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At least 973 records · Page 54Linked to original sources
PubMed2004

Immunogenicity of superoxide radical modified-DNA: studies on induced antibodies and SLE anti-DNA autoantibodies.

Superoxide anion radical (SAR) is formed in almost all aerobic cells and it is the most abundant species generated by several enzymatic and non-enzymatic pathways in mammalian tissues, leading to unfavorable alteration of biomolecules including DNA. The SAR-modified macromolecules have been implicated in several disease states including disorders of inflammation. The SAR-induced damage to DNA showed hyperchromicity, single strand breaks, decrease in melting temperature, and modification of bases. Superoxide modified-DNA in rabbits elicited high titer antibodies and showed diverse antigens binding characteristics. The induced antibodies recognized native DNA and other nucleic acid polymers. Anti-DNA IgG from SLE sera, purified on Protein-A-Sepharose matrix, exhibited increased recognition of superoxide anion radical modified-DNA than native DNA in competitive immunoassay. The visual formation of immune complex between induced antibodies and native DNA, and between SLE anti-DNA IgG and superoxide modified-DNA, is a clear indication of property sharing between SLE autoantibodies and experimentally induced antibodies against superoxide modified-DNA.

Animals↗
PubMed2005

Modified stapes prosthesis to limit postoperative vertigo.

OBJECTIVE: To investigate the anatomic relationship between utricle, saccule, and stapes footplate, and adapt the stapes prosthesis tip to reduce postoperative vertigo. STUDY DESIGN: Five temporal bones were serially sectioned and stained, and the distance from the inner lining of stapes footplate to saccule and utricle, respectively, were measured. The Fisch prosthesis was modified with a slope of 45 degrees at its tip to adapt to the anatomic configuration of the vestibule. Fisch's original piston or the modified piston was used in 174 ears (Group I) and 108 ears (Group II), randomly. RESULTS: There was no statistically significant difference in hearing improvement between the 2 groups (P > 0.5). However, postoperative vertigo was significantly reduced when the modified prosthesis was inserted (P < 0.005). CONCLUSIONS: The modified piston improved the hearing to the level of the original piston, and the incidence of postoperative vertigo was significantly decreased. SIGNIFICANCE: A modified prosthesis is presented for a patient undergoing stapedotomy.

Adolescent↗
PubMedDate not supplied

Proposal of a modified, treatment-oriented classification of odontoid fractures.

BACKGROUND CONTEXT: The classification scheme of odontoid fractures described by Anderson and D'Alonzo is the one most commonly used. However, uncertainty exists in the distinction between Type II and "shallow" Type III fractures. Moreover, fractures at the base of the odontoid (Anderson and D'Alonzo Type II) include a spectrum of injury patterns. PURPOSE: To modify the Anderson and D'Alonzo classification of odontoid fractures based on current clinical treatment options. STUDY DESIGN: Proposal of a modified classification system for odontoid fractures. METHODS: A more precise distinction between Type II and III fractures based on the presence/absence of C1-C2 facet involvement is proposed. A modified classification of Type II fractures based on fracture line obliquity, displacement and comminution is then proposed, because these are factors deemed to influence management. To evaluate the reproducibility of this classification, 52 odontoid fractures were reviewed and classified by four attending spine surgeons and three spine fellows. RESULTS: There was substantial agreement (at least five of seven respondents) in 70% of cases. The overall kappa value for the modified classification system was 0.48, indicating moderate agreement, and there were no differences in kappa values between attending spine surgeons and fellows. CONCLUSIONS: The reproducibility of this system was demonstrated by the moderate agreement observed when applied to odontoid fractures at our institution. The proposed utility of this system is its ability to guide clinical decision making in the treatment of odontoid fractures. Prospective application of this modified classification system and suggested treatment options is now required.

Classification↗
PubMed2003

Removal of metal ions by modified Pinus radiata bark and tannins from water solutions.

Pinus radiata bark and tannins, chemically modified with an acidified formaldehyde solution were used for removing metal ions from aqueous solutions and copper mine acidic residual waters. The adsorption ability to different metal ions [V(V), Re(VII), Mo(VI), Ge(IV), As(V), Cd(II), Hg(II), Al(III), Pb(II), Fe(II), Fe(III), Cu(II)] and the factors affecting their removal from solutions were investigated. Effect of pH on the adsorption, desorption, maximum adsorption capacity of the adsorbents, and selectivity experiments with metal ion solutions and waste waters from copper mine were carried out. The adsorbents considerably varied in the adsorption ability to each metal ion. The adsorption depends largely upon the pH of the solution. Modified tannins showed lower adsorption values than the modified bark. For the same adsorbent, the maximum capacity at pH 3 for the different ions were very different, ranging for modified bark from 6.8 meqg(-1) for V to 0.93 meqg(-1) for Hg. Waste waters were extracted with modified bark as adsorbent and at pH 2. The ions Cu(II) (35.2 mgL(-1)), Fe(III) (198 mgL(-1)), Al(III) (83.5 mgL(-1)) and Cd(II) (0.15 mgL(-1)) were removed in 15.6%, 46.9%, 83.7% and 3.3%, respectively, by using 1g of adsorbent/10 mL of waste water. In general, a continuous adsorption on a packed column gave higher adsorbed values than those observed in the batchwise experiment.

Adsorption↗
PubMed2004

Partitioning of hydrophobic organic chemicals (HOC) into anionic and cationic surfactant-modified sorbents.

Surfactant-modified sorbents have been proposed for the removal of organic compounds from aqueous solution. In the present study, one cationic (HDTMA) and three anionic (DOWFAX-8390, STEOL-CS330, and Aerosol-OT) surfactants were tested for their sorptive behavior onto different sorbents (alumina, zeolite, and Canadian River Alluvium). These surfactant-modified materials were then used to sorb a range of hydrophobic organic chemicals (HOCs) of varying properties (benzene, toluene, ethylbenzene, 1,2-dichlorobenzene, naphthalene, and phenanthrene), and their sorption capacity and affinity (organic-carbon-normalized sorption coefficient, K(oc)) were quantified. The HDTMA-zeolite system proved to be the most stable surfactant-modified sorbent studied because of the limited surfactant desorption. Both anionic and cationic surfactants resulted in modified sorbents with higher sorption capacity and affinity than the unmodified Canadian River Alluvium containing only natural organic matter. The affinities of the surfactant-modified sorbents (K(oc)) for most HOCs are lower than octanol/water partition coefficient (K(ow)) normalized to the organic carbon content (f(oc)) and the density of octanol (K(oc) octanol); naphthalene and phenanthrene are the exceptions to this rule.

Adsorption↗
PubMed1997

Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria.

OBJECTIVES: To compare the acceptability of fat- and sodium-modified entrees before and after implementation of a marketing program and to determine the effect offering and marketing these healthful entrees had on total cafeteria and entree sales in a worksite cafeteria. DESIGN: The research was conducted in five phases, including sales data collection, acceptance testing of unmodified hot entrees, acceptance testing of modified entrees, and implementation of a marketing campaign for promoting low-fat, sodium-controlled food selections. SETTING: The Kansas Farm Bureau and Affiliated Services (KFB) employee cafeteria. SUBJECTS: KFB employees who ate lunch in the employee cafeteria and were willing to participate in the study. MAIN OUTCOME MEASURES: Sales data (percent of customers purchasing a modified entree and sales of modified entree as a percent of total sales); nutrient analysis data (energy, grams of total fat, percent of energy from fat, milligrams of cholesterol, and milligrams of sodium); and acceptability data (11 characteristics were measured using a seven-point hedonic scale). STATISTICAL ANALYSIS PERFORMED: General linear model analysis of variance was used to compare sales data from phases 1 to 5 and to compare acceptability data from phases 2 to 4. RESULTS: No significant differences in sales data were observed during the 7-month study. No significant changes in overall acceptability were found for any entree. However, customers tended to rate overall acceptability higher when entrees were marketed as lower in fat and sodium. APPLICATIONS/CONCLUSIONS: Customers in worksite cafeterias may be more willing to tolerate changes in flavor attributes when modified entrees are marketed as "healthful" and nutrition information is available.

Diet, Fat-Restricted↗
PubMed1997

Modified ultrafiltration after cardiopulmonary bypass in pediatric cardiac surgery.

BACKGROUND: Cardiopulmonary bypass in children results in considerable water retention, especially in neonates and small infants. Dilution of plasma proteins increases water loss into the extravascular compartments. Excessive total body water may prolong ventilatory support and may contribute to a prolongation of intensive care convalescence. After discontinuation of cardiopulmonary bypass, modified ultrafiltration can be used to withdraw plasma water from the total circulating volume. METHODS: This retrospective study included 198 pediatric patients who underwent cardiac operations in the period from September 1991 to November 1994. Two groups were compared: 99 patients without ultrafiltration and 99 patients receiving modified ultrafiltration. The following indices were analyzed: cardiopulmonary bypass prime volume, transfused blood volume during and after the operation, postoperative chest drain loss, and hemoglobin and hematocrit levels before, during, and after the procedure. RESULTS: Modified ultrafiltration resulted in a significant increase in hemoglobin and hematocrit levels and a significantly lower amount of transfused blood. Mean postoperative chest drain loss was significantly less in the patients who underwent modified ultrafiltration. CONCLUSIONS: Modified ultrafiltration decreases blood transfusion requirements and chest drain loss after pediatric cardiac surgical procedures.

Blood Transfusion↗
PubMed1999

Does the modified Blalock-Taussig shunt cause growth of the contralateral pulmonary artery?

BACKGROUND: Although some pediatric cardiology departments have a policy of adopting primary correction of tetralogy of Fallot in all symptomatic infants, we and others still palliate neonates and infants. Effective palliation should ameliorate symptoms and allow growth of the pulmonary arteries. Although studies on the growth of the ipsilateral and contralateral pulmonary arteries after a classic Blalock-Taussig shunt have been reported, pulmonary artery growth after a modified Blalock-Taussig shunt has not been studied as thoroughly. Therefore, we examined whether there is equal growth of the contralateral pulmonary artery after a modified Blalock-Taussig shunt. METHODS: We retrospectively analyzed the records of 140 patients with symptomatic tetralogy of Fallot who had a modified Blalock-Taussig shunt between October 1985 and October 1995. The median age at the time of the Blalock-Taussig shunt was 1.6 months. All patients had corrective procedures at a median age of 1.7 years. Cineangiography was done before the corrective procedure. From the angiograms the diameter of the right and left pulmonary arteries before their first lobar branches and the diameter of the descending thoracic aorta at the level of the diaphragm were measured. For each patient the ratios of right pulmonary artery to descending thoracic aorta and left pulmonary artery to descending thoracic aorta were determined and compared using Student's t test. RESULTS: Of the 140 patients, 114 had a left-sided Blalock-Taussig shunt, 20 had a right-sided shunt, and 6 patients had bilateral shunts. The mean right pulmonary artery to descending thoracic aorta ratio was 1.10 and the mean left pulmonary artery to descending thoracic aorta ratio was 0.98. This difference was not significant. CONCLUSION: We showed equal growth of the right and left pulmonary arteries with no distortion after a modified Blalock-Taussig shunt. If palliation is considered, the modified Blalock-Taussig shunt remains our choice.

Cardiac Surgical Procedures↗
PubMed1999

Thermosensitive polymer-modified liposomes that release contents around physiological temperature.

To obtain temperature-sensitive liposomes which release their contents around the physiological temperature, we designed dioleoylphosphatidylethanolamine liposomes modified with copolymers of N-isopropylacrylamide and acryloylpyrrolidine. Copolymers of acryloylpyrrolidine and N-isopropylacrylamide, which exhibit a lower critical solution temperature around the physiological temperature, were prepared by free radical copolymerization using azobis(isobutyronitrile) as the initiator. The copolymers with anchors to the liposome membrane were obtained by using N, N-didodecylacrylamide as an additional comonomer. The copolymer having the anchor group at the terminal of the polymer chain was also synthesized by copolymerization of these monomers in the presence of 2-aminoethanethiol and subsequent conjugation of N, N-didodecyl succinamic acid to the terminal amino group of the copolymer. Calcein-loaded dioleoylphosphatidylethanolamine liposomes modified with these copolymers were prepared and release of the contents from these liposomes was investigated. It was found that the release from these copolymer-modified liposomes was promoted around and above the lower critical temperature of the copolymer. Also, the liposomes modified with the terminal anchor-type copolymer released the contents more drastically responding to a small temperature change than the liposomes modified with random copolymers containing N,N-didodecylacrylamide units as the anchor.

Acrylamides↗
PubMed1999

Temperature-controlled interaction of thermosensitive polymer-modified cationic liposomes with negatively charged phospholipid membranes.

To obtain cationic liposomes of which affinity to negatively charged membranes can be controlled by temperature, cationic liposomes consisting of 3beta-[N-(N', N'-dimethylaminoethane)carbamoyl]cholesterol and dioleoylphosphatidylethanolamine were modified with poly(N-acryloylpyrrolidine), which is a thermosensitive polymer exhibiting a lower critical solution temperature (LCST) at ca. 52 degrees C. The unmodified cationic liposomes did not change its zeta potential between 20-60 degrees C. The polymer-modified cationic liposomes revealed much lower zeta potential values below the LCST of the polymer than the unmodified cationic liposomes. However, their zeta potential increased significantly above this temperature. The unmodified cationic liposomes formed aggregates and fused intensively with anionic liposomes consisting of egg yolk phosphatidylcholine and phosphatidic acid in the region of 20-60 degrees C, due to the electrostatic interaction. In contrast, aggregation and fusion of the polymer-modified cationic liposomes with the anionic liposomes were strongly suppressed below the LCST. However, these interactions were enhanced remarkably above the LCST. In addition, the polymer-modified cationic liposomes did not cause leakage of calcein from the anionic liposomes below the LCST, but promoted the leakage above this temperature as the unmodified cationic liposomes did. Temperature-induced conformational change of the polymer chains from a hydrated coil to a dehydrated globule might affect the affinity of the polymer-modified cationic liposomes to the anionic liposomes.

Anions↗
PubMed1997

Investigation of the image contrast of tapping-mode atomic force microscopy using protein-modified cantilever tips.

In this work we have designed a simple system to investigate empirically the image contrast of tapping-mode atomic force microscopy (TMAFM). We modified the cantilever tips with protein molecules (bovine serum albumin or goat anti-biotin antibody) and used these protein-modified cantilevers to scan poly-L-lysine films and antibody layers deposited on mica in air under ambient conditions. We also investigated the effects of manipulating the setpoint voltage in this system. It was found that extra topographic features with a patchlike appearance were introduced into the TMAFM images of both the poly-L-lysine and antibody films when scanned with the protein-modified tips, even at initial preset setpoints, and were superimposed on the topography of the samples. The surface coverage of the patchlike features in the TMAFM images changes significantly with the setpoint voltage in a reversible and nonlinear manner. These are believed to arise from the surface indentation of the sample or from the structural deformation of the proteins at the tip induced in TMAFM imaging. Interestingly, it was observed in the experiment that no structural alteration or damage was discernible on the sample surface, even after continuous scanning with the protein-modified tips for a long period of time, with varying setpoint voltage. This study provides experimental evidence that cantilever tips modified with protein molecules or, under certain circumstances, even unmodified tips introduce extra topographical features (i.e., artifacts) and enhance the image contrast of TMAFM imaging of soft materials, which is dependent on their mechanical properties.

Aluminum Silicates↗
PubMed2004

Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success.

BACKGROUND: Increasingly, pancreatic stents are being placed to prevent post-ERCP pancreatitis. However, guidewire and stent placement may fail if the duct is small or tortuous, potentially exacerbating the risk. This study assessed the impact of unsuccessful pancreatic stent placement on complications and the efficacy of a modified technique for stent insertion when pancreatic ductal anatomy makes stent insertion technically difficult. METHODS: Technical variables and 30-day complications of consecutive therapeutic ERCPs, including attempted major papilla pancreatic stent insertion were prospectively studied. Success rates for pancreatic stent placement were compared for a 1-year period during which conventional deep guidewire insertion was used and another 1-year period in which a modified technique was used as needed in patients with ductal anatomy that made stent placement technically difficult. In the modified technique, a short (2-3 cm) small diameter (3F-5F) stent was placed over a 0.018-in nitinol-tipped guidewire, passed as little as 1 to 2 cm beyond the pancreatic sphincter. RESULTS: In 225 high-risk therapeutic ERCPs, pancreatitis occurred after the procedure in two of 3 (66.7%) patients in whom pancreatic stent insertion failed vs. 32 of 222 (14.4%) patients with successful insertion (p=0.06). Severe pancreatitis occurred only after unsuccessful stent insertion. Significant multivariate risk factors for post-ERCP pancreatitis were unsuccessful pancreatic stent insertion (odds ratio 16.1: 95% CI[1.3, 200]), sphincter of Oddi dysfunction (odds ratio 3.2: 95% CI[1.4, 7.5]), and prior post-ERCP pancreatitis (odds ratio 3.2: 95% CI[1.4, 7.1]). The following were not risk factors: performance of pancreatic, biliary, or needle-knife pre-cut sphincterotomy; number of pancreatic contrast injections; and difficult cannulation. Stent placement was unsuccessful in 3 (3.2%) of 93 attempts during the 1-year period in which a conventional technique was used vs. none of 132 attempts in a subsequent year in which the modified technique was used. CONCLUSIONS: Failed attempts at pancreatic stent placement are associated with an extremely high risk of post-ERCP pancreatitis. Success can be consistently achieved by use of a modified technique.

Adult↗
PubMed2000

Study of dead volume measurement in packed subcritical fluid chromatography with ODS columns and carbon dioxide-modifier mobile phases.

Studies were done for providing a simple, rapid and reliable procedure of void volume measurement in packed subcritical fluid chromatography (pSubFC), with CO2-modifier mobile phases containing high modifier amounts. Methods used in RPLC with ODS columns were applied in pSubFC: gravimetric, homologous series linearisation and unretained marker injection. Results lead us to propose the method of marker injection to determine the void volume in pSubFC. Acetonitrile was chosen as the void volume marker among six tested markers. Furthermore, void volume variations vs. the modifier volume (from 5 to 45%) were studied for nine organic modifiers. The void volume variations were related both to adsorption-desorption phenomena between the mobile phase and the stationary phase and to mobile phase density changes. These variations allowed the classification of the modifiers into four groups on the basis of the molecular interactions.

Carbon Dioxide↗
PubMed2003

Viscosity function in polymer-modified asphalts.

Asphalt is a multidisperse micellar system with rheological behavior resembling that of a low-molecular-weight polymer. Nowadays, asphalt is frequently modified by blending it with various polymers. Such modified asphalt has rheological properties that differ from the properties of the base asphalt. It is quite common to study asphalt in dynamic experiments. Such studies, however useful, cannot reveal all characteristic features of polymer-modified asphalts. Asphalt modification by polymers is strongly manifested in the region of transitions from a viscoelastic fluid to the Newtonian fluid. The viscosity study in this region can reveal behavior characteristic of the used polymer modifier, thus complementing the dynamic studies of these materials. The viscosity of base asphalt modified by styrene-butadiene-styrene and by ethylene-vinyl acetate polymers (in several concentrations) is studied and discussed in this note.

Journal Article↗
PubMed1997

Efficacy of the transthoracic modified Heller myotomy in children with achalasia--a 21-year experience.

From 1974 to 1995, 19 children with achalasia of the esophagus have been treated at our institution. Presenting symptoms included vomiting (n = 14), dysphagia (n = 13), failure to thrive (n = 6), and odynophagia (n = 1). Diagnosis was established by a barium swallow in 19, with eight also undergoing esophageal manometry. Six boys and 13 girls with an average age of 10 years (range, 1.3 to 17.6) underwent a transthoracic, modified anterior Heller esophagomyotomy (HM). Five underwent a concomitant, modified, Belsey fundoplication (BF). Follow-up ranging from 6 months to 21 years (mean, 9 years) was accomplished in all 19 patients by both office visits and telephone interviews. Early postoperative follow-up showed initial swallowing difficulty in two (14%) patients with a HM alone and in four out of five (80%) patients treated with a HM and BF. All patients (n = 5) with a HM and BF and one with a HM alone required one esophageal dilation during the first postoperative year. These initial swallowing difficulties resolved in all six patients during this first postoperative year. Late postoperative follow-up, however, indicates occasional, mild dysphagia in two out of five with an HM and BF resulting in complete relief of presenting symptoms in 17 of the 19 patients (90%). All patients rated their overall result as either excellent (68%) or good (32%) with none rating it as fair or poor. None of the 19 patients had clinical evidence of gastroesophageal reflux, although five patients had evidence of nonpathologic reflux noted during upper gastrointestinal x-ray. Recurrent vomiting, asthma, wheezing, or esophagitis symptoms have not been reported by any patients. No patients required reoperation, and there were no deaths or postoperative complications. Modified Heller esophagomyotomy is safe (0% mortality) and effective (90% relief of symptoms) in children with achalasia. A concurrent modified Belsey fundoplication results in early and late mild postoperative dysphagia that was responsive to esophageal dilation. The transthoracic, modified Heller esophagomyotomy without a fundoplication is currently our treatment of choice for achalasia in children.

Adolescent↗
PubMed1997

Radiopacity of resin-modified glass ionomer liners and bases.

STATEMENT OF PROBLEM: Lining and base materials for restorations have traditionally been autopolymerized and include conventional glass ionomer cements. Light-cured resin-modified glass ionomer cements have recently become available, but a lack of information exists regarding their radiopacity. PURPOSE OF STUDY: In this study the radiopacity of glass ionomer cements was assessed with a standard method that related densitometric measurements to an equivalent thickness of aluminum. MATERIAL AND METHODS: Radiographs were made of specimens with seven materials commonly used as liners and bases: two reinforced zinc oxide-eugenol cements (Kalzinol and Intermediate Restorative Material, De Trey Dentsply), a zinc phosphate cement (SS White, S.S. White Manufacturing), three resin-modified glass ionomer liners (Vitrebond [3M Dental Products], Fuji Lining LC [GC Dental], and Photac-Bond [ESPE Dental Medizin GmbH]), and a conventional glass ionomer liner/base (Ketac-Bond, ESPE Dental-Medizin GmbH), with dentin as a control. The radiopacity of all materials was compared with dentin. RESULTS: Kalzinol had the greatest radiopacity of the materials tested. The glass ionomer cements were substantially less radiopaque than other materials. The conventional glass ionomer cement, Ketac-Bond, was more radiopaque than the three resin-modified glass ionomer cements. Of the three resin-modified glass ionomer materials, Vitrebond was the most radiopaque and Fuji Lining LC was the least radiopaque. CONCLUSION: Future resin-modified glass ionomer materials are recommended to be formulated to increase radiopacity for improved clinical detection.

Absorptiometry, Photon↗
PubMed1999

Microleakage of Class V resin-modified glass ionomer and compomer restorations.

STATEMENT OF PROBLEM: Resin-modified glass ionomers and polyacid-modified resin composites (compomers) have been introduced to provide esthetic restorations. However, there is concern about the marginal sealing ability of these materials, especially at the dentin (cementum) aspects of restorations. PURPOSE: This in vitro study evaluated the microleakage of Class V restorations made with resin-modified glass ionomers or a compomer. MATERIAL AND METHODS: Thirty noncarious human molar teeth were used. Standardized kidney-shaped Class V cavity preparations were placed in the buccal and lingual surfaces at the cementoenamel junction. Teeth were randomly assigned to 3 experimental groups of 10 teeth each and restored as follows: group 1, Fuji II LC; group 2, Vitremer; and group 3, Dyract. In all cases, the manufacturers' instructions were strictly followed. All materials were placed in a single increment. Unfinished restorations were immediately coated with the respective manufacturers' sealer or varnish and this was either light cured for 20 seconds or allowed to air-dry. After 24 hours, teeth were finished to contour and to the cavosurface margins, coated with nail varnish except for 1 mm around the restoration margin, thermocycled (1000x, 5-55 degrees C) and placed in a solution of 2% basic fuchsin dye for 24 hours at room temperature. The staining along the tooth restoration interface was recorded. RESULTS: Kruskal-Wallis 1-way analysis of variance revealed significant differences among all restorative materials for the overall, occlusal, and gingival scores (P =.03, P =.01, P =.01, respectively). Occlusal and gingival scores for each matched pair of restorative materials using the Wilcoxon test showed statistically significant differences between Fuji II LC glass ionomer cement and Dyract composite, both for the occlusal (P =.005) and gingival (P =.005) margins and also as an overall evaluation (P =.01), with Fuji II LC showing the least dye penetration. Vitremer revealed dye penetration scores not significantly different from Fuji II LC glass ionomer cement or Dyract composite. CONCLUSION: Resin-modified glass ionomers showed less or similar microleakage than the polyacid-modified composite resin tested.

Analysis of Variance↗
PubMed2003

The modified Fontan procedure: early and late results in 132 adult patients.

OBJECTIVE: The modified Fontan procedure, usually performed in children, is used for the treatment of anomalies with a single functional ventricle. We reviewed our experience with the modified Fontan procedure performed in the adult patient. METHODS: Between October 1973 and May 2001, the modified Fontan procedure was performed on 132 adult patients (74 men, 58 women). Median age was 23 years (range, 18 to 53 years). Diagnoses included tricuspid atresia in 34 patients (26%), double-inlet left ventricle in 48 (36%), and complex lesions in 50 (38%). The majority of patients (89%) had at least one prior palliative procedure; the most common procedures were Blalock-Taussig shunt in 85 patients and Glenn anastomosis in 31. RESULTS: Operations included an atriopulmonary connection in 74 patients, lateral tunnel in 27, intra-atrial conduit in 14, right atrium-to-right ventricle in 9, extra-cardiac conduit in 3, and other in 5. Overall early mortality was 8.3%. Mortality was 6.5% for operations performed after 1980. This is comparable to the mortality of the modified Fontan procedure performed in children during the same time interval at our institution. All 7 of the early deaths since 1980 occurred in the complex lesion group. Morbidity included prolonged pleural effusion in 36 patients, atrial arrhythmias in 25, reoperation for bleeding in 13, permanent pacemaker in 8, and stroke in 2. Mean follow-up was 9.1 years with a maximum of 21.2 years. Actuarial survival for early survivors was 89% (84,95), 75% (67,84), and 68% (58,79) at 5, 10, and 15 years, respectively. Freedom from late reoperation was 89% (83,95), 85% (78,93), and 80% (70,91) at 5, 10 and 15 years, respectively. The majority (90%) of present survivors were New York Heart Association class I or II at follow-up. CONCLUSIONS: In properly selected adult patients with functional single ventricle, the modified Fontan procedure can be performed with early mortality similar to younger patients. Early mortality is more likely with complex lesions. The majority of late survivors have a good quality of life.

Adolescent↗