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At least 1,315 records · Page 73Linked to original sources
PubMed1980

Noninvasive radioisotopic technique for detection of platelet deposition in mitral valve prosthesis and renal microembolism in dogs.

At 24 hrs after implantation of Björk-Shiley mitral prosthesis in 5 dogs, in vivo images were obtained with a gamma camera after intravenous administration (0.5-0.6 mCi) one hour postoperatively of autologous Indium-111-labeled platelets. The site of platelet deposition in the teflon ring and perivascular damaged cardiac tissue is clearly delineated in the scintiphoto. In vitro biodistribution (mean % +/- SD of injected dose) at 24 hrs after injection of the 5 implanted and 7 normal dogs performed with a gamma counter demonstrated that (45.1 +/- 10.6)% and (0.7 +/- 0.4)% were in blood and kidneys in normal dogs and (28.5 +/- 6.8)%, (1.6 +/- 0.6)%, (0.3 +/- 0.1)%, and (0.2 +/- 0.1)% were in blood, kidneys, teflon rings, and perivascular damaged cardiac tissue, respectively. The strut and pyrolytic carbon-coated disc retained only (0.0033 +/- 0.0004)% and (0.0031 +/- 0.0003)%, respectively. There was a 2.3-fold increase of labeled platelets in kidneys of implanted dogs due to renal trapping of microembolism. Also, three- to fivefold increase in ratios of lung, brain, cardiac, and skeletal muscle to blood indicates that internal organs and whole body work as filter for microembolism generated by cardiovascular surgery and mitral prosthesis. Twenty percent of the administered platelets are consumed in surgical repair of damaged tissue. Indium-111-labeled platelets thus provide a sensitive marker for noninvasive imaging of Björk-Shiley mitral prosthesis, thromboembolism after implantation of prosthetic device, and in vitro quantitation of surgical consumption.

Animals↗
PubMed1980

[Dilemmas in anesthesiology].

The article is survaing sone of the latest developement in anaesthesiology. Dilemmas are pointed out in the filed of toxicity of anaestetics and use of scavenging devices. In intravenous anaesthesia ketamine microdrip and new analgesics have widened the scope and the anaesthetist today can chose from a biger pool of i.v. anaesthetic to pick the one best suitable for bis patient. The care for the patient does not only invoive the care for the time the patient is inder anaesthesia but is aimed at a much higher level. Planing anaesthesia starts in praenesthetic clinic and includes evaluation of the patients tolerance for anesthesia and surgery, preanaesthetic treatment and postanaesthetic treatment. Blood replacement during surgery using electric transfusion pumps and filters has shown to be very useful. Patients not only beter tolerate rapid blood losses. Rapid substitution of adequate amount of filtered blood in these patients gives a smother postoperative course. In intesive care there is a diference of opinion between one group of doctors who feel that good results and satisfactory diagustic results can be obtained wilhout the use of microporcessors and the other group wich states that microprocessors would and actualy do improve continous diagnonstic and monitoring i the criticaly ill, an opinion wich I support. Central laboratories are good and give accurate results but are expansive if used for inbetween checks or monitoring. There fore every ICU should have an own laboratory in order to monitor pH, blood gases, Na, K, Hematocrit and osmotic pressure. This notonly lowers the cost but gives the young resident the chance to learn. Pain treatment has become very actuel during last year and pain clinics are being opened in many places. However we hould be aware that a pain clinic should offer at least nerve bloks, stimulation and acupuncture.

Anesthesia↗
PubMed1977

Evaluation of a polycarbonate filter for the detection of microfilaremia in dogs in central Michigan.

Several diagnostic techniques were used in determining the prevalence of microfilaremia in 479 dogs entering the holding facility for research animals at Michigan State University. The modified Knott test and cellulose filter procedures were initially applied, but persistent difficulties with the cellulose filter system prompted evaluation of the use of clear polycarbonate filters. This procedure was found to be equally as sensitive as the modified Knott test and more sensitive than the microhematocrit tube method. Microfilariae trapped on polycarbonate filters were easy to detect, and there were no problems with clogging of the filter pores. Losses of up to 3.5% of the microfilariae occurred with 8-micron pore size filters, but no more than 1% passed through 5-micron pore size filters. Identification of microfilariae was based on size and shape of the parasites. In questionable cases, the diagnosis was confirmed by means of the histochemical test for acid phosphatase distribution. Satisfactory results were obtained when the latter test was applied to microfilariae of Dirofilaria immitis trapped and fixed on filters. Twenty blood samples in the surgery (4.2%) contained microfilariae, all of which were classified as D imitis.

Animals↗
PubMed2002

Intraoperative insertion of Greenfield filters: lessons learned in a personal series of 152 cases.

The objective of this study was to define outcomes of 151 patients who underwent insertion of 152 Greenfield filters in the operating room by general and vascular surgery residents with supervision by one attending vascular surgeon. Each patient was taken to the operating room for inferior vena cava (IVC) interruption immediately after a vena cavagram was performed. One patient required a subsequent return to the operating room after developing paradoxical arterial embolism from a large venous thromboembolism which was trapped by and spanned both sides of the first IVC filter. In this case a second suprarenal filter was placed at the time of arterial embolectomy. In each of these 152 cases intraoperative venacavography was performed using a mobile C-arm. Complications such as hemothorax, filter misplacement, and vena cava perforation were identified. Late survival was defined using the Social Security Death Index. Of the 151 patients undergoing intraoperative insertion of Greenfield filters there was one hemothorax from attempts at acquiring venous access via percutaneous puncture of the internal jugular vein. This required transfusion but not thoracotomy, and IVC interruption was achieved. A separate patient had insertion of a Greenfield filter into a gonadal vein which required placement of a second filter into the IVC. There was one IVC perforation from a transfemoral filter insertion which required placement of a second filter above this perforation and laparotomy to retrieve the filter and repair the IVC. In one more patient the IVC filter initially failed to open, and a second filter was placed above the first filter. In this experience the misplacement rate was 0.7 per cent and the serious complication rate was 1.3 per cent. None of the patients was adversely affected per se by transfer to the operating room for Greenfield filter insertion. No patient died from filter insertion, but in two cases serious associated complications contributed to the adverse outcomes in these already terminally ill patients. Overall 30-day mortality rate was 6.6 per cent. Late survival was defined as follows: survival at one year after filter insertion was 75 per cent, at 2 years 63 per cent, at 3 years 60 per cent, at 4 years 57 per cent, and at 5 years 54 per cent. Mean survival after filter placement was 4.96 years. We conclude that Greenfield filters can be inserted in the operating room by general and vascular surgery residents with attending supervision with reasonable safety and with a low rate of filter misplacement. The caval perforation and gonadal vein filter misplacement could both have been avoided by use of an over-the-wire filter deployment system, which at the time of these specific complications was not available. Vena cava filter insertion should remain within the scope of practice of surgeons and can be done with reasonable safety under C-arm guidance in the operating room. Use of over-the-wire systems could have helped reduce the likelihood of all but one of the filter-related complications experienced in this series.

Adult↗
PubMed1994

[Diseases of peripheral vessels during pregnancy and puerperium: diagnosis, prevention and treatment].

Pregnancy and puerperal period are favorable factors for appearance of or deterioration of peripheral vessels diseases and simultaneously limits ability of treatment. In the case of varicose veins the compressing therapy is the method of choice. The appearance of thromboemboli is the indication to the long time heparin treatment and according to other authors even to the surgery. In some cases implantation of the special filter to the inferior vena cava is necessary to prevent the pulmonary embolism. The worst form of thrombosis-phlegmasia cerulea dolens is the absolute indication to surgery. Pregnancy at patients with previous reconstructions in the aorto-iliac segment needs frequent examination of fetus and blood flow in the graft to avoid many dangerous complications. At pregnant women with peripheral vessels diseases examination using color ultrasonic doppler is method of choice. In some cases pregnancy should be treated as a high risk pregnancy and should remain under obstetrician and vascular surgeon care.

Female↗
PubMed1990

Cost effectiveness of trauma quality assurance audit filters.

The American College of Surgeons Committee on Trauma (ACSCOT) has published recommended minimal audit filters for trauma quality assurance. In this study ten filters were assessed through variable sample sizes over a 1-year period for cost and efficiency. Each filtered case was screened by trauma nurse coordinators. The trauma director reviewed possible deviations from standard and presented cases at peer review conferences for consensus on problem identification. While several filters had reasonable yield, most filters had minimal or no yield. Ten de novo problems were identified at a cost of +1,000 per de novo problem. Six filters were modified based on common reasons for overfiltration, resulting in a substantial reduction in filtration rate without losing problem identification. We conclude that ACSCOT audit filters 1 (unexpected deaths), 4 (ICU LOS greater than twice the average), 5 (trauma surgeon response), and 9 (major surgery greater than 24 hours) have a reasonable yield. Filters 2, 3, 7, 8, 11, and 12 have limited value to an established suburban trauma center and are not cost effective. Modifications of these filters can reduce cost without obvious impact on effectiveness. Specific audit filters recommended for future study are presented.

Cost-Benefit Analysis↗
PubMed1988

Effect of heparin, tissue plasminogen activator, and increased intracaval pressure on the acute morbidity of Greenfield filter insertion.

The effects of anticoagulation, thrombolytic therapy, and augmented intracaval pressure on the risks of acute caval hemorrhage from Greenfield filter insertion have not been rigorously investigated. To examine these risk factors, the device was placed in three groups of five dogs. Group 1 served as controls, with filter placement only. Groups 2 and 3 received anticoagulants before surgery. Group 3 was additionally given a continuous infusion of tissue plasminogen activator begun immediately after filter insertion. Animals were killed after a 6-hour period of observation and measurement. A second phase was carried out at autopsy in group 3: intracaval pressure was augmented and its effects on caval integrity noted. During the period of observation there were no significant decrements in central venous pressure or hematocrit. At autopsy, no evidence of caval hemorrhage and no caval perforations were found. Increased intracaval pressure did not alter these findings. These results support the clinical experience with the device, and suggest that the risk of acute hemorrhage from a properly seated filter is minimal, even with concurrent use of heparin and thrombolytic agents or high caval pressures.

Animals↗
PubMed2000

Scanning electron microscopic analysis of arterial line filters used in cardiopulmonary bypass.

The clinical value of arterial line filters is still a controversial issue. Proponents of arterial line filtration argue that filters remove particulate matter and undissolved gas from circulation while opponents argue the absence of conclusive clinical data. We conducted scanning electron microscope (SEM) studies of arterial line filters used clinically in the cardiopulmonary bypass circuits during adult cardiac surgery and analyzed the types and characteristics of materials entrapped in the arterial line filters. Twelve arterial line filters were obtained during routine hypothermic cardiopulmonary bypass in 12 adult cardiac patients. The arterial line filter was a screen type with a pore size of 40 microm (Baxter Health Care Corporation, Bentley Division, Irvine, CA, U.S.A. ). After opening the housing, the woven polyester strands were examined with SEM. All segments examined (120 segments, each 2.5 x 2. 5 cm) contained no embolic particles larger in their cross-sectional area than the pore size of the filter (40 microm). The origins of embolic particulates were mostly from environmental foreign bodies. This may suggest a possible need for more aggressive filtration of smaller particulates than is generally carried out at the present time.

Adult↗
PubMed2001

Myocardial protection with leukocyte depletion in cardiac surgery.

A role of neutrophils in ischemia-reperfusion injury has been focused on as one of the mediating factors of inflammatory reactions. Current studies have reported the efficacy of leukocyte-depletion in reperfusion by using leukocyte removal filter to attenuate reperfusion injury during open heart surgeries. For clinical application, we have introduced leukocyte-depleted terminal blood cardioplegia (LDTC) in adult patients and leukocyte-depleted blood cardioplegia in pediatric patients. The results of elective surgery in noncompromised LDTC did not significantly alter the results in terms of leakage of creatine kinase (CK)-MB, production of malondialdehyde from myocardium, and dopamine dose required at the weaning from cardiopulmonary bypass compared with the whole-blood reperfusion or with terminal cardioplegia alone. In contrast, the results in emergency coronary artery bypass graft (CABG) patients differed significantly between the LDTC group and the other two groups. Leukocyte-depleted reperfusion was also effective in a similar fashion for patients with severe left ventricular hypertrophy caused by chronic aortic valve disease. Leukocyte-depleted blood cardioplegia was useful in pediatric patients. Thus, leukocyte depletion may be beneficial as an adjunct to terminal blood cardioplegia or blood cardioplegia during cardiac surgery to attenuate leukocyte-mediated ischemia-reperfusion injury in patients with compromised hearts, such as those with preoperative ischemic insults, severe left ventricular hypertrophy, and in pediatric patients.

Calcium↗
PubMed1980

[Differential diagnosis of postoperative glaucoma following iridectomy and filtering procedures (author's transl)].

The various causes of elevated intraocular pressure following glaucoma surgery are described. One has to differentiate between failures after peripheral iridectomy (Table 1) and those following filtering interventions. The clinical picture of a postoperative narrow-angle glaucoma must be analyzed carefully; it may be due to pupillary block, plateau-iris syndrome or even to a ciliary block (malignant glaucoma). The failure of filtering procedures may be due to mechanisms blocking the trephination opening, cicatrization of the conjunctiva or a ciliary block. The diagnosis criteria of the different conditions and the respective therapeutic measures are outlined.

Diagnosis, Differential↗
PubMedDate not supplied

Clinical experience with temporary vena caval filters.

PURPOSE: To look at the benefits and complications of different vena caval filters inserted prophylactically. Three temporarily implantable caval filter systems were used in 67 patients. MATERIALS AND METHODS: Twelve Cook filters (six transjugular, six transfemoral), 11 Angiocor filters (one transjugular, 10 transbrachial), and 44 Antheor filters (three transjugular, four transfemoral, 37 transbrachial) were successfully implanted. In known iliac vein or caval thrombosis, the prophylactic filters were placed during thrombolytic therapy in 46 cases, surgery in 17 cases, thrombosis in pregnancy in three cases, and high-dose heparinization without lysis in one case. RESULTS: One patient had a fatal pulmonary embolism during treatment; seven thrombi were detected in the filter. Other complications were caused either by the underlying therapy alone (one fatal outcome of abdominal aorta aneurysmal surgery, two cases of cerebral hemorrhage, two cases of retroperitoneal hematomas, two cases of streptokinase fever reactions, one compartment syndrome, two cases of macrohematuria), by the combination of therapy and caval filter implantation (three cases of groin hematomas, three cases of arm hematomas), or by filter implantation alone (two cases of subclavian vein thrombosis, one catheter infection, one dislocation, one air embolism, one basket rupture). The bleeding complications were related to the aggressive thrombolytic therapy and would have occurred without filter implantation. CONCLUSION: Because temporary caval filters have no long-term complications per se, their use seems sensible as long as there are stringent indications, including the presence of iliac vein or caval thrombosis and risk of thrombus mobilization. The Antheor filter system was the most convenient system for implantation.

Adolescent↗
PubMed1997

[How successful is the filtering bleb "needling"?].

BACKGROUND: "Needling" may become necessary when filtering blebs fail due to scarring or encapsulation. Our goal was to calculate the medium term success rate of the needling procedure. METHODS: The results of 90 needling procedures performed on 58 eyes were analyzed, 52 eyes required one single needling (group 1) after simple trabeculectomy, whereas 19 eyes had to have double needling (group 2) and 3 eyes had to be needled 3 times (group 3). These figures do not include a 4th group of 16 eyes which had been needled after repeated and complicated surgery. Success rates were calculated at t1 = 0 - 1 day, t2 = 1 - 4 weeks, t3 = 4 - 8 weeks, t4 = 3 - 5 months and t5 = > 6 months after the treatment. RESULTS: The mean IOP (n = 90) was 29 +/- 6 mm Hg preoperatively, 15 +/- 10 mm Hg at t1, 23 +/- 9 mm Hg at t2, 20 +/- 7 mm Hg at t3, 17 +/- 5 at t4 and 17 +/- 3 at t5. The overall success rates were 80% (t1), 45% (t2), 37% (t3), 35% (t4) and 31% (t5). The corresponding success rates were 74%, 36%, 32%, 28% and 26% for group 1.89%, 52%, 37%, 37% and 31% for group 2.67% at all times for group 3 and 100%, 69%, 54%, 54% and 45% for group 4. CONCLUSIONS: In one third of all cases the needling is effective for more than 6 months. A complicated pressure lowering surgery does not necessarily diminish the effectiveness of a needling procedure. Re-needlings are as successful as the first one.

Aged↗
PubMed1977

Sympathetic uveitis following glaucoma surgery.

We had two cases of sympathetic uveitis after filtering procedures were performed on blind, painful eyes. A review of the literature shows that it is not the type of antiglaucoma operation that has to be incriminated in precipitating sympathetic uveitis, but the condition of the eye undergoing a filtering procedure. The risk is much higher when the glaucoma is absolute. There is much danger in operating on blind, painful eyes.

Aged↗
PubMed1986

[Value of transvenous caval occlusion surgery in view of the complications].

180 vena cava filters (9 23 mm and 120 28 mm Mobin-Uddin and 51 Kimray-Greenfield filters) were implanted from 1970 till December 1985. Technical problems prevented insertion in 5 cases with each filter. With the Mobin-Uddin filter misplacement occurred in 5 cases (3.8%); in two patients embolisation of the 23 mm filter into the pulmonary artery, once with lethal outcome, developed. One perforation of the right ventricle during insertion was successfully treated. Recurrent embolism was found in 3.8% with Mobin-Uddin (M-U) filters, none with Greenfield (K-G) filters. Filter-related operative mortality rate was 3.1% and 0% respectively.

Filtration↗
PubMed1997

An unusual complication of a postcataract filtering bleb.

Inadvertent blebs are sometimes encountered after cataract surgery using sutured limbal incisions. A number of surgical techniques have been described in the planned management of such blebs. Occasionally, an intraoperative bleb rupture may occur. The authors describe a rotational scleral autograft technique that can help in the management of this complication.

Anterior Chamber↗
PubMed1996

[Indications and results of surgically treated, with temporary vena cava filter managed patients].

Heavily injured patients, patients who underwent operations on pelvis, hips, abdomen or malignoma surgery, as well as gynaecology patients suffering from malignoma or previous deep femoral vein thrombosis in connection with pregnancy or obesity are at risk to suffer from pulmonary embolism with potentially lethal course. In a retrospective study we evaluated the advantage of the prophylactic use of temporary vena cava filters and their side effects. The indications were 18 cases of surgery, with known iliacal vein or cava thrombosis, 3 cases of pregnancy thromboses, and 1 high-dose heparinisation after acute pulmonary embolism without lysis. Additionally a postoperative lysis therapy was performed due to a life-threatening pulmonary embolism in 1 patient. 1 Cook filter (transfemoral), 3 Angiocor filters (transbrachial), and 19 Antheor filters (3 transjugular, 5 transfemoral, 11 transbrachial) were implanted. In these patients no clinically visible pulmonary embolism occurred under therapy, 3 thrombi were detected in the filter. Complications were caused either by the underlying therapy alone (1 lethal outcome of abdominal aortic aneurysm surgery), by the combination of therapy and cava filter implantation (1 case of arm haematoma, 1 ascending thrombosis) or by filter implantation alone (2 cases of v. subclavia thrombosis, 1 dislocation, 1 basket rupture). Since temporary cava filters have no secondary complications per se, their use seems justified as long as there is strict indication including presence of iliacal vein or cava thrombosis and risk of thrombi mobilisation.

Abdominal Neoplasms↗
PubMed1996

Leucocyte depletion filter removes cancer cells in human blood.

BACKGROUND: Autologous blood transfusion has been avoided in cancer surgery because of the metastatic potential of reinfused tumour cells. METHODS: This study evaluated the efficacy of a blood transfusion filter in removing tumour cells from blood. Whole human blood was admixed with two different malignant cell lines (breast cancer PM1 and MCF7). The blood was filtered through a RC400TE leucocyte depletion filter. Unfiltered blood was used as a control. Detection of malignant cells was performed with immunomagnetic beads and clonogenic assays. RESULTS: No viable tumour cells were found after filtration with the leucocyte depletion filter. CONCLUSION: These findings suggest that the use of a leucocyte filter after intra-operative blood salvage may make autotransfusion safe even in tumour surgery.

Blood Transfusion, Autologous↗