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PubMed2006

Leukocyte filtration to decrease the number of adherent leukocytes in the cerebral microcirculation after a period of deep hypothermic circulatory arrest.

OBJECTIVE: Cardiopulmonary bypass and hypothermic circulatory arrest induce a systemic inflammatory response, including a cascade of leukocyte and endothelial cell activity, during the postischemic reperfusion phase. Accumulation of leukocytes in the brain can lead to neurologic problems after cardiac surgery. The beneficial effects of a leukocyte-depleting filter have been documented, but because of contradictory results the underlying function of the filter remains unclear. METHODS: Twenty-two juvenile piglets (6 to 8 weeks) were randomly assigned to undergo cardiopulmonary bypass with or without a leukocyte-depleting filter 60 minutes before and 60 minutes after a 75-minute hypothermic circulatory arrest at 18 degrees C. The cerebral vessels were visualized with intravital microscopy through a cranial window placed over the parietal cortex. Rhodamine staining was used to observe adherent and rolling leukocytes in the cerebral postcapillary venules. The animals were electively killed 1 hour after weaning from cardiopulmonary bypass. RESULTS: There were no significant differences between the study groups regarding hemodynamic data. Numbers of adherent activated leukocytes were lower in the leukocyte filtration group, reaching borderline statistical significance when assessed throughout the experiment (between-groups P = .069) and actual statistical significance when assessed during the rewarming period (between-groups P = .029). CONCLUSION: The leukocyte-depleting filter succeeded in reducing the number of adherent leukocytes during the reperfusion period in an experimental operation with deep hypothermic circulatory arrest. Such a filter thus could mitigate cerebral reperfusion injury after cardiac surgery.

Animals↗
PubMed1999

Prestorage leukocyte filtration may reduce leukocyte-derived bioactive substance accumulation in patients operated for burn trauma.

Adverse effects of perioperative blood transfusion appear to be storage-time-dependent and may be related to extracellular accumulation of bioactive substances in blood products. In this study the clinical effects of leukofiltered and non-filtered blood products in patients undergoing surgery for burn trauma are investigated. 24 consecutive patients were randomly selected to receive transfusion with non-filtered blood components (group A, n = 12) or similar products, which were prestorage leukofiltered (group B, n = 12). The burn injury was scored using the Bull and Fischer index of age and burn surface area. Histamine, interleukin-6 (IL-6), plasminogen activator inhibitor-1 (PAI-1), eosinophil cationic protein (ECP) and myeloperoxidase (MPO) were analysed in plasma or serum collected from all patients 30 min before skin incision, at skin incision and 5, 10 and 30 min and thereafter every 30 min after skin incision until the grafts were secured by wrapping. Samples were also taken 8 h after skin incision and in the morning of postoperative days 1-5. The amount of blood products transfused from admission until day 5 postoperatively was recorded. All patients were followed until discharge or death. The Bull and Fischer index was comparable in the two groups. Prestorage leukofiltration reduced the amount of blood products required for transfusion significantly (p < 0.05) compared with non-filtered products. The levels of the various bioactive substances changed during and after the operation. In particular, ECP and MPO levels increased significantly (p < 0.05) in group A patients compared with unchanged (ECP) or decreased (MPO) levels in group B patients. IL-6 analyses showed, that the trauma had more severe impact on group B patients than on group A patients. Nevertheless, 4 patients died in group A and 2 in group B; all with a Bull and Fischer index between 1.0 and 2.0. Prestorage leukocyte filtration may reduce transfusion related accumulation of various bioactive substances and the requirement for blood in burn trauma patients.

Adult↗
PubMed1995

[Implantation of a LGM suprarenal vena cava filter--case report].

In the case of 53 years old woman LGM filter was inserted over renal veins. Indications for those procedures were: vena cava thrombosis in distal part of vena cava what not allowed to place filter below renal veins, malignancy, planned surgery, proximal deep vein thrombosis and past history of pulmonary embolism. Indications for suprarenal placement of vena cava filters and results of such as procedure were discussed.

Colonic Neoplasms↗
PubMed2003

Results of phacoemulsification in eyes with preexisting glaucoma filters.

PURPOSE: To evaluate the intraocular pressure (IOP), best corrected visual acuity (BCVA), and glaucoma medication requirements in patients having phacoemulsification after preexisting glaucoma filters. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis of 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or a scleral tunnel (26 eyes) approach after filtration surgery was performed with a minimum follow-up of 12 months. Two-tailed homoscedastic t tests were used for statistical analysis. RESULTS: The mean preoperative IOP in all eyes was 11.8 mm Hg +/- 4.2 (SD), and the mean final postoperative IOP was 13.7 +/- 4.6 mm Hg (P<.022). The mean preoperative logMAR equivalent BCVA was 0.8 +/- 0.4, which improved to a mean of 0.4 +/- 0.4 postoperatively (P<.0000002). There was no statistically significant change in glaucoma medication requirements postoperatively. The differences in IOP, BCVA, and postoperative glaucoma medication requirements were not statistically significant between the clear corneal group and the scleral tunnel group or between patients who received mitomycin at the time of filtration surgery and those who did not. There were no intraoperative complications; 1 patient required additional glaucoma surgery. CONCLUSION: Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medicines required for IOP control over a minimum follow-up of 1 year.

Aged↗
PubMed1999

Ex vivo testing of the Quart arterial line filter.

Arterial line filters are now routinely used in cardiac surgery in order to decrease the microemboli load to the patient. The Quart filter (Jostra, Hirrlingen, Germany) with a new planar construction design, an easy de-airing system and an integrated bypass, was tested for air filtration capacity and resistance to blood path in a standardized setting with surviving animals. Three calves (mean body weight: 71+/-3.4 kg) were connected to a standard cardiopulmonary bypass (CPB) circuit by jugular venous and carotid arterial cannulation with a mean flow rate of 3.5 l/min. The arterial line filter was challenged with upstream injections of boluses of air of 5, 10 and 15 ml, respectively. A Doppler ultrasound was positioned downstream on the arterial line to measure bubble count and size. The pressure drop through the filter was monitored at flow rates of between 1 and 6 l/min. At the end of the procedure the animals were weaned from the CPB and, thereafter, from the ventilator. After 7 days, the animals were sacrificed electively. This study shows that important quantities of air can be injected into the arterial line upstream of the filter with small volumes of small sized bubbles recorded downstream. With the 5 ml air bolus injection, mean values of 0.3+/-0.6 bubbles of 30 and 40 microm were detected, whereas with the 20 ml bolus, 32.6+/-8.7 bubbles of 10 microm, 3.7+/-1.1 bubbles of 30 microm, 3.3+/-0.6 bubbles of 40 microm and 0.7+/-1.1 bubbles of 50 microm were recorded. The blood path resistance at different blood flow rates was well within the acceptable range with a pressure drop of 20+/-0 and 26.6+/-5.7 mmHg at flow rates of 4 and 5 l/min, respectively. With its planar concept, the Quart filter offers good air filtering capacity both in terms of bubble count and size after injection of large boluses of air, without any increase of resistance to the blood path. Moreover, it offers a venting function and an integrated bypass system.

Air↗
PubMed2006

Clinical outcome and complications of temporary inferior vena cava filter placement.

OBJECTIVE: We evaluated the current clinical experience of temporary inferior vena cava (IVC) filter placement and its related complications. METHODS: From January 2000 to December 2005, we enrolled 33 patients (8 men and 25 women) who underwent percutaneous insertion of a temporary IVC filter in the Department of Vascular Surgery of Tokyo University Hospital. Deep vein thrombosis (DVT) was proven in 78.8% of the patients. The indications for filter insertion were contraindication to anticoagulation therapy (9.1%), thrombolytic therapy (12.1%), perioperative prophylactic implantation (84.8%), pregnancy with DVT (3.0%), and prophylactic implantation in the absence of DVT (15.2%). A Neuhaus Protect was used in 13 patients, and an Antheor was used in 20 patients. RESULTS: The mean +/- SD duration of filter placement was 10.6 +/- 7.0 days. There was no case of pulmonary embolism during filter protection and retraction. Filter thrombosis (capture of thrombus) was observed in four patients (12.1%), who then received additional thrombolytic therapy. Thrombi were dissolved by thrombolysis in three, one of whom had replacement with a permanent filter. The thrombus was not dissolved in one patient and was removed under venotomy at the insertion site. Major filter-related complications occurred in nine patients (27.3%), including filter dislocation in four patients (12.1%), catheter fracture in three (9.1%), and catheter-related infection in one (3.0%). In a patient with giant ovarian cancer, the IVC was nearly occluded with massive thrombus around the filter 2 days after operation, and the vena cava was then ligated under open laparotomy. No patients died during filter protection and retraction. CONCLUSIONS: Temporary IVC filters were effective for the prevention of fatal pulmonary embolism. However, our experience of a high incidence of complications related to temporary filters suggests that this device has limited indications and supports the need for innovative design of temporary filters.

Adolescent↗
PubMed2000

[Anesthetic management of a patient with deep venous thrombosis using temporary inferior vena cava filter].

A patient with deep venous thrombosis caused by a huge uterine leiomyoma underwent abdominal hysterectomy. To prevent pulmonary thromboembolism, the patient received anticoagulant therapy until 6 hr before surgery and temporary inferior vena cava filter was placed. A combination of preoperative anticoagulant therapy and the filter placement during perioperative period enabled this patient to be successfully-managed.

Anesthesia, General↗
PubMed1988

Internal trans-pars plana filtering procedure in humans.

Two patients (two eyes) with end-stage, medically uncontrollable glaucoma underwent transvitreal pars plana filtering procedures with a contact Nd:YAG laser with a sapphire probe. Intraocular pressure was being maintained without medication four months after surgery, with persistence of a diffuse filtering bleb.

Aged↗
PubMedDate not supplied

A diathermy suppression filter for external pacemakers.

Some patients undergoing cardiothoracic surgery require cardiac pacing. Surgical diathermy interferes with the operation of external pacemakers, and can cause a loss of cardiac output. The addition of a simple two-stage LC filter to the front end of the pacemaker enables cardiac output to be maintained during the use of surgical diathermy. (Although this article refers specifically to the Devices E4160 series pacemakers, the filter can, in principle, be used with any external pacemaker.

Diathermy↗
PubMed2006

Protective effects of soft acrylic yellow filter against blue light-induced retinal damage in rats.

Recently, a yellow intraocular lens (IOL) was developed for the purpose of reducing potential blue light-induced retinal damage after cataract surgery. However, the effect of yellow filters on retinal protection remains to be clarified. To test the protective effects of yellow filters on blue light-induced retinal damage, a yellow and a clear soft acrylic filter were attached to the right and left eyes, respectively, of albino rats and exposed to 4.5 k lux blue fluorescent lights with peak wavelength at 420 nm (ranging 380-500 nm; short blue) or 446 nm (ranging 400-540 nm; long blue) for 6h. To assess retinal damage, the electroretinogram (ERG) was recorded at 7 days, outer nuclear layer (ONL) thickness and area were measured at 7 days, apoptosis was analyzed by TUNEL staining at 24 h, and the level of lipid peroxidation in retinas was assessed by Western dot blots using specific antibodies against 4-hydroxynonenal (4-HNE)- and carboxyethylpyrrole (CEP)-modified proteins immediately after light exposure. After short blue light exposure, a- and b-wave ERG amplitudes and the ONL thickness at 1-2.5 mm inferior and 0.5-2.5 mm superior to optic nerve head (ONH) were significantly reduced. TUNEL staining in the ONL at 0-2 mm inferior and 1-2 mm superior to the ONH, and retinal levels of 4-HNE- and CEP-modified proteins were significantly increased in the clear filter-covered eyes compared to yellow filter-covered eyes. After long blue light exposure, the only difference seen was a greater ONL thickness at 1.5 mm superior to the ONH in yellow filter-covered eye. Transmission of light through the yellow filter was 58% for short blue and 89% for long blue compared to the clear filter. The ONL area was not different between clear filter-covered and -uncovered eyes after exposure to short or long blue light. Given the results, yellow IOL material protects the retina against acute shorter wavelength blue light exposure more effectively than the clear IOL material.

Animals↗
PubMed2006

A cemented caval vein filter: case report.

STUDY DESIGN: Case report. OBJECTIVE: To present a previously undescribed complication of bone cement use during spinal surgery. SUMMARY OF BACKGROUND DATA: Surgical cement reaching the circulation is a frequently described complication. The placement of caval vein filters is a routine measure in specific patients to prevent thrombotic material, usually from deep venous thrombosis in the lower extremities, from reaching the pulmonary circulation. A case of bone cement getting trapped in the caval filter rendering it unremovable has not been published. METHODS: A 66-year-old patient underwent dorsal spondylodesis of the lumbar spine for superinfected metastasis with instability. Because of deep venous thrombosis of both femoral and iliac veins, a caval filter had been placed before surgery. Bone cement from the surgical procedure migrated into the venous bloodstream and got caught in the caval filter, thus rendering the filter unremovable. RESULTS: Surgical removal of the filter was necessary. CONCLUSION: If caval filters are present in patients undergoing surgery involving the use of bone cement, the possibility of cement being caught by the filter must be considered.

Aged↗
PubMed1997

Transconjunctival mitomycin C as an adjunct to conventional glaucoma filtration surgery in rabbits.

PURPOSE: Subconjunctival mitomycin C has been used in glaucoma filtration surgery with success. A prospective, randomized, masked, placebo-controlled study was performed to evaluate whether single transconjunctival mitomycin C applied either preoperatively or postoperatively would enhance the success of filtration surgery in rabbits. METHODS: Two groups of 5 rabbits were studied. In Group I, a Weck-Cel sponge soaked in 0.5 mg/ml mitomycin C was applied transconjunctively for 7 minutes immediately before a full thickness filtering procedure. The other eye was treated similarly with a sponge soaked in balanced salt solution. Group II first underwent filtration surgery followed by treatment with either mitomycin-c or balanced salt solution 3 days later. Postoperative intraocular pressure, bleb status, and complications were evaluated. Treatment failure was defined as postoperative pressure within 4 mmHg of that determined preoperatively or the absence of bleb formation. RESULTS: In Group I, mean time to failure (+/- SD) was significantly longer (p = 0.03) in experimental eyes (30 +/- 15.1 days) than control eyes (8.6 +/- 0.8 days). In Group II, the time to failure was 12.4 (+/- 2.6) days versus 9.6 (+/- 2.5) days in the experimental and control eyes respectively, but this was not statistically significant (p = 0.10). Transient limbal vascularization and corneal haze were seen in all experimental eyes. Serious complications included late bleb rupture in eyes pretreated with mitomycin C (all eyes in Group I) and corneal decompensation (one mitomycin-c eye). CONCLUSIONS: This study demonstrates that a single preoperative tranconjunctival application of mitomycin-c is more effective at the time of surgery than an application applied in the intermediate postoperative period. Additional studies are needed, however, to further refine both the dose and timing of mitomycin-c application during filtration surgery.

Animals↗
PubMed2002

[Vena cava filters in complicated venous thromboembolism. Ten years' experiences at Malmo University Hospital].

All 74 patients treated with vena cava filter insertion during 1991-2000 at Malmö University Hospital were reviewed. Thirty-nine patients (53%) died during follow-up. Indications for permanent filter insertion (n = 63, age 25-89 years, 35 men) were contraindication for or side effects of anticoagulant treatment, or pulmonary embolism during anticoagulant treatment. Temporary vena cava filters (n = 11, age 19-85 years, three men) were inserted during surgery or thrombolysis. No complications occurred during temporary filter insertion. During 33 (1-120) months of follow-up of patients with permanent vena cava filters 37 patients (59%) died, thrombosis of the inferior vena cava occurred in 14 patients (22%), and recurrent pulmonary embolism in five patients (8%). Vena cava filter insertion should be considered as an alternative treatment in a selected group of patients with contraindications to or insufficient effect of anticoagulant treatment.

Adult↗
PubMed1989

Effects of ovariectomy on blood and plasma viscosity, fibrinogen and whole blood filterability.

Blood and plasma viscosity, fibrinogen concentrations and whole blood filterability (VB) were evaluated before surgery and 7 and 30 days postoperatively in 2 groups of subjects, one of which comprised 10 hysterectomized women and the other 14 women who had undergone both hysterectomy and ovariectomy. Oestrogens and various metabolic haematological parameters were measured and correlated with the haemorrheological data. By day 7 after surgery fibrinogen concentrations and plasma viscosity had increased, while VB had decreased. Plasma viscosity and fibrinogen levels correlated negatively with VB in the non-ovariectomized women. Three weeks later almost complete normalization of all parameters was observed in all of the subjects, except for the persistence of low oestrogen concentrations and a further decrease in VB values in the ovariectomized patients, these parameters showing a positive correlation. This study demonstrates that haemorrheological alterations occur after hysterectomy (with or without ovariectomy) in the early post-operative period. The striking decrease in VB values and its correlation with the oestrogen concentrations observed 1 mth after ovariectomy suggest that the fall in oestrogen levels might be responsible for the decrease in whole blood filterability.

Adult↗
PubMed2000

Sentinel node biopsy in melanoma using technetium-99m rhenium colloid: the London experience.

Nodal metastases in patients with melanoma identify a reduction of survival by 50%; however, elective lymph node dissection (ELND) has not been shown clearly to improve survival. Morton's technique of sentinel node biopsy, using preoperative lymphoscintigraphy and intraoperative blue dye, addresses elegantly the controversy regarding ELND. Sentinel node biopsy has been shown to stage the patient accurately because metastases from melanoma follow an orderly progression from the sentinel node to the remainder of the basin. Fifty-six consecutive patients with American Joint Committee on Cancer stage 1b or 2 melanoma seen at the London Health Sciences Center between July 1998 and January 2000 were enrolled prospectively to undergo sentinel node biopsy. Preoperative lymphoscintigraphy was conducted in the nuclear medicine department. A total of 10 to 15 MBq (0.27-0.41 mCi) of technetium 99m (99mTc) rhenium colloid or filtered sulfur colloid was injected intradermally around the biopsy scar. Images were obtained to localize all draining nodal basins. The location of the sentinel node was marked on the skin. The patient was taken to the operating room and anesthetized. Isosulfan blue dye was injected intradermally around the biopsy scar. A hand-held gamma probe was used intraoperatively as a guide to the first draining node. Blue-stained lymphatic channels aided in the dissection. Sentinel node localization was successful in 55 of 56 patients, for an overall success rate of 98%. Preoperative lymphoscintigraphy identified a sentinel node in an unpredictable location in 32% of patients. On average, 2.3 sentinel nodes per patient were identified on the initial scan, and 2.2 sentinel nodes per patient were recovered at surgery. Both 99mTc rhenium and filtered sulfur colloid showed no substantial differences in tracer uptake and retention in the sentinel node. Twelve patients had a positive sentinel node on routine histology, and 11 patients subsequently underwent completion lymphadenectomy. The mean thickness of the primary melanoma in the 12 patients with positive sentinel nodes was 3.7 mm compared with a mean tumor thickness of 1.8 mm in the remaining 41 patients with negative biopsies (p = 0.0003). Two patients experienced recurrence in a regional basin after negative pathological evaluation of the sentinel node. Reverse transcription-polymerase chain reaction analysis of both of these patients was positive. Two patients are alive with metastatic disease and 54 patients are alive without disease, with a mean follow-up of 1 year (range, 2-24 months). Complications occurred at a substantially higher rate (45%) after completion lymphadenectomy than after sentinel node biopsy alone (9%). Sentinel node biopsy is a feasible technique with a high success rate (98%), but it requires a multidisciplinary approach. This study validates the clinical usefulness of 99mTc rhenium colloid for lymphoscintigraphy.

Adult↗
PubMed1990

Transatrial interruption of the inferior vena cava.

Transatrial placement of a Greenfield filter at the time of cardiac surgery was performed on three patients with recent femoral venous thrombosis and unstable angina, and at the time of pulmonary embolectomy on four others. The filter carrier was passed through the right atrial cannulation site under fluoroscopic guidance into the inferior vena cava. A preliminary venacavogram was performed through the carrier or a previously placed angiographic catheter. Two complications were encountered: the first was misplacement of a filter in the right renal vein before routine venacavography was employed; the second was caudal displacement of a filter by a right atrial venous drainage cannula that projected into the inferior vena cava. The latter complication can be prevented by the use of a right atrial "sump" drain that does not protrude into the inferior vena cava.

Angina, Unstable↗