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PubMed2004

Technical note: a procedure for the preparation and quantitative analysis of samples for titanium dioxide.

A procedure was developed for the rapid analysis of titanium dioxide (TiO2) concentrations in feed and fecal samples. Samples were digested in concentrated H2SO4 for 2 h, followed by addition of 30% H2O2, and absorbance was measured at 410 nm. Standards were prepared by spiking blanks with increasing amounts of TiO2, resulting in a linear standard curve. Complete analysis using this procedure can typically be accomplished within 4.5 h. This procedure was compared to a previously published dry-ash procedure for the analysis of TiO2 in bovine fecal samples. Three sources of OM devoid of TiO2 (a forage sample, a bovine fecal sample without Cr2O3, and a bovine fecal sample containing Cr2O3) were spiked with graded amounts (0, 2, 4, 6, 8, or 10 mg) of TiO2. With our procedure, TiO2 recoveries averaged 96.7, 97.5, and 98.5%, for the three OM sources, respectively, vs. 74.3, 83.8, and 53.1% for the same samples analyzed using the dry-ash method. These results suggest that our procedure is a rapid and accurate alternative to dry-ash procedures for the determination of TiO2.

Animal Feed↗
PubMed2004

Evaluation of procedures to predict fat-free lean in swine carcasses.

The objectives were to develop equations for predicting fat-free lean in swine carcasses and to estimate the prediction bias that was due to genetic group, sex, and dietary lysine level. Barrows and gilts (n = 1,024) from four projects conducted by the National Pork Board were evaluated by six procedures, and their carcass fat-free lean was determined. Pigs of 16 genetic groups were fed within weight groups one of four dietary regimens that differed by 0.45% in lysine content and slaughtered at weights between 89 and 163 kg. Variables in equations included carcass weight and measures of backfat depth and LM. Fat-free lean was predicted from measures of fat and muscle depth measured with the Fat-O-Meater (FOM), Automated Ultrasonic System (AUS), and Ultrafom (UFOM) instruments, carcass 10th-rib backfat and LM area (C10R), carcass last-rib backfat (CLR), and live animal scan of backfat depth and LM area with an Aloka 500 instrument (SCAN). Equations for C10R (residual standard deviation, RSD = 2.93 kg) and SCAN (RSD = 3.06 kg) were the most precise. The RSD for AUS, FOM, and UFOM equations were 3.46, 3.57, and 3.62 kg, respectively. The least precise equation was CLR, for which the RSD was 4.04 kg. All procedures produced biased predictions for some genetic groups (P < 0.01). Fat-free lean tended to be overestimated in fatter groups and underestimated in leaner ones. The CLR, FOM, and AUS procedures overestimated fat-free lean in barrows and underestimated it in gilts (P < 0.01), but other procedures were not biased by sex. Bias due to dietary lysine level was assessed for the C10R, CLR, FOM, and SCAN procedures, and fat-free lean in pigs fed the lowlysine dietary regimen was overestimated by CLR, FOM, and SCAN (P < 0.05). Positive regressions of residuals (measured fat-free lean minus predicted fat-free lean) on measured fat-free lean were found for each procedure, ranging from 0.204+/-0.013 kg/kg for C10R to 0.605+/-0.049 kg/kg for UFOM, indicating that all procedures overestimated fat-free lean in fat pigs and underestimated it in lean pigs. The pigs evaluated represent the range of variation in pigs delivered to packing plants, and thus the prediction equations should have broad application within the industry. Buying systems that base fat-free lean predictions on measures of carcass fat depth and muscle depth or area will overvalue fat pigs and undervalue lean pigs.

Adipose Tissue↗
PubMedDate not supplied

Interventional procedures in superficial lesions: the value of 2D with additional coronal reformatted 4D ultrasonography guidance.

OBJECTIVE: We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions. MATERIALS AND METHODS: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture. RESULTS: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US. CONCLUSION: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

Adolescent↗
PubMed1983

Norepinephrine, dopamine, and serotonin in brain parts of female Japanese quail (Coturnix coturnix japonica) as found by two dissimilar fluorometric procedures.

Two dissimilar fluorometric procedures were used to compare norepinephrine, dopamine, and serotonin in the telencephalon, diencephalon, cerebellum, and brain stem of female Japanese quail. Amount of norepinephrine in the telencephalon and brain stem was similar using both procedures, but more norepinephrine was found in the cerebellum and diencephalon by the Jacobowitz-Richardson method compared to the Anton-Sayre method. Serotonin could not be determined using the Anton-Sayre procedure but was detected easily by the Jacobowitz-Richardson procedure in all brain parts assayed. The most striking difference between the two procedures was in the level of dopamine detected. Dopamine was found only in the telencephalon using the Anton-Sayre procedure, but it was found in all brain parts using the Jacobowitz-Richardson procedure. This is the first report of significant dopamine in all principle parts of the Japanese quail brain.

Animals↗
PubMed2006

[Cognitive aging mechanism of signaling effects on the memory for procedural sentences].

The aim of this study was to clarify the cognitive aging mechanism of signaling effects on the memory for procedural sentences. Participants were 60 younger adults (college students) and 60 older adults. Both age groups were assigned into two groups; half of each group was presented with procedural sentences with signals that highlighted their top-level structure and the other half with procedural sentences without them. Both groups were requested to perform the sentence arrangement task and the reconstruction task. Each task was composed of procedural sentences with or without signals. Results indicated that signaling supported changes in strategy utilization during the successive organizational processes and that changes in strategy utilization resulting from signaling improved the memory for procedural sentences. Moreover, age-related factors interfered with these signaling effects. This study clarified the cognitive aging mechanism of signaling effects in which signaling supports changes in the strategy utilization during organizational processes at encoding and this mediation promotes memory for procedural sentences, though disuse of the strategy utilization due to aging restrains their memory for procedural sentences.

Adolescent↗
PubMed2004

[Evaluation and estimation of entrance skin dose in patients during diagnostic and interventional radiology procedures].

A study was performed to evaluate the total entrance skin dose (ESD) of patients during diagnostic and interventional radiology procedures (IVR) and to estimate ESD with body mass index (BMI) and fluoroscopy time. The study included 26 cases of transcatheter arterial embolization therapy (TAE) for hepatocellular carcinoma (HCC) and 19 cases of diagnostic digital subtraction angiography (DSA) for HCC. The ESD of patients was evaluated with a zinc-cadmium sensor linked to a digital counter (SDM: skin dose monitor). Exposure doses were measured with SDM attached to the front of the X-ray beam-limiting device like a dose area product monitor. ESD was calculated from the measured exposure dose. In 26 TAE for HCC, ESD was 1793.7+/-739.1 mGy, with the mean fluoroscopic time of 23.5 minutes and 4.4 DSA acquisitions. The fluoroscopic dose rate was 52.4+/-11.5 mGy/min. In 19 diagnostic DSA for HCC, ESD was 962.9+/-375.2 mGy, with the mean fluoroscopic time of 11.1 minutes and 4.0 DSA acquisitions. The fluoroscopic dose rate was 32.7+/-12.7 mGy/min. Although 33.2% of ESD was from fluoroscopy in diagnostic procedures, the figure was 68.8% in TAE procedures. It was demonstrated that the increase in ESD during IVR was caused by the rise of fluoroscopy dose rate caused by high-magnification fluoroscopy and the extension of fluoroscopy time. In order to reduce ESD, it is necessary to use a low fluoroscopy dose rate with low-rate pulse fluoroscopy, in addition to shortening fluoroscopy time. Fluoroscopy time was a poor predictor of risk because it did not correlate well with ESD during IVR (diagnostic procedures r(2)= 0.897, IVR r(2)= 0.594). However, ESD correlated well with the product of BMI and fluoroscopy time (diagnostic procedures r(2)= 0.910, IVR r(2)= 0.783). The linear relationship between ESD and the product of BMI and fluoroscopy time provides a simple monitoring mechanism of the ESD delivered to the patient during interventional radiology procedures. This linear relationship needs to be established for other types of interventional procedures.

Angiography, Digital Subtraction↗
PubMed2001

Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research.

PURPOSE: The cause of racial disparities in the use of invasive cardiac procedures remains unclear. To summarize, evaluate, and clarify gaps in the literature, studies examining racial differences in cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass grafting (CABG) were reviewed. DATA SOURCES: MEDLINE search for English-language articles published from 1966 to May 2000. STUDY SELECTION: Empirical studies of adults. DATA EXTRACTION: The odds ratios for procedure use by race were examined for each study; cohorts and covariates were also documented. DATA SYNTHESIS: Literature was classified as one of three groups on the basis of study design. For the first group, which used administrative data, odds ratios (ORs) for African-American patients compared with white patients ranged from 0.41 to 0.94 for cardiac catheterization, from 0.32 to 0.80 for PTCA, and from 0.23 to 0.68 for CABG. Procedure rates were also lower for Hispanic and Asian patients. In the second group, which used detailed clinical data, African-American patients remained disproportionately less likely to receive cardiac catheterization (OR, 0.03 to 0.85), PTCA (OR, 0.20 to 0.87), and CABG (OR, 0.22 to 0.68). A few studies noted that Hispanic and Asian patients were also disproportionately less likely to receive such procedures. The third group used survey methods but found conflicting results regarding patient refusals as a source of racial variation. Less-educated patients and patients who were not as experienced with the procedure were more likely to decline PTCA. Physician bias was also associated with racial variation in recommendations for treatment. CONCLUSIONS: Racial differences in invasive cardiac procedure use were found even after adjustment for disease severity. Future studies should comprehensively and simultaneously examine the full range of patient, physician, and health care system variables related to racial differences in the provision of invasive cardiac procedures.

Adult↗
PubMed1999

Laparoscopic and open cholecystectomy in New York State: mortality, complications, and choice of procedure.

BACKGROUND: With the advent of laparoscopic cholecystectomy patient outcomes and choice of procedure (laparoscopic vs open) are of vital interest. The purpose of this study was to examine the mortality and complication rates for patients undergoing laparoscopic and open cholecystectomy in New York State and to test for differences among hospital peer groups and regions of the state in the tendency to use the laparoscopic approach. METHODS: A population-based, retrospective cohort study of laparoscopic and open cholecystectomy was conducted in which data were analyzed on all 30,968 patients who underwent cholecystectomy as a principal procedure in New York State in 1996. RESULTS: A total of 78.7% of the 30,968 patients who underwent cholecystectomy as a principal procedure in New York State in 1996 underwent laparoscopic cholecystectomy. The mortality rate was lower for laparoscopic cholecystectomy than for the open procedure (0.23% vs 1.90%, P < .0001) and remained significantly lower after patient characteristics related to patient survival (odds ratio 0.34, P < .0001) were controlled for. The prevalence rate of the 8 most common complications among cholecystectomy patients was also much lower among patients undergoing laparoscopic cholecystectomy. Patients undergoing cholecystectomy in public hospitals, Bronx County, and Kings County were found to be significantly less likely to have laparoscopic procedures, and patients undergoing cholecystectomy on Long Island were found to be significantly more likely to have laparoscopic procedures than were other patients in the state. CONCLUSIONS: There are reasonably large differences among hospitals, hospital groups, and regions of the state in the type of cholecystectomy used, even after adjustment for differences in patient comorbidities and indications for type of procedure.

Adult↗
PubMed1999

[Is a Whipple operation in chronic pancreatitis still a current procedure?].

Until the eighties, the surgical procedure of choice in chronic pancreatitis with an inflammatory mass in the head of the pancreas has been partial duodenopancreatectomy (pDP). Since neither stomach, duodenum nor the common bile duct are directly involved in the inflammatory process of the pancreas, the Whipple's procedure (pDP) might lead to overtreatment. Therefore, duodenum-preserving pancreatic head resection (DPPHR), developed by Beger in 1972, has become in several centers the standard procedure for patients with an inflammatory enlargement of the head of the pancreas. We reviewed the literature of the last ten years and evaluated the different surgical procedures for pancreatic head resection. Comparing pDP and DPPHR. Whipple procedure has a higher hospital mortality (3.2% versus 0.6%), a higher late mortality (22% versus 8.4%), a higher morbidity and a higher incidence of a new "surgical" diabetes (17.6% versus 2%). With regard to relief of pain long-term investigations show totally pain-free patients after pDP in 72%, after pylorus-preserving duodenopancreatectomy (PPDP) in 82% and after DPPHR in 89%. Furthermore, other disadvantages of PPDP are the high rate of gastric outlet dysfunction (17% on average with a range of 4-32%) and the high rate of marginal ulcers (8.4% on average with a range of 5-11%). In summary, we conclude that in patients with chronic pancreatitis and an inflammatory enlargement of the pancreatic head. DPPHR is the procedure of choice. Whipple's procedure should only be performed if a suspicion of malignancy is suspected or, secondly, if a patient suffers from persistent pain (5%) after DPPHR.

Chronic Disease↗
PubMed1983

A problem-oriented assessment procedure for individual program planning and evaluation.

This article describes the development, implementation, and evaluation of an assessment procedure for use in a psychiatric day therapy setting. The assessment procedure, which incorporates a behavioural problem-oriented approach, serves as a basis for individual program planning with day patients, and provides data for program evaluation purposes. Evaluation of the assessment procedure indicated satisfaction among staff and clients with the process and results of collecting assessment information. Overall, it was concluded that the original objectives guiding development of the assessment procedure had been achieved. The purpose of this paper is to describe an assessment procedure developed for use in a day therapy program associated with a 30-bed psychiatric unit in a general hospital. The procedure, which provides a basis for individual program planning as well as program evaluation, was devised in response to staff concerns about the functioning of the day program. Since the assessment procedure was designed, in part, to meet the requirements of staff working in a generic day therapy psychiatric program, it was thought that it might be of interest to others working in similar settings.

Day Care, Medical↗
PubMed1999

[Evaluation of the results of the combined maze procedure for chronic atrial fibrillation with organic heart disease].

To examine the surgical indications and the results of the maze procedure, we reviewed 30 cases who underwent the maze procedure concomitantly with other open heart surgery from October 1995 to October 1997.: the average age was 60.9 years (37 to 75 years) and mean follow up period was 12.3 months (1 to 25 months). The modified maze procedure described by Kosakai and associates was applied in all patients. Twenty one patients (72.4%) regained atrial rhythm and eight patients (27.6%) sustained atrial fibrillation in the follow up periods. The left atrial diameter measured by echocardiography and cardiothoracic ratio were significantly larger in the latter group of patients, compared with those who recovered normal sinus rhythm (63.8 +/- 19.5 versus 51.2 +/- 7.8 mm and 67.7 +/- 8.1 versus 59.2 +/- 5.4%). In order to perform the combined maze procedure, cardiac arrest time and cardiopulmonary bypass time were extended for 56.9 minutes and 65.9 minutes, respectively, compared with the cases without a maze procedure. Four patients (brady atrial fibrillation 2, brady junctional rhythm 1, and complete AV block 1) required permanent pacemaker implantation. There was no operative death, but one patient who underwent the maze procedure and AVR + MAP + TAP died after 4 months due to pulmonary infection, sepsis and multiple organ dysfunction. This patient had shown low output syndrome for 3 days postoperatively. Having considered the data that the preoperative ejection fraction was 51%, cardiopulmonary bypass and cardiac arrest time were 200 min and 165 min respectively, occurrence of low cardiac output had been influenced by prolonged aortic cross-clamp. No late deaths have been observed in follow up period. In conclusion, maze procedure should not be performed in patients who have enlarged left atrium or complex cases requiring relatively longer operative time.

Adult↗
PubMed1999

[Voluntary testing procedures of farm animal housing equipment according to the Animal Welfare Act of 1998].

Before its broad application in practice, housing equipment should be tested, in particular with regard to animal welfare. The differing positions of the German Federal Council (Bundesrat) and the German Federal Parliament (Bundestag), whether such testing should be mandatory or voluntary, have been conciliated in the amended animal welfare act by empowering the Federal Ministry of Food, Agriculture and Fisheries (BML) to fix official standards for voluntary testing procedures by regulation. On request of the BML, a report as scientific basis for a draft regulation is currently prepared by the scientific animal welfare committee of the German Agricultural Society (DLG). The scientific animal welfare committee has been appointed by the DLG in order to provide support in the effort to strengthen animal welfare aspects in the DLG-utility testing procedure of housing equipment, which is in place since 1953. The committee elaborates standards concerning testing methods, assessment criteria and the necessary size of investigations. As required, the scientific animal welfare committee may support the DLG-testing bodies in the implementation of the animal welfare part of the testing procedure. It will, moreover, be involved in the welfare assessment based on the testing results. The amendments of the already established testing procedure will help to fulfill the general requirements on an acceptable animal welfare testing procedure. While keeping in mind that there are certain limits in what can be achieved by a voluntary testing procedure, the enhanced consideration of animal welfare aspects within the DLG-utility testing procedure has the advantage to be relatively unbureaucratic and in line with EU legislation, and is, therefore, an appropriate tool for a contibrution to improved animal welfare in livestock housing.

Agriculture↗
PubMed1999

[Surgical repair of postinfarction ventricular septal defect: modified Komeda-David procedure].

Since Cooley first reported surgical repair of postinfarction ventricular septal defect in 1957, there have been technical improvements in this procedure. However, the outcome of surgery has not been gratifying thus far. In 1990, Komeda and associates reported a single patch of bovine pericardium sutured to the healthy myocardium around the infarcted area on the left side of the septum that excludes the infarcted myocardium from the left ventricular cavity; a procedure based on a completely different idea. Since the satisfactory outcome of the surgical treatment in this procedure was obtained in a series of 12 patients, this surgical procedure has been in widespread use in Japan. On the other hand, this procedure has a drawback that there is a difficulty in suturing the patch and may lead to a postoperative residual shunt. We investigated a modified surgical procedure that could overcome this difficulty and would like to report it in this paper. At first, the perforated area should be covered with a felt strip and closed with mattress sutures. Secondly, the infarcted myocardium from the left ventricular cavity should be obliterated using a two-patch method. The primary advantage of this procedure is that it achieves a broader range of vision than a single patch method and enables easy suturing. Additionally, the development of a residual shunt can be prevented owing to the closure of perforation even if sutures fail to hold and leakage occurs. The tow-patch method has the advantage of avoiding tension against sutures since the patch is not everted around the sutures. However, the question arises whether only the healthy myocardium can be picked out and sutured without fail. In order to make the two-patch method more reloable the perforation should be closed in advance.

Aged↗
PubMed1999

Procedural skills training. Canadian family practice residency programs.

OBJECTIVE: To survey Canadian family practice residency programs to discover which procedural skills residents are expected to learn. DESIGN: Cross-sectional eight-item questionnaire. SETTING AND PARTICIPANTS: The survey was sent to all 92 program directors and site or unit directors of family practice residency programs across Canada. MAIN OUTCOME MEASURES: Information on procedural skills lists was solicited. We sought date of creation, date of most recent revision, and who was involved in creating the list. A copy of the most recent list available was requested. RESULTS: We received 65 responses, for a 71% return rate. Surveys were received from all provinces and from all Canadian universities offering family practice residency programs. We received 24 unique lists of procedural skills: the shortest listed only 10 procedural skills; the longest, 75 skills; and the average, 36 skills. Only five procedural skills were found on more than 80% of the lists; 30 skills were listed on half or more of the lists. CONCLUSIONS: Canadian family practice residency programs have widely varying expectations of procedural skills for their residents. This survey is a first step in examining the whole issue of procedural skills training in Canadian family medicine programs.

Canada↗
PubMedDate not supplied

Comparison of virus isolation, immunohistochemistry, and reverse transcriptase-polymerase chain reaction procedures for detection of turkey coronavirus.

A reverse transcriptase-polymerase chain reaction (RT-PCR) procedure and two monoclonal antibody (MAb)-based immunohistochemical procedures were developed for detection of turkey coronavirus (TCV) in tissues and intestinal contents/dropping samples. The RT-PCR, MAb-based fluorescent antibody (FA), and MAb-based immunoperoxidase (IP) procedures were compared with virus isolation (VI) for detection of TCV in experimentally infected turkeys. TCV was detected in experimentally infected turkeys as early as day 1 postexposure (PE) by each of the four detection procedures. TCV was detected as late as day 35 PE by FA or IP and days 42 and 49 PE by VI and RT-PCR, respectively. With VI as a reference, sensitivity and specificity of RT-PCR were 93% and 92%, respectively; specificity of both FA and IP was 96%, and sensitivities were 69% and 61%, respectively. Each of the examined procedures was highly specific, but the RT-PCR procedure was also highly sensitive. These findings demonstrate the utility of both immunohistochemistry and RT-PCR for detection of TCV. In addition, the findings indicate that RT-PCR is a highly sensitive and specific alternative to conventional diagnostic procedures.

Animals↗
PubMed1975

Trabeculectomy: a re-evaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to and including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in cases of primary glaucoma treated with a Scheie procedure and 16 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior changes than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye; (2) chronic angle closure glaucoma where an iridectomy is considered insufficient; (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential; (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery; and (5) cases where endophthalmitis is a real concern, as in the very young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Administration, Topical↗
PubMed2001

Femoral arterial puncture management after percutaneous coronary procedures: a comparison of clinical outcomes and patient satisfaction between manual compression and two different vascular closure devices.

BACKGROUND: Vascular access site management is crucial to safe, efficient and comfortable diagnostic or interventional transfemoral percutaneous coronary procedures. Two new femoral access site closure devices, Perclose and Angio-Seal , have been proposed as alternative methods to manual compression (MC). We compared these two devices and tested them in reference to standard MC for safety, effectiveness and patient preference. METHODS: Prospective demographic, peri-procedural, and late follow-up data for 1,500 patients undergoing percutaneous coronary procedures were collected from patients receiving femoral artery closure by MC (n = 469), Perclose (n = 492), or Angio-Seal (n = 539). Peri-procedural, post-procedural, and post-hospitalization endpoints were: 1) safety of closure method; 2) efficacy of closure method; and 3) patient satisfaction. RESULTS: Patients treated with Angio-Seal experienced shorter times to hemostasis (p < 0.0001, diagnostic and interventional) and ambulation (diagnostic, p = 0.05; interventional, p < 0.0001) than those treated with Perclose. Those treated with Perclose experienced greater access site complications (Perclose vs. Angio-Seal, p = 0.008; Perclose vs. MC, p = 0.06). Patients treated with Angio-Seal reported greater overall satisfaction, better wound healing and lower discomfort (each vs. Perclose or vs. MC, all p < or = 0.0001). For diagnostic cath only, median post-procedural length of stay was reduced by Angio-Seal (Angio-Seal vs. MC, p < 0.0001; Angio-Seal vs. Perclose, p = 0.009). No difference was seen in length of stay for interventional cases. CONCLUSIONS: Overall, Angio-Seal performed better than Perclose or MC in reducing time to ambulation and length of stay among patients undergoing diagnostic procedures. There was a higher rate of successful deployment and shorter time to hemostasis for Angio-Seal, and this was accomplished with no increase in bleeding complications throughout the follow-up. Additionally, Angio-Seal performed better than Perclose in exhibiting a superior 30-day patient satisfaction and patient assessment of wound healing with less discomfort.

Abciximab↗
PubMedDate not supplied

Trabeculectomy: a reevaluation after three years and a comparison with Scheie's procedure.

Seventy-one patients with glaucoma needing surgical correction had either a peripheral iridectomy with a thermal sclerostomy or a trabeculectomy utilizing a modification of Watson's technique in which the scleral flap was closed tightly with sutures. Results of surgery were analyzed at intervals up to an including three years following the surgical procedure. The success of the operations was judged both in terms of the effect on intraocular pressure as well as on the visual ability of the eye. Since the surgeon's aim is to lower intraocular pressure to a particular level, not simply to an arbitrary level that facilitates statistical analysis, the control of the disease was graded in terms of how completely the operative procedure fulfilled the goal set by the surgeon at the time the decision to operate was made. While this method of grading success introduces a subjective element, a more valid assessment of the true value of the surgery may be obtained. The results suggest that the Scheie procedure lowers pressure to a lower level and for a longer duration than does the trabeculectomy (mean intraocular pressure three years postoperatively was 12.3 mm Hg in patients with primary glaucoma treated with a Scheie procedure and 16.6 mm Hg in those with trabeculectomy with a sutured scleral flap). In this study the long-term visual result was apparently no different with the Scheie procedure and trabeculectomy. Trabeculectomy causes fewer flat anterior chambers than the Scheie procedure. The degree of pressure lowering in trabeculectomy is directly related to the amount of postoperative filtration. The relative indications for trabeculectomy include: (1) malignant glaucoma in the other eye, (2) chronic angle-closure glaucoma where an iridectomy is considered insufficient, (3) "high pressure glaucoma" where pressure below 20 mm Hg is not essential, (4) low inflow glaucoma in which persistent flat anterior chambers may be expected following routine filtration surgery, and (5) patients where endophthalmitis is a real concern, as in the young, those remote from medical care and those with poor personal hygiene. Trabeculectomy gives such poor results in secondary glaucoma that the procedure is probably relatively contraindicated. Trabeculectomy is a valuable operation, but not the final solution to glaucoma surgery. It should be chosen with full recognition of its specific advantages and disadvantages.

Adolescent↗