of EMS systems, and 82% believe PIP should be implemented at the local or regional level. However, only 33% routinely educate their patients how to modify injury risk behaviors, and only 19% routinely provide instruction about proper use of protective devices. Approximately 63% of our paramedics received any PIP education during their training. A majority of paramedics in our survey believe that PIP should be a routine part of EMS. However, many paramedics have not received any PIP education, and few paramedics practice PIP during their clinical practice.

Clinical Competence↗
PubMed2003

Early and late outcome after carotid artery bypass grafting with saphenous vein.

OBJECTIVES: This study was undertaken to determine outcome and durability of internal carotid artery bypass grafting with saphenous vein. METHODS: Data for 50 patients undergoing serial clinical and ultrasound surveillance were collected prospectively and analyzed retrospectively. RESULTS: Bypass grafting was performed in 50 patients between 1995 and 2002, the commonest reasons being excessive endarterectomy zone thinning or penetrating atheroma (n = 22), severe internal carotid artery coiling above the endarterectomy zone (n = 14), and patch infection (n = 5). Perioperative mortality was 2%, and death and stroke rate was 6%. Perioperative complications were associated with complex cardiovascular events, including hemorrhage after prosthetic patch infection, on-table thrombosis after endarterectomy, and synchronous carotid artery-cardiac reconstruction. One patient had a late ipsilateral stroke (10 months; normal scan). Cumulative stroke-free survival at 3 years (including operative events) was 91%. Cumulative freedom from recurrent stenosis greater than 70% or occlusion was 86% at 1 year and 83% at 3 years. Severe recurrent stenosis or occlusion developed in 7 patients, within 9 months of surgery in 6 patients and with 18 months in 1 patient. Angioplasty was performed without complication (no protection device, no stent) in 5 patients, 3 of whom required repeat angioplasty on at least one further occasion. CONCLUSIONS: In common with venous conduits elsewhere, carotid artery bypass grafting with saphenous vein is associated with a high incidence of early graft stenosis. The long-term stroke risk, however, is low. Carotid artery bypass grafting is a safe and durable alternative when endarterectomy would prove hazardous or inadvisable, but regular surveillance is necessary.

Blood Vessel Prosthesis Implantation↗
PubMed2001

[Urban noise pollution].

Noise is responsible for cochlear and general damages. Hearing loss and tinnitus greatly depend on sound intensity and duration. Short-duration sound of sufficient intensity (gunshot or explosion) will not be described because they are not currently encountered in our normal urban environment. Sound levels of less than 75 d (A) are unlikely to cause permanent hearing loss, while sound levels of about 85 d (A) with exposures of 8 h per day will produce permanent hearing loss after many years. Popular and largely amplified music is today one of the most dangerous causes of noise induced hearing loss. The intensity of noises (airport, highway) responsible for stress and general consequences (cardiovascular) is generally lower. Individual noise sensibility depends on several factors. Strategies to prevent damage from sound exposure should include the use of individual hearing protection devices, education programs beginning with school-age children, consumer guidance, increased product noise labelling, and hearing conservation programs for occupational settings.

Animals↗
PubMed1996

Knowledge of paediatric first aid in the general population.

If accidents cannot be prevented or ameliorated by protective devices, good first aid is essential to reduce the further effects of an injury. This paper highlights deficiencies in first aid knowledge among a random selection of the general population in Edinburgh. The results of this study indicate that first aid knowledge is generally deficient, with only 13% of people able to correctly treat all paediatric emergencies described. Recognised first aid courses, such as those run by voluntary agencies, focus their training on adult injuries, adapting care for children from this. There is no specific paediatric first aid course run by a recognised authority. Recommendations to improve this are made.

Accidents↗
PubMed1996

Managing exposure to tuberculosis in the PACU: CDC guidelines and cost analysis.

The Postanesthesia Care Unit (PACU) is an area of high risk for the transmission of Mycobacterium tuberculosis. The Centers for Disease Control (CDC) have recommended administrative controls, engineering controls, and personal protection devices to reduce the risks; nevertheless, perianesthesia nurses inhale airborne pathogens. The CDC guidelines are enforced by the Occupational Safety and Health Administration (OSHA). If an exposure occurs, the health-care facility has an OSHA-mandated course of action. The cost of follow-up of exposed persons can be high, depending on the patient census of the PACU at the time of unprotected exposure. This report presents the CDC guidelines for follow-up of exposure and costs based on typical surgical volumes and admission patterns for a large hospital with 10 thousand or more annual surgical procedures.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Usage of real-time ultraviolet radiation data to modify the daily erythemal exposure of primary schoolchildren.

BACKGROUND/AIMS: Primary schoolchildren in their everyday school life are exposed to solar ultraviolet radiation. This may be through time spent outdoors whilst having meal breaks, physical education classes and other class orientated outdoor activities. METHODS: This research investigates the UV exposure of primary schoolchildren and the effect real-time UV irradiances data and an associated software package, UVGUIDE, have on UV exposure. This software utilises scientifically collected data, such as facial distribution of UV, as well as accessing real-time on-line UV irradiances data to estimate the UV distribution to the head region. The students can also enter other parameters such as hat usage and hat type to show the effect of using such a UV protective device on their facial UV distribution. CONCLUSIONS: The results from this study found that the average 3-day erythemal UV exposure in late summer and early autumn to the left shoulder was 33% higher for the students not having access to the on-line UV data and software package.

Child↗
PubMed2006

Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy.

A prospective analysis of renal artery stent revascularization with distal embolic protection in a high-risk patient population with ischemic nephropathy is presented. A total of 63 patients (median age 70.2 years, range 54-86 years) had significant atherosclerotic stenosis of 83 renal arteries documented on pre-procedural imaging. All patients had baseline chronic renal insufficiency with a documented deterioration in renal function in the 6 months before revascularization. The endovascular technique used in all patients involved primary passage of an embolic filter into the distal main renal artery followed by primary stent deployment with a balloon expandable stainless steel stent. The filter baskets were recaptured and contents submitted for pathological analysis. At 6 months post-intervention, 97% of patients demonstrated stabilization or improvement in renal function. Only 3% of patients had an inexorable decline in renal function, unchanged by the intervention. After a mean follow up of 16.0 months (6-27), 94% of patients demonstrated stabilization or improvement in renal function. One patient suffered an acute post-procedural deterioration in renal function. In total, 60% of the filter baskets contained embolic material. This study confirms the technical feasibility of renal artery stent deployment with adjuvant embolic protection. The excellent results for renal preservation at 6 months post-intervention also suggest that a distal embolic protection device may improve the impact of percutaneous renal revascularization on progressive deterioration in renal function. The postulated mechanism is through the prevention of atheromatous embolization and the embolic yield from the distal filters supports this hypothesis. Patients most likely to receive the greatest benefit are those with mild baseline chronic renal insufficiency and a recent decline in renal function.

Aged↗
PubMed2006

Revascularization in atherosclerotic renovascular disease: problems beyond the obstruction.

The main goal in the treatment of obstructive atherosclerotic renovascular disease (ARVD) is to preserve or recover renal function. The ARVD kidney continues to deteriorate in 20-40% of cases despite restoration of blood flow. Holden et al. report that renal function stabilized or improved in up to 97% of patients with the use of a distal embolic protection device.

Angioplasty, Balloon↗
PubMed2004

Estimations of the human 'vitamin D' UV exposure in the USA.

Human exposure to sunlight promotes the formation of pre-vitamin D in the skin. Low or marginal levels of vitamin D has been linked to a wide range of human health outcomes, including the development of various types of cancer. However, few data exist on the actual exposure to human due to vitamin D producing ultraviolet radiation. Most studies of human disease and vitamin D have linked latitude and location of residence to expected exposure form the available ambient UV radiation. Human UV exposure for the development of vitamin D depends on a variety of factors such as time spent outdoors, percent available skin, skin type, UV protective devices used and distribution of UV over the human form. In this paper, we investigate how latitude impacts not only on the amount of UV available for vitamin D synthesis, but also the distribution of UV over the human form.

Erythema↗
PubMed2002

Effects of educational intervention on changing parental practices for recurrent febrile convulsions in Taiwan.

PURPOSE: To evaluate the effects of educational interventions on parental practices for recurrent febrile convulsions (FC). METHODS: A 2-year follow-up, nonequivalent comparison group design was used to evaluate the intervention effects. Two educational interventions were provided for FC parents in southern Taiwan. The 326 parents voluntarily chose either to receive a mailed pamphlet (n=196) or to attend a 2-h educational program (n=130). Five telephone interviews focused on investigating FC episodes and parental practices for seizures were conducted at months 3, 6, 12, 18, and 24 after the interventions. RESULTS: Of the 326 FC children, 78 (23.9%) had recurrent FCs within the 2-year follow-up. Parents who only received pamphlets did not show significant improvements. Parents who attended the educational program demonstrated significant improvements in the recommended practices, particularly in protecting the convulsing child (8.3 vs. 36.1%; p=0.02 by McNemar) and placing the child on his or her side (19.4 vs. 47.2%; p=0.01). Nonrecommended practices including rushing the convulsing child to the hospital (88.9 vs. 30.6%; p < 0.01) and putting protective devices in the child's mouth (38.9 vs. 8.3%; p < 0.01) significantly decreased. By generalized estimating equation analyses, the types of interventions are the single significant factor influencing parental practice changes from initial to recurrent FCs. CONCLUSIONS: Most parents used inappropriate practices for their child's initial FC. Compared with the mailed pamphlet, the educational program had significant improvements in recommended and nonrecommended practices from initial to recurrent FCs.

Adult↗
PubMed2001

Clinical experience with a dual-chamber implantable cardioverter defibrillator to treat atrial tachyarrhythmias.

INTRODUCTION: This study evaluated the safety and efficacy of a new dual-chamber implantable cardioverter defibrillator (ICD) to detect and treat atrial tachyarrhythmias in patients with drug-refractory atrial fibrillation (AF) and no indication for a ventricular ICD. METHODS AND RESULTS: A dual-chamber ICD (Medtronic 7250 Jewel AF) was implanted in 144 of 146 patients. The device discriminates atrial tachycardia from AF based on cycle length and regularity, and uses atrial overdrive pacing as well as shocks to terminate tachyarrhythmia episodes. Patients were followed for an average of 12.6+/-6.2 months. Use of antiarrhythmic drugs was 63% at baseline and did not change over time. Kaplan-Meier estimates of 12-month complication-free survival, device therapy survival, and patient survival were 85%, 91%, and 98%, respectively. Positive predictive accuracy of spontaneous atrial tachyarrhythmia detection was 99%, while atrial overdrive pacing and shocks terminated 40% and 87% of treated episodes, respectively. Median duration of successfully treated episodes was 8.9 minutes versus 144 minutes for the therapy failures. There was no reduction in the use of patient-activated shock therapy over time; at the 12-month follow-up evaluation, 94% of patients were in sinus rhythm. Ventricular tachyarrhythmias (67 episodes) were detected and appropriately treated in 7.6% of patients. CONCLUSION: This dual-chamber ICD appears to be safe and well tolerated in patients with drug-refractory symptomatic atrial tachyarrhythmias. The device, used in combination with drugs, effectively treats atrial tachyarrhythmias with pacing and/or shock therapies and decreases the median episode duration. In addition, the device protects from ventricular tachyarrhythmias in patients with AF and structural heart disease.

Aged↗
PubMed2003

Carotid angioplasty in a pulsatile flow model: factors affecting embolic potential.

OBJECTIVES: Carotid endoluminal intervention is an alternative to surgery but carries a risk of embolic stroke even with distal protection devices. We investigated the clinical features and degree of stenosis related to number and size of emboli during carotid angioplasty. DESIGN: An experimental ex vivo study. MATERIALS: An ex vivo pulsatile flow model was used in which temperature, velocity, flow, pressure and viscosity characteristics were designed to simulate the carotid circulation. METHODS: Carotid endarterectomy specimens excised as intact cylinders (n = 28) were subjected to a standardised angioplasty procedure using radiological guidance. Emboli collected in filters placed distally were counted and sized using microscopy. RESULTS: Median number of emboli during angioplasty was 133 (range 15-1331). Median size of the largest embolus was 700 microns (range 75-2400). Severity of stenosis correlated with increased maximum size (r = 0.55, p = 0.012). Statin therapy >4 weeks pre-operatively was associated with reduced emboli number and size (54 (range 15-748) vs 247 (range 37-1331) [p = 0.023] and 400 microm (range 75-2400) vs 1300 microm (range 600-2200) [p = 0.022]). CONCLUSIONS: In this model a wide range of emboli number and size were produced. Number and size of embolic particles were highest in patients with high-grade stenoses not receiving statin therapy.

Aged↗
PubMed2004

Establishing an endovascular carotid stent program.

FDA approval of carotid stent and distal protection devices has transformed carotid artery stenting (CAS) from an investigational procedure to a practical application. Recent approval by the Center for Medicare Services (CMS) has ensured that CAS will be a part of everyday practice throughout the country. To establish a competitive endovascular carotid stent program, one needs to develop an effective strategy. The key to success is substance and service. A high-quality clinical program with excellent communication between the patient and referring physician is essential. You must first get access to the patient by establishing a clinical practice. As a radiologist, you have the advantage of gaining access by identifying appropriate patients through noninvasive vascular labs, CTA, and MRA. An algorithm-driven evaluation and treatment protocol with good pre- and postoperative care, along with a quality assurance program, will ensure that your carotid stent program has substance and delivers optimal service. With good planning, you will have a firm clinical foundation for treatment of carotid artery stenosis in your community. Putting all of the ingredients together will ensure a successful carotid endovascular program.

Algorithms↗
PubMedDate not supplied

Coronary microembolization.

Atherosclerotic plaque rupture is a key event in the pathogenesis of acute coronary syndromes and during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the entire epicardial coronary artery with subsequent acute myocardial infarction; however, in milder forms it may result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. The present report summarizes the available morphologic evidence for coronary microembolization in patients who died of coronary artery disease, especially sudden death. The report then goes on to address the experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and heart failure. Finally, the report presents the available clinical evidence for coronary microembolization, highlights its key features--arrhythmias, contractile dysfunction, infarctlets and reduced coronary reserve--and addresses prevention by mechanical protection devices and glycoprotein IIb/IIIa antagonism.

Animals↗
PubMed2002

Protection of femoral neck taper in revision of acetabular component.

In hip revision restricted to the acetabular component, the taper of a modular stem is in constant danger of scratching. We used a plastic syringe to protect the taper of the femoral component. A plastic syringe of appropriate size remains well in place and offers a novel and inexpensive protective device for the taper of the femoral component available in every operation room.

Arthroplasty, Replacement, Hip↗
PubMed2003

[The centennial of oxygen-therapy (1902 - 2002) -- reassessing its history. Part II: The contributions of the "Roth-Draeger anaesthesia apparatus" (1902) and other inventions of 100 years of Draeger-Medical-Technology (1902-2002) to the history of truly "therapeutic" application of oxygen].

This is the second part of a survey which analyses the history of inhalative oxygen therapy and its interactions with the history of anaesthesiology. Specific emphasis is put here on illustrating inventions of modern pressure gas technology such as pressure reducing valves. These enabled Draeger Inc. to be the first firm to develop and trade on a large scale technically convincing products allowing a rational, therapeutic application of oxygen. Especially Draeger anaesthesia apparatus (e. g. the "Roth-Draeger Anaesthesia Apparatus") and respiratory protective devices, which were available from 1902, proved also internationally successful from the very beginning. In the international historiography on inhalative oxygen therapy, however, these contributions have to our knowledge so far never been systematically considered. Consequently, J. S. Haldane (1860 - 1936) is regarded there to have "founded" of modern oxygen therapy in 1917. Critically reviewing this earlier research, we propose a historical reassessment, concluding that the year 1902 was the historically decisive "turning point" towards the development of modern oxygen therapy.

Anesthesiology↗