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At least 1,513 records · Page 84Linked to original sources
PubMed2005

The era of ultrasonography during laparoscopic cholecystectomy.

BACKGROUND: The use of ultrasound cholangiography during cholecystectomy has been well described. This study was undertaken to assess the use of the umbilical port exclusively for ultrasound and to assess its employment on the use of fluoroscopy resources. In addition, we also looked at the increased use of ultrasound from 2000 to 2004. METHODS: The use of imaging techniques during all cholecystectomies was analyzed from January 2000 to July 2001 for one surgeon and compared with that surgeon's present use from January 2004 to June 2004. Patient demographics, intraoperative finding, and postoperative results were reviewed. RESULTS: During the first study period, ultrasound was used in 29% of 189 laparoscopic cholecystectomies. During 2004, ultrasound was used in 77% of 66 laparoscopic cholecystectomies. Throughout both periods, fluoroscopy was only used during 6 laparoscopic common bile duct explorations (2.4% of all cases). There were no false-positive or -negative ultrasounds, and there were no bile duct injuries. CONCLUSIONS: As experience with ultrasound cholangiography increases, there is little indication for fluoroscopic cholangiography except for rare questions concerning anatomy and during therapeutic maneuvers for common bile duct stones.

Adolescent↗
PubMed2006

Occasional single beat regurgitation observed with the medtronic advantage bileaflet heart valve.

BACKGROUND: The purpose of this clinical study was to obtain further evidence of the underlying mechanism causing the echocardiographically detected phenomenon of single beat regurgitation in a new bileaflet heart valve. As part of a prospective multicenter trial at our institution, 63 patients received the Advantage bileaflet mechanical heart valve (Medtronic, Minneapolis, Minnesota) in aortic position. During routine follow-up performed at discharge and annually after the operation, intermittent moderate transvalvular regurgitation was detected by echocardiography in 5 patients. METHODS: Fluoroscopy of leaflet motion (n = 4), invasive blood pressure measurements in the ascending aorta (n = 3) and digital phonocardiography (n = 5) was obtained in the patients showing an intermittent regurgitation during echocardiography. RESULTS: Valve thrombosis, sutures, or pannus ingrowth impairing valve closure was not detected. Fluoroscopy of leaflet motion showed intermittent incomplete closure of either one of the two leaflets in the same prosthesis. This could be correlated with a distinct diastolic blood pressure drop in the same cardiac cycle. Digital phonocardiography showed pathologic closure sounds in those cycles in which echocardiographically the intermittent regurgitation was observed. CONCLUSIONS: Some patients with the Medtronic Advantage prosthesis in the aortic position show an intermittent inability of complete valve closure that leads to a single beat transvalvular regurgitation. As thrombotic or other material that might cause a disturbance of leaflet motion could not be detected, and the patients seem not to be exposed to any risk except for some chronic regurgitant volume, we decided not to replace the prostheses.

Aortic Valve Insufficiency↗
PubMedDate not supplied

Estimation of radiation dose received during treatment of in-stent restenosis using ionizing radiation.

BACKGROUND: Angioplasty is a widely accepted procedure for the treatment of coronary artery disease. However, restenosis of the treated vessel occurs in 30% of patients within 6 months. Intravascular brachytherapy (IVB) is used to inhibit the formation of new tissue growth at the vessel treatment site. IVB protocols using either gamma ray or beta particle emitting isotopes have been tested and approved. However, very little data are available on resultant whole-body dose and the potential for long-term radiation effects. METHODS: Using thermoluminescence dosimetry (TLD) devices, specifically lithium fluoride (LiF) doped with Mg, Cu, and P, the radiation dose on the surface of patients undergoing IVB was measured. The TLDs were positioned on the body to obtain a measure of the gamma dose at selected anatomic locations. Additionally, the skin dose from fluoroscopy was estimated. RESULTS: Measurements indicate that the average body dose on the skin surface from all TLDs, clinical requirements, and gamma source configurations varies from 0.95 mSv (95 mrem) at the head to 27.06 mSv (2706 mrem) at the sternal notch. For beta sources, the dose varied from 0.11 mSv (11.4 mrem) at the head to 0.49 mSv (49.5 mrem) at the sternal notch. The fluoroscopy contribution of dose to the body dose (15-min exposure time) was 0.10 mSv (10 mrem) at the head and 2.57 mSv (257 mrem) to the sternal notch. CONCLUSIONS: The results suggest that surface skin exposures from gamma sources used in IVB pose acceptable risks considering the medical benefits of the procedures.

Brachytherapy↗
PubMed2006

Sagittal curvature of total knee replacements predicts in vivo kinematics.

BACKGROUND: It is known that in vivo kinematics after total knee replacement is influenced by the design of the implant. The goal of this study was to show that the sagittal curvature of two different knee prostheses differing in geometric design predicts their in vivo motion behavior. METHODS: Three-dimensional tibio-femoral displacements of two prosthesis designs (single radius vs. dual radius) were measured during knee extension under weight bearing conditions by in vivo video fluoroscopy. Finite helical axes were computed to represent the tibio-femoral motions. Angular deviation alpha and the spatial localization deviation delta were used to characterize the motions. Angular deviation is the angle between each incremental finite helical axis and the medio-lateral axis of the femoral component of the prosthesis. The spatial localization deviation is the distance between each finite helical axis and the center of the femoral component of the prosthesis. Statistical comparisons were performed using the median and the interquartile range of the angular deviation and the spatial localization deviation. FINDINGS: The single-radius design showed finite helical axes concentrated at a single axis near to the medio-lateral axis of the femoral component. The angular and spatial localization deviation of the dual radius design were larger compared to the single radius design, exhibiting finite helical axes varying between two axes. INTERPRETATION: Video fluoroscopy in combination with finite helical axis analysis proved to be suitable methods to evaluate the in vivo kinematical behavior of total knee arthroplasty, which can be useful for implant designers. Knowledge of in vivo kinematics can also provide surgeons with more background information about the total knee arthroplasty models they implant.

Arthroplasty, Replacement, Knee↗
PubMed2006

Post-mortem tissue sampling using computed tomography guidance.

PURPOSE: Currently, in forensic medicine cross-sectional imaging gains recognition and a wide use as a non-invasive examination approach. Today, computed tomography (CT) or magnetic resonance imaging that are available for patients are unable to provide tissue information on the cellular level in a non-invasive manner and also diatom detection, DNA, bacteriological, chemical toxicological and other specific tissue analyses are impossible using radiology. We hypothesised that post-mortem minimally invasive tissue sampling using needle biopsies under CT guidance might significantly enhance the potential of virtual autopsy. The purpose of this study was to test the use of a clinically approved biopsy needle for minimally invasive post-mortem sampling of tissue specimens under CT guidance. MATERIAL AND METHODS: ACN III biopsy core needles 14 gauge x 160 mm with automatic pistol device were used on three bodies dedicated to research from the local anatomical institute. Tissue probes from the brain, heart, lung, liver, spleen, kidney and muscle tissue were obtained under CT fluoroscopy. RESULTS: CT fluoroscopy enabled accurate placement of the needle within the organs and tissues. The needles allowed for sampling of tissue probes with a mean width of 1.7 mm (range 1.2-2 mm) and the maximal length of 20 mm at all locations. The obtained tissue specimens were of sufficient size and adequate quality for histological analysis. CONCLUSION: Our results indicate that, similar to the clinical experience but in many more organs, the tissue specimens obtained using the clinically approved biopsy needle are of a sufficient size and adequate quality for a histological examination. We suggest that post-mortem biopsy using the ACN III needle under CT guidance may become a reliable method for targeted sampling of tissue probes of the body.

Biopsy, Needle↗
PubMed2006

What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.

BACKGROUND: Performance parameters for double-balloon enteroscopy (DBE) have not been described. OBJECTIVE: To determine the learning curve for DBE. DESIGN: Prospective cohort study. SETTING: Six U.S. tertiary centers. PATIENTS: A total of 188 subjects undergoing 237 DBE procedures; 130 (69%) with obscure GI bleeding. INTERVENTIONS: Performance parameters from each center's initial 10 cases were compared to the subsequent examinations. MAIN OUTCOME MEASUREMENTS: Exam duration, depth of insertion, and findings on DBE examination. RESULTS: DBE was introduced by mouth in 149 (63%) cases, by rectum in 77 (33%) cases, and through a stoma in 6 (2.5%) patients. The mean (+/-SD) duration was 109.1 +/- 44.6 minutes for the first 10 cases and 92.4 +/- 37.6 minutes for subsequent cases (P = .005) but did not change for rectal DBE procedures. There was no change in mean depth of insertion, but the mean fluoroscopy time declined significantly (P = .025). Diagnostic or therapeutic maneuvers were performed in 64% of cases; DBE led to a diagnosis in 81 (43%) patients. A total of 78% of patients had prior capsule endoscopy (CE) with significant agreement between DBE and CE (kappa = 0.74). One perforation occurred (0.4%). Per-rectal cases failed to reach the small bowel in 24 (31%) cases. LIMITATIONS: All patients did not undergo initial CE. The therapeutic DBE scope was not available for the initial 8 months of the study. CONCLUSIONS: There was a significant decline in overall procedural time and fluoroscopy time after the initial 10 DBE cases. There was no improvement in performance parameters when DBE was performed via the rectal approach despite increased, but limited, operator experience.

Adolescent↗
PubMed2004

Correlation of lung tumor motion with external surrogate indicators of respiration.

PURPOSE: To assess the correlation of respiratory volume and abdominal displacement with tumor motion as seen with X-ray fluoroscopy. Measurements throughout the patient's treatment course allowed an assessment of the interfractional reproducibility of this correlation. METHODS AND MATERIALS: Data were acquired from 11 patients; 5 were studied over multiple days. Measurements of respiratory volume by spirometry and abdominal displacement by a real-time position tracking system were correlated to simultaneously acquired X-ray fluoroscopy measurements of superior-inferior tumor displacement. The linear correlation coefficient was computed for each data acquisition. The phase relationship between the surrogate and tumor signals was estimated through cross-correlation delay analysis. RESULTS: Correlation coefficients ranged from very high to very low (0.99-0.39, p < 0.0001). The correlation between tumor displacement and respiratory volume was higher and more reproducible from day to day than between tumor displacement and abdominal displacement. A nonzero phase relationship was observed in nearly all patients (-0.65 to +0.50 s). This relationship was observed to vary over inter- and intrafractional time scales. Only 1 of 5 patients studied over multiple days had a consistent relationship between tumor motion and either surrogate. CONCLUSIONS: Respiratory volume has a more reproducible correlation with tumor motion than does abdominal displacement. If forming a tumor-surrogate prediction model from a limited series of observations, the use of surrogates to guide treatment might result in geographic miss.

Aged↗
PubMed2005

Intraoperative fluoroscopic dose assessment in prostate brachytherapy patients.

PURPOSE: To evaluate a fluoroscopy-based intraoperative dosimetry system to guide placement of additional sources to underdosed areas, and perform computed tomography (CT) verification. METHODS AND MATERIALS: Twenty-six patients with prostate carcinoma treated with either I-125 or Pd-103 brachytherapy at the Puget Sound VA using intraoperative postimplant dosimetry were analyzed. Implants were performed by standard techniques. After completion of the initial planned brachytherapy procedure, the initial fluoroscopic intraoperative dose reconstruction analysis (I-FL) was performed with three fluoroscopic images acquired at 0 (AP), +15, and -15 degrees. Automatic seed identification was performed and the three-dimensional (3D) seed coordinates were computed and imported into VariSeed for dose visualization. Based on a 3D assessment of the isodose patterns additional seeds were implanted, and the final fluoroscopic intraoperative dose reconstruction was performed (FL). A postimplant computed tomography (CT) scan was obtained after the procedure and dosimetric parameters and isodose patterns were analyzed and compared. RESULTS: An average of 4.7 additional seeds were implanted after intraoperative analysis of the dose coverage (I-FL), and a median of 5 seeds. After implantation of additional seeds the mean V100 increased from 89% (I-FL) to 92% (FL) (p < 0.001). In I-125 patients an improvement from 91% to 94% (p = 0.01), and 87% to 93% (p = 0.001) was seen for Pd-103. The D90 increased from 105% (I-FL) to 122% (FL) (p < 0.001) for I-125, and 92% (I-FL) to 102% (FL) (p = 0.008) for Pd-103. A minimal change occurred in the R100 from a mean of 0.32 mL (I-FL) to 0.6 mL (FL) (p = 0.19). No statistical difference was noted in the R100 (rectal volume receiving 100% of the prescribed dose) between the two techniques. The rate of adverse isodose patterns decreased between I-FL and FL from 42% to 8%, respectively. The I-125 patients demonstrated a complete resolution of adverse isodose patterns after the initial isodose reconstruction (I-FL). The Pd-103 patients demonstrated a final rate of 8% gaps, 0% islands, and 0% holes on corrected isodose reconstruction. CONCLUSION: The use of intraoperative fluoroscopy-based dose assessment can accurately guide in the implantation of additional sources to supplement inadequately dosed areas within the prostate gland. Additionally, guided implantation of additional source, can significantly improve V100s and D90s, without significantly increasing rectal doses.

Brachytherapy↗
PubMed2004

Clinical applications--pelvis.

Navigation procedures based on CT data were introduced into spinal surgery in 1994. Since then, the method has been used in other areas such as joint replacement, reconstructive surgery, and tumor surgery because of its high precision and reduced radiation exposure. The original CT-based spine module can be adjusted for pelvic surgery with the prerequisite that the positioning of the fragments is identical in CT and in the OR; otherwise a new dataset has to be acquired. Our experiences with CT-based navigation in pelvic surgery are explained on five percutaneous screw fixations and three tumor resections, including description of the technique. For modality-based navigation, the navigated procedure is performed in the CT suite with the advantage of immediate CT control of reduction quality and screw positioning. The technique is explained and illustrated on two cases. Fluoroscopy-based navigation has been used in trauma surgery since the late nineties. Since then, the method has been wide spread in the field of joint replacement and reconstructive surgery. Between June 2000 and December 2002, we performed 36 percutaneous screw fixations in the pelvis with postoperative x-ray and CT control. 35 of the 36 screws were placed correctly. In one screw, an anterior cortex perforation of the sacrum was seen in the CT without any neurological consequences. The Iso C 3-D fluoroscope has recently been approved for pelvic surgery. With the ability to reconstruct images, visualization of the acetabulum and the posterior pelvic ring, there is marked an improvement compare to conventional 2-D fluoroscopy. Thus, the field for navigation is also enhanced. Based on our clinical experiences, the indications for navigated techniques in pelvic and acetabular surgery are defined and illustrated.

Adult↗
PubMed2005

Fluoroscopically guided implantation of modern cardiac resynchronization devices: radiation burden to the patient and associated risks.

OBJECTIVES: To establish radiation risks for patients undergoing fluoroscopically guided cardiac resynchronization device implantation. BACKGROUND: Cardiac resynchonization therapy (CRT) may be associated with extended fluoroscopic exposure. METHODS: The fluoroscopy time, dose-area product (DAP), exposure parameters, and percentage contribution of the fluoroscopic projections commonly used were recorded in a series of 14 consecutive patients referred for cardiac resynchronization device implantation and compared to corresponding data obtained from a control group of 20 patients who underwent a conventional rhythm device implantation operation. The DAP to peak skin dose, DAP to effective dose, and DAP to gonadal dose conversion factors were determined for biventricular pacing and conventional rhythm device implantation using a humanoid phantom and thermoluminescence dosimetry. RESULTS: The mean total fluoroscopy time and DAP values were 35.2 min and 4,765 cGy cm2, respectively, for biventricular pacing and 8.2 min and 1,106 cGy cm2, respectively, for conventional rhythm device implantation. Patient skin dose from biventricular pacing procedures requiring extended fluoroscopic exposure may exceed threshold dose for the induction of skin effects only if X-ray source-to-skin distance is kept low. The risk values for fatal cancer and severe hereditary disorders, respectively, associated with a typical CRT procedure were 273 per million and 0.2 per million treated patients. CONCLUSIONS: Radiation risks associated with fluoroscopically guided CRT procedures may be considerable. Present data may be used for the estimation of patient radiation risks from CRT procedures performed in other institutions.

Aged↗
PubMed2006

Remote-control percutaneous coronary interventions: concept, validation, and first-in-humans pilot clinical trial.

OBJECTIVES: This study was designed to assess the feasibility and safety of a Remote Navigation System (RNS, NaviCath, Haifa, Israel) in which the angioplasty guidewire, the balloon, and the stent are navigated via a computerized system. BACKGROUND: Percutaneous coronary interventions (PCIs) are manually performed under fluoroscopic guidance, requiring lead protection for the operators. A system in which the operator can remotely, safely, and precisely navigate the procedure during PCI would have clear advantages. METHODS: The RNS involves a computer-controlled wire and delivery system navigator. Following preclinical validation, the system was assessed in patients undergoing single-vessel PCI. RESULTS: The study involved 18 patients (age 55.9 years, 16% women). The RNS successfully crossed lesions with the guidewire in 17 patients. The stent was then advanced by the advance/rotate mode and adequately positioned in 15 of 17 cases. Technical malfunction was encountered in three patients in whom the procedure was successfully completed manually. Direct stenting was employed in 10 of 18 patients, pre-dilation in 7 patients, and after-stent balloon dilation in 5 patients. The total fluoroscopy time for 17 RNS patients was compared with the corresponding time of 20 consecutive patients who underwent standard single-lesion PCI. Fluoroscopy time was similar for both procedures, with 8.8 +/- 4.8 min with the RNS versus 9.1 +/- 3.5 min with the standard techniques (p = NS). Clinical success was 100% and technical success 94% for the guidewire and 83% for the overall procedure. CONCLUSIONS: The use of the RNS for guidewire, balloon, and stent manipulation during PCI appears safe and feasible for the treatment of patients with coronary stenosis. The system offers operator radiation safety and may enhance precision of stent placement and balloon dilation strategies.

Adult↗
PubMed2005

Radiation exposure in hand surgery: mini versus standard C-arm.

PURPOSE: The use of intraoperative fluoroscopy in hand surgery is common. Two types of fluoroscopic units are available: the mini C-arm and the standard C-arm. There is little literature on the radiation exposure from the mini C-arm, therefore, the primary goal of this study was to quantify and compare the amount of radiation exposure to members of the surgical team (surgeon, first assistant, nurse, anesthesiologist) using both standard and mini C-arms in a simulated wrist surgery setup. Mini C-arm positioning was also examined to determine the safest configuration to minimize radiation exposure to surgeons. METHODS: Radiation dosimeters were used to test 2 commercially available fluoroscopy units in a simulated wrist surgery setup with a cadaveric upper extremity. Several different configurations of the C-arms were tested to determine radiation exposure rates to surgeons and the operating room staff. RESULTS: The mean in-beam radiation exposures with the use of the mini and standard C-arms were 3,720 mR/h and 6,540 mR/h, respectively. The mini C-arm had universally less radiation exposure than the standard C-arm in the clinical configurations tested. The safest configuration of mini C-arm use to minimize radiation exposure was with the surgeon standing on the image intensifier side of the unit as compared with the source side. Mini C-arm radiation exposure to the hands, groin, chest, and thyroid of the operating surgeons were well below the National Council of Radiation Protection and Measurement's annual dose limits. CONCLUSIONS: In the clinical configurations tested in this study the mini C-arm had lower radiation exposures than the standard C-arm. To reduce radiation exposure maximally surgeons should stand behind the lead-encased image intensifier and should use techniques to reduce exposure.

Cadaver↗
PubMed2006

Esophageal foreign bodies in the pediatric population: our first 500 cases.

BACKGROUND: Children with esophageal foreign bodies are frequently seen by pediatric surgeons. Choking and dysphagia are common presentations; however, esophageal perforation has been reported. Historically, rigid esophagoscopy with extraction of the foreign body has been the recommended treatment. Alternatively, Foley balloon extraction is a safe and effective approach. METHODS: Over a 16-year period, 555 children presented with an esophageal foreign body. Retrospective analysis of the medical record was undertaken. Statistics were by univariate analysis. RESULTS: Two hundred ninety-eight boys and 257 girls presented with a mean age of 3.24 years. Dysphagia (37%) and drooling (31%) were the most common symptoms. Foreign bodies were lodged in the superior esophagus in 73%, and 88% of the objects were coins. Balloon extraction with fluoroscopy was performed in 468 children. Eighty percent of the objects were successfully removed with a mean fluoroscopy time of 2.2 min, and 8% were advanced into the stomach. The overall success rate was 88%, with failures necessitating rigid esophagoscopy under general anesthesia. Children younger than 1 year were the most likely to fail (25% failure rate). Airway aspiration never occurred. Significant savings in patient charges were observed with this approach. CONCLUSIONS: Balloon extraction of pediatric esophageal foreign bodies is a safe and cost-effective procedure. This technique is applicable for infants, children, and adolescents. Experienced practitioners should be able to achieve greater than 80% success rate.

Adolescent↗
PubMed2006

Can a fluoroscopic estimation of pharyngeal constriction predict aspiration?

BACKGROUND: The pharyngeal constriction ratio (PCR) is a ratio of pharyngeal area measured in lateral fluoroscopic view at the point of maximum pharyngeal constriction during the swallow to the pharyngeal area measured with the bolus held in the oral cavity. We hypothesize that the PCR may represent a surrogate measure of pharyngeal strength. OBJECTIVE: To investigate the relationship between the PCR and aspiration. STUDY DESIGN AND SETTING: Data from a computerized clinical database of individuals undergoing a videofluoroscopic swallow evaluation at a tertiary academic swallowing center was acquired. RESULTS: Two hundred sixty videofluoroscopic studies were abstracted. The mean PCR was 0.32 (+/- 0.02) for individuals who aspirated and 0.20 (+/- 0.02) for individuals who did not (P < 0.001). In a multiple logistic regression analysis, the PCR was significantly associated with the prevalence of aspiration (P < 0.01). Individuals with a PCR greater than 0.25 were 3 times more likely to aspirate (95% CI = 1.7, 5.1). CONCLUSIONS: The pharyngeal constriction ratio is associated with the presence of aspiration on fluoroscopy. Before the PCR can be used as a surrogate measure of pharyngeal constriction, correlation with pharyngeal manometry will be necessary. SIGNIFICANCE: The pharyngeal constriction ratio is associated with the presence of aspiration on fluoroscopy. EBM RATING: B-3b.

Aged↗
PubMed1996

Learning curve for radiofrequency catheter ablation in pediatrics at a single institution.

We examined the learning curve for radiofrequency ablation in pediatrics at a single institution. The first 146 cases were retrospectively reviewed, including patients < or = 21 years old with a single tachycardia diagnosis who were undergoing radiofrequency ablation for the first time. Data regarding demographics, electrophysiologic properties of the tachycardia, and procedural characteristics were tabulated. Data were then analyzed for evidence of association between these characteristics, success, and experience. Results revealed that success rates improved significantly with experience, reaching 85% success for all cases after < 100 cases attempted. Success for accessory pathway tachycardias alone reached > 93%. The number of cases of nonpathway tachycardias undertaken significantly increased as experience was gained. Fluoroscopy time improved to 34 +/- 27 minutes after < 100 cases. In conclusion, as experience was gained, (1) success rates showed a steep improvement; (2) the population undergoing radiofrequency ablation clearly shifted to include more difficult diagnoses; and (3) fluoroscopy time significantly decreased.

Adolescent↗
PubMed1995

The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients. Participating members of the Pediatric Electrophysiology Society.

The results of radiofrequency ablation for treatment of supraventricular tachyarrhythmias have been reported to improve with increasing experience; however, the precise nature of the learning curve in children is unknown. From November 1990 to October 1993, 1,546 consecutive procedures from the Pediatric Radiofrequency Ablation Registry were categorized into deciles based on number of prior pediatric procedures at the submitting institution. Negative exponential models were tested for strength of relation between volume of prior experience and 4 measures of outcome: success rate, complication rate, fluoroscopy time, and procedure time. Negative exponential curves described the experience-outcome relations well (r = 0.81 to 0.97). Learning rates were most rapid for successful ablation of left free wall accessory pathways, and slowest for right free wall pathway ablation. These models suggest that, given enough experience, procedural success rates > 90% (regardless of pathway location) and fluoroscopy and procedure times averaging < 40 minutes and 250 minutes, respectively, can be achieved in pediatric patients.

Adolescent↗
PubMed1995

Racial differences in coronary calcium prevalence among high-risk adults.

A total of 1,461 asymptomatic high-risk adult subjects were studied with digital subtraction fluoroscopy and conventional cinefluoroscopy to detect coronary calcium. Ethnicity and risk factor data were recorded. No subject had a history or electrocardiographic evidence of prior myocardial infarction. The prevalence of coronary calcium by digital subtraction fluoroscopy was high (58%). Substantial ethnic differences in prevalence were noted: 36% of African American subjects, 60% of Caucasian subjects, and 60% of Asian American subjects had definite radiographic evidence of coronary calcium. The difference in prevalence between African American and other subjects was significant (p < 0.0001) by chi-square test for all 3 races. These differences persisted in the unsubtracted cinefluoroscopic images (p < 0.0001) and after controlling for age, gender, and other risk factors (p = 0.003). After 20 +/- 11 months of follow-up, African Americans had more coronary artery disease events (13%) than Caucasians (6%) or Asian Americans (5%) (p = 0.04). Thus, African Americans have a significantly lower prevalence of coronary calcium than do Caucasians or Asian Americans. Based on the follow-up results, these differences in prevalence are not explained by differences in coronary artery disease risk.

Aged↗
PubMed1997

Laparoscopic Roux-en-Y choledochojejunostomy.

OBJECTIVE: Although surgical biliary bypass for nonresectable periampullary tumors is superior to endoscopic stent placement, the latter has become popular because of the "minimally invasive" approach. Laparoscopic biliary bypass would appear to offer the advantages of both. However, this technique remains technically difficult using existing instrumentation. This study investigates the efficacy of a new endoscopic device designed for rapidly completing a small-diameter intestinal anastomosis under laparoscopic guidance. METHODS: Eighteen female pigs (mean weight 35 kg, range 31 to 44) were randomly divided into three groups: animals undergoing handsewn (group H) or instrumental transient endoluminally stented anastomosis (TESA; groups P and D) laparoscopic Roux-en-Y choledochojejunostomy. For TESA two different reabsorbable stents were used, polyglycolic acid (PGA; group P) and polyurethane ester (Degrapol; group D). Blood chemistry, weight gain, and abdominal X-rays were taken weekly to document any possible migration or reabsorption of the radio-opaque stents. After 3 months, necropsy was performed. Patency of the biliary bypass and choledochojejunostomy were examined using fluoroscopy and measured by introducing graduated dilators into the anastomosis. RESULTS: Fluoroscopy revealed immediate passage of contrast through the anastomosis in all animals. Weight gain, bilirubin, and alkaline phosphatase were within normal range in all groups. Diameter of the bile duct (group H 10.7 +/- 2.9 mm/group P 9.5 +/- 3.6 mm/group D 11.0 +/- 4.6 mm) and choledochojejunostomy (group H 4.5 +/- 1.1 mm/group P 4.7 +/- 1.8 mm/group D 3.6 +/- 1.9 mm) did not differ. The time required to complete the biliary bypass was significantly decreased when TESA was applied (group H 152 +/- 13 min/group P 86 +/- 14 min, P <0.001/group D 110 +/- 20 min, P <0.002). CONCLUSIONS: Applying TESA, laparoscopic choledochojejunostomy can be performed rapidly and safely, revealing good bypass function over a period of 3 months. With regard to treatment for nonresectable periampullary tumors, TESA may offer a new therapeutic approach combining the benefits of minimally invasive endoscopic stent placement with the functional results and lower readmission of conventional Roux-en-Y choledochojejunostomy.

Anastomosis, Surgical↗