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PubMed2004

Current applications for nicardipine in invasive and interventional cardiology.

Interventional coronary procedures, such as rotational atherectomy and coronary artery bypass graft (CABG) stenting, are associated with a risk of postoperative vasoconstriction, which can lead to sequelae that produce morbidity and even death. Vasodilators, such as calcium channel blockers, sodium nitroprusside and adenosine, are often administered to prevent or reverse these sequelae, and have proven effective for this purpose. The injectable dihydropyridine calcium channel blocker, nicardipine, has several unique properties that make it an effective option for preventing and/or reversing microvascular or conductance vessel vasoconstriction. In this review, we describe the evidence-based uses of nicardipine injection in interventional cardiology and cardiac catheterization procedures. In comparison to other calcium channel blockers, nicardipine injection appears to be potentially safer, easier to administer and capable of producing a more predictable response. This drug has potential advantages in preventing or reversing the no-reflow phenomenon that sometimes occurs after interventions in coronary bypass grafts. Nicardipine may also be effective when administered in a flush solution with other drugs during rotational atherectomy and clot debulking with or without distal protection devices. It also can control the hypertension that occurs after sternotomy and cardiac surgery, and in the cardiac catheterization laboratory. In summary, the dihydropyridine calcium channel blocker, nicardipine, has a wide range of useful applications during cardiovascular interventions.

Atherectomy, Coronary↗
PubMed2004

Percutaneous carotid stenting: a novel treatment for carotid artery stenosis.

BACKGROUND: Stroke is currently a leading cause of physical disability and carries a high mortality rate. About 20% of ischemic stroke is caused by carotid artery stenosis. Carotid stenting is now another therapeutic modality for the treatment of extracranial carotid artery stenosis. MATERIAL AND METHOD: All patients who underwent carotid stenting at King Chulalongkorn Memorial Hospital from March 2001 to December 2002 were analyzed. The case success was determined by residual angiographic stenosis of less than 30% without any major adverse cardiovascular events such as death, stroke or emergency re-intervention. RESULTS: Carotid stenting was performed in 6 patients with 9 vessels disease. Their mean age was 71.8 years. Hypertension was the most common risk factor detected in all patients, followed by smoking (83.3%), dyslipidemia (83.3%) and diabetes (33.3%). One third of the patients had a prior history of stroke or transient ischemic attack and 16.6% occurred within 6 months. Five of six (83.3%) had severe coronary disease and required coronary artery bypass grafting after successful carotid stenting. The procedures were successful in all patients. The average percent of stenosis was reduced from 83.2% to 9.4%. The distal protection device was used in one-third of the cases. The average procedure time was 63.6 minutes and fluoroscopic time was 16.6 minutes. There was no evidence of stroke or death after the procedures. Only one (11.1%) developed hypotension and bradycardia that required intravenous fluid loading and inotropic support for 24 hours. CONCLUSION: Carotid stenting at our center is feasible and considered to be a safe procedure for the treatment of carotid artery stenosis. This procedure is another alternative treatment and may be superior to carotid endarterectomy, the standard treatment of carotid artery stenosis.

Aged↗
PubMedDate not supplied

[Methodology for assessing occupational dermal exposure].

BACKGROUND: Dermal risk assessment of exposure to chemicals is difficult due to the lack of standardisation of the methods used in exposure quantification; further limits concern the extent of skin contamination and especially dermal absorption of different substances. To solve these problems many authors proposed conceptual models founded on theoretical assumptions and experimental data, but their use in occupational settings revealed many difficulties. A possible alternative is the use of a check-list that permits evaluation of occupational dermal contamination hazards. AIMS: To propose a simplified method for dermal risk assessment. METHODS: Dermal contamination risk evaluation, chemical hazard quantification and duration of exposure are the basic features of the method. The first step assesses working conditions, use of protective devices, skin contamination directly observed, personal hygiene of workers: all information, collected by a trained observer, is scored according to literature data and/or to authors'personal experience. Chemical hazard quantfication is obtained from safety data sheet evaluation (R phrases classification and chemical-physical characteristics of the chemical in use). The method allows a preliminary dermal exposure assessment to be made, subdivided on hazard bands. RESULTS: The method permits a rapid dermal exposure assessment to be made and suggests intervention measures to decrease dermal risk. CONCLUSIONS: A check-list is proposed that can be a useful and easy method to assess dermal exposure to chemicals, particularly in small- and medium-sized enterprises.

Dermatitis, Occupational↗
PubMedDate not supplied

Inpatient mortality of hip fracture patients in the Veterans Health Administration.

Hip fractures among elderly people frequently result in permanent disabilities, nursing home placement, and death. The bulk of hip fracture research focuses on elderly women. Within the Veterans Health Administration (VHA), the majority of patients are men. There are no published national reports on hip fractures with large male samples, or on related inpatient mortality among veterans. This retrospective study of 13,546 veterans with hip fracture discharges from 1998-2002 found unadjusted mortality rates are higher in the VHA, compared with the general population. VHA patients tend to be older men in poor health who stay in the hospital longer Increased knowledge about the risks and outcomes associated with hip fractures in men could lead to improved primary and secondary injury-prevention programs. Rehabilitation nurses in acute care can be catalysts in proactively incorporating protective devices, screening for osteoporosis, and initiating lifestyle changes in their plans of care to optimize outcomes for hip fracture patients.

Aged↗
PubMed1992

Protection against hip fractures by energy absorption.

Impact lateral to the hip was noted in 37 of 60 patients with hip fracture. Women with hip fracture (n = 12) had an average 22 mm thick soft tissue cover of the hip as compared to 32 mm in healthy women (n = 27), even for the same body mass index. Experiments where a steel weight was dropped from various heights onto porcine soft tissue showed that a layer of 29 mm could absorb 60% more energy than a 20 mm thick layer before nearly metallic contact would occur, corresponding to a sharp rise in load. If the results are related to conditions in vivo, then the passive protection of soft tissue over the hip is important for the development of hip fractures, and may under certain assumptions explain the higher risk of hip fractures in thin persons. An external hip protection device might therefore prevent some hip fractures.

Adult↗
PubMed1992

Stun gun injury: a new presentation of the battered child syndrome.

Stun guns are self-protection devices that are increasingly available with few restrictions on their use and sale. We present a case of child abuse with a stun gun. The signs of such abuse are often subtle, and they may be underrecognized currently. The skin lesions that are often seen are hypopigmented circular macules, measuring approximately 0.5 cm in diameter. They may be raised slightly and erythematous if inflicted recently Most characteristic of stun gun assault is pairing of lesions approximately 5 cm apart. We discuss the design, operation, and effects of stun guns, and give an extensive differential of abusive and nonabusive circular lesions.

Battered Child Syndrome↗
PubMed2004

Effects of duration of exposure to wood dust on peak expiratory flow rate among workers in small scale wood industries.

OBJECTIVES: Occupational and environmental lung diseases are one of major problems of clinical medicine. Several occupations are associated with adverse health effects, and the lung is one of the parts of the body most vulnerable to airborne hazards. Exposure to gas, fume, and dust can lead to occupational lung diseases. The objective of the study was to assess the effects of wood dust and the duration of exposure on peak expiratory flow rate (PEFR) and additionally, to minimize possible health risks for wood workers by providing them with information about wood dust related hazards. METHODS: The present study was conducted under the supervision of the Department of Physiology, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia during the year 2002. It was designed as a matched case-control cross-sectional study of spirometry in forty six non-smoking wood workers, aged 20-60 years, who worked without the benefit of wood dust control ventilation or respiratory protective devices. PEFR measurements were performed using an electronic spirometer. RESULTS: The present study results demonstrated that in wood workers exposed for longer periods than 8 years, PEFR was significantly reduced as compared with their matched controls. CONCLUSION: Based on the results of the present study, we conclude that PEFR in wood workers is impaired and the stratification of results shows a dose-response effect of years of wood dust exposure on its value.

Adult↗
PubMed2005

Use of a second buddy wire during percutaneous coronary interventions: a simple solution for some challenging situations.

The buddy wire technique, i.e. the use of a second 0.014 inch guide wire placed alongside the one employed to advance balloons and stents inside the coronary artery during percutaneous coronary intervention (PCI), may help in a series of procedural challenges during PCI. Indeed, by improving both the stability of the guiding catheter and the support for balloon and stent, a buddy wire use is sometimes the simplest way to accomplish a successful procedure. In this paper, we discuss technical aspects of some specific circumstances frequently encountered during PCI, in which a buddy wire may be helpful. These include: 1) The reduction of balloon slippage during angioplasty for in-stent restenosis; 2) insufficient back-up of the guiding catheter; 3) stenting of lesions located in vessels with proximal tortuosities/angulations; 4) stenting of lesions distally located in the vessel; 5) facilitation in the positioning of distal protection devices; 6) stenting of a lesion distally located from a previously implanted stent or from a coronary segment with both calcification and sharp bend; 7) PCI on coronary arteries with anomalous origin. Because of its simplicity, low cost, and availability, the use of a buddy wire should be considered when dealing with the aforementioned conditions during PCI procedures.

Angioplasty, Balloon, Coronary↗
PubMed2005

Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry).

AIM: Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers. METHODS: Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method. RESULTS: Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (>50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively. CONCLUSIONS: The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.

Adult↗
PubMed1992

Ligamentous injuries to the lateral aspect of the ankle: the ankle sprain.

Good protective devices are available which will prevent or reduce the severity of ankle sprains. If an injury to the lateral ligaments of the ankle--an ankle sprain--is sustained, functional treatment with early tape support, followed by a plastic support device will return the vast majority of the injured athletes to competition rapidly and with a stable ankle. In a few cases, surgical repair is the most appropriate treatment to return the individual to his chosen endeavor with a stable ankle.

Ankle Injuries↗
PubMed2004

Lung function and respiratory symptoms of pesticide sprayers in state farms of Ethiopia.

Chemical pesticides are health hazards affecting the livelihood of those who are occupationally engaged in spraying farm fields. The objective of the study was to determine the extent of the hazard of chemical pesticide application by farm workers in selected farms. The major parameters used were measurements of lung function and respiratory symptoms. The design of the study was cross-sectional and was conducted in four state farms. Lung function and respiratory symptoms of 102 pesticide sprayers of state farms of Ethiopia and of 69 non-sprayers were assessed All data were analysed by decade age groups adjusting for smoking habits. The results of lung function and respiratory symptoms of 102 pesticide sprayers and of 69 non-sprayers are presented. The 15-24 years age group of pesticide sprayers had significantly reduced forced expiratory vital capacity (FVC) and forced expiratory volume in one second (FEV1), as compared to that of similar age group non-sprayers. Analysis of variance on FVC and FEV for the five predictors (age, height, weight, chest circumference and FFM) of the non-sprayers was highly significant (F = 4.647, 5.563 & P = 0.001, 0.000 for FVC and FEV1 respectively). 5.9% and 16.7% of the pesticide sprayers had symptoms of cough and breathlessness respectively. Pesticide applications resulted in reduced lung function and evoking respiratory symptoms. Pesticide sprayers need to be sensitised to the hazardous consequences of pesticide applications for human health and the environment and should be encouraged to wear personal protective devices during work on farms.

Adolescent↗
PubMedDate not supplied

[Sapphire: precious stone or ersatz?].

The SAPPHIRE trial compared the results of carotid endarteriectomy to those of carotid artery stenting with an emboli-protection device in patients with carotid artery stenosis and coexisting conditions that potentially increased the risk posed by endarteriectomy. The trial concluded that stenting was not inferior to endarteriectomy. This publication was selected by the AHA among the "Top Ten of Heart Disease and Stroke Research" for 2004. Yet, from the start, it raised a considerable controversy which was already exposed in the Editorial which appeared in the same issue of the NEJM. The present paper analyses and summarizes the various potential bias which raised suspicion regarding the SAPPHIRE data. It also underlines the fact that the results obtained in the SAPPHIRE surgical series are considerably inferior to those generally cited in the literature, or those obtained locally.

Angioplasty, Balloon↗
PubMed2005

Failure of the Symbiot PTFE-covered stent to reduce distal embolization during percutaneous coronary intervention in saphenous vein grafts.

OBJECTIVES: To examine the effect of the Symbiot PTFE-covered stent on distal embolization during percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). BACKGROUND: Covered stents are intended to trap friable debris and reduce distal embolization during vein graft PCI, but have consistently failed to improve clinical outcomes in randomized trials. The reasons for this lack of benefit are unclear. METHODS: Thirty patients undergoing SVG PCI, and eligible for a FilterWire distal protection device, were randomized to Symbiot or to a conventional bare-metal stent. Postprocedure, the FilterWire was removed, fixed in formalin, and photographed under high magnification. The primary end-point was embolic debris area, measured by semi-automated edge-detection analysis of digital images. Secondary end points were no-reflow, "Filter no-reflow", and distal embolization. RESULTS: There was no significant difference between the Symbiot and conventional stent groups in embolic debris area (10.5 +/- 7.2 versus 6.6 +/- 7.8 mm2; p = 0.18). No-reflow occurred in 3/14 Symbiot versus 0/16 conventional (p = 0.09), and final TIMI flow was lower in the Symbiot group (2.7 +/- 0.5 versus 3.0 +/- 0.5; p = 0.01). However, there was no difference in the incidence of Filter no-reflow (7/14 versus 7/16; p = NS) or distal embolization (9/14 versus 8/16; p = NS). Distal embolization in the Symbiot group occurred predominantly after postdilatation (7/9; p = 0.05). CONCLUSIONS: The Symbiot PTFE-covered self-expanding stent does not reduce distal embolization compared to a conventional bare metal stent. Distal embolization with the Symbiot occurs almost exclusively after mandatory postdilatation. These findings may explain the failure of the Symbiot, and of covered stents in general, to improve clinical outcomes during vein graft PCI.

Aged↗
PubMed2005

[Follow-up study in endovascular therapy for the renal artery stenosis].

OBJECTIVE: To evaluate the safety and efficacy of endovascular therapy for renal artery stenosis. METHODS: Percutaneous transluminal renal angioplasty with stent (PTRAS) was performed on 33 consecutive patients with severe renal artery stenosis who suffered from poorly controlled hypertension or renal dysfunction. They were subsequently underwent 7 to 49 months clinical follow up for the effect of the procedure on renal function, blood pressure control, mortality. RESULTS: Angiographic success was obtained in 32 (97.0%) of the 33 patients. The mortality was 18.2%. After PTRAS, two (6.1%) died of myocardial infarction within 4 months. Four (12.1%) patients with preoperative serum creatinine (Scr) > or = 177 micromol/L died of uraemia within 17 approximately 28 months. Twelve and twenty-four months after the procedure, systolic and diastolic blood pressure of 26 (78.8%) cases with preoperative Scr < 177 micromol/L significantly decreased (P < 0.05), with less antihypertensive medications taken and satisfactory renal function. CONCLUSION: For patients without serious cardiorenal disease, PTRAS has a beneficial effect on blood pressure and renal function. For patients with serious cardiorenal disease or preoperative Scr > or = 177 micromol/L, the mortality is higher. PTRAS should be performed prudently. The preservation of renal function may be enhance by using renal protection device.

Adolescent↗
PubMed2005

Perceived industrial deafness and hearing loss among people in a small Queensland rural community.

This paper aims to describe chronic diseases including hearing loss reported by people in a small rural community. It will present the results of audiometric screening among a group of people in this community and their self reported risk factors of hearing loss. Different risk factors experienced by men and women will be compared. Two surveys were conducted in a small Queensland rural community. The first survey gathered information relating to chronic diseases among 604 people using a telephone interview method. The second survey assessed the level of hearing among 64 people who presented themselves for audiometric screening, their history of exposure to loud noise and their previous use of hearing protective measures. A higher rate of "industrial deafness" was reported (110.75 per 1,000 population) than the 1995 National rate (95.2 per 1,000 population). Of 64 people who attended the audiometric assessment, 60 (93.8%) had some level of hearing loss using the 2000 International Standard of hearing level (ISO 7029: 2000) taking age and gender into account. However, 15 persons (23.4%) perceived that they had good hearing. When compared to ISO 7029: 2000 standard, men and women had a similar pattern of hearing loss. Compared to men, a lower percentage of women were exposed to different sources of loud noise and were less likely to use hearing protection devices.

Adult↗
PubMed1992

Disease prevention strategies for Army aviators: clues from a descriptive analysis of the flying duty medical examination.

The U.S. government spends approximately $300,000 to train an Army aviator. Maintaining a healthy aviator population is important not only to the completion of the aviation mission, but also for budgetary reasons. We reviewed Army aviator physical examinations and self-reported risk behavior questionnaires from the Aeromedical Epidemiological Data Repository at Fort Rucker, Alabama, to assess aviator health. Overall, aviators are healthy adults; however, the health status of aviators can be improved by reducing tobacco use, limiting cholesterol and fat intake, and wearing hearing protection devices both during and off duty.

Adult↗
PubMed2005

[Changes in clinical characteristics and interventional modalities of renal artery stenosis in recent years].

OBJECTIVE: To observe the changes of clinical characteristics and interventional methods of patients with renal artery stenosis in recent 17 years. METHODS: Comparing the clinical characteristics and interventional treatment of patients diagnosed renal artery stenosis by the means of renal angiography in recent 17 years. RESULTS: The numbers of renal artery stenosis were increasing year by year. the average ages before the year of 2000 was younger than that after 2000 (P < 0.05) and the main cause of renal artery stenosis was aorto-arteritis at that time, however, it turned to atherosclerosis after the year of 2000. Same patients indicated renal angiography due to plash pulmonary edema, unstable angina on abnormal serum creatinine. The interventional methods to renal artery stenosis shifted from balloon angioplasty only before the year of 2000 to stent implantation post-balloon dilatation after the year of 2000. The distal protective device was more used during the procedure. CONCLUSIONS: The numbers of patients indicated renal angiography had been increasing in the two decades. The main causes of renal artery stenosis had been considered arthro-sclerosis instead of aorta-arteritis before. The methods of treatment to renal artery stenosis had been changed to renal stenting post-balloon angioplasty after the year of 2000.

Adult↗
PubMed2005

The results of compression forces applied to the isolated human calvaria.

Data for the force necessary to fracture the isolated calvaria (skull cap) are not available in the extant literature. Twenty dry adult calvaria were tested to failure quasistatically at the vertex using a 15-kN load cell. The forces necessary to fracture or cause diastasis of calvarial sutures were then documented and gross examination of the specimens made. Failure forces had a mean measurement of 2772 N. Initial fractures did not cross suture lines. Prior to complete destruction of the calvaria there were 7 specimens in which all sutures of the calvaria became diastatic, 6 specimens in which the calvaria became diastatic along only the coronal sutures, 2 specimens in which the calvaria became diastatic along only the sagittal suture and 5 specimens in which there were diagonal linear parietal bone fractures. Our hopes are that these data may contribute to the structural design of more safer protective devices for use in our society, assist in predicting injury and aid in the construction of treatment paradigms.

Adult↗