Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Filtering Surgery”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,693 records · Page 94Linked to original sources
PubMed2002

In vitro hydrodynamics of the Embol-X cannula.

BACKGROUND: Prevention of intraoperative plaque dislodgement in patients with atherosclerotic ascending aorta by development of innovative aortic cannula designs gains growing interest in cardiac surgery. To increase knowledge about the hydrodynamics of the innovative Embol-X cannula, which includes an intra-aortic filter device targeting at atheromatous emboli capture, was the aim of the present study. METHODS: Pressure gradients and back pressures of the Embol-X cannula were measured at varying flow rates in a mock circulation and compared with two commonly used single-stream cannulae. RESULTS: At a flow rate of 5.5 l/min, pressure gradients across the Argyle and the RMI cannulae were 48% and 62% and back pressures 25% and 47% lower than the corresponding values across the Embol-X cannula. CONCLUSIONS: The novel concept of integrating a filter device may provide clinical advantages concerning neurologic outcome. Further in vivo studies seem to be desirable to obtain more information concerning the clinical effects of the Embol-X cannula hydrodynamics.

Cardiac Surgical Procedures↗
PubMed2005

[Surgical controversy. Limiting postoperative scarring].

Postoperative follow-up of glaucoma surgery must be rigorous and carried out over the long term. Data acquired on the make-up of the filtering bleb justifies using postoperative anti-inflammatory drugs, even if the eye is clinically quiet. When using antimetabolites, the risk factors for failure must be well known and either 5-fluorouracile or mitomycin should be chosen depending on the level of risk of scarring. Their use in needle revision must be adapted case by case. anti-TGF-beta-2 antibody, currently being investigated, may prove advantageous in the very near future.

Cicatrix↗
PubMed1977

Laser application to the angle structures in animals and in human glaucomatous eyes.

Argon laser lesions were induced in the structures of the anterior chamber angle of rabbits, cats and monkeys and in a pre-enucleated infnat's eye. Histopathological changes produced by this mode of treatment at different follow-up periods were analysed. The argon laser beam has also been applied in 28 selected, uncontrolled glaucomatous eyes. 25 eyes responded by an abrupt hypotensive effect, but in 21 of them, the elevated pressure returned during the 20- to 40-day follow-up period. Eight eyes sustained low intraocular pressure throughout the 12- to 20-month follow-up period. Of these, 3 were babies with congenital glaucoma, and 3 had simple glaucoma following an unsuccessful filtering operation. Seven eyes were medically controlled post-operatively and 13 eyes were failures which had to undergo further surgery.

Adult↗
PubMed1996

[Carotid-jugular fistula after an attempt at placement of a vena cava filter].

A carotid-jugular fistula complicated the placement of a Green-field filter via the right internal jugular percutaneous passage: the local signs of an arterio-venous fistula were associated with right parietal infarction neurological symptoms. A crossography showed a carotid-jugular fistula and a limited dissection of the original carotid artery. An elective echo-guided compression failed. The surgical treatment eliminated the fistula, fixed the carotid dissection and placed a vena cava filter with an excellent result 34 months later. Percutaneous placement of vena cava filters can lead to rare vascular complications such as carotid-jugular fistulas which can, in certain cases, be treated with an elective external compression or endovascular procedures. Surgery offers a reliable technical solution that is complete and stable in time, particularly with recent fistulas and associated neurological symptoms.

Aged↗
PubMed2000

[Current role of the surgeon in the treatment of venous thromboembolism].

The most frequent complications of deep venous thrombosis (DVT) are post-thrombotic syndrome (PTS) and pulmonary embolism (PE); the main purpose of DVT therapy is to prevent their onset. A range of treatment is now available, including physical, medical and surgical forms. Physical: elastic compression mobilization postural therapy. Medical: anticoagulants (heparin, LMW heparins, oral anticoagulants), thrombolytic agents. Surgical: if DVT is diagnosed at an early stage, anticoagulant treatment may be accompanied by attempted surgical deobstruction, above all if DVT is localised at the popliteal and femoral confluents (greater risk of evolution towards severe "ischemic" forms potential cause of venous gangrene). These treatments include locoregional endogenous thrombolysis followed after phlebography, by surgical thrombectomy in the event of thrombotic residue, enabling the possible embolization of the pulmonary district using a caval filter. The combined medical and surgical approach reduces the long-term incidence of PTS. Temporary caval filters are also available. In short, a modern approach to the clinical problem of DVT now takes the form of early diagnosis and combined thrombolysis-surgery, which appears to be the most appropriate choice, ensuring the best form of venous functional recovery. However, this requires hospitalization in specialist units and multidisciplinary skills (hematological, medical, radiological and surgical) to ensure the best results.

Administration, Oral↗
PubMedDate not supplied

Venous interruption as prophylaxis of pulmonary embolism: vena cava filters.

Interruption of vena cava for prevention of pulmonary embolism (PE) was achieved in the past with surgical ligation or placement of clips outside the infrarenal vena cava. At present, this procedure is performed with percutaneous insertion of vena cava filters. Vena cava filters can be permanent or temporary, catheter-retrievable. Main indications for placement of a vena cava filter are: contraindication for anticoagulant therapy in patients with severe PE in whom a further embolic episode would be fatal or patients with PE (or its recurrence) undergoing adequate anticoagulant therapy. Temporary filters are reserved to patients where the risk of PE is limited in time as in posttraumatic, post-partum or postoperative thromboembolism. The incidence of recurrence after placement of a vena cava filter varies between 0.5 and 7%. Procedure-associated complications are usually mild. However, severe complications as filter migration into the pulmonary artery or vena cava perforation were described. Our experience concerns the insertion of 61 vena cava filters (47 permanent and 14 temporary). Indications were as follows: iliofemoral thrombosis at embolic risk (37 cases), contraindication for anticoagulant therapy in the presence of deep vein thrombosis with embolic risk (7 cases), protection during fibrinolytic therapy (3 cases), PE during anticoagulant therapy (5 cases) complications of anticoagulant therapy which required discontinuation (5 cases), prophylaxis in view of surgery at high risk for PE (2 cases), protection for surgical venous thrombectomy (2 cases). Mortality was nil. Clinically evident PE was not observed in any patient in whom vena cava filter was inserted. Complications were mild and asymptomatic. Vena cava filters represent an effective prevention of PE together with medical and surgical treatment. At present, problems of this procedure are not technical but rather concern correct indications. Interruption of vena cava is effective if planned within a global strategy for prevention of thromboembolism.

Adolescent↗
PubMed1999

Temporary vena caval filtration. Preliminary clinical experience with removable vena caval filters.

Removable vena caval devices look attractive in order to prevent pulmonary embolism (PE) in high risk patients when anticoagulant therapy has to be discontinued for periods shorter than 14 days. We describe our preliminary experience about 10 consecutive patients. All patients were anticoagulated for recent venous thromboembolism and the indication of vena caval filtration was mainly a short-term contraindication to anticoagulation due to surgery (8 cases) or delivery (1 case). Gunther Tulip retrievable vena caval device was used. No clinical manifestation of PE occurred during the filtration period. No thrombosis was detected at the insertion site, nor was any filter thrombosis found at the time of retrieval. Eight out of ten filters were easily retrieved through internal jugular vein. In one patient, filter could not be removed due to device tilting; in two patients, permanent filtration was secondarily requested. These results suggest that temporary vena caval filtration is efficient and safe for preventing pulmonary embolism during a short-term discontinuation of anticoagulant therapy in high risk patients.

Adult↗
PubMed2004

Does modified ultrafiltration reduce the systemic inflammatory response to cardiac surgery with cardiopulmonary bypass?

Cardiopulmonary bypass (CPB) is associated with an accumulation of total body water and a systemic inflammatory response syndrome (SIRS), which, in turn, is associated with organ dysfunction and postoperative morbidity. It has been suggested that modified ultrafiltration (MUF) may be capable of reducing SIRS and improving clinical outcome by filtering out the inflammatory mediators generated during CPB. This paper reviews the data regarding the use of MUF in paediatric and adult settings. Specifically, three issues will be considered: 1) Does MUF improve clinical outcome? 2) Does MUF reduce the systemic inflammatory response to cardiac surgery with CPB? 3) Is MUF more effective than conventional ultrafiltration in improving clinical outcome?

Cardiopulmonary Bypass↗
PubMed1998

Cerebral functional changes following cardiac surgery: Neuropsychological and EEG assessment.

OBJECTIVE: Some form of organic and functional cerebral deficit may occur in up to one third of patients following cardiopulmonary bypass surgery. This study was designed to assess cerebral functional deficit in cardiac surgical patients. METHODS: Neuropsychological and quantitative electroencephalographic (EEG) changes were assessed in 62 first time coronary artery bypass graft surgery patients before surgery and within 1 week and 2 months after surgery. Patients underwent surgery with a standard Hammersmith Hospital anaesthesia and hypothermic cardiopulmonary bypass (28 degrees C), using either bubble (Harvey 1700, n = 28) or membrane (Cobe CML, n = 34) oxygenators with arterial line filters (Pall 40 microm). Neuropsychological performance was assessed using a well established battery of ten tests. Four EEG relative power frequency bands; delta (1-3.5 Hz), theta (4-7.5 Hz), alpha (8-11.5 Hz), and beta (12-23 Hz), were determined using Fast Fourier Transformation (FFT). RESULTS: Neuropsychological and EEG deficits were found in 48% of patients 1 week after surgery and in 34% 2 months after surgery. Post-operative deficits were not associated with duration of perfusion, type of oxygenator used in surgery or patient age. Neuropsychological and EEG deficits were associated 2 months after surgery, but not 1 week after surgery. Post-operative EEG deficit was associated with pre-operative deficit. CONCLUSIONS: Cerebral functional deficit was found following CABG surgery using quantitative EEG and neuropsychological assessments. Patients who had neuropsychological deficit were also more likely to show EEG deficit. EEG deficit before and after surgery suggests vulnerability of patients with already compromised cerebral function to the effects of CPB procedure.

Adult↗
PubMed2002

Vacuum-assisted venous drainage does not increase the neurological risk.

BACKGROUND: Vacuum-assisted venous drainage (VAVD) with negative pressure applied to integral sealed-hardshell venous reservoir facilitates valvular surgery through minimally invasive approaches. Despite concerns regarding air entrainment from the right atrium, cerebral microemboli of air and neurological complications, VAVD was used in patients who underwent valvular surgery throughout the last two years in our institution. METHODS: We compared the rate of neurological complications in patients who underwent surgery with and without VAVD from June 1997 to July 2001. VAVD was added to solid venous reservoirs with membrane oxygenators and arterial filters. Clinical results were prospectively entered in our valve database and were used for the analysis. RESULTS: Eight hundred twenty-two consecutive patients averaging 65 +/- 11 years of age underwent aortic, mitral and tricuspid valve replacements including 40 redos (40/822, 5%) and 265 associated CABG (265/822, 32%) with VAVD in 1999 to 2001 compared to 723 patients averaging 63 +/- 11 years of age (p = 0.01) who underwent the same procedures with 79 redos (79/723, 11%) and 177 CABG (177/723, 24%) without VAVD in 1997 to 1999. CPB time averaged 117 +/- 50 minutes in VAVD patients compared to 108 +/- 43 minutes in those without VAVD (p = 0.001). Thirty-day mortality averaged 5% (39/822) in patients with VAVD and 4% (30/723) in those without VAVD (p = 0.6). Seven patients of the VAVD group (7/822, 1%) and 11 patients without VAVD (11/723, 1.5%, p = 0.2) suffered from temporary or permanent neurological deficit. CONCLUSION: VAVD is a useful adjunct to modern cardiopulmonary bypass systems. When used with appropriate care, VAVD does not appear to significantly increase air microemboli and is not associated with an increased neurological risk following valvular surgery.

Aged↗
PubMedDate not supplied

[Deep venous thrombosis and the prevention of a pulmonary embolism with temporary caval filters: the experience in 2 pediatric cases].

Deep venous thrombosis with pulmonary embolism is considered rare in pediatric population, but a literature review points out this disease more frequent than would be expected in children. The low incidence and the poor consideration of this occurrence in pediatric age group, cause the thromboembolic disease with pulmonary involvement an often missed diagnosis. The illness is usually related to intravenous catheters, surgery, trauma, sepsis, prolonged immobilization, neoplasia, drugs, some congenital or acquired diseases. The Authors report their experience with two pediatric cases of inferior vena cava thrombosis and pulmonary embolism treated with anticoagulant therapy, temporary vena cava filters and locoregional fibrinolysis.

Adolescent↗
PubMed1994

[Comparison of Orth-Evac and Solcotrans Plus devices for the autotransfusion of blood drained after total knee joint arthroplasty].

Surgical wound blood which is ched through drains after total knee replacement surgery with a tourniquet may be returned to the patient using special collecting devices. This study aimed to compare two systems, Orth-Evac and Solcotrans Plus an to assess the safety of the reinfusion of non washed blood cells. It included 30 patients scheduled for total knee replacement surgery, free from tumoral or coagulation disease and allocated randomly in three groups of 10 each: the Orth-Evac group (OGr), the Solcotrans Plus group (SGr) and the Control group (CGr). The devices, not containing an anticoagulant, were connected to the deep suction drains in the operating room, after skin closure and before the tourniquet removal. The salvaged blood was reinfused in the subsequent six hours via a 40 microns filter. The volume of collected blood was measured and homologous blood was added as required, to maintain a hematocrit of 30%. A blood sample was obtained the day before surgery (D - 1), before reinfusion (D0), two hours later (D + 2h), one day later (D + 1), and from the collecting device before reinfusion. The statistical analysis used the Kruskal-Wallis test and Steel-Dwass procedure to confirm the difference between two groups. The three groups did not differ in age, weight, height and gender. The volume of salvaged and autotransfused blood was 925 +/- 156 mL in OGr and 605 +/- 178 mL in SGr respectively, transfusion of homologous blood was required in two patients of OGr, four of SGr and six of CGr. At D + 1, the hematocrit was comparable in all groups (OGr = 28%, SGr = 28.2% and CGr = 28.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Right atrial thrombi: percutaneous mechanical thrombectomy.

The current therapeutic options for right atrial thrombi-surgical embolectomy and thrombolysis-are associated with high mortality and such patients often have contraindications to these therapeutic options. The purpose of this study was to evaluate the feasibility of endovascular right atrial embolectomy. Two patients with contraindications to thrombolysis and surgery were treated by a femoral approach. A catheter was placed in the right atrium, under fluoroscopic control, and a basket device was used to trap the thrombus. The location and extent of the thrombus was established before the procedure by transesophageal echocardiography (TEE) and the procedure was performed with TEE and fluoroscopy. Thrombi were withdrawn in the basket into the inferior vena cava (IVC) and a filter was inserted by a jugular approach and positioned in the IVC, just above the thrombi. The basket was removed leaving the thrombus below the filter. One patient died immediately after the procedure. In conclusion, endovascular extraction of right atrial thrombi may represent a potential therapeutic alternative, particularly in patients with contraindications to thrombolysis and surgery.

Aged↗
PubMed1976

Diagnosis and treatment of tumours in the pineal region.

In a series of 3.072 cases of intracranial neoplasms up to the end of 1973 there were 82 tumours in the pineal region (2.7%), excluding meningiomas of the falx and tentorium. More than half (forty seven) were pinealomas (two cell pattern type tumours, and pineoblastomas), twelve were teratomas, eight were ependymomas, three were epidermoids, and the remainder were gliomas. In addition to ventriculography, millipore filter-cell culture of cerebrospinal fluid, and fibre ventriculoscopy were found useful for diagnosis. Most of the patients were treated by surgery followed by radiotherapy. Results with the pinealomas were fairly good, the one year, five year, and ten year survival rates being 87.5%, 71.4%, and 33.3% in those below the age of 15 years, and 80.0%, 46.2%, and 12.5% in those above that age. The radiosensitivity of pinealomas and the beneficial effect of reduction of tumour bulk by direct surgery may both be important factors in the achievement of good results.

Adolescent↗
PubMed1992

Thrombolytic therapy for postoperative pulmonary embolism.

The use of thrombolytic agents in the treatment of postoperative pulmonary embolism presents a dilemma to the surgeon. On one hand, postoperative pulmonary embolism usually occurs within 2 weeks of surgery. On the other hand, recent surgery is considered a contraindication for the use of thrombolytics. We developed a protocol for treating pulmonary embolism patients who have recently undergone surgery. Urokinase, at a dose of 2,200 U/kg wt, is injected directly into the clot via a catheter positioned in the pulmonary artery. This is followed by continuous infusions of urokinase at 2,200 U/kg wt/hr until the clot is lysed (up to 24 hrs). Simultaneously, heparin is administered peripherally at 500 U/hr. The level of serum fibrinogen is monitored every 6 hours and maintained at no less than 0.2 g/dL to prevent bleeding. Thirteen patients were treated for angiographically proven pulmonary embolism within 14 days of surgery. Complete lysis of every embolus was achieved, and no deaths or bleeding complications occurred. Two patients received inferior vena cava filters, and nine patients no longer needed chronic anticoagulants within 3 months after the embolic event.

Adult↗
PubMed2005

Altered renal elimination of organic anions in rats with chronic renal failure.

The progress of chronic renal failure (CRF) is characterized by the development of glomerular and tubular lesions. However, little is known about the expression of organic anions renal transporters. The objective of this work was to study, in rats with experimental CRF (5/6 nephrectomy), the expression of the organic anion transporter 1 (OAT1) and organic anion transporter 3 (OAT3) and their contribution to the pharmacokinetics and renal excretion of p-aminohippurate (PAH). Two groups of animals were used: Sham and CRF. Six months after surgery, systolic blood pressure and plasma creatinine concentrations were significantly higher in CRF groups. CRF rats showed a diminution in: the filtered, secreted and excreted load of PAH; the systemic clearance of PAH; the renal OAT1 expression; and the renal Na-K-ATPase activity. No remarkable modifications were observed in the OAT3 expression from CRF kidneys. The diminution in the systemic depuration and renal excretion of PAH may be explained by the decrease in its filtered and secreted load. The lower OAT1 expression in remnant renal mass of CRF rats or/and the lower activity of Na-K-ATPase might justify, at least in part, the diminished secreted load of this organic anion.

Animals↗
PubMed1989

Alteration of red cell deformability during extracorporeal bypass: membrane v bubble oxygenator.

Red cell deformability is essential for normal microcirculation, since the red cell is greater in diameter than the caliber of small capillaries. Red cell filtration rate (RFR) was measured using a 5 microns nucleopore polycarbonate filter as an index of red cell deformability before, during, and after two hours of extracorporeal circulation for coronary artery bypass surgery, with a bubble oxygenator (eight patients) or a hollow fiber membrane oxygenator (14 patients). RFR decreased steadily and significantly during bypass in the bubble oxygenator group. After the start of bypass, RFR was significantly higher at all measurement intervals in the membrane oxygenator group as compared with the bubble oxygenator group. It can be postulated that significantly impaired red cell deformability caused by the bubble oxygenator is attributed to mechanical damage secondary to a huge blood-gas interface, and possibly to neutrophil-mediated oxygen free radical formation due to complement activation. Results indicate that the hollow fiber membrane oxygenator is superior to the bubble oxygenator in maintaining red cell deformability.

Carbon Dioxide↗
PubMed2003

Management of anticoagulation in patients who require invasive procedures.

When orally anticoagulated patients need to have surgery, the goals of management are to minimize the risks of thromboembolism and of bleeding from the invasive procedure. Some invasive procedures can be performed while patients are fully or partially anticoagulated because bleeding is rare and/or easily controlled. When it is necessary to reverse oral anticoagulant therapy it should be interrupted for as short a time as possible, usually 4 or 5 days. Intravenous unfractionated heparin or therapeutic-dose subcutaneous low-molecular-weight heparin (LMWH) can be given as "bridging therapy" to reduce the risk of thromboembolism while oral anticoagulation is interrupted. However, the risks and benefits of bridging therapy are uncertain. Bridging therapy, particularly with LMWH, may not be very effective at preventing embolism in patients with atrial fibrillation or mechanical heart valves, and it may be associated with bleeding. My preference is to minimize the time that patients are off oral anticoagulant therapy, generally restarting warfarin the day of surgery; reserve bridging therapy for those at highest risk of thromboembolism; and to use "prophylactic" rather than "therapeutic" doses of heparin after major surgery. As major surgery markedly increases the risk of venous thromboembolism, postoperative bridging therapy should be considered for patients without an inferior vena caval filter that have had proximal deep vein thrombosis or pulmonary embolism during the previous month.

Algorithms↗