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PubMed1987

Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma.

We reviewed 75 consecutive cases of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in 69 patients with glaucoma. The mean preoperative intraocular pressure was 19.3 mm Hg on an average of 2.3 glaucoma medications. Visual acuity improved in 58 eyes (77%) at two months, with an average improvement of 3.3 and 3.6 lines at two and 12 months, respectively. Of the 75 eyes, 49 (65%) achieved a visual acuity of 20/40 or better; three patients (4%) had further deterioration in vision at the completion of follow-up because of progressive glaucoma or macular disease. Postoperatively, the average intraocular pressure was 3.8 and 3.0 mm Hg lower than the preoperative level at two and 12 months (P less than .001) on 0.63 and 0.79 glaucoma medications, respectively. However, 27 (36%) of the 75 eyes had a recorded intraocular pressure greater than 30 mm Hg and 30 (40%) had a pressure 7 mm Hg or more above their preoperative level during the first six months after surgery. Despite improved long-term control of intraocular pressure, detectable conjunctival filtering blebs were present in only 31 (41%) of 75 eyes at two months and in seven (12%) of 56 eyes at 12 months. Hyphema occurred in 34 (45%) of the cases.

Cataract↗
PubMed1996

Randomised comparison of leucocyte-depleted versus buffy-coat-poor blood transfusion and complications after colorectal surgery.

BACKGROUND: Allogeneic blood transfusion is associated with an increased frequency of postoperative infection. We studied whether such events can be avoided by the intraoperative and postoperative use of leucocyte-depleted blood. METHODS: 589 consecutive patients scheduled for elective colorectal surgery were randomised to receive buffy-coat poor (n = 299) or filtered leucocyte-depleted red-cells (n = 290) when transfusion was indicated. 260 patients actually received blood transfusion. Three patients were excluded from analysis. FINDINGS: The 142 patients randomised to and transfused with buffy-coat-poor blood had a significantly higher frequency of wound infections and intra-abdominal abscesses than the 155 patients who were allocated to this group but who were not transfused. (12 vs 1%, p < 0.0001) and (5 vs 0%, p = 0.005), respectively. Those receiving buffy-coat-poor blood also had a significantly higher frequency of wound infections and intra-abdominal abscesses than the 118 randomised to and receiving leucocyte-depleted blood (12 vs 0%, p < 0.0001) and (5 vs 0%, p = 0.017), respectively. Postoperative pneumonia occurred at a significantly higher rate in patients receiving buffy-coat-poor blood: 23 versus 3% in non-transfused patients (p < 0.0001), and 23 versus 3% in patients transfused with leucocyte-depleted blood (p < 0.001). The mortality rate between the groups was not statistically different. INTERPRETATION: Our data suggests that the association between allogeneic blood transfusion and postoperative infection is limited to allogeneic blood products that are not adequately depleted of immunosuppressive leucocytes. This undesirable effect can be reduced by leucocyte depletion with high-efficiency filters.

Aged↗
PubMed2005

Costs associated with blood transfusions in Sweden--the societal cost of autologous, allogeneic and perioperative RBC transfusion.

Anaemia is characterised by an insufficient number of red blood cells (RBCs) and might occur for different reasons, e.g. surgical procedures are often with associated blood loss. Patients who suffer from anaemia have the option of treatment with blood transfusion or medical treatment. In this study, the societal cost, for the case of Sweden, of RBC transfusion using three different techniques, i.e. allogeneic, autologous and intraoperative transfusion, was estimated. The analysis was based on information from interviews with hospital staff at large Swedish hospitals and from published data. The average cost for a 2 units transfusion was found to be Swedish kronor (SEK) 6330 (702 Euro) for filtered allogeneic RBCs and SEK 5394 (598 Euro) for autologous RBCs for surgery patients. Transfusion reactions accounted for almost 35 per cent of the costs of allogeneic RBC transfusions. The administration cost was found to be much higher for autologous transfusions compared with allogeneic transfusions. The cost of intraoperative erythrocyte salvage was calculated to be SEK 2567 (285 Euro) per transfusion (>4 units).

Anemia↗
PubMedDate not supplied

The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid.

This investigation was undertaken to assess the risk to the embryo/fetus associated with sentinel lymph node biopsy and lymphoscintigraphy of the breast performed in pregnant patients. Approximately 92.5 MBq (2.5 mCi) of filtered Tc-99m sulfur colloid was injected peritumorally the day before surgery in two nonpregnant women with breast cancer. The whole-body distribution of the radiopharmaceutical was evaluated using a gamma camera 1 hour after injection. We then calculated the absorbed dose to the embryo/fetus for three theoretical extreme scenarios of biodistribution and pharmacokinetics: 1) all of the injected radiopharmaceutical remains in the breast and is eliminated only by physical decay; 2) all of the injected radiopharmaceutical is instantaneously transported to the urinary bladder, where it remains and is eliminated only by physical decay; and 3) the injected radiopharmaceutical behaves as though it were administered intravenously, that is, it has the biodistribution and pharmacokinetics of Tc-99m sulfur colloid injected for a liver/spleen or bone marrow scan. The fetal radiation absorbed dose was then estimated for two Tc-99m dosages: 18.5 MBq (0.5 mCi) and 92.5 MBq (2.5 mCi). The Medical Internal Radiation Dosimetry (MIRD) program was used to estimate the absorbed doses to the embryo/fetus for the first two scenarios. Published data were used to calculate the doses for the third scenario. A single breast is not among the source organs in the MIRD program, so the heart was used as a surrogate in the first scenario. In the two breast cancer patients, whole-body gamma-camera images obtained 1 hour after radiopharmaceutical injection revealed no radioactivity except in the vicinity of the injection site. In the theoretical scenarios, with 92.5 MBq, the highest absorbed doses to the embryo/fetus were as follows: scenario 1, 7.74 x 10(-2) mGy at 9 months of pregnancy; scenario 2, 4.26 mGy during early pregnancy; and scenario 3, 0.342 mGy at 9 months of pregnancy. The maximum absorbed dose to the fetus of 4.3 mGy calculated for the worst-case scenario is well below the 50 mGy that is believed to be the threshold absorbed dose for adverse effects. Thus breast lymphoscintigraphy during pregnancy appears to present a very low risk to the embryo/fetus.

Breast Neoplasms↗
PubMed1992

[Separation of urologic tumors cells from Cell Saver blood using a membrane filter. A new method in autotransfusion?].

Tumor cells of three urological longterm cell lines have been labelled with 35[S]-Methionin and added to red cell concentrates. Red cell concentrates rich in tumor cells were passed through a cell saver and two special membranfilters under standard conditions. The 35[S]-Methionin labelled tumor cells were detected by liquid scintillation counting. On an average, only 0.027% of the radioactivity was left after passing through the cell saver and the membran filters in the 12 experiments. If investigations in clinical use of cell-saver and membran filter confirm these results, there will be significant consequences in urological tumor surgery by the possibility of transfusing the salvaged autologous blood.

Blood Component Removal↗
PubMed1988

Transient lenticular opacification following trabeculectomy.

Permanent lens changes may occur following filtering procedures for glaucoma, most often within a few years after the surgery. We present a case in which transient lenticular opacification occurred two days after trabeculectomy without intraoperative injury to the lens. The patient regained her preoperative vision 2 weeks postoperatively. We postulate that such reversible lenticular opacities may be due to changes in lens metabolism associated with hypotony.

Adolescent↗
PubMed1994

[Acute renal failure after major surgery: effectiveness of continuous arterio-venous hemofiltration (CAVH)].

Thirteen patients with acute renal failure after mayor surgery were treated with CAVH, 6 children after liver transplantation (OLT) and 7 after extracorporeal cardiac surgery (ECS). The ages ranged from 4 months to 19 years, with filters from 0.16 m2 to 0.5 m2, according to the weights. CAVH was initiated 19 hours (mean) after OLT and 10.5 hours (mean) after ECS. Mean creatinine clearance was 6.3 ml/min/1.73 m2 (ECS) and 10.1 ml/min/1.73 m2 (OLT). Serum creatinine remained under acceptable values (mean 2.1 mg.%) in both groups. Mean fluid removal was 5.7 L/day (242 ml/kg/day), which allowed plasma administration despite oligoanuria in the OLT group. Fluid removal decreased central venous pressure (p < 0.001) and increased mean arterial pressure (p < 0.01) in the ECS group, and inotropic support could be diminished. CAVH was well tolerated and it was maintained for 79 hours (ECS) and 105 hours (OLT).

Acute Kidney Injury↗
PubMed1996

[Toward the ideal bag: a clinical evaluation of a new aid for ostomized patients].

The authors report the results of a multicentre trial to evaluate the characteristics of a new bag for ostomised patients (Coloplast Alterna). While affirming that a correct technique is essential to avoid complications and to achieve good stoma function, the authors emphasise that the bag also pays an important role in giving confidence to patients and enabling them to enjoy a social life which is as similar as possible to that before surgery. In the search for the ideal bag the trial evaluated adhesive, filter and the bag and a whole. 85% of the 92 patients who tested the new bag for four weeks considered it good or excellent. Although it cannot yet be considered ideal, Alterna represents a further step towards this aim.

Colostomy↗
PubMed1997

[Experimental study of detection of brain tumor at surgery using fluorescent imaging under a surgical microscope after fluorescein administration].

Total resection is the optimal treatment for malignant gliomas. However, we sometimes find an unexpected residual tumor mass on magnetic resonance imaging performed after an operation because of a macroscopically unclear margin of the tumor during operation. This study was designed to evaluate the effect of fluorescein sodium on imaging of glioma in combination with a surgical microscope for detection of the tumor at surgery in a rat glioma model. For this study, we produced two filters for the excitation and emission of fluorescein that can be easily fitted to and removed from a surgical microscope manually during the operation. For the in vivo study, Wistar rat brains bearing C6 glioma were removed at appropriate intervals after the intravenous administration of 10-20 mg/kg body weight of fluorescein sodium, and their surface and coronal sections through the tumor were observed using a surgical microscope with the filters. For the in vitro study, the cultured C6 glioma cells were exposed to 5 micrograms/ml of fluorescein sodium for 2 hours and then observed by confocal laser scanning microscopy. In the in vivo study, the C6 glioma itself and the brain within 2-3 mm of the gross surface of the tumor (probably indicating part of the perifocal edema) were well stained a brilliant yellowish green for a few hours. The normal brain was not stained. The intensity of the fluorescence was dose-dependent and was stronger under the xenon than under the halogen lamp. The in vitro study demonstrated almost no uptake of fluorescein by the C6 glioma cells. This fact indicates that the fluorescein in the stained tumor exists in extracellular spaces due to the disruption of the blood-brain barrier. These results suggest that this staining technique using fluorescein sodium and a surgical microscope with special filters during the operation may be the intravenous administration of 10 useful for detection of gliomas and warrants evaluation of clinical application.

Animals↗
PubMed1997

Effectiveness of leukocyte filters in reducing tumor cell contamination after intraoperative blood salvage in lung cancer patients.

OBJECTIVES: In an effort to reduce allogeneic blood transfusions in patients undergoing elective surgery for lung cancer, we investigated the effectiveness of a method of processing shed blood with an automated device for intra operative blood salvage (IOBS) and filtration with a 3rd-generation polyester filter to remove tumor cells. METHODS: Sixteen patients were operated on for different types of lung cancer. We searched for malignant cells in pre- and postprocessed shed blood employing density gradient centrifugation, staining of cytospins with hematoxylin-eosin, and antibodies to human cytokeratins. RESULTS: In 9 out of 16 cases (56%), neoplastic cells were detected in prefiltration samples, but none were found in postfiltration cytospins. CONCLUSION: IOBS combined with appropriate filtration could be a very useful and safe tool in reducing allogeneic blood transfusion in cancer patients.

Aged↗
PubMedDate not supplied

Leukocytes-depleting filters preferentially remove activated leukocytes and reduce the expression of surface adhesion molecules during the simulated extracorporeal circulation of human blood.

The effect of leukocyte-depleting filters on the total and activated leukocyte counts and the expression of surface adhesion molecules CD11b, CD18, and CD62L during the in vitro extracorporeal circulation of human blood was studied. A 200 ml blood sample was taken from 10 patients undergoing CABG surgery. The blood was circulated for 60 minutes within an experimental extracorporeal circuit. A leukocyte-depleting filter was attached in five circuits (filtered group). In five other circuits, no filter was used (controls). Total leukocyte counts were determined manually. Activated leukocytes were identified using nitroblue tetrazolium staining. The expression of CD11b, CD18, and CD62L was measured with flow cytometry. At 60 minutes, total leukocyte counts were reduced by 49% from the baseline values in the filtered group and 10% in the control group (p < 0.0001). Activated leukocyte counts decreased by 86% in the filtered group and increased by 116% in the control group (p < 0.0001). In the filtered group, the expression of CD11b, CD18, and CD612L decreased by 60%, 21%, and 79%, respectively, and in the control group it increased by 24%, 6%, and 28% (p < 0.0001). Leukocyte-depleting filters preferentially remove activated leukocytes and reduce the expression of CD11b, CD18, and CD62L during the in vitro extracorporeal circulation of human blood.

Aged↗
PubMed1996

Epidemiologic characteristics, management, and outcome of deep venous thrombosis in a tertiary-care hospital: the Brigham and Women's Hospital DVT registry.

Entry into clinical trials of treatment for deep venous thrombosis (DVT) involves a screening process that excludes many patients with this condition. Therefore, to obtain a profile of patients with DVT that reflects actual day-to-day clinical practice, we initiated a prospective registry of 150 consecutive patients with DVT at Brigham and Women's Hospital, Boston. We reviewed the medical records of all patients who received a diagnosis of DVT from November 1, 1994 through March 31, 1995 and did not exclude any patients. Of the 150 patients, 120 (80%) were symptomatic and 30 (20%) were asymptomatic. Frequent baseline characteristics included surgery within the preceding 6 months (47%), cancer (26%), and previous venous thromboembolism (23%). DVT was diagnosed by ultrasonography(n = 145), contrast venography (n = 3), or clinical evaluation (in 2 patients who had technically unsatisfactory ultrasound results). Overall, 133 (89%) patients received anticoagulation; 5 (3%) received thrombolysis; and 27 (18%) underwent placement of an inferior vena caval filter. In 3 patients major hemorrhage developed from anticoagulation or thrombolysis. The 3-month mortality rate was 19%, including 10 patients who died during the index hospitalization. In no case was pulmonary embolism thought to be the cause of death. Ten patients had recurrent venous thrombosis during the initial 3 months after diagnosis. The most surprising findings in the DVT registry were the high rates of cancer and surgery, the high rate of filter placement, and the high mortality rate. These registry results differ substantially from findings in randomized controlled trials of DVT treatment.

Adult↗
PubMed1991

Absence of particle-induced coronary vasoconstriction during cardioplegic infusion: is it desirable to use a microfilter in the infusion line?

Many cardiac surgical units now use a microfilter in the infusion line for delivery of crystalloid cardioplegic solution to protect against the potential hazards of particulate contamination of cardioplegic solution. The aim of this group of studies was to determine the effects of particulate contamination of cardioplegic solutions, in order to establish whether a microfilter is needed in the infusion line. Total particle counts performed on two commercial cardioplegic solutions were low, but there were sufficient particles greater than 10 microns in diameter to cause coronary vasoconstriction. In isolated rat hearts a 20-minute infusion of St. Thomas' Hospital cardioplegic solution produced a progressive reduction in coronary flow, which was not prevented by the inclusion of a 0.8 micron filter in the infusion line. Two studies were performed on canine hearts to determine the effects of unfiltered cardioplegic solution on coronary vascular resistance. In the first, cardioplegic solution at 20 degrees C was infused for 20 minutes at a constant pressure of 50 mm Hg and flow rate was measured. In the second, the same solution at 4 degrees C was infused at a constant flow rate for 2 1/2 minutes and the infusion pressure was measured. In neither study did coronary vascular resistance rise. A final clinical study involving patients undergoing coronary bypass surgery compared the effects on coronary resistance of infusion at a constant flow of filtered versus unfiltered cardioplegic solution (n = 10 in each group). There was a similar rise in coronary perfusion pressure in both groups during the infusion. We conclude that there is insufficient evidence of particle-induced coronary vasoconstriction to justify the expense of a microfilter in the cardioplegic infusion line.

Animals↗
PubMed1989

[The role of radiotherapy in the combined treatment of cancer of the middle ear].

The results of treatment of 26 patients with the middle ear cancer were evaluated. Manifestation of the disease is not specific, so it is often diagnosed only in advanced stages. 16 patients were radically treated, 15 of them by radiotherapy and surgery. They received the dose of 60 Gy in 20-30 fractions of megavoltage therapy, with use of oblique beam technique with wedge filters. 10 patients were irradiated with palliative intention. Estimated 5-years survival in radically treated patients equals 47%. Other reports and own observations advocate combined treatment: surgery and irradiation for cancer of the middle ear.

Adult↗
PubMed1993

[Blood transfusion increases the risk of surgical infection].

In a prospective randomized trial the frequency of infectious complications and natural killer cell function were investigated in 197 patients undergoing elective colorectal surgery and having either no blood transfusion (n = 93), transfusion with whole blood (n = 56), or filtered blood free from leucocytes (n = 48). Postoperative infections developed in 13 patients transfused with whole blood (23%), in one patient transfused with blood free from leucocytes (2%) and in two non-transfused patients (2%) (p < 0.01). Natural killer cell function was significantly (p < 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.

Adolescent↗
PubMed2002

Leukocyte filtration fails to limit functional neutrophil activity during cardiac surgery.

OBJECTIVE AND DESIGN: The beneficial effects of leukocyte filtration on the outcome of cardiac surgery with cardiopulmonary bypass (CPB) is probably due to the limitation of pathogenesis mediated by over-stimulated neutrophils. However, the influence of leukocyte filtration on the functional neutrophil activity has not been studied in detail. Therefore, by using different filtration timing strategies we determined neutrophil effector functions before and after the filter passage as well as blood surrogate markers for neutrophil activation. METHODS: We randomly assigned 80 cardiac surgery patients to four groups (n = 20 each) without (1) and with three different filtration timing strategies (II-IV). As functional end points neutrophil phagocytic activity and oxidative burst upon ex vivo stimulation with E.coli were analyzed from blood of 31 patients whereas polymorphonuclear elastase (PMNE), myeloperoxidase, and malondialdehyde (MDA), a marker for lipid peroxidation was determined in plasma samples from 80 patients. Blood was harvested immediately before and behind the filter (Pall LG6) at different times during CPB. RESULTS: We found that none of the filtration strategies either reduced the number of neutrophils capable of eliciting phagocytic activity and oxidative burst or the activity per cell. In contrast, PMNE and MPO levels in peripheral venous blood were found to be significantly increased in groups II-IV compared with group I throughout the entire filtration period in all patients. MDA was not enhanced in the filter groups. CONCLUSIONS: Our results show that the leukocyte depletion filter in the arterial line of the heart-lung machine failed to limit neutrophil stimulation but rather augmented PMNE plasma levels. We speculate that augmented PMNE and MPO levels mainly stem from neutrophils that are captured within the mesh of the leukocyte filter.

Aged↗
PubMed2004

Cell salvage does not minimize perioperative allogeneic blood transfusion in abdominal vascular surgery: a systematic review.

PURPOSE: To determine whether the use of cell salvage reduces the proportion of patients receiving at least one unit of allogeneic packed red blood cells during the perioperative period of an elective vascular surgery. SOURCE: We identified all relevant articles through the combined use of electronic searches of the MEDLINE and EMBASE databases, the Cochrane library as well as hand searching of all randomized clinical trials and review articles. The electronic search included articles published between 1966 and April 2001. The search included textword searches using "autotransfusion," "cell salvage," "device," or Medical Subject Headings "autologous blood transfusion" or a "randomized controlled trials" filter. PRINCIPAL FINDINGS: Five randomized controlled trials (RCT) were identified involving cell salvage and vascular surgeries. In infra renal abdominal aortic aneurysm surgery the risk ratio (the risk of receiving at least one unit of allogeneic red cells) was 0.37 [95% confidence intervals (CI) of 0.06 to 2.36]. In elective aorto-femoral bypass surgery the risk ratio was 0.97 (95% CI of 0.66 to 1.42). The pooled risk ratio for cell salvage in vascular surgery was 0.67 (95% CI of 0.35 to 1.28). CONCLUSION: Cell salvage, a commonly used technique to recover red cells from the operative field, has been the subject of several studies in vascular surgery. There is insufficient evidence to recommend the routine use of cell salvage in elective abdominal aortic aneurysm and aorto-femoral bypass surgeries. A large RCT would elucidate whether cell salvage is effective as a blood conservation technique.

Abdomen↗
PubMed1996

[Criteria for utilization and indications for use of permanent and short- and medium term temporary endocaval filters. Personal experience and review of the literature].

Screening and prophylaxis of the population at risk is the most correct approach to thromboembolic disease. Caval filters play a major role in the prevention of pulmonary embolism, but their use remains widely controversial, even if they are an alternative or additional method to medical therapy and not antithetical to it. July, 1990, to September, 1995, seventy-seven permanent vena cava filters (59 LGM, 13 Filcard and 5 titanium-Greenfield), 22 short-duration temporary vena cava filters (11 LGT, 6 Filcard, 3 Filcard-Emanuelli and 2 Lysofilter) and 10 mid-duration temporary vena cava filters (Tempofilter) were inserted in 109 patients (55 men and 54 women) aged 17-88 years. An inferior vena cavogram was always made before filter insertion to "map" the inferior vena cava and its tributaries (renal veins) and to assess caval size. This is a mandatory step to exclude or confirm the presence of endocaval thrombi. Sixty-eight filters were inserted percutaneously via a right internal transjugular approach, 40 via a common transfemoral approach (34 right and 6 left) using the same route as inferior cavography and digital pneumoangiography. One temporary filter was inserted via a right transhumeral approach. Sixty-three patients (57.8%) (44 with a permanent filter, 14 with a temporary filter and 5 with a Tempofilter) had medical diseases, 7 patients (6.4%) (4 with a permanent filter, one with a temporary filter and 2 with a Tempofilter) had surgical conditions; 10 patients (9.2%) (7 with a permanent filter and 3 with a Tempofilter) were surgical-orthopedic patients. Twenty-seven patients (24.8%) (22 with a permanent and 5 with a temporary filter) had cancer. Two patients (1.8%) with a temporary filter were breast feeding. All the patients had deep venous thrombosis of the lower limbs, including the inferior vena cava and the right renal vein in two patients. A proximal floating thrombus and a pulmonary thromboembolism was diagnosed in 41 (37.6%) and 34 (31.2%) cases, respectively. The temporary filters remained in situ 1-4 days and the Tempofilters 3-5 weeks. A pelvic hematoma developed (because of heparin?) after the insertion of a temporary filter and a Tempofilter branch detached and migrated into a lower branch of the left pulmonary artery were reported as immediate and short-term consequences. There were no early or late consequences for the patients. An axillary hemorrhage was observed in the site of previous surgery, during fibrinolysis with a Lysofilter, as well as the incomplete opening of a titanium-Greenfield filter and of two permanent LGM filters, partly trapped within endocaval thrombi. No further consequences to the patients due to permanent filters were observed, nor any case of symptomatic pulmonary thromboembolism, in patients with permanent or temporary filters. With reference to the relative literature and to their own experience, the Authors propose a detailed and rational synthesis of the diagnostic-instrumental approach protocol to thromboembolic disease.

Adolescent↗