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PubMed2001

[The clinical effect of non-penetrating trabecular surgery with reticulated sodium hyaluronate implant for treatment of primary open-angle glaucoma].

OBJECTIVE: To evaluate the clinical effect of non-penetrating trabecular surgery (NPTS) with reticulated sodium hyaluronate implant in primary open-angle glaucoma (POAG). METHODS: NPTS with reticulated sodium hyaluronate implant was performed on 27 eyes of 25 patients with POAG. The procedure consisted of excising a deep scleral tissue including the external wall of the Schlemm's canal under a scleral flap without opening the anterior chamber, as the inner wall of the canal was left in place. Then placing a 3.0 mm x 4.5 mm x 0.5 mm or 3.5 mm x 3.5 mm x 3.5 mm reticulated sodium hyaluronate implant was placed under the flap, so that the aqueous humor may filter through the thin layer of trabeculocorneal membrane spontaneously without forming a flat chamber. The postoperative intraocular pressure (IOP), inflammation and filtering bleb were analyzed. All of patients undertook ultrasound biomicroscopy (UBM) and gonioscopy to evaluate the surgical site on the postoperative 2 weeks, 3, 6 and 9 months. The mean follow-up was (6.61 plus minus 2.47) months. RESULTS: The IOP decreased from a mean preoperative value of (26.36 +/- 9.02) mm Hg (1 mm Hg = 0.133 kPa) to a mean postoperative value of (14.18 +/- 3.51) mm Hg (t = 6.875, P < 0.05). The number of anti-glaucomatous medications, topical or systemical, was reduced from (2.96 +/- 1.43) sorts preoperatively to (0.77 +/- 1.07) sorts postoperatively. The visual acuity remained stable (no statistical difference with chi(2) test). Six eyes had elevated IOP after operation and were controlled by eyedrops or trabecular puncture with ND: YAG laser. A slight hyphema occurred in 4 eyes with small puncture during operation. The complications such as flat chamber, inflammation and choroidal detachment were not observed. The UBM showed that the sodium hyaluronate implant degraded and a transparent liquid space existed under the scleral flap in all of patients at postoperative 3 months. The gonioscopy showed that at the surgical site the thinner and semitransparent trabecular membrane and changes of a transparent cavity could be seen in 23 eyes. In the other eyes, at the site the trabecula was translucent. The filtering blebs were formed in 8 eyes. CONCLUSION: Non-penetrating trabecular surgery with reticulated sodium hyaluronate implant can effectively lower the IOP and reduce the sorts of anti-glaucomatous medications. The visual acuity may remain unchanged, and no serious complications commonly seen in the traditional trabeculectomy occur. The procedure is a new simple and effective one for the treatment of POAG.

Adolescent↗
PubMed2001

[Anesthetic management of a patient with congenital antithrombin III Deficiency using temporal inferior vena cava filter].

We described the perioperative management of a patient with congenital antithrombin III deficiency using temporal inferior vena cava filter. A 30-year-old man with congenital antithrombin III deficiency was scheduled for artificial head replacement of the hip joint under general anesthesia. He was diagnosed as having congenital antithrombin III deficiency when he had had an episode of venous thrombosis after artificial head replacement of the right hip joint. He had been taking warfarin as an anticoagulant, and it was discontinued three days before surgery. To prevent perioperative thrombus formation, the plasma AT III activity was maintained above 80% before, during and after surgery using AT III concentrates. We also placed the temporal inferior vena cava filter. There was no serious thrombosis or embolism perioperatively. The use of the filter during the perioperative period helped to avoid development of serious thrombosis and embolism.

Adult↗
PubMed1995

[Indications for prophylactic vena cava filters introduced subcutaneously in patients with thromboembolic disease--preliminary report].

In 10 patients with thromboembolic disease 1 Gunther filter and 9 LGM filters were inserted. Indications for filter placement were: pulmonary hypertension caused by recurrent pulmonary embolism in 3 cases; planned surgery in 2 patients with pulmonary embolism and deep venous thrombosis; recurrent pulmonary embolism despite of anticoagulant treatment in 2 cases, previously performed thrombo-endarterectomy in 1 case; contraindications for anticoagulant treatment in 1 case and complications of anticoagulant therapy also in 1 case. No serious complications after filter placement were observed.

Adult↗
PubMed1994

[Floating thrombus in the right atrium and severe pulmonary embolism. Value of intravenous thrombolysis].

Mobile right atrial thrombi carry a high risk of pulmonary embolism which may be massive and are a medical emergency. Although surgery is commonly indicated, treatment with intravenous thrombolytics is an alternative and was successful in 4 out of 6 cases reported by the authors. Six patients, admitted for severe pulmonary embolism confirmed by pulmonary scintigraphy (6 cases) and by angiography (2 cases), underwent echocardiography which demonstrated a mobile right atrial thrombus. One patient was operated as an emergency and died immediately afterwards. Another, treated with heparin because of contraindications to surgery and thrombolysis had a recurrent fatal pulmonary embolism. In the other four cases, intravenous thrombolytic therapy was started immediately after echocardiography with 250,000 IU of streptokinase in 30 minutes, followed by 100,000 IU per hour for 48 to 72 hours associated with heparin 300 to 500 IU/kg/day. The biological efficacy of the treatment was confirmed in all cases (fibrinogen < 1 milligram; TCA > 60 s). A clinical improvement with improved blood gases was rapidly obtained in all 4 cases. The thrombus had totally disappeared at control echocardiography 8 to 12 hours after the initial examination. There were no complications, in particular no haemorrhages. After 6 months' follow-up, the outcome was good with oral anticoagulants (4 cases) associated with implantation of a caval filter in 1 case. Thrombolysis seems to be an effective alternative to surgery as there four cases demonstrate.

Aged↗
PubMed1988

Is sufentanil removed by blood conservation devices?

To conserve blood during open heart surgery, cell savers and hemoconcentrators are used. Cell savers retrieve and filter shed blood from the operative field and then wash and separate reconcentrated erythrocytes from a supernatant by centrifugation. Hemoconcentrators are extracorporeal devices that extract an ultrafiltrate from the circulating perfusate during cardiopulmonary bypass. Both cell saver supernatant and hemoconcentrator ultrafiltrate are discarded. Twenty patients were anesthetized with a single dose of sufentanil, 30 microg/kg, and the cell saver supernatant and hemoconcentrator ultrafiltrate were analyzed for sufentanil. The supernatant contained only 0.1% of the total administered dose. Hemoconcentrators from two different manufacturers were tested, and 0.1% of the administered sufentanil was detected in one ultrafiltrate and none was found in the other. Thirty minutes after induction of anesthesia, the plasma sufentanil concentration was 8.5 ng/mL (1.3% of the given dose); 1 hour later, it was 4.9 ng/mL (0.8%). During cardiopulmonary bypass, the plasma level decreased to 2.5 ng/mL (0.6%); after bypass, it fell to 1.5 ng/mL (0.3%). It is concluded that intravenous (IV) sufentanil rapidly leaves the plasma compartment, and little remains available to be extracted by the devices used to process and conserve blood.

Aged↗
PubMed2000

A tale of two syndromes: ovarian hyperstimulation and abdominal compartment.

Abdominal compartment syndrome complicated severe ovarian hyperstimulation in a 35 year old woman with multiple bowel resections due to Crohn's disease. Pain from ovarian enlargement necessitated hospital admission. Despite intravenous fluid administration and heparin prophylaxis, ilio-femoral deep vein thrombosis developed. Treatment by intravenous heparin was complicated by repeated intra-ovarian bleeding, anaemia and acute renal failure requiring haemodialysis. Intra-abdominal pressures were elevated. After placement of an inferior vena caval filter and discontinuation of heparin, there was slow spontaneous recovery without surgery.

Abdomen↗
PubMed2001

Are leukocytes in salvaged washed autologous blood harmful for the recipient? The results of a pilot study.

To explore whether polymorphonuclear leukocytes (PMNL) are activated to the priming threshold through intraoperative blood salvage, and are thus able to induce endothelial damage, we investigated chemotactic response (n = 20) and respiratory burst (RB; n = 20) of PMNL without (basal respiratory burst, bPMNL-RB) and after in vitro stimulation with formyl-Met-Leu-Phe (fMLP-RB) and phorbol myristate acetate (PMA-RB). Blood was processed with a continuous autotransfusion device (CATS). Heparin (Heparin group) and sodium citrate (Citrate group) were used alternately as an anticoagulant for each half of the chemotaxis and RB studies. Comparison of measurements from the processed autologous erythrocyte concentrates (paEC) to pre- and intraoperative arterial blood samples showed no statistically significant difference for any test of PMNL functional responses in an orthopedic patient population. Analysis of intraindividual changes demonstrated a significantly increased bPMNL-RB (both groups, P = 0.0032; Heparin group, P = 0.0098), fMLP-RB (both groups, P = 0.0484; Citrate group, P = 0.0371), and PMA-RB (Citrate group, P = 0.002) in the paEC compared with intraoperative arterial samples, whereas the chemotactic response did not change. Nevertheless, median values of all RB measurements in the paEC were within the range of pre- and intraoperative values, indicating that PMNLs contained in the paEC are neither impaired nor activated to the priming threshold. The results confirm the clinical experience that intraoperative blood salvage is safe to use during major orthopedic surgery and questions the beneficial effect of special leukocyte-removing filters.

Adolescent↗
PubMed2002

Functional reconstruction and minimally invasive techniques.

Recent years have seen notable advances in imaging technologies. Three-dimensional computer-rendered techniques with rapid image acquisition have led to the development of virtual reality imaging. Virtual reality imaging allows interactive intraluminal navigation through any hollow viscus, simulating conventional endoscopy. This technique of virtual endoscopy has been applied to many organs, including the urinary tract. Virtual reality endoscopy is beginning to challenge the gold standard of conventional endoscopic evaluation. Recent advances in laparoscopic surgery are largely attributable to technological improvements in imaging equipment. Laparoscopic ultrasound has become a common adjunct in laparoscopic surgery. In particular, advances in video cameras and digital imaging technology have decreased the steep learning curve associated with laparoscopic procedures. Telerobotic systems offer several advantages to laparoscopic surgery, such as all six degrees of freedom, dexterity enhancement, tremor filtering, and stereovision. In addition, technological breakthroughs allow many procedures to evolve from open operations involving lengthy hospital stays to imaging-guided minimally invasive procedures performed on an outpatient basis. Finally, Internet-based imaging is changing the way in which urology services are delivered, by allowing rapid communication between remote locations.

Cystoscopy↗
PubMed1991

Closure of leaking filtering blebs with cyanoacrylate tissue adhesive.

Five leaking filtering blebs, occurring between 10 months and 21 years after trabeculectomy, were closed with cyanoacrylate tissue adhesive. Filtering bleb integrity was preserved in four cases, so that additional microsurgery was avoided. The only problem associated with use of tissue adhesive was the development of corneal abrasions in three cases. Although it is an accepted treatment for these conjunctival fistulas, only nine previous cases have been reported to our knowledge. We strongly recommend the use of tissue adhesive as a presurgical treatment in the management of leaking filtering blebs which present as a late postoperative complication of glaucoma surgery.

Aged↗
PubMed1979

Applications of xeroradiography in dentistry-a review.

Xeroradiography is the technique in which electrostatically charged plates sensitive to X-rays are used in diagnostic radiology in place of conventional film. There has however been anxiety that radiation dosage for xeroradiography may be at unacceptably high levels. James et al., however, in 1973 showed that by increasing the kilovoltage to at least 120 the exposure could be reduced by 60 per cent. Using higher kV lateral oblique jaw and lateral and anteroposterior skull xeroradiographs have been produced with lower radiation exposure than conventional film. Bony detail is much more sharply delineated on xeroradiographs and soft tissues are visible on the same picture without use of a grid or wedge filter. These features are of obvious advantage in cephalometrics and orthognathic surgery. Panoramic techniques are potentially the most useful way of applying xeroradiography. The combination of full jaw coverage with the sharp definition only possible at present with intra-oral radiographs would provide more information for the dentist, save time for the radiographer and reduce the dose to the patient. Excellent results have been obtained with autopsy specimens on machines which develop 90kVp, but optimal exposure for a normal adult requires a panoramic X-ray machine development 120 kVp. Xeroradiography has the advantage, therefore, of providing more detail of diagnostic value with lower radiation exposure to the patient. The process requires no silver, which is in increasingly short supply.

Humans↗
PubMed1987

A model intraocular lens.

With so many different kinds of intraocular lenses from which to choose, the cataract surgeon is often faced with a difficult decision--which is the best lens for the patient. Although, there is no perfect intraocular lens, we attempt to delineate several desirable features. These include pliability, inert ultraviolet-filtering lens material, compact design, and posterior concavity to facilitate laser surgery. Successful blending of these features can make a well-tolerated intraocular lens.

Elasticity↗
PubMedDate not supplied

Emergency pulmonary embolectomy.

Pulmonary embolectomy maybe a life saving procedure in the unresponsive hypotensive patient following a massive pulmonary embolectomy despite optimal medical therapy. We report a successful pulmonary embolectomy in a 47 year old patient, three days post post coronary artery bypass grafting (CABG) and a new approach to the problem of caval filters in such patients. This case demonstrates the benefit of early surgery in this life threatening situation.

Embolectomy↗
PubMed1993

[Clinical application of the thoracic balloon for postpneumonectomy patients].

Pneumonectomy may result in complications such as continuous intrathoracic bleeding and mediastinal shift. We used a thoracic balloon made of silicone rubber in 15 postpneumonectomy patients in an attempt to prevent such complications. Two types of thoracic balloons were used in our series. Type 1 thoracic balloon is a simple balloon requiring cooperation with a drainage tube, and Type 2 is a combination balloon and drainage tube. During surgery, air was injected into the thoracic balloon through an air filter. After removal of the thoracic balloon, infusion of sulfur hexafluoride, SF 6, into the thoracic cavity was performed on the 7th to 10th postoperative days. Placement of thoracic balloons in the pleural space after pneumonectomy is a simple, safe and useful method of preventing both intrathoracic bleeding and mediastinal shift.

Aged↗
PubMedDate not supplied

Misplaced Greenfield filter: diagnosis by transesophageal echocardiography.

A case of accidental placement of a Greenfield filter in the right atrium is described. Transthoracic echocardiography demonstrated the filter but was unable to provide details regarding the exact location of the filter. Transesophageal echocardiography showed the filter to be fixed to the tricuspid anulus. This finding, which was confirmed during surgery, was used to guide the subsequent surgical management.

Echocardiography↗
PubMed1990

[Evaluation of the cost-efficacy ratio of Pall BB 22 15 filters for the bacterial protection of anesthesia circuits].

The aim of this study is to assess wether the use of the bacteriological filter Pall BB 22 15 placed on the Y piece of the anesthesia equipment decreases contamination and furthermore to evaluate the cost of this practice versus changing anesthetic circuits after every patient. Randomized trials are conducted with three "Engström" machines in three cardiac surgery operating rooms. The Y pieces were examined with qualitative and quantitative bacteriological analysis. Use filters is less expensive than changing circuit for each patient for a comparable efficacy.

Air Microbiology↗
PubMed1999

Deep venous thrombosis after percutaneous insertion of vena caval filters.

PURPOSE: A large multicenter study has recently questioned the overall clinical efficacy of vena caval filters, especially when inserted prophylactically, because of the subsequent development of deep venous thrombosis (DVT) at the insertion site. We examined the incidence of this complication with newer, smaller diameter percutaneous devices. METHODS: We reviewed our vascular surgery and interventional radiology clinical registries to identify patients in whom a femoral percutaneous vena caval filter had been placed from 1993 to 1998. This list was cross referenced with patients who had undergone lower extremity venous ultrasound scan examinations for the diagnosis of DVT in the vascular laboratory within a 60-day period before and after the insertion of the filter device. RESULTS: A total of 35 patients during this 5-year period had timely follow-up venous duplex scan studies performed. The indications for filter placement were DVT in 16 patients (46%), pulmonary embolus in 13 patients (37%), DVT and pulmonary embolus in three patients (9%), and prophylactically in three patients (9%) at high risk for thromboembolization. Of the patients with documented thromboembolic events, 91% (29 of 32) had contraindications to anticoagulation therapy, and the remaining 9% (3 of 32) represented failure of anticoagulation therapy. A Greenfield filter was used in 13 patients (37%), a Simon Nitinol filter was used in 11 patients (31%), and a VenaTech filter was used in nine patients (26%). The other two patients (6%) had a Bird's Nest filter inserted. At a mean follow-up period of 12 +/- 2 days (median, 6 days), there was a 40% (14 of 35) incidence of proximal DVT in venous segments without evidence of thrombus before filter insertion. The majority (71%; 10 of 14) occurred in the common femoral vein, with three located in the superficial femoral vein and one in the external iliac vein. The lowest incidence of DVT was seen with the Greenfield and Bird's Nest filters as compared with the smaller Simon Nitinol and VenaTech filters (20% vs 55%; P < .05). The highest incidence of thrombosis occurred in patients with pre-insertion pulmonary emboli (50%; 8 of 16) as compared with those patients with DVT (38%; 6 of 16) and prophylactic insertion (0%; 0 of 3). However, the subgroups were too small to attain statistical significance. CONCLUSION: There is a continuing and significant incidence of new DVT development ipsilateral to the percutaneous femoral insertion site of vena caval filters. The smaller diameter filters are not associated with a lower incidence of femoral thrombosis.

Anticoagulants↗
PubMed1993

Pseudo-Brown's syndrome as a complication of glaucoma drainage implant surgery.

Two cases of pseudo-Brown's syndrome occurring after superior nasal implantation of glaucoma filtering devices are described. We hypothesize that this restriction in ocular motility was due to the mechanical effects of large filtering blebs or increased inflammation and scar formation in the superior nasal quadrant. Serial ultrasound examinations of our patients demonstrated development of a large bleb, coincidental with the disturbance in motility. Because of the risk of strabismus, we no longer recommend placing large implant devices in the superior nasal quadrant in eyes that have good vision.

Aged↗