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At least 1,621 records · Page 90Linked to original sources
PubMed2005

Bacterial biofilm formation on a human cochlear implant.

OBJECTIVE: To report the characteristics of a bacterial biofilm from the surface of a cochlear implant. BACKGROUND: Bacterial biofilm formation on implanted devices causes intractable infections and device extrusions necessitating device removal, with loss of function. More information is needed about biofilm characteristics and interactions with the implant surface before better treatments can be designed. STUDY DESIGN: A retrospective case review was combined with a descriptive histological study of the surface of an otologic device. METHODS: The receiver/stimulator device removed from a cochlear implant patient because of intractable infection and partial device extrusion was fixed and processed for microscopic examination. Its surface and the material present on its surface were analyzed using light and electron microscopy, focusing on surface texture, cell types, and bacteria species and extracellular polymeric substances present within the biofilm. RESULTS: Stereomicroscopic examination revealed extracellular polymeric substances, pinkish yellow in color, with spheres of uniform size scattered throughout, indicative of a biofilm containing Staphylococcus aureus. Biofilm density was greatest in depressions on the surface of the implant. Cross-sectional analysis revealed bacteria interspersed with polymorphonuclear leukocytes. Scanning electron microscopic examination demonstrated an amorphous layer of extracellular polymeric substances containing small filaments, bacteria, and inflammatory cells. Only Staphylococcus aureus was detected. CONCLUSION: Cochlear implant material can provide a surface for bacterial biofilm formation. Impressions can provide an environment conducive to biofilm establishment and growth, ultimately necessitating device removal, with loss of implant function. Biofilm characterization should aid in design of cochlear implant devices less susceptible to biofilm formation.

Anti-Bacterial Agents↗
PubMed2005

The functional role of C-reactive protein in aortic wall calcification.

As an ongoing effort to elucidate the mechanisms involved in bioprosthetic heart valve (BHV) calcification, the role of C-reactive protein (CRP) in the tissue calcification process was investigated. The profile of calcium-associated proteins (CAP) on glutaraldehyde-preserved (0.6%) porcine aortic wall, which were subcutaneously implanted in rats for up to 8 weeks, showed a temporal appearance pattern. The total extracted amount of proteins from the control tissues implanted for 8 weeks was significantly greater than that from ethanol-treated tissues (1.78+/-0.2 vs. 1.27+/-0.18 microg/mg), indicating that the binding affinity of CAP for BHV pretreated with an anticalcification agent was significantly decreased (p<0.05). The dye Stains-All method showed that the dark-blue colored bands, representing high calcium binding and phosphorylated proteins, were stained from the extract of the control BHV at the molecular weight varying from 4 to 250 kDa, but rarely seen in the extract of BHV pretreated with ethanol. One of those proteins was exclusively immunoreactive with CRP antibody, while there was no immunoreaction in less calcified tissues. When aortic wall was exposed to an excess amount of CRP in an in vitro simulating model, the calcification rate of aortic wall increased as the concentration of CRP increased. The results of this work clearly revealed that CRP has indirect vascular effects, leading to an increased rate of aortic wall calcification.

Animals↗
PubMed1992

[Saphenous vein bypass stenoses, early diagnosis with color coded Doppler sonography].

In a prospective study 54 patients with 62 saphenous vein arterial bypass grafts were examined by colour-coded Doppler sonography and angiography. Five cases of graft occlusion were diagnosed by colour-coded Doppler sonography and confirmed by angiography. In comparison with angiography, colour-coded Doppler sonography showed a sensitivity of 92% and a specificity of 100% in the detection of focal graft stenosis. Only two stenoses in the region of the distal anastomosis could not be detected by colour-coded Doppler sonography. In 28 cases a marked dilatation of the proximal anastomosis was found corresponding to the surgically used patch angioplasty. Within this dilated bypass segment, turbulence and flow reversal zones were demonstrated, which might be predisposing factors for graft stenosis. Colour-coded Doppler sonography can accurately detect saphenous vein arterial bypass graft stenoses and should be routinely used in postoperative screening.

Adult↗
PubMed2004

Donor-specific sensitization by cadaveric venous allografts used for arterial reconstruction in peripheral arterial occlusive vascular disease.

The use of allogeneic venous grafts from postmortal organ donors allows for the reconstruction of critically affected arteries in patients with peripheral occlusive vascular disease. We were interested to determine the prevalence and specificity of anti-HLA antibodies in patients after allogeneic vein transplantation. Anti-HLA class I and II alloantibodies were analyzed by flowcytometric analysis using color-coded microbeads coated with HLA antigens including recombinant single antigens. Nine out of 10 patients involving 12 venous allografts were positive for anti-HLA alloantibodies. All antibody-positive patients carried both anti-HLA class I and II alloantibodies. Anti-donor HLA specificity of the anti-HLA alloantibodies was seen in seven out of nine patients for anti-class I antibodies and in eight out of nine patients for anti-HLA class II antibodies. A high rate of donor-specific allosensitization was seen after allogeneic venous transplantation. In conclusion, allosensitization not only includes a humoral response against the constitutively expressed class I antigens but also extends to class II antigens.

Aged↗
PubMedDate not supplied

Clinical evaluation of ceramic inlays and onlays fabricated with two systems: two-year clinical follow up.

This study evaluated the clinical performance of ceramic inlays and onlays made with two systems: sintered (Duceram, Dentsply-Degussa)--D and pressable (IPS Empress, Ivoclar-Vivadent)--IPS after two years. Eighty-six restorations, 44 IPS and 42 D, were cemented into the mouths of 35 patients. Twenty-seven premolars and 59 molars received Class II preparations totaling 33 onlays and 53 inlays. All restorations were cemented with dual-cured resin cement (Variolink II, Ivoclar-Vivadent) and Syntac Classic adhesive under rubber dam. The evaluations were conducted by two independent investigators at the baseline and after one and two years using the modified USPHS criteria. Additionally, radiographs and slides were made. After two years, 100% of the restorations were assessed and all the restorations were considered clinically excellent or acceptable. Among the analyzed criteria, the following received Bravo ratings: marginal discoloration--IPS (31.82%), D (23.81%); marginal integrity--IPS (18.18%), D (11.9%), color match-IPS (4.55%), D (9.52%) and surface texture-IPS (2.27%); D (14.29%). No "Charlie" or "Delta" scores were attributed to the restorations. The results were subjected to the Fisher and McNemar Statistical Tests. No significant differences were noticed between the two ceramic materials. Among the analyzed criteria, only marginal discoloration presented an increased percentage of "Bravo" scores that increased with time for both ceramic materials. Compared with the baseline data, the difference was statistically significant (p < 0.05). No difference was found between inlay and onlay restorations or between restorations placed in premolars or molars. In conclusion, these two types of ceramic materials demonstrated excellent clinical performance after two years.

Adult↗
PubMed2004

Aortic valve regurgitation in alkaptonuria.

Aortic valve lesions associated with alkaptonuria tend mostly to be due to aortic valve stenosis, while aortic valve regurgitation is only rarely observed. Herein, a case is reported of severe aortic valve regurgitation and a fibrous strand in a patient with alkaptonuria. A 65-year-old male, with a history of inferior myocardial infarction, presented with symptoms of congestive heart failure. Alkaptonuria was diagnosed based on urine coloration, skin pigmentation and ochronotic arthropathy in the vertebrae and hip. Grade IV aortic valve regurgitation with mild aortic valve stenosis and occlusive disease in the right coronary artery indicated a need for aortic valve replacement and coronary artery bypass grafting. Sclerotic change in the cusps, and shrinkage of the non-coronary cusp, impeded normal coaptation of the aortic valve, and the left-coronary cusp also had a fibrous strand suspending the free margin of the cusp from the aortic wall just above the commissure. The sclerotic change in the cusps, and shrinkage of the non-coronary cusp, appeared to be the causative lesion of aortic valve regurgitation, implying that cardiovascular ochronosis may cause aortic valve regurgitation.

Aged↗
PubMed1998

[The value of a fabric-coated self-expanding stent in iliac arterial occlusions or aneurysms--the primary and long-term results].

PURPOSE: The objective of this study was to analyze the primary and long-term results of implanting self-expanding covered nitinol stents (EndoPro I) in iliac arteries. MATERIAL AND METHODS: A total of 48 EndoPro (length 8.3 +/- 4.2 cm) were implanted in 39 patients. In 22 cases (group A) the implantation was performed after excimer laser-assisted recanalization (PTLA) of long iliac occlusions (mean 9.8 +/- 3.9 cm). Other indications were aneurysmatic lesions (n = 16) and one arterial perforation (group B). RESULTS: In 21 of 22 patients of group A the patency of the blood vessel was successfully restored. In all cases of group B the aneurysmatic lesions were finally excluded. This was correlated with a clinical improvement of at least one grade (Rutherford criteria) in 86.4% of patients (group A). The primary patency rate based on clinical examination (treadmill test) and color-coded Doppler was evaluated at 6 (89.7%), 12 (87.1%), and 24 (84.2%) months follows up, respectively. Subacute thromboses occurred in two, relevant restenoses in three cases (group A). In three of these 5 cases the vessel segment was successfully reopened by PTLA or rt-PA thrombolysis, leading to secondary patency rates of 94.9% at 6 and 92.1% at 12 and 24 months, respectively. CONCLUSION: In cases of relevant dissection following PTLA of long pelvic artery occlusions implantation of covered stents is effective to stabilize the results. Furthermore, the device is well applicable to seal arterial ruptures or aneurysms.

Adult↗
PubMed1995

Transplantation of autologous tissue fragments into an e-PTFE graft with long fibrils.

An expanded polytetrafluoroethylene (e-PTFE) graft with long fibrils transplanted with bone marrow showed rapid and uniform neointima formation in a dog study. The e-PTFE grafts (fibril length, 90 microns; 6 mm internal diameter; length, 6-8 cm) transplanted with autologous bone marrow were implanted in the abdominal aortae of 10 dogs and retrieved at 3 weeks and 3 months after implantation. Control e-PTFE grafts without bone marrow treatment were also implanted in the same manner in 8 dogs. Macroscopically the treated graft wall appeared red in color; however, there was no thrombus deposition on the surface. Light microscopic observation revealed that the treated grafts were completely lined with endothelial cells at 3 weeks. The neointima was uniform without intimal hyperplasia at the anastomotic sites. Inside the graft wall many capillary blood vessels were observed. At 3 months moderate intimal hyperplasia throughout the graft with complete endothelialization was observed. In the control grafts, endothelialization was observed at the anastomotic sites; however, half of the other areas were covered with a fibrin layer devoid of endothelial cells even in the 3-month grafts. These results indicated that neointima formation was effectively accelerated with the autologous bone marrow transplantation, but moderate intimal hyperplasia throughout the graft was inevitable in e-PTFE grafts even after complete endothelialization.

Animals↗
PubMed1990

[Echography in surgical mitral insufficiency. Pathologic diagnosis and provision of the surgical procedure].

The aim of this study was to determine the reliability of preoperative transthoracic and transesophageal echocardiography compared with the surgical findings in pure or dominant severe mitral regurgitation with respect to: the evaluation of the lesions, mechanism and etiology; the provision of the type of surgery (valve replacement or reconstruction); One hundred and fifty patients were divided into two groups: Group I (N = 120) in which preoperative assessment included transthoracic echo-Doppler coupled with color Doppler in the last 32 patients; Group II (N = 30) operated recently who underwent both transesophageal and transthoracic echo-Doppler examination. In Group I, the sensitivity of transthoracic echo in the evaluation of the etiological was 86% overall [100% in rheumatic valve disease (N = 28), 86% in degenerative or dystrophic valves (N = 72), 44% in endocarditis (N = 9), 87% in ischaemic dysfunction (N = 8)]. The echo evaluation of the mechanism of the regurgitation was also reliable with the exception of ruptured chordae in which direct visualisation of the rupture was only possible in 19 of the 64 cases (30%). The type of surgery predicted by echo was practiced in 87% of cases.

Adolescent↗
PubMed2003

Iatrogenic vertebral arteriovenous fistula treated with a hemobahn stent-graft.

PURPOSE: To illustrate the utility of color flow duplex ultrasound (CFDU) in the diagnosis and stent-graft treatment of a rare arteriovenous fistula (AVF) involving the vertebral artery and vein. CASE REPORT: An iatrogenic AVF involving the right vertebral artery and vein was diagnosed in a 45-year-old man using CFDU. Treatment was recommended due to the large volume of blood shunted through the fistula and the associated loud bruit. Endoluminal treatment involved deployment of a covered stent within the vertebral artery to exclude the fistula. Postoperative CFDU confirmed the success of the treatment. CONCLUSIONS: CFDU can be utilized to accurately diagnose unusual lesions, such as AVFs involving the vertebral artery. The technique is also useful in planning treatment and monitoring the durability of stent-grafts implanted to obliterate this type of defect.

Arteriovenous Fistula↗
PubMed1990

[The value of using transesophageal echocardiographic Doppler color flow imaging in patients undergoing cardiac valvular surgery].

To assess the value of intraoperative transesophageal echocardiographical Doppler color flow imaging (TEE-DCFI) during cardiac valvular surgery, 85 consecutive patients with 102 diseased valves for surgery were studied with pre-and post-operative TEE-DCFI. There were 34 women and 51 men with an age range of 15 to 55 years (mean age, 34.91 +/- 9.33 years). The etiology of valve lesion was rheumatic in 57 (AV 10, MV 47), prolapse in 9 (AV 2, MV 7), endocarditis in 21 (AV 12, MV 3, PV 2, prosthetic infection 4), prosthetic dysfunction in 14 (AV 5, MV 9), congenital in 1 (TV). Preoperative TEE-DCFI findings were helpful either in completing with some new information or changing the operation plan in 29 valves (28.43%) including abscess at aortic root in 1, perforation of aortic valve in 2, perforation of mitral valve leaflets in 5 patients with aortic valvular endocarditis, regurgitation or perivalvular leak of prosthetic valve in 4 MVs and 4AVs, left atrial thrombus detected in 8 and excluded in 3 patients with MV disease, small calcified vegetation on PV with normal valve function in 2 patients with congenital heart disease. Postoperative TEE-DCFI evaluation was performed in 53 patients with 70 diseased valves. There was only one mild regurgitation of mitral bioprosthesis and one mild perivalvular leak of aortic prosthesis detected among 40 replaced prosthetic valves. Of 30 valves repaired 23 (77%) valves had trivial or mild residual regurgitation (Group A) and 7 (23%) had moderate residual regurgitation (Group B). Postoperative congestive heart failure was seen in 6 (26.09%) of Group A and 5 (71.43%) of Group B (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Popliteal artery aneurysms: is endovascular reconstruction durable?

PURPOSE: To describe an endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization. METHODS: Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB). The endovascular procedure was performed using an angioscopically guided side branch coil occlusion system. The PAAs were coil embolized under fluoroscopic surveillance. RESULTS: No deaths or wound complications occurred in the EISB group. The mean hospital length of stay (LOS) was 2.1 days. Seven EISB procedures were performed through 2 incisions, whereas 3 operations required an additional incision. One graft occluded at 3 months. All PAAs remained occluded by color-flow ultrasonography at follow-up ranging from 4 to 23 months (mean 13.6); cumulative primary patency was 89%. In the conventional bypass group, no deaths occurred, but 3 (25%) patients had wound complications. The mean LOS was 6.2 days, and 1 graft occluded, giving an 86% cumulative primary patency at 42 months. CONCLUSIONS: This minimally invasive technique obviates an extensive incision to harvest the SV and ligate the PAA proximally and distally. If long-term endovascular bypass graft patency and PAA occlusion rates prove to be similar to open operative results, the benefits of reduced wound complications, decreased hospital LOS, and increased health care savings support further investigation of this endovascular approach for the treatment of PAA.

Adult↗
PubMed2006

Refractory hypoxemia after mitral valve surgery: an unusual cause and its successful percutaneous treatment.

We describe the case of a patient who underwent elective mitral valve replacement and whose postoperative progress was complicated by a persistently high inspired oxygen requirement and consequent inability to wean from respiratory support. The reason for this was initially unclear, but transesophageal echocardiography identified the cause as a postoperative iatrogenic atrial septal defect (ASD). This complication was specifically related to the transseptal surgical approach that had been employed. The refractory arterial hypoxemia encountered postoperatively was due to an element of right-to-left shunting across the defect, in the absence of raised pulmonary artery pressures, likely related to a baffle-like effect of the residual atrial septal tissue. This postulated mechanism was supported both by Doppler color flow mapping across the defect at transesophageal echocardiography, and later by observing a rise in systemic arterial oxygen saturations immediately after device closure of the ASD. Once the iatrogenic ASD had been diagnosed, there was a consensus of opinion that the patient was too unwell to survive further open heart surgery. Hence, percutaneous closure of the defect was performed using an Amplatzer occluder device. This was technically successful and led to a marked improvement in the patient's clinical state, subsequent rapid weaning from ventilatory support and later hospital discharge. This case illustrates a rare presentation of an occasional complication of mitral valve surgery. Percutaneously delivered device closure of the ASD proved highly effective in this patient for whom no other options were felt to be feasible.

Aged↗
PubMed2026

Clinical performance of monolithic and veneered zirconia three-unit posterior FDPs: A five-year multicenter randomized controlled trial.

AIM: This randomized controlled clinical study compared monolithic, partially veneered, and fully veneered zirconia FDPs over a 5-year period with respect to survival, technical and biological complications, and patient-reported outcome measures (PROMs). MATERIALS AND METHODS: Sixty-four patients requiring three-unit posterior FDPs were randomly allocated to monolithic (MONO-FDP), partially veneered (PV-FDP), or fully veneered (FV-FDP) groups. All FDPs were fabricated from 4 mol% Y&#x2082;O&#x2083; partially stabilized zirconia (4Y-TZP). Follow-up examinations were conducted at baseline, 1, 3, and 5 years. Technical parameters were evaluated using modified USPHS criteria. Periodontal measurements (PPD, BOP, PI) and patient satisfaction were assessed at all time points. RESULTS: A total of 63 FDPs were evaluated at baseline, 57 at 3 years, and 54 at 5 years. Survival at 5 years was 94.7% for MONO-FDPs, 100% for FV-FDPs and 100% for PV-FDPs. Technical complications occurred exclusively in PV-FDP (33%) and FV-FDP (38%) groups and consisted of minor, polishable chipping; no chipping or fractures were recorded in MONO-FDPs (0%) with statistically significant difference between MONO-FDP and the other two groups (p &#x2264; 0.014). Biological parameters remained stable across all groups, with no significant differences in PPD, BOP, or PI. PV-FDPs and FV-FDPs tended to receive more favorable professional color ratings, whereas PROMs were similar among the groups. CONCLUSIONS: All three FDP designs-monolithic, partially veneered, and fully veneered-fabricated from 4Y-TZP zirconia demonstrated excellent 5-year clinical performance. Technical complications were limited to PV- and FV-FDPs and consisted of minor chipping. Biological outcomes and patient satisfaction were similar across groups. CLINICAL SIGNIFICANCE: The five-year outcomes suggest that veneered, partially veneered, and monolithic FDPs can be used with high clinical reliability; however, restorations incorporating veneering ceramic may present an elevated risk of ceramic chipping.

Humans↗
PubMed1992

[Transesophageal echocardiography from the surgical viewpoint].

Following the development of new techniques in echocardiography and especially of Doppler color flow imaging, a new dimension of cardiac surgery has been brought about. The use of transesophageal probes facilitates routine surgery to be performed without interferences and, also, comparability between repeated ultrasonic measurements. Originally, echocardiography was mainly applied for quality control by comparing pre- and postoperative echocardiograms. Now it is equally important in perioperative strategy planning guiding the surgeon's decision throughout the operation as well as in cardiac emergencies. Using intraoperative echocardiography routinely in cardiac surgery establishes a more and more close cooperation between surgeons, cardiologists, and anesthesiologists. In order to evaluate the clinical relevance of echo findings, they have to be repeatedly correlated to surgical realities and to long term results of clinical outcome.

Adult↗
PubMed1992

Doppler echocardiographic evaluation of pseudoaneurysms complicating composite grafts of the ascending aorta.

BACKGROUND: Pseudoaneurysms of the ascending aorta is a rare and serious complication after composite graft surgery for combined disorders of the aortic valve and ascending aorta. METHODS AND RESULTS: Echocardiographic and Doppler findings are described in eight patients (seven men, one woman; mean age, 45 +/- 12 years) with documented pseudoaneurysm of the ascending aorta and are compared with those by aortography and at surgery. The diameter of the ascending aorta ranged from 6 to 14 cm. Pseudoaneurysm was diagnosed by echocardiography in seven cases (six transthoracic, one transesophageal), by aortography in five, and by both methods in all patients. All three patients not diagnosed by aortography had a single dehiscence at the aortic annulus anastomosis. Five patients had more than one site of origin of the pseudoaneurysm. Periannular dehiscence (n = 7) was identified by color flow Doppler in six cases and by aortography in only one, and coronary artery dehiscence (n = 6) was detected by echocardiography in three and by aortography in two arteries. Of the three patients with distal graft dehiscence, one was identified by aortography and none by echocardiography. In cases of dehiscence at the aortic annulus, continuous wave Doppler further supported the diagnosis by demonstrating two distinct jets, one through the prosthetic valve and another with higher velocity through the communication. CONCLUSIONS: Echocardiography with Doppler can diagnose the presence of pseudoaneurysms complicating composite grafts and identify their proximal sites of origin. Furthermore, it complements aortography in the overall evaluation of patients with suspected pseudoaneurysm, particularly in those with single dehiscence of the graft at the aortic annulus anastomosis.

Adult↗
PubMed1997

Surgical treatment for prolapse of the anterior mitral leaflet.

BACKGROUND AND AIMS OF THE STUDY: Mitral valvuloplasty (MVP) for the prolapse of the anterior mitral leaflet (AML) is more difficult than that for the posterior mitral leaflet. The introduction of artificial chordae (November, 1986) and the concomitant maze operation (November, 1992) were surgical 'turning points' in our 17 years' experience. METHODS: In total, 163 surgical cases of AML prolapse based on the above turning points, and carried out between 1979 and 1996, were reviewed. These included 110 MVP and 53 mitral valve replacements. MVP was performed in only 46% (29/63) of patients before October 1986 (Group I); in 72% (42/58) of patients between November 1986 and October 1992 (Group II); and in 93% (39/42) of patients after November 1992 (Group III). RESULTS: Reoperation was required in nine patients. The reoperation-free rate after MVP was 79% at 17 years in all cases, 82% at 17 years in Group I, 86% at 10 years in Group II and 97% at four years in Group III. Besides reoperation cases, grade 3/4 mitral regurgitation (MR), assessed by color Doppler echocardiography, was detected in seven patients. The event-free (reoperation, MR, thromboembolism) rate was 69% at 17 years in all cases, 78% at 17 years in Group I, 71% at 10 years in Group II and 92% at 4 years in Group III. A concomitant maze operation was performed in 19 of 20 current patients with atrial fibrillation. The percentage of sinus rhythm after operation in Group I, II and III was 53%, 60% and 84%, respectively. CONCLUSIONS: During 17 years' experience, mortality and morbidity after MVP for AML prolapse were satisfactory. With the use of artificial chordae, we have been able to perform MVP in more than 90% of current patients with AML prolapse. Further, a concomitant maze procedure could provide a higher incidence of postoperative sinus rhythm.

Actuarial Analysis↗
PubMed1990

Color-coded image-directed Doppler sonography compared with digital subtraction angiography in the follow-up of percutaneous vascular endoprostheses.

Color-coded image-directed Doppler sonography (CCIDS) was used in the follow-up of self-expandable vascular endoprostheses and was compared with the results of digital subtraction angiography and Doppler pressure indices. The stents were implanted in iliac and femoral arteries or hemodialysis fistulae of 26 patients. The aim of the study was to evaluate the potential of the new imaging method to identify local flow patterns inside of vascular endoprostheses. The stents were identified by sonography in all cases; laminar flow was represented in CCIDS by homogeneous Doppler signals. In case of a distinctly reduced lumen, intravenous digital subtraction angiography (DSA) and CCIDS were both able to identify the stenotic process; however, CCIDS was superior in the demonstration of minute flow irregularities. No different flow patterns were detected in comparing recent with older vascular implants.

Angiography, Digital Subtraction↗