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PubMed1997

Clinically silent microemboli in patients with artificial prosthetic aortic valves are predominantly gaseous and not solid.

BACKGROUND AND PURPOSE: Microembolic signals (MES) are frequently observed by transcranial Doppler ultrasound after prosthetic heart valve implantation. Whether these MES are due to solid or gaseous particles is uncertain. We hypothesized that MES are gaseous and that if they are due to cavitation effects, their occurrence should respond to changes of dissolved oxygen concentration in the blood. METHODS: Transcranial monitoring of MES was performed in five patients with prosthetic aortic valves, who inspired 100% oxygen through a facial mask. In one patient 100% oxygen was administered under hyperbaric (2.5 kPa) conditions in a hyperbaric chamber. RESULTS: Inspiration of 100% oxygen reduced the total number of MES from 96/30 min to 2/30 min. Increasing the concentration of dissolved oxygen in the hyperbaric chamber led to an increase from 0.3 MES per minute (1.0 kPa) to 0.9 MES per minute (2.5 kPa). CONCLUSIONS: The dependence of occurrence of MES in patients with prosthetic cardiac valves on the oxygen partial pressure in blood provides strong evidence that these microemboli are gaseous.

Aged↗
PubMed2006

[Preliminary clinical results of a prospective study of IPS e.max Press- and Cerec ProCAD- partial coverage crowns].

UNLABELLED: It was the aim of this prospective clinical splitmouth investigation to evaluate the survival rate and long-term behavior of all-ceramic partial coverage restorations (PCR) on molars. Pressed ceramic (IPS e.max Press) and CAD/CAM made (ProCAD) PCR were compared. 80 vital molars of 25 patients were restored with all-ceramic PCR (40 IPS e.max Press* and 40 ProCAD*). All PCR were adhesively luted with a light-polymerizing composite (Syntac*/Tetric*) (*Ivoclar-Vivadent AG, Schaan, Liechtenstein). The ProCAD PCR were produced with Cerec 3 and Cerec Inlab CAD/CAM system (Sirona Dental Systems, Bensheim, Germany). IPS e.max Press PCR were heat-pressed following the lost-wax IPS-Empress method. Clinical recall was arranged in average 8, 14, 20 and 28 months after cementation of the restoration. PCR were classified by USPHS criteria. The prospective survival rate of ProCAD PCR was 97% and 100% for IPS e.max Press PCR after an observation period of 24 months. After fracture, one ProCAD restoration had to be replaced after nine months. The clinical accuracy of the marginal fit of ProCAD PCR and IPS e.max Press PCR was recorded "Alfa". Limitations were recognized with respect to the color matching of both types of PCR ("Bravo"). CONCLUSION: Within the limits of the present clinical results, the tested all-ceramic materials IPS e.max Press und ProCAD seem to be indicated for partial coverage restorations on molars.

Aluminum Silicates↗
PubMed2005

[Endovascular treatment with bifurcated stent-grafts in patients with abdominal aortic aneurysms].

UNLABELLED: During past few years endovascular procedures at patients with abdominal aorta aneurysm (AAA) have widely replaced surgical treatment. The interest put in endovascular treatment is high. The number of patients being operated by the use of this method has been growing. AIM OF THE STUDY: The objective of this article was the evaluation of the results of the endovascular treatment with 42 patients with abdominal aorta aneurysms. MATERIAL AND METHODS: All patients (38 men and 4 women, mean age 65 years) belong to the high risk group. The qualification for the endovascular treatment was after the clinical examination and angio-CT, abdominal and pelvis digital subtraction angiography (DSA). 36 operations were performed under supradural anesthesia and 6 under general anesthesia. Among all patients implanted bifurcated abdominal stent-grafts Zenith (COOK) fixing above the renal arteries. RESULTS: All operations were ended with success. Some early complications were. the leakage to sack of aneurysm, thrombosis of a leg of stent-graft, the curve of a leg, the growth of the thrombus in stent-graft. All patients had the control examinations (abdominal-rtg, pelvis-rtg, USG-color Doppler and angio-CT) immediately after the operation and successively after 1, 3 and 6 months. CONCLUSION: 1. The endovascular procedure among patients with AAA by means of bifurcated aortic stent-grafts is in many cases a principal method of treatment. 2. Early results of endovascular treatment are good. 3. Longer follow-up is needed for the evaluation of late results.

Aged↗
PubMed1997

Technique for realistic anterior crowns using the IPS Empress porcelain system.

In dentistry, the concept of realism can be applied to the creation of an artificial prosthesis that is not perfect, but real. If prosthesis are made to a flawless perfection, they will appear artificial. Ultimately, the clinician and ceramist should strive for realism. The IPS Empress System (Ivoclar Williams, Amherst, NY) is an all-ceramic restorative alternative utilizing a pressable leucite-reinforced glass ceramic for a variety of indications (e.g., crowns, inlays/onlays, veneers). The resulting tooth-colored and metal-free restorations combine strength and aesthetics approaching those of natural teeth. This article describes the technique and procedures required to achieve realistic anterior crowns with this all-ceramic system.

Aged↗
PubMed1997

Prophylactic balloon angioplasty fails to prolong the patency of expanded polytetrafluoroethylene arteriovenous grafts: results of a prospective randomized study.

PURPOSE: Maintenance of hemodialysis access grafts represents an enormous social and clinical problem. Current grafts and graft salvage techniques are inadequate. Consequently, there has been increasing interest in the use of minimally invasive catheter techniques to prophylactically treat stenoses in functioning arteriovenous grafts. Prophylactic balloon angioplasty has been widely suggested as prolonging assisted primary patency. We have performed a prospective randomized trial to compare patients who underwent percutaneous transluminal angioplasty (PTA) for graft stenoses > 50% with a control group that received no intervention. Our hypothesis was that to be efficacious a minimal benefit of 20% prolongation in patency would be necessary. METHODS: Color flow duplex scanning was used to detect > 50% stenoses in functioning expanded polytetrafluoroethylene grafts. Patients were then subjected to confirmatory angiographic evaluation. Those who had angiographic stenoses > 50% were randomized to balloon angioplasty or observation. Patients were followed-up with duplex scanning every 2 months. Statistical analysis was performed using the Kaplan-Meier technique. Although demographically the patient groups were well matched, there were more prior interventions and concurrent central stenoses in the treatment group. Outcomes were graft thrombosis, graft dysfunction that precluded dialysis, and six or more PTA procedures within 18 months. RESULTS: In the treatment and observation groups, the 6-month patency rates were 69% +/- 7% and 70% +/- 7%, respectively. The 12-month patency rates for the treatment and observation groups were 51% +/- 6% and 47% +/- 4%, respectively. There was no significant difference between these two groups (p = 0.97), with an 80% confidence limit for detection of a difference greater than 20%. CONCLUSIONS: This study demonstrates that a generic approach of PTA to treat all polytetrafluoroethylene grafts with stenoses > 50% does not prolong patency and cannot be supported.

Adult↗
PubMed2006

Virtual histology and color flow intravascular ultrasound in peripheral interventions.

The quality and interpretation of intravascular ultrasound (IVUS) imaging has been revolutionized in recent years by two new and major advances: virtual histology and color flow IVUS. Virtual histology intravascular ultrasound (VHIVUS) is a catheter-based technology where IVUS is generated from the transducer on the catheter tip and the reflected signals from the artery wall produce a color-coded map of the arterial disease. Different histological constituents of the plaque produce different reflected signals and these are assigned different colors (dark green, fibrous; yellow/green, fibrofatty; white, calcified; red, necrotic lipid core plaque). This color-coded map assists the interventionalist in understanding more fully how the lesion will behave at the moment of treatment, whether it will resist complete stent deployment or be liable to embolization. Originally introduced for coronary interventions, VHIVUS is now being applied to peripheral situations. Because it provides a detailed and close-proximity view of plaque, its potential to improve the safety and efficacy of carotid endoluminal repair is stimulating substantial interest. Similarly, color flow IVUS provides greater understanding for the operator of blood flow, and the interface between the vessel wall and the blood stream, lumen size, and success of treatment. Color flow IVUS does not use the Doppler effect, but creates real-time images that resemble color flow Doppler ultrasound. These two technological advances in IVUS have greatly improved the ability of the endovascular specialist to understand the arterial disease they are treating and to assess the completion of treatment.

Blood Vessel Prosthesis Implantation↗
PubMed1990

[Special intra-ocular lenses].

Intraocular lens (IOL) implantation is the method established worldwide for visual rehabilitation following cataract surgery. IOL's with particular characteristics and/or for special purposes are available for clinical or experimental use. Bifocal and multifocal IOLs have two or more foci for simultaneous far and near vision. The first clinical results are promising. The theoretically expected disadvantages, i.e., reduced contrast sensitivity or reduced visual acuity under reduced contrast conditions, have not yet been found in clinical studies. In cases of age-related macular degeneration, IOLs with a high negative diopter power in the center can be implanted as part of a Galilei telescope. By using high-plus power spectacles, a 2.5x to 4x magnification and a wide field of view can be achieved. Clinical investigation has started recently. Intraocular lenses for the correction of high-grade myopia are being tested by some surgeons. These lenses are made to be implanted in phakic eyes with a clear crystalline lens. Angle-supported and iris-fixated types are under investigation. Longterm results will show the clinical efficacy and safety. Other special intraocular lenses are iris-color lenses and a polymethymethacrylate (PMMA) iris diaphragm.

Humans↗
PubMed1998

The natural history of "failing" arterial bypass grafts in a duplex surveillance protocol.

Though color duplex ultrasonography (CDU) can identify threatened arterial bypass grafts, the natural history of grafts predicted to fail is not known. We examined patency of "failing grafts" followed by CDU for prolonged periods without intervention. A graft was defined as failing if there was elevation of the peak systolic flow velocity (PSFV) to a ratio of three times the PSFV in the adjacent graft, or if PSFV was less than 45 cm/sec throughout the graft. Only patients followed with CDU abnormalities without intervention for more than 2 months were included. Forty-six CDU abnormalities were noted after construction or revision of lower extremity bypass grafts in 34 patients. Grafts were autogenous in 25 cases, prosthetic in 16, and composite in 5. Focal abnormalities were noted in 35 grafts (76.1%), low PSFV throughout the graft in 6 (13.0%), while both findings were present in 5 grafts (10.7%). For various reasons no intervention was performed during follow-up ranging from 2 to 50 (mean 10) months, during which time patients had a mean of 3.6 CDU studies. Abnormalities regressed in 10 grafts (21.7%), progressed to 5 (10.9%), and were stable in the remainder. Fourteen grafts (30.4%) were ultimately revised with surgery or angioplasty at a mean of 5 months after the first abnormal CDU. Only 3 grafts (6.5%) occluded while being followed. Two of the 3 were among the 5 grafts with both focal elevated PSFV ratio and low PSFV throughout the remaining graft, while all 3 were among the 7 grafts with PSFV ratio in excess of 7.0. Compared to grafts without these features, occlusion was significantly more likely (p = 0.03 and p = 0.001, respectively). Currently defined threshold CDU criteria for prediction of graft failure may be excessively sensitive.

Anastomosis, Surgical↗
PubMed2005

Closure of a moderately large atrial septal defect with a self-fabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle.

Percutaneous closure of an atrial septal defect (ASD) in the elderly with reduced diastolic elasticity of the left ventricle poses a significant management challenge. We report on the case of an 85-year-old patient who was admitted for percutaneous device closure of a moderately large secundum atrial septal defect. Hemodynamic evaluation documented an increase in left atrial pressure from a mean of 12 mm Hg to a mean of 32 mm Hg after balloon test occlusion of the ASD. Two months later, after adequate pretreatment with diuretics and afterload-reducing substances, he underwent successful closure of the ASD using a self-fabricated fenestrated Amplatzer septal occluder, which resulted in a postimplantation left atrial pressure of a mean of 18 mm Hg. Recovery was unremarkable and the fenestration has remained patent for 3 months since implantation of the device. This unique case highlights the feasibility of using a self-fabricated fenestrated Amplatzer septal occluder to close interatrial communications in elderly patients with diastolic dysfunction of the left ventricle.

Aged↗
PubMed2000

[Interventional occlusion of atrial septum defects larter than 20 mm in diameter].

UNLABELLED: Over the last few years, various devices for the interventional closure of atrial septal defects (ASD) up to a diameter of 20 mm have been developed. We report our clinical experience in closing ASD with a diameter larger than 20 mm diameter with the Amplatzer Septal Occluder (ASO). METHOD: The stretched diameter of the ASD was measured by inflating a sizing balloon within the defect until an indentation in the circumference in the balloon could be observed. An ASO with a stent diameter 2-4 mm larger than the indentation in the circumference of the balloon was chosen and implanted via 9-12 French sheaths. In contrast to the closure of smaller defects, pullback of the device onto the atrial septum was only performed when the connecting stent of the ASO was completely deployed in order to achieve maximal centering characteristics and optimal support of the retention skirt of the left atrial disc on the edges of the defect. Only then was the right atrial disc deployed and actively configured by advancing the sheath and the delivery cable against the atrial septum. Implantation was only attempted if the atrial septal rims (except the anterior rim around the aorta) measured more than 7 mm by echocardiography to avoid injury or disturbance of sensitive intracardiac structures. After placement, the fixation of the device and the mechanical stability was proven by an extensive "Minnesota wiggle". The ASO was released only when TEE showed no or a trivial residual color flow through the connecting stent; otherwise repositioning was performed. RESULTS: Out of 352 patients (P) with successful closure of interatrial defects, 70 P (age: 1.1-77.3 years) had stretched defects larger than 20 mm diameter (median 22 mm diameter (20-36), 25/75% quartiles = 20/26 mm). Mean shunt size was Qp:Qs 2.1:1 (0.7-3.9:1), mean fluoroscopy time 10.9 min (0-63). Complete closure could be achieved in 85.7/93.1/100% after 3 months, 1 and 2 years, respectively. Besides 3 P with persistent atrial fibrillation, only 5 P showed transient atrial tachyarrhythmias, 2 only periprocedural and 3 within the first 3 months after implantation were treated with beta-blocker. In one patient, an acute embolization of the device occurred because a diminished posterior rim was not visualized by a monoplane TEE probe necessitating surgical explantation and defect occlusion. Despite oversizing the device, no "mushrooming" misconfiguration were observed. CONCLUSION: Transcatheter closure of large atrial septal defects with the Amplatzer Septal Occluder is feasible, safe and effective. Risk of complications do not seem to occur more frequently than after closure of smaller defects if one adheres to certain sizing and implantation measures. The incidence of transient atrial tachyarrhythmias seems to be low.

Adolescent↗
PubMed2000

Report of a patient with aortic dissection evolving into binocular ischemic retinopathy.

BACKGROUND: Carotid artery disease is known to cause a variety of ischemic ocular syndromes. We report a patient with an aortic dissection that evolved into binocular ischemic retinopathy. METHODS: Case report. RESULTS: A 49-year-old male patient presented with stomach pains and with no ophthalmologic symptoms. After extensive examination, a diagnosis of aortic dissection was made to account for the acute abdominal pain. Sixteen days later, he noted binocular photopsia and ophthalmoscopy revealed ischemic retinopathy. Arterial stent implantation and right coronary reconstitution surgery were performed. Subsequently, the ischemic lesions in the retina disappeared and no abnormality was observed by retinal angiography 1 year later. CONCLUSION: Binocular ischemic retinopathy can be a sign of aortic or carotid dissection, and these observations suggest that aortic dissection should be included in the differential diagnosis whenever ischemic changes are detected in the retina.

Aortic Dissection↗
PubMed2006

Does free cell area influence the outcome in carotid artery stenting?

OBJECTIVES: To identify if carotid stent design, especially free cell area, impacts on the 30-day rates for stroke, death and TIA after carotid artery stenting (CAS). MATERIAL AND METHODS: A CAS database of 3179 consecutive CAS patients was retrospectively assessed. The distribution of neurological complications were analysed for association with the different stent types and designs. Events where subdivided into procedural and postprocedural events. RESULTS: The overall combined rate of TIA, stroke and death was 2.8% at 30 days (late events 1.9%). The post-procedural event rate analyzed for differences stents varied from 1.2% using BSCI Carotid Wallstent to 5.9% using Medtronic Exponent. The late event rates varied from 1.2% to 3.4% for free cell areas <2.5mm(2) and >7.5mm(2) respectively (p<0.05). Post-procedural event rate was 1.3% for closed cells and 3.4% for open cells. All these differences were highly pronounced among symptomatic patients (p<0.0001). CONCLUSIONS: After carotid stenting, complication rates vary according to stent type, free cell area and cell design. In the symptomatic population (and also in the total population), post-procedural complication rates are highest for the open cell types and increase with larger free cell area.

Blood Vessel Prosthesis Implantation↗
PubMed2005

Blue-light filtering intraocular lens in patients with diabetes: contrast sensitivity and chromatic discrimination.

PURPOSE: To evaluate potential changes in contrast sensitivity and color discrimination in diabetic patients who had cataract surgery and implantation of the blue-light filtering AcrySof Natural (SN60AT) intraocular lens (IOL) compared with an ultraviolet-only filtering (AcrySof SA60AT) IOL. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty-four eyes of 22 diabetic patients were enrolled in a blue-light filtering fellow-eye control study. Patients received yellow-tinted IOLs (AcrySof Natural) in 1 eye and non-yellow-tinted IOLs (AcrySof SA60AT) in the fellow eye. Three months after surgery, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and color discrimination was tested with the Farnsworth-Munsell 100-hue test. RESULTS: Eyes implanted with the blue-light filtering IOLs showed better contrast sensitivity values than fellow eyes implanted with non-yellow-tinted IOLs (P<.05). The blue-light filtering IOL did not modify chromatic discrimination compared with the non-yellow-tinted IOL (P = .62). In the blue-yellow axis discrimination study, the eyes implanted with the AcrySof Natural IOL had statistically significant better color vision (P = .008). CONCLUSIONS: In diabetic patients, the AcrySof Natural IOL provides better contrast sensitivity than the AcrySof SA60AT. The blue-light filter of the AcrySof Natural IOL did not cause chromatic discrimination defects based on total error scores and improved color vision in the blue-yellow chromatic axis in diabetic patients.

Aged↗
PubMed1999

Transcatheter closure of atrial septal defect with a new flexible, self-centering device (the STARFlex Occluder).

The purpose of this study was to evaluate the short-term safety and efficacy of the STARFlex Occluder for transcatheter closure of atrial septal defects with difficult anatomy. Transcatheter closure of the defect was attempted and successfully performed in 5 patients; the "stretched" defect diameter ranged from 12 to 24 mm and the implanted devices ranged from 23 to 33 mm.

Cardiac Catheterization↗
PubMed2001

Transesophageal color Doppler three-dimensional echocardiographic detection of prosthetic aortic valve dehiscence: correlation with surgical findings.

Three-dimensional echocardiography is being used with increasing frequency to evaluate cardiac function and structure. We present two cases of prosthetic aortic valve endocarditis where three-dimensional transesophageal echocardiography correlated with the intraoperative surgical findings of prosthetic dehiscence and communication with an abscess cavity. When compared with two-dimensional transesophageal echocardiography, three-dimensional echocardiography was more accurate in defining the exact site of dehiscence and communication with an abscess cavity. The echocardiographic images were oriented as a clockface watch to conform to the surgeon's visualization of the aortic root as viewed from the right side of the patient.

Abscess↗
PubMed1999

Subclavian stents and stent-grafts: cause for concern?

PURPOSE: To report cases of stent and stent-graft fracture in the subclavian vessels. METHODS AND RESULTS: Three patients with self-expanding stents of 3 different types in 1 subclavian artery and 2 subclavian veins presented with recurrent symptoms 6 months to 2 years after stenting. All devices showed signs of compression with stent fracture. The covered stent in the subclavian artery was excised. Of the 2 venous patients, 1 was treated with first rib resection and the other refused further treatment. CONCLUSIONS: The subclavian vessels are prone to flexion during movement, and the vessels may be compressed by external structures, including the clavicle and first rib. Stents that have not been designed to withstand these forces may be damaged.

Adult↗
PubMedDate not supplied

Imaging of early postoperative complications after polypropylene mesh repair of inguinal hernia.

PURPOSE: We report our experience with the use of US and CT in postoperative complications of inguinal hernioplasty using a prosthetic polypropylene mesh. MATERIALS AND METHODS: This study was divided into two parts. In the first we evaluated the in-vitro sonographic and CT appearance of a fragment of prosthetic mesh. In the second, we retrospectively reviewed the imaging findings in 31 patients (aged 42 to 75 years) examined after inguinal hernia repair between December 2000 and December 2002. Seventeen hernias had been repaired with a laparoscopic approach, and the others with the anterior tension-free technique proposed by Lichtenstein (12 cases) and Trabucco (2 cases). Sonography was performed to assess suspected complications between the second and the fourth postoperative day. Both high-resolution 7.5-10 MHz linear transducers and a 3.5 MHz convex probe were employed to ensure complete evaluation of superficial and deep structures. Eight obese patients also underwent CT for confirmation of the US results. RESULTS: At sonography the prosthetic mesh appeared as a linear hyperechoic image measuring about 2 mm in thickness, with posterior acoustic shadow and a finely irregular surface. Only one of the 17 patients examined after laparoscopic inguinal hernioplasty had a seroma; in the other 14 repaired with the anterior tension-free technique we identified 2 abscesses, 3 seromas, 2 "foldings" of the prosthetic mesh, and 2 mesh displacements with associated recurrence of hernia. CT confirmed the US results as to the presence of fluid collections, and visualised the prosthetic mesh in only 2/8 cases. CONCLUSIONS: Sonography is a useful means of assessing postoperative changes in laparoscopic and in anterior tension-free hernia repair. It can differentiate these complications from recurrences of hernia. Colour-Doppler US can also correctly detect normal blood flow of the testes. Sonography is the only technique that can easily demonstrate the prosthetic mesh in the abdominal wall.

Abscess↗