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At least 1,567 records · Page 87Linked to original sources
PubMed2003

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection.

PURPOSE: Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology. CLINICAL FEATURES: A 32-yr-old female with right pelvic chondrosarcoma presented for right hemipelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery. CONCLUSION: This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of noncardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.

Adult↗
PubMed2003

HLA alloimmunization of surgical patients by transfusion with bedside leukoreduced blood components.

High efficiency leukocyte reducing filters can remove more than 99.9-99.99% of white cells from cellular blood components and are considered to be effective in decreasing HLA alloimmunization of patients with haematological malignancies. A multi-institution study was performed to determine whether white cell filtration would also be effective in preventing alloimmunization in surgical transfusion recipients. Patients who were to receive red cell blood transfusions during and/or within 48 hours after surgery were randomly assigned to receive red cells/ fresh frozen plasma that had been leukoreduced using a high efficiency filter at the bedside or buffycoat-depleted red cells transfused through an aggregate filter. Of 87 patients with no alloantibodies at entry, 17% (8/47) of those in the leukoreduction group, who received a mean of 0.3 x 10(6) leukocytes as a result of their transfusions, produced lymphocytotoxic antibodies at day 14 after transfusion, compared to 5% (2/40) in the buffycoat-depleted group, who had received a mean of 1,234.2 x 10(6) leukocytes. This difference in the alloimmunization rate between the two arms was not statistically significant. Reduction of leukocytes by bedside filtration does not appear to be effective in preventing HLA alloimmunization in surgical transfusion recipients. The alloimmunized cases suggest that an indirect allorecognition pathway may be involved in the formation of anti-HLA. Further measures are needed to reduce alloimmunization of immunocompetent patients.

Adult↗
PubMed1992

[A comparative study of the cost of open-circuit as opposed to closed-circuit ventilation].

The authors compared two open randomized groups of patients undergoing surgery through general anaesthesia. Group 1 consisted of 54 patients ventilated by a Siemens 900 B ventilator in open circuit, and group 2, 56 patients ventilated by an ELSA de Gambro ventilator in a closed circuit. Comparative hour cost for nitrous oxide (N2O), oxygen (O2) and halogen gas, Enflurane, Isoflurane, was noted. All patients received the same regimen of anaesthesia and the two groups were identical in age, weight, surgery, respiratory volume and ventilation time. The evaluation of comparative hour cost included specific materials of close circuit ventilator: CO2 filter (Aridus), Lime. Were excluded maintenance and gas consumption expenditures before patient connected to the ventilator. The total hour cost (O2, N2O, specific materials for close circuit, without halogen gas) was 8.23 FF in closed circuit against 13.28 FF in open circuit, an economy of 38.27%. Hence, for oxygen, the hour cost was 0.70 FF in open circuit against 0.27 FF in closed circuit (gain of 65.3%). For nitrous oxide, the hour cost in open circuit was 12.50 FF against 2.44 FF in closed circuit (80.5%). For Isoflurane, the open circuit hour cost was 41.38 FF against 22.44 FF in closed circuit (47%). For Enflurane, the open circuit hour cost was 14.17 FF against 5.94 FF in closed circuit (58.1%). And, lastly for Enflurane, open circuit hour cost was 14.17 FF against 5.94 FF in close circuit, gain of 58.1%. These "modest" economy against those found in previous studies can be explained by the long-time duration of ventilation, saturating time in open circuit more or less long, depending on the physician, specific materials for closed circuit ventilation--lime, CO2 filter--in not taken into account, the hour cost of O2 + NO2 goes from 8.23 FF to 2.71 FF, and the gain against the close circuit becomes 79.6%: reducing hour cost by 5 times. In order to improve the effective cost of close circuit, the authors proposed: the use of closed circuit ventilation for more than 3 hours surgery, gas saturation in closed circuit after denitrogenation--which demands the use of halogen infjectors, and lime in containers cheaper than disposable cartridges. Respecting the above criteria, the total hour cost in close circuit fell to 4.90 FF, gain of 63% against open circuit. For O2 et N2O, the hour cost goes from 1.34 FF in close circuit to 13.28 FF in open circuit, 90% economy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Changes in muscle compartment pressure after cardiopulmonary bypass.

PURPOSE: Hemodilution and inflammation lead to edema and increased muscle compartment pressure after cardiac surgery. The aim of this study was to find whether muscle compartment pressure was affected by the addition of albumin and mannitol to the pump prime, heparin coating or leukocyte depletion. Additionally, we studied the relationship between intraocular pressure and lower leg muscle compartment pressure. Edema during and following cardiac surgery is due to hemodynamic, osmotic and inflammatory changes, according to Starling's Law. We attempted to influence the osmotic balance and reduce the inflammatory response in order to reduce the edema. METHODS: Thirty-six patients who underwent cardiac surgery were randomly allocated into four groups. Group A received albumin and mannitol into the pump prime. Group B had an, heparin-coated perfusion system, Group C had a leukocyte-depletion arterial line filter and Group D was the control group, where intraocular pressure was also measured. RESULTS: Lower leg muscle compartment pressure increased significantly during and after cardiac surgery in all groups, but this increase was significantly less in Group A than in the control group 24 h after surgery. No correlation was found between muscular compartment pressure and intraocular pressure. The intraocular pressure profile is different from the muscular compartment pressure and recovers much faster. CONCLUSION: Lower leg muscle compartment pressure and intraocular pressure behave differently during and after cardiac surgery. Albumin and mannitol added to the pump prime decreases muscle compartment pressure after cardiac surgery.

Aged↗
PubMed1987

Lensectomy and vitrectomy in the presence of filtering blebs.

We describe a technique for preserving a filtering bleb in glaucoma patients undergoing pars plana lensectomy and vitrectomy. It involves making a conjunctival incision away from the filtering site and injecting the anterior chamber and bleb with (hyaluronic acid) Healon before vitreous surgery is begun.

Adult↗
PubMed2003

[Measurement of scotopic pupils: comparison of scotic pupil measurements using a colvard pupilometer and the slitlamp green light test].

PURPOSE: The aim of the study was to compare the accuracy and the reproducibility of scotopic pupil measurements using two different methods. PATIENTS AND METHODS: We developed a simple test to measure scotopic pupil diameters using a narrow slit of light through a green filter of the Haag-Streit slitlamp. A total of 100 eyes from 50 refractive surgery candidates were prospectively examined by 2 independent investigators using both the Colvard pupilometer (Oasis/USA) and Sekundo's slitlamp green light test. Results were compared using all pairwise multiple comparison procedures (Student-Newman-Keuls method, SigmaStat/Jandel Scientific). The mean age of the patients was 36.3 years with a male:female ratio of 16:34. The colour of the iris was considered blue for 36 individuals and brown for the remainder. RESULTS: Reproducibility: the right eye mean pupil diameter using Sekundo's method was 6.4 mm (+/-0.9) measured by both the first (Slit 1R) and the second (Slit 2R) investigator. The left eye mean pupil diameter was 6.5 mm (+/-1) (Slit 1L) and 6.35 mm (+/-1) (Slit 2L), respectively. The following measurements were obtained with the Colvard pupillometer: (Colv1R)=6.25+/-0.85 mm, (Colv2R)=5.99+/-1 mm, (Colv1L)=6.15+/-0.91 mm, (Colv2L)=6.05+/-0.9 mm. There were no statistically significant differences between the two investigators within the same method of examination. Comparability:The data of both investigators were combined to form 4 groups: (Slit R)=6.4+/-0.96 mm, (Slit L)=6.4+/-1 mm, (Colv R)=6.05+/-0.9 mm, (Colv L)=6.1+/-0.93 mm. There was a significant difference ( p=0.024) between the two methods for both right and left eyes. Particularly for large pupils, the slitlamp green light measurements were significantly higher (up to 0.35 mm) than those with Colvard's device. CONCLUSIONS: The slitlamp green light test provides similar reproducibility for the measurement of the scotopic pupil diameter as the commercially available Colvard pupilometer.

Adult↗
PubMed1984

Reopening filtration fistulas with transconjunctival argon laser photocoagulation.

Three patients (a 15-year-old girl, a 45-year-old woman, and a 61-year-old woman) with previously successful full-thickness filtering procedures developed pigmented tissue in the fistula sites and uncontrolled intraocular pressures despite maximum tolerable medical therapy. The filtering procedures in the first and second patients spontaneously failed two and four years after surgery. The filtration bleb of the third patient, after successfully controlling intraocular pressure for six years, failed two months after cataract extraction. Argon laser therapy was applied through the conjunctiva to treat visible subconjunctival pigmented tissue within the sites of the previous surgical filtration blebs. In all three cases, there was an immediate and significant decrease in intraocular pressure associated with reestablishment of the filtration bleb (from 44 to 16 mm Hg in Case 1, from 40 to 15 mm Hg in Case 2, and from 25 to 12 mm Hg in Case 3). Long-term follow-up showed well controlled intraocular pressures without glaucoma medications (Case 1, 5 mm Hg after 18 months; Case 2, 17 mm Hg after one year; and Case 3, 9 mm Hg after five months).

Adolescent↗
PubMed1980

The use of sodium hyaluronate (Healon) in human anterior segment surgery.

The safety and efficacy of sodium hyaluronate (Healon) was evaluated in a wide spectrum of anterior segment surgical procedures. Healon is not only safe, but actually facilitates the outcome of surgery. Healon placed intracamerally before cataract removal results in significantly decreased endothelial cell loss. In filtering procedures, use of intracameral and subconjunctival Healon promotes superior bleb formation while still maintaining chamber depth postoperatively. Corneal grafts performed over intracameral Healon receive maximal endothelial protection and manifest striking postoperative clarity.

Anterior Chamber↗
PubMedDate not supplied

Microaggregate blood filtration in patients with compromised pulmonary function.

To determine the effect of microaggregate blood filtration on patients with compromised pulmonary function, we divided 50 patients having elective coronary bypass surgery into two groups. One group received all blood transfusions via a 170-micron standard filter (SF). The other group received blood through a 20-micron microaggregate blood filter (MF). Patients were monitored pre- and postoperatively for changes in arterial blood gases and cardiopulmonary function. Mean transfusion volume was seven units (SF) and six units (MF). Preoperatively, patients in both groups showed abnormal lung function with elevated intrapulmonary shunting (Qs/Qt) and alveolar-arterial gradients (A-aO2). Postoperatively, no significant differences (p greater than 0.05) were found between the groups for any of the tests of cardiopulmonary function evaluated. Posttransfusion, none of the patients in either group showed clinical signs of respiratory distress. We conclude that even for patients with some degree of pretransfusion pulmonary dysfunction, use of a microaggregate blood filter for six- to seven- unit transfusions does not provide significant clinical benefit.

Blood Gas Analysis↗
PubMed1999

Immunologic changes after transfusion of autologous or allogeneic buffy coat-poor versus white cell-reduced blood to patients undergoing arthroplasty. I. Proliferative T-cell responses and the balance of helper and suppressor T cells.

BACKGROUND: Donor white cells (WBCs) contained in red cell (RBC) transfusions are thought to provoke down-regulation of T-cell-mediated immunity. This study investigated this topic in otherwise healthy patients receiving buffy coat-depleted or WBC-filtered RBCs and undergoing standardized perioperative management. STUDY DESIGN AND METHODS: Patients undergoing elective orthopedic surgery (primary hip and knee replacement surgery) were enrolled in a prospective study. Perioperative changes in T-cell proliferation (stimulation with phytohemagglutinin and mixed lymphocyte culture) and T-cell balance (T-lymphocytes, helper T cells, and suppressor T cells) were compared after random assignment to allogeneic buffy coat-depleted (Group 2, n = 8) or WBC-reduced RBC (Group 3, n = 11) transfusion regimens. Recipients of autologous buffy coat-depleted RBC transfusions (n = 15) served as controls (Group 1). RESULTS: Compared to that in autologous transfusion recipients, alloantigen-induced T-cell proliferation was significantly reduced in recipients of allogeneic WBC-reduced RBCs (Day 3, p = 0.0274). After the transfusion of allogeneic buffy coat-depleted RBCs, a weak trend toward decreased T-cell proliferation was observed (p = 0.0933) and the numbers of CD4+ T cells were also significantly lower (Day 7, p = 0.0389). On Day 10, alloantigen-induced T-cell proliferation remained significantly below baseline after transfusion of WBC-reduced RBCs (p = 0.05), the numbers of CD3+ cells decreased in allogeneic RBC recipients (Group 2, p = 0.078; Group 3, p = 0.05), and those of CD8+ cells decreased significantly after the transfusion of allogeneic buffy coat-depleted RBCs (p = 0.0234) concomitant with an increased CD4:CD8 ratio (p = 0.0391). CONCLUSION: Results of the present study confirm the hypothesis of impaired T-cell-mediated immunity after allogeneic transfusion.

Arthroplasty↗
PubMed1994

Increased prevalence of disciform macular degeneration after cataract extraction with implantation of an intraocular lens.

After cataract extraction with implantation of an intraocular lens the increased transmission of ultraviolet and blue light may accelerate the development of age-related macular degeneration by producing free radicals in the retina. The maculae of 82 randomly selected postmortem human pseudophakic eyes and 16 fellow phakic eyes were examined by light microscopy. The presence of a basal laminar deposit, hard and soft drusen, thickening and calcification of Bruch's membrane, geographic atrophy, subretinal neovascularisation, and disciform scars was assessed in a standardised way. An age-matched series of 126 postmortem phakic eyes was used as control group. There was no difference between the two groups, except for a higher prevalence of hard drusen (exact trend test, p = 0.038) and disciform scars for the pseudophakic eyes (Fisher's exact test, p = 0.007). There was no significant correlation between either age-related changes in the macula or disciform degeneration and the length of time between cataract surgery and death. No significant difference was found between pseudophakic eyes with or without ultraviolet filter. These findings do not confirm that disciform scar formation is caused by an increase in ultraviolet or blue light.

Age Distribution↗
PubMed2003

The dynamic bubble trap reduces microbubbles in extracorporeal circulation and high intensity transient signals in the middle cerebral artery: a case report.

Microemboli during extracorporeal circulation (ECC) might be a reason for postoperative neuropsychological dysfunction. This case report shows that reduction of microbubbles in the arterial line, as well as high intensity transient signals (HITS) in the middle cerebral artery (MCA), could be accomplished by use of a dynamic bubble trap (DBT) during routine coronary artery bypass graft (CABG) surgery in a 63-year-old male. The DBT was placed after the arterial filter, an ultrasound Doppler device was used for detection of microemboli before and after the DBT. HITS were measured by a transcranial ultrasound Doppler in both MCAs. For first 32 min of ECC, the DBTwas excluded; 54 916 microbubbles and 507 HITS were counted. In the next 30 min, blood flow was directed through the DBT. This led to a significant reduction of microbubbles from 55 888 to 18 237; accordingly, only 120 HITS were registered. A DBT, integrated in ECC for routine CABG, effectively reduces air bubbles, thus protecting the cerebrovascular system from microembolization, as demonstrated by lower HITS counts.

Cerebrovascular Circulation↗
PubMed2001

[Surgical treatment of chronic pulmonary thromboembolism caused by a cavernous hemangioma at the lower limb].

A 48-years old man complained of dyspnea and was admitted to the hospital. Chest enhanced CT confirmed the presence of the thrombus in the pulmonary artery. Cardiac catheterization showed severe pulmonary hypertension (mean PAP 75 mmHg). ATIII level, protein C and S antigen were within normal range. Anticardiolipin antibody and lupus anti-coagulant determination were negative. He was diagnosed as chronic pulmonary thromboembolism, and underwent pulmonary thromboendarterectomy via median sternotomy under deep hypothermic intermittent circulatory arrest. At the same time IVC filter was inserted. The origin of the thrombus was not detected before operation, but after surgery, MR angiography of total body showed a cavernous hemangioma at left lower limb. We speculated this lesion was the origin of pulmonary embolism.

Chronic Disease↗
PubMed2002

The benefit of using two techniques for sentinel lymph node mapping in breast cancer.

Sentinel lymph node (SLN) mapping has revolutionized the way we stage breast cancer. A blue dye technique (BD) and the use of a radiotracer with the assistance of a gamma-detecting probe (GDP) have been used for the identification of the sentinel nodes. Some groups have suggested that only one technique is necessary. The reported false negative rates have been 0 to 12 per cent and success rates as low as 65 per cent. We have prospectively evaluated these techniques and have used both for the identification of the SLN. Ten surgeons participated in this study. From April 1998 through May 1999, 58 patients underwent SLN mapping followed by an axillary lymph node dissection. After the injection of 0.3 to 1.96 mCi of filtered sulfur colloid diluted to 4 mL all patients had preoperative lymphoscintigraphy. Five minutes before surgery 3 to 5 mL of isosulfan blue was injected around the tumor or tumor bed. Even though preoperative lymphoscintigraphy identified an SLN in 35 patients (63%) successful intraoperative detection of an SLN was possible using both techniques in 53 patients (91%). The SLN was detected by the BD and the GDP in 37 (65%) and 45 (80%) respectively. Nineteen patients (33%) were positive for metastatic disease in the axilla. Twenty-two (19%) of 113 SLNs removed were positive for disease. All cases of metastatic disease in the axilla were detected by the mapping technique. False negative rate was 0 per cent. In 11 patients the only positive node was the sentinel node (58%). Furthermore six (32%) patients were upstaged by the use of immunostains for cytokeratin. Twenty-two positive SLNs were detected in the 19 patients. The positive lymph node was identified only by BD in four patients (21%), only by GDP in six patients (31%), and by both techniques in nine patients (47%). We conclude that if only one technique had been used the false negative rate could have been as high as 32 per cent. Both techniques must be used to obtain a low false negative rate and high yield in the identification of the SLN.

Breast Neoplasms↗
PubMed1992

Delayed filtering bleb encapsulation.

Encapsulated filtering blebs concomitant with increased intraocular pressure (IOP) developed 47 and 6 months, respectively, after surgery in two women, 46 and 60 years old, respectively, who had undergone trabeculectomy operations in one eye. Both blebs were associated with mild anterior uveitis. Following treatment with topical steroids, cyclopentolate, hypotensive medications, and digital massage, the uveitis resolved and the IOP fell. The likely cause of these late-appearing encapsulated blebs was anterior uveitis.

Epinephrine↗
PubMed1981

Particle-free environment for refractive keratoplasty.

The refractive keratoplasty techniques of keratomileusis and keratophakia require meticulous care to avoid intralamellar foreign particles. A portable High Efficiency Particular Air Filter Unit has been designed to meet the needs of those surgeons clinically performing this surgery. The unit, combined with amorphic techniques has minimized the clinical problem of particulate matter for the general hospital.

Air Conditioning↗
PubMed1996

Haemodynamic and renal effects of dopexamine after cardiac surgery in children.

Dopexamine hydrochloride, a synthetic dopamine analog with predominantly beta and delta agonist properties, has been shown to improve cardiac performance and renal function in adults with heart failure. This study was designed to investigate the haemodynamic and renal effects of dopexamine in children after cardiac surgery. Seven children were selected in whom a need for postoperative vasodilation after cardiac surgery was anticipated. Haemodynamics and renal function were determined under baseline conditions and during a continuous infusion of dopexamine at 2 and 6 micrograms.kg-1.min-1 for 90 minutes, the sequence being randomized for the initial dose. Cardiac output was measured by thermodilution and glomerular filtration rate (GFR) and renal plasma flow (RPF) by the clearances of inulin and para-aminohippurate respectively. Dopexamine induced a dose-related increase in cardiac index (CI) expressed as mean (SD) from 3.5 (0.7) to 3.9 (0.76) and 4.5 (0.8) l.min.-1m-2 (both P < 0.05), and in heart rate (HR) from 107 (17) to 122 (17) and 136 (17) beats.min-1 (P < 0.05). Stroke volume index (SVI) and mean systemic pressure were unchanged, but pulmonary wedge pressure decreased from 14 (3) to 11 (4) and 12 (3) mmHg (both P < 0.05). Systemic vascular resistances (SVR) decreased from 24 (7) to 20 (5) mmHg.l-1.min-1.m-2 (P < 0.05), with dopexamine 6 micrograms.kg-1.min-1. Renal blood flow (RBF) increased from 319 (113) to 441 (230) and 410 (138) ml.min-1.m-2 (both P < 0.05), GFR from 115 (32) to 142 (34) and 146 (29) ml.min-1.1.73m-2 (both P < 0.05), urine output and fractional excretion of sodium respectively from 3.12 (2) to 7.16 (8) and 7.21 (6) ml.kg-1 (both P < 0.05) and from 2.24 (1) to 4.25 (3.4) (P < 0.05) and 3.15 (3.1)% (n.s.). The fraction of CI delivered to the kidneys, the fraction of RBF filtered in the kidneys, plasma renin activity and aldosterone levels remained unchanged. In children after cardiac surgery, dopexamine increases CI at the expense of a concomitant increase in heart rate and demonstrates few selective vascular systemic or intrinsic renal actions.

Adolescent↗
PubMed1990

Effect of surgery on the systemic inflammatory response to intermittent claudication.

The hypothesis that intermittent claudication initiates a systemic inflammatory response was investigated by studying the effect of exercise on markers of neutrophil activation and vascular permeability in 25 claudicants and 10 controls. Urinary albumin excretion, previously demonstrated to reflect vascular permeability, increased significantly after exercise in claudicants and was associated with decreased neutrophil filterability and increased serum lysozyme activity. No similar exercise-induced changes were seen in controls or in claudicants after successful arterial bypass surgery. These results suggest that intermittent claudication is associated with potentially deleterious systemic manifestations that are surgically reversible.

Aged↗