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At least 1,405 records · Page 78Linked to original sources
PubMed1997

Temporal corneal phacoemulsification in patients with filtered glaucoma.

OBJECTIVE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that underwent prior trabeculectomy. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive patients who underwent temporal clear corneal phacoemulsification subsequent to trabeculectomy (trabeculectomy-phacoemulsification group) were identified, and 40 control patients who underwent trabeculectomy alone (trabeculectomy group) were matched to the case patients for length of follow-up, age, IOP, number of antiglaucoma medications, number of 5-fluorouracil injections, race, sex, and diagnosis. MAIN OUTCOME MEASURES: Intraocular pressure before vs 1 year after phacoemulsification in the trabeculectomy-phacoemulsification group compared with IOP in the trabeculectomy group and survival analysis of IOP control after trabeculectomy in the 2 groups. RESULTS: In the trabeculectomy-phacoemulsification group, IOP 1 year after phacoemulsification was not significantly different from the prephacoemulsification IOP value (P = .65). Kaplan-Meier survival analysis showed that the rates of IOP control 3, 6, and 9 years after trabeculectomy in the trabeculectomy-phacoemulsification group were 80%, 66%, and 44%, respectively; in the trabeculectomy group, these were 79%, 69%, and 55%, respectively. These survival curves were not statistically different (P = .55). CONCLUSION: Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long-term IOP control.

Aged↗
PubMed1997

Temporal corneal phacoemulsification in filtered glaucoma patients.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that had prior trabeculectomy. DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive patients (cases; TRAB-PHACO group) who underwent temporal corneal phacoemulsification subsequent to trabeculectomy were identified. Forty patients (controls; TRAB group) who had trabeculectomy alone were matched to the cases for length of follow-up, age, IOP, number of anti-glaucoma medications, number of 5-fluorouracil (5-FU) injections, race, sex and diagnosis. MAIN OUTCOME MEASURES: Comparison of IOP before and one year after phacoemulsification in the TRAB-PHACO group, and comparison with the TRAB group. Survival analysis of IOP control after trabeculectomy in the TRAB-PHACO and TRAB groups. RESULTS: In the TRAB-PHACO group, IOP one year after phacoemulsification was not significantly different from the pre-phacoemulsification IOP value (p = 0.65). Kaplan-Meier survival analysis showed that the rates of IOP control at 3, 6 and 9 years after trabeculectomy in the TRAB-PHACO group were 80%, 66% and 44%; in the TRAB group these were 79%, 69% and 55%. These survival curves were not statistically different (p = 0.55). CONCLUSIONS: Cataract surgery by temporal clear corneal phacoemulsification in eyes with filtering blebs after trabeculectomy does not adversely affect long term IOP control.

Aged↗
PubMed2005

Clinical experience with retrievable vena cava filters: results of a prospective observational multicenter study.

BACKGROUND: Retrievable inferior vena cava (IVC) filters offer the attractive possibility to be definitive or to be removed when they become unnecessary. OBJECTIVE: The purpose of this study was to evaluate the efficacy and the likelihood to remove the retrievable IVC filter ALN. METHODS: A total of 30 patients (13 males and 17 females, mean age 57 +/- 15 years) underwent placement of ALN filters. Indications for implantation were acute venous thromboembolism (VTE) with a contraindication to anticoagulation in 26 cases (86%), primary prophylaxis after major trauma in two cases (7%) or before surgery in two patients with very high thromboembolic risk (7%). RESULTS: The filter was successfully placed in all patients. After a median follow-up of 18.2 months, there were three cases (10%) of trapped emboli within the filter, one case (3%) of asymptomatic migration of the filter toward the heart and two patients (7%) had deep vein thrombosis (DVT) recurrences. ALN retrieval was attempted through transjugular approach in 18 patients (60%) and the maneuver was successful in 14 of them (78%); when the decision of removal was taken more than 3 months after the implantation, the retrieval was possible only in four of eight patients (50%). The median implantation period was 123 days (range: 30-345). CONCLUSIONS: The present study shows the efficacy of ALN filter; it also demonstrates the feasibility and safety of retrieval after a medium-term period of placement. Removal after 3 months after implantation can be unsuccessful and maximum implantation time requires further studies.

Adult↗
PubMed2001

Heparin coating of the extracorporeal circuit combined with leukocyte filtration reduces coagulation activity, blood loss and blood product substitution.

BACKGROUND: Cardiopulmonary bypass is associated with activation of the coagulation cascade. Occasionally, this results in postoperative hemorrhage and consequently the need for blood products associated with increasing costs and risk of infection. Contact activation of the intrinsic coagulation pathway, and damage to cellular blood components with the release of proteolytic substances from neutrophil granulocytes have been linked to these coagulation disorders. METHODS: Eighteen routine CABG-patients were randomly assigned to totally heparin coated circuits (Bioline coating) combined with leukocyte filtration in a double blind protocol (group I), 34 patients served as controls (group II). Leukocyte filters were activated before release of the aortic crossclamp. Coagulation activity, postoperative blood loss, and substitution with blood products were assessed. RESULTS: Blood loss in the first 24h after surgery was significantly lower with combined application of heparin coating and leukocyte filters (group I) vs. controls (group II) (526+/-78 ml vs. 786+/-88 ml; p<0.05). Thrombin formation represented by prothrombin fragments 1+2 was significantly lower in group I vs. group II after declamping of the aorta (2.1+/-0. 3 nmol/L vs. 4.0+/-0.3 nmol/L; p<0. 05). Group I showed higher AT II plasma than group II (48.8+/-3.2% vs. 41.5+/-1.77%; p<0.05). CONCLUSIONS: Leukocyte filtration during reperfusion in heparin coated cardiopulmonary bypass circuits is associated with lower coagulation activation, decreased blood loss and reduced transfusion of packed red cells in elective CABG patients.

Aged↗
PubMed2002

Endoscopic cyclophotocoagulation.

Glaucoma surgery can be classified as either cyclodestructive (reducing inflow) or filtering (increasing outflow). Filtration has traditionally been the procedure of first resort because of its efficacy and relative predictability, whereas ciliary destruction has been reserved for more refractory cases of glaucoma and in eyes which have little or no visual potential. Refractory glaucomas include neovascular glaucoma, post-traumatic glaucoma, glaucoma associated with aphakia, severe congenital/developmental glaucoma, post-retinal surgery glaucoma, glaucoma associated with penetrating keratoplasties, and glaucoma in eyes with scarred conjunctiva from surgery or disease processes.

Blindness↗
PubMed2005

[Characteristics of filtering blebs after fornix-based trabeculectomy with a scleral tunnel].

PURPOSE: To evaluate the characteristics of filtering blebs after fornix-based trabeculectomy with a scleral tunnel. PATIENTS AND METHODS: We studied 119 eyes of 149 patients who had undergone fornix-based trabeculectomy with mitomycin C as their primary surgery between 2000 and 2002 and in whom we could evaluate the characteristics of filtering blebs after a follow-up period of 6 months or more, and whose intraocular pressure at the evaluation time was 18 mmHg or less. We evaluated the width, depth, height, border, avascular area, conjunctival thickness, and late-onset bleb leak of the filtering blebs. RESULTS: The mean period of evaluation was 528 +/- 243 days (mean +/- standard deviation) after surgery, and the mean intraocular pressure at that time was 12.0 +/- 3.0 mmHg. Among these patients, 108 eyes (72.5%) had completely diffuse blebs and 90 eyes (60.4%) had completely vascular blebs. There was no apparent late-onset bleb leak. CONCLUSION: Fornix-based trabeculectomy with a scleral tunnel appears to be an effective method of developing diffuse, vascular and safe blebs with a low risk of late-onset bleb leak.

Adult↗
PubMed2003

Relationship between natriuretic peptides and residual diuresis during continuous hemodiafiltration.

BACKGROUND: The reasons for the decrease or increase of urine output following the start of continuous venovenous hemodiafiltration (CVVHDF) have not yet been explained sufficiently. The renoprotective properties of natriuretic peptides were described. METHODS: The levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in 23 mechanically ventilated patients before and during the first 48 h of CVVHDF. Samples were drawn both from the ports proximal and distal to the filter. The results were compared between the group where daily diuresis (Vu) remained low or decreased and the group where diuresis increased to the level of 1.5 ml x kg(-1) x h(-1) or higher after 48 h of treatment. Left ventricular dysfunction (LVD) was defined as LV ejection fraction below 40%. A control group consisted of 10 patients exposed to abdominal surgery. RESULTS: The average AVdiff (%) of ANP and BNP on filter were insignificant. Patients with increasing diuresis (n = 12) had significantly lower levels of both ANP (p < 0.001) and BNP (p < 0.005) than the patients with decreasing diuresis (n = 11). Significant correlations were revealed for ANP and Vu (p < 0.01) and for BNP and Vu (p < 0.05). The levels of both peptides were grossly elevated in comparison to controls and were predictive of survival. The differences between cardiac and non-cardiac patients were significant both for ANP and for BNP. CONCLUSIONS: The elimination of ANP and BNP by the CVVHDF is negligible. The levels of natriuretic peptides are inversely related to Vu and predict survival. ANP and BNP levels correlate with left ventricular function even during acute renal failure and CVVHDF.

Acute Kidney Injury↗
PubMed2000

Proteolysis of von Willebrand factor and shear stress-induced platelet aggregation in patients with aortic valve stenosis.

BACKGROUND: Excessive bleeding may complicate congenital cardiac defects. To explain the pathogenesis of this abnormality, we evaluated selected parameters of primary hemostasis in patients with aortic valve stenosis before and after corrective surgery. METHODS AND RESULTS: We examined shear-induced platelet aggregation with the filter aggregometer test and von Willebrand factor (vWF) structure by evaluating the multimeric distribution and extent of subunit proteolysis. The platelet count was reduced before corrective surgery, and shear-induced platelet aggregation was impaired. Moreover, vWF multimers of higher molecular mass were decreased, and proteolytic subunit fragments were increased. After correction of the cardiac defect, all of these parameters returned to normal. CONCLUSIONS: Alterations of vWF and platelet function may contribute to the bleeding diathesis in patients with aortic valve stenosis. Improvement after corrective surgery suggests that the passage of blood through a stenosed aortic valve may result in shear forces that induce vWF interaction with platelets in the circulation and, in turn, trigger platelet clearance, vWF degradation, and the impairment of primary hemostasis.

Adult↗
PubMed2005

[Intraocular lenses with blue light filter].

PURPOSE: To evaluate if a SN60AT < > IOL (Alcon) with IMPRUV filter (Alcon) offers any advantage in patients having cataract surgery, as compared with Acrysof SA60 IOL (Alcon). METHODS: This was a prospective analytical study. We studied sixty-four eyes from 32 patients with cataracts. After a random assignment, phacoemulsification with the implant was performed using the Acrysof SN60AT tinted lens in one eye and Acrysof SA60 in the other. A variety of variables was subsequently assessed: contrast sensitivity with a CSV 1000E test, colour perception through a Farnsworth 25 test and subjective measures by a patient survey. Differences between the groups were assessed statistically. RESULTS: The contrast sensitivity results were obtained for 3, 6, 12 and 18 cycles per degree (cpd) frequencies under scotopic conditions, with better results obtained following the use of SN60AT: 0.75 (CSV 1000E test units) for 3 cpd, 0.86 for 6 cpd, 0.54 for 12 cpd and 0.35 for 18 cpd. The differences were statistically significant between the two groups for 3 cpd and 6 cpd. A total of 62.5% of patients using a tinted lens and 50% with SA60 achieved good results in the Farnsworth test; 12.5% and 21% had fair results and 25% and 28.1% respectively had poor results. CONCLUSIONS: We obtained an improvement in favour of the tinted lens for all frequencies, with this being statistically significant at lower frequencies (3 and 6 cpd). No significant differences in the Farnsworth test performance or in the patient survey were found. The tinting provided by the IMPRUV filter brings an increase in contrast sensitivity without affecting colour perception.

Aged↗
PubMed2000

[A clinical comparative study of interferon alpha-2b with mitomycin C applied in glaucoma filtering operation].

OBJECTIVE: To compare the results of interferon alpha-2b (IFN alpha-2b) with mitomycin C (MMC) treatment in trabeculectomy. METHOD: 41 cases 68 eyes with late stage of primary open angle glaucoma (POAG) were randomly studied by treatment with IFN alpha-2b or MMC following trabeculectomy, each group consisting of 34 eyes. Of the cases, 27 were bilateral, one eye was designed to use IFN alpha-2b, and the other eye, apply MMC. All patients were ranged from 15 to 40 years old, and they all received the surgery the first time. The surgical procedure was similar in all eyes. The IFN alpha-2b treated eyes were subconjunctivally injected 5 x 10(5) IU at filtering bleb when the operation was finished immediately and on the postoperative day 3, 7, 10 and 14, respectively. The MMC-receiving eyes were intraoperatively administered with 0.25 mg/ml via a sponge under the conjunctival flap for 5 minutes. The follow-up was ranged from 6 to 15 months. RESULTS: (1) The 12th month life-table success rate of functional bleb formation was (70.95 +/- 9.72)% in IFN alpha-2b-treated group and (77.01 +/- 10.51)% in MMC-received group, the difference being not statistically significant (u = 0.2165, P > 0.05). The eyes with IFN alpha-2b tended to form type II blebs were according to Kronfeld classification, whereas type I blebs were commonly seen in MMC-treated eyes (chi(2) = 6.261, P < 0.05). The percentages of intraocular pressure between 10 - 15 mmHg on postoperative month 3, 6, 9 and 12, respectively in IFN alpha-2b group were higher than that in MMC group. (2) The 12th month life-table complete and qualified success rates were (70.95 +/- 9.72)% and (94.59 +/- 5.26)% in IFN alpha-2b group, (65.15 +/- 10.51)% and (84.61 +/- 7.26)% in MMC group, respectively (u = 0.8174, 0.1011, P > 0.05). (3) Complications induced by IFN alpha-2b were rare, mainly involving transient corneal epithelial defect, whereas by MMC included thin-wall blebs, persistent hypotony and hypotonous maculopathy. The decrease of visual acuity was seen in 44.1% of the cases in MMC group, whereas only 17.6% occurred in IFN alpha-2b group (chi(2) = 5.217 4, P < 0.05). CONCLUSION: IFN alpha-2b has similar effect as MMC to reduce the risk of failure of glaucoma filtration surgery, but it has more advantages over because of its fewer complications.

Adolescent↗
PubMed2005

Accuracy of assessing infrabony defects using a special digital filter for periodontal bone loss.

PURPOSE: To assess the accuracy of linear measurements of bone loss within infrabony defects on digitized radiographs after digital filtering particularly designed to image periodontal bone loss. METHODS: Before surgery, 50 standardized radiographs of 50 infrabony defects were obtained. Intrasurgically the distances from the cementoenamel-junction (CEJ) to the alveolar crest (AC), from the CEJ to the bottom of the bony defect (BD), and the depth of the infrabony component (INFRA) were assessed. All radiographs were digitized and the distances CEJ-AC, CEJ-BD, and INFRA were measured on digitized but unchanged radiographs and after use of the filter. RESULTS: There was a small overestimation of CEJ-AC (0.35-0.68 mm) and underestimation of CEJ-BD (0.84-1.12 mm) and INFRA (0.66-0.76 mm). Accuracy of measurement of the distance CEJ-AC was influenced by vertical angulation difference (P= 0.047) and the intrasurgical CEJ-AC (P= 0.003). Accuracy of CEJ-BD was influenced by intrasurgically assessed bone loss (P= 0.012). Accuracy of INFRA was influenced by individual patient, intrasurgically assessed INFRA (P< 0.001), and filter (P= 0.018).

Adult↗
PubMed2000

Filtration of activated granulocytes during cardiopulmonary bypass surgery: a morphologic and immunologic study to characterize the trapped leukocytes.

Cardiopulmonary bypass surgery induces an inflammatory reaction among others by activation of granulocytes. Leukocyte filtration has been shown to reduce the postoperative morbidity mediated by activated granulocytes. However, little is known about the mechanism of filter-leukocyte interaction. This study examines whether a leukocyte filter removes activated granulocytes or a general leukocyte population. Eleven patients undergoing cardiopulmonary bypass surgery were included in this study. Leukocyte filtration was achieved before the reperfusion phase with a Pall non-woven polyester filter located at the venous side of the heart-lung machine. After filtration, the trapped granulocytes inside the filter were examined morphologically with light and scanning electron microscopy and immunologically by CD45RO antigen binding to the filter material. Furthermore, leukocyte release markers were measured to determine whether cells were activated during filtration. Microscopic evaluation revealed 84% granulocytes and 14% lymphocytes trapped in the filter, compared with 78% granulocytes and 22% lymphocytes in the blood before filtration. Granulocytes were trapped significantly more in the first blood contact layer of the filter material than in the middle layer and last layer, whereas lymphocytes trapped slightly more in the middle layer. The near maximum level of CD45RO expression was measured on granulocytes trapped inside the filter material, whereas CD2 and CD19 measured on lymphocytes were bound to a minor extent. Beta-glucuronidase concentration did not increase after filtration, suggesting the absence of activation of granulocytes by filtration. A leukocyte filter made of non-woven polyester material removes the activated granulocytes rather than leukocytes at random. This implies that this particular type of leukocyte removal filter is suitable for use in cardiopulmonary bypass patients whose granulocytes in the circulation are activated. Furthermore, measurement of activated granulocytes instead of total leukocyte count is likely preferable for functional assessment of leukocyte removal devices.

Aged↗
PubMed2004

A model of spectral filtering to reduce photochemical damage in age-related macular degeneration.

BACKGROUND/PURPOSE: Cumulative sunlight exposure and cataract surgery are reported risk factors for advanced age-related macular degeneration (AMD). Laboratory studies suggest that accumulation and photochemical reactions of A2E (N-retinylidene-N-retinylethanolamine) and its epoxides, components of lipofuscin, are important in AMD. To relate this data to the clinical setting, we modeled the effects of macular irradiance and spectral filtering on production of A2E and reactive oxygen intermediates (ROIs) in pseudophakic eyes with a clear or "yellow" intraocular lens (IOL) and in phakic eyes. METHODS: We calculated relative changes of macular irradiance as a function of light (390 to 700 nm) intensity, pupil size, age, and lens status, and modeled resulting all-trans-retinal concentration and rates of production of A2E-related photochemicals and photon-induced ROIs in rods and retinal pigment epithelium (RPE). We compared these photoproducts following cataract surgery and IOL implantation with and without spectral sunglasses to normal age-related nuclear sclerotic lens changes. RESULTS: Following cataract and IOL surgery, all-trans-retinal and lipofuscin photochemistry would theoretically increase average generation of 1) A2E-related photochemicals, 2) ROI in rods and 3) ROI in RPE, respectively, 2.6-, 15- and 6.6-fold with a clear IOL, and 2.1-, 4.1- and 2.6 fold with a yellow IOL, but decrease approximately 30-, approximately 20- and 4-fold with a vermillion filter sunglass and clear IOL compared to an average 70 year old phakic eye. CONCLUSION: Sunglasses that strongly decrease both deep blue light and rod photobleaching, while preserving photopic sensitivity and color perception, would provide upstream protection from potential photochemical damage in subjects at risk for AMD progression after cataract surgery.

Aged↗
PubMed1987

Radiotherapy of gastric cancer with a three field combination: feasibility, tolerance, and survival.

From 1980 to 1984, forty-five patients suffering gastric cancer were irradiated with curative intent. Twenty-three were considered at high risk of recurrence after complete surgical resection (invasion of the serosa, lymph nodes and/or surgical margins); eleven were treated after partial resection, and for eleven others, the local extension precluded surgery. Radiotherapy combined two lateral fields (usually with wedge filters) and an anterior field. The planned dose was 40 to 50 Gy, according to the amount of residual disease and doses delivered to the major part of the liver and the right and left kidneys did not exceed 30, 5, and 18 Gy, respectively. For patients aged less than 71 and whose general condition was acceptable, one cycle of chemotherapy (FAM for 20 patients and 5-FU for 10) preceded irradiation, followed if possible by 6 other cycles. Adverse effects, essentially anorexia, vomiting, and weight loss, led to definitively stopping irradiation in 8 cases, and were present in 21 other patients. Mean weight loss was 2.5 kg. Apart from one patient who developed a subphrenic abcess and died after reoperation, there was neither chronic complication, nor radiation hepatitis or nephritis. For 34 patients, the observation time was superior to 3 years: 23 died of their cancer, 1 of a subphrenic abcess, and 2 of an intercurrent disease. Eight were disease-free at 3 years (three of these were irradiated for macroscopic disease). For the overall series, the 4-year survival rate is 23%. There is a significant survival advantage for females versus males (p less than 0.01), a non-significant tendency in favor of microscopic residual disease versus macroscopic, and no advantage for the combination with FAM compared with no chemotherapy (non-randomized). This technique appears feasible with an acceptable tolerance and can control local tumor in a few cases. The planned dose of 40 Gy was probably too small and we are now testing 45 Gy delivered over the large initial volume, and boosts of 10-15 Gy to residual disease.

Adult↗
PubMed1997

[Clinical observation of trabeculectomy without conjunctival incision].

OBJECTIVE: To reduce the formation of cicatrization of filtering bleb and elevate the successful rate of filtration surgery of glaucoma. METHODS: Trabeculectomy without conjunctival incision was performed on 37 eyes of 35 patients with glaucoma. RESULTS: They were followed up for 3-16 months. The rate of control of the intraocular pressure was 94.6%, and the operative complications were few and mild. CONCLUSION: The results show that the trabeculectomy without conjunctival incision is a safe and effective anti-glaucoma technique.

Adult↗
PubMed1989

[Intraoperative monitoring of spinal interventions with evoked potentials].

Monitoring the spinal cord can improve the safety margin during spinal surgery. This technique requires a stimulus source, transmitted through filters and amplifiers, and resulting in an enhanced signal that is recorded. Several techniques are now available, both non-invasive and invasive. We have carried out intraoperative monitoring during 178 spinal operations to correct deformities. Cortical somatosensory evoked potentials (CSEP) were obtained with Fz-Cz' recording sites, following bilateral posterior tibial nerve stimulation. In addition, unilateral median nerve stimulation was performed as a control. Six cases with an intraoperative alteration in waveform are described.

Adolescent↗
PubMed1979

Blood saving techniques: indications and contraindications.

Pre- and peroperative blood saving can be realised in different ways, without inducing important changes in the biological parameters of the organism. Different replacement solutions are studied in detail. Three principal techniques are as follows: a) The peroperative autotransfusion consists in recovering the blood lost in the operative field during the surgical intervention, filtering it and transfusing it at the end of surgery. b) The peroperative normodilution consists in collecting a certain amount of blood (till up 2 l.) from the patients before operation; it is replaced by plasma expanders and transfused at the end of operation. c) The third technique, called the 'frog leap', consists in collecting blood during the weeks preceding surgery, in various amounts in function of the importance of the estimated blood loss. This blood is stored and transfused during intervention.

Blood Preservation↗
PubMed1993

[The dynamics of blood composition changes in leukocyte filtration during cardiopulmonary bypass. Preliminary results].

Activation of leukocytes (especially neutrophils) during cardiopulmonary bypass (CPB) causes a reperfusion injury through the release of oxygen free radicals and formation of microvascular occlusions. Leukocyte filtration during CPB could solve these drawbacks. We investigated the selectivity of leukocyte filtration by fifteen patients undergoing coronary artery bypass surgery. Leukocyte depleted patients (n = 8) had a leukocyte filter incorporated in the bypass circuit. We evaluated the number of lymphocytes, neutrophils and platelets as well as hematocrit values at following time points: a) before CPB, b) 15 min after the start of CPB, c) before the administration of protamin and d) 3 hours after the CPB. No statistically significant changes of hematocrit values, lymphocyte or platelet counts between control and leukocyte depleted group of patients were observed. However, the use of leukocyte filter caused significant decrease in number of circulating neutrophils at 15 min after begin of CPB (1.20 +/- 0.17 x 10(9)/l for leukocyte depleted patients and 1.90 +/- 0.42 x 10(9)/l for control group of patients, p < 0.05). Our temporary results indicate the selectivity of leukocyte filtration during the cardiopulmonary bypass.

Adult↗