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PubMed2003

[Image diagnosis].

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Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Study of the microcirculation of oral mucosa in healthy subjects.

The research has the following aims: 1: to verify the applicability of capillaroscopic investigation to oral mucosa; 2: to propose oral mucosa as an alternative to the fingernail fold for capillaroscopic investigation; 3: to describe the characteristics of the microcirculation of oral mucosa in healthy subjects. 100 healthy patients were examined. The characteristics of the micro-circulation in the areas of gum mucosa and the mucosa covering of the lower lip were examined using computerised videomicroscopic techniques. For each patient we evaluated the visibility, the course, the density, the tortuosity and any images characteristic of capillary loops, besides the possible presence of microhaemorrhages, the average calibre of capillary loops and the number of capillary loops visible per square millimetre. The investigation was simple, non invasive and repeatable for each patient. An investigation of gum mucosa has revealed a course of capillary loops both parallel and perpendicular to the surface: often the tops of the capillary loops appear as regularly distributed dots or commas. Microcirculatory architecture in the area of the mucosa covering is characterised by capillary loops with a variable diameter, course and length; next to typical capillary loops with the appearance of horse stirrups, there are other loops similar to hairpins, commas and cork screws; there are also rare microhaemorrhages with the aspect of reddish stains, that could be caused by microtraumas. Visibility was very good in the area of the mucosa covering of the lower lip: mediocre in the area of gum mucosa. Our research has highlighted, that today it is possible to carry out a capillaroscopic investigation of oral mucosa in a simple and reliable way. Future research could evaluate how "normal microcirculation", that we describe in this paper, is modified during pathology

Adult↗
PubMed2002

Continuous graft perfusion: optimizing the quality of saphenous vein grafts.

BACKGROUND: Healthy unaltered vascular endothelium in graft material is a prerequisite for a successful CABG operation. Damage done to the endothelium during vein harvest is responsible for an early graft occlusion rate of 20% in the first year after operation. Minimally invasive vein harvesting is regarded to minimize the damage done to the Endothelium. We compared minimally invasive vein harvesting with conventional vein harvesting and studied the influence of a continuous perfusion of the veins with patient autologous blood on their endothelial integrity. METHODS: 80 patients were randomly split into 4 groups: Group 1: Conventional vein harvest and storage of the vein in a crystalloid solution before usage. Group 2: Endoscopic vein harvest and storage in cristallloid solution. Group 3: Conventional harvest under continuous perfusion of the vein with 100 ml blood via the heart lung machine. Group 4: Endoscopic vein harvest under continuous perfusion. Immediately prior to the first peripheral anastomosis a sample was taken from each graft and evaluated by scanning electron microscopy. The endothelial integrity was rated in 5 categories (from "completely confluent endothelium" (1) to "no endothelium" (5)). RESULTS: Group 1: 2.7+/-1.13 Group 2: 2.2+/-1.06 Group 3: 1.6+/-0.68 Group 4: 1.6+/-0.69 CONCLUSION: In regard to the endothelial integrity endoscopic vein harvesting is superior to conventional vein harvest. If the grafts are harvested while continuously perfused with blood there is no more difference between the groups. Considering the well known additional benefits such as reduction in wound healing disorders endoscopic vein harvesting appears to be the preferable technique.

Angioscopy↗
PubMed2002

Endoscopic vein harvest: early results of a prospective trial with open vein harvest.

BACKGROUND: Conventional open long saphenous vein harvest (OVH) is often associated with significant wound pain and serious morbidity in some patients with a resultant extended treatment period. Endoscopic vein harvest (EVH) in theory should alleviate wound pain, be less predisposed towards leg wound infection and lead to greater patient satisfaction. This study aims to compare the two techniques on this basis and determine whether EVH is a viable technique within normal operative time. METHODS: During September and December 2000, 60 saphenous vein harvests were prospectively randomised to EVH (n=30) and OVH (n=30); all performed by one surgeon with the Clearglide(r) endoscopic vein harvest system (Ethicon Inc). End points were impaired wound healing (ASEPSIS score) and postoperative pain (Visual analogue scale) and operative variables. Statistical analysis done using Fisher s exact test and Mann-Whitney U test as appropriate. RESULTS: The groups were well matched demographically. Patients in the EVH group had significantly lower ASEPSIS scores (p<0.001) and postoperative pain (p<0.001). The vein was harvested at 0.96cm/min (0.43-1.5+/-0.33) in the OVH group compared to 0.81cm/min (0.41-1.13+/-0.19) in the EVH group (p=0.09). The new procedure did not prolong the overall operative time (p=0.53). Two patients needed to be converted to open technique. There was no difference found in the vein quality by histological analysis. CONCLUSIONS: These data clearly demonstrate that endoscopic vein harvest results in significantly reduced post-operative pain, better impaired wound healing, allows earlier ambulation and does not prolong the operative time significantly with no compromise in vein quality.

Aged↗
PubMed2003

The influence of Emla cream on cutaneous microcirculation.

Emla cream is frequently used in surgical dermatology and in anesthesiology, for instance, during vascular surgery procedures. Because local anesthetics can have a vasoactive effect in addition to producing analgesia, we decided to document the effect of 5% Emla cream on cutaneous circulation in a prospective, placebo-controlled study. Skin circulation was monitored continuously under standardized conditions using video capillaroscopy, laser Doppler flowmetry and skin temperature. Recordings were made at the nailfold of the fourth finger (DIV) of the left hand of 12 volunteers with healthy veins over an observation period of 60 minutes under either Emla occlusive dressing or an occlusive dressing with placebo. Mean capillary red blood cell velocity changed only minimally under the Emla occlusive dressing, while placebo occlusive dressing led to a reduction of mean capillary red blood cell velocity from 0.21 mm/s to 0.12 mm/s (p<0.01). There was no statistically significant change of arterial capillary diameter under Emla or placebo occlusive dressing. Skin temperature dropped after 60 minutes of Emla cream occlusive dressing from an initial 26.7 to 24.0 degrees C (-10.1%; p<0.02). The same duration of placebo caused skin temperature to drop from 27.6 to 23.0 degrees C (-16.7%; p<0.001). Laser Doppler flux (543 nm) rose 13% with Emla (p=0.9) and dropped 41.9% under placebo occlusive dressing (p<0.03). Emla cream upregulated nutritive perfusion. No clinically relevant vasoconstrictive effects are expected from an application period of 60 minutes.

Adult↗
PubMed2003

Elevated vascular endothelial growth factor in systemic sclerosis.

OBJECTIVE: To determine the serum levels of vascular endothelial growth factor (VEGF) in patients with systemic sclerosis (SSc) and to search for relationships between its serum levels and the clinical manifestations. METHODS: Serum levels of VEGF in patients with SSc and healthy controls were determined by ELISA. At the time of blood sampling, individual organ involvement was assessed, and a video microscope and PC based image processing were used to visualize nailfold capillaries and to quantify capillary density. RESULTS: Serum levels of VEGF in 48 patients with SSc were significantly higher than in 30 controls (432 +/- 356 vs 91 +/- 64 pg/ml; p < 0.001). Patients with diffuse cutaneous SSc (n = 21) had higher levels of serum VEGF than those with limited cutaneous SSc (n = 27) (432 +/- 356 vs 135 +/- 127 pg/ml; p < 0.001). Serum VEGF levels correlated well with the extent of skin sclerosis, as determined by modified Rodnan skin score (r = 0.656, p < 0.001) and serum TGF-beta levels (r = 0.530, p < 0.001). In particular, serum VEGF levels were inversely correlated with the capillary density of nailfold (r = -0.649, p < 0.001). However, no significant differences were found in the serum levels of VEGF between patients with systemic organ involvement and those without. CONCLUSION: The extent of skin sclerosis may contribute to the elevation of serum VEGF and high VEGF levels may serve as a surrogate indicator of capillary damage in SSc.

Adult↗
PubMed2003

[Characteristics of hypoxia development in aged people].

The aim of the study was to investigate the peculiarities of tissue oxygen provision on the level of microcirculatory bed and to determine the significance of the indices taken separatively in pathogenesis of hypoxia in practically healthy elderly people. The study comprised 30 practically healthy people aged 60-74. It included investigation of oxygen tension in peripheral tissues, skin and bulbar microcirculation, functional state of endothelium in the group of elderly healthy people. The results obtained were compared with analogous data obtained in practically healthy young subjects. The tissue oxygen provision was found to decrease with age.

Aged↗
PubMed2003

Review of efforts to decrease costly leg wound complications in the medicare population following coronary revascularization.

BACKGROUND: Current trends show that patients referred for coronary artery bypass grafting (CABG) are significantly older, sicker, and at higher risk for complications than ever before. Eliminating leg wound complications would significantly benefit these patients and reduce the consumption of health care time and dollars. Endoscopic vein harvesting (EVH) decreases the risk of wound complications in patients following CABG and may decrease costly long-term wound-related problems. METHODS: In this retrospective study, the cases of 1909 Medicare patients who had undergone EVH or open vein harvesting (OVH) for CABG were reviewed. The risk factors of these patients were examined and compared with those of 1485 non- Medicare patients. Readmissions, home health care costs, and office lengths of service were reviewed and analyzed. RESULTS: The results of univariate analyses of the Medicare versus non-Medicare populations indicated significant differences for peripheral vascular disease (25.4% versus 17.2%; P <.0001), renal failure (6.0% versus 2.8%; P <.0001), hypertension (75.4% versus 71.5%; P =.011), female sex (31.1% versus 22.4%; P <.0001), mean age (69.8 years versus 57.1 years; P <.0001), and mortality risk (4.6% versus 2.2%; P <.0001). The wound rates in the Medicare group were 1.1% for EVH (n = 741) versus 2.8% for OVH (n = 1168), and this difference was significant (P =.0163) despite a higher frequency of morbid obesity in the EVH population (P <.0001). No significant differences were found in readmission frequency, home health care costs, or office length of service. CONCLUSION: EVH benefits Medicare patients. Although this study is the largest to date to use disposable instruments, there is a lack of statistical power in the analysis of cost comparisons due to the small sample size of wound complications. However, there appears to be a general trend toward a lower treatment cost per patient and less resource use with EVH.

Aged↗
PubMedDate not supplied

[Endovascular treatment: peripheral vascular disease].

Peripheral arterial disease comprises those entities that result in obstruction to blood flow in the supra-aortic, mesenteric, renal and infrainguinal vessels. This review focuses on the endovascular treatment of extracranial internal carotid obstructive lesions, descending thoracic aorta aneurysms, and reconstruction of the aortoiliac bifurcation. The utilization of carotid artery stenting as a less invasive alternative to the surgical treatment for the extracranial internal carotid artery stenosis has progressively increased. Preliminary reports of carotid stenting with distal protection have shown a favorable reduction in the adverse event rates; but, the advantage of the endovascular approach has to be established in comparative and randomized trials. Transluminal endovascular stent grafting is rapidly emerging as a modality to repair descending thoracic aorta aneurysms. Preliminary experience has demonstrated the feasibility and safety of endovascular stent-graft treatment. However, further long-term follow-up is mandatory. Reconstruction of the aortoiliac bifurcation is not usually considered an indication for percutaneous treatment. Although there is limited experience, the results are encouraging with > 90% technical success and high primary patency at 3 years. Endovascular intervention has the potential benefit to reduce the cardiopulmonary and neurological complications and to be applicable to most traditional vascular operations.

Angioplasty↗