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PubMed1980

[Initial experience in accident surgery performed in an operation theater equipped with ASID sterile filter partition screen (author's transl)].

The article reports on initial experience in accident surgery performed in an operation theater equipped with an ASID sterile filter partition screen. This filter screen is representative of, and corresponds to, the room-within-room solution with laminar airflow in horizontal direction. The advantages of this sterile filter partition in the performance of the broad spectrum of accident surgery operations are explained. During the first twelve months since we started using this screen, no postoperative infection was observed, whereas the infection rate in primarily aseptic surgery performed in the conventional operation theaters of the type normally used to date, amounted to 0.36% during the same period.

Asepsis↗
PubMed2006

Pulmonary embolus after retrieval of a temporary inferior vena caval filter in a Jehovah's Witness undergoing gastric bypass surgery.

We present the case of pulmonary embolus after retrieval of a temporary inferior vena caval (IVC) filter in a Jehovah's Witness patient who underwent uneventful laparoscopic gastric bypass surgery. The 40-year-old female was admitted to the hospital 2 days after retrieval of the filter with bilateral pulmonary emboli for which she received anticoagulation therapy and consequently developed thoracic bleeding. We present this complicated case to highlight the risk of pulmonary emboli after IVC filter removal without anticoagulation, and to demonstrate the additional risk in managing a Jehovah's Witness patient.

Adult↗
PubMed1981

Cataract extraction and intraocular lens implantation after fistulizing glaucoma surgery.

Cataract extraction with implantation of an intraocular lens was performed in 33 patients who had previously undergone fistulizing glaucoma surgery. A functioning filtering bleb and normal intraocular pressure were important preoperative criteria, however success depended largely upon enhanced postoperative aqueous outflow. Bleb failure following cataract surgery may be caused by prolonged intraoperative hypotony, vitreous or intraocular lens occlusion of the filtering site, or the presence of postoperative inflammatory components in the aqueous. Extracapsular cataract extraction was the most satisfactory technique. Most cases received prepupillary iridocapsular lenses.

Aged↗
PubMed2004

[Defect closure with scleral grafts].

BACKGROUND: Excessively draining fistulas may lead to enucleation when primary suture closure is not effective. In these cases preserved cadaver tissues such as sclera, fascia lata, dura mater and peritoneum have been used for patch graft repair with variable results. In this study, the clinical outcomes after transplantation of scleral patch grafts have been investigated. METHOD: Twenty-eight eyes of twenty-seven patients underwent surgery with homologous scleral patch grafts for repair of excessively draining scleral fistulas after cataract surgery (n = 2), leaking filtering blebs following full-thickness filtration surgery (n = 7), large scleral perforations due to trauma (n = 7), corneo-scleral ulcerations due to severe eye burns (n = 9) or after radiotherapy of malignant melanoma (n = 3). The mean size of the rectangular grafts was 8.6 x 6.7 mm (+/- 2.8/3.1 mm). Clinical follow-up was up to 73 months (median 30 months). RESULTS: Twenty-three of 28 eyes (82.1 %) showed functional closure after initial surgery without any wound complication such as patch retraction or leakage and without evidence of inflammation. In five eyes surgical revision was necessary. Two of these eyes had to be enucleated due to uncontrollable dehiscence after the second operation. Two eyes were enucleated at the patient's demand due to pain. The fifth eye showed effective closure after the second operation. CONCLUSION: In our study scleral patch grafts were useful in adequately closing large corneo-scleral defects in 24 of 28 eyes (85.7 %). The antigen load and, therefore, the rejection of the scleral grafts is minimized due to the denaturation of proteins during the alcohol treatment before storage.

Eye Injuries, Penetrating↗
PubMed2001

Combined cataract and glaucoma surgery.

The management of cataract in glaucoma patients has been continuously changing over the past decade. Extracapsular cataract extraction has been replaced by small-incision phacoemulsification with foldable lenses, and in glaucoma surgery, adjunctive antifibrotic therapy based on risk factors for failure has become standard. Furthermore, new techniques in filtering and nonfiltering surgery have been suggested. The techniques, however, change so fast that well-controlled studies with a follow-up of more than 12 months are increasingly seldom. The purpose of this paper is to review the current literature and to point out some new ideas for the future investigation.

Antimetabolites↗
PubMed1999

[Therapeutic and prophylactic application of TPA (recombinant tissue plasminogen activator) into the anterior chamber of the eye].

BACKGROUND: In therapy-resistant fibrin reactions within the anterior chamber, especially following combined cataract and glaucoma surgery, injection of TPA is indicated. We report our results. PATIENTS AND METHODS: From August 1994 to August 1998 we applied TPA 185 times into anterior chambers. A total of 123 injections were for therapeutic reasons (if local therapy with eyedrops showed no fibrinolytic effect), 32 for prophylactic reasons at the end of operations with intensive manipulation of the iris and following postoperative fibrin risk, and 30 applications for nonfunctional filtering blebs following glaucoma surgery. We applied 10 microg/0.1 ml. RESULTS: On the first day after therapeutic application of TPA, the fibrin was completely dissolved in 61 % of the eyes, and in 36.6 % of the eyes partial fibrinolysis occurred (total 97.6 %). Only 2.4 % of the eyes showed no fibrinolysis. Seventy-five percent of the eyes showed no fibrin reaction within the anterior chamber after prophylactic application of TPA. In all eyes (100 %) we would have expected fibrin reactions. Application of TPA for a filtering blebs disorder after glaucoma surgery resulted in restoration of the filtering bleb function in two-thirds of the eyes. COMPLICATIONS: After 185 applications of TPA into the anterior chamber we saw ten occurrences anterior chamber bleeding (5.4 %). In six eyes (3.2 %) we saw transcient clouding of the corneal endothelium and/or corneal stroma. These complications were reversible, except for irreversible endothelial decompensation in one eye with Fuchs' corneal dystrophy. CONCLUSION: TPA is effective for treating fibrin formation within the anterior chamber and maintaining the function of the filtering bleb. To confirm and quantify the efficiency of prophylactic use, a controlled prospective study is recommended.

Adolescent↗
PubMed2001

Adenoviral-mediated gene transfer to the filtering bleb in rabbits.

PURPOSE: To determine if genes can be transferred to fibroblasts in the filtering bleb using adenoviral vectors. MATERIALS AND METHODS: Twelve New Zealand albino rabbits underwent bilateral full-thickness sclerostomies. On postoperative day 1 an adenoviral vector carrying a reporter gene (lacZ) was injected into the right-eye bleb and saline was injected into the left eye bleb of each rabbit. Three rabbits were euthanized on each of the after days (days 3, 7, 14, and 21). The eyes were enucleated and tissue samples from the filtering bleb were processed for beta-galactosidase activity (a marker for lacZ gene expression) and expression of vimentin (a fibroblast marker). The median number of cells per high-power field with both beta-galactosidase activity and vimentin expression on days 3, 7, 14, and 21 in the right and left eyes were counted to determine adenoviral-mediated gene expression in fibroblasts. RESULTS: In the adenoviral vector-treated eyes, the median number of cells per high-power field with both beta-galactosidase and vimentin expression on days 3, 7, 14, and 21 was 83,100, 1, and 0, respectively. No beta-galactosidase activity was noted in the saline-treated eyes. CONCLUSIONS: Adenoviral vectors can transfer genes to fibroblasts in filtering blebs after glaucoma surgery. The peak efficiency of gene transfer to fibroblasts occurred 7 days after glaucoma surgery. These studies show a potential for genetic manipulation of fibroblast activity in filtering blebs after glaucoma surgery.

Adenoviridae↗
PubMed2004

The effect of leucocyte-depleting arterial line filters on cerebral microemboli and neuropsychological outcome following coronary artery bypass surgery.

OBJECTIVES: A randomised clinical trial sought evidence as to whether leucocyte-depleting (LD) arterial line filters added a further degree of neuroprotection in patients undergoing elective coronary artery bypass graft (CABG) surgery. METHODS: One hundred and ninety-two patients were randomised to the use of a Pall Leukoguard-6 LD filter or either an Avecor Affinity or Pall Autovent-6 control filter. Cerebral microemboli during surgery were recorded by transcranial Doppler (TCD) monitor over the right middle cerebral artery. Evidence of cerebral impairment was obtained by comparing patients' performance in a neuropsychological (NP) test battery (nine tests) administered 6-8 weeks post-operatively with their pre-operative scores. RESULTS: The groups proved well balanced in pre-operative variables. During cardiopulmonary bypass (CPB) the median number and range of microemboli was 15 (3-180) in the LD group compared to 67 (5-846) and 55 (2-773) for the Avecor and AV6 groups, respectively (P<0.0001). One hundred and sixty-two patients completed all the NP tests. The LD group showed better post-operative performance in all but one of the nine tests although the difference in a total change score just failed to reach significance (P=0.07 one-tailed t-test). CONCLUSIONS: LD filtration during CABG reduced the number of cerebral microemboli recorded by TCD and showed a strong trend towards improving NP performance post-operatively. These findings suggest that the use of such filters in CABG surgery may offer increased neuroprotection.

Aged↗
PubMed2004

Elimination of microbubbles from the extracorporeal circuit: dynamic bubble trap versus arterial filter.

BACKGROUND: Open heart surgery is associated with important risk of cerebral and peripheral organ dysfunction, attributed in part to microbubbles generated in or not eliminated from the ECC. For elimination of microbubbles, a dynamic bubble trap (DBT) was developed for the arterial line of ECCs. METHODS: Bubble eliminating properties of an arterial filter were evaluated in four CABG patients and compared to the performance of the DBT in four patients. One patient received both devices. RESULTS: Elimination of bubbles between 40-120 microm was significantly higher with the DBT (88% vs. 57% with arterial filter, p=0.034). Reduction of bubbles below 40 microm was equivalent in both groups. The combination of both devices was most effective (94% for bubbles >40 microm). CONCLUSION: Arterial filter and DBT are equally effective in elimination of smaller gas bubbles. However, bigger bubbles possibly causing cerebral and peripheral organ damage are eliminated to a greater degree by the DBT.

Coronary Artery Bypass↗
PubMed1999

Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes.

OBJECTIVE: To determine the indications and outcome of conjunctival advancement surgery for late-onset filtering bleb leaks. PATIENTS AND METHODS: Retrospective medical record review of a consecutive case series of all patients who underwent conjunctival advancement surgery for persistent late-onset glaucoma filtering bleb leaks at a tertiary referral center between December 1, 1985, and April 30, 1997. MAIN OUTCOME MEASURES: Indications for surgery, preoperative and postoperative intraocular pressure (IOP), visual acuity, status of bleb leak, and need for reinstitution of medical therapy or reoperation for glaucoma. RESULTS: Twenty-six eyes of 26 patients were analyzed. Complications from bleb leaks that necessitated surgical intervention included chronic ocular hypotony (n = 21), decreased visual acuity (n = 9), bleb-related infection (n = 11), hypotony maculopathy (n = 4), corneal edema with folds (n = 7), choroidal effusion (n = 3), and persistent shallow anterior chamber (n = 3). The mean +/- SD preoperative IOP was 5.7 +/- 4.9 mm Hg (range, 0-16 mm Hg). After a follow-up of 19.6 +/- 22.6 months, the IOP was 14.2 +/- 4.1 mm Hg for patients taking 1.1 +/- 1.3 glaucoma medications (all data given as mean +/- SD). Twelve patients (46%) had early-onset bleb leaks after revision, of which 7 (27%) closed spontaneously and 5 (19%) required resuturing. Two patients (8%) had a persistent bleb leak throughout the follow-up period. Thirteen patients (50%) required reinstitution of medical therapy during the follow-up period, and 2 (8%) required a reoperation for glaucoma for uncontrolled IOP. CONCLUSIONS: Conjunctival advancement is a successful procedure for closing late-onset filtering bleb leaks. Some patients require suturing in the early postoperative period, but most patients eventually obtain permanent closure of the leak. Patients should be counseled of the possibility of requiring medical or surgical intervention for IOP control after revision.

Adolescent↗
PubMed2001

Facilitation of artificial retinal detachment for macular translocation surgery tested in rabbit.

PURPOSE: For macular translocation surgery, the native attached retina has to be detached either locally or completely. Although different surgical techniques are used, there is a general search for supporting procedures that facilitate and accelerate the retinal detachment. METHODS: Pars plana vitrectomies were performed in pigmented rabbits. In all experimental groups, a local retinal detachment was created by infusing the test solution with a thin glass micropipette attached to a glass syringe. In control animals a standard balanced salt solution was used at room temperature, in combination with a standard vitrectomy light source. In two test groups, a calcium- and magnesium-free solution was used for the vitrectomy, under illumination by a standard light source in group I (solution at room temperature) and group II (solution heated up to body temperature). In group III the rabbits were dark-adapted for half an hour, and then, during surgery, a red filter was used in front of the light source (standard balanced salt solution at room temperature). After the rabbits were killed at the end of surgery, the adherence of the retinal pigment epithelium (RPE) to the neural retina in the detachment area was quantified microscopically, and the morphologic integrity of the detached retinal tissue was examined by light and electron microscopy. No electrophysiology was performed. RESULTS: In all four groups, it was possible to detach the retina. The maximum adherence of the RPE cells to the neural retina was observed in the control group. Virtually no decrease in adherence was found in test group II (36 degrees C solution without calcium and magnesium), whereas a significant decrease was seen in both group I (calcium- and magnesium-free solution at room temperature) and group III (dark adaptation-red light technique; standard balanced salt solution at room temperature). In none of the experimental groups was any obvious damage of the retinal structure observed, even after exposure to the test solutions for 60 minutes. CONCLUSIONS: Both dark adaptation (red illumination) and the use of a calcium chloride- and magnesium chloride-free solution (at room temperature) can facilitate retinal detachment in macular translocation surgery. Both techniques are proposed as a gentle support for the operation, because they protect an intact RPE cell layer and do not cause retinal damage at the ultrastructural level.

Animals↗
PubMed2005

Leukocyte depleting filter attenuates myocardial injury during elective coronary artery bypass surgery.

BACKGROUND: Ischemia-reperfusion injury secondary to leukocyte activation has been widely recognized as one of the most relevant mechanism leading to postoperative organ dysfunction occurring after a period of ischemia. The aim of the present study was to evaluate in a prospective, randomized study, the value of leukocyte depleting filter in patients undergoing elective coronary artery bypass surgery. METHODS: Twenty patients scheduled for elective on-pump coronary artery bypass surgery were randomized to undergo cardiopulmonary bypass either with a leukocyte depleting filter incorporated in the extracorporeal circulation arterial line or without a filter. RESULTS: The main finding of this study was the significantly lower postoperative concentrations of cardiac troponin I in the leukocyte filter group (Tests of between-subjects effects: p = 0.024). There were also slightly better cardiac indices in the leukocyte filter group. A larger amount of blood units was infused intra- and postoperatively in patients undergoing cardiopulmonary bypass with leukocyte filtration (median, 600 [IQR, 0-1200] vs. 0 [IQR, 0-600], p = 0.08). Two patients in the leukocyte filter group underwent reoperation for bleeding but none in the control group (p = 0.48). Intra-and postoperative platelet count was lower in the leukocyte filter group (Tests of between-subjects effects: p = 0.08). Despite a significant increased concentration of C-reactive protein on the first postoperative day in the control group (p = 0.029), repeated-measures analysis failed to show any significant increase during the study period (p = 0.33). CONCLUSIONS: The results of this study suggest a myocardial protective effect of leukocyte filter in the setting of elective coronary artery bypass surgery.

Aged↗
PubMedDate not supplied

Continuous renal replacement therapies: anticoagulation in the critically ill at high risk of bleeding.

BACKGROUND: The ongoing necessity for systemic heparinization is a well-known disadvantage of continuous renal replacement therapies (CRRT), and alternative methods of anticoagulation may be required. Our aim was to evaluate, in patients with a high risk of bleeding, the possibility of an acceptable filter life with non-anticoagulation CRRT and, in case of early filter failure, the efficacy and safety of bedside monitored regional anticoagulation with heparin and protamine. METHODS: Fifty-nine patients underwent CRRT for acute renal failure (ARF) following cardiac surgery. Patients who fulfilled one of the following criteria were selected for non-anticoagulation CRRT: spontaneous bleeding, aPTT > 45 sec, thrombocytopenia and recent surgery (< 48 hr). Filter life < 24 hr without anticoagulation was the cut-off point for starting the regional anticoagulation CRRT. Heparin was infused pre-filter and protamine post-filter at an initial ratio of 1 mg protamine:100 IU heparin. The ratio was adjusted to achieve a patient aPTT < 45 sec and a circuit > 55 sec. RESULTS: Twenty-two (37.3%) patients had been selected for non-anticoagulation. Of them, 12 patients continued to receive non-anticoagulation (filter life: 38.3 +/- 30.5 hr) while 10 switched to regional anticoagulation (filter life: 38.6 +/- 25 hr). During regional anticoagulation no statistical difference was found between baseline aPTT (36.7 +/- 6.4 sec) and patient aPTT (41.5 +/- 12.6 sec) while circuit aPTT (77.7 +/- 43.3 sec) was significantly higher than patient aPTT (p < 0.0001). The probabilities of the circuits remaining free from clotting after 24, 48 and 72 hr were: a) non-anticoagulation: 55.5%, 30.1% and 16.6%, b) regional anticoagulation: 76.2%, 39.6% and 19.8%. There was no rebound anticoagulation observed after regional anticoagulation CRRT ended. CONCLUSIONS: Non-anticoagulation CRRT allowed an adequate filter life in most patients with a high risk of bleeding for prolonged aPTT and/or thrombocytopenia. Despite concerns regarding the need for careful monitoring, regional anticoagulation with heparin and protamine can be considered as a safe and valid alternative when non-anticoagulation is unsuitable because of early filter failure.

APACHE↗
PubMed1991

Photic retinal injury from endoillumination during vitrectomy.

We treated a patient who developed a paramacular area of light-induced retinal damage after endoscopic epimacular membrane removal. Postoperative color photographs showed complete absence of the membrane, but fluorescein angiography demonstrated a previously absent superior paramacular lesion consistent with a photic injury. Operative microscope illumination had been eliminated by corneal shielding, which implicated endoillumination as the source of injury. We recommend the following procedures to avoid this complication: careful planning of vitreous surgery for epimacular membrane removal; using filters; minimizing the length of surgery; keeping the light output low; maintaining maximal light pipe distance from the retina; eccentric orientation of the light pipe; and use of intermittent and variable site illumination techniques.

Aged↗
PubMed1986

Greenfield vena caval filter for management of selected cases of venous thromboembolic disease following hip surgery. A report of five cases.

The use of the Greenfield vena caval filter for thromboembolic disease following major hip surgery is an important part of the orthopedist's armamentarium for treatment of complications or contraindications to standard anticoagulation therapy. The authors report five cases in which a Greenfield vena caval filter was employed for treatment of a femoral thrombus or pulmonary embolism in postoperative hip patients who developed bleeding complications from heparin, had a recurrent embolism while on heparin, or who had had a contraindication to anticoagulation therapy.

Aged↗
PubMed1992

Greenfield filter prophylaxis of pulmonary embolism in patients undergoing surgery for acetabular fracture.

Pulmonary embolism is a potentially lethal complication among patients with acetabular fractures requiring surgery. The reliability, safety, and extent of efficacy of pharmacologic as well as existing nonpharmacologic anticoagulation prophylaxis in this patient group has not been determined. A careful analysis of the myriad factors acting on these patients who have had major trauma and have undergone a major surgical procedure about the hip prompted a change in our approach to prophylaxis in this patient group. In the period from March 1984 through October 1987, 51 patients having 52 acetabular fractures underwent osteosynthesis at the Wake Forest University Medical Center. Twenty-four patients had two or more identifiable risk factors and underwent insertion of a Greenfield filter for prevention of pulmonary emboli. Filters were inserted at the time of acetabular surgery with C-arm guidance via the internal jugular vein approach. The average time for insertion was 57 min. Placements were verified by plain roentgenograms. There were no complications during filter insertion. Four patients with filters (17%) developed leg edema; in three the edema was minor, and in one the filter trapped what could have been a fatal embolus but caused lower extremity venous stasis severe enough to result in peripheral lower extremity tissue loss. There were no pulmonary emboli (by clinical criteria). The remaining 27 patients had routine medical prophylaxis and no filters. In this group, two patients had a clinically evident pulmonary embolus (7%), and one of these patients died. Two other patients (7%) had minor chronic leg edema. In one of them, a proximal deep venous thrombosis in the lower extremity was documented with venography, requiring rehospitalization and anticoagulant therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1991

The effect of whole body disinfection on intraoperative wound contamination.

As part of a large whole body disinfection (WBD) trial two small sub-groups of patients who showered preoperatively with either a 4% chlorhexidine (CHX: N = 29) or placebo (N =27) detergent were studied to assess intraoperative wound contamination. The groups were well matched for age, sex and length of surgery. A membrane filter contact technique was used for bacterial recovery from the wounds after the initial skin incision and before wound closure. The membrane filters were incubated aerobically on blood agar plates with a CHX neutralizer for 48 h at 37 degrees C and colonies were counted. The results show a significant difference, between the bacterial counts at the start and end of surgery in the CHX and placebo groups. There was no difference in bacterial counts at the start of surgery between the CHX and placebo groups. There was a significant difference in the bacterial counts at the end of surgery between the CHX and placebo groups. These results indicate that preoperative WBD with CHX reduces intraoperative wound contamination but the effect of this on postoperative wound sepsis rates awaits the results of a large WBD trial.

Adult↗