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At least 973 records · Page 54Linked to original sources
PubMed1999

Economic evaluation of different minimally invasive procedures for the treatment of coronary artery disease.

OBJECTIVE: Several different techniques exist within the field of minimally invasive coronary artery surgery. In this study the impact of all these techniques on the total costs and economics has been evaluated. METHODS: Since May 1997, 121 minimally invasive direct coronary artery bypass (MIDCAB) procedures, 125 off-pump coronary artery bypass (OPCAB), ten Port-Access coronary artery bypass (PA-CABG) and 10 endoscopic coronary artery bypass grafting (ENDO-CABG) procedures were performed at our institution. A relative cost analysis of the different procedures was carried out in addition to a thorough evaluation done in five patients of each group dividing the costs into staff-related costs, material-related costs and general hospital costs. The costs were set in relation to regular CABG procedures. RESULTS: Specific less invasive coronary artery surgical techniques, such as the MIDCAB or OPCAB technique already are able to reduce the total costs when compared to regular CABG procedures. Within the Port-Access group as well as the ENDO-CABG group, increased material- and general costs are present when compared to regular CABG leading to increased total hospital costs for PA-CABG and Endo-CABG in Germany. CONCLUSION: At present, MIDCAB and OPCAB procedures are able to reduce total hospital charges, when compared to regular CABG procedures. Increased costs for Port-Access, as well as Endo-CABG surgeries may be compensated in the future by decreased costs due to a shorter phase of rehabilitation and faster return to regular professional activities.

Angioscopy↗
PubMed1999

[Capillaroscopy and vascular acrosyndromes].

Periungual capillaroscopy is a simple noninvasive exploration contributing to the clinical examination. It is highly contributive to the etiological diagnosis of Raynaud's phenomenon and is the simplest means of detecting scleroderma early. Capillaroscopy has also largely contributed to better understanding of the pathogenesis of vascular disorders encountered in acrosyndromes. Experience has shown however that clinical indications should be more precise and results interpreted with more scientific rigor (J Mal Vasc 1999; 24: 357-362).

Cyanosis↗
PubMed2000

Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis.

OBJECTIVE: To correlate microvascular abnormalities, evaluated by nailfold videocapillaroscopy (NVC), with the duration of both Raynaud's phenomenon (RP) and systemic sclerosis (SSc) from the date of diagnosis, in a large number of patients with SSc. METHODS: Ninety-seven consecutive patients were recruited and distributed into 3 groups on the basis of the morphological NVC patterns observed: "early" (E), "active" (A), and "late" (L). In each group the age of patients, age at onset, and the duration of RP as well as of overt SSc were investigated and correlated with the different NVC pattern variables. RESULTS: The early appearance of giant capillaries and hemorrhages (E pattern) is of great relevance for the early diagnosis of SSc. Therefore, these alterations are more evident in the active phase of the disease (A pattern). Conversely, the NVC observation of loss of capillaries and vascular architectural disorganization and the presence of ramified/bushy capillaries (L pattern) represents the clearest aspect of advanced SSc microvascular damage. These morphological alterations were found to correlate significantly with the duration of both RP and SSc, as well as with age of patients (p = 0.0001). No significant differences were observed when the variables were analyzed in the patients classified as having limited cutaneous SSc or diffuse cutaneous SSc. CONCLUSION: Classification of defined major nailfold patterns may be useful in assessing the appearance and progression of sclerodermic microangiopathy. As well, nailfold changes might represent a morphological reproduction of the evolution of SSc.

Female↗
PubMedDate not supplied

[Periungual capillaroscopy in psoriatic arthritis].

PURPOSE: The aim of the study is the evaluation of the microcirculation trough periungueal capillaroscopy in patients suffering from psoriatic arthritis. MATERIALS AND METHODS: Eighteen patients (mean age 44 years, nine males and nine females) were examined according to the different clinical forms (spondylitic, mutilans, simil-rheumatoid, onyco-arthritis, oligo-articular) of the disease. RESULTS: In most of the patients, the exam showed a reduction in ansas' density and in capillary length and calibre as well as interstitial edema and expansion of the ansa venular portion with coiling and kinking, demonstrating the re-organization of the veins and the neo-angiogenesis. Avascular areas and microaneurysm have been found only in the "mutilans" form. In the "simil-rheumatoid" form, ansa reduced in length and calibre have been observed at capillaroscopy, a pattern different from that reported by others, in rheumatoid arthritis (characterized by thin but lengthened ansa). In the "spondylitic" form, the video-microscopical pattern was negative. CONCLUSIONS: This study is still ongoing in order to evaluate the results in a more representative sample.

Adult↗
PubMedDate not supplied

[Video-thoracoscopic sympathectomy in the treatment of Raynaud's disease and palmar hyperhidrosis].

BACKGROUND AND AIM: Raynaud's syndrome is a clinical entity characterised by episodic vascular spasm, digital ischemia in response to cold or emotional stimuli and hyperhidrosis. Many patients suffering from Raynaud's syndrome are successfully treated using medical therapy alone. Those patients who do not respond to medical treatment undergo surgery but the indications continue to be a source of controversy. A modern approach to thoracic sympathectomy requires a video-assisted technique. The aim of this study is to attempt to use mini-invasive type surgery to treat Raynaud's disease and hyperhidrosis in order to evaluate the real efficacy of thoracic sympathectomy in a large number of patients. The results of this method were compared for the two different pathologies in question. METHODS: The methodology used by this study is based on instrumental and clinical tests performed before and after surgery on treated patients using a comparative criterion and with a minimum 5-year follow-up. The pre- and postoperative diagnostic tests were performed by the vascular surgery laboratory and using a C.W. Doppler and a reflected light photoplethysmograph. Capillaroscopy and laboratory evaluations relating to secondary Raynaud's disease were carried out by internist type structures. The patients enrolled in the study responded to the following criteria: primary Raynaud's disease, palmar hyperhidrosis and associated syndromes. The population came from a mixed sociodemographic background, albeit within a strictly regional zone (Sardinia). A total of 42 patients were studied. The surgical technique used consisted of the ablation of thoracic ganglia from the 2nd to the 4th. RESULTS: The results showed a resolution of symptoms in 95% of patients treated for hyperhidrosis, whereas a 50% recidivation rate was observed in patients with Raynaud's disease alone, although symptoms were less intense. The results for Raynaud's disease were more disappointing, but it is important to remember that surgery is the ultimate choice for cases with advanced lesions which do not respond to medical treatment. Under these circumstances, the possibility of halting the evolution of the pathology represents an auspicious achievement. CONCLUSIONS: The authors affirm that mini-invasive surgical treatment of hyperhidrosis was resolutive during a mean follow-up of 3 years. It therefore represents a valid method which causes minimum esthetic damage to the patient and the greatest functional benefit. The postoperative period is short (about 3 days) and free of major complications. There is virtually no post-surgical pain.

Adult↗
PubMedDate not supplied

[X-ray guided endovascular repair of venous bed of contracted kidney from pyelonephritis in the treatment of renal hypertension and chronic renal failure].

For compensation for chronic ischemia of the pyelonephritically contracted kidney, the authors used X-ray endovascular venous revascularization for the first time. The surgical intervention was to stenose the subsegmental veins of the diseased kidney, resulting in recanalization of the arterial system. The outcomes of X-ray treatment were analyzed in 38 patients with chronic degree I-II renal failure and nephrogenic hypertension. In 35 (92.1%) patients of them, there was improvement in the clinical picture of the underlying disease and in the filtrating and reabsorbing function of the kidney operated on, an increase in its sizes, and a decrease in systemic blood pressure.

Adolescent↗
PubMed2000

Video-endoscopic dissection of multiple pedicled arterial grafts for use in minimally invasive coronary artery bypass surgery.

BACKGROUND: We evaluated the possibility of video-endoscopic dissection of both internal thoracic arteries (rTAs) through the left thoracic approach and right gastroepiploic artery (GEA) via a small laparoscopic access, for use in minimally invasive coronary artery bypass surgery. METHODS: The procedure was performed on twenty-two mongrel dogs. Three 10 mm ports were inserted in the left hemithorax to enable the introduction of a rigid 0-degree videoscope and forceps which allowed access to the left and right ITAs. For dissection of the GEA, one 10 mm and two 5 mm ports were inserted in the para-umbilical region. RESULTS: The left and right ITAs and the GEA were easily visualized and dissection and complete mobilization was achieved without injury, which was checked by the presence of good blood flow. The ITAs and GEA were divided distally, exteriorized through a small left anterior thoracotomy and the length of these three grafts were able to reach all of the left coronary artery branches. CONCLUSIONS: We have demonstrated, in dogs, the feasibility of video-assisted dissection of both the left and right ITAs through the left thoracic approach, without sternotomy, avoiding the risks of sternal complications and expanding its use for all patients. Furthermore, a third arterial conduit (the RGA) can be used without requiring laparotomy.

Angioscopy↗
PubMed2000

[Endoscopic harvesting of the radial artery at coronary artery bypass graft: a new surgical technique].

The radial artery as arterial graft is applied ever increasingly in coronary artery bypass grafting. With the endoscopic technique described by the authors, the radial artery can be lifted out extremely quickly and gently through transverse 2 cm incisions, using a so-called "spiral instruments for radial artery harvesting" and a 30 degrees endoscope. The ultrasonic knife used for incision and hemostasis does not cause thermic and mechanical damage. The radial artery and accompanying veins remain protected inside the spiral interior. The authors present a case where this method was applied successfully.

Angioscopy↗
PubMed2000

Intercellular and vascular cell adhesion molecule levels in endoscopic and open saphenous vein harvesting for coronary artery bypass surgery.

BACKGROUND: Numbers of intercellular and vascular cell adhesion molecules (ICAM and VCAM) and major ligands on endothelial cells for adherence of activated polymorphnuclear leukocytes, macrophages, and lymphoid cells increase in many inflammatory disorders and after trauma to different tissues. METHODS: Samples of human saphenous veins were harvested from 90 randomly selected patients who underwent coronary artery bypass graft (CABG) surgery, utilizing two different techniques (open and endoscopic). Endothelial cells were collected from the vein samples and cultured for 72 hours. Pre- and postoperative sera, in addition to the supernatants from the cultures, were analyzed for ICAM-1 and VCAM-1 using enzyme-linked immunosorbent assay. RESULTS: Mean preoperative levels of ICAM-1 and VCAM-1 (0.95 +/- 0.58 ng/mL and 1.81 +/- 1.03 ng/mL, respectively) did not differ significantly from that of postoperative sera (0.98 +/- 0.451 ng/mL and 1.74 +/- 1.05 ng/mL, respectively) (p = 0.77 and p = 0.73, respectively). Mean ICAM-1 and VCAM-1 levels in endothelial cell culture supernatants did not differ significantly between the endoscopic (0.16 +/- 0.05 ng/mL and 0.23 +/- 0.10 ng/mL, respectively) and the open method (0.18 +/- 0.08 ng/mL and 0.30 +/- 0.27 ng/mL, respectively) (p = 0.19 and 0.13, respectively). CONCLUSION: Our findings indicate that endoscopic and open saphenectomies are technically comparable in their effects on ICAM-1 and VCAM-1 synthesis during saphenous vein harvesting for CABG. We recommend the endoscopic method for its low morbidity and earlier hospital discharge.

Angioscopy↗
PubMed2000

[Arteriography, endoscopy and periscopy: simultaneous digital imaging].

The author reports his personal, limited experience as well as a literature review concerning first results of a simultaneous study of the blood vessels obtained in a similar approach to conventional angiography, but using a digital approach of the vascular lumen, the normal or pathological endothelium, the adventice and/or the perivascular environment. A static and morphologic iconography aims to demonstrate the potential of this imaging approach in the future, especially knowing that those images may be combined to kinetic and/or functional images of the blood circulation.

Angiography↗
PubMed2001

Laboratory evaluation of a microangioscope for potential percutaneous cerebrovascular applications.

A laboratory-based study of the physical and performance characteristics of a new 0.25-mm-thin microangioscope was performed. The microangioscope tested was compatible with currently available microcatheters, but its tip was considerably stiff and of limited radiopacity. Poor image quality and difficult image interpretation were further drawbacks. Intensive efforts are directed at addressing current limitations and testing further innovations that could pave the way for future performance in neurovascular endoscopy.

Angiography↗