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Sample records for extracorporeal irradiated autograft

  1. Recycling of extracorporeally irradiated autograft for malignant bone tumors: long-term follow-up.

    Science.gov (United States)

    Kotb, Samir Z; Mostafa, Mohamed F

    2013-11-01

    This study was conducted to evaluate the long-term oncological and functional outcomes. Forty-two patients (29 men and 13 women) with primary malignant bone tumors were included in this study. The procedure consisted of wide en bloc resection, clearing the extraosseous soft tissue and medullary content, extracorporeal irradiation with a single dose of 50 Gy using linear accelerator, and reimplantation using suitable fixation devices. The mean survivor follow-up was 54 months (24-174 months). There were 32 (76.2%) patients continuously disease free, 7 (16.7%) died of disease, and 3 (7.1%) alive with disease. Local recurrence was encountered in 4 (9.5%) patients. Nonunion occurred at 3 (6.4%) osteotomy sites. Deep infection developed in 4 (9.5%) cases. There were 13 patients rated excellent, 17 good, 10 fair, and 2 failures according to the Mankin scoring system. The mean ratings of the Musculoskeletal Tumor Society score and the Toronto Extremity Salvage Score were 77 and 81, respectively. The long-term oncological and functional results are encouraging and suggest that extracorporeal irradiation and reimplantation can be a long-lasting biological reconstructive technique in properly selected patients.

  2. Extracorporeal irradiation -Physicist perspective

    International Nuclear Information System (INIS)

    Vijayaprabhu, N.; Saravanan, K.S.; Gunaseelan; Vivekanandam, S.; Reddy, K.S.; Parthasarathy; Mourougan, S.; Elangovan, K.

    2008-01-01

    Extracorporeal irradiation (ECI) involves irradiation of body tissues, particularly malignant bones of the extremities, outside the body. This involves en bloc resection of the tumour, extracorporeal irradiation of the bone segment with a single dose of 50 Gy or more, and reimplantation of the irradiated bone with fixation devices. Bone tumours like Ewing's Sarcoma, Chondrosarcoma and Oesteosarcoma; in the involved sites like femur, tibia, humerus, ilium and sacrum can be treated with ECI. The reimplanted bone simply acts as a framework for appositional bone growth from surrounding healthy bones. The conventional indications for postoperative irradiation are still applied. The major advantages of ECI are the precise anatomic fit of the reimplanted bone segment, preservation of joint mobility and its potential in avoiding the growth discrepancy commonly seen in prosthetic replacement. The use of ECI was first described in 1968 and practiced in Australia since 1996. In our center, we have completed six ECIs

  3. Extracorporeal irradiation for malignant bone tumors

    International Nuclear Information System (INIS)

    Hong, Angela; Stevens, Graham; Stalley, Paul; Pendlebury, Susan; Ahern, Verity; Ralston, Anna; Estoesta, Edgar; Barrett, Ian

    2001-01-01

    Purpose: Extracorporeal irradiation (ECI) has been used selectively in the management of primary malignant bone tumors since 1996. We report our techniques for ECI and the short-term oncologic and orthopedic outcomes. Methods and Materials: Sixteen patients with primary malignant bone tumors were treated with ECI from 1996 to 2000. The median age was 14 years. The histologic diagnoses were Ewing's sarcoma (11), osteosarcoma (4) and chondrosarcoma (1). The treated sites were femur (7), tibia (4), humerus (2), ilium (2), and sacrum (1). Following induction chemotherapy in Ewing's sarcomas and osteosarcoma, en bloc resection of the tumor and tumor-bearing bone was performed. A single dose of 50 Gy was delivered to the bone extracorporeally using either a linear accelerator (9 cases) or a blood product irradiator (7 cases). The orthopedic outcome was recorded using a standard functional scale. Results: At a median follow-up of 19.5 months, there were no cases of local recurrence or graft failure. One patient required amputation due to chronic osteomyelitis. For the 10 patients with follow-up greater than 18 months, the functional outcomes were graded good to excellent. Conclusion: The short-term oncologic and orthopedic results are encouraging and suggest that ECI provides a good alternative for reconstruction in limb conservative surgery in selected patients. This technique should only be used in a multidisciplinary setting, where careful follow-up is available to assess the long-term outcomes

  4. Glycogen accumulation in normal and irradiated minced muscle autografts on frog gastrocnemius

    International Nuclear Information System (INIS)

    Malhotra, R.K.; Kaul, R.; Malhotra, N.

    1989-01-01

    Alterations induced in glycogen content and phosphorylase activity have been studied in normal and irradiated minced muscle autografts on frog gastrocnemius at days 1, 3, 5, 7, 10, 15 and 30 postgrafting. The changes observed in the glycogen content and phosphorylase activity conform to the degeneration and regeneration phases of muscle repair. An attempt has been made to explain the altered glycogen utilizing capacities of the frog skeletal muscle during its repair and regeneration. (author)

  5. Blood leukocyte responses to extracorporeal circulation. 1. Short term extracorporeal circulation in dogs without and with extracorporeal irradiation

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    Szemere, P.; Fliedner, T.M. (Ulm Univ. (Germany, F.R.). Abt. Klinische Physiologie)

    1983-01-01

    Short term (1 h) extracorporeal circulation without or with irradiation of blood was performed in two normal dogs in a series of experiments. The granulocyte count was constantly diminished, while the lymphocytes did not show any particular change in their concentration. In the majority of the experiments a decrease of the CFU-C content occurred to less than 70% of the initial level. There was no difference in the results of experiments with or without irradiation. In the 'bag to bag' procedures, no significant change in the blood leukocyte counts including CFU-C, was established.

  6. An experimental studies of skin autograft in irradiated bed

    International Nuclear Information System (INIS)

    Ueda, Minoru

    1981-01-01

    Effects of irradiation to revascularization and skin grafting were studied. Wistar rats were irradiated with 1000, 2000, and 3000 rad of x-ray. One 2, 4, 6, 8, 12, and 24 weeks after irradiation each group, consisted of 10 rats, was compared with that of 34 untreated rats. A new score system of skin reaction was proposed. The highest moist skin reaction was observed after 2 weeks in 3 irradiated groups. In the 2000 and 3000 rad groups, the acute reaction appeared with 1 week latent period and recovered in 8 weeks followed by marked skin atrophy and epilation, while in the 1000 rad group complete recovery was observed in 3 weeks without late squlae. In order to carry out microangiography, a new device to inject the contrast medium at constant temperature and pressure was used. Marked inflammation was observed in 4 weeks, began to recover in 4 weeks, and hypovascular area appeared in 8 weeks. As for the blood area density, no variation was found for the 1000 rad group. However, in the 2000 and 3000 rad groups, the highest density was observed in 2 weeks and decreased after 8 weeks to that lower than the control. Revascularization after the skin grafting was followed by microangiography. In the control group, primary and secondary revascularization was observed one and 3 days after transplantation. As for the 3000 rad groups both revascularizations were hardly recognized when transplanted 8 weeks after irradiation. The optimum time for skin grafting was found to be acute or subacute period of the vascular damage. (Nakanishi, T.)

  7. Extracorporeal irradiation of dog blood: the effects of a radiostrontium irradiator on blood stem cells (CFU-C)

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    Szemere, P.; Fliedner, T.M.; Nothdurft, W.; Breitig, D.

    1982-07-01

    The radiation sensitivity of dog blood stem cells was measured in vitro and in an extracorporeal circulation passing through a radiation field. It was established that the calculated D/sub 0/ was as low as 0.45 Gy. Investigating the cell killing rate in our equipment (Buchler type /sup 90/Sr device for extracorporeal irradiation), we found an overkill situation; the dose delivered was in excess of that which would be required for the total eradication of all stem cells in the peripheral blood passing through the radiation field. Various other types of devices used for extracorporeal irradiation of blood are also reviewed.

  8. Blood leukocyte responses to extracorporeal circulation. 2. Medium term extracorporeal circulation without and with extracorporeal irradiation in normal and splenectomized dogs

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    Szemere, P.; Fliedner, T.M. (Ulm Univ. (Germany, F.R.). Abt. Klinische Physiologie)

    1983-01-01

    Medium term (6-8 h) extracorporeal irradiation without and with irradiation of blood was performed in normal and splenectomized dogs to reveal the changes of blood leukocytes including CFU-C. A regular but transitory decrease of granulocytes and a longer lasting diminution of lymphocytes in the blood were observed. The CFU-C level became and mostly remained very low during the procedure. Splenectomy did not influence significantly the changes of peripheral leukocyte counts. No marked difference of leukocytes was seen in the blood samples taken from the arterial or venous side of the shunt or even from the cubital vein. Also, the irradiation did not produce any difference in the alterations of blood cell counts compared to those without irradiation. The possible explanations of these results are discussed.

  9. Blood leukocyte responses to extracorporeal circulation. 3. Long term extracorporeal circulation without and with irradiation in normal and splenectomized dogs

    Energy Technology Data Exchange (ETDEWEB)

    Szemere, P.; Fliedner, T.M. (Ulm Univ. (Germany, F.R.). Abt. Klinische Physiologie)

    1983-01-01

    Long term (12-48 h) extracorporeal circulation without and with irradiation of the blood was performed in normal and splenectomized dogs in order to observe the effect of these procedures on blood leukocyte counts including CFU-C. A transient granulocytopenia and a decrease of lymphocyte count were observed. The blood CFU-C level diminished to a very low level and remained low for the whole time of the experiments. There was no significant difference between the results of procedures with or without irradiation. The similar effect of a shortened tubing system on the blood leukocyte count is also reported. Heparin infusion alone did not decrease the peripheral CFU-C concentration. The possible explanations for the observed phenomena are discussed.

  10. Alterations of blood and blood coagulation by extracorporeal irradiation in leukemia and radiophosphor therapy in polycythemia

    International Nuclear Information System (INIS)

    Huhn, D.; Kaboth, W.; Theml, H.; Murr, H.; Schramm, W.; Leisner, B.

    1974-01-01

    Animal experiments prove a high radiation resistance of megakaryocytes and thrombocytes. Radiophosphorus is thought to influence mainly the megakaryocytes in their beginnings; an effect on the vessel system of the bone marrow is particularly to be discussed in the case of very early and quickly reversible drop in thrombocytes. In the very first week after radiophosphorus administration, a considerable drop in thrombocytes is already seen in some patients, the number of patients remaining the same during the following 3 weeks. After blood irradiation, the thrombocytes are for a certain period reduced due to the influence of the extracorporal circulation, but in general their number increases again during the following months. A considerable disfunction of the thrombocytes or a disturbed coagulation is not found either after radiophosphorus treatment or after extracorporal blood irradiation. (orig.) [de

  11. Simple computational modeling for human extracorporeal irradiation using the BNCT facility of the RA-3 Reactor

    International Nuclear Information System (INIS)

    Farias, Ruben; Gonzalez, S.J.; Bellino, A.; Sztenjberg, M.; Pinto, J.; Thorp, Silvia I.; Gadan, M.; Pozzi, Emiliano; Schwint, Amanda E.; Heber, Elisa M.; Trivillin, V.A.; Zarza, Leandro G.; Estryk, Guillermo; Miller, M.; Bortolussi, S.; Soto, M.S.; Nigg, D.W.

    2009-01-01

    We present a simple computational model of the reactor RA-3 developed using Monte Carlo transport code MCNP. The model parameters are adjusted in order to reproduce experimental measured points in air and the source validation is performed in an acrylic phantom. Performance analysis is carried out using computational models of animal extracorporeal irradiation in liver and lung. Analysis is also performed inside a neutron shielded receptacle use for the irradiation of rats with a model of hepatic metastases.The computational model reproduces the experimental behavior in all the analyzed cases with a maximum difference of 10 percent. (author)

  12. Reconstruction of the proximal humerus with a composite of extracorporeally irradiated bone and endoprosthesis following excision of high grade primary bone sarcomas.

    Science.gov (United States)

    Moran, Matthew; Stalley, Paul D

    2009-10-01

    Functional reconstruction of the shoulder joint following excision of a malignant proximal humeral tumour is a difficult proposition. Eleven patients with primary osteosarcoma or Ewing's sarcoma underwent reconstruction with a composite of extra-corporeally irradiated autograft with the addition of a long stemmed hemiarthroplasty. At a mean follow-up of 5.8 years two patients had died from disseminated disease and one patient had undergone amputation for local recurrence. The eight patients with a surviving limb were examined clinically and radiographically. The mean Toronto Extremity Salvage Score was 74 and Musculo-Skeletal Tumour Society score 66. Rotation was well preserved but abduction (mean 32 degrees ) and flexion (40 degrees ) were poor. There was a high rate of secondary surgery, with five out of eleven patients requiring re-operation for complications of reconstruction surgery. Radiographic estimate of graft remaining at follow up was 71%. There were no infections, revisions or radiographic failures. Whilst the reconstructions were durable in the medium term, the functional outcome was no better than with other reported reconstructive methods. The composite technique was especially useful in subtotal humeral resections, allowing preservation of the elbow joint even with very distal osteotomy. Bone stock is restored, which may be useful for future revision surgery in this young group of patients.

  13. Extracorporeal blood irradiation (ECIB) by the 137Cs-teletherapy unit. Pt. 2

    International Nuclear Information System (INIS)

    Scherer, E.; Makoski, H.B.

    1976-01-01

    The present report on experiences with extracorporeal blood irradiation comprises a systematical investigation of the conditions in blood picture and, in one case, of the morphological findings with lymph node punctures, during long-term treatment of two selected patients with a rather different course of the disease. One of the cases showed a typical pattern of chronic lymphadenosis which was to be influenced fairly well; the other case revealed an aggressive tendency with only a feeble response to extracorporeal blood irradiation. By means of toluidine blue staining, until now being used for the verification of nucleoli and their different shapes only in experimentations on animals, a good correlation of the nucleole analysis in the peripheral blood picture and in the lymph node biopsies with the clinical progress of the disease has been observed. Thus, this simple cytological method combined with customary clinical examinations may serve as a criterion for the judgement on the course of the disease and on the therapeutic success. (orig./MG) [de

  14. Extracorporeal irradiation of calves blood. Effects on: the lymphocytes, the blood-platelet function, seric proteins, and fibrinogen

    International Nuclear Information System (INIS)

    Hollard, D.; Suscillon, M.; Benabid, Y.; Concord, E.; Ivanoff, M.; Laurent, M.; Rambaud, F.

    1969-01-01

    The present paper reports the results obtained after extracorporeal irradiation of circulating blood of calves. Animals are divided in 3 groups as follows: - control animals: blood circulation without irradiation; - calves which received 40000 rads during 24 hours of continuous irradiation; - calves which received the same dose, during a period of 5 days (5 hours every day). The more interesting results are: - the early lymphopenia which persists for 7 or 8 weeks and may be in relationship with the change of immunoglobulins; - a constant hyperfibrinemia (12 g/l) never reported, as far as we know, by authors using I.E.C. Several hypothesis are advanced to explain this phenomenon. (authors) [fr

  15. Which is the best method of sterilization for recycled bone autograft in limb salvage surgery: a radiological, biomechanical and histopathological study in rabbit.

    Science.gov (United States)

    Yasin, Nor Faissal; Ajit Singh, Vivek; Saad, Marniza; Omar, Effat

    2015-04-15

    Limb salvage surgery is a treatment of choice for sarcomas of the extremities. One of the options in skeletal reconstruction after tumour resection is by using a recycled bone autograft. The present accepted methods of recycling bone autografts include autoclaving, pasteurization and irradiation. At the moment there is lack of studies that compare the effectiveness of various sterilization methods used for recycling bone autografts and their effects in terms of bone incorporation. This study was performed to determine the effects of different methods of sterilization on bone autografts in rabbit by radiological, biomechanical and histopathological evaluations. Fresh rabbit cortical bone is harvested from the tibial diaphysis and sterilized extracorporeally by pasteurization (n = 6), autoclaving (n = 6), irradiation (n = 6) and normal saline as control group (n = 6). The cortical bones were immediately reimplanted after the sterilization process. The subsequent process of graft incorporation was examined over a period of 12 weeks by serial radiographs, biomechanical and histopathological evaluations. Statistical analysis (ANOVA) was performed on these results. Significance level (α) and power (β) were set to 0.05 and 0.90, respectively. Radiographic analysis showed that irradiation group has higher score in bony union compared to other sterilization groups (p = 0.041). ANOVA analysis of 'failure stress', 'modulus' and 'strain to failure' demonstrated no significant differences (p = 0.389) between treated and untreated specimens under mechanical loading. In macroscopic histopathological analysis, the irradiated group has the highest percentage of bony union (91.7 percent). However in microscopic analysis of union, the pasteurization group has significantly higher score (p = 0.041) in callus formation, osteocytes percentage and bone marrow cellularity at the end of the study indicating good union potential. This experimental study shown that both irradiation and

  16. Intraoperative extracorporeal autogenous irradiated tendon grafts for functional limb salvage surgery of soft tissue sarcomas of the wrist and hand.

    Science.gov (United States)

    Omori, Shinsuke; Hamada, Kenichiro; Outani, Hidetatsu; Oshima, Kazuya; Joyama, Susumu; Tomita, Yasuhiko; Naka, Norifumi; Araki, Nobuhito; Yoshikawa, Hideki

    2015-05-12

    In patients with soft tissue sarcoma of the wrist and hand, limb salvage operation is extremely challenging for surgeons in attempting a complete tumor resection with negative surgical margins. In this study, we report four patients with soft tissue sarcoma of the wrist and hand treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts. The patients were all male, and the mean age at the time of surgery was 45 years. Histological diagnoses included clear cell sarcoma in two patients, synovial sarcoma in one, and angiosarcoma in one. All four patients had high grade tumors, wherein three had American Joint Committee on Cancer (AJCC) stage III disease and one with AJCC stage IV disease. The tumors were resected en bloc with involved tendons. The tendons were isolated from the resected tissues, irradiated ex vivo, and re-implanted into the host tendons. In one patient, the bone was resected additionally because of tumor invasion to the bone. Hand function was evaluated using Musculoskeletal Tumor Society (MSTS) rating system. Of the four patients, three died of distant metastatic disease. The remaining patient lives and remains disease-free. The mean follow-up period was 33 months. One patient had local recurrence outside the irradiated graft at 20 months after surgery. The functional rating was 22. Lower scores were seen in patients with reconstruction of flexor tendons than extensor tendons. Limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts is an acceptable method in selected patients with soft tissue sarcoma of the wrist and hand.

  17. Application of the autoblood treated by preliminary extracorporeal X-ray irradiation in the therapy of bronchial asthma patients

    International Nuclear Information System (INIS)

    Goguev, N.T.

    1985-01-01

    A therapeutic method including extracorporeal x-ray irradiation of the autoblood of patients with bronchial asthma complicated by cortisone dependence and polyvalent drug intolerance, has been elaborated and clinically tested. The use of this method brings about good short-term results in 90% of cases and good long-term results in 40% of cases (14-38 months). It provides an opportunity to give up corticosteroids in more than 60% of patients and to decrease the hormone dose in the rest of cortisone-dependent patients with bronchial asthma. The above therapeutic method can be used as an independent type of treatment, especially in the presence of polyvalent drug allergy and as an element of multiple modality therapy of bronchial asthma patients. The method was used under in-patient conditions only. No side effects were marked in the course of the clinical trial. To carry out this type of therapy, patients should be thoroughly screened

  18. Are there unexploited possibilities for the therapeutic use of radioactive and stable isotopically labeled DNA precursors and extracorporeal irradiation of the blood in treatment of leukemia

    International Nuclear Information System (INIS)

    Cronkite, E.P.; Fairchild, R.G.; Miller, M.E.

    1983-01-01

    The radiobiology of tritium and iodine-125 is reviewed. The killing of cells and apparent beneficial effect of tritiated thymidine in human leukemia are described. The reasons for considering the use of tritiated thymidine and/or 125 I deoxyuridine to attack leukemic cells in sanctuaries are discussed. Photon activation therapy as a method to improve effectiveness of extracorporeal irradiation of the blood is presented showing that one can in principle substantially increase the radiation dose to the leukemic cells and reduce the dose to red cells in transit through the irradiator. (orig.)

  19. Mitral Valve Replacement with a Pulmonary Autograft in an Infant

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    Yong Ho Jeong

    2018-04-01

    Full Text Available A 76-day-old infant weighing 3.4 kg was referred for surgical intervention for severe mitral valve stenoinsufficiency caused by leaflet fibrosis and calcification. He had experienced a cerebral infarction in the left middle cerebral artery territory, which was deemed attributable to an embolism of a calcified particle from the dysmorphic mitral valve. Because mitral valve replacement using a prosthetic valve was not feasible in this small baby, mitral valve replacement with a pulmonary autograft was performed. After a brief period of extracorporeal membrane oxygenation (ECMO support, he was weaned from ECMO and was discharged home without further cardiovascular complications.

  20. Conjunctival autograft for pterygium

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    Clearfield, Elizabeth; Muthappan, Valliammai; Wang, Xue; Kuo, Irene C

    2016-01-01

    Background A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. Prevalence ranges widely around the world. Evidence suggests that ultraviolet light is a major contributor in the formation of pterygia. Pterygia impair vision, limit eye movements, and can cause eye irritation, foreign body sensation, and dryness. In some susceptible patients, the pterygium can grow over the entire corneal surface, blocking the visual axis. Surgery is the only effective treatment for pterygium, though recurrences are common. With simple excision techniques (that is, excising the pterygium and leaving bare sclera), the risk of recurrence has been reported to be upwards of 80%. Pterygium excision combined with a tissue graft has a lower risk of recurrence. In conjunctival autograft surgery, conjunctival tissue from another part of the person’s eye along with limbal tissue is resected in one piece and used to cover the area from which the pterygium was excised. Another type of tissue graft surgery for pterygium is amniotic membrane graft, whereby a piece of donor amniotic membrane is fixed to the remaining limbus and bare sclera area after the pterygium has been excised. Objectives The objective of this review was to assess the safety and effectiveness of conjunctival autograft (with or without adjunctive therapy) compared with amniotic membrane graft (with or without adjunctive therapy) for pterygium. We also planned to determine whether use of MMC yielded better surgical results and to assess the direct and indirect comparative costs of these procedures. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature

  1. Extracorporeal irradiation of calves blood. Effects on: the lymphocytes, the blood-platelet function, seric proteins, and fibrinogen; Irradiation extracorporelle du sang de veau effets sur: les lymphocytes, la fonction plaquettaire, les proteines seriques et le fibrinogene

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    Hollard, D; Suscillon, M; Benabid, Y; Concord, E; Ivanoff, M; Laurent, M; Rambaud, F [Commissariat a l' Energie Atomique, Grenoble (France). Centre d' Etudes Nucleaires

    1969-07-01

    The present paper reports the results obtained after extracorporeal irradiation of circulating blood of calves. Animals are divided in 3 groups as follows: - control animals: blood circulation without irradiation; - calves which received 40000 rads during 24 hours of continuous irradiation; - calves which received the same dose, during a period of 5 days (5 hours every day). The more interesting results are: - the early lymphopenia which persists for 7 or 8 weeks and may be in relationship with the change of immunoglobulins; - a constant hyperfibrinemia (12 g/l) never reported, as far as we know, by authors using I.E.C. Several hypothesis are advanced to explain this phenomenon. (authors) [French] Ce travail presente l'ensemble des resultats hematologiques obtenus apres irradiation extracorporelle du sang de veaux repartis en 3 series: - veaux temoins: circulation du sang sans irradiation - veaux soumis a une irradiation continue dose globale integree de 40000 rads en 24 heures; - veaux ayant recu la meme dose globale en irradiation fractionnee repartie sur 5 jours (5 heures par jour). Les resultats les plus marquants sont d'une part une lymphopenie precoce se prolongeant durant 7 a 8 semaines et qui pourrait etre reliee aux modifications observees sur les immunoglobulines. D'autre part une hyperfibrinemie (12 g/l) constante, apparemment jamais signalee par d'autres auteurs utilisant l'I.E.C. Plusieurs hypotheses explicatives de ce phenomene sont exposees et sont a l'etude. (auteurs)

  2. Extracorporeal irradiation of calves blood. Effects on: the lymphocytes, the blood-platelet function, seric proteins, and fibrinogen; Irradiation extracorporelle du sang de veau effets sur: les lymphocytes, la fonction plaquettaire, les proteines seriques et le fibrinogene

    Energy Technology Data Exchange (ETDEWEB)

    Hollard, D.; Suscillon, M.; Benabid, Y.; Concord, E.; Ivanoff, M.; Laurent, M.; Rambaud, F. [Commissariat a l' Energie Atomique, Grenoble (France). Centre d' Etudes Nucleaires

    1969-07-01

    The present paper reports the results obtained after extracorporeal irradiation of circulating blood of calves. Animals are divided in 3 groups as follows: - control animals: blood circulation without irradiation; - calves which received 40000 rads during 24 hours of continuous irradiation; - calves which received the same dose, during a period of 5 days (5 hours every day). The more interesting results are: - the early lymphopenia which persists for 7 or 8 weeks and may be in relationship with the change of immunoglobulins; - a constant hyperfibrinemia (12 g/l) never reported, as far as we know, by authors using I.E.C. Several hypothesis are advanced to explain this phenomenon. (authors) [French] Ce travail presente l'ensemble des resultats hematologiques obtenus apres irradiation extracorporelle du sang de veaux repartis en 3 series: - veaux temoins: circulation du sang sans irradiation - veaux soumis a une irradiation continue dose globale integree de 40000 rads en 24 heures; - veaux ayant recu la meme dose globale en irradiation fractionnee repartie sur 5 jours (5 heures par jour). Les resultats les plus marquants sont d'une part une lymphopenie precoce se prolongeant durant 7 a 8 semaines et qui pourrait etre reliee aux modifications observees sur les immunoglobulines. D'autre part une hyperfibrinemie (12 g/l) constante, apparemment jamais signalee par d'autres auteurs utilisant l'I.E.C. Plusieurs hypotheses explicatives de ce phenomene sont exposees et sont a l'etude. (auteurs)

  3. Inferior limbal conjunctival autografting in primary pterygium

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    Farouk M Othman

    2015-01-01

    In patients with primary pterygium, conjunctival limbal autografting from the lower bulbar conjunctiva is an effective technique with a low recurrence rate. It can be a suitable treatment for glaucomatous patients with pterygium to leave the upper bulbar conjunctiva untouched.

  4. Aortic root reoperations after pulmonary autograft implantation

    NARCIS (Netherlands)

    J.A. Bekkers (Jos); L.M.A. Klieverik (Loes Maria Anne); G. Bol-Raap (Goris); J.J.M. Takkenberg (Hanneke); A.J.J.C. Bogers (Ad)

    2010-01-01

    textabstractObjective: To report the results of aortic root reoperations after pulmonary autograft implantation. Methods: All consecutive patients in our prospective Ross research database were selected for analysis, and additional information for patients requiring reoperation was obtained from the

  5. Microsurgical head and neck tissue repair by visceral mini-autografting

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    A. D. Kaprin

    2015-01-01

    Full Text Available Objective. To minimize surgical trauma in patients with head and neck tumors during microsurgical plasty with visceral autografts.Subjects and methods. Clinical experience has been gained in the treatment of 53 patients with locally advanced craniofascial (n = 27 and oropharyngeal (n = 36 cancers. Abdominal organs were used for plastic closure of extensive defects after surgical resection. Paraumbilical incision allowing for an adequate approach into the abdominal cavity with minimal external trauma in the anterior abdominal wall was chosen as an access procedure. Video-assisted techniques were used to excise the midline aponeurosis. Donor organs, such as the omentum, greater curvature of the stomach, transverse colon, small intestine were taken through a mini-laparotomic incision to the anterior abdominal wall, then the vascular pedicle was exposed and a visceral autograft was made. After forming and cutting off the autograft, organ anastomoses were created extracorporeally.Results. Mini-access surgery could be completed in 50 of the 53 cases (4 patients had previously undergone abdominal interventions. Omental (n = 26, colo-omental (n = 15, gastro-omental (n = 7, and entero-omental (n = 5 flaps were made and prepared for autografting. No intra- or postoperative abdominal complications were found.Conclusion. Minimally invasive technologies used to create visceral authografts for head and neck tissue repair can minimize surgical trauma and reduce treatment duration. The indications for this access are the debilitating state of a cancer patient or the young age of a patient who does not wish to have an additional scar in the donor region.

  6. MRI of anterior cruciate ligament autografts

    International Nuclear Information System (INIS)

    Ogi, Shigeyuki; Ariizumi, Mitsuko; Yamagishi, Tsuneo; Agata, Toshihiko; Tada, Shinpei; Fukuda, Kunihiko

    2000-01-01

    The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy. (author)

  7. [Acute transformation of chronic myeloid leukemia: disappearance of the Philadelphia chromosome after autograft].

    Science.gov (United States)

    Reiffers, J; David, B; Bernard, P; Vezon, G; Marit, G; Moulinier, J; Broustet, A

    1984-04-12

    Two patients with chronic granulocytic leukemia (C.G.L.) undergoing transformation were treated by high dose chemotherapy and total body irradiation followed by autografting of hematopoietic stem cells collected and cryo-preserved at the time of diagnosis. Recovery of hematopoiesis was characterized by disappearance of the Philadelphia chromosome in most metaphases. A new approach of the management of C.G.L. is discussed.

  8. The use of dermal autograft as an adjunct to breast reconstruction with tissue expanders.

    Science.gov (United States)

    Rinker, Brian

    2012-12-01

    Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV.

  9. Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction

    DEFF Research Database (Denmark)

    Stensbirk, Frederik; Thorborg, Kristian; Konradsen, Lars

    2014-01-01

    PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament......PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi...

  10. Extracorporeal treatment for thallium poisoning

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S

    2012-01-01

    The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl).......The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl)....

  11. Extracorporeal membrane oxygenation (ECMO)

    African Journals Online (AJOL)

    Extracorporeal membrane oxygenation (ECMO) is not a novel therapy in the true sense of the ... Intention-to-treat analysis showed benefit for ECMO, with a relative risk ... no doubt that VV-ECMO is an advance in medical technology, and that.

  12. Extracorporeal treatment for acetaminophen poisoning

    DEFF Research Database (Denmark)

    Gosselin, S; Juurlink, D N; Kielstein, J T

    2014-01-01

    BACKGROUND: The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTR) in poisoning and the results are presented here for acetaminophen (APAP). METHODS: After a systematic review of the litera...... of NAC has not been definitively demonstrated....

  13. Extracorporeal Treatment for Lithium Poisoning

    DEFF Research Database (Denmark)

    Decker, Brian S; Goldfarb, David S; Dargan, Paul I

    2015-01-01

    The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxico......The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical...... extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li...... treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity...

  14. Outcomes of Reintervention on the Autograft After Ross Procedure.

    Science.gov (United States)

    Kumar, S Ram; Bansal, Neeraj; Wells, Winfield J; Starnes, Vaughn A

    2016-11-01

    After a Ross procedure, a small subset of patients requires reintervention for autograft dilatation or valve insufficiency. We sought to determine the indications, nature, and outcomes of autograft reinterventions in the left ventricular outflow tract after a Ross procedure. We retrospectively reviewed the charts of 316 consecutive patients, age 4 days to 70 years, who underwent a Ross procedure at our institution. Of these, 47 patients (15%) required autograft reintervention during a median follow-up of 8.2 years. Forty-seven patients, median age 26 years (interquartile range [IQR], 14.4 to 44.8 years), 32 (68%) men, required autograft reintervention a median 5.5 years (IQR, 1.8 to 9.4 years) after a Ross procedure. In 47% (22 of 47 patients), the autograft valve could be salvaged (15 valve-sparing aortic replacements, 7 valve repairs). The remaining 53% underwent replacement of the root (10 mechanical, 5 homograft) or valve alone (7 mechanical, 3 bioprosthetic). Twenty patients presented without autograft root dilatation 1 year (IQR, 0.5 to 2.9 years) after Ross. Fifteen of them (75%) required valve replacement. The 27 patients who demonstrated root dilatation presented 6.9 years (IQR, 4.5 to 9.7 years; p Ross, and 17 (63%) of these valves could be spared (p = 0.01). There was no surgical mortality and 5 (11%) major morbidity events. Patients were followed up for 4.9 years (IQR, 2.1 to 7 years) after left ventricular outflow tract reintervention. For patients whose autograft valve could be spared, 3-, 5-, and 8-year freedom from valve replacement was 92%, 86%, and 86%, respectively. At last follow-up, only 1 patient had greater than mild aortic insufficiency, and all but 1 had normal ejection fraction. Autograft reintervention after a Ross appears to follow a bimodal distribution. Patients with primary autograft leaflet problems tend to present early without root dilatation and frequently require valve replacement. The autograft valve can be salvaged in the

  15. Extracorporeal Treatment for Metformin Poisoning

    DEFF Research Database (Denmark)

    Calello, Diane P; Liu, Kathleen D; Wiegand, Timothy J

    2015-01-01

    diverse professions, presents its systematic review and clinical recommendations for extracorporeal treatment in metformin poisoning. METHODS: A systematic literature search was performed, data extracted, findings summarized, and structured voting statements developed. A two-round modified Delphi method...... was used to achieve consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Anonymized votes and opinions were compiled and discussed. A second vote determined the final recommendations. RESULTS: One hundred seventy-five articles were identified, including 63 deaths...... appears to be amenable to extracorporeal treatments. Despite clinical evidence comprised mostly of case reports and suboptimal toxicokinetic data, the workgroup recommended extracorporeal removal in the case of severe metformin poisoning....

  16. Biceps Autograft Augmentation for Rotator Cuff Repair : A Systematic Review

    NARCIS (Netherlands)

    Veen, Egbert J D; Stevens, Martin; Diercks, Ronald L

    Purpose: To improve surgical outcomes in patients with massive cuff defects, different techniques and augmentations are proposed. The biceps tendon is easily available as an autograft. Our aim was to conduct a qualitative systematic review of various methods and surgical techniques that use a biceps

  17. Placement of implant bridge anterior maxilla post autograft (Serial case

    Directory of Open Access Journals (Sweden)

    Rifaat Nurrahma

    2016-06-01

    Full Text Available An advanced technology with implants based has now been developed in recent years.Implant with the bridge superstructure method is employed after variety of considerations where it is expected to meet its function, aesthetics, and comfortability.The alveolar bone existed is one reason for the process of adding bone (bonegraft.This case report proposes to determine the successful insertion of a superstructure anterior implant bridge post autograft.Two female patients were asked to use dental implant anterior with bridge system.The first case, the autograft application is made for a 20-year-old woman with edentulous teeth 11, 21, 22. One year later it was then inserted in the area of dental implant fixture 11 and 22. After 9 months, the healing abutments and the superstructure were inserted too.2 weeks after, the abutments of bridge and crowns of teeth 11, 21 and 22 with a pontic in the teeth 21 had been inserted. The second case, a 46-year-old woman with edentulous 11,12,21,22.They want to change the denture because they did not feel comfortable with the removable denture acrylic.Fixture placement was done a year after autograft.Insertion of healing abutments and the superstructure printing can be done after 6 months.A month later implant abutments and crowns could be inserted.Labial fullness is corrected; an implant-retained in the region of 12 and 21, 12, and 22 used the pontic.Prosthodontic rehabilitation with a fixed denture using the implant bridge after autograft anterior maxilla is an alternative fixed denture placement with satisfactory results, aesthetic correction and comfortably.

  18. Accidental ovarian autograft after a laparoscopic surgery: case report.

    Science.gov (United States)

    Marconi, G; Quintana, R; Rueda-Leverone, N G; Vighi, S

    1997-08-01

    To report an autograft of ovarian tissue in the incision of the surgical trocar during laparoscopic surgery and to assess the potentiality of grafting of ovarian parenchyma in nonpelvic tissue in humans. A case report. Instituto de Fertilidad y Ginecología de Buenos Aires (IFER), Buenos Aires, Argentina. Infertile patient undergoing surgery due to an endometriotic cyst of the left ovary. Laparoscopic cystectomy. Accidental retention of a portion of the capsule and adjacent ovarian tissue of the endometrioma in SC cellular tissue. Months after surgery, a SC tumor was formed under the surgical incision. It was subsequently excised. Observation of tumor growth during menstrual cycles and ovulation induction; anatomopathologic study of the tissue after its extirpation. The tumor grew spontaneously in the periovulatory period and during treatments of ovulation induction. The anatomopathologic report of the tumor, removed 15 months after the first surgery, revealed functioning ovarian tissue with vessels of neoformation. This is the first description of autografted ovarian tissue in humans. We describe that the ovary can maintain its ovulatory function even in the absence of its pedicel. Also, we suggest that extirpation of surgical material through the incision of the trocar is not recommended, as the possibility of "sowing" or of autografts may occur.

  19. Viability of osteocytes in bone autografts harvested for dental implantology

    International Nuclear Information System (INIS)

    Guillaume, Bernard; Gaudin, Christine; Georgeault, Sonia; Mallet, Romain; Basle, Michel F; Chappard, Daniel

    2009-01-01

    Bone autograft remains a very useful and popular way for filling bone defects. In maxillofacial surgery or implantology, it is used to increase the volume of the maxilla or mandible before placing dental implants. Because there is a noticeable delay between harvesting the graft and its insertion in the receiver site, we evaluated the morphologic changes at the light and transmission electron microscopy levels. Five patients having an autograft (bone harvested from the chin) were enrolled in the study. A small fragment of the graft was immediately fixed after harvesting and a second one was similarly processed at the end of the grafting period when bone has been stored at room temperature for a 20 min ± 33 s period in saline. A net increase in the number of osteocyte lacunae filled with cellular debris was observed (+41.5%). However no cytologic alteration could be observed in the remaining osteocytes. The viability of these cells is known to contribute to the success of autograft in association with other less well-identified factors.

  20. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AS ...

    African Journals Online (AJOL)

    Objective To evaluate extracorporeal shock wave lithotripsy (ESWL) as a monotherapy for urolithiasis in patients with solitary kidney and to determine the factors that may affect its results. Patients and Methods Using the Dornier MFL 5000 lithotriptor, 106 patients with solitary kidney (80 men and 26 women) were treated for ...

  1. Extracorporeal Treatment in Phenytoin Poisoning

    DEFF Research Database (Denmark)

    Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A

    2016-01-01

    The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles......) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia...... is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available...

  2. Extracorporeal treatment for barbiturate poisoning

    DEFF Research Database (Denmark)

    Mactier, Robert; Laliberté, Martin; Mardini, Joelle

    2014-01-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all...... treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least......-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory...

  3. Alternatives to Autograft Evaluated in a Rabbit Segmental Bone Defect

    Science.gov (United States)

    2015-07-09

    mesenchymal stem cells for off-the-shelf bone tissue engineering application. Biomaterials 33(9):2656–2672. doi:10.1016/j.biomaterials.2011.12.025 14...segmental bone defects in the rabbit with vascularized tissue engineered bone . Biomaterials 31(6):1171– 1179. doi:10.1016/j.biomaterials.2009.10.043 International Orthopaedics (SICOT) ...ORIGINAL PAPER Alternatives to autograft evaluated in a rabbit segmental bone defect Jennifer S. McDaniel1 & Marcello Pilia1 & Vivek Raut2 & Jeffrey

  4. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  5. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    2007-01-01

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  6. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  7. Hospital Costs Of Extracorporeal Life Support Therapy

    NARCIS (Netherlands)

    Oude Lansink-Hartgring, Annemieke; van den Hengel, Berber; van der Bij, Wim; Erasmus, Michiel E.; Mariani, Massimo A.; Rienstra, Michiel; Cernak, Vladimir; Vermeulen, Karin M.; van den Bergh, Walter M.

    Objectives: To conduct an exploration of the hospital costs of extracorporeal life support therapy. Extracorporeal life support seems an efficient therapy for acute, potentially reversible cardiac or respiratory failure, when conventional therapy has been inadequate, or as bridge to transplant, but

  8. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often.

    Science.gov (United States)

    Sheean, Andrew J; Musahl, Volker; Slone, Harris S; Xerogeanes, John W; Milinkovic, Danko; Fink, Christian; Hoser, Christian

    2018-04-28

    Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Valve-sparing root replacement for freestanding pulmonary autograft aneurysm after the Ross procedure.

    Science.gov (United States)

    Ratschiller, Thomas; Eva, Sames-Dolzer; Schimetta, Wolfgang; Paulus, Patrick; Müller, Hannes; Zierer, Andreas; Mair, Rudolf

    2018-02-20

    Autograft dilatation is the main long-term complication following the Ross procedure using the freestanding root replacement technique. We reviewed our 25-year experience with the Ross procedure with a special emphasis on valve-sparing reoperations. From 1991 to 2016, 153 patients (29.6 ± 16.6 years; 29.4% pediatric) underwent a Ross operation at our institution with implantation of the autograft as freestanding root replacement. The follow-up is 98.7% complete with a mean of 12.2 ± 5.5 years. Mortality at 30-days was 2.0%. Echocardiography documented no or trivial aortic regurgitation in 99.3% of the patients at discharge. Survival probability at 20 years was 85.4%. No case of autograft endocarditis occurred. Autograft deterioration rate was 2.01% per patient-year, and freedom from autograft reoperation was 75.3% at 15 years. A reoperation for autograft aneurysm was required in 35 patients (22.9%) at a mean interval of 11.1 ± 4.6 years after the Ross procedure. A valve-sparing root replacement was performed in 77% of patients, including 10 David and 17 Yacoub procedures with no early mortality. Three patients required prosthetic valve replacement within 2 years after a Yacoub operation. At latest follow-up, 92% of all surviving patients still carry the pulmonary autograft valve. Freedom from autograft valve replacement was 92.1% at 15 years. Using the David or Yacoub techniques, the autograft valve can be preserved in the majority of patients with root aneurysms after the Ross procedure. Reoperations can be performed with no early mortality, a good functional midterm result, and an acceptable reintervention rate. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  10. The Ross II procedure: pulmonary autograft in the mitral position.

    Science.gov (United States)

    Athanasiou, Thanos; Cherian, Ashok; Ross, Donald

    2004-10-01

    The surgical management of mitral valve disease in women of childbearing age, young patients, and children with congenital mitral valve defects is made difficult by the prospect of lifelong anticoagulation. We suggest the use of a pulmonary autograft in the mitral position (Ross II procedure) as an alternative surgical technique. We present a review of the literature, historical perspectives, indications, selection criteria, and surgical technique for the Ross II procedure. Our literature search identified 14 studies that reported results from the Ross II operation. Performed in 103 patients, the overall in-hospital mortality was 7 (6.7%), with a late mortality of 10 (9%). Although further research is needed, current evidence suggests the Ross II operation is a valuable alternative in low-risk young patients where valve durability and the complication rate from other procedures is unsatisfactory and anticoagulation not ideal.

  11. Can bone scintigraphy predict the final outcome of pasteurized autografts?

    International Nuclear Information System (INIS)

    Eid, Ahmed Shawky; Jeon, Dae-Geun; Cho, Wan Hyeong

    2010-01-01

    As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters. Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing. Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic ''tramline appearance''. Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases. Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas. (orig.)

  12. Can bone scintigraphy predict the final outcome of pasteurized autografts?

    Energy Technology Data Exchange (ETDEWEB)

    Eid, Ahmed Shawky [Ain Shams University, Department of Orthopedic Surgery, Cairo (Egypt); Jeon, Dae-Geun; Cho, Wan Hyeong [Korea Cancer Center Hospital, Department of Orthopedic Surgery, Seoul (Korea)

    2010-10-15

    As pasteurization is becoming more widely used in limb salvage reconstruction, more study is required to understand about host-graft junction healing, graft revascularization and incorporation, and the incidence and type of complications among pasteurized autografts. This was mainly achieved by follow-up radiography. We aimed to clarify whether Tc99m bone scanning can be considered a reliable method in determining these three parameters. Twenty-seven osteosarcoma patients with pasteurized autograft reconstructions were retrospectively reviewed using available scintigraphic and radiographic follow-up every 6 months postoperatively for 36 months. Follow-up of the unhealed cases was continued for the maximum follow-up period available for each case beyond the original study period, ranging from 1 to 15 months. Tc99m uptake was classified as cold, faint, moderate and high uptake. Junction healing was classified as none, partial and complete healing. Seventy percent of junctions united with a mean of 22 months. Ninety to 100% of junctions showed increased uptake (high or moderate) at one time of the study regardless of final outcome. 85% of the pasteurized grafts showed the characteristic ''tramline appearance''. Four grafts (15%) were complicated: pseudoarthrosis and implant failure (1), fractured plate (1), intramedullary nail (IMN) fracture (1), and prosthesis stem loosening in the host bone (1), with underlying unhealed junctions in all cases. Bone scanning can determine the stages of the graft's rim revascularization and incorporation; however, it cannot detect or predict junction healing or occurrence of complications. Supplementary treatment of unhealed junctions showing either decreased junctional uptake or graft quiescence may be warranted. Otherwise, detection of distant metastasis and early local recurrence remains the main application of Tc99m scanning in the management of bone sarcomas. (orig.)

  13. Ipsilateral femoral autograft reconstruction after resection of a pelvic tumor.

    Science.gov (United States)

    Biau, David J; Thévenin, Fabrice; Dumaine, Valérie; Babinet, Antoine; Tomeno, Bernard; Anract, Philippe

    2009-01-01

    Reconstruction of bone after the resection of a pelvic tumor is challenging. The purpose of the present study was to evaluate the use of the ipsilateral femur as the graft material for reconstruction. We performed a retrospective review of thirteen patients with a malignant pelvic lesion who underwent resection followed by reconstruction with an ipsilateral femoral autograft and insertion of a total hip replacement. The study group included nine men and four women with a median age of fifty-one years at the time of the reconstruction. The diagnosis was chondrosarcoma in eight patients, metastasis in three, and myeloma and radiation-induced malignant disease in one each. The surviving patients were assessed functionally and radiographically; the cumulative probability of revision was estimated while taking into account competing risks. The median duration of follow-up was forty-nine months. At the time of the latest follow-up, seven patients were alive and disease-free and six had died from metastatic disease. Four patients had had revision of the reconstruction, two for the treatment of mechanical complications and two for the treatment of infection. Three other patients had mechanical complications but had not had a revision. The cumulative probability of revision of the reconstruction for mechanical failure was 8% (95% confidence interval, 0% to 23%), 8% (95% confidence interval, 0% to 23%), and 16% (95% confidence interval, 0% to 39%) at one, two, and four years, respectively. Although it has attendant complications consistent with pelvic tumor surgery, an ipsilateral femoral autograft reconstruction may be an option for reconstruction of pelvic discontinuity in a subgroup of patients following tumor resection. This innovative procedure requires longer-term follow-up studies.

  14. Extracorporeal Pregnancy as a Feminist Issue

    Directory of Open Access Journals (Sweden)

    Iskra Krstić

    2015-10-01

    Full Text Available Extracorporeal pregnancy (ectogenesis presents perhaps the culmination of reproductive technology (NRT. Second wave feminism welcomed the use of NRT (including extracorporeal pregnancy as a means of women’s liberation. Later on, theories belonging to the third wave pointed out the negative implications of NRT and reclaimed the power of unassisted reproduction. This paper will try to point out some remaining productive potentials of NRT and extracorporeal pregnancy. The author wishes to explore the changes in the conceptualisation of the integrity of the individual in the context of the feminist critique of ectogenesis.

  15. The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup

    DEFF Research Database (Denmark)

    Lavergne, Valéry; Nolin, Thomas D; Hoffman, Robert S

    2012-01-01

    Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from...

  16. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

    OpenAIRE

    Tejsu Malla; Jing Jiang; Kai Hu

    2018-01-01

    AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively follo...

  17. Changes in the blood system after extracorporeal radiation

    International Nuclear Information System (INIS)

    Bobkov, Yu.I.; Yalikov, V.Ya.; Belopol'skij, A.A.; Alekseeva, L.M.; Apollonova, L.A.; Babayan, S.S.; Burkov, I.M.; Vasina, T.A.

    1985-01-01

    The effect of singles extracorporal blood irradiation (ECBI) on cellular and biochemical blood composition, activity of non specific immunity factors has been studied using no breed dogs. A shunt of plastic tube has been superimposed between the femoral artery and vein of the anesthetized animals and during 3h blood irradiation has been carried out for creating dose load from 6.0 to 12.0 Gy. It has been found that hematologic factors upon ECBI are changed unambiguously. Hemoglobin content and hematocrit are increased after irradiation. ESR factor somewhat increases during 7 days then it decreases, attainig 44% of the initial one by the end of the experiment. During 7 days upon ECBI a strongly pronounced leukocytosis is developed. Erythrocytes content for certain is increased on the 3-rd, 5-th and 7-th weeks of the experiment, respectively by 15, 17 and 31%. The change in the quantity of erythrocytes is accompanied by reconstruction in them of energy processes revealed on changing G-6-EDG and transketolaze activity. Simultaneously nucleic acids quantity in blood is increased in animals. In the course of 7-30 days upon irradiation the change of activity of a series of factors of natural immunity such as activity of lysozymb, β lysines content activity of β lytic properties is observed. When administering penicillin the increase of antibiotic activity in irradiated blood is pointed out. The data obtained in the authors opinion show the prospects in using the ECBI method for stimulation in organism of non specific protective mechanisms

  18. Surgical myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2003-05-01

    Full Text Available OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5% of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

  19. State of the art extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kandel, L.B. (State Univ. of New York at Stony Brook, Stony Brook, NY (US)); Harrison, L.H.; McCullough, D.L. (Wake Forest Univ. Medical Center, Winston-Salem, NC (US))

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL.

  20. State of the art extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kandel, L.B.; Harrison, L.H.; McCullough, D.L.

    1987-01-01

    This book contains 16 chapters. Some of the topics that are covered are: Extracorporeal Shock Wave Lithotripsy Development; Laser-Generated Extracorporeal Shock Wave Lithotripter; Radiation Exposure during ESWL; Caliceal Calculi; and Pediatric ESWL

  1. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  2. Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

    Science.gov (United States)

    Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

    2014-01-01

    It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

  3. Neuroradiology of extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Fitz, C.R.; Taylor, G.A.

    1986-01-01

    Extracorporeal membrane oxygenation (ECMO) is a new method of treating respiratory diseases, especially meconium aspiration, in newborns. It requires continued heparinization of the infant and carries the risk of intracranial bleeding. At the author's institution this risk is monitored with daily US examinations. CT is routinely performed at the end of treatment, or at other times to confirm the presence of any pathology that might require the cessation of ECMO treatment. Of the first 62 newborns receiving ECMO therapy, all underwent daily US examinations; 48 underwent CT. In ten patients (16%) hemorrhages developed that were detected on US; the incidence was evenly distributed between primary intraventricular and parenchymal bleeding. Five of these patients died without CT having been performed. Follow-up CT scans in another five also showed hemorrhage. In five patients CT scans showed definite small punctate areas of bleeding in unusual locations, not visible on US. CT scans in another four patients were suspicious for similar bleeding. One subarachnoid hemorrhage was found. In three infants performed widening of the interhemispheric fissure was seen, and six others had probable abnormal widening of the fissure. Overall, 14 (29%) CT scans were definitely abnormal and 21% probably abnormal. Follow-up has not been significantly long enough to allow evaluation the significance of the smaller bleeding areas and interhemispheric fissure widening seen on CT. At this time, both US and CT have a definite role in the care of newborn infants undergoing ECMO

  4. Successful vitrification and autografting of baboon (Papio anubis) ovarian tissue.

    Science.gov (United States)

    Amorim, Christiani A; Jacobs, Sophie; Devireddy, Ram V; Van Langendonckt, Anne; Vanacker, Julie; Jaeger, Jonathan; Luyckx, Valérie; Donnez, Jacques; Dolmans, Marie-Madeleine

    2013-08-01

    Can a vitrification protocol using an ethylene glycol/dimethyl sulphoxide-based solution and a cryopin successfully cryopreserve baboon ovarian tissue? Our results show that baboon ovarian tissue can be successfully cryopreserved with our vitrification protocol. Non-human primates have already been used as an animal model to test vitrification protocols for human ovarian tissue cryopreservation. Ovarian biopsies from five adult baboons were vitrified, warmed and autografted for 5 months. After grafting, follicle survival, growth and function and also the quality of stromal tissue were assessed histologically and by immunohistochemistry. The influence of the vitrification procedure on the cooling rate was evaluated by a computer model. After vitrification, warming and long-term grafting, follicles were able to grow and maintain their function, as illustrated by Ki67, anti-Müllerian hormone (AMH) and growth differentiation factor-9 (GDF-9) immunostaining. Corpora lutea were also observed, evidencing successful ovulation in all the animals. Stromal tissue quality did not appear to be negatively affected by our cryopreservation procedure, as demonstrated by vascularization and proportions of fibrotic areas, which were similar to those found in fresh ungrafted ovarian tissue. Despite our promising findings, before applying this technique in a clinical setting, we need to validate it by achieving pregnancies. In addition to encouraging results obtained with our vitrification procedure for non-human ovarian tissue, this study also showed, for the first time, expression of AMH and GDF-9 in ovarian follicles. This study was supported by grants from the Fonds National de la Recherche Scientifique de Belgique (grant Télévie No. 7.4507.10, grant 3.4.590.08 awarded to Marie-Madeleine Dolmans), Fonds Spéciaux de Recherche, Fondation St Luc, Foundation Against Cancer, and Department of Mechanical Engineering at Louisiana State University (support to Ram Devireddy), and

  5. Extracorporeal Shockwave Lithotripsy of Primary Intrahepatic Stones

    Science.gov (United States)

    Kim, Myung Hwan; Lee, Sung Koo; Min, Young Il; Lee, Mun Gyu; Sung, Kyu Bo; Cho, Kyung Sik; Lee, Sung Gyu; Min, Pyung Chul

    1992-01-01

    Extracorporeal shockwave lithothripsy (ESWL) was performed in intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n = 9) or percutaneous transhepatic biliary drainge tube (n = 9). Average treatment session was four and shock-wave numbers were in the range of 3,064 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shockwave lithothripsy was very helpful in facilitating extraction of stones in unfavorable locations or located above the severe stricture. In summary, extracorporeal Shockwave lithotripsy, followed by percutaneous stone extraction, will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis. PMID:1477027

  6. Extracorporeal Membrane Oxygenation for Complicated Scrub Typhus

    Directory of Open Access Journals (Sweden)

    Eun Sun Kim

    Full Text Available Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi . Although early diagnosis and appropriate antibiotic therapy improve the prognosis for the majority of patients, life-threatening complications are not uncommon. Here, we present a case of successful veno-veno-type extracorporeal membrane oxygenation for scrub typhus-induced complications, including acute respiratory distress syndrome, myocarditis and multi-organ dysfunction. To our knowledge, this is the first case report of successful extracorporeal membrane oxygenation in complicated scrub typhus in Korea.

  7. Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Do Wan Kim

    2015-05-01

    Full Text Available Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

  8. Reducing Postoperative Pterygium Recurrence: Comparison of Free Conjunctival Auto-Graft and Conjunctival Rotation Flap Techniques

    International Nuclear Information System (INIS)

    Akhter, W.; Tayyab, A.; Kausar, A.; Masrur, A.

    2014-01-01

    Objective: To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Study Design: Quasi-experimental study. Place and Duration of Study: Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Methodology: Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group (n=26) cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group (n=31) cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences (SPSS) version 20. Results: The median (and inter-quartile range) age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 (51.50 - 63.00) and 57 (45.00 - 60.00) years, 28.50 (27.00 - 30.50) and 16.00 (15.00 - 17.00) minutes respectively. Recurrence was seen in 2 (7.96%) and 3 (9.76%) cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups (p=0.60). Conclusion: The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and

  9. Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts.

    Science.gov (United States)

    Buescu, Cristian Tudor; Onutu, Adela Hilda; Lucaciu, Dan Osvald; Todor, Adrian

    2017-03-01

    The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level I Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  10. Severe hypoxemia during veno-venous extracorporeal membrane oxygenation: exploring the limits of extracorporeal respiratory support

    Directory of Open Access Journals (Sweden)

    Liane Brescovici Nunes

    2014-03-01

    Full Text Available OBJECTIVE: Veno-venous extracorporeal oxygenation for respiratory support has emerged as a rescue alternative for patients with hypoxemia. However, in some patients with more severe lung injury, extracorporeal support fails to restore arterial oxygenation. Based on four clinical vignettes, the aims of this article were to describe the pathophysiology of this concerning problem and to discuss possibilities for hypoxemia resolution. METHODS: Considering the main reasons and rationale for hypoxemia during veno-venous extracorporeal membrane oxygenation, some possible bedside solutions must be considered: 1 optimization of extracorporeal membrane oxygenation blood flow; 2 identification of recirculation and cannula repositioning if necessary; 3 optimization of residual lung function and consideration of blood transfusion; 4 diagnosis of oxygenator dysfunction and consideration of its replacement; and finally 5 optimization of the ratio of extracorporeal membrane oxygenation blood flow to cardiac output, based on the reduction of cardiac output. CONCLUSION: Therefore, based on the pathophysiology of hypoxemia during veno-venous extracorporeal oxygenation support, we propose a stepwise approach to help guide specific interventions.

  11. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad

    2017-01-01

    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  12. Extracorporeal shockwave therapy in musculoskeletal disorders

    OpenAIRE

    Wang, Ching-Jen

    2012-01-01

    Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave ...

  13. Frequency of stone clearance after extracorporeal shockwave ...

    African Journals Online (AJOL)

    Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent ESWL. The indications for ESWL were determined by the ...

  14. Extracorporeal total artificial heart as bailout surgery.

    Science.gov (United States)

    Perrodin, Stéphanie F; Muller, Olivier; Gronchi, Fabrizio; Liaudet, Lucas; Hullin, Roger; Kirsch, Matthias

    2017-03-01

    We report the use of a total extracorporeal heart for uncontrolled bleeding following a proximal left anterior descending artery perforation, using two centrifugal ventricular assist devices after heart explantation. The literature describing similar techniques and patient outcomes for this "bailout" technique are reviewed. © 2017 Wiley Periodicals, Inc.

  15. Proximal hamstring reconstruction using semitendinosus and gracilis autograft: a novel technique.

    Science.gov (United States)

    Muellner, Thomas; Kumar, Sandeep; Singla, Amit

    2017-01-01

    The complete proximal hamstring avulsion is relatively uncommon injury and predominantly occurs in young athletes but causes significant functional impairment. In chronic cases, the muscle mass is so much retracted that primary repair is not possible. A surgical technique for reconstruction of chronic proximal hamstring avulsion using contralateral semitendinosus and gracilis autograft is described in this case report. V.

  16. Production of functional sperm by subcutaneous auto-grafting of immature testes in rainbow trout.

    Science.gov (United States)

    Hayashi, Makoto; Sakuma, Daika; Yoshizaki, Goro

    2018-02-01

    Sexually mature individuals are indispensable for breeding programs. Salmonids require a long period before reaching sexual maturity, so we aimed to shorten the period required to obtain functional sperm by grafting immature testicular fragments into mature recipients, which we predicted would allow the grafted testicular fragments to skip the long pre-pubertal period. First, we demonstrated successful subcutaneous auto-grafting of testicular fragments in rainbow trout. Unilateral testectomy was performed, and the isolated immature testicular fragment was auto-grafted into the subcutaneous space along the back of recipient fish. The grafted testicular fragments developed synchronously with the recipients' testis remaining in its body cavity, and both eventually produced functional sperm. Next, immature testicular fragments were auto-grafted into the subcutaneous space of sexually mature males. We achieved this, without immune rejection, by isolating and cryopreserving testes from immature fish, and rearing these unilaterally testectomized fish until sexual maturity. The cryopreserved testes were then auto-grafted into the original, now spermiating fish. The grated immature testicular fragments differentiated and produced functional sperm within 5 months after grafting. By combining this grafting method with a technique to avoid immune rejection, we expect to develop a practical method for producing sperm in a shorter period in salmonids. © 2017 Wiley Periodicals, Inc.

  17. [Experimental work: reconstruction of the pelvi-ureteric junction and ureter using testicular tunica vaginalis autograft].

    Science.gov (United States)

    Usupbaev, A Ch; Kurbanaliev, R M; Chernetsova, G S; Kolesnichenko, I V; Sultanov, B M; Myrzakanov, N M; Zolotukhin, A O; Vagner, N A

    2017-12-01

    To evaluate the results of surgical reconstruction of the upper urinary tract using an autograft of testicular tunica vaginalis in experimental animals. The article presents the results of partial replacement of the renal pelvis and ureter with an autograft in 25 male dogs. The grafts were harvested by resection of the parietal layer of the testicular tunica vaginalis, which was transplanted into the region of the pelvi-ureteric junction and the proximal ureter. The upper urinary tract was drained using a ureteral stent catheter. The results were evaluated at week 1 and months 1, 3 and six after the operation. The functional state of the kidneys and ureters was analyzed using excretory urography and ultrasound; the autograft biopsy specimens were examined histologically. In all cases, the viability of the autograft was completely preserved, there were no signs of secondary infection, necrosis and impaired patency in the anastomosis zone. Histological examination revealed signs of epithelialization, connective tissue substitution and neovasculogenesis in the implantation zone. The proposed surgical modality is an alternative method to restore normal urine flow in the upper urinary tract in obstructive urological diseases. The group of obstructive urological diseases was studied using the model of the strictures of the pelvi-ureteric junction in the intrarenal pelvis and ureteral strictures measuring up to 3-4 cm in length.

  18. Extracorporeal life support in pediatric cardiac patients

    Directory of Open Access Journals (Sweden)

    Matteo Di NARDO

    2016-10-01

    Full Text Available Extracorporeal Life Support (ECLS is a valuable tool in the management of neonates and older children with severe cardiac or respiratory failure. In this review, we focus on ECLS when used for neonatal and pediatric cardiac disease. Strict selection of patients and timely deployment are necessary to optimize outcomes. Although every attempt should be made to deploy ECLS urgently rather than emergently, extracorporeal cardiopulmonary resuscitation (ECPR is being increasingly used and reasonable survival rates have been achieved after initiation of ECLS during active compressions of the chest following in-hospital cardiac arrest. Contraindications to ECLS are falling over time, although lethal chromosomal abnormalities, severe irreversible brain injury, and extremely low gestational age and weight (<32 weeks gestation or <1.5 kg remain firm contraindications.

  19. Extracorporeal treatment for tricyclic antidepressant poisoning

    DEFF Research Database (Denmark)

    Yates, Christopher; Galvao, Tais; Sowinski, Kevin M

    2014-01-01

    The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined...... methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND...... yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers...

  20. Optimal time for initiating extracorporeal membrane oxygenation.

    Science.gov (United States)

    Haile, Dawit T; Schears, Gregory J

    2009-09-01

    The technical evolution of extracorporeal membrane oxygenation (ECMO) coincides with the vast improvement in intensive care medicine of the past 4 decades. Extracorporeal circulatory technology substitutes for acutely failed cardiac or pulmonary function until these organs regain sustainable function through goal-oriented intensive care practice. The technology has been validated to improve survival in select patients who would otherwise have 100% mortality. This is by far the most complex life-sustaining technology employed and thus can contribute significant risks such that the decision to institute ECMO requires prompt risk and benefit analysis. Delaying the institution of ECMO may cause irreversible pulmonary and cardiac injuries in addition to other organs. Therefore, the optimal time of initiating ECMO support is crucial to the survival of a critically ill patient.

  1. Extracorporeal shockwave for chronic patellar tendinopathy.

    Science.gov (United States)

    Wang, Ching-Jen; Ko, Jih-Yang; Chan, Yi-Sheng; Weng, Lin-Hsiu; Hsu, Shan-Lin

    2007-06-01

    Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Randomized controlled clinical trial; Level of evidence, 2. This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm(2) energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 +/- 10.22 and 39.25 +/- 10.85, respectively, before treatment (P = .129) and 92.0 +/- 10.17 and 41.04 +/- 10.96, respectively, after treatment (P Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

  2. Nitric oxide : An ally in extracorporeal circulation?

    OpenAIRE

    Melki, Vilyam

    2016-01-01

    Many complications associated with heart surgery are due to the negative effects of extracorporeal circulation (ECC). Some of these complications may be attributed to ECC-induced activation of inflammation and coagulation pathways. The inflammatory reaction may be caused by the interaction of blood components with air and the artificial surfaces of the ECC, from substances produced due to ischaemia-reperfusion injury of the heart and lungs, and from increased release of endotoxin from ischemi...

  3. Extracorporeal photopheresis: Review of technical aspects.

    Science.gov (United States)

    Arora, Satyam; Setia, Rasika

    2017-01-01

    Extracorporeal photochemotherapy (ECP) is considered as an immune modulating therapy majorly targeting the T cells of the Immune system. ECP induces an anti-inflammatory condition with tolerogenic responses without inducing a global immunosuppression state which is a typical feature of other therapeutic options such as steroids. Clinical indication of ECP has grown over time since its initial applications. Our review discusses the technical aspects of the concept of photopheresis with the available methods for its clinical applications.

  4. Kidney changes after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Yoshioka, Hiroyasu; Shindo, Hiroshi; Mabuchi, Nobuhisa; Kawakami, Akira; Fujii, Koichi; Hamada, Tatsumi; Ishida, Osamu; Umekawa, Toru; Kohri, Kenjiro

    1991-01-01

    MRI was performed before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Of the 40 kidneys studied, 24 showed one or more changes on MRI: loss of the corticomedullary junction (n=15), subcapsular fluid (n=14), subcapsular hematoma (n=1), thickening of bridging septa (n=8), high intensity area in the muscle (n=8). These relatively subtle changes detected on MRI may not be apparent with other imaging techniques. (author)

  5. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction?

    DEFF Research Database (Denmark)

    Olsen, Anne B; Persiani, Marie; Boie, Sidsel

    2015-01-01

    OBJECTIVE: The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. MATERIALS AND METHODS: This prospective, randomized, blinded, placebo-controlled study included 112 ...... are needed. KEYWORDS: Erectile dysfunction; extracorporeal shockwave; penis...

  6. Extracorporeal shock wave lithotripsy of biliary and pancreatic stones

    NARCIS (Netherlands)

    R. den Toom (Rene)

    1993-01-01

    textabstractThe aim of the study was to answer the following questions: Is extracorporeal shock wave lithotripsy for gallbladder stones a safe and effective therapy? (Chapter 2) Is simultaneous treatment with extracorporeal shock wave lithotripsy and the solvent methyl te.rt-butyl ether feasible,

  7. Combined Conjunctival Autograft and Overlay Amniotic Membrane Transplantation; a Novel Surgical Treatment for Pterygium

    Directory of Open Access Journals (Sweden)

    Siamak Zarei Ghanavati

    2014-01-01

    Full Text Available The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0 years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate. No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.

  8. One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

    Science.gov (United States)

    Kejriwal, Ritwik; Buelow, Jens

    2017-01-01

    Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

  9. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

    Science.gov (United States)

    Epstein, Nancy E.

    2012-01-01

    Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

  10. Number and Quality of Oocytes Collected from Heterotopic Autografted Mice Ovary after PMSG Induction

    Directory of Open Access Journals (Sweden)

    NURBARIAH

    2011-12-01

    Full Text Available Heterotopic grafting sites can be useful in producing oocytes for in vitro Fertilization, therefore, maximising the oocyte yield from the graft by gonadotrophin stimulation would be advantageous. The aim of this study was to investigate the number and quality of oocytes collected from heterotopic autografted ovary after Pregnant Mare Serum Gonadothropin (PMSG induction. Graft recipients were treated either with or without PMSG stimulation 48 hours prior to graft collection. Ovarian tissue from four weeks old mice (DDY strain were autotransplanted under the kidney capsule of the same ovariectomized mice and the oocytes were collected 21 days after autotransplantation. The results showed that the average number of oocytes collected from autografted ovaries without PMSG induction were 9.0. ± 2.8 not significantly different with those received PMSG induction, 10.9 ± 5.1. The percentage of matured and fertilized oocytes and the developed embryos from the autografted ovaries without PMSG induction were 52.4, 33.4, and 26.0%, respectively not significantly different with those received PMSG induction, 53.2, 35.1, and 29.9%, respectively. The number of oocytes and the capacity to matured, fertilized and developed were significantly lower (P < 0.05 compared to the superovulated nongrafted (control ovaries. In conclusion, PMSG induction on the graft recipients did not significantly increase oocytes yield from grafted heterotopic ovaries. The number and quality of oocytes produced from the autografted ovaries were lower than the superovulated nongrafted ovaries, but still can be used for in vitro embryo production after sequential in vitro maturation and fertilization.

  11. Inverse Implantation and Rapid Postoperative Necrosis of Conjunctival Autograft in Pterygium Surgery

    Directory of Open Access Journals (Sweden)

    Murat Küçükevcilioğlu

    2012-07-01

    Full Text Available A 72 year-old female underwent surgery for nasal pterygium in the right eye. Conjunctival autograft with Mytomycine-C was performed. In the postoperative period slit lamp examination revealed a pale and avascular appearance of the conjunctival graft. On postoperative fifth day inverse graft implantation and graft necrosis was diagnosed. The graft was removed. We herein discuss the reason and possible preventive measures of this unusual outcome. (Turk J Oph thal mol 2012; 42: 298-9

  12. Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft

    International Nuclear Information System (INIS)

    Virendra K. Malik; Sandeep Kumar

    2010-01-01

    To evaluate whether use of fibrin glue instead of sutures for the treatment of recurrent pterygium with conjunctival auto-graft (CAG) further decreases its recurrence. A prospective, clinical open trial of 50 eyes of 50 patients with recurrent pterygium, who were randomly assigned to either, pterygium excision and CAG with fibrin glue (Group 1) or with 6 interrupted sutures (Group 2), was carried out from January 2009 to July 2010 at the outpatient department of Subharti Medical College, Meerut, North India. Both groups had 25 patients each. The groups were compared with regards to the surgical time taken, development of recurrence, postoperative symptoms (irritation, watering, and redness), and complications. Recurrence was seen in one (4%) eye in group I, and 3 (12%) eyes in group II after 9-13 months of follow up. The difference between the 2 groups was not statistically significant. The surgical time was significantly reduced, and postoperative inflammation and complications were less in group I. Postoperative symptoms were significantly more in group II patients. While conjunctival autograft with sutures for management of recurrent pterygium appears to be a safe and feasible modality, fibrin glue fixation of the autograft is a more viable option in terms of surgical ease, less time consuming, less postoperative complications, and less recurrence (Author).

  13. MRI of anterior cruciate ligament repair with patellar and hamstring tendon autografts

    International Nuclear Information System (INIS)

    Jansson, K.A.; Karjalainen, P.T.; Harilainen, A.; Sandelin, J.; Tallroth, K.; Soila, K.; Aronen, H.J.

    2001-01-01

    Objective. Several MRI sequences were used to evaluate the 2-year postoperative appearance of asymptomatic knee with a torn anterior cruciate ligament (ACL) reconstructed with bone-patellar tendon-bone (BTB) and semitendinosus and gracilis (STG) tendon autografts.Design and patients. Two groups with successful repair of ACL tear with BTB (n=10) or STG (n=10) autografts were imaged at 1.5 T with sagittal and oblique coronal proton density-, T2-weighted and sagittal STIR sequences and plain and contrast-enhanced oblique coronal T1-weighted sequences. The appearance of the graft and periligamentous tissues was evaluated.Results. In all 20 cases, the ACL graft showed homogeneous, low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted images. In 10 cases, localised areas of intermediate signal intensity were seen in the intra-articular segment of the graft on proton density- and T1-weighted images. The graft itself did not show enhancement in either of the two groups, but mild to moderate periligamentous enhancement was detected in 10 cases.Conclusion. The MRI appearance of ACL autograft is variable on proton density- and T1-weighted images. Periligamentous tissue showing contrast enhancement is a typical MRI finding after clinically successful ACL reconstruction. (orig.)

  14. [Biomaterials for bone filling: comparisons between autograft, hydroxyapatite and one highly purified bovine xenograft].

    Science.gov (United States)

    Chappard, D; Zhioua, A; Grizon, F; Basle, M F; Rebel, A

    1993-12-01

    Bone grafts are becoming increasingly common in orthopaedics, neurosurgery and periodontology. Twenty one New Zealand rabbits were used in the present study comparing several materials usable as bone substitutes. A 4.5 mm hole was drilled in the inner femoral condyles. Holes were filled with either an autograft (from the opposite condyle), an hydroxylapatite (Bioapatite), or a highly purified bovine xenograft (T650 Lubboc). Animals were sacrificed at 1, 3 and 6 months post implantation and a quantitative analysis of newly-formed bone volume (BNF/IV) and remaining biomaterials (BMAT/IV) was done. In addition, some holes were left unfilled and served as controls. At 6 months, there was no tendency for spontaneous repair in the control animals. The autografted animals have repaired their trabecular mass and architecture within the first month. Hydroxylapatite appeared unresorbed at six months and only thin and scanty new trabeculae were observed. The xenograft induced woven bone trabeculae formation on the first month. This was associated with resorption of the material by two multinucleated cell populations. At six months, the epiphyseal architecture was restored and the biomaterial has disappeared in most cases. Xenografts appear a promising alternative to autografts and allografts, whose infectious risks and ethical problems should always be borne in mind.

  15. Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

    Science.gov (United States)

    Hurley, Eoghan T; Calvo-Gurry, Manuel; Withers, Dan; Farrington, Shane K; Moran, Ray; Moran, Cathal J

    2018-05-01

    To systematically review the current evidence to ascertain whether quadriceps tendon autograft (QT) is a viable option in anterior cruciate ligament reconstruction. A literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Cohort studies comparing QT with bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT) were included. Clinical outcomes were compared, with all statistical analyses performed using IBM SPSS Statistics for Windows, version 22.0, with P < .05 being considered statistically significant. We identified 15 clinical trials with 1,910 patients. In all included studies, QT resulted in lower rates of anterior knee pain than BPTB. There was no difference in the rate of graft rupture between QT and BPTB or HT in any of the studies reporting this. One study found that QT resulted in greater knee stability than BPTB, and another study found increased stability compared with HT. One study found that QT resulted in improved functional outcomes compared with BPTB, and another found improved outcomes compared with HT, but one study found worse outcomes compared with BPTB. Current literature suggests QT is a viable option in anterior cruciate ligament reconstruction, with published literature showing comparable knee stability, functional outcomes, donor-site morbidity, and rerupture rates compared with BPTB and HT. Level III, systematic review of Level I, II, and III studies. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Nodular Scleroderma - Successful Treatment With Extracorporeal Photochemotherapy

    Directory of Open Access Journals (Sweden)

    Wollina U

    2001-01-01

    Full Text Available Nodular seleroderma is rare variant of circumscribed scleroderma (morphea. Treatment is often unsatisfactory. This report is on the use of extracorporeal photochemotherapy. A 12 year old girl and a 49 year old woman have been treated once a month on two consecutive days. A complete remission was achieved in one patient after 10 months and an almost complete remission in the young girl after 6 months. The treatment was well-tolerated and no severe side â€" effects occurred. In contrast to previous attempts in treating nodular scleroderma with different modalities, ECP seems to be an effective therapy.

  17. Extracorporeal shock wave therapy (ESWT) in urology

    DEFF Research Database (Denmark)

    Fojecki, Grzegorz Lukasz; Thiessen, Stefan; Osther, Palle Jörn Sloth

    2017-01-01

    PURPOSE: The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. METHODS: We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline...... deviation and plaque size were observed. Four studies on erectile dysfunction (ED) including 337 participants were included. Using International Index of Erectile Function (IIEF-EF) and erectile hardness scale (EHS) data suggested a significant positive effect of ESWT in phosphodiesterase-5 inhibitor (PDE-5...

  18. A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

    Science.gov (United States)

    Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

    2016-03-01

    Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

  19. The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery

    NARCIS (Netherlands)

    Yuruk, Koray; Bezemer, Rick; Euser, Mariska; Milstein, Dan M. J.; de Geus, Hilde H. R.; Scholten, Evert W.; de Mol, Bas A. J. M.; Ince, Can

    2012-01-01

    OBJECTIVES: To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery

  20. Guidelines on the use of extracorporeal photopheresis.

    Science.gov (United States)

    Knobler, R; Berlin, G; Calzavara-Pinton, P; Greinix, H; Jaksch, P; Laroche, L; Ludvigsson, J; Quaglino, P; Reinisch, W; Scarisbrick, J; Schwarz, T; Wolf, P; Arenberger, P; Assaf, C; Bagot, M; Barr, M; Bohbot, A; Bruckner-Tuderman, L; Dreno, B; Enk, A; French, L; Gniadecki, R; Gollnick, H; Hertl, M; Jantschitsch, C; Jung, A; Just, U; Klemke, C-D; Lippert, U; Luger, T; Papadavid, E; Pehamberger, H; Ranki, A; Stadler, R; Sterry, W; Wolf, I H; Worm, M; Zic, J; Zouboulis, C C; Hillen, U

    2014-01-01

    After the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. In order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. These guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion. © 2013 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.

  1. Outcome of Extracorporeal Shock Wave Lithotripsy

    Directory of Open Access Journals (Sweden)

    B Shrestha

    2010-03-01

    Full Text Available NTRODUCTION: Extracorporeal Shock Wave Lithotripsy is an effective noninvasive method to treat urolithiasis. This study aims to evaluate itsoutcome and determine appropriate management strategies for urolithiasis. METHODS: It was a prospective study which included one hundred patients who underwent ESWL for the management of solitary urolithiasis during a period of eight months (December 2007-August 2008. Status of stone and complications were observed and managed accordingly within a period of six postoperative weeks. RESULTS: Out of 100 patients, 93% had complete clearance of stone by the end of six postoperative weeks. Seven percent of the patients required adjunct invasive intervention including open surgery in 3%. Number of sessions of ESWL was found to increase as the size of stone increased. However, in three patients stones were completely refractory to ESWL even after two consecutive sessions. CONCLUSIONS: ESWL is highly effective noninvasive modality in the management of urolithiasis in appropriately selected patients. Keywords: double J stent, extracorporal shockwave lithotripsy, steinstrasse, ultrasonography, ureterorenoscopy.

  2. Extracorporeal Circulation Using an Extracorporeal Membrane Oxygenation System and an Autotransfusion System

    Directory of Open Access Journals (Sweden)

    Yu. A. Bakhareva

    2010-01-01

    Full Text Available The authors draw attention to the fact that complete cardiopulmonary bypass can be made in the emergency situation in order to perform an extracorporeal membrane oxygenation (ECMO procedure in a 5-year-old boy weighing 15 kg, diagnosed as having Fallot tetrad. By taking into account the technological features of the system for ECMO, there is an additional need for a blood cell separator to be applied.

  3. Guidelines for reporting case studies on extracorporeal treatments in poisonings

    DEFF Research Database (Denmark)

    Lavergne, Valéry; Ouellet, Georges; Bouchard, Josée

    2014-01-01

    A literature review performed by the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup highlighted deficiencies in the existing literature, especially the reporting of case studies. Although general reporting guidelines exist for case studies, there are none in the specific field...... of extracorporeal treatments in toxicology. Our goal was to construct and propose a checklist that systematically outlines the minimum essential items to be reported in a case study of poisoned patients undergoing extracorporeal treatments. Through a modified two-round Delphi technique, panelists (mostly chosen...... reports containing data on extracorporeal treatments in poisoning published in Medline in 2011 were reviewed during the external validation rounds. Twenty-one panelists (20 from the EXTRIP workgroup and an invited expert on pharmacology reporting guidelines) participated in the modified Delphi technique...

  4. Cerebral aspects of neonatal extracorporeal membrane oxygenation: a review.

    NARCIS (Netherlands)

    Mol, A.C. de; Liem, K.D.; Heijst, A.F.J. van

    2013-01-01

    Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral

  5. LEUKOCYTE AND PLATELET ACTIVATION DURING EXTRACORPOREAL-CIRCULATION

    NARCIS (Netherlands)

    VANOEVEREN, W

    1994-01-01

    Extracorporeal circulation of blood has become a routine procedure in plasmapheresis, hemodialysis and cardiopulmonary bypass. Specifically in cardiopulmonary bypass, blood is exposed to a large material surface area, which induces an inflammatory reaction and bleeding disorders. It has been

  6. Long-term results of bone-retinaculum-bone autograft for scapholunate instability.

    Science.gov (United States)

    Soong, Maximillian; Merrell, Gregory A; Ortmann, Fred; Weiss, Arnold-Peter C

    2013-03-01

    To report long-term follow-up of scapholunate interosseous ligament reconstruction with bone-retinaculum-bone autograft in patients with dynamic scapholunate instability. Of the 14 patients from the previously reported cohort who had bone-retinaculum-bone autograft for dynamic instability, 6 returned for clinical examination and radiographs, 3 were reached by telephone, and 2 were lost to follow-up. The remaining 3 had salvage procedures (2 total wrist arthrodeses and 1 proximal row carpectomy) between the prior report and the current study and thus reached an endpoint, at 2 to 4 years. For the 6 who returned, outcome measurements included scapholunate angle and gap, radiographic evidence of secondary arthritis, wrist extension and flexion, grip strength, and Mayo wrist score. Follow-up averaged 11.9 years (range, 10.7-14.1 y). Clinical and radiographic outcomes deteriorated moderately from the prior report. Mayo wrist score averaged 83. There were 3 failures, resulting in 1 proximal row carpectomy and 2 total wrist arthrodeses. Findings at repeat surgery in the failed group included an intact graft without any apparent abnormalities, a partially ruptured graft (after a subsequent re-injury), and a completely resorbed graft. Bone-retinaculum-bone autograft reconstruction is a viable treatment option for dynamic scapholunate instability in which the scaphoid and lunate can be reduced. Results may deteriorate but are similar to those reported previously from other techniques. Problems with graft strength or stiffness may necessitate further surgery. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions.

    Science.gov (United States)

    Pluchino, F; Luccarelli, G

    1981-05-01

    Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

  8. Plasmapheresis and other extracorporeal filtration techniques in critical patients.

    Science.gov (United States)

    Daga Ruiz, D; Fonseca San Miguel, F; González de Molina, F J; Úbeda-Iglesias, A; Navas Pérez, A; Jannone Forés, R

    2017-04-01

    Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  9. Extracorporeal respiratory support in adult patients

    Directory of Open Access Journals (Sweden)

    Thiago Gomes Romano

    Full Text Available ABSTRACT In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO, which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.

  10. EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL PADA BATU GINJAL

    Directory of Open Access Journals (Sweden)

    Anak Agung Sri Satyawati

    2014-09-01

    Full Text Available Latar Belakang. Extracorporeal shockwave lithotripsy (ESWL merupakan pilihan terapi yang paling cost effective pada kasus kasus batu ginjal, namun sayangnya modalitas terapi ini belum banyak dipilih karena dianggap mahal dan kurangnya informasi mengenai keuntungan penggunaannya. Kasus. Perempuan usia 65 tahun mengeluh nyeri pinggang yang dirasakan mendadak dan semakin memberat  sejak 2 bulan sebelum masuk rumah sakit, disertai mual dan penurunan nafsu makan. Berdasarkan pemeriksaan foto polos abdomen dan USG Urologi  didapatkan kesan adanya batu renal dekstra ukuran 16mm x 18mm, dengan hidronefrosis derajat I renal dekstra. Kemudian dilakukan tindakan ESWL. Hasil. Setelah dilakukan tindakan ESWL berupa penghantaran gelombang kejut pada permukaan ginjal  kanan selama 20-30 menit, keluar pecahan pecahan kecil batu kalsium. Berdasarkan pemeriksaan radiografi post ESWL tidak ditemukan gambaran radioopak pada kaliks ginjal, ureter maupun kandung kemih. Kesimpulan. Batu kalsium dengan ukuran 16mm x 18mm pada renal dekstra berhasil dikeluarkan total tanpa adanya komplikasi.

  11. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

    Science.gov (United States)

    Malla, Tejsu; Jiang, Jing; Hu, Kai

    2018-01-01

    AIM To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below), 18 (10, 8) and 2 (1, 1) in groups A, B, and C respectively; dry eyes were 22 (16, 6), 27 (18, 9) and 7 (3, 4); conjunctival inflammations were 30 (17, 13), 27 (16, 11) and 11 (6, 5). Patients in group C (either primary or recurrent or both) mainly showed significantly better results than those in group A or B (P<0.05) regarding above-mentioned clinical effects. CONCLUSION Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone. PMID:29600172

  12. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

    Directory of Open Access Journals (Sweden)

    Tejsu Malla

    2018-03-01

    Full Text Available AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT, conjunctival autograft transplantation (CAT alone and amniotic membrane transplantation (AMT alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent who underwent CAT (group A, AMT (group B or CAT with AMT (group C respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS: The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below, 18 (10, 8 and 2 (1, 1 in groups A, B, and C respectively; dry eyes were 22 (16, 6, 27 (18, 9 and 7 (3, 4; conjunctival inflammations were 30 (17, 13, 27 (16, 11 and 11 (6, 5. Patients in group C (either primary or recurrent or both mainly showed significantly better results than those in group A or B (P<0.05 regarding above-mentioned clinical effects. CONCLUSION: Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

  13. Extracorporeal Membrane Oxygenation for Adult Community-Acquired Pneumonia: Outcomes and Predictors of Mortality.

    Science.gov (United States)

    Ramanathan, Kollengode; Tan, Chuen Seng; Rycus, Peter; MacLaren, Graeme

    2017-05-01

    Extracorporeal membrane oxygenation is a rescue therapy used to support severe cardiorespiratory failure. Data on outcomes from severe community-acquired pneumonia in adults receiving rescue extracorporeal membrane oxygenation are mainly confined to single-center experiences or specific pathogens. We examined data from the Extracorporeal Life Support Organisation registry to identify risk factors for poor outcomes in adult patients with community-acquired pneumonia. Retrospective data analysis. Extracorporeal Life Support Organization Registry database. We collected deidentified data on adult patients (> 18 yr) receiving extracorporeal membrane oxygenation for community-acquired pneumonia between 2002 and 2012. Patients with incomplete data or brain death were excluded. The primary outcome measure was in-hospital mortality. Other measurements included demographic information, pre-extracorporeal membrane oxygenation mechanical ventilation and biochemical variables, inotrope requirements, extracorporeal membrane oxygenation mode, duration, and complications. Initial univariate analysis assessed potential associations between survival and various pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation factors. Variables with p values of less than 0.1 were considered for logistic regression analysis to identify predictors of mortality. None. One thousand fifty-five patients, who satisfied inclusion criteria, were included in the final analysis. There was an increase in the number of patients cannulated per annum over the 10-year period studied. Univariate analysis identified pre-extracorporeal membrane oxygenation and extracorporeal membrane oxygenation variables associated with high mortality. Further multiple regression analysis identified certain pre-extracorporeal membrane oxygenation factors as predictors of mortality, including duration of mechanical ventilation prior to extracorporeal membrane oxygenation, lower arterial pressure, fungal

  14. The Effect of Iliac Crest Autograft on the Outcome of Fusion in the Setting of Degenerative Spondylolisthesis

    Science.gov (United States)

    Radcliff, Kristen; Hwang, Raymond; Hilibrand, Alan; Smith, Harvey E.; Gruskay, Jordan; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd; Weinstein, James

    2012-01-01

    Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22878599

  15. Ectopic bone formation in bone marrow stem cell seeded calcium phosphate scaffolds as compared to autograft and (cell seeded allograft

    Directory of Open Access Journals (Sweden)

    J O Eniwumide

    2007-08-01

    Full Text Available Improvements to current therapeutic strategies are needed for the treatment of skeletal defects. Bone tissue engineering offers potential advantages to these strategies. In this study, ectopic bone formation in a range of scaffolds was assessed. Vital autograft and devitalised allograft served as controls and the experimental groups comprised autologous bone marrow derived stem cell seeded allograft, biphasic calcium phosphate (BCP and tricalcium phosphate (TCP, respectively. All implants were implanted in the back muscle of adult Dutch milk goats for 12 weeks. Micro-computed tomography (µCT analysis and histomorphometry was performed to evaluate and quantify ectopic bone formation. In good agreement, both µCT and histomorphometric analysis demonstrated a significant increase in bone formation by cell-seeded calcium phosphate scaffolds as compared to the autograft, allograft and cell-seeded allograft implants. An extensive resorption of the autograft, allograft and cell-seeded allograft implants was observed by histology and confirmed by histomorphometry. Cell-seeded TCP implants also showed distinct signs of degradation with histomorphometry and µCT, while the degradation of the cell-seeded BCP implants was negligible. These results indicate that cell-seeded calcium phosphate scaffolds are superior to autograft, allograft or cell-seeded allograft in terms of bone formation at ectopic implantation sites. In addition, the usefulness of µCT for the efficient and non-destructive analysis of mineralised bone and calcium phosphate scaffold was demonstrated.

  16. Repair of sheep long bone cortical defects filled with COLLOSS, COLLOSS E, OSSAPLAST, and fresh iliac crest autograft.

    Science.gov (United States)

    Huffer, William E; Benedict, James J; Turner, A S; Briest, Arne; Rettenmaier, Robert; Springer, Marco; Walboomers, X F

    2007-08-01

    COLLOSS and COLLOSS E are osteoinductive bone void fillers consisting of bone collagen and noncollagenous proteins from bovine and equine bone, respectively. The aim of this study was to compare COLLOSS, COLLOSS E, iliac bone autograft, sintered beta tricalcium phosphate (beta-TCP; OSSAPLAST), and COLLOSS E plus OSSAPLAST. Materials were placed for 4, 8, or 24 weeks in 5-mm cortical bone defects in sheep long bones. Histological sections in a plane perpendicular to the long axis of the bone were used to measure the total repair area (original defect plus callus) and the area of bone within the total repair area. The incidence of defect union was also evaluated. At 4 and 8 weeks, defects treated with COLLOSS and COLLOSS E with or without OSSAPLAST had total repair and bone areas equivalent to autograft, and larger than OSSAPLAST-treated defects. At 8 weeks, the incidence of defect union was higher in defects treated with autograft or COLLOSS E plus OSSAPLAST than in untreated defects. At 24 weeks, the incidence of union was 100% in all treatment groups and 0% in untreated defects. The incidence of union was related to the degree of remodeling between 8 and 24 weeks. This was greater in all treated than nontreated defects. In conclusion, COLLOSS and COLLOSS E were equivalent to each other and to autograft, and superior to beta-TCP, in this study model.

  17. Repair of sheep long bone cortical defects filled with COLLOSS, COLLOSS E, OSSAPLAST, and fresh iliac crest autograft.

    NARCIS (Netherlands)

    Huffer, W.E.; Benedict, J.J.; Turner, A.S.; Briest, A.; Rettenmaier, R.; Springer, M.; Walboomers, X.F.

    2007-01-01

    COLLOSS and COLLOSS E are osteoinductive bone void fillers consisting of bone collagen and noncollagenous proteins from bovine and equine bone, respectively. The aim of this study was to compare COLLOSS, COLLOSS E, iliac bone autograft, sintered beta tricalcium phosphate (beta-TCP; OSSAPLAST), and

  18. OP-1 compared with iliac crest autograft in instrumented posterolateral fusion a randomized, multicenter non-inferiority trial

    NARCIS (Netherlands)

    Delawi, Diyar; Jacobs, Wilco; Van Susante, Job L C; Rillardon, Ludovic; Prestamburgo, Domenico; Specchia, Nicola; Gay, Emmanuel; Verschoor, Nico; Garcia-Fernandez, Carlos; Guerado, Enrique; Van Ufford, Henriette Quarles; Kruyt, Moyo C.; Dhert, Wouter J A; Cumhur Oner, F.

    2016-01-01

    Background: Spinal fusion with the use of autograft is a commonly performed procedure. However, harvesting of bone from the iliac crest is associated with complications. Bone morphogenetic proteins (BMPs) are extensively used as alternatives, often without sufficient evidence of safety and efficacy.

  19. Extracorporeal respiratory support in adult patients.

    Science.gov (United States)

    Romano, Thiago Gomes; Mendes, Pedro Vitale; Park, Marcelo; Costa, Eduardo Leite Vieira

    2017-01-01

    In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation. RESUMO Em pacientes com insuficiência respiratória grave (hipoxêmica ou hipercápnica), o suporte somente com ventilação mecânica pode ser insuficiente para suas necessidades, especialmente quando se tenta evitar o uso de parâmetros ventilatórios que possam causar danos aos pulmões. Nesses pacientes, extracorporeal membrane oxygenation (ECMO, oxigenação extracorpórea por membrana), que também é muito eficaz na remoção de dióxido de carbono do sangue, pode manter a vida, permitindo o uso de ventilação pulmonar protetora. No presente artigo de revisão, objetivamos explorar alguns dos aspectos mais relevantes do suporte respiratório por ECMO. Discutimos a história do suporte respiratório por ECMO em adultos; evidências clínicas; custos; indicações; instalação do equipamento; parâmetros ventilatórios; cuidado diário do paciente e do sistema; solução de problemas comuns; desmame e descontinuação.

  20. Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity.

    Science.gov (United States)

    Dolan, Christopher M; Henning, Jeffrey A; Anderson, John G; Bohay, Donald R; Kornmesser, Marc J; Endres, Terrence J

    2007-01-01

    Operative treatment of stage II posterior tibial tendon insufficiency (PTTI) is controversial. Many soft-tissue and bony procedures and various combinations of the two have been reported for treatment of stage II PTTI. Orthopaedists recognize the lateral column lengthening component of the procedure as a successful reconstructive technique. The use of cortical allograft for lateral column lengthening in the correction of pes planus in the pediatric patient population has been routine. In the adult population, however, tricortical iliac crest autograft has been the bone graft of choice. Harvest of this autograft can precipitate significant morbidity and cost. Therefore, we undertook this randomized controlled trial to compare graft incorporation and healing of allograft and autograft in the lateral column lengthening component of adult flatfoot reconstruction. Lateral column lengthening was done as a component of operative correction for stage II PTTI in adult patients (older than 18 years) by two surgeons using similar procedures. The patients were randomized to either the allograft or autograft procedures. The primary endpoint was graft incorporation and healing as assessed by radiographs. The study included 33 randomized feet in 31 patients. We followed 18 feet in the allograft group and 15 in the autograft group to the point of union. There were 21 women and 10 men. There were no delayed unions, nonunions, or hardware failures. All patients in both groups achieved bony union by the 12-week followup evaluation. Two superficial foot infections were successfully treated with oral antibiotics. Two patients in the autograft group continued to have hip donor site pain at 3 months. This study suggests that union rates of allograft and autograft (iliac crest bone graft) are equal. The use of allograft in the lateral column lengthening component of operative correction of adult stage II PTTI appears to be a viable alternative to the use of iliac crest autograft and

  1. Extracorporeal shockwave therapy in musculoskeletal disorders.

    Science.gov (United States)

    Wang, Ching-Jen

    2012-03-20

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  2. Arrhythmia during extracorporeal shock wave lithotripsy.

    Science.gov (United States)

    Zeng, Z R; Lindstedt, E; Roijer, A; Olsson, S B

    1993-01-01

    A prospective study of arrhythmia during extracorporeal shock wave lithotripsy (ESWL) was performed in 50 patients, using an EDAP LT01 piezoelectric lithotriptor. The 12-lead standard ECG was recorded continuously for 10 min before and during treatment. One or more atrial and/or ventricular ectopic beats occurred during ESWL in 15 cases (30%). The occurrence of arrhythmia was similar during right-sided and left-sided treatment. One patient developed multifocal ventricular premature beats and ventricular bigeminy; another had cardiac arrest for 13.5 s. It was found that various irregularities of the heart rhythm can be caused even by treatment with a lithotriptor using piezoelectric energy to create the shock wave. No evidence was found, however, that the shock wave itself rather than vagal activation and the action of sedo-analgesia was the cause of the arrhythmia. For patients with severe underlying heart disease and a history of complex arrhythmia, we suggest that the ECG be monitored during treatment. In other cases, we have found continuous monitoring of oxygen saturation and pulse rate with a pulse oximeter to be perfectly reliable for raising the alarm when depression of respiration and vaso-vagal reactions occur.

  3. US evaluation in extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Baumgartner, B.R.; Steinberg, H.V.; Ambrose, S.S.; Walton, K.N.; Bernardino, M.E.

    1986-01-01

    Real-time US was performed in 100 consecutive patients the day preceding and/or 24 and 48 hours after extracorporeal shock wave lithotripsy (ESWL) therapy. In the 87 treated kidneys containing three or fewer stones, a total of 111 stones were found; 104 were radiopaque. Pre-ESWL US was not available for six stones. Sixty-eight stones (64.5%) were visualized. Of the 37 stones not seen, 10 (27%) were ≤ 5 mm in diameter, and of the larger stones, 19 (51%) were in the ureter or ureteropelvic junction; only six (16%) were in the calyces, and two (5%) were in the renal pelvis. Comparison of pre-ESWL and post-ESWL in 80 kidneys revealed no change in 37 (46%), more stones or fragments detected in 23 (29%), fewer stones or a change in location of stones in 12 (15%), and decreased size of the original stone in eight (10%). The ability of US to detect renal calculi seems to be related not only to stone size but also to location. Hydronephrosis was detected on pre-ESWL US in 16 kidneys (20%). After ESWL the hydronephrosis did not change in seven, decreased or resolved in eight, and increased in only one. Hydronephrosis was noted to develop after ESWL in 21 (26%) other kidneys. Pre-ESWL and post-ESWL hydronephrosis found on US must be considered in conjunction with the clinical picture and other radiographic studies

  4. Extracorporeal shockwave therapy in musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Wang Ching-Jen

    2012-03-01

    Full Text Available Abstract The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders.

  5. Cavitation phenomena in extracorporeal microexplosion lithotripsy

    Science.gov (United States)

    Tomita, Y.; Obara, T.; Takayama, K.; Kuwahara, M.

    1994-09-01

    An experimental investigation was made of cavitation phenomena induced by underwater shock wave focusing applied to the extracorporeal microexplosion lithotripsy (microexplosion ESWL). Firstly an underwater microexplosion generated by detonation of a 10 mg silver azide pellet was studied and secondly underwater shock focusing and its induced cavitation phenomena were investgated. Underwater shock wave was focused by using a semi-ellipsoidal reflector in which a shock wave generated at the first focal point of the reflector was reflected and focused at the second focal point. It is found that an explosion product gas bubble did not produce any distinct rebound shocks. Meantime cavitation appeared after shock focusing at the second focal point where expansion waves originated at the exit of the reflector were simultaneously collected. A shock/bubble interaction is found to contribute not only to urinary tract stone disintegration but also tissue damage. The cavitation effect associated with the microexplosion ESWL was weaker in comparison with a spark discharge ESWL. The microexplosion ESWL is an effective method which can minimize the number of shock exposures hence decreasing tissue damage by conducting precise positioning of urinary tract stones.

  6. Extracorporeal shock wave lithotripsy: What is new?

    Science.gov (United States)

    Bach, Christian; Karaolides, Theocharis; Buchholz, Noor

    2012-01-01

    Objectives Thirty years after its introduction, extracorporeal shockwave lithotripsy (ESWL) is still first-line treatment for more than half of all urinary tract stones, but machines and treatment strategies have significantly developed over time. In this review, we summarise the latest knowledge about the clinically important aspects of ESWL. Methods We searched PubMed to identify relevant reports and the latest European Association of Urology guidelines, and standard urological textbooks were consulted. Results New technical developments include: Twin-head and tandem-pulse shock-wave generators; wide-focus, low-pressure systems; optimised coupling; and automated location and acoustic tracking systems. Indications have been refined, making possible the identification of patients in whom ESWL treatment is likely to fail. By lowering the shock-wave rate, improving coupling, applying abdominal compression, power ‘ramping’ and postoperative medical expulsion therapy, treatment protocols have been optimised. Conclusions Promising new technical developments are under development, with the potential to increase the stone-free rate after ESWL. For optimal results, the refined indications need to be respected and optimised treatment protocols should be applied. PMID:26558039

  7. Patient and personnel exposure during extracorporeal lithotripsy

    International Nuclear Information System (INIS)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-01-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) [range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)] which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required

  8. Patient and personnel exposure during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Glaze, S.; LeBlanc, A.D.; Bushong, S.C.; Griffith, D.P.

    1987-12-01

    Extracorporeal shock wave lithotripsy (ESWL) has provided a nonsurgical approach to treatment of renal stones. The Dornier lithotripter uses dual image intensified x-ray systems to center the stone before treatment. Three imaging modes are offered: a fluoroscopic mode and two video spot filming modes. The average entrance exposure to the stone side of the typical patient at our facility is 2.6 X 10(-3) C kg-1 (10 R) (range: 0.5-7.7 X 10(-3) C kg-1 (2-30 R)) which is comparable and often much less than that reported for percutaneous lithotripsy. Recommendations are made for minimizing patient exposure. Scattered radiation levels in the lithotripter room are presented. We have determined that Pb protective apparel is not required during this procedure provided x-ray operation is temporarily halted should personnel be required to lean directly over the tub to attend to the patient. If the walls of the ESWL room are greater than 1.83 m (6 feet) from the tub, shielding in addition to conventional construction is not required.

  9. Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation.

    Science.gov (United States)

    Veljkovic, Andrea; Le, Vu; Escudero, Mario; Salat, Peter; Wing, Kevin; Penner, Murray; Younger, Alastair

    2018-03-21

    Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

  10. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft.

    Science.gov (United States)

    Caterev, Sergiu; Nistor, Dan Viorel; Todor, Adrian

    2016-10-01

    Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.

  11. Impact of pregnancy on autograft dilatation and aortic valve function following the Ross procedure.

    Science.gov (United States)

    Carvajal, Horacio G; Lindley, Kathryn J; Shah, Trupti; Brar, Anoop K; Barger, Philip M; Billadello, Joseph J; Eghtesady, Pirooz

    2018-03-01

    The effects of pregnancy on autograft dilatation and neoaortic valve function in patients with a Ross procedure have not been studied. We sought to evaluate the effect of pregnancy on autograft dilatation and valve function in these patients with the goal of determining whether pregnancy is safe after the Ross procedure. A retrospective chart review of female patients who underwent a Ross procedure was conducted. Medical records for 51 patients were reviewed. Among the 33 patients who met inclusion criteria, 11 became pregnant after surgery and 22 did not. Echocardiographic reports were used to record aortic root diameter and aortic insufficiency before, during, and after pregnancy. Patient's charts were reviewed for reinterventions and complications. Primary endpoints included reinterventions, aortic root dilation of ≥5 cm, aortic insufficiency degree ≥ moderate, and death. There were 18 pregnancies carried beyond 20 weeks in 11 patients. There was no significant difference in aortic root diameter between nulliparous patients and parous patients prior to their first pregnancy (3.53 ± 0.44 vs 3.57 ± 0.69 cm, P = .74). There was no significant change in aortic root diameter after first pregnancy (3.7 ± 0.4 cm, P = .056) although there was significant dilatation after the second (4.3 ± 0.7 cm, P = .009) and third (4.5 ± 0.7 cm, P = .009) pregnancies. Freedom from combined endpoints was significantly higher for patients in the pregnancy group than those in the nonpregnancy group (P = .002). Pregnancy was not associated with significantly increased adverse events in patients following the Ross procedure. Special care should be taken after the first pregnancy, as multiparity may lead to increased neoaortic dilatation. © 2017 Wiley Periodicals, Inc.

  12. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    Directory of Open Access Journals (Sweden)

    Christos Bakoyiannis

    2012-01-01

    Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

  13. [Extracorporeal shock wave therapy in chronic prostatitis].

    Science.gov (United States)

    Kul'chavenya, E V; Shevchenko, S Yu; Brizhatyuk, E V

    2016-04-01

    Chronic prostatitis is a prevalent urologic disease, but treatment outcomes are not always satisfactory. As a rule, chronic prostatitis results in chronic pelvic pain syndrome, significantly reducing the patient's quality of life. Open pilot prospective non-comparative study was conducted to test the effectiveness of extracorporeal shock wave therapy (ESWT) using Aries (Dornier) machine in patients with chronic prostatitis (CP) of IIIb category. A total of 27 patients underwent ESWL as monotherapy, 2 times a week for a course of 6 sessions. Exposure settings: 5-6 energy level (by sensation), the frequency of 5 Hz, 2000 pulses per session; each patient received a total energy up to 12000 mJ. per procedure. Treatment results were evaluated using NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) upon completing the 3 week course of 6 treatments and at 1 month after ESWT. Immediately after the ESWT course positive trend was not significant: pain index decreased from 9.1 to 7.9, urinary symptom score remained almost unchanged (4.2 at baseline, 4.1 after treatment), quality of life index also showed a slight improvement, dropping from 7.2 points to 6.0. Total NIH-CPSI score decreased from 20.5 to 18.0. One month post-treatment pain significantly decreased to 3.2 points, the urinary symptom score fell to 2.7 points, the average quality of life score was 3.9 points. ESWT, performed on Aries (Dornier) machine, is highly effective as monotherapy in patients with category IIIb chronic prostatitis.

  14. Mechanical ventilation during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Schmidt, Matthieu; Pellegrino, Vincent; Combes, Alain; Scheinkestel, Carlos; Cooper, D Jamie; Hodgson, Carol

    2014-01-21

    The timing of extracorporeal membrane oxygenation (ECMO) initiation and its outcome in the management of respiratory and cardiac failure have received considerable attention, but very little attention has been given to mechanical ventilation during ECMO. Mechanical ventilation settings in non-ECMO studies have been shown to have an effect on survival and may also have contributed to a treatment effect in ECMO trials. Protective lung ventilation strategies established for non-ECMO-supported respiratory failure patients may not be optimal for more severe forms of respiratory failure requiring ECMO support. The influence of positive end-expiratory pressure on the reduction of the left ventricular compliance may be a matter of concern for patients receiving ECMO support for cardiac failure. The objectives of this review were to describe potential mechanisms for lung injury during ECMO for respiratory or cardiac failure, to assess the possible benefits from the use of ultra-protective lung ventilation strategies and to review published guidelines and expert opinions available on mechanical ventilation-specific management of patients requiring ECMO, including mode and ventilator settings. Articles were identified through a detailed search of PubMed, Ovid, Cochrane databases and Google Scholar. Additional references were retrieved from the selected studies. Growing evidence suggests that mechanical ventilation settings are important in ECMO patients to minimize further lung damage and improve outcomes. An ultra-protective ventilation strategy may be optimal for mechanical ventilation during ECMO for respiratory failure. The effects of airway pressure on right and left ventricular afterload should be considered during venoarterial ECMO support of cardiac failure. Future studies are needed to better understand the potential impact of invasive mechanical ventilation modes and settings on outcomes.

  15. Simulation training for extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Roberta Brum

    2015-01-01

    Full Text Available Background: Extracorporeal membrane oxygenation (ECMO is a complex treatment. Despite this, there are a lack of training programs designed to develop relevant clinical and nonclinical skills required for ECMO specialists. The aim of the current study was to describe the design, implementation and evaluation of a 1-day simulation course for delivering training in ECMO. Methods: A 1-day simulation course was developed with educational and intensive care experts. First, the delegates received a lecture on the principles of simulation training and the importance of human factors. This was, followed by a practical demonstration and discussion of the ECMO circuit, console components, circuit interactions effects and potential complications. There were then five ECMO simulation scenarios with debriefing that covered technical and nontechnical issues. The course culminated in a knowledge-based assessment. Course outcomes were assessed using purpose-designed questionnaires. Results: We held 3 courses with a total of 14 delegates (9 intensive care nurses, 3 adult intensive care consultants and 2 ECMO technicians. Following the course, 8 (57% gained familiarity in troubleshooting an ECMO circuit, 6 (43% increased their familiarity with the ECMO pump and circuit, 8 (57% perceived an improvement in their communication skills and 7 (50% perceived an improvement in their leadership skills. At the end of the course, 13 (93% delegates agreed that they felt more confident in dealing with ECMO. Conclusions: Simulation-training courses may increase knowledge and confidence in dealing with ECMO emergencies. Further studies are indicated to determine whether simulation training improves clinical outcomes and translates to reduced complication rates in patients receiving ECMO.

  16. [Extracorporeal shock-wave lithotripsy of gallstones].

    Science.gov (United States)

    Freund, H R; Lebensart, P D; Muggia-Sullam, M; Durst, A L

    1989-08-01

    We performed 16 extracorporeal shock-wave lithotripsies (ESWL) to fragment gallstones in 11 women and 2 men, aged 19 to 57 (mean 41 +/- 10) years, during the past 10 months. Criteria for selection included a history of biliary colic, not more than 3 stones with a total diameter of not more than 30 mm, and a functioning gallbladder. 210 patients were examined, of whom 98 were referred for additional screening by combined ultrasonography and oral cholecystography. This resulted in rejection of another 71 patients due to multiple stones (38%), nonfunctioning gallbladder (22%), calcified stones (12%), stones not visualized in the prone position (9%), excessively large stones (3%) and other reasons (16%). Only 27 patients fulfilled all the criteria. Under epidural or general anesthesia (11 and 2 patients, respectively), we administered 1200-3500 (mean 2250 +/- 750) shock waves at 20-24 KV with the Tripter X1 (Direx, Israel-USA). This is an ultrasound-guided, modular portable, shock-wave generator utilizing underwater high energy spark discharge. Chenodeoxycholic or ursodeoxycholic acid, 10 mg/kg/day, was started 1 week prior to ESWL and continued for 3 months after disappearance of fragments and debris. We encountered skin petechiae in all patients, transient hematuria in 8, mild biliary colic in 1 and a small liver hematoma in 1. To date, 3 patients are free of stones, while in 7 only sludge and tiny fragments are present which we expect to disappear as a result of the litholytic therapy. 3 patients had fragments larger than 5 mm and required a second ESWL. Thus ESWL, which was indicated in only 13% of screened patients, proved to be safe and can be expected to be successful in 75% of selected candidates.

  17. Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

    LENUS (Irish Health Repository)

    El-Khuffash, A

    2011-03-01

    Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical

  18. Collateral flow after extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Smith, A.S.; Wiznitzer, M.; Haacke, E.M.

    1990-01-01

    MR angiography was used to evaluate collateral flow after extracorporal membrane oxygenation (ECMO) in patients with permanent ligation of the right common carotid artery (RCCA). One year after ECMO, MR angiography of the cerebral circulation was performed in 11 survivors and MR angiography of the neck in seven. The diameters of the left common carotid (LCCA) and vertebral (Vert) arteries in the neck and of the basilar (Bas) and internal carotid arteries in the head were measured. Ratios of the artery diameters were compared with those of seven children (aged 6 months - 17 years) who had normal MR angiographic and brain MR imaging studies. Compared with carotid artery diameter, the ECMO population had proportionately larger vertebral (RVert/LCCA, -0.82 ± 0.12 vs 0.56 ± 0.20 [<.02], LVert/LCCA, -0.86 ± 0.15 vs 0.67 ± 0.05 [P < .02] and basilar artery diameters (LICA/Bas, -0.91 ± 0.15 vs 1.49 ± 0.48 [p < .003]) than did control subjects. Ratios in five children with enlarged RPComA after ECMO were not significantly different from those in controls. The RICA was present and smaller than the LICA in the ECMO population, but not in control subjects (RICA/LICA, -0.75 ± 0.06 vs 0.91 ± 0.23 [p < .05]). Increased vertebral and basilar artery flow is a response to RCCA ligation in the neonate and is independent of RPComA collateral flow. This suggests the presence of more extensive parenchymal collaterals from posterior cerebral arteries, from the vertebrobasilar circulation to the external carotid artery or other collaterals. Consequently, later abnormalities of vertebrobasilar flow might adversely affect right hemispheric function in this children

  19. Allograft versus autograft in cervical and lumbar spinal fusions: an examination of operative time, length of stay, surgical site infection, and blood transfusions.

    Science.gov (United States)

    Murphy, Meghan E; McCutcheon, Brandon A; Grauberger, Jennifer; Shepherd, Daniel; Maloney, Patrick R; Rinaldo, Lorenzo; Kerezoudis, Panagiotis; Fogelson, Jeremy L; Nassr, Ahmad; Bydon, Mohamad

    2016-11-23

    Autograft harvesting for spine arthrodesis has been associated with longer operative times and increased blood loss. Allograft compared to autograft in spinal fusions has not been studied in a multicenter cohort. Patients enrolled in the ACS-NSQIP registry between 2012 and 2013 who underwent cervical or lumbar spinal fusion with either allograft or autograft through a separate incision were included for analysis. The primary outcomes of interest were operative time, length of stay, blood transfusion, and surgical site infection (SSI). A total of 6,790 and 6,718 patients received a cervical or lumbar spinal fusion, respectively. On unadjusted analysis in both cervical and lumbar cohorts, autograft was associated with increased rates of blood transfusion (cervical: 2.9% vs 1.0%, poperative time (cervical: 167 vs 128 minutes, poperative times (cervical: 27.8 minutes, 95% CI 20.7-35.0; and lumbar: 25.4 minutes, 95% CI 17.7-33.1) relative to allograft. Autograft was not associated with either length of stay or SSI. In a multicenter cohort of patients undergoing cervical or lumbar spinal fusion, autograft was associated with increased rates of blood transfusion and increased operative time relative to allograft.

  20. Extracorporeal circuits and autoregulation: effect of albumin coating

    NARCIS (Netherlands)

    Borgdorff, P.; Kok, W. E.; van den Bos, G. C.

    1992-01-01

    Autoregulation of muscle blood flow often is difficult to demonstrate when extracorporeal perfusion is used. This could be caused by contact of blood and foreign material. Accordingly, we tested whether autoregulation is preserved when the system is coated with albumin. Polyurethane tubing between

  1. Nosocomial transmission of Cupriavidus pauculus during extracorporeal membrane oxygenation.

    Science.gov (United States)

    Stovall, S H; Wisdom, C; McKamie, W; Ware, W; Dedman, H; Fiser, R T

    2010-01-01

    Patients undergoing extracorporeal membrane oxygenation (ECMO) are at increased risk of infection. We present the first known report of nosocomial infection with Cupriavidus pauculus attributable to contamination from ECMO equipment and describe the measures taken to halt subsequent infections. A cluster of infections in ECMO patients should prompt team members to consider contamination of equipment with environmental pathogens as a possible cause.

  2. Management of retained encrusted urethral catheter with extracorporeal shockwave lithotripsy

    Directory of Open Access Journals (Sweden)

    Sameh Anwar Kunzman

    2002-01-01

    Full Text Available We report a case of non-deflating heavily encrusted Foley catheter successfully removed by extracorporeal shockwave lithotripsy (ESWL. To our knowledge this is the first case of using ESWL to remove encrusted foley catheter retained in the bladder.

  3. 21 CFR 876.5990 - Extracorporeal shock wave lithotripter.

    Science.gov (United States)

    2010-04-01

    ..., control console, imaging/localization system, and patient table. Prior to treatment, the urinary stone is targeted using either an integral or stand-alone localization/imaging system. Shock waves are typically... shock wave lithotripter. (a) Identification. An extracorporeal shock wave lithotripter is a device that...

  4. Extracorporeal membrane oxygenation after intravenous injection of paraffin oil

    DEFF Research Database (Denmark)

    Pasgaard, Thomas; Huynh, Anh-Nhi Thi; Gjedsted, Jakob

    2016-01-01

    We present a rare cause of acute respiratory distress syndrome (ARDS) due to an accidental intravascular injection of paraffin oil. While there is no specific therapy, we decided to support the patient with veno-venous extracorporeal membrane oxygenation (V-V ECMO) to allow the ARDS to resolve. A...

  5. Factors affecting lower calyceal stone clearance after Extracorporeal ...

    African Journals Online (AJOL)

    Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

  6. Radiation Protection Practices of Staff during Extra-Corporeal Shock ...

    African Journals Online (AJOL)

    Methodology: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure ...

  7. paediatric ureteric calculi: in-situ extracorporeal shock wave lithotripsy

    African Journals Online (AJOL)

    Objective To evaluate prospectively the efficacy of in-situ extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi in the paediatric age group. Patients and Methods Twenty children (aged 2.2 16 years) with 22 ureteric stones were evaluated and treated with in-situ ESWL using the Dornier S lithotripter ...

  8. Normothermal or Hypothermal Extracorporeal Circulation Regimens in Patients with Acquired Heart Disease

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2013-01-01

    Full Text Available Background. Hypothermal extracorporeal circulation has been used in cardiosurgery over 50 years. However, recent trials have not shown its predominant effect on the protection of the brain, lung, and myocardium in patients during surgery. We have presumed that when normothermal extracorporeal circulation used in patients with acquired heart disease, its pathophysiological effect on the body is comparable with that of hypothermal extracorporeal circulation. Subjects and methods. One hundred and forty patients who were to undergo acquired heart disease correction were randomized into two equal groups: that using hypothermal or normothermal extracorporeal circulation. Perioperative troponin I and NT-proBNP concentrations, postoperative clinical course, and hospital morbidity and mortality rates were estimated. Results. There were no significant differences in the concentrations of troponin I and NT-proBNP at the study stages. In the normothermal extracorporeal circulation group patients with isolated aortic stenosis, the concentration of troponin I was higher than that in the hypothermal extracorporeal circulation group. Analyzing the postoperative course indicated that the duration of mechanical ventilation was significantly lower in the hypothermal extracorporeal circulation group than in the normothermal extracorporeal circulation group. There were no differences in hospital complications and mortality rates. Conclusion. Hypothermal versus normothermal extracorporeal circulation in the correction of acquired heart diseases has no predominant effect on tro-ponin I and NT-proBNP concentrations, postoperative clinical course, and hospital complications and mortality rates. Key words: extracorporeal circulation, hypothermia, acquired heart disease, troponin I, NT-proBNP.

  9. Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog

    Science.gov (United States)

    Verbeke, Fei; Binst, Dominique; Stegen, Ludo; Waelbers, Tim; de Rooster, Hilde; Van Goethem, Bart

    2012-01-01

    A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence. PMID:23543933

  10. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P < 0.05). The "SmartECLA" demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Clinical results of primary malignant musculoskeletal tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen.

    Science.gov (United States)

    Paholpak, Permsak; Sirichativapee, Winai; Wisanuyotin, Taweechok; Kosuwon, Weerachai; Jeeravipoolvarn, Polasak

    2015-06-01

    To evaluate the clinical results of primary malignant musculoskeletal tumors treated with wide resection and recycling autograft reconstruction using liquid nitrogen. We reviewed 12 patients who had a primary malignant bone and soft tissue tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen between March 2006 and March 2013. The results were judged by recurrence, functional status and complications. Functional status was assessed according to the Musculoskeletal Tumor Society Score (MSTSS). Clinical failure was defined as need for reoperation in order to change the type of reconstruction or to amputate, and the presence of local recurrence. The most common tumor was osteosarcoma (eight cases) followed by Ewing's sarcoma (two cases). The tibia was the most frequently involved skeletal site (six cases) followed by the femur (three cases). The median follow-up period was 32 months. In 12 patients, 7 were still alive without recurrence. There were 3 clinical failures: 1 local recurrence and 2 graft complications at 28, 51 and 20 months after reconstruction, respectively. The main complication was infection (three cases). All osteotomy sites were radiographic unions, and the union time was 8.2 ± 2.7 months. The mean ± SD MSTSS score was 79% ± 11%; excellent functional results were achieved in seven patients. Recycling autograft reconstruction using liquid nitrogen had favorable clinical outcomes in terms of functional status and local recurrence. This reconstruction method, therefore, represents a reasonable alternative for limb salvage surgery. © 2014 Wiley Publishing Asia Pty Ltd.

  12. When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy.

    Science.gov (United States)

    Barbier, O; Danis, J; Versier, G; Ollat, D

    2015-10-01

    Inadvertent contamination of the autograft can occur during anterior cruciate ligament (ACL) reconstruction if the autograft is dropped on the floor during surgery. A study was undertaken to determine the incidence of contamination when a graft is dropped on the operating room floor and the efficacy of antimicrobial solutions to decontaminate it. Samples from 25 patients undergoing ACL reconstruction with a hamstring tendon were sectioned and dropped onto the floor. Cultures were taken after immersion in antiseptic solutions (a chlorhexidine gluconate solution (group 1), a povidone-iodine solution (group 2), and a sodium hypochlorite solution (group 3)). A fourth piece (group 0) was cultured without being exposed to any solution. Cultures of a floor swab were taken at the same time. The floor swab cultures were positive in 96% of cases. The rate of contamination was 40% in group 0, 8% in group 1, 4% in group 2, and 16% in group 3. There was a significant difference between groups 1 and 2 and group 0 (p<0.05) but not between groups 3 and 0. Immersing a graft dropped on the floor during surgery in a chlorhexidine gluconate solution or povidone-iodine solution significantly reduces contamination of the graft. Soaking of the hamstring autograft in one of these solutions is recommended in the case of inadvertent contamination. Laboratory investigation (level 2). Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Anterior cruciate ligament reconstruction in a rabbit model using silk-collagen scaffold and comparison with autograft.

    Directory of Open Access Journals (Sweden)

    Fanggang Bi

    Full Text Available The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application.

  14. The indications and donor-site morbidity of tibial cortical strut autografts in the management of defects in long bones.

    Science.gov (United States)

    Lauthe, O; Soubeyrand, M; Babinet, A; Dumaine, V; Anract, P; Biau, D J

    2018-05-01

    Aims The primary aim of this study was to determine the morbidity of a tibial strut autograft and characterize the rate of bony union following its use. Patients and Methods We retrospectively assessed a series of 104 patients from a single centre who were treated with a tibial strut autograft of > 5 cm in length. A total of 30 had a segmental reconstruction with continuity of bone, 27 had a segmental reconstruction without continuity of bone, 29 had an arthrodesis and 18 had a nonunion. Donor-site morbidity was defined as any event that required a modification of the postoperative management. Union was assessed clinically and radiologically at a median of 36 months (IQR, 14 to 74). Results Donor-site morbidity occurred in four patients (4%; 95% confidence interval (CI) 1 to 10). One patient had a stress fracture of the tibia, which healed with a varus deformity, requiring an osteotomy. Two patients required evacuation of a haematoma and one developed anterior compartment syndrome which required fasciotomies. The cumulative probability of union was 90% (95% CI 80 to 96) at five years. The type of reconstruction (p = 0.018), continuity of bone (p = 0.006) and length of tibial graft (p = 0.037) were associated with the time to union. Conclusion The tibial strut autograft has a low risk of morbidity and provides adequate bone stock for treating various defects of long bones. Cite this article: Bone Joint J 2018;100-B:667-74.

  15. Immuno-therapy of Acute Radiation Syndromes : Extracorporeal Immuno-Lympho-Plasmo-Sorption.

    Science.gov (United States)

    Popov, Dmitri; Maliev, Slava

    Methods Results Summary and conclusions Introduction: Existing Medical Management of the Acute Radiation Syndromes (ARS) does not include methods of specific immunotherapy and active detoxication. Though the Acute Radiation Syndromes were defined as an acute toxic poisonous with development of pathological processes: Systemic Inflammatory Response Syndrome (SIRS), Toxic Multiple Organ Injury (TMOI), Toxic Multiple Organ Dysfunction Syndrome(TMODS), Toxic Multiple Organ Failure (TMOF). Radiation Toxins of SRD Group play an important role as the trigger mechanisms in development of the ARS clinical symptoms. Methods: Immuno-Lympho-Plasmo-Sorption is a type of Immuno-therapy which includes prin-ciples of immunochromato-graphy, plasmopheresis, and hemodialysis. Specific Antiradiation Antitoxic Antibodies are the active pharmacological agents of immunotherapy . Antiradia-tion Antitoxic Antibodies bind selectively to Radiation Neurotoxins, Cytotoxins, Hematotox-ins and neutralize their toxic activity. We have developed the highly sensitive method and system for extracorporeal-immune-lypmh-plasmo-sorption with antigen-specific IgG which is clinically important for treatment of the toxic and immunologic phases of the ARS. The method of extracorporeal-immune-lypmh-plasmo-sorption includes Antiradiation Antitoxic Antibodies (AAA) immobilized on microporous polymeric membranes with a pore size that is capable to provide diffusion of blood-lymph plasma. Plasma of blood or lymph of irradiated mammals contains Radiation Toxins (RT) that have toxic and antigenic properties. Radiation Toxins are Antigen-specific to Antitoxic blocking antibodies (Immunoglobulin G). Plasma diffuses through membranes with immobilized AAA and AA-antibodies bind to the polysaccharide chain of tox-ins molecules and complexes of AAA-RT that are captured on membrane surfaces. RT were removed from plasma. Re-transfusion of plasma of blood and lymph had been provided. We show a statistical significant

  16. New ultrasound stone locking system in extracorporeal lithotripsy: Decreased duration of fluoroscopy and radiation doses

    International Nuclear Information System (INIS)

    Abid, N.; Ravier, E.; Codas, R.; Crouzet, S.; Martin, X.

    2013-01-01

    Extracorporeal shock wave lithotripsy is the most common method of treatment for kidney stones. Both fluoroscopy and ultrasound imaging can be used to locate stones, but fluoroscopy is more frequently employed. Evaluation of a new stereotaxic navigational system: the stone was located using an ultrasound probe, and its 3D location was saved. The table automatically moved to position the stone at the focal point. A real-time follow-up was possible during treatment. Our objective was to demonstrate a decrease in the use of fluoroscopy to locate kidney stones for extracorporeal shock wave lithotripsy through the use of a 3D ultrasound stone locking system. Prospective analysis of the case records of the 20 patients preceding and the 20 patients succeeding the arrival of the ultrasound stone locking system Visio-Track (EDAP-TMS). We used a Student test to compare age, BMI, kidney stone size, number of shock waves and administered energy. Patient characteristics were comparable. The average age was 55 years old and the average kidney stone size was 10.7 mm. Radiation duration was 174.8 seconds in the group without Visio-Track versus 57.1 seconds in the group with it (P < 0.0001). A similar result was observed for radiation doses: 5197.25 mGy.cm 2 for the group without versus 1987.6 mGy.cm 2 for the group with Visio-Track (P ≡ 0.0033). The stone locking system Visio-Track reduced fluoroscopy in our first group of patients, which decreased the patient's individual absorbed irradiation dose. (authors)

  17. Fotoferese extracorpórea Extracorporeal photopheresis

    Directory of Open Access Journals (Sweden)

    Márcia M. Silva

    2008-04-01

    Full Text Available Fotoferese extracorpórea é uma modalidade de terapia celular que tem demonstrado eficácia e segurança em pacientes portadores de doenças auto-imunes e mediadas por células T, incluindo esclerodermia, linfoma de células T cutâneo/ Síndrome de Sézary e doença enxerto-contra-hospedeiro após transplante de células-tronco hematopoiéticas. Tem sido empregada, ainda, com o intuito de induzir tolerância em transplantes de órgãos sólidos. O tratamento se baseia no efeito biológico de uma substância fotossensibilizante, o 8-metoxipsoraleno, e da radiação ultravioleta A, nas células mononucleares coletadas por aférese e reinfundidas ao paciente. O mecanismo de ação parece ser devido à indução de imunidade anticlonotípica direcionada a clones patogênicos de células T. O tratamento induz a apoptose de células T patogênicas, e a ativação de células apresentadoras de antígenos desempenha papel importante no processo imunomodulador.Extracorporeal photopheresis is a method of cell therapy that has demonstrated efficacy in autoimmune diseases, cutaneous T-cell lymphoma/Sézary syndrome and graft-versus-host disease after hematopoietic stem-cell transplantation. This technique has also been employed as a treatment strategy to induce tolerance after solid organ transplants. Treatment is based on the biological effect of ultraviolet A radiation and a photosensitizing drug, 8-methoxypsoralen, on mononuclear cells collected by apheresis and reinfused into the patient. The suggested mechanism of action is related to the induction of anticlonotypic immunity directed against pathogenic clones of T lymphocytes. Treatment induces apoptosis of pathogenic T-cells, and it appears that activation of antigen-presenting cells has an important role in this process.

  18. Extracorporeal shock wave lithotripsy for urinary stones

    International Nuclear Information System (INIS)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun

    1988-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization was

  19. Extracorporeal shock wave lithotripsy for urinary stones

    Energy Technology Data Exchange (ETDEWEB)

    Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

    1988-06-15

    Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization

  20. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  1. Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization.

    Science.gov (United States)

    Jeys, Lee; Korrosis, Sotiris; Stewart, Todd; Harris, Nicholas J

    2004-01-01

    Autograft stabilization uses free semitendinosus tendon grafts to anatomically reconstruct the anterior talofibular ligament. Study aims were to evaluate the biomechanical properties of Mitek GII anchors compared with the Arthrex Bio-Tenodesis Screw for free tendon reconstruction of the anterior talofibular ligament. There are no differences in load to failure and percentage specimen elongation at failure between the 2 methods. Controlled laboratory study using porcine models. Sixty porcine tendon constructs were failure tested. Re-creating the pull of the anterior talofibular ligament, loads were applied at 70 degrees to the bones. Thirty-six tendons were fixed to porcine tali and tested using a single pull to failure; 10 were secured with anchors and No. 2 Ethibond, 10 with anchors and FiberWire, 10 with screws and Fiberwire, and 6 with partially gripped screws. Cyclic preloading was conducted on 6 tendons fixed by anchors and on 6 tendons fixed by screws before failure testing. Two groups of 6 components fixed to the fibula were also tested. The talus single-pull anchor group produced a mean load of 114 N and elongation of 37% at failure. The talus single-pull screw group produced a mean load of 227 N and elongation of 22% at failure (P anchors. The improved biomechanics of interference screws suggests that these may be more suited to in vivo reconstruction of the anterior talofibular ligament than are bone anchors.

  2. FIRST USE OF STEREOLOGY TO QUANTIFY THE SURVIVAL OF FAT AUTOGRAFTS

    Directory of Open Access Journals (Sweden)

    Eduardo Serna Cuéllar

    2011-05-01

    Full Text Available It is not usual to perform quantitative analyses on surgical materials. Rather, they are evaluated clinically, through qualitative methods, and if quantitation is done, it is on a 2-dimensional basis. In this study, the long-term survival of fat autografts (FAG in 40 subjects with facial soft tissue defects is quantified. An adipose tissue preparation from the abdomen obtained through liposuction and centrifugation is injected subcutaneously. Approximately 14 months later, the treated area is biopsied. Extensive computer-based histological analyses were performed using the stereological method in order to directly obtain three parameters: volume fraction of adipocytes in the fat tissue (VV, density (number per volume of adipocytes in the fat tissue (NV, and the mean cell volume of adipocytes (VA in each tissue sample. A set of equations based on these three quantitative parameters is produced for evaluation of the volumetric survival fraction (VSF of FAG. The presented data evidenced a 66% survival fraction at the 14-month follow-up. In routine practice, it would be sufficient to perform this volumetric analysis on the injected and biopsied fat samples to know what fraction of the FAG has survived. This is an objective method for quantifying FAG survival and will allow a standardized comparison between different research series and authors.

  3. Clinical observation on fibrin glue technique in pterygium surgery performed with limbal autograft transplantation

    Directory of Open Access Journals (Sweden)

    Hui Liu

    2013-07-01

    Full Text Available AIM: To compare the efficiency and safety of fibrin glue to suture technique in pterygium surgery performed with limbal autograft.METHODS: A prospective randomized clinical trial was carried out in 60 eyes of 48 patients operated for primary nasal pterygium. Autologous limbal graft taken from the superotemporal limbus was used to cover the sclera after pterygium excision under local anesthesia with 2% lidocaine. In 22 cases(30 eyes, the transplant was attached to the sclera with a fibrin tissue adhesive(group 1and in 26 cases(30 eyeswith 10-0 Virgin silk sutures(group 2. Patients were followed up at least for 3 months. Time of operation, matching degree of graft and visual analogue scale(VASscore were mainly observed and recorded. RESULTS: Patient symptoms were significantly less and biomicroscopic findings were better in group 1. Pterygium recurrence was seen in 1 case of group 1, and 1 case of group 2. Average surgery time was shorter(PCONCLUSION: Using fibrin glue for graft fixation in pterygium surgery causes significantly less postoperative pain and shortens surgery time significantly.

  4. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    OpenAIRE

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    2017-01-01

    Objective: To review the principles of neonatal‐pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource‐limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly‐indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac res...

  5. Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care.

    Science.gov (United States)

    Lasa, Javier J; Jain, Parag; Raymond, Tia T; Minard, Charles G; Topjian, Alexis; Nadkarni, Vinay; Gaies, Michael; Bembea, Melania; Checchia, Paul A; Shekerdemian, Lara S; Thiagarajan, Ravi

    2018-02-01

    Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorporeal cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. None. Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extracorporeal membrane oxygenation cannulation "most of the time" by 58% of respondents and 94% report using afterload reducing/antihypertensive agents "some" to "most of the time" after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common

  6. Adjunctive Therapies During Extracorporeal Membrane Oxygenation to Enhance Multiple Organ Support in Critically Ill Children

    Directory of Open Access Journals (Sweden)

    Marguerite Orsi Canter

    2018-04-01

    Full Text Available Since the advent of extracorporeal membrane oxygenation (ECMO over 40 years ago, there has been increasing interest in the use of the extracorporeal circuit as a platform for providing multiple organ support. In this review, we will examine the evidence for the use of continuous renal replacement therapy, therapeutic plasma exchange, leukopheresis, adsorptive therapies, and extracorporeal liver support in conjunction with ECMO.

  7. Experimental studies on hemolysis following extracorporcal blood irradiation in sheep and goat

    International Nuclear Information System (INIS)

    Heilmann, E.; Vogel, M.; Richter, K.D.; Widmer, H.W.

    1978-01-01

    In experimental studies extracorporal blood irradiation was performed in 3 sheep and 1 goat by means of a 500 Ci 137 Cs source. The sheep died of the sequelae of narcosis, with anemia being only moderately marked. In the goat a transit dosis of 466,566 rad could be applied before the animal died of the sequelae of hemolytic anemia. (author)

  8. Dense pulmonary opacification in neonates treated with extracorporeal membrane oxygenation

    Energy Technology Data Exchange (ETDEWEB)

    Schlesinger, A.E.; Cornish, J.D.; Null, D.M.

    1986-09-01

    Chest radiographic findings in three neonates with respiratory failure secondary to meconium aspiration treated with extracorporeal membrane oxygenation (ECMO) are described. The degree of pulmonary opacification on the chest radiographs failed to correlate with the patients' clinical status as measured by the arterial oxygen levels but correlated well with the peak airway pressure (PAP) and continuous positive airway pressure (CPAP) settings on the mechanical ventilator. Because a variable portion of the arterial blood oxygenation is performed by the extracorporeal membrane oxygenator and unusually large fluctuations in airway pressure settings can occur in these patients while on ECMO, it is important to realize that the chest radiography may not be an accurate predictor of the patients' clinical status.

  9. Dense pulmonary opacification in neonates treated with extracorporeal membrane oxygenation

    International Nuclear Information System (INIS)

    Schlesinger, A.E.; Cornish, J.D.; Null, D.M.

    1986-01-01

    Chest radiographic findings in three neonates with respiratory failure secondary to meconium aspiration treated with extracorporeal membrane oxygenation (ECMO) are described. The degree of pulmonary opacification on the chest radiographs failed to correlate with the patients' clinical status as measured by the arterial oxygen levels but correlated well with the peak airway pressure (PAP) and continuous positive airway pressure (CPAP) settings on the mechanical ventilator. Because a variable portion of the arterial blood oxygenation is performed by the extracorporeal membrane oxygenator and unusually large fluctuations in airway pressure settings can occur in these patients while on ECMO, it is important to realize that the chest radiography may not be an accurate predictor of the patients' clinical status. (orig.)

  10. Novel experimental surgical strategy to prevent traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft.

    Science.gov (United States)

    Bolleboom, Anne; de Ruiter, Godard C W; Coert, J Henk; Tuk, Bastiaan; Holstege, Jan C; van Neck, Johan W

    2018-02-09

    OBJECTIVE Traumatic neuromas may develop after nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often resistant to therapy, and excision of the neuroma frequently leads to recurrence. In this study, the authors present a novel surgical strategy to prevent neuroma formation based on the principle of centro-central anastomosis (CCA), but rather than directly connecting the nerve ends to an autograft, they created a loop using a 3D-printed polyethylene Y-shaped conduit with an autograft in the distal outlets. METHODS The 3D-printed Y-tube with autograft was investigated in a model of rat sciatic nerve transection in which the Y-tube was placed on the proximal sciatic nerve stump and a peroneal graft was placed between the distal outlets of the Y-tube to form a closed loop. This model was compared with a CCA model, in which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended-arm Y-tube. Results were analyzed at 12 weeks of survival using nerve morphometry for the occurrence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the different surgical groups, the Y-tube with interposed autograft was the only model that did not result in neuroma formation at 12 weeks of survival. In addition, a 13% reduction in the number of myelinated axons regenerating through the interposed autograft was observed in the Y-tube with autograft model. In the CCA model, the authors also observed a decrease of 17% in the number of myelinated axons, but neuroma formation was present in this model. The closed Y-tube resulted in minimal nerve regeneration inside the tube together with extensive neuroma formation before the entrance of the tube. The extended-arm Y-tube model clearly showed that the majority of the regenerating axons merged into the Y-tube arm, which was connected to the autograft

  11. Cupriavidus pauculus bacteremia in a child on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Uzodi, Adaora S; Schears, Gregory J; Neal, James R; Henry, Nancy K

    2014-01-01

    We report a case of bacteremia secondary to Cupriavidus pauculus in a 15-month-old boy on extracorporeal membrane oxygenation (ECMO). The source of the organism was water in the thermoregulator reservoir. The child responded well to cefepime and ciprofloxacin, a delayed oxygenator change out and replacement of the thermoregulator reservoir with a unit that was cleaned and decontaminated with sodium hypochlorite. Isolation of Cupriavidus pauculus from a patient on ECMO support should raise suspicion of the reservoir as a source.

  12. Extracorporeal therapy in sepsis: are we there yet?

    Science.gov (United States)

    Shukla, Ashutosh M

    2012-02-01

    The role of extracorporeal therapies (ECTs) in sepsis is unclear and is a strongly debated topic in critical-care medicine. Unfortunately, much of this debate arises because we lack a clear understanding of what defines the stage and severity of the disease, and the pivotal pathophysiological events dictating outcomes. In the absence of this knowledge, ECTs remain among a large group of therapies with high promise but unproven efficacy.

  13. Acoustic sensing of renal stone fragmentation in extracorporeal shockwave lithotripsy

    OpenAIRE

    Fedele, Fiammetta

    2008-01-01

    This thesis describes the research carried out by the author on the exploitation of acoustic emissions detected during extracorporeal shockwave lithotripsy (a non-invasive procedure for the treatment of urinary stones) to develop a new diagnostic system. The work formed part of a research project on lithotripsy undertaken by the University of Southampton in collaboration with Guy's and St Thomas' NHS Foundation Trust (London) and a UK based company, Precision Acoustics Ltd (Dorche...

  14. Severe myocardial injury and extracorporeal membrane oxygenation following perinatal asphyxia

    Directory of Open Access Journals (Sweden)

    P. Benson Ham

    2015-05-01

    Full Text Available Perinatal asphyxia is a common cause of morbidity and mortality in the newborn and is associated with myocardial injury in a significant proportion of cases. Biomarkers, echocardiography, and rhythm disturbances are sensitive indicators of myocardial ischemia and may predict mortality. We present a case of severe myocardial dysfunction immediately after delivery managed with extracorporeal membrane oxygenation (ECMO and discuss the role of cardiac biomarkers, echocardiography, electrocardiography, and ECMO in the asphyxiated newborn.

  15. Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Mabel Chung

    2014-01-01

    Full Text Available Venoarterial extracorporeal membrane oxygenation (VA ECMO provides mechanical support to the patient with cardiac or cardiopulmonary failure. This paper reviews the physiology of VA ECMO including the determinants of ECMO flow and gas exchange. The efficacy of this therapy may be determined by assessing patient hemodynamics and device flow, overall gas exchange support, markers of adequate oxygen delivery, and pulsatility of the arterial blood pressure waveform.

  16. Kidney changes after extracorporeal shock wave lithotripsy; MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Hiroyasu; Shindo, Hiroshi; Mabuchi, Nobuhisa; Kawakami, Akira; Fujii, Koichi; Hamada, Tatsumi; Ishida, Osamu; Umekawa, Toru; Kohri, Kenjiro (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

    1991-02-01

    MRI was performed before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Of the 40 kidneys studied, 24 showed one or more changes on MRI: loss of the corticomedullary junction (n=15), subcapsular fluid (n=14), subcapsular hematoma (n=1), thickening of bridging septa (n=8), high intensity area in the muscle (n=8). These relatively subtle changes detected on MRI may not be apparent with other imaging techniques. (author).

  17. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes.

    Science.gov (United States)

    McAdams, Sean; Shukla, Aseem R

    2010-10-01

    Extracorporeal shock wave lithotripsy (ESWL) is currently a first-line procedure of most upper urinary tract stones ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  18. Extracorporeal shock wave therapy for treatment of plantar fasciitis

    International Nuclear Information System (INIS)

    Dastgir, N.

    2014-01-01

    Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

  19. Extracorporeal Cardiopulmonary Resuscitation Among Patients with Structurally Normal Hearts.

    Science.gov (United States)

    Conrad, Stephanie J; Bridges, Brian C; Kalra, Yuvraj; Pietsch, John B; Smith, Andrew H

    Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria. Median age was 16 years. Overall survival to hospital discharge was 32%. Conditional logistic regression demonstrated an independent survival benefit among smaller patients, patients with a lower partial pressure of carbon dioxide (PaCO2) on cannulation, and those with a shorter duration from intubation to eCPR cannulation. A diagnosis of sepsis was independently associated with a nearly threefold increase in odds of mortality, whereas the diagnosis of myocarditis portended a more favorable outcome. Neurologic complications, pulmonary hemorrhage, disseminated intravascular coagulation, CPR, pH less than 7.20, and hyperbilirubinemia after eCPR cannulation were independently associated with an increase in odds of mortality. When utilizing eCPR in patients with structurally normal hearts, a diagnosis of sepsis is independently associated with mortality, whereas a diagnosis of myocarditis is protective. Neurologic complications and pulmonary hemorrhage while on extracorporeal membrane oxygenation (ECMO) are independently associated with mortality.

  20. Extracorporeal membrane oxygenation: experience in an adult medical ICU.

    Science.gov (United States)

    Hermans, G; Meersseman, W; Wilmer, A; Meyns, B; Bobbaers, H

    2007-06-01

    Extracorporeal membrane oxygenation (ECMO) is a technology that can provide extracorporeal gas exchange to patients with severe pulmonary or cardiac dysfunction. We report on our clinical experience with ECMO in critically ill patients. We performed a retrospective analysis of 23 patients treated with ECMO in a medical intensive care unit in a tertiary referral academic centre. 13 patients were considered immunocompetent and 10 were immunocompromised when extracorporeal membrane oxygenation was started. 16 patients presented with acute respiratory distress syndrome (ARDS), 2 patients had intractable cardiac failure, and 5 patients had combined respiratory and cardiac failure. In 16 patients, a veno-venous bypass was constructed; in 7 patients, the initial bypass was venoarterial. 11 patients survived. In 2 patients technical complications were fatal. Our data indicate that patients with community-acquired pneumonia and no underlying disease will benefit most from this technique. However, long-term survival is possible in immunocompromised patients. Venoarterial bypass can carry a higher risk for technical complications. Increasing experience apparently also reduces the risk of technical complications.

  1. Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

    Directory of Open Access Journals (Sweden)

    Yatinder Kharbanda

    2014-01-01

    Full Text Available Background: Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees. Materials and Methods: Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used. Results: Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years. We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC scores in terms of pain, stiffness and physical function during activities of daily living. Conclusion: Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.

  2. Microstructural properties of trabecular bone autografts: comparison of men and women with and without osteoporosis.

    Science.gov (United States)

    Xie, Fen; Zhou, Bin; Wang, Jian; Liu, Tang; Wu, Xiyu; Fang, Rui; Kang, Yijun; Dai, Ruchun

    2018-03-05

    The microstructure of autologous bone grafts from men over 50 years old and postmenopausal women undergoing spinal fusion were evaluated using micro-CT. We demonstrated postmenopausal women, especially those with osteoporosis (OP) presented more serious microarchitectural deterioration of bone grafts. This study was undertaken to determine microstructural properties of cancellous bone used as autologous bone grafts from osteoporosis patients undergoing lumbar fusion by comparing microstructural indices to controls. Cancellous bone specimens from spinous processes were obtained from 41 postmenopausal women (osteoporosis women, n = 19; controls, n = 22) and 26 men over 50 years old (osteoporosis men, n = 8; controls, n = 18) during lumbar fusion surgery. The microstructural parameters were measured using micro-CT. Significant difference in bone volume fraction (BV/TV), specific bone surface (BS/BV), trabecular thickness (Tb.Th), and structure model index (SMI) value existed between postmenopausal women with OP and controls. Significant difference in trabecular number (Tb.N) existed between men over 50 years old with OP and controls. Postmenopausal women exhibited lower BV/TV, Tb.Th, and higher SMI value than men over 50 years old. Postmenopausal women with OP exhibited lower BV/TV, Tb.Th, and higher BS/BV than men over 50 years old with OP. Post-menopausal women and older men with OP have worse bone quality in autografts than non-osteoporotic men and women. Postmenopausal women with OP presented serious microarchitectural deterioration in older population.

  3. Mini buffy coat photopheresis for children and critically ill patients with extracorporeal photopheresis contraindications.

    Science.gov (United States)

    Hackstein, Holger; Misterek, Joachim; Nockher, Angelika; Reiter, Alfred; Bein, Gregor; Woessmann, Willi

    2009-11-01

    Conventional extracorporeal photopheresis (ECP) has proven efficacy for the treatment of several diseases but is limited to patients with sufficient body weight. A novel simplified mini buffy coat ECP technique that allows treatment of small children and patients with apheresis contraindications has been developed. White blood cell (WBC)-rich buffy coat fractions were prepared from 5 to 8 mL/kg whole blood in a closed system, diluted, and ultraviolet A (UVA)-irradiated after addition of 8-methoxypsoralen (8-MOP). Apoptosis and cell death were analyzed by annexin V and 7-aminoactinomycin staining. Lymphocyte proliferation was measured after CD3/CD28 and phytohemagglutinin (PHA) stimulation. Autologous residual blood and UVA-irradiated buffy coat were returned to the patients. Fifty-six mini buffy coat ECP procedures were applied to three children with acute steroid-refractory skin graft-versus-host disease and apheresis contraindications. Mean whole blood and buffy coat volumes were 166 (+/-61.8) and 8 (+/-1.6) mL, respectively, and resulted in a hematocrit of 2.2% (+/-0.4) after saline dilution (median +/- SD). UVA irradiation of 8-MOP buffy coat preparations resulted in significant induction of WBC apoptosis at 48-72 hours (p laboratory side effects were observed during mini ECP procedures and the three patients responded to the therapy. Mini buffy coat ECP induces apoptosis and lymphocyte proliferation inhibition, both of which occur after standard ECP. This study proposes that mini buffy coat ECP be used as a simple and inexpensive alternative to classical ECP in children and adult patients with apheresis contraindications.

  4. [Effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults].

    Science.gov (United States)

    Pu, Xiaobing; Yang, Shuangshi; Cao, Haiquan; Jing, Xingquan; Yin, Jun

    2014-03-01

    To investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults. Between January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0 +/- 1.1 and 75.3 +/- 11.2, respectively. The operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0 +/- 0.5 and 17.6 +/- 3.4, respectively, showing significant differences when compared with preoperative ones (t = 30.523, P = 0.000; t = 45.312, P = 0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found. The U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.

  5. Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    Hofhuis, W.; Hanekamp, M.N.; Ijsselstijn, H.; Nieuwhof, E.M.; Hop, W.C.J.; Tibboel, D.; Jongste, J.C. de; Merkus, P.J.F.M.

    2011-01-01

    OBJECTIVE: To collect longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation and to evaluate relationships between lung function and perinatal factors. Longitudinal data on lung function in the first year of life after extracorporeal membrane

  6. Extracorporeal Organ Support following Trauma: The Dawn of a New Era in Combat Casualty Critical Care

    Science.gov (United States)

    2013-01-01

    liver support has undergone significant technological advances. The Food and Drug Administration approved (December 2012) the Molecular Adsorbent Re...Williams & Wilkins Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. encephalopathy caused by...chronic liver disease decompen- sation. The Extracorporeal Liver Assist Device (ELAD) pro- vides continuous extracorporeal liver support with

  7. Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation

    NARCIS (Netherlands)

    Gerritsen, W. B.; van Boven, W. J.; Smelt, M.; Morshuis, W. J.; van Dongen, H. P.; Haas, F. J.; Aarts, L. P.

    2006-01-01

    Several recent studies have shown differences in blood loss and allogeneic transfusion requirements between on-pump and off-pump coronary artery bypass grafting (CABG). Recently a new concept, the mini-extracorporeal circulation, was introduced to minimize the side effects of extracorporeal

  8. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup

    Science.gov (United States)

    Decker, Brian S.; Goldfarb, David S.; Dargan, Paul I.; Friesen, Marjorie; Gosselin, Sophie; Hoffman, Robert S.; Lavergne, Valéry; Nolin, Thomas D.

    2015-01-01

    The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li+] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of the [Li+] (1D). Extracorporeal treatment is suggested if the [Li+] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li+] to 36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li+] is treatments should be continued for a minimum of 6 hours if the [Li+] is not readily measurable (1D). Hemodialysis is the preferred extracorporeal treatment (1D), but continuous RRT is an acceptable alternative (1D). The workgroup supported the use of extracorporeal treatment in severe lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the

  9. Persistent bone marrow edema after osteochondral autograft transplantation in the knee joint

    International Nuclear Information System (INIS)

    Nemec, Stefan Franz; Marlovits, Stefan; Trattnig, Siegfried

    2009-01-01

    Background and objective: The assessment of bone marrow edema-like signal intensity in magnetic resonance imaging (MRI) in patients after osteochondral autograft transplantation (OCT) in the knee joint is a parameter of yet indefinite value. This study determines the prevalence of persistent edema-like signal intensity in OCT patients and evaluates the correlation between edema and morphological imaging findings of the graft and clinical pain symptoms. Materials and methods: In this longitudinal observational study, 10 patients after OCT were followed by MRI prospectively 1 month, 3 months, 6 months, 12 months, and 24 months post-operatively. All MR examinations were performed on a 1.0 T MR unit with the same protocol using a modified scoring system (magnetic resonance observation of cartilage repair tissue-MOCART) for evaluation. Edema-like signal intensity in and beneath the osteochondral graft was assessed in its prevalence and graded using a coronal short tau inversion recovery fast spin echo (STIR-FSE) sequence: grade 1, normal; grade 2, moderate (diameter 2 cm). The finding of edema-like signal intensity was correlated with graded parameters describing the morphology of the repair tissue assessed in a sagittal dual FSE sequence including: (a) surface of repair tissue: grade 1, intact; grade 2, damaged. (b) Cartilage interface: grade 1, complete; grade 2, incomplete. (c) Bone interface: grade 1, complete; grade 2, delamination. The finding of edema-like signal intensity was also correlated with the KOOS pain score assessing knee pain after 12 months. Results: Initially, after 1 month the prevalence of edema-like signal intensity was 70% (7/10 patients) and finally after 24 months 60% (6/10 patients). We found no significant relationship between the prevalence and degree of edema-like signal intensity and parameters describing the morphology of the repair tissue. Also the clinical pain score did not show significant correlation with edema. Conclusion

  10. Clinically applicable bulk isolation of blood CD34+ cells for autografting in children.

    Science.gov (United States)

    Kawano, Y; Takaue, Y; Law, P; Watanabe, T; Abe, T; Okamoto, Y; Makimoto, A; Sato, J; Nakagawa, R; Kajiume, T; Hirao, A; Watanabe, A; Kuroda, Y

    1998-11-01

    CD34+ cells were purified in bulk from apheresis-collected cells of children with cancer using monoclonal antibody (MoAb) and magnetic beads (Baxter ISOLEX system). To improve the purity of the final product for possibly better tumor cell purging and to make the manufacturer's original procedure more cost-effective, we incubated the cells for 30 min with l-phenylalanine methylester hydrochloride (PME) to reduce the cell number by removing contaminating granulocytes and monocytes in the initial step before incubation with MoAb. Our modification prevented nonspecific interactions between MoAb and magnetic beads, and thereby saved expensive materials for purification. A total of 40 purifications were performed with samples containing a mean of 3.1 x 10(9) blood cells mobilized from 15 children by chemotherapy plus granulocyte colony-stimulating factor (G-CSF). The entire purification procedure, from the end of apheresis to storage, was completed within 5h. After incubation with PME and double-layered (40/60%) Percoll separation, the number of CD34+ cells was reduced to 48+/-29%, which suggests the possibility that half of the CD34+ cells in the inoculum were nonclonogenic in the hematopoietic progenitor assay. PME/Percoll-treated cells were then subjected to a final isolation procedure with MoAb according to the manufacturer's suggestions, and 52+/-42% and 32+/-22%, respectively, of the CFU-GM and CD34+ cells present in the initial bag inoculums were recovered. The recovery rates were, respectively, 54% and 67%, when the calculation was limited to the isolation procedure with MNoAb. The purity of isolated CD34+ cells and the plating efficiency in methylcellulose culture were, respectively, 77+/-24% and 33+/-13%. Fourteen children were subsequently autografted with purified CD34+ cells after marrow ablative chemotherapy. The median number of days to achieve an ANC of 0.5 x 10(9)/l was 12 and that to achieve a platelet count of 50 x 10(9)/l was 22.5, which were

  11. Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft.

    Science.gov (United States)

    Monllau, Joan C; Masferrer-Pino, Àngel; Ginovart, Gerard; Pérez-Prieto, Daniel; Gelber, Pablo E; Sanchis-Alfonso, Vicente

    2017-08-01

    To analyse the clinical and radiological outcomes of a quasi-anatomical reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis tendon autograft. Patients with objective recurrent patellar instability that were operated on from 2006 to 2012 were included. A quasi-anatomical surgical technique was performed using a gracilis tendon autograft. It was anatomically attached at the patella, and the adductor magnus tendon was also used as a pulley for femoral fixation (non-anatomical reconstruction). The IKDC, Kujala and Lysholm scores as well as Tegner and VAS for pain were collected preoperatively and at final follow-up. Radiographic measurements of patellar position tilt and signs of osteoarthritis (OA) as well as trochlear dysplasia were also recorded. Thirty-six patients were included. The mean age at surgery was 25.6 years. After a minimum 27 months of follow-up, all functional scores significantly improved (p patellofemoral surfaces at the short term, as shown by the absence of radiological signs of OA in the CT scan. The procedure has been shown to be safe and suitable for the treatment of chronic patellar instability, including in adolescents with open physis. A new effective, inexpensive and easy-to-perform technique is described to reconstruct MPFL in the daily clinical practice. Therapeutic case series, Level IV.

  12. Extracorporeal radiotherapy of blood using conventional radiation sources for treatment of CLL

    International Nuclear Information System (INIS)

    Oehl, N.

    1980-01-01

    A comparison of extracorporeal irradiation of blood (ECIB) with other forms of therapy for treatment of CLL reveals that ECIB has considerably fewer side-effects. This justifies its application in the early stages of illness. Intermittent ECIR treatment over a period of months enables a partial remission attained following initial intensive treatment to be upheld without serious complications. ECIB treatment also appears useful in chemo-resistant cases, since chemotherapy has been reported to be successful in a number of cases directly following ECIB therapy. ECIB therapeutic trials for pregnant patients is highly recommended. Although no negative effects of ECIB have to date been observed on the normal blood cell physiology it is nevertheless possible that intact strains are destroyed and thus further adversely affect the already injured normal blood cell status. The question as to how far ECIB, in treating special cases of CLL, may cause an increase in proliferation rate of lymphatic cells, ultimately remains unclarified. Further studies on possible feedback mechanisms are essential. Should these reveal that a recruitment of pathological cells is influenced by stimulation then ECIB treatment combined chemotherapy would show promise in phases of increased cell division. (orig./MG) [de

  13. Hematological complications in children subjected to extracorporeal membrane oxygenation.

    Science.gov (United States)

    Santiago, M J; Gómez, C; Magaña, I; Muñoz, V; Saiz, P; Sánchez, A; López-Herce, J

    2018-03-29

    To analyze the hematological complications and need for transfusions in children receiving extracorporeal life support (ECLS). A retrospective study was carried out. A pediatric intensive care unit. Children under 18 years of age treated with ECLS between September 2006 and November 2015. None. Patient and ECLS characteristics, anticoagulation, hematological and coagulation parameters, transfusions and clinical course. A total of 100 patients (94 with heart disease) with a median age of 11 months were studied. Seventy-six patients presented bleeding. The most frequent bleeding point being the mediastinum and 39 patients required revision surgery. In the first 3days, 97% of the patients required blood transfusion (34.4ml/kg per day), 94% platelets (21.1ml/kg per day) and 90% plasma (26.6ml/kg per day). Patients who were in the postoperative period, those who were bleeding at the start of ECLS, those requiring revision surgery, those who could not suspend extracorporeal circulation, and those subjected to transthoracic cannulation required a greater volume of transfusions than the rest of the patients. Thromboembolism occurred in 14 patients and hemolysis in 33 patients. Mortality among the children who were bleeding at the start of ECLS (57.6%) was significantly higher than in the rest of the patients (37.5%) (P=0.048). Children treated with ECLS present high blood product needs. The main factors related to transfusions were postoperative period, bleeding at the start of ECLS, revision surgery, transthoracic cannulation, and the impossibility of suspending extracorporeal circulation. Children with bleeding suffered greater mortality than the rest of the patients. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. Cell-mediated immunity in operable bronchial carcinoma: the effect of injecting irradiated autologous tumour cells and BCG

    International Nuclear Information System (INIS)

    Stack, B.H.R.; McSwan, N.; Stirling, J.M.

    1979-01-01

    In 52 patients undergoing tests of cell-mediated immunity before surgical resection of bronchial carcinoma a positive tuberculin test result was found in 71% compared with 68% of age - and sex-matched controls. Sensitization to DNCB occurred in 52% of 37 patients but in 78% controls. There was depression of lymphocyte transformation by PPD in 19 patients compared with controls (p=0.001), but there was no difference in lymphocyte transformation by PHA pr pokeweed mitogen between 34 patients and controls. In a pilot study patients were randomly allocated to autograft (eight) or non-autograft (seven) groups. The autograft group were given an intradermal injection of a suspension of irradiated autologous tumour-cells mixed with intradermal BCG on the day of operation. Tests of cell-mediated immunity were repeated two weeks after operation. Five patients in each group received a course of radiotherapy to the mediastinum three weeks after operation. There was a rise in a cutaneous tuberculin reactivity (p=0.08) and total leucocyte count (p=0.09) in the autograft group postoperatively with a fall in total lymphocyte and T lymphocyte counts in the non-autograft group (p<0.05). These differences, however, were not followed by any difference in the frequency of tumour recurrence or the survival rate two years after operation. The results show that the immunological surveillance mechanism is impaired even in patients with early bronchial carcinoma and that it is possible to overcome postoperative immunological depression with specific immunotherapy combined with BCG. This treatment did not produce any clinical advantage in this small number of patients and the skin lesions caused the patients considerable discomfort. (author)

  15. Appliance of entersorbent Vaulen and extracorporally radiated autoblood transfusion for correction of leukopenia reactions in patients with Hodgkin's disease

    International Nuclear Information System (INIS)

    Muravskaya, G.V.; Krutilina, N.I.; Sinajko, V.V.; Morozova, A.A.

    1994-01-01

    Investigation of comparative effectiveness of different methods of leukostimulation has been conducted for 120 patients with II-III grade Hodkins disease developed in the process of radiotherapy of leukopenia. With every patient a course of intensive radiotherapy with the single seat dose 4 Gy and staged change of the modes of fractioning of dose has been conducted. 4 methods of treatment have been applied: traditional hemostimulated therapy; blood transfusion of 200-250 mg of autoblood, preliminarily irradiated with 20 MeV electrons of 220 Gy dose for dose power 2.2-2.7 Gy/min; application of fibrous carbon entersorbent Vaulen for dose 50 mg/kg of body mass three times a day; simultaneous application of irradiated autoblood and Vaulen. Effectiveness of the method of treatment was estimated over the following criteria: dynamics of the level of leukocytes of periphery blood during 14 day of treatment; frequency and duration of breaks in radiotherapy, necessary for correction of leukocytes number; requirements in traditional hemostimulation remedy. The most effective method is transfusion of extracorporally irradiated autoblood together with application of Vaulen-remedy, which permitted 2.2 times shorten the frequency of breaks in the radiotherapy and decrease 3-5 times the requirements in traditional hemostimulation means. 5 refs., 2 tabs

  16. CT evaluation of the kidneys following extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Rubin, J.I.; Arger, P.H.; Pollack, H.M.; Banner, M.P.; Coleman, B.G.; Mintz, M.C.; Van Arsdalen, K.N.

    1986-01-01

    CT scans of the kidneys were obtained iln 50 patients before and after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) and intrarenal hematomas in two (4%) patients. Water-density subcapsular collections were seen in three (6%) patients. Treated kidneys showed a mean increase in renal size of 9%. Perinephric stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae. While most patients undergoing ESWL will show some posttreatment abnormality on CT, the procedure appears to be associated with a low incidence of serious renal trauma

  17. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-07-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation.

  18. Radiation exposure to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Marti, J.M.; Robles, J.E.; Arbizu, J.; Castro, F. de; Berian, J.M.; Richter, J.A.

    1992-01-01

    We analyzed the radiological exposure to patients during Extracorporeal Shock Wave Lithotripsy (ESWL) using a second generator lithotriptor. Stone location is accomplished by fluoroscopy and 'quick pics' or snapshots. A prospective study over 55 patients showed a mean exposure of 32.2 R. The introduction of the ALARA criterion reduced it to 16.1 R in the following 145 patients. Mean radiation exposure to patient varies according to treatment difficulty. A mean increase of radiation exposure of 1.6 between low and high difficulty treatment groups was observed. This variation was about 96% when the physician who performed the treatment was considered. (author)

  19. CT appearance of renal hemorrhage after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kanazawa, Susumu; Araki, Toru; Takamoto, Hitoshi; Hata, Kazuhiro

    1988-01-01

    Computed Tomography (CT) was performed in three patients who were suspicious of renal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). Post-ESWL scans demonstrated subcapsular hematoma in all three cases, and intrarenal hemorrhage in two cases, one of which had fluid collection in the pararenal space and hemorrhage in the posterior pararenal space on CT. Thickening of gerota fascia and bridging septa in the perirenal space was visualized on CT in all of them. CT demonstrated clearly the anatomic distribution and extent of renal hemorrhage, and it is important to comprehend the imaging anatomy of the perirenal area for CT evaluation. (author)

  20. Laparoscopic-assisted extracorporeal ovarian cystectomy: a new technique.

    Science.gov (United States)

    Ikuma, Kenichino; Amin, Magdy; Yukio, Yamada; Hisato, Okuo; Yoshihiro, Ito; Shintaro, Ueda; Masako, Tanaka; Yasuki, Koyasu

    2004-01-01

    An increasing number of adnexal masses are currently managed laparoscopically, which has hampered progress regarding the different techniques of laparoscopic surgery. In this chapter, a modified application of surgical instrument was described in laparoscopic ovarian cystectomy-we named this device, Lap-Disc Mini. This new instrument has three rings, an inner flexible ring fixed to a middle ring by a rubber corset, and an additional dynamic outer ring that has a rubbery-like iris opening, which allows the application of different-sized trocars and extracorporeal ovarian cystectomy. This technique has proved to be effective and safe, especially in removing large ovarian cyst.

  1. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  2. [How can we define the extracorporeal circulation quality?].

    Science.gov (United States)

    Blaffart, F; Defraigne, J-O

    2014-04-01

    Extracorporeal circulation (ECC) has to ensure homeostasis of the patient and to minimize pathophysiological disorders inherent in the technique. However, we cannot dissociate it from the surgery and anesthesia knowing that the discipline involves a close partnership with these stakeholders. The purpose of this publication is to review the essential elements that at present can contribute to the quality of the CEC and suggest improvements and developments to be implemented in this area. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  3. Effect of topical autologous platelet-rich fibrin versus no intervention on epithelialization of donor sites and meshed split-thickness skin autografts: a randomized clinical trial

    DEFF Research Database (Denmark)

    Danielsen, P.; Jorgensen, B.; Jorgensen, L.N.

    2008-01-01

    BACKGROUND: Autologous platelet-rich fibrin contains multiple growth factors. The aim of this randomized clinical trial was to study the effect of topical platelet-rich fibrin on epithelialization of donor sites and meshed split-thickness skin autografts. METHODS: Twenty consecutive leg ulcer pat...

  4. Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup.

    Science.gov (United States)

    Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A; Ghannoum, Marc; Hoffman, Robert S; Gosselin, Sophie; Lavergne, Valery; Nolin, Thomas D

    2016-02-01

    The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles, extracted data, summarized findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 51 articles met the inclusion criteria. Only case reports, case series, and pharmacokinetic studies were identified, yielding a very low quality of evidence. Clinical data from 31 patients and toxicokinetic grading from 46 patients were abstracted. The workgroup concluded that phenytoin is moderately dialyzable (level of evidence = C) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available (graded 1D). In summary, phenytoin appears to be amenable to extracorporeal removal. However, because of the low incidence of irreversible tissue injury or death related to phenytoin poisoning and the relatively limited effect of ECTR on phenytoin removal, the workgroup proposed the use of ECTR only in very select patients with severe phenytoin poisoning. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  5. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries.

    Science.gov (United States)

    Kattan, Javier; González, Álvaro; Castillo, Andrés; Caneo, Luiz Fernando

    To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Extracorporeal membrane oxygenation provides "time" for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  6. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    Directory of Open Access Journals (Sweden)

    Javier Kattan

    Full Text Available Abstract Objective: To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America. Sources: The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports. Summary of the findings: Extracorporeal membrane oxygenation provides “time” for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter. Conclusions: The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

  7. Review of 1,000 consecutive extracorporeal membrane oxygenation runs as a quality initiative.

    Science.gov (United States)

    Lovvorn, Harold N; Hardison, Daphne C; Chen, Heidi; Westrick, Ashly C; Danko, Melissa E; Bridges, Brian C; Walsh, William F; Pietsch, John B

    2017-08-01

    Extracorporeal membrane oxygenation is a resource-intensive mode of life-support potentially applicable when conventional therapies fail. Given the initial success of extracorporeal membrane oxygenation to support neonates and infants in the 1980s, indications have expanded to include adolescents, adults, and selected moribund patients during cardiopulmonary resuscitation. This single-institution analysis was conducted to evaluate programmatic growth, outcomes, and risk for death despite extracorporeal membrane oxygenation across all ages and diseases. Beginning in 1989, we registered prospectively all extracorporeal membrane oxygenation patient data with the Extracorporeal Life Support Organization. We queried this registry for our institution-specific data to compare the parameter of "discharge alive" between age groups (neonatal, pediatric, adult), disease groups (respiratory, cardiac, cardiopulmonary resuscitation), and modes of extracorporeal membrane oxygenation (veno-venous; veno-arterial). Extracorporeal membrane oxygenation-specific complications (mechanical, hemorrhagic, neurologic, renal, cardiovascular, pulmonary, infectious, metabolic) were analyzed similarly. Descriptive statistics, Kaplan-Meier, and linear regression analyses were conducted. After 1,052 extracorporeal membrane oxygenation runs, indications have expanded to include adults, to supplement cardiopulmonary resuscitation, to support hemodialysis in neonates and plasmapheresis in children, and to bridge all age patients to heart and lung transplant. Overall survival to discharge was 52% and was better for respiratory diseases (P < .001). Probability of individual survival decreased to <50% if pre-extracorporeal membrane oxygenation mechanical ventilation exceeded respectively 123 hours for cardiac, 166 hours for cardiopulmonary resuscitation, and 183 hours for respiratory diseases (P = .013). Complications occurred most commonly among cardiac and cardiopulmonary resuscitation runs

  8. Mechanical ventilation during extracorporeal membrane oxygenation. An international survey.

    Science.gov (United States)

    Marhong, Jonathan D; Telesnicki, Teagan; Munshi, Laveena; Del Sorbo, Lorenzo; Detsky, Michael; Fan, Eddy

    2014-07-01

    In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear. Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO). We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis. We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation. Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation.

  9. Extracorporeal Detoxification in Victims with Severe Concomitant Injury

    Directory of Open Access Journals (Sweden)

    S. Ye. Khoroshilov

    2009-01-01

    Full Text Available Objective: to improve the results of victims with massive crushes of soft tissues in severe concomitant injury (SCI, by applying extracorporeal detoxification techniques as soon as possible. Subjects and methods. The results of examination and treatment were studied in 41 victims with SCI treated at the N. N. Burdenko Main Military Clinical Hospital in 2006 to 2008. In the early posttraumatic period (on days 1—3, all the victims (n=41 were divided into 2 groups. Group 1 victims (n=19 underwent hemodiafiltration (HDF with replacement at 35 ml/kg/hr; Group 2 (n=22 had plasmapheresis. Results. Early HDF applied to Group 1 victims could achieve 32, 44, and 37% reductions in the elevated levels creatine phosphokinase, myoglobin, and middle-sized molecules, respectively. In Group 2, plasmapheresis showed a lower effect (19, 25, and 26% reductions. Furthermore, there was a decrease in total protein in Group 1, which was absent in Group 2. Conclusion. The timely use of extracorporeal detoxification techniques in victims with massive crushes of soft tissues in the early posttraumatic period prevents the development of fatal complications of SCI, at the same time HDF is more effective and safe than plasmapheresis. Key words: severe concomitant injury, rhabdomyolysis, myoglobin, plasmapheresis, hemodiafiltration.

  10. Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.

    Science.gov (United States)

    Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S; Roberts, Darren M; Mactier, Robert; Mowry, James B; Dargan, Paul I; Maclaren, Robert; Hoegberg, Lotte C; Laliberté, Martin; Calello, Diane; Kielstein, Jan T; Anseeuw, Kurt; Winchester, James F; Burdmann, Emmanuel A; Bunchman, Timothy E; Li, Yi; Juurlink, David N; Lavergne, Valery; Megarbane, Bruno; Gosselin, Sophie; Liu, Kathleen D; Hoffman, Robert S

    2012-10-01

    The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is poisoning.

  11. [Renal hematomas after extracorporeal shock-wave lithotripsy (ESWL)].

    Science.gov (United States)

    Pastor Navarro, Héctor; Carrión López, Pedro; Martínez Ruiz, Jesús; Pastor Guzmán, José Ma; Martínez Martín, Mariano; Virseda Rodríguez, Julio A

    2009-03-01

    The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It's the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasive treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock-waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirenal hematoma which we followed up and treated. After the urological complications (pain, obstruction and infection) the renal and perirenal hematic collections are the most frequent adverse effects of shock-waves used in lithotripsy, these are related to the power of energy used and patient age. Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%. Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy.

  12. Two decades' experience with interfacility transport on extracorporeal membrane oxygenation.

    Science.gov (United States)

    Bryner, Benjamin; Cooley, Elaine; Copenhaver, William; Brierley, Kristin; Teman, Nicholas; Landis, Denise; Rycus, Peter; Hemmila, Mark; Napolitano, Lena M; Haft, Jonathan; Park, Pauline K; Bartlett, Robert H

    2014-10-01

    Interfacility transport of patients on extracorporeal membrane oxygenation (ECMO) has been performed in large numbers at only a few programs. Limited data are available on outcomes after ECMO transport to justify expanding or discontinuing these programs. This was a retrospective review of a 20-year, single-institution experience with interhospital ECMO transport as well as a systematic review of reports of transfers of patients on ECMO. Results of both were compared with historical data from the international registry of the Extracorporeal Life Support Organization (ELSO). Between 1990 and 2012, ECMO was used to facilitate transport of 221 patients to our institution, and 135 (62%) survived to discharge. Review of an additional 27 case series describing ECMO transport of 643 patients showed an overall survival of 61%. After stratifying by age and primary indication for ECMO, survival of transported patients was not significantly different compared with all ECMO patients in the ELSO registry, with the exception of pediatric patients treated for respiratory failure (transported patients in this category had higher survival than those in the ELSO registry). Interfacility transport on ECMO is feasible and can be accomplished safely in the critically ill. Survival of transported patients is comparable to age-matched and treatment-matched ECMO patients at large. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Early and mid-term results of autograft rescue by Ross reversal: A one-valve disease need not become a two-valve disease.

    Science.gov (United States)

    Hussain, Syed T; Majdalany, David S; Dunn, Aaron; Stewart, Robert D; Najm, Hani K; Svensson, Lars G; Houghtaling, Penny L; Blackstone, Eugene H; Pettersson, Gösta B

    2018-02-01

    Risk of reoperation and loss of a second native valve are major drawbacks of the Ross operation. Rather than discarding the failed autograft, it can be placed back into the native pulmonary position by "Ross reversal." We review our early and mid-term results with this operation. From 2006 to 2017, 39 patients underwent reoperation for autograft dysfunction. The autograft was successfully rescued in 35 patients: by Ross reversal in 30, David procedure in 4, and autograft repair in 1. Medical records were reviewed for patient characteristics (mean age was 46 ± 13 years, range 18-67 years, and 23 were male), previous operations, indications for reoperation, hospital outcomes, and echocardiographic findings for the 30 patients undergoing successful Ross reversal. Follow-up was 4.1 ± 3.5 years (range 7 months-11 years). Median interval between the original Ross procedure and Ross reversal was 12 years (range 5-19 years). Eight patients also had absolute indications for replacement of the pulmonary allograft. There was no operative mortality. One patient required reoperation for bleeding. Another had an abdominal aorta injury from use of an endoballoon clamp. There was no other major postoperative morbidity, and median postoperative hospital stay was 7.2 days (range 4-41 days). No patient required reoperation during follow-up. Twenty-four patients had acceptable pulmonary valve function, and 6 had clinically well-tolerated moderate or severe pulmonary regurgitation. Ross reversal can be performed with low morbidity and acceptable pulmonary valve function, reducing patient risk of losing 2 native valves when the autograft fails in the aortic position. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  14. Conjunctival-limbal autograft in total unilateral limbal stem cell deficiency

    Directory of Open Access Journals (Sweden)

    Petra Schollmayer

    2017-09-01

    Full Text Available Background: Corneal epithelium is renewed by stem cells (SC that reside at the corneal limbus. Reduced number of SC or their abnormal function lead to the ocular surface disease called limbal stem cell deficiency (LSCD, characterized by corneal conjunctivalization, vascularization, persistent epithelial defects, chronic inflammation, and loss of vision. In a case of total unilateral LSCD, autologous transplantation of limbal epithelial stem cells (LESC from the healthy eye is needed. We describe the surgical technique of choice for autologous limbal transplantation, called conjunctival limbal autograft (CLAU that we combined with amniotic membrane (AM use. We present the results of CLAU in three patients with total unilateral LSCD due to chemical injury.Methods: Autologous limbal transplantation CLAU begins with the removal of fibrovascular pannus from the diseased corneal surface and the harvesting of two conjunctival-limbal grafts from the healthy eye. The grafts are then transplanted on to the limbal area of the recipient eye. AM is used as a patch to cover the denuded cornea and limbal grafts, as well as a barrier preventing the conjunctival epithelium from encroaching on to the temporal and nasal side of the corneal surface. In the donor eye, AM is used to cover the donor sites. CLAU with the use of AM was performed in 3 patients with unilateral LSCD due to chemical eye injury. In one patient limbal transplantation was combined with symblepharon lysis for entropium repair. In all cases AM was removed 3–6 days postoperatively to assess the growth of new epithelium from the limbal grafts. In all patients the ocular surface was covered with another AM until the cornea was completely epithelized and the new epithelium stable. In one patient the corneal regrafting and cataract removal was performed subsequently.Results: CLAU was successful in 2 patients and partially successful in 1 patient during the follow up. In all cases the growth of new

  15. Significant social events and increasing use of life-sustaining treatment: trend analysis using extracorporeal membrane oxygenation as an example.

    Science.gov (United States)

    Chen, Yen-Yuan; Chen, Likwang; Huang, Tien-Shang; Ko, Wen-Je; Chu, Tzong-Shinn; Ni, Yen-Hsuan; Chang, Shan-Chwen

    2014-03-04

    Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan. Taiwan's extracorporeal membrane oxygenation uses from 2000 to 2009 were collected from National Health Insurance Research Dataset. The number of the worldwide extracorporeal membrane oxygenation cases was mainly estimated using Extracorporeal Life Support Registry Report International Summary July 2012. The trend of Taiwan's crude annual incidence rate of extracorporeal membrane oxygenation use was compared with that of the rest of the world. Each trend of extracorporeal membrane oxygenation use was examined using joinpoint regression. The measurement was the crude annual incidence rate of extracorporeal membrane oxygenation use. Each of the Taiwan's crude annual incidence rates was much higher than the worldwide one in the same year. Both the trends of Taiwan's and worldwide crude annual incidence rates have significantly increased since 2000. Joinpoint regression selected the model of the Taiwan's trend with one joinpoint in 2006 as the best-fitted model, implying that the significant social events in 2006 were significantly associated with the trend change of extracorporeal membrane oxygenation use following 2006. In addition, significantly social events highlighted by the media are more likely to be associated with the increase of extracorporeal membrane oxygenation use than being fully covered by National Health Insurance. Significant social events, such as a well-known person's successful extracorporeal membrane oxygenation use highlighted by the mass media, are associated with the use of

  16. Mandibular Reconstruction by Using a Liquid Nitrogen-Treated Autograft in a Dog with an Oral Tumor.

    Science.gov (United States)

    Okamura, Yasuhiko; Heishima, Kazuki; Motegi, Tomoki; Sasaki, Jun; Goryo, Masanobu; Nishida, Hideji; Tsuchiya, Hiroyuki; Katayama, Masaaki; Uzuka, Yuji

    A 10 yr old intact female German shepherd dog presented with a large peripheral odontogenic fibroma and malignant melanoma on her lower jaw. The tumor was resected with a unilateral subtotal rostral hemimandibulectomy. After the mandible was removed, it was devitalized intraoperatively by freezing it in liquid nitrogen. It was subsequently reimplanted. New bone tissue formed in the gap between the frozen bone and the host bone. The regenerated bone contained osteocytes, osteoblasts, and blood vessels. The cosmetic appearance of the dog was preserved. The dog had normal mastication. The malignant melanoma recurred rostral of the left canine tooth at 159 days after the reconstruction surgery. A subtotal hemimandibulectomy was consequently performed. This is the first reported case of mandibular reconstruction using a liquid nitrogen-treated autograft in a dog with oral tumors.

  17. Surgical treatment of 2 cases of irradiation induced constrictive pericarditis

    Energy Technology Data Exchange (ETDEWEB)

    Osawa, Hiroshi; Takahashi, Wataru; Yoshii, Shinpei [Yamanashi Medical Univ., Tamaho (Japan)] (and others)

    1999-11-01

    A 72-years-old man underwent radiation therapy (62 Gy) for esophageal carcinoma. Twelve months later, symptoms of heart failure such as syncope, cough and hepatomegaly manifested. On catheter study, a dip and plateau pattern of right ventricular pressure curve was evident. Pericardiectomy without extracorporeal circulation was performed. Operative findings and pathological results were compatible with radiation-induced constrictive pericarditis. He recovered from the heart failure, and has been doing well 3 months after the surgery. A 54-years-old man underwent thymectomy for malignant thymoma. He underwent a radiation therapy (52 Gy) postoperatively. After 12 months from the irradiation, syncope and dyspnea manifested. On catheter study, a dip and plateau pattern of right ventricular pressure curve was observed. Pericardiectomy with extracorporeal circulation was performed. He recovered from the heart failure after pericardiectomy, however he died of radiation-induced pneumonitis 6 months later. (author)

  18. Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

    Directory of Open Access Journals (Sweden)

    Tsukada Sachiyuki

    2012-07-01

    Full Text Available Abstract Background Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure. Methods The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity. Results All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient. Conclusions There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

  19. Effect of autoclave devitalization on autograft incorporation and bone morphogenetic protein of tibia in Sprague-Dawley rats

    Directory of Open Access Journals (Sweden)

    Anak A.G.Y. Asmara

    2014-06-01

    Full Text Available Background: Heating process with autoclave is one of limb salvage modalities that are widely used. but the results are not satisfying, due to mechanical bone fragility. However, considering this treatment modality is widely accepted in terms of financial, religion and sociocultural aspects, we conducted a on study rats treated with resection and reconstruction with autoclave heating method to assess bone healing by sequential radiology, histopathologic osteoblasts count, and bone morphogenetic protein (BMP.Methods: Thirty six Sprague-Dawley rats were divided into two groups with one group being the autoclave group and others served as control group. In both groups, the tibial diaphysis was extracted en bloc for 7 mm. All groups were kept for 8 weeks and treated under the same condition except the autoclave group, where the extracted bones were put into autoclave at 134°C for 15 minutes and refixed again with k-wire. We performed radiological examination at 5th and 8th week using Lane and Sandhu radiological score. After extraction, the tibial bones were inspected for histological pattern using Salked modified score, osteoblast quantity counting and BMP-2 values.Results: There were statistically significant diffences between control and autoclave group on radiological score at 5th (5.12 ± 1.6 g vs 3.21 ± 2.42, p = 0.023 and 8th week (6.06 ± 1.71 vs 4.29 ± 2.53, p = 0.040, histological score between groups (6.06 ± 1.14 vs 4.14 ± 1.99, p = 0.005, osteoblast count (p < 0.001, and BMP-2 expression,  respectively.Conclusion: Autoclave recycling autograft lowered the speed of graft incorporation and BMP-2 expression. Therefore, autoclave recycling autograft as a method of limb salvage surgery must be reevaluated and not considered to be applied for treatment in bone malignancy.  

  20. METHODS OF EXTRACORPOREAL HEMOCORRECTION IN COMPLEX TREATMENT OF BACTERIAL AND VIRAL INFECTIONS AFTER KIDNEY TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    A. V. Vatazin

    2013-01-01

    Full Text Available Scientific publications devoted to the contemporary prospective selected and combined extracorporeal modalities to treat complications after renal allotransplantation were analyzed involving pyoseptic processes and viral hepatites.

  1. Evaluation of furosemide regimens in neonates treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.M.J. van der Vorst (Maria); E.D. Wildschut (Enno); R.J.M. Houmes (Robert Jan); S.J. Gischler (Saskia); J.E. Kist-Van Holthe (Joana); J. Burggraaf (Jacobus); A.J. van der Heijden (Bert); D. Tibboel (Dick)

    2006-01-01

    textabstractIntroduction: Loop diuretics are the most frequently used diuretics in patients treated with extracorporeal membrane oxygenation (ECMO). In patients after cardiopulmonary bypass (CPB) surgery, the use of continuous furosemide infusion is increasingly documented. Because ECMO and CPB are

  2. Use of Hypertonic Sodium Chloride Solution at Surgery under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    V. V. Lomivorotov

    2012-01-01

    Full Text Available The paper analyzes the data available in the references on different aspects of using hypertonic sodium chloride solution during surgery under extracorporeal circulation in cardiosurgical care. The hypertonic solution is shown to lower positive fluid balance in the perioperative period, to increase cardiac output with simultaneously decreased vascular resistance, to improve lung oxygenating function, and to normalize tissue blood circulation and neurological status in patients exposed to artificial perfusion. There is evidence for its effect on the immune system and capillary endothelium. It is suggested that it is necessary to study the effect of the hypertonic solution on the incidence of complications and death rates during surgery under extracorporeal circulation and it is proposed to use the solution under long-term extracorporeal circulation. Key words: hypertonic saline, sodium chloride, extracorporeal circulation.

  3. Liver fibrosis after extracorporeal shock-wave lithotripsy of gallbladder stones - A case report

    NARCIS (Netherlands)

    P.W. Plaisier; J.F. Hamming (Jaap); R.L. van der Hul (René); R. den Toom (Rene); H.A. Bruining (Hajo)

    1994-01-01

    textabstractWe encountered significant liver fibrosis in a healthy young patient undergoing laparoscopic cholecystectomy for symptomatic gallstone disease. Twelve months prior to cholecystectomy the patient underwent multiple extracorporeal shock-wave lithotripsy (ESWL) sessions with adjuvant oral

  4. Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention

    NARCIS (Netherlands)

    Skolarikos, Andreas; Alivizatos, Gerasimos; de la Rosette, Jean

    2006-01-01

    OBJECTIVE: We review the pathophysiology and possible prevention measures of complications after extracorporeal shock wave lithotripsy (ESWL). METHODS: A literature search was performed with the Medline database on ESWL between 1980 and 2004. RESULTS: ESWL application has been intuitively connected

  5. A Neutrophil Phenotype Model for Extracorporeal Treatment of Sepsis.

    Directory of Open Access Journals (Sweden)

    Alexander D Malkin

    2015-10-01

    Full Text Available Neutrophils play a central role in eliminating bacterial pathogens, but may also contribute to end-organ damage in sepsis. Interleukin-8 (IL-8, a key modulator of neutrophil function, signals through neutrophil specific surface receptors CXCR-1 and CXCR-2. In this study a mechanistic computational model was used to evaluate and deploy an extracorporeal sepsis treatment which modulates CXCR-1/2 levels. First, a simplified mechanistic computational model of IL-8 mediated activation of CXCR-1/2 receptors was developed, containing 16 ODEs and 43 parameters. Receptor level dynamics and systemic parameters were coupled with multiple neutrophil phenotypes to generate dynamic populations of activated neutrophils which reduce pathogen load, and/or primed neutrophils which cause adverse tissue damage when misdirected. The mathematical model was calibrated using experimental data from baboons administered a two-hour infusion of E coli and followed for a maximum of 28 days. Ensembles of parameters were generated using a Bayesian parallel tempering approach to produce model fits that could recreate experimental outcomes. Stepwise logistic regression identified seven model parameters as key determinants of mortality. Sensitivity analysis showed that parameters controlling the level of killer cell neutrophils affected the overall systemic damage of individuals. To evaluate rescue strategies and provide probabilistic predictions of their impact on mortality, time of onset, duration, and capture efficacy of an extracorporeal device that modulated neutrophil phenotype were explored. Our findings suggest that interventions aiming to modulate phenotypic composition are time sensitive. When introduced between 3-6 hours of infection for a 72 hour duration, the survivor population increased from 31% to 40-80%. Treatment efficacy quickly diminishes if not introduced within 15 hours of infection. Significant harm is possible with treatment durations ranging from 5

  6. Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

    Directory of Open Access Journals (Sweden)

    Javier Kattan

    2017-03-01

    Conclusions: The best results in short‐ and long‐term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.

  7. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup.

    Science.gov (United States)

    Decker, Brian S; Goldfarb, David S; Dargan, Paul I; Friesen, Marjorie; Gosselin, Sophie; Hoffman, Robert S; Lavergne, Valéry; Nolin, Thomas D; Ghannoum, Marc

    2015-05-07

    The Extracorporeal Treatments in Poisoning Workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments in poisoning. Here, the EXTRIP workgroup presents its recommendations for lithium poisoning. After a systematic literature search, clinical and toxicokinetic data were extracted and summarized following a predetermined format. The entire workgroup voted through a two-round modified Delphi method to reach a consensus on voting statements. A RAND/UCLA Appropriateness Method was used to quantify disagreement, and anonymous votes were compiled and discussed in person. A second vote was conducted to determine the final workgroup recommendations. In total, 166 articles met inclusion criteria, which were mostly case reports, yielding a very low quality of evidence for all recommendations. A total of 418 patients were reviewed, 228 of which allowed extraction of patient-level data. The workgroup concluded that lithium is dialyzable (Level of evidence=A) and made the following recommendations: Extracorporeal treatment is recommended in severe lithium poisoning (1D). Extracorporeal treatment is recommended if kidney function is impaired and the [Li(+)] is >4.0 mEq/L, or in the presence of a decreased level of consciousness, seizures, or life-threatening dysrhythmias irrespective of the [Li(+)] (1D). Extracorporeal treatment is suggested if the [Li(+)] is >5.0 mEq/L, significant confusion is present, or the expected time to reduce the [Li(+)] to 36 hours (2D). Extracorporeal treatment should be continued until clinical improvement is apparent or [Li(+)] is lithium poisoning. Clinical decisions on when to use extracorporeal treatment should take into account the [Li(+)], kidney function, pattern of lithium toxicity, patient's clinical status, and availability of extracorporeal treatments. Copyright © 2015 by the American Society of Nephrology.

  8. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

    OpenAIRE

    Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus BM; Schmitz, Christoph

    2014-01-01

    Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predict...

  9. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tramm, Ralph; Ilic, Dragan; Murphy, Kerry; Sheldrake, Jayne; Pellegrino, Vincent; Hodgson, Carol

    2017-06-01

    To explore the experiences of family members of patients treated with extracorporeal membrane oxygenation. Sudden onset of an unexpected and severe illness is associated with an increased stress experience of family members. Only one study to date has explored the experience of family members of patients who are at high risk of dying and treated with extracorporeal membrane oxygenation. A qualitative descriptive research design was used. A total of 10 family members of patients treated with extracorporeal membrane oxygenation were recruited through a convenient sampling approach. Data were collected using open-ended semi-structured interviews. A six-step process was applied to analyse the data thematically. Four criteria were employed to evaluate methodological rigour. Family members of extracorporeal membrane oxygenation patients experienced psychological distress and strain during and after admission. Five main themes (Going Downhill, Intensive Care Unit Stress and Stressors, Carousel of Roles, Today and Advice) were identified. These themes were explored from the four roles of the Carousel of Roles theme (decision-maker, carer, manager and recorder) that participants experienced. Nurses and other staff involved in the care of extracorporeal membrane oxygenation patients must pay attention to individual needs of the family and activate all available support systems to help them cope with stress and strain. An information and recommendation guide for families and staff caring for extracorporeal membrane oxygenation patients was developed and needs to be applied cautiously to the individual clinical setting. © 2016 John Wiley & Sons Ltd.

  10. [Extracorporeal photopheresis as an alternative therapy for drug-resistant graft versus host disease: three cases].

    Science.gov (United States)

    D'incan, M; Kanold, J; Halle, P; De Lumley, L; Souteyrand, P; Deméocq, F

    2000-02-01

    Graft versus host reaction is a life-threatening complication of allogenic bone marrow transplantation. Extracorporeal photopheresis has been used for some years in the treatment of graft versus host reaction. We report on three children treated with extracorporeal photopheresis for a graft versus host reaction resistant to immunosuppresive drugs. Three children with a graft versus host reaction were submitted to 18, 30 and 46 extracorporeal photopheresis courses respectively. In the same time, the other immunosuppressive treatments were tapered or definitively stopped (ciclosporin). A dramatic improvement of cutaneous status and biological data was observed after the first courses. However, the extracorporeal photopheresis treatment did not improve the mucous lesions. No serious adverse effect was encountered. As published elsewhere, extracorporeal photopheresis was effective on the graft versus host reaction lichenoid cutaneous lesions and in case of visceral involvement. In all of our cases, the immunosuppressive drug could have been tapered. No adverse event was observed. Thus, extracorporeal photopheresis should be indicated in case of resistance to immunosuppressive drugs.

  11. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Science.gov (United States)

    Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K.

    2014-01-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome. PMID:25024562

  12. Extracorporeal shock wave therapy in periodontics: A new paradigm.

    Science.gov (United States)

    Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K

    2014-05-01

    The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  13. Extracorporeal shock wave therapy in periodontics: A new paradigm

    Directory of Open Access Journals (Sweden)

    Munivenkatappa Lakshmaiah Venkatesh Prabhuji

    2014-01-01

    Full Text Available The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

  14. Efficacy Management of Urolithiasis: Flexible Ureteroscopy versus Extracorporeal Shockwave Lithotripsy.

    Science.gov (United States)

    Tauber, Volkmar; Wohlmuth, Martin; Hochmuth, Andreas; Schimetta, Wolfgang; Schimetta, Wofgang; Krause, F Steffen

    2015-01-01

    To evaluate the efficacy of flexible ureterscopy (fURS) and extracorporal shockwave lithotripsy (SWL) in the treatment of urolithiasis, complemented by a subgroup analysis of lower pole calyx. Retrospective analysis of patients treated by fURS or SWL was performed by independent variables such as gender, age, nephrolith size, double-J stent (DJ stent) and stone localisation. Out of 326 patients, 165 were treated by SWL and 161 by fURS. Complete stone removal was achieved by fURS in 83.2% and by SWL in 43.0% (p auxillary DJ stent was performed more often preoperative before fURS. The subgroup analysis of lower pole calyx confirmed these evaluations. Complete stone-free removal was almost 8 times higher after fURS compared to SWL. The efficacy of fURS in treatment of urolithiasis is substantially higher than the efficacy of SWL. © 2015 S. Karger AG, Basel.

  15. Stenting and extracorporeal shock wave lithotripsy in chronic pancreatitis

    DEFF Research Database (Denmark)

    Holm, M; Matzen, Peter

    2003-01-01

    BACKGROUND: Early observational studies of endoscopic treatment and extracorporeal shock wave lithotripsy (ESWL) reported considerable or complete relief of pain in 50%-80% of patients with chronic pancreatitis. There is no consensus on the measurement of pain, making comparison of observational...... studies difficult, and little attention has been paid to the type and amount of analgesics used by patients before and after decompressive treatment. METHODS: We performed a retrospective study of all patients with chronic pancreatitis and large-duct disease and receiving decompressing treatment between 1...... November 1994 and 31 July 1999. Primary parameters were type and amount of analgesics used. RESULTS: Forty-nine patients with chronic pancreatitis and large-duct disease received stenting of the pancreatic duct (28 patients), ESWL (6 patients) or both (15 patients). After a median follow-up of 21 months...

  16. Radiation exposure to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Van Swearingen, F.L.; McCullough, D.L.; Dyer, R.; Appel, B.

    1987-01-01

    Extracorporeal shock wave lithotripsy is rapidly becoming an accepted treatment of renal calculi. Since fluoroscopy is involved to image the stones it is important to know how much radiation the patient receives during this procedure. Surface radiation exposure to the patient was measured in more than 300 fluoroscopic and radiographic procedures using thermoluminescent dosimeters. Initial results showed an average skin exposure of 10.1 rad per procedure for each x-ray unit, comparing favorably with exposure rates for percutaneous nephrostolithotomy and other routine radiological procedures. Factors influencing exposure levels include stone characteristics (location, size and opacity), physician experience and number of shocks required. Suggestions are given that may result in a 50 per cent reduction of radiation exposure

  17. Low-Intensity Extracorporeal Shockwave Therapy in Sexual Medicine

    DEFF Research Database (Denmark)

    Fode, Mikkel; Lowenstein, Lior; Reisman, Yacov

    2017-01-01

    INTRODUCTION: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a treatment option for male sexual dysfunction. However, results have been contradictory. AIM: To investigate the knowledge, practice patterns, and attitudes regarding LI-ESWT among experts in sexual medicine....... METHODS: A study-specific questionnaire was handed out at the 18th Congress for the European Society for Sexual Medicine. Participants were queried on their knowledge about LI-ESWT and about their use of the equipment. MAIN OUTCOME MEASURES: Descriptive data on the knowledge of LI-ESWT and perception...... of treatment effects. RESULTS: One hundred ninety-two questionnaires were available for analysis. Most respondents were physicians (79.7%) and most of these specialized in urology (58.9%). Overall, 144 of 192 (75%) reported that they were familiar with LI-ESWT in sexual medicine. Twenty-seven (14.1%) had...

  18. Second generation extracorporeal lithotripsy: Whither American radiologic leadership

    International Nuclear Information System (INIS)

    Pfister, R.C.

    1987-01-01

    Extracorporeal shock wave lithotripsy was developed by Dornier Medical Systems, Inc., and West German urologists. In the United States the marketing, training, and operation of these wet-tub units were limited to urologists. New dry-treatment lithotriptors are being developed in various countries, including the United States (Medstone), and will be marketed to radiologists, among others, once approved by the FDA for clinical use; future applications will include gallstones as well as renal calculi. Some of these new lithotripors are radiologically intensive, requiring US or fluroscopic guidance and radiography. Since the stone pulverization process in an image-controlled procedure, the units should be managed by radiologists; this will require supportive leadership from all current radiology department chiefs. This presentation reviews the lithotriptors available

  19. Spleen injury following left extracorporeal shockwave lithotripsy (ESWL).

    Science.gov (United States)

    Marinkovic, Serge P; Marinkovic, Christina M; Xie, Donghua

    2015-02-18

    A splenic rupture associated with extracorporeal shockwave lithotripsy (ESWL) is exceedingly rare. We report a case of stage 3 splenic laceration, hemoperitoneum and subsequent splenic rupture following an ESWL for a left mid polar renal calculus. During the ESWL, although the patient's pain was controlled the gentleman was very nervous and had to be repositioned eight individual times. Approximately 6 hours after the ESWL, the patient phoned the urologist complaining of severe left flank pain unlike any previous episode of renal colic. A computerized tomography (CT) scan demonstrated a stage 3 splenic injury with hemoperitoneum. The patient decompensated and an emergent splenectomy was then performed and the patient experienced an uneventful recovery. Splenic injury likely results from unintentional movement during the sound wave administration for the stone fragmentation procedure. Utilizing noise cancelling headphones during ESWL may preclude the potential pitfalls of patient nervousness.

  20. MR imaging of kidneys following extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Baumgartner, B.R.; Dickey, K.W.; Nelson, R.C.; Ambrose, S.S.; Walton, K.N.; Bernardino, M.E.

    1986-01-01

    MR images were obtained the day after extracorporeal shock wave lithotripsy (ESWL) therapy in 34 patients; the untreated kidneys served as controls. Five patients underwent ESWL of both kidneys before MR imaging. The kidneys were imaged with a spin-echo technique. Multisection coronal, sagittal, and axial images were obtained with T1-weighted pulse sequences. MR imaging studies of 39 kidneys after ESWL showed no abnormality in ten (25%) cases. The other kidneys (75%) had one or more of several findings. Small subcapsular or perinephric fluid collections were noted in ten (25%) patients. Generalized loss of corticomedullary junction (CMJ) was noted in eight (21%) cases and focal loss in 16 (24%). The more pronounced alterations in the CMJ correlated with increased numbers of shock waves received by the kidney

  1. Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Wei Chuan Chen; Ying Huei Lee; Ming Tsun Chen; Jong Khing Huang; Luke S Chang (Division of Urology, Dept. of Surgery, National Yang-Ming Medical College and Veterans General Hospital-Taipei, Taiwan (China))

    1991-01-01

    A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation. (au).

  2. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    International Nuclear Information System (INIS)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon; Yoon, Seok Hwan

    2006-01-01

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications

  3. Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Wei Chuan Chen; Ying Huei Lee; Ming Tsun Chen; Jong Khing Huang; Luke S Chang

    1991-01-01

    A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation. (au)

  4. Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon [Asan Medical Center, Seoul (Korea, Republic of); Yoon, Seok Hwan [Dongnam Health College, Suwon (Korea, Republic of)

    2006-06-15

    We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications.

  5. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  6. Some health physics implications of extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Henderson, J.E.

    1987-01-01

    Extracorporeal Shock Wave Lithotripsy (ESWL) is a relatively new, noninvasive technique for the destruction of renal calculi (kidney stones) in vivo. X-ray localizing techniques are used to position the stone for shock wave destruction. The combination of radiographic and fluoroscopic exposure contributes significantly to patient dose. This presentation considers alternative techniques for measuring patient exposure during ESWL and details many of the problems attendant to those measurements. Factors that contribute to patient dose are described. Comparisons are made to previous interventions for renal calculi involving radiological considerations. Operator exposures are negligible for this procedure, but skin entrance exposures for patients have been found on the order of 10 R to 17 R. Attempts to quantify gonadal doses during ESWL treatment at the University of Virginia are described. A rationale for continued studies in this area is offered

  7. Chronic blood irradiation: a new approach

    International Nuclear Information System (INIS)

    Hungate, F.P.; Riemath, W.F.; Bunnell, L.R.; Gillis, M.F.

    1976-01-01

    Extracorporeal irradiation of blood is beneficial in suppressing early rejection of renal allografts and in treating chronic lymphocytic leukemia. Previously, nearly all blood irradiation has involved brief intermittent exposures with high dose rates. The small amount of data available involving chronic irradiation suggests that doses given chronically at lower rates are more effective in suppressing graft rejection. However, no suitably portable device has been available to permit chronic irradiation. This work has been directed toward developing a fully portable irradiator. After preliminary testing of a variety of source materials, 170 Tm was selected for its favorable beta energy, low cost, and compatibility with the fabrication requirements. The body of the irradiator is cast from polyfurfuryl alcohol with subsequent high-temperature conversion to vitreous carbon. By sequential layering of the alcohol and suspending of 169 Tm 2 O 3 in the midlayer, a unit is produced without any radiation exposure and with the source material contained on both a macro and a micro scale. Exposure of the unit to reactor neutrons produces 170 Tm without activation of the vitreous carbon. A 170 Tm irradiator giving a transit dose of 16 rads (100 ml/min flow) was connected in a carotid--jugular shunt on a 20-kg goat. Lymphocyte levels decreased to about 15 percent of the preexposure level during the first week and thereafter slowly rose to about 50 percent of preexposure levels 2 months after exposure. Reciprocal skin grafts made at the end of irradiation (12 days) were rejected at 12 days on the nonirradiated control and at 24 days on the irradiated goat. These results are consistent with data reported on chronically irradiated baboons even though the dose rate for the present test was only about one-fourth that for the baboons

  8. Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

    Science.gov (United States)

    Mactier, Robert; Laliberté, Martin; Mardini, Joelle; Ghannoum, Marc; Lavergne, Valery; Gosselin, Sophie; Hoffman, Robert S; Nolin, Thomas D

    2014-09-01

    The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all articles, extracted data, summarized key findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 617 articles met the search inclusion criteria. Data for 538 patients were abstracted and evaluated. Only case reports, case series, and nonrandomized observational studies were identified, yielding a low quality of evidence for all recommendations. Using established criteria, the workgroup deemed that long-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory depression necessitating mechanical ventilation, shock, persistent toxicity, or increasing or persistently elevated serum barbiturate concentrations despite treatment with multiple-dose activated charcoal. (3) Intermittent hemodialysis is the preferred mode of ECTR, and multiple-dose activated charcoal treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  9. Quantification of Postmembrane Gaseous Microembolization During Venoarterial Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Jiao, York; Gipson, Keith E; Bonde, Pramod; Mangi, Abeel; Hagberg, Robert; Rosinski, David J; Gross, Jeffrey B; Schonberger, Robert B

    Prolonged use of venoarterial extracorporeal membrane oxygenation (VA ECMO) may be complicated by end-organ dysfunction. Although gaseous microemboli (GME) are thought to damage end organs during cardiopulmonary bypass, patient exposures to GME have not been well characterized during VA ECMO. We therefore performed an observational study of GME in adult VA ECMO patients, with correlation to clinical events during routine patient care. After institutional review board (IRB) approval, we used two Doppler probes to detect GME noninvasively in extracorporeal membrane oxygenation (ECMO) circuits on four patients for 15 hours total while also recording patient care events. We then conducted in vitro trials to compare Doppler signals with gold-standard measurements using an Emboli Detection and Classification EDAC quantifier (Luna Innnovations, Inc. Roanoke, VA) (Terumo Cardiovascular, Ann Arbor, MI) during simulated clinical interventions. Correlations between Doppler and EDAC data were used to estimate GME counts and volumes represented by clinical Doppler data. A total of 503 groups of Doppler peaks representing GME showers were observed, including 194 statistically larger showers during patient care activities containing 92% of total Doppler peaks. Intravenous injections accounted for an estimated 68% of GME and 88% of GME volume, whereas care involving movement accounted for an estimated 6% of GME and 3% of volume. Overall estimated embolic rates of 24,000 GME totaling 4 μl/hr rivals reported GME rates during cardiopulmonary bypass. Numerous GME are present in the postmembrane circuit during VA ECMO, raising concern for effects on microcirculation and organ dysfunction. Strategies to detect and minimize GME may be warranted to limit embolic exposures experienced by VA ECMO patients.

  10. Osteogenic Matrix Cell Sheets Facilitate Osteogenesis in Irradiated Rat Bone

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    Yoshinobu Uchihara

    2015-01-01

    Full Text Available Reconstruction of large bone defects after resection of malignant musculoskeletal tumors is a significant challenge in orthopedic surgery. Extracorporeal autogenous irradiated bone grafting is a treatment option for bone reconstruction. However, nonunion often occurs because the osteogenic capacity is lost by irradiation. In the present study, we established an autogenous irradiated bone graft model in the rat femur to assess whether osteogenic matrix cell sheets improve osteogenesis of the irradiated bone. Osteogenic matrix cell sheets were prepared from bone marrow-derived stromal cells and co-transplanted with irradiated bone. X-ray images at 4 weeks after transplantation showed bridging callus formation around the irradiated bone. Micro-computed tomography images at 12 weeks postoperatively showed abundant callus formation in the whole circumference of the irradiated bone. Histology showed bone union between the irradiated bone and host femur. Mechanical testing showed that the failure force at the irradiated bone site was significantly higher than in the control group. Our study indicates that osteogenic matrix cell sheet transplantation might be a powerful method to facilitate osteogenesis in irradiated bones, which may become a treatment option for reconstruction of bone defects after resection of malignant musculoskeletal tumors.

  11. Saving a Child’s Elbow Joint: A Novel Reconstruction for a Tumour of the Distal Humerus

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    Calogero Graci

    2015-01-01

    Full Text Available Reconstruction after wide resection of a malignant bone tumor can be obtained using several techniques such as the use of prostheses, allograft, autograft, or combined procedure. We describe a 12-year-old girl with parosteal osteosarcoma of the distal right humerus treated by en bloc resection, intraoperative extracorporeal irradiation, and implantation. We inserted a nonvascularised fibular autograft through the middle of irradiated graft to obtain a greater stability. We have not recorded any complication associated with this technique such as nonunion, pathological fracture, infection, and bone necrosis and we obtained an excellent functional result. 10 years after surgery, the patient had no recurrence. Extracorporeal irradiation and reimplantation is a valid and inexpensive technique for the treatment of bone tumors when there is reasonable residual bone stock. With this procedure we have a precise fit being the patient’s own bone. In this way we avoid all the problems related to the adaptation of the shape and size.

  12. The study of the use of a latex biomembrane and conjunctival autograft in rabbit conjunctiva wound healing.

    Science.gov (United States)

    Pinho, Erika Christina Canarim Martha de; Chahud, Fernando; Lachat, João-José; Coutinho-Netto, Joaquim José; Sousa, Sidney Julio Faria E

    2018-04-01

    RESUMO Objetivo: Estudar o uso da biomembrana de látex e o transplante conjuntival autólogo na cicatrização conjuntival em coelhos. Métodos: Em nove coelhos albinos, neo-zelandeses, machos foram removidas áreas retangulares idênticas, do quadrante supero nasal, adjacente ao limbo, de ambos os olhos. As áreas desnudas da camada esclerótica nos olhos direitos foram recobertas com biomembrana de látex e a dos olhos esquerdos com enxerto conjuntival autólogo. Os animais foram sacrificados em grupos de três, aos 7, 14 e 21 dias após a cirurgia. Os tecidos do local cirúrgico, incluindo a córnea, foram fixados em formaldeído, antes de serem processados em parafina e corados com hematoxilina e eosina. A natureza e a intensidade da resposta inflamatória e o padrão de epitelização da superfície conjuntival foram avaliados sob microscopia óptica, em seções histológicas longitudinais, passando pelo centro dos espécimes anatômicos. Resultados: Até o décimo quarto dia pós-operatório, o grupo que recebeu a biomembrana apresentou reação inflamatória mais intensa do que o grupo com auto enxerto conjuntival. Aos 14 dias, os olhos com biomembrana apresentavam-se menos inflamados e com estroma mais espesso do que aos 7 dias. Aos 21 dias, a reparação conjuntival de ambos os grupos apresentavam características semelhantes. Conclusão: Apesar de apresentar uma cicatrização mais lenta, a biomembrana de látex se mostrou tão eficaz quanto o auto enxerto conjuntival na reconstrução da superfície ocular após três semanas de cicatrização pós-operatória. Devido as suas baixas toxicidade e alergenicidade, este material parece ser uma opção terapêutica promissora na reconstrução da conjuntiva.ABSTRACT Purpose: To study a latex biomembrane and conjunctival autograft with regard to the promotion of conjunctival healing in rabbits. The study included nine male albino rabbits. In these rabbits, a rectangular area of the conjunctiva was surgically

  13. Clinical application of a tissue-cultured skin autograft: an alternative for the treatment of non-healing or slowly healing wounds?

    Science.gov (United States)

    Zöller, Nadja; Valesky, Eva; Butting, Manuel; Hofmann, Matthias; Kippenberger, Stefan; Bereiter-Hahn, Jürgen; Bernd, August; Kaufmann, Roland

    2014-01-01

    The treatment regime of non-healing or slowly healing wounds is constantly improving. One aspect is surgical defect coverage whereby mesh grafts and keratinocyte suspension are applied. Tissue-cultured skin autografts may be an alternative for the treatment of full-thickness wounds and wounds that cover large areas of the body surface. Autologous epidermal and dermal cells were isolated, expanded in vitro and seeded on collagen-elastin scaffolds. The developed autograft was immunohistochemically characterized and subsequently transplanted onto a facial chronic ulceration of a 71-year-old patient with vulnerable atrophic skin. Characterization of the skin equivalent revealed comparability to healthy human skin due to the epidermal strata, differentiation and proliferation markers. Within 138 days, the skin structure at the transplantation site closely correlated with the adjacent undisturbed skin. The present study demonstrates the comparability of the developed organotypic skin equivalent to healthy human skin and the versatility for clinical applications.

  14. Food irradiation

    International Nuclear Information System (INIS)

    Soothill, R.

    1987-01-01

    The issue of food irradiation has become important in Australia and overseas. This article discusses the results of the Australian Consumers' Association's (ACA) Inquiry into food irradiation, commissioned by the Federal Government. Issues discussed include: what is food irradiation; why irradiate food; how much food is consumer rights; and national regulations

  15. Comparison between lamellar keratoplasties produced by conjunctival pedicle and free corneal autografts. Experimental study in the dog (Canis familiaris - LINNAEUS, 1758

    Directory of Open Access Journals (Sweden)

    José Luiz Laus

    1996-03-01

    Full Text Available A comparative study of conjunctival pedicle and corneal autografts, for experimental healing of superficial keratectomies in dogs (Canis familiaris was performed. It was carried out by using 24 animals, and the technical procedures were analysed according to clinical, histologic and scanning electron microscopy parameters, in early and late postoperative periods. The obtained results are believed to represent feasible methods of proteresis, applied to the healing ophthalmic surgery. There were few, irrelevant differences between the two tested techniques.

  16. Food irradiation

    International Nuclear Information System (INIS)

    Lindqvist, H.

    1996-01-01

    This paper is a review of food irradiation and lists plants for food irradiation in the world. Possible applications for irradiation are discussed, and changes induced in food from radiation, nutritional as well as organoleptic, are reviewed. Possible toxicological risks with irradiated food and risks from alternative methods for treatment are also brought up. Ways to analyze weather food has been irradiated or not are presented. 8 refs

  17. A novel silk–TCP–PEEK construct for anterior cruciate ligament reconstruction: an off-the shelf alternative to a bone–tendon–bone autograft

    International Nuclear Information System (INIS)

    Li, Xiang; Snedeker, Jess G; He, Jiankang; Li, Dichen; Bian, Weiguo; Li, Zheng

    2014-01-01

    Bone–tendon–bone autograft represents a gold-standard for anterior cruciate ligament (ACL) reconstruction but at the cost of a secondary surgical site that can be accompanied by functional impairment and discomfort. Although numerous in vitro and in vivo studies have investigated tissue engineering alternatives to autografting, the achievement of a functional histological transition between soft and hard tissue has remained elusive. To bridge this gap we developed and tested a novel multiphase scaffold of silk, tricalcium phosphate (TCP) and polyether ether ketone for ACL reconstruction. We present in vitro biomechanical tests demonstrating that the construct recapitulates native ACL function under typical physiological loads. A pilot in vivo experiment in two pigs with a three-month follow-up showed a robust histological transition between regenerated fibrous tissue and the margins of the bone tunnel, with histological features similar to the native ACL to bone insertion. These histological observations suggest that the construct was stably anchored until TCP incorporation to the host tissues. On the strength of these preliminary results, we conclude that the described approach may offer a promising alternative to autograft for ACL reconstruction. This study thus provides proof for a concept that warrants further development. (paper)

  18. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

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    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.    

  19. Comparison of outcomes and safety of using hydroxyapatite granules as a substitute for autograft in cervical cages for anterior cervical discectomy and interbody fusion

    Directory of Open Access Journals (Sweden)

    Hosein Mashhadinezhad

    2014-03-01

    Full Text Available Background:   After cervical discectomy, autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies, but donor site–related complications can still occur. In this study we evaluate the use   of hydroxyapatite granules as a substitute for autograft for interbody fusion.     Methods:   From November 2008 to November 2011, 236 patients participated in this study. Peek cages were packed with autologous bone grafts taken from the iliac crest in 112 patients and hydroxyapatite (HA granules in 124 patients.   Patients were followed for 12 months. The patients’ neurological signs, results, and complications were fully recorded   throughout the procedure. Radiological imaging was done to assess the fusion rate and settling ratio.     Results:   Formation of bony bridges at the third month was higher in the autograft group versus the granule group. However, there was no difference between both groups at the 12-month follow-up assessment. No difference (     P > 0.05   was found regarding improvement in neurological deficit as well as radicular pain and recovery rate between the two groups. Conclusions:   Interbody fusion cage containing HA granules proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Clinical and neurological outcome, radiographic measurement and fusion rate   in cage containing HA are similar and competitive with autograft packed cages.

  20. Food irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gruenewald, T

    1985-01-01

    Food irradiation has become a matter of topical interest also in the Federal Republic of Germany following applications for exemptions concerning irradiation tests of spices. After risks to human health by irradiation doses up to a level sufficient for product pasteurization were excluded, irradiation now offers a method suitable primarily for the disinfestation of fruit and decontamination of frozen and dried food. Codex Alimentarius standards which refer also to supervision and dosimetry have been established; they should be adopted as national law. However, in the majority of cases where individual countries including EC member-countries so far permitted food irradiation, these standards were not yet used. Approved irradiation technique for industrial use is available. Several industrial food irradiation plants, partly working also on a contractual basis, are already in operation in various countries. Consumer response still is largely unknown; since irradiated food is labelled, consumption of irradiated food will be decided upon by consumers.

  1. Extracorporeal shockwave therapy: A systematic review of its use in fracture management

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    Petrisor B

    2009-01-01

    Full Text Available Extracorporeal shockwave therapy is increasingly used as an adjuvant therapy in the management of nonunions, delayed unions and more recently fresh fractures. This is in an effort to increase union rates or obtain unions when fractures have proven recalcitrant to healing. In this report we have systematically reviewed the English language literature to attempt to determine the potential clinical efficacy of extracorporeal shockwave therapy in fracture management. Of 32 potentially eligible studies identified, 10 were included that assessed the extracorporeal shockwave therapy use for healing nonunions or delayed unions, and one trial was included that assessed its use for acute high-energy fractures. From the included, studies′ overall union rates were in favor of extracorporeal shockwave therapy (72% union rate overall for nonunions or delayed unions, and a 46% relative risk reduction in nonunions when it is used for acute high-energy fractures. However, the methodologic quality of included studies was weak and any clinical inferences made from these data should be interpreted with caution. Further research in this area in the form of a large-scale randomized trial is necessary to better answer the question of the effectiveness of extracorporeal shockwave therapy on union rates for both nonunions and acute fractures.

  2. Development of an Extracorporeal Perfusion Device for Small Animal Free Flaps.

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    Andreas M Fichter

    Full Text Available Extracorporeal perfusion (ECP might prolong the vital storage capabilities of composite free flaps, potentially opening a wide range of clinical applications. Aim of the study was the development a validated low-cost extracorporeal perfusion model for further research in small animal free flaps.After establishing optimal perfusion settings, a specially designed extracorporeal perfusion system was evaluated during 8-hour perfusion of rat epigastric flaps followed by microvascular free flap transfer. Controls comprised sham-operation, ischemia and in vivo perfusion. Flaps and perfusate (diluted blood were closely monitored by blood gas analysis, combined laser Doppler flowmetry and remission spectroscopy and Indocyanine-Green angiography. Evaluations were complemented by assessment of necrotic area and light microscopy at day 7.ECP was established and maintained for 8 hours with constant potassium and pH levels. Subsequent flap transfer was successful. Notably, the rate of necrosis of extracorporeally perfused flaps (27% was even lower than after in vivo perfusion (49%, although not statistically significant (P = 0,083. After sham-operation, only 6% of the total flap area became necrotic, while 8-hour ischemia led to total flap loss (98%. Angiographic and histological findings confirmed these observations.Vital storage capabilities of microvascular flaps can be prolonged by temporary ECP. Our study provides important insights on the pathophysiological processes during extracorporeal tissue perfusion and provides a validated small animal perfusion model for further studies.

  3. Prospective longitudinal evaluation of lung function during the first year of life after extracorporeal membrane oxygenation.

    Science.gov (United States)

    Hofhuis, Ward; Hanekamp, Manon N; Ijsselstijn, Hanneke; Nieuwhof, Eveline M; Hop, Wim C J; Tibboel, Dick; de Jongste, Johan C; Merkus, Peter J F M

    2011-03-01

    To collect longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation and to evaluate relationships between lung function and perinatal factors. Longitudinal data on lung function in the first year of life after extracorporeal membrane oxygenation are lacking. Prospective longitudinal cohort study. Outpatient clinic of a tertiary level pediatric hospital. The cohort consisted of 64 infants; 33 received extracorporeal membrane oxygenation for meconium aspiration syndrome, 14 for congenital diaphragmatic hernia, four for sepsis, six for persistent pulmonary hypertension of the neonate, and seven for respiratory distress syndrome of infancy. Evaluation was at 6 mos and 12 mos; 39 infants were evaluated at both time points . None. Functional residual capacity and forced expiratory flow at functional residual capacity were measured and expressed as z score. Mean (sem) functional residual capacities in z score were 0.0 (0.2) and 0.2 (0.2) at 6 mos and 12 mos, respectively. Mean (sem) forced expiratory flow was significantly below average (z score = 0) (p capacity significantly above normal: mean (sem) z score = 1.2 (0.5). Infants treated with extracorporeal membrane oxygenation have normal lung volumes and stable forced expiratory flows within normal range, although below average, within the first year of life. There is reason to believe, therefore, that extracorporeal membrane oxygenation either ameliorates the harmful effects of mechanical ventilation or somehow preserves lung function in the very ill neonate.

  4. Extracorporeal CO2 removal: Technical and physiological fundaments and principal indications.

    Science.gov (United States)

    Romay, E; Ferrer, R

    2016-01-01

    In recent years, technological improvements have reduced the complexity of extracorporeal membrane oxygenation devices. This have enabled the development of specific devices for the extracorporeal removal of CO2. These devices have a simpler configuration than extracorporeal membrane oxygenation devices and uses lower blood flows which could reduce the potential complications. Experimental studies have demonstrated the feasibility, efficacy and safety of extracorporeal removal of CO2 and some of its effects in humans. This technique was initially conceived as an adjunct therapy in patients with severe acute respiratory distress syndrome, as a tool to optimize protective ventilation. More recently, the use of this technique has allowed the emergence of a relatively new concept called "tra-protective ventilation"whose effects are still to be determined. In addition, the extracorporeal removal of CO2 has been used in patients with exacerbated hypercapnic respiratory failure with promising results. In this review we will describe the physiological and technical fundamentals of this therapy and its variants as well as an overview of the available clinical evidence, focused on its current potential. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  5. Irradiated strut allografts for reconstructing tumour defects: how effective?

    International Nuclear Information System (INIS)

    Astrid Lobo Gajiwala; Manish Agarwal; Ajay Puri; Cynthia D Lima

    2008-01-01

    Full text: Allografts are biological options for reconstructing large bone defects. We report our experience with 87 irradiated (25 kGy of gamma radiation) strut allografts used in various defects following tumour surgery. Reconstruction in 35 full segment defects involved 22 full segment allografts used alone, 4 allograft prosthetic composites (APC) and 9 allografts combined with a vascularized fibula. Twelve partial segment defects were reconstructed with allograft struts (including 2 APC). Full segment allograft struts (mainly fibulae) were used in 40 contained post-curettage defects. The cases were studied for time to incorporation and complications. The follow-up ranged from 12 to 72 months. Of the 26 full segment defects where allograft alone or APC was used, 2 were lost to follow-up, 5 died before incorporation and 3 grafts were removed (2 infection and 1 local recurrence). Six united primarily at 2-4 years. Seven patients with non union were autografted at both junctions resulting in 6 unions. One patient had early plate breakage and refused further treatment. One allograft fractured after union after autografting. Two of 4 APC also united. In contrast, the 9 allograft-vascularized fibula combinations showed unambiguous incorporation between 5-9 months with only one junction requiring bone grafting. Of the 12 partial segment struts, barring one removed for infection, 11 have completely incorporated. Thirty one out of 40 struts placed within contained post curettage defects have incorporated (2 removed for infection and seven lost to follow-up). There were total 6 infections (7%) 4 of which occurred 1-2 years after surgery. Irradiated full segment struts alone incorporate poorly and are best used combined with a live fibula. Irradiated full and partial segment allografts used inside contained defects give consistently good results. Frozen grafts seem to incorporate faster and better than lyophilised grafts. (Author)

  6. In vivo performance of combinations of autograft, demineralized bone matrix, and tricalcium phosphate in a rabbit femoral defect model

    International Nuclear Information System (INIS)

    Kim, Jinku; McBride, Sean; Hollinger, Jeffrey O; Dean, David D; Sylvia, Victor L; Doll, Bruce A

    2014-01-01

    Large bone defects may be treated with autologous or allogeneic bone preparations. Each treatment has advantages and disadvantages; therefore, a clinically viable option for treating large (e.g., gap) bone defects may be a combination of the two. In the present study, bone repair was determined with combinations of autografts, allografts, and synthetic bone grafts using an established rabbit femoral defect model. Bilateral unicortical femoral defects were surgically prepared and treated with combinatorial bone grafts according to one of seven treatment groups. Recipient sites were retrieved at six weeks. Cellular/tissue responses and new bone formation were assessed by histology and histomorphometry. Histological analysis images indicated neither evidence of inflammatory, immune responses, tissue necrosis, nor osteolysis. Data suggested co-integration of implanted agents with host and newly formed bone. Finally, the histomorphometric data suggested that the tricalcium phosphate-based synthetic bone graft substitute allowed new bone formation that was similar to the allograft (i.e., demineralized bone matrix, DBM). (paper)

  7. Nerve autografts and tissue-engineered materials for the repair of peripheral nerve injuries: a 5-year bibliometric analysis

    Directory of Open Access Journals (Sweden)

    Yuan Gao

    2015-01-01

    Full Text Available With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the repair of peripheral nerve injuries, in particular multiple injuries and large-gap defects, must be chosen carefully. Various methods and materials for protecting the healthy tissue and repairing peripheral nerve injuries have been described, and each method or material has advantages and disadvantages. Recently, a large amount of research has been focused on tissue-engineered materials for the repair of peripheral nerve injuries. Using the keywords "pe-ripheral nerve injury", "autotransplant", "nerve graft", and "biomaterial", we retrieved publications using tissue-engineered materials for the repair of peripheral nerve injuries appearing in the Web of Science from 2010 to 2014. The country with the most total publications was the USA. The institutions that were the most productive in this field include Hannover Medical School (Germany, Washington University (USA, and Nantong University (China. The total number of publications using tissue-engineered materials for the repair of peripheral nerve injuries grad-ually increased over time, as did the number of Chinese publications, suggesting that China has made many scientific contributions to this field of research.

  8. The use of extracorporeal membrane oxygenation in blunt thoracic trauma: A study of the Extracorporeal Life Support Organization database.

    Science.gov (United States)

    Jacobs, Jordan V; Hooft, Nicole M; Robinson, Brenton R; Todd, Emily; Bremner, Ross M; Petersen, Scott R; Smith, Michael A

    2015-12-01

    Reports documenting the use of extracorporeal membrane oxygenation (ECMO) after blunt thoracic trauma are scarce. We used a large, multicenter database to examine outcomes when ECMO was used in treating patients with blunt thoracic trauma. We performed a retrospective analysis of ECMO patients in the Extracorporeal Life Support Organization database between 1998 and 2014. The diagnostic code for blunt pulmonary contusion (861.21, DRG International Classification of Diseases-9th Rev.) was used to identify patients treated with ECMO after blunt thoracic trauma. Variations of pre-ECMO respiratory support were also evaluated. The primary outcome was survival to discharge; the secondary outcome was hemorrhagic complication associated with ECMO. Eighty-five patients met inclusion criteria. The mean ± SEM age of the cohort was 28.9 ± 1.1 years; 71 (83.5%) were male. The mean ± SEM pre-ECMO PaO2/FIO2 ratio was 59.7 ± 3.5, and the mean ± SEM pre-ECMO length of ventilation was 94.7 ± 13.2 hours. Pre-ECMO support included inhaled nitric oxide (15 patients, 17.6%), high-frequency oscillation (10, 11.8%), and vasopressor agents (57, 67.1%). The mean ± SEM duration of ECMO was 207.4 ± 23.8 hours, and 63 patients (74.1%) were treated with venovenous ECMO. Thirty-two patients (37.6%) underwent invasive procedures before ECMO, and 12 patients (14.1%) underwent invasive procedures while on ECMO. Hemorrhagic complications occurred in 25 cases (29.4%), including 12 patients (14.1%) with surgical site bleeding and 16 (18.8%) with cannula site bleeding (6 patients had both). The rate of survival to discharge was 74.1%. Multivariate analysis showed that shorter duration of ECMO and the use of venovenous ECMO predicted survival. Outcomes after the use of ECMO in blunt thoracic trauma can be favorable. Some trauma patients are appropriate candidates for this therapy. Further study may discern which subpopulations of trauma patients will benefit most from ECMO. Therapeutic

  9. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit.

    Science.gov (United States)

    Yetimakman, Ayse Filiz; Tanyildiz, Murat; Kesici, Selman; Kockuzu, Esra; Bayrakci, Benan

    2017-06-01

    Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

  10. Extracorporeal membrane oxygenation for the treatment of postcardiotomy shock.

    Science.gov (United States)

    Whitman, Glenn J R

    2017-01-01

    Use of extracorporeal membrane oxygenation (ECMO), one of an increasing variety of mechanical circulatory support strategies, was first used close to 50 years ago. For decades, it was mostly applied to the pediatric population. However, during the past several years, its use has dramatically increased as therapy for pulmonary and cardiac failure in the adult. In particular, ECMO is being used more and more for postcardiotomy shock. Unfortunately, despite its increased application in this setting, improved outcomes have been hard to come by. Improved results must be grounded on an approach that honors the tenets of myocardial recovery, minimizing the work done by the heart during the recovery period. Left ventricular decompression should be a tenet of ECMO support in the setting of postcardiotomy shock, universally applied if we are to see any significant improvement in our results. Furthermore, the point is made that surgeons should play a leadership role in the immediate counseling of patients' families to assure realistic expectations on their part. To address the need for family support during this very difficult time, ECMO centers should design a programmatic approach to care for patients and their families so as to provide them with education, guidance, and emotional support. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  11. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2006-04-01

    Full Text Available Background: Conventional diagnostic procedures and therapy of acute liver failure (ALF and acute-on-chronic liver failure (ACLF focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus, because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives: To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods: An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results: Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed

  12. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN TREATMENT OF PEDIATRIC UROLITHIASIS

    Directory of Open Access Journals (Sweden)

    Emilija Golubovic

    2006-04-01

    Full Text Available The paper presents the experiences in the treatment of urinary tract calculosis in 114 children aged 6 months to 14 years by means of extracorporeal shock wave lithotripsy (ESWL.The treatment was performed at the Institute of Radiology and the Clinic for Pediatric Surgery and Orthopedics in Nis, in the period 1988-2000 on Siemens Litostar lithotriptor. The children were treated after clinical, laboratory and radiological preparation, provided that the stone was not greater than 3 cm (measured in native urinary tract graph and that it was not located in the pelvic part of the ureter. In the present study, the success in application of ESWL for treating pediatric patients was 88%. The total clearance of fragments was found in 57% of patients, whereas retention of fragments smaller than 4 mm three months after the last treatment was present in 31% of patients. ESWL treatment failed in 12% of patients since they had retained fragments greater than 4 mm.The authors recommend this method as a method of choice in the treatment of renal and urethral calculi in children.

  13. Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Hyoung Soo Kim

    2017-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

  14. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

    Science.gov (United States)

    López Sanchez, M

    2017-11-01

    Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO 2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis.

    Science.gov (United States)

    Venzin, C; Ohlerth, S; Koch, D; Spreng, D

    2004-03-01

    A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.

  16. Highlighting Indication of extracorporeal membrane oxygenation in endocrine emergencies.

    Science.gov (United States)

    Chao, Anne; Wang, Chih-Hsien; You, Hao-Chun; Chou, Nai-Kwoun; Yu, Hsi-Yu; Chi, Nai-Hsin; Huang, Shu-Chien; Wu, I-Hui; Tseng, Li-Jung; Lin, Ming-Hsien; Chen, Yih-Sharng

    2015-08-24

    Extracorporeal membrane oxygenation (ECMO) has been repeatedly used to rescue patients with cardiopulmonary arrest. However, its clinical utility in endocrine emergencies remains unclear. Herein, we describe a case series of 12 patients presenting with refractory shock secondary to endocrine emergencies who were rescued by ECMO support. Patients were identified between 2005 and 2012 from our ECMO registry. The diagnostic distribution was as follows: pheochromocytoma crisis (n = 4), thyroid storm (n = 5), and diabetic ketoacidosis (n = 3). The initial presentation of pheochromocytoma crisis was indistinguishable from acute myocardial infarction (AMI) and frequently accompanied by paroxysmal hypertension and limb ischemia. Thyroid storm was characterized by hyperbilirubinemia and severe gastrointestinal bleeding, whereas neurological symptoms were common in diabetic ketoacidosis. The clinical outcomes of patients with endocrine emergencies were compared with those of 80 cases with AMI who received ECMO because of cardiogenic shock. The cardiac function and the general conditions showed a significantly faster recovery in patients with endocrine emergencies than in those with AMI. We conclude that ECMO support can be clinically useful in endocrine emergencies. The screening of endocrine diseases should be considered during the resuscitation of patients with refractory circulatory shock.

  17. Extracorporeal Membrane Oxygenation in Premature Infants With Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Cuevas Guamán, Milenka; Akinkuotu, Adesola C; Cruz, Stephanie M; Griffiths, Pamela A; Welty, Stephen E; Lee, Timothy C; Olutoye, Oluyinka O

    2017-11-14

    Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure. We highlight the interdisciplinary nature of modern decision-making. All three neonates had severe congenital diaphragmatic hernia diagnosed prenatally, had normal fetal karyotypes, were born prematurely, and weighed less than 2 kg. All three neonates underwent cervical venoarterial cannulation, stabilization on ECMO, and repair of their congenital diaphragmatic hernia early in their ECMO courses. All three infants had long courses of respiratory support attributable to lung hypoplasia, but there were no short- or long-term complications attributable to ECMO support directly. All three are alive at 2 years of age and were making progress developmentally. In conclusion, with interdisciplinary collaboration and clinical guidelines uniformly implemented, low birth weight infants may benefit from ECMO and should not be denied the therapy arbitrarily based on gestational age or size alone. Further research is essential to determine appropriate patient selection in premature infants.

  18. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    International Nuclear Information System (INIS)

    Fedele, F; Coleman, A J; Thomas, K; Ryves, S; Phillips, D; Leighton, T G

    2011-01-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  19. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Fedele, F; Coleman, A J [Medical Physics Department, Guy' s and St Thomas NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London (United Kingdom); Thomas, K; Ryves, S; Phillips, D [Urology Department, Guy' s and St Thomas NHS Foundation Trust, Great Maze Pond, SE1 9RT, London (United Kingdom); Leighton, T G, E-mail: fiammetta.fedele@gstt.nhs.uk [Institute of Sound and Vibration Research, University of Southampton, Highfield, S017 1BJ, Southampton (United Kingdom)

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  20. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Science.gov (United States)

    Fedele, F.; Thomas, K.; Leighton, T. G.; Ryves, S.; Phillips, D.; Coleman, A. J.

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p ESWL or if the patient should be sent for surgery.

  1. A passive acoustic monitor of treatment effectiveness during extracorporeal lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Fedele, F; Coleman, A J [Medical Physics Department, Guy' s and St Thomas NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London (United Kingdom); Thomas, K; Ryves, S; Phillips, D [Urology Department, Guy' s and St Thomas NHS Foundation Trust, Great Maze Pond, SE1 9RT, London (United Kingdom); Leighton, T G, E-mail: fiammetta.fedele@gstt.nhs.uk [Institute of Sound and Vibration Research, University of Southampton, Highfield, S017 1BJ, Southampton (United Kingdom)

    2011-02-01

    Although extracorporeal shockwave lithotripsy (ESWL) has now been in the clinic for at least three decades, there has been little advance in efforts (i) to estimate the efficacy of the treatment whilst it is in progress, or (ii) to determine the end-point of a treatment session in terms of the degree of stone fragmentation achieved. Previous in vitro experimentation and clinical trials have shown that a passive acoustic monitor has the potential to provide evidence of the effectiveness and end-point of lithotripsy. The system exploits secondary emissions generated during shock-tissue interaction, whose features depend on the quality of tissue at the beam focus. This prototype was developed into the first commercially available clinical ESWL treatment monitor (Precision Acoustic Ltd, Dorchester, UK), and a unit has been acquired and tested in the clinical routine by urologists at Guy's and St Thomas NHS Trust in March 2009. This paper critically assesses the performance of the new system for the first 25 treatments monitored. The ESWL monitor correctly predicted the treatment outcome of 15 of the 18 treatments that were followed-up clinically. In addition, it was noted that the measure of treatment effectiveness provided by the monitor after 500 shocks was predictive of the final treatment outcome (p < 0.001). This suggests that the system could be used in pre-assessment; indicating if the stone is susceptible to ESWL or if the patient should be sent for surgery.

  2. Tandem shock wave cavitation enhancement for extracorporeal lithotripsy

    Science.gov (United States)

    Loske, Achim M.; Prieto, Fernando E.; Fernández, Francisco; van Cauwelaert, Javier

    2002-11-01

    Extracorporeal shock wave lithotripsy (ESWL) has been successful for more than twenty years in treating patients with kidney stones. Hundreds of underwater shock waves are generated outside the patient's body and focused on the kidney stone. Stones fracture mainly due to spalling, cavitation and layer separation. Cavitation bubbles are produced in the vicinity of the stone by the tensile phase of each shock wave. Bubbles expand, stabilize and finally collapse violently, creating stone-damaging secondary shock waves and microjets. Bubble collapse can be intensified by sending a second shock wave a few hundred microseconds after the first. A novel method of generating two piezoelectrically generated shock waves with an adjustable time delay between 50 and 950 µs is described and tested. The objective is to enhance cavitation-induced damage to kidney stones during ESWL in order to reduce treatment time. In vitro kidney stone model fragmentation efficiency and pressure measurements were compared with those for a standard ESWL system. Results indicate that fragmentation efficiency was significantly enhanced at a shock wave delay of about 400 and 250 µs using rectangular and spherical stone phantoms, respectively. The system presented here could be installed in clinical devices at relatively low cost, without the need for a second shock wave generator.

  3. Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL).

    Science.gov (United States)

    Inoue, Hiromasa; Kamphausen, Thomas; Bajanowski, Thomas; Trübner, Kurt

    2011-01-01

    A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy.

  4. Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

    Science.gov (United States)

    Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

    2003-05-01

    To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

  5. Development of a new extracorporeal whole-liver perfusion system.

    Science.gov (United States)

    Naruse, Katsutoshi; Sakai, Yasuyuki; Guo, Lei; Natori, Takeshi; Shindoh, Junichi; Karasawa, Yasuaki; Iida, Yuhki; Kojima, Kentaro; Michishita, Kazuya; Makuuchi, Masatoshi

    2003-01-01

    We have developed a new extracorporeal whole-liver accommodation device in which a whole swine liver is placed in a physiological state by modeling the intraabdominal arrangement in the pig body, with the liver supported by a special inferior vena cava tube. Furthermore, we employed a diaphragm-type artificial heart in our system to produce pulsatile blood flow through the hepatic artery, which is considered to be indispensable to dilate peripheral vessels and supply oxygenated whole blood to the peripheral liver tissue. Beneficial effects were demonstrated in visual findings and bile juice secretion. The color of the liver surface in our system remained bright red, indicating that the liver vessels were well drained and free from congestion, and bile juice secretion was maintained at more than 10 ml/h throughout the perfusion period. Our system exhibited excellent ammonia removal and urea nitrogen synthesis, and serum aspartate aminotransferase levels showed no increase, indicating the absence of hepatocyte destruction. Histological findings showed that the liver could expand appropriately and was free from compression caused by its own weight. In conclusion, our original liver accommodation device enabled appropriate expansion of the whole liver and supplied adequate oxygenated blood to peripheral areas by means of a pulsatile pump.

  6. A novel minimal invasive mouse model of extracorporeal circulation.

    Science.gov (United States)

    Luo, Shuhua; Tang, Menglin; Du, Lei; Gong, Lina; Xu, Jin; Chen, Youwen; Wang, Yabo; Lin, Ke; An, Qi

    2015-01-01

    Extracorporeal circulation (ECC) is necessary for conventional cardiac surgery and life support, but it often triggers systemic inflammation that can significantly damage tissue. Studies of ECC have been limited to large animals because of the complexity of the surgical procedures involved, which has hampered detailed understanding of ECC-induced injury. Here we describe a minimally invasive mouse model of ECC that may allow more extensive mechanistic studies. The right carotid artery and external jugular vein of anesthetized adult male C57BL/6 mice were cannulated to allow blood flow through a 1/32-inch external tube. All animals (n = 20) survived 30 min ECC and subsequent 60 min observation. Blood analysis after ECC showed significant increases in levels of tumor necrosis factor α, interleukin-6, and neutrophil elastase in plasma, lung, and renal tissues, as well as increases in plasma creatinine and cystatin C and decreases in the oxygenation index. Histopathology showed that ECC induced the expected lung inflammation, which included alveolar congestion, hemorrhage, neutrophil infiltration, and alveolar wall thickening; in renal tissue, ECC induced intracytoplasmic vacuolization, acute tubular necrosis, and epithelial swelling. Our results suggest that this novel, minimally invasive mouse model can recapitulate many of the clinical features of ECC-induced systemic inflammatory response and organ injury.

  7. A Novel Minimal Invasive Mouse Model of Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Shuhua Luo

    2015-01-01

    Full Text Available Extracorporeal circulation (ECC is necessary for conventional cardiac surgery and life support, but it often triggers systemic inflammation that can significantly damage tissue. Studies of ECC have been limited to large animals because of the complexity of the surgical procedures involved, which has hampered detailed understanding of ECC-induced injury. Here we describe a minimally invasive mouse model of ECC that may allow more extensive mechanistic studies. The right carotid artery and external jugular vein of anesthetized adult male C57BL/6 mice were cannulated to allow blood flow through a 1/32-inch external tube. All animals (n=20 survived 30 min ECC and subsequent 60 min observation. Blood analysis after ECC showed significant increases in levels of tumor necrosis factor α, interleukin-6, and neutrophil elastase in plasma, lung, and renal tissues, as well as increases in plasma creatinine and cystatin C and decreases in the oxygenation index. Histopathology showed that ECC induced the expected lung inflammation, which included alveolar congestion, hemorrhage, neutrophil infiltration, and alveolar wall thickening; in renal tissue, ECC induced intracytoplasmic vacuolization, acute tubular necrosis, and epithelial swelling. Our results suggest that this novel, minimally invasive mouse model can recapitulate many of the clinical features of ECC-induced systemic inflammatory response and organ injury.

  8. Clinical and billing review of extracorporeal membrane oxygenation.

    Science.gov (United States)

    Blum, James M; Lynch, William R; Coopersmith, Craig M

    2015-06-01

    Extracorporeal membrane oxygenation (ECMO) is a temporary technique for providing life support for cardiac dysfunction, pulmonary dysfunction, or both. The two forms of ECMO, veno-arterial (VA) and veno-venous (VV), are used to support cardiopulmonary and pulmonary dysfunction, respectively. Historically, ECMO was predominantly used in the neonatal and pediatric populations, as early adult studies failed to improve outcomes. ECMO has become far more common in the adult population because of positive results in published case series and clinical trials during the 2009 influenza A(H1N1) pandemic in 2009 to 2010. Advances in technology that make the technique much easier to implement likely fueled the renewed interest. Although exact criteria for ECMO are not available, patients who are good candidates are generally considered to be relatively young and suffering from acute illness that is believed to be reversible or organ dysfunction that is otherwise treatable. With the increase in the use in the adult population, a number of different codes have been generated to better identify the method of support with distinctly different relative value units assigned to each code from a very simple prior coding scheme. To effectively be reimbursed for use of the technique, it is imperative that the clinician understands the new coding scheme and works with payers to determine what is incorporated into each specific code.

  9. Pediatric extracorporeal shock wave lithotripsy: Predicting successful outcomes

    Directory of Open Access Journals (Sweden)

    Sean McAdams

    2010-01-01

    Full Text Available Extracorporeal shock wave lithotripsy (ESWL is currently a first-line procedure of most upper urinary tract stones <2 cm of size because of established success rates, its minimal invasiveness and long-term safety with minimal complications. Given that alternative surgical and endourological options exist for the management of stone disease and that ESWL failure often results in the need for repeat ESWL or secondary procedures, it is highly desirable to identify variables predicting successful outcomes of ESWL in the pediatric population. Despite numerous reports and growing experience, few prospective studies and guidelines for pediatric ESWL have been completed. Variation in the methods by which study parameters are measured and reported can make it difficult to compare individual studies or make definitive recommendations. There is ongoing work and a need for continuing improvement of imaging protocols in children with renal colic, with a current focus on minimizing exposure to ionizing radiation, perhaps utilizing advancements in ultrasound and magnetic resonance imaging. This report provides a review of the current literature evaluating the patient attributes and stone factors that may be predictive of successful ESWL outcomes along with reviewing the role of pre-operative imaging and considerations for patient safety.

  10. Food irradiation

    International Nuclear Information System (INIS)

    Sato, Tomotaro; Aoki, Shohei

    1976-01-01

    Definition and significance of food irradiation were described. The details of its development and present state were also described. The effect of the irradiation on Irish potatoes, onions, wiener sausages, kamaboko (boiled fish-paste), and mandarin oranges was evaluated; and healthiness of food irradiation was discussed. Studies of the irradiation equipment for Irish potatoes in a large-sized container, and the silo-typed irradiation equipment for rice and wheat were mentioned. Shihoro RI center in Hokkaido which was put to practical use for the irradiation of Irish potatoes was introduced. The state of permission of food irradiation in foreign countries in 1975 was introduced. As a view of the food irradiation in the future, its utilization for the prevention of epidemics due to imported foods was mentioned. (Serizawa, K.)

  11. Extracorporeal gas exchange and spontaneous breathing for the treatment of acute respiratory distress syndrome: an alternative to mechanical ventilation?*.

    Science.gov (United States)

    Langer, Thomas; Vecchi, Vittoria; Belenkiy, Slava M; Cannon, Jeremy W; Chung, Kevin K; Cancio, Leopoldo C; Gattinoni, Luciano; Batchinsky, Andriy I

    2014-03-01

    Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate the use of extracorporeal gas exchange in awake, spontaneously breathing sheep with healthy lungs and with acute respiratory distress syndrome and describe the interactions between the native lung (healthy and diseased) and the artificial lung (extracorporeal gas exchange) in this setting. Laboratory investigation. Animal ICU of a governmental laboratory. Eleven awake, spontaneously breathing sheep on extracorporeal gas exchange. Sheep were studied before (healthy lungs) and after the induction of acute respiratory distress syndrome via IV injection of oleic acid. Six gas flow settings (1-10 L/min), resulting in different amounts of extracorporeal CO2 removal (20-100% of total CO2 production), were tested in each animal before and after the injury. Respiratory variables and gas exchange were measured for every gas flow setting. Both healthy and injured sheep reduced minute ventilation according to the amount of extracorporeal CO2 removal, up to complete apnea. However, compared with healthy sheep, sheep with acute respiratory distress syndrome presented significantly increased esophageal pressure variations (25 ± 9 vs 6 ± 3 cm H2O; p 80% of total CO2 production). Spontaneous ventilation of both healthy sheep and sheep with acute respiratory distress syndrome can be controlled via extracorporeal gas exchange. If this holds true in humans, extracorporeal gas exchange could be used in awake, spontaneously breathing patients with acute respiratory distress syndrome to support gas exchange. A deeper understanding of the pathophysiology of spontaneous breathing during acute respiratory distress syndrome is however warranted in order to be able to propose

  12. Extended normothermic extracorporeal perfusion of isolated human liver after warm ischaemia: a preliminary report.

    Science.gov (United States)

    Bellomo, Rinaldo; Marino, Bruno; Starkey, Graeme; Fink, Michael; Wang, Bao Zhong; Eastwood, Glenn M; Peck, Leah; Young, Helen; Houston, Shane; Skene, Alison; Opdam, Helen; Jones, Robert

    2014-09-01

    Donation after circulatory death (DCD) livers are at markedly increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to transplant DCD livers and may allow their use for artificial extracorporeal liver support of patients with fulminant liver failure. We conducted two proof-of-concept experiments using human livers after DCD to assess the feasibility and functional efficacy of NELP over an extended period. We applied extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion and physiological perfusion pressures to two livers obtained after DCD. We achieved NELP and evidence of liver function (bile production, paracetamol removal and maintenance of normal lactate levels) in both livers; one for 24 hours and the other for 43 hours. Histological examination showed areas of patchy ischaemia but preserved biliary ducts and canaliculi. Our experiments justify further investigations of the feasibility and efficacy of extended DCD liver preservation by ex-vivo perfusion.

  13. Gamma irradiator

    International Nuclear Information System (INIS)

    Simonet, G.

    1986-09-01

    Fiability of devices set around reactors depends on material resistance under irradiation noticeably joints, insulators, which belongs to composition of technical, safety or physical incasurement devices. The irradiated fuel elements, during their desactivation in a pool, are an interesting gamma irradiation device to simulate damages created in a nuclear environment. The existing facility at Osiris allows to generate an homogeneous rate dose in an important volume. The control of the element distances to irradiation box allows to control this dose rate [fr

  14. Food irradiation

    International Nuclear Information System (INIS)

    Anon.

    1985-01-01

    The article explains what radiation does to food to preserve it. Food irradiation is of economic importance to Canada because Atomic Energy of Canada Limited is the leading world supplier of industrial irradiators. Progress is being made towards changing regulations which have restricted the irradiation of food in the United States and Canada. Examples are given of applications in other countries. Opposition to food irradiation by antinuclear groups is addressed

  15. Food irradiation

    International Nuclear Information System (INIS)

    Beyers, M.

    1977-01-01

    The objectives of food irradiation are outlined. The interaction of irradiation with matter is then discussed with special reference to the major constituents of foods. The application of chemical analysis in the evaluation of the wholesomeness of irradiated foods is summarized [af

  16. An optimum source neutron spectrum and holder shape for extra-corporal treatment of liver cancer by BNCT

    International Nuclear Information System (INIS)

    Nievaart, Sander; Moss, Ray; Sauerwein, Wolfgang; Malago, Massimo; Kloosterman, Jan Leen; Hagen, Tim van der; Dam, Hugo van

    2006-01-01

    In extra-corporal treatment of liver cancer by BNCT, it is desired to have an as homogeneous as possible thermal neutron field throughout the organ. Previous work has shown that when using an epithermal neutron beam, the shape of the holder in which the liver is placed is the critical factor. This study develops the notion further as to what is the optimum neutron spectrum to perform such treatments. In the design calculations, when using Monte Carlo techniques, it is shown that when the expected contributions of the source neutrons in every part of the liver is calculated, a linear optimization scheme such as the Simplex method results in a mix of thermal and epithermal source neutrons to get the highest homogeneity for the thermal neutron field. This optimisation method is demonstrated in 3 holder shapes: cuboid, cylindrical and spherical with each 3 volumes of 2, 4 and 6 litres. A 10 cm thick cuboid model, irradiated from both sides gives the highest homogeneity. The spherical (rotating) holder has the lowest homogeneity but the highest contribution of every source neutron to the thermal neutrons in the liver. This can be advantageous when using a relatively small sized neutron beam with a low strength. (author)

  17. Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution

    International Nuclear Information System (INIS)

    Haneya, Assad; Philipp, Alois; Foltan, Maik; Camboni, Daniele; Rupprecht, Leopold; Puehler, Thomas; Hirt, Stephan; Hilker, Michael; Kobuch, Reinhard; Schmid, Christof; Arlt, Matthias; Mueller, Thomas

    2009-01-01

    Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation. From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4. All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO. Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care. (author)

  18. Lateral epicondylitis: This is still a main indication for extracorporeal shockwave therapy.

    Science.gov (United States)

    Thiele, S; Thiele, R; Gerdesmeyer, L

    2015-12-01

    Extracorporeal shockwave therapy (ESWT) is used in a number of indications in the medical field. A number of tendinopathies show good and excellent results due to evidence based medicine. The treatment of lateral epicondylitis is known to show conflicting results. This overview of the published RCT's on ESWT for lateral epicondylitis tries to show the reasons for this conflicting data-base and point out, why we think that this is still a main indication for extracorporeal shockwave therapy. Copyright © 2015. Published by Elsevier Ltd.

  19. Can cellulite be treated with low-energy extracorporeal shock wave therapy?

    Science.gov (United States)

    Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

    2007-01-01

    The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment. PMID:18225463

  20. Food irradiation

    International Nuclear Information System (INIS)

    Macklin, M.

    1987-01-01

    The Queensland Government has given its support the establishment of a food irradiation plant in Queensland. The decision to press ahead with a food irradiation plant is astonishing given that there are two independent inquiries being carried out into food irradiation - a Parliamentary Committee inquiry and an inquiry by the Australian Consumers Association, both of which have still to table their Reports. It is fair to assume from the Queensland Government's response to date, therefore, that the Government will proceed with its food irradiation proposals regardless of the outcomes of the various federal inquiries. The reasons for the Australian Democrats' opposition to food irradiation which are also those of concerned citizens are outlined

  1. Food irradiation

    International Nuclear Information System (INIS)

    Duchacek, V.

    1989-01-01

    The ranges of doses used for food irradiation and their effect on the processed foods are outlined. The wholesomeness of irradiated foods is discussed. The present food irradiation technology development in the world is described. A review of the irradiated foods permitted for public consumption, the purposes of food irradiaton, the doses used and a review of the commercial-scale food irradiators are tabulated. The history and the present state of food processing in Czechoslovakia are described. (author). 1 fig., 3 tabs., 13 refs

  2. Irradiated foods

    International Nuclear Information System (INIS)

    Darrington, Hugh

    1988-06-01

    This special edition of 'Food Manufacture' presents papers on the following aspects of the use of irradiation in the food industry:- 1) an outline view of current technology and its potential. 2) Safety and wholesomeness of irradiated and non-irradiated foods. 3) A review of the known effects of irradiation on packaging. 4) The problems of regulating the use of irradiation and consumer protection against abuse. 5) The detection problem - current procedures. 6) Description of the Gammaster BV plant in Holland. 7) World outline review. 8) Current and future commercial activities in Europe. (U.K.)

  3. The use of cultured epithelial autograft in the treatment of major burn injuries: a critical review of the literature.

    Science.gov (United States)

    Wood, F M; Kolybaba, M L; Allen, P

    2006-06-01

    The need to achieve rapid wound closure in patients with massive burns and limited skin donor sites led to the investigation of in vitro cellular expansion of keratinocytes. The use of cultured epithelial autografts (CEA) was first reported in the treatment of major burns in 1981. Since that time, support for the use of CEA has varied, ranging from 'a useful agent' to having 'no demonstrable effect on the outcome of extensively burned patients'. This critical review of the literature examines issues associated with the use of CEA and the introduction of the technology into clinical practice. The factors potentially limiting the use of cultured CEA are the time necessary to culture CEA sheets, the reliability of 'take', vulnerability of grafts on the newly healed surface, long-term durability and the cost implications of such treatment. The available literature was located and critically evaluated using the Australian National Health and Medical Research Council Guidelines. In the identified literature, the level of evidence to support the use of CEA in major burn injures is limited and often restricted to case studies and case series with no Level 1 evidence currently available. The main question arising 'Does CEA have a role in the treatment of major burns?' has proven difficult to answer due to the wide variation in both the quality of study design and the findings. At best, the literature review has highlighted areas of concern that have hindered the successful use of CEA. Our review critically evaluates the use of CEA and explores the advances in techniques towards attempting to improve reliable clinical implementation of CEA. The need for higher level research into the use of CEA is emphasised by this review.

  4. Indirect MR-arthrography in osteochondral autograft and crushed bone graft with a collagen membrane-Correlation with histology

    Energy Technology Data Exchange (ETDEWEB)

    Streitparth, F. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany)], E-mail: florian.streitparth@charite.de; Schoettle, P.; Schell, H. [Center for Musculoskeletal Surgery, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Lehmkuhl, L.; Madej, T.; Wieners, G. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Duda, G.N. [Center for Musculoskeletal Surgery, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Schroeder, R.J. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany)

    2009-04-15

    Objective: To analyze the spectrum of findings in indirect MR-arthrography following osteochondral autograft transfer system (OATS) and crushed bone graft using a magnetic resonance imaging (MRI) scoring and grading system in relation to histology as the standard of reference. Materials and methods: Iatrogenic lesions were set at ovine condylar facets (n = 6/group), treated with OATS or crushed bone graft. 1.5 T MRI was performed 6 months after surgery using PD-weighted (w fat saturated (fs) fast spin echo (FSE), T1-w 2D, and 3D fs gradient echo (GE) sequences 30 min. after i.v. Gd-DTPA administration and passive joint exercise. The repair tissue was evaluated by two independent radiologists. The MR findings were compared to histology. Results: In all cases, MRI and histologic grading correlated well and showed significant superior repair in OATS at 6 months (p < 0.05), reproducing the original articular contour and a good subchondral restoration. FsT1-w3DGE proved most appropriate identifying characteristic post-operative findings: the OATS group demonstrated bone marrow edema at the donor site and the graft/host interface showed significant enhancement in indirect MR-arthrography, indicating fibrocartilage. After crushed bone graft, we found an irregular structure and significant contrast uptake, consistent with remnants of bone grafts surrounded by inflammatory tissue. Conclusion: Indirect MR-arthrography is an accurate, non-invasive monitoring tool following OATS and crushed bone graft as the MRI scoring and grading system allows a reliable evaluation of normal and pathological osteochondral repair with a high histologic correlation.

  5. The superiority of the autografts inactivated by high hydrostatic pressure to decellularized allografts in a porcine model.

    Science.gov (United States)

    Morimoto, Naoki; Mahara, Atsushi; Jinno, Chizuru; Ogawa, Mami; Kakudo, Natsuko; Suzuki, Shigehiko; Fujisato, Toshia; Kusumoto, Kenji; Yamaoka, Tetsuji

    2017-11-01

    We are developing a novel skin regeneration therapy in which the inactivation of nevus tissue via high hydrostatic pressure (HHP) is used in the reconstruction of the dermis in combination with a cultured epidermal autograft. In this study, we used a porcine skin graft model to explore whether autologous skin including cellular debris inactivated by HHP or allogeneic skin decellularized by HHP is better for dermal reconstruction. Grafts (n = 6) were prepared for five groups each: autologous skin without pressurization group (control group), autologous skin inactivated by 200 MPa group, autologous skin inactivated by 1000 MPa group, allogeneic skin decellularized by 200 MPa group, and allogeneic skin decellularized by 1000 MPa group. All of the grafts at 1, 4, and 12 weeks showed complete engraftment macroscopically. The mean areas of the grafts of the control group (p < 0.01) and autologous 200 MPa group (p < 0.01) were larger than that of the allogeneic 1000 MPa group at four weeks after implantation. The thickness of the control group and autologous 200 MPa group was comparable, and that of the autologous 200 MPa group was significantly thicker than that of the allogeneic 200 MPa group (p < 0.01). This suggests that the autologous dermis was superior to the allogeneic decellularized dermis as a skin graft, and that HHP at 200 MPa provided a better outcome than HHP at 1000 MPa. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2653-2661, 2017. © 2016 Wiley Periodicals, Inc.

  6. The effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis.

    Science.gov (United States)

    Lee, Ji-Hyun; Lee, Sangyong; Choi, SeokJoo; Choi, Yoon-Hee; Lee, Kwansub

    2017-03-01

    [Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients' function.

  7. Logistics and safety of extracorporeal membrane oxygenation in medical retrieval.

    Science.gov (United States)

    Burns, Brian J; Habig, Karel; Reid, Cliff; Kernick, Paul; Wilkinson, Chris; Tall, Gary; Coombes, Sarah; Manning, Ron

    2011-01-01

    This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. We describe the logistics involved in ECMO road and rotary-wing retrieval by a multidisciplinary team during the H1N1 influenza epidemic in winter 2009 (i.e., June 1 to August 31, 2009). Basic patient demographics and key retrieval time lines were analyzed. There were 17 patients retrieved on ECMO, with their ages ranging from 22 to 55 years. The median weight was 110 kg. Four critical events were recorded during retrieval, with no adverse outcomes. The retrieval distance varied from 20.8 to 430 km. There were delays in times from retrieval booking to both retrieval tasking and retrieval team departure in 88% of retrievals. The most common reasons cited were "patient not ready" 23.5% (4/17); "vehicle not available," 23.5% (4/17); and "complex retrieval," 41.2% (7/17). The median time (hours:minutes) from booking with the medical retrieval unit (MRU) to tasking was 4:35 (interquartile range [IQR] 3:27-6:15). The median time lag from tasking to departure was 1:00 (IQR 00:10-2:20). The median stabilization time was 1:30 (IQR 1:20-1:55). The median retrieval duration was 7:35 (IQR 5:50-10:15). The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.

  8. Prolonged Extracorporeal Membrane Oxygenation Support for Acute Respiratory Distress Syndrome

    Directory of Open Access Journals (Sweden)

    Wen-Je Ko

    2006-01-01

    Full Text Available When all conventional treatments for respiratory failure in patients with acute respiratory distress syndrome (ARDS have failed, extracorporeal membrane oxygenation (ECMO can provide a chance of survival in these desperately ill patients. A 49-year-old male patient developed septic shock and progressive ARDS after liver abscess drainage. Venovenous ECMO was given due to refractory respiratory failure on postoperative day 6. Initially, two heparin-binding hollow-fiber microporous membrane oxygenators in parallel were used in the ECMO circuit. Twenty-two oxygenators were changed in the first 22 days of ECMO support because of plasma leak in the oxygenators. Each oxygenator had an average life of 48 hours. Thereafter, a single silicone membrane oxygenator was used in the ECMO circuit, which did not require change during the remaining 596 hours of ECMO. The patient's tidal volume was only 90 mL in the nadir and less than 300 mL for 26 days during the ECMO course. The patient required ECMO support for 48 days and survived despite complications, including septic shock, ARDS, acute renal failure, drug-induced leukopenia, and multiple internal bleeding. This patient received an unusually long duration of ECMO support. However, he survived, recovered well, and was in New York Heart Association functional class I-II, with a forced expiratory volume in 1 second of 81% of the predicted level 18 months later. In conclusion, ECMO can provide a chance of survival for patients with refractory ARDS. The reversibility of lung function is possible in ARDS patients regardless of the severity of lung dysfunction at the time of treatment.

  9. Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation.

    Science.gov (United States)

    Kisch, Tobias; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix; Mailänder, Peter; Krämer, Robert

    2015-11-01

    Extracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable. High energy ESWT influences cutaneous microcirculation at body regions remote from application site. Eighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10 J) or placebo shock wave treatment (Group B: 0 impulses, 0 J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry. In Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (p = 0.01). Postcapillary venous filling pressure remained statistically unchanged (p > 0.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (p = 0.220). High energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  10. Quantification of Operational Learning in Minimal Invasive Extracorporeal Circulation.

    Science.gov (United States)

    Anastasiadis, Kyriakos; Antonitsis, Polychronis; Asteriou, Christos; Argiriadou, Helena; Deliopoulos, Apostolos; Konstantinou, Dimitrios; Grosomanidis, Vassilios; Tossios, Paschalis

    2017-07-01

    Minimal invasive extracorporeal circulation (MiECC) has initiated important new efforts within science and technology towards a more physiologic perfusion. In this study, we aim to investigate the learning curve of our center regarding MiECC. We studied a series of 150 consecutive patients who underwent elective coronary artery bypass grafting by the same surgical team during the initial phase of MiECC application. Patients were randomly assigned into two groups. Group A (n = 75) included patients operated on MiECC, while group B (n = 75) included patients operated with conventional cardiopulmonary bypass (cCPB). The primary end-point of the study was to identify whether there is a learning curve when operating on MiECC. The following parameters were unrelated with increasing experience, even though the results favored MiECC use: reduced CPB duration (102.9 ± 25 vs. 122.2 ± 33 min, P learning applied to postoperative hematocrit and hemoglobin levels (R 2  = 0.098, P = 0.006). We identified that advantages of MiECC technology in terms of reduced hemodilution and improved end-organ protection and clinical outcome are evident from the first patient. Optimal results are obtained with 50 cases; this refers mainly to significant reduction in the need for intraoperative blood transfusion. Teamwork from surgeons, anesthesiologists, and perfusionists is of paramount importance in order to maximize the clinical benefits from this technology. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Extracorporeal life support in the treatment of colchicine poisoning.

    Science.gov (United States)

    Boisramé-Helms, Julie; Rahmani, Hassène; Stiel, Laure; Tournoud, Christine; Sauder, Philippe

    2015-01-01

    Ingestions of Colchicum autumnale may lead to severe poisoning. It begins with gastrointestinal symptoms and leukocytosis, followed by multi-organ failure with shock and a possible late recovery phase. Mortality is highly dependent on the ingested dose. We report a case of accidental C. autumnale poisoning with refractory cardiogenic shock and eventual survival after extracorporeal life support (ECLS). A 68-year-old woman was admitted to the intensive care unit (ICU) on day 3 after ingestion of C. autumnale in a meal. She first suffered from nausea and vomiting leading to severe dehydration. She then developed multi-organ failure and refractory cardiogenic shock, with a mean arterial pressure nadir of 50 mmHg despite high doses of catecholamines and a left ventricular ejection fraction at 5-10%. Venous-arterial ECLS was therefore started at an initial rate of 3.5 L/min and 3,800 rev/min. Her symptoms also included pancytopenia on day 4 with diffuse bleeding requiring iterative blood product transfusion. Platelet and leukocyte count nadirs were 13 × 10(9)/L (normal range: 150-400 × 10(9)/L) and 0.77 × 10(9)/L (normal range: 4.2-10.7 × 10(9)/L), respectively. ECLS allowed good cardiac contractility recovery within a few days, with complications including bleeding made controllable. Indeed, because of hemostasis disorders, the patient presented hemoptysis and hematuria. She was treated with tranexamic acid and transfused with blood products. She received 15 erythrocyte concentrates, 13 platelet concentrates, and 7 fresh frozen plasma. ECLS was removed by day 10, with subsequent weaning from mechanical ventilation as well as from hemodialysis in the following days. This patient survives after the use of ECLS in Colchicum poisoning, with controllable complications. Thus, ECLS might be indicated to overcome the potentially refractory cardiogenic shock phase.

  12. Extracorporeal membranous oxygenation (ecmo in children – 12 years experience

    Directory of Open Access Journals (Sweden)

    Janez Primožič

    2006-02-01

    Full Text Available Background: Extracorporeal membranous oxigenation (ECMO is an established treatment of children with severe yet amenable lung or heart failure.Methods: Retrospective analysis of 12 years of experience (1994–2005 includes: a ECMO treatment type, b selection and status of children upon connection, c percentage and quality of survival, d influence of pre-ECMO risk factors on survival, and e complications.Results: ECMO was applied in 18 children: veno-venous type in 6 (33%, veno-arterial in 12 (66% children. All children had deep hipoxy and 80% probability of dying. There were 12 boys (66% and 6 girls (34%. The majority were newborns – there were 12 (66% while the other 6 children (34% were aged 2 to 24 months. Average duration of ECMO in newborns was 131 hours (SD 83; range 27–288, and in older children 253 hours (151; 45–434. Average birth weight of newborns was 3190 g (654; 2320–4360, average gestation age 38.5 weeks (2.2; 34–41. Of the 18 children treated with ECMO, 11 survived (61%, while 4 died subsequently. Observed 24 hours after ECMO survival rate was higher in newborns (67% than in older children (50%, but the difference was not statistically significant (p = 0.627. Up to the present, 7 of the 11 have survived, five reached normal mental and physical development at final check-up, one has moderate motor disturbances with behavioural disorders, one has severe disability. It can be inferred that in addition to oxygenation index, plasma HCO3 level, mean arterial blood pressure and mean airway pressure before ECMO treatment are potential prognostic factors for newborn survival.Conclusions: The results of ECMO treatment justify the use and continuation of the ECMO programme in Slovenia.

  13. Does extracorporeal shock wave lithotripsy cause hearing impairment?

    Science.gov (United States)

    Tuncer, Murat; Erdogan, Banu A; Yazici, Ozgur; Sahin, Cahit; Altin, Gokhan; Faydaci, Gokhan; Eryildirim, Bilal; Sarica, Kemal

    2014-07-01

    To evaluate the possible effects of extracorporeal shock wave lithotripsy (ESWL) on the hearing status of the patients in this prospective controlled study. A total of 40 patients with normal hearing function were included to the study. We had 20 patients each in the study group and control group. The treatment parameters were standardized in all 3 sessions in which a total of 3000 shock waves with a rate of 90/min along with a total energy value of 126 J at the fourth energy level have been applied (Dornier Compact Sigma, Medtech, Germany). In addition to the testing of hearing functions and possible cochlear impairment by Transient Evoked Otoacoustic Emissions test at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz frequencies, complications such as ear pain, tinnitus, and hearing loss have been well evaluated in each patient before the procedure and 2 hours and 1 month after the completion of the third session of ESWL in the study group. The same evaluation procedures were performed before the study and after 7-weeks in the control group. Regarding Transient Evoked Otoacoustic Emissions data obtained in study group and control group patients, there was no significant alteration in values obtained after ESWL when compared with the values before the procedure. A well-planned ESWL procedure is a safe and effective treatment in urinary stones and causes no detectable harmful effect on the hearing function of treated patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Gallbladder Dynamics Before and After Extracorporeal Shock Wave Lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Myung Hea; Suk, Jae Dong; Moon, Dae Hyuk; Kim, Myung Hwan; Min, Young Il [Asian Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Extracorporeal shock wave lithotripsy (ESWI.) with adjunctive oral litholytic therapy has proven to be a useful treatment in selected patients with gallbladder stones. To study the effect of ESWL on gallbladder dynamics, {sup 99m}Tc-DISIDA hepatobiliary scintigraphy was done for 25 patients with symptomatic gallstones and 10 normal controls. Of these 25 patients, 15 were treated with ESWL and adjunctive oral litholytic agents (ESWL group) and 10 were treated only with oral litholytic agents (UDCA group). After overnight fast and gallbladder visualization on a routine hepatobiliary scintigraphy with 7 mCi of {sup 99m}Tc-DISIDA, subjects were given fatty meal and imaged with a gamma camera interfaced to a computer (I frame/minute for 70 minutes). A gallbladder time-activity curve was generated and latent period (LP), ejection period (EP), ejection fraction (EF) and ejection rate (ER) were calculated, ESWL group were studied before, l day after and 2 weeks after ESWL, and UDCA group were studied before and 2 weeks after starting oral medication Mean basal EF was significantly reduced in patients but other parameters were not reduced. In ESlVL group, mean EF and mean ER at 1 day after ESWL were reduced. In 3 of them, gallbladder was not visualized at all. Two weeks after ESWL, however, all parameters were recovered to basal level. In UDCA group, all parameters were not changed significantly during medication. We can conclude that ESWL has such immediate adverse effect on gallbladder dynamics as reducing contractility and nonvisualization of gallbladder but it has no long-term effect.

  15. [Study on preparation of laser micropore porcine acellular dermal matrix combined with split-thickness autograft and its application in wound transplantation].

    Science.gov (United States)

    Liang, Li-Ming; Chai, Ji-Ke; Yang, Hong-Ming; Feng, Rui; Yin, Hui-Nan; Li, Feng-Yu; Sun, Qiang

    2007-04-01

    To prepare a porcine acellular dermal matrix (PADM), and to optimize the interpore distance between PADM and co-grafted split-thickness autologous skin. Porcine skin was treated with trypsin/Triton X-100 to prepare an acellular dermal matrix. Micropores were produced on the PADM with a laser punch. The distance between micropores varied as 0.8 mm, 1.0 mm, 1.2 mm and 1.5 mm. Full-thickness defect wounds were created on the back of 144 SD rats. The rats were randomly divided into 6 groups as follows, with 24 rats in each group. Micropore groups I -IV: the wounds were grafted with PADM with micropores in four different intervals respectively, and covered with split-thickness autologous skin graft. Mesh group: the wounds were grafted with meshed PADM and split-thickness autograft. with simple split-thickness autografting. The gross observation of wound healing and histological observation were performed at 2, 4, 6 weeks after surgery. The wound healing rate and contraction rate were calculated. Two and four weeks after surgery, the wound healing rate in micropore groups I and II was lower than that in control group (P micropore groups I , II and mesh group (P > 0.05) until 6 weeks after grafting( P micropore groups I and II ([(16.0 +/- 2.6)%, (15.1 +/- 2.4)%] was remarkably lower than that in control group 4 and 6 weeks after grafting (P micropore PADM (0.8 mm or 1.0 mm in distance) grafting in combination with split-thickness autografting can improve the quality of wound healing. PADM with laser micropores in 1.0 mm distance is the best choice among them.

  16. A COMPARATIVE STUDY BETWEEN SURGICAL OUTCOME OF PATIENT’S OWN BLOOD VS. 10-0 NYLON FOR CONJUNCTIVAL AUTOGRAFTING IN PTERYGIUM EXCISION

    Directory of Open Access Journals (Sweden)

    Ayush Mahendra

    2016-04-01

    Full Text Available CONTEXT (BACKGROUND Pterygium is a frequently occurring progressive ocular surface disorder which is a fleshy triangular wing shaped growth, encroaching from conjunctiva on cornea. Pterygium is frequent in hot, dry, dusty environment and prevalence is 0.3% to 29%. Surgical removal is main treatment for pterygium. The recurrence rate after pterygium surgery varies according to type of surgery. Various surgical modalities tried like simple excision, bare sclera technique, amniotic membrane transplantation and conjunctival autografting. AIM To compare surgical outcome of patient’s own blood Vs 10-0 Nylon for conjunctival autografting in pterygium excision. SETTINGS AND DESIGN It is a prospective randomised interventional control trial, with a sample size of minimum 30 patients in each group studied in a tertiary care hospital from Oct. 2013 to Dec. 2015. METHODS AND MATERIAL Out of 63 patients who underwent pterygium excision, patient’s own blood was used in 32 patients (Group A and 10-0 Nylon suture was used in 31 patients (Group B for conjunctival autografting. All patients were followed up regularly on postoperative day 1, 8, 30, 90 and 180. Variables for postoperative assessment were pain, watering, irritation, redness, graft displacement, graft loss and recurrence. STATISTICAL ANALYSIS Statistical analysis was performed using SPSS 13.0 (SPSS, Chicago. Outcome variables between the two groups were compared using the non-parametric Mann–Whitney U Test. RESULTS The mean surgical time of group B (31.48±6.15 min is significantly high as compared to group A (19.71±5.13 min with p<0.001. The regression analysis revealed that except surgery type, no other variable had significant impact on the duration of surgery. Postoperative symptoms are less in group A as compared to group B. Group B showed two recurrences whereas no recurrence was seen in group A. CONCLUSIONS Conjunctival autografting by patient’s own blood is better than 10-0 Nylon

  17. Successful Use of Extracorporeal Life Support after Double Traumatic Tracheobronchial Injury in a Patient with Severe Acute Asthma

    Directory of Open Access Journals (Sweden)

    Xavier Valette

    2011-01-01

    Full Text Available We report the case of an asthmatic patient with blunt trachea and left main bronchus injuries who developed acute severe asthma after surgical repair. Despite medical treatment and ventilatory support, asthma persisted with high airway pressures and severe respiratory acidosis. We proposed venovenous extracorporeal life support for CO2 removal which allowed arterial blood gas normalization and airway pressures decrease. Extracorporeal life support was removed on day five after medical treatment of acute severe asthma. So we report the successful use of extracorporeal life support for operated double blunt tracheobronchial injury with acute severe asthma.

  18. Foodstuff irradiation

    International Nuclear Information System (INIS)

    1982-01-01

    Report written on behalf of the Danish Food Institute summarizes national and international rules and developments within food irradiation technology, chemical changes in irradiated foodstuffs, microbiological and health-related aspects of irradiation and finally technological prospects of this conservation form. Food irradiatin has not been hitherto applied in Denmark. Radiation sources and secondary radiation doses in processed food are characterized. Chemical changes due to irradiation are compared to those due to p.ex. food heating. Toxicological and microbiological tests and their results give no unequivocal answer to the problem whether a foodstuff has been irradiated. The most likely application fields in Denmark are for low radiation dosis inhibition of germination, riping delay and insecticide. Medium dosis (1-10 kGy) can reduce bacteria number while high dosis (10-50 kGy) will enable total elimination of microorganisms and viruses. Food irradiation can be acceptable as technological possibility with reservation, that further studies follow. (EG)

  19. Impact of extracorporeal blood flow rate on blood pressure, pulse rate and cardiac output during haemodialysis

    DEFF Research Database (Denmark)

    Schytz, Philip Andreas; Mace, Maria Lerche; Soja, Anne Merete Boas

    2015-01-01

    BACKGROUND: If blood pressure (BP) falls during haemodialysis (HD) [intradialytic hypotension (IDH)] a common clinical practice is to reduce the extracorporeal blood flow rate (EBFR). Consequently the efficacy of the HD (Kt/V) is reduced. However, only very limited knowledge on the effect...

  20. em>In vivoem> biological response to extracorporeal shockwave therapy in human tendinopathy

    DEFF Research Database (Denmark)

    Waugh, C. M.; Morrissey, D.; Jones, E.

    2015-01-01

    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment for chronic tendinopathies, however little is known about the in-vivo biological mechanisms of ESWT. Using microdialysis, we examined the real-time biological response of healthy and pathological tendons to ESWT. A single session...

  1. Ligation of the Rectum with an Extracorporeal Sliding Knot Facilitating Laparoscopic Cross-Stapling

    DEFF Research Database (Denmark)

    Bulut, Orhan

    2013-01-01

    : The extracorporeal ligation of the rectum just proximal to the cut end of the rectum before applying the linear stapling stapler facilitates the procedure and requires only a few firings of the stapler during the laparoscopic rectal resections. Results: Ten patients with a median age of 72 years underwent rectal...

  2. ExtraCorporeal Membrane Oxygenation in Newborns. Implications for Brain and Lung.

    NARCIS (Netherlands)

    Heyst, A.F.J. van

    2004-01-01

    Extracorporeal membrane oxygenation (ECMO) is a rescue treatment for newborns with severe respiratory insufficiency. In veno-arterial ECMO, venous blood is drained from the right atrium, oxygenated in an artificial lung and reinfused in the aorta. For vascular access the right internal jugular vein

  3. Verbal and visual-spatial memory problems at adolescent age after neonatal extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.J. Madderom (Marlous); F.K. Aarsen (Femke); R.M. Schiller (Raisa); S.J. Gischler (Saskia); A.F.J. van Heijst (Arno); D. Tibboel (Dick); H. IJsselstijn (Hanneke)

    2018-01-01

    markdownabstract__Objectives__ To assess neuropsychological outcome in 17- and 18-year–old neonatal extracorporeal membrane oxygenation survivors. __Design__ A prospective longitudinal follow-up study. __Setting__ Follow-up program at the Erasmus MC-Sophia Children’s Hospital in Rotterdam, The

  4. Extracorporeal shockwave therapy for patellar tendinopathy : a review of the literature

    NARCIS (Netherlands)

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment;

  5. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure

    Directory of Open Access Journals (Sweden)

    Mugford Miranda

    2006-12-01

    Full Text Available Abstract Background An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. Methods/Design The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress' by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18–65 years with severe, but potentially reversible, respiratory failure (Murray score ≥ 3.0 or hypercapnea with pH Discussion Analysis will be based on intention to treat. A concurrent economic evaluation will also be performed to compare the costs and outcomes of both treatments.

  6. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    van Houte, J; Donker, D W; Wagenaar, L J; Slootweg, A P; Kirkels, J H; van Dijk, D

    We report on the use of percutaneous femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in a fully awake, non-intubated and spontaneously breathing patient suffering from acute, severe and refractory cardiogenic shock due to a (sub)acute anterior myocardial infarction. Intensified

  7. The effect of epoprostenol on platelet activation and consumption during experimental extracorporeal perfusion

    DEFF Research Database (Denmark)

    Skogby, M; Adrian, K; Friberg, L

    1999-01-01

    Hemorrhages are major complications experienced in 10-35% of neonates treated with extracorporeal life support (ECLS). The increased bleeding tendency is partly due to an ECLS induced thrombocytopenia and impaired platelet function. In the present study, we evaluated the effect of epoprostenol on...

  8. Motor performance in five-year-old extracorporeal membrane oxygenation survivors: A population-based study

    NARCIS (Netherlands)

    M.W.G. Nijhuis-van der Sanden (Maria); M.H.M. van der Cammen-van Zijp (Monique); A.J.W.M. Janssen (Anjo); J.J.C.M. Reuser (Jolanda); P. Mazer (Petra); A.F.J. van Heijst (Arno); S.J. Gischler (Saskia); D. Tibboel (Dick); L.A. Kollee

    2009-01-01

    textabstractIntroduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique to provide life support in acute reversible cardio-respiratory failure when conventional management is not successful. Most neonates receiving ECMO suffer from meconium

  9. Cyclosporine and Extracorporeal Photopheresis are Equipotent in Treating Severe Atopic Dermatitis

    DEFF Research Database (Denmark)

    Koppelhus, Uffe; Poulsen, Johan; Grunnet, Niels

    2014-01-01

    BACKGROUND: Severe atopic dermatitis (AD) is a recurrent and debilitating disease often requiring systemic immunosuppressive treatment. The efficacy of cyclosporine A (CsA) is well proven but potential side effects are concerning. Several reports point at extracorporeal photopheresis (ECP) as an ...

  10. Cytoflavin as an Additional Method for Myocardial Salvage During Operations Under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Z. Z Nadiradze

    2006-01-01

    Full Text Available The paper presents the results of use of the combined antihypoxant Cytoflavin during operations under extracorporeal circulation. Twenty-nine patients operated on for rheumatic mitral valvular disease were examined. The examinations have shown that the use of Cytoflavin positively affects the restoration of cardiovascular performance and improved tissue oxygen transport in the postperfusion period.

  11. Leucocyte depletion in a drowning victim during rewarming with extracorporeal circulation may limit pulmonary oedema

    NARCIS (Netherlands)

    Vermeijden, Wytze J.; de Vries, Hans; Kieboom, Joke; Waterbolk, Tjalling

    2006-01-01

    We report two drowning victims with hypothermic circulatory arrest who were resuscitated with the use of extracorporeal circulation (ECC). The first patient developed severe post-bypass pulmonary oedema and inspired us to use a leucocyte-depletion filter in the second patient to attenuate

  12. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers

    DEFF Research Database (Denmark)

    Jeppesen, S M; Yderstraede, K B; Rasmussen, B S B

    2016-01-01

    OBJECTIVE: To investigate the efficacy of extracorporeal shockwave therapy (ESWT) on healing chronic diabetic foot ulcers (DFU). METHOD: Patients with chronic DFUs were randomised (1:1) to receive a series of six ESWT treatments over 3 weeks in combination with standard care or standard care alone...

  13. Role of extracorporeal shock wave lithotripsy in hepato-biliary-pancreatic surgery

    NARCIS (Netherlands)

    R.L. van der Hul (René); P.W. Plaisier; O.T. Terpstra (Onno); H.A. Bruining (Hajo)

    1993-01-01

    textabstractSince the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed

  14. Acoustic wave focusing in an ellipsoidal reflector for extracorporeal shock-wave lithotripsy

    Science.gov (United States)

    Lottati, Itzhak; Eidelman, Shmuel

    1993-07-01

    Simulations of acoustic wave focusing in an ellipsoidal reflector for extracorporeal shock-wave lithotripsy (ESWL) are presented. The simulations are done on a structured/unstructured grid with a modified Tait equation of state for water. The Euler equations are solved by applying a second-order Godunov method. The computed results compare very well with the experimental results.

  15. Bacterial sepsis after extracorporeal shock-wave lithotripsy (ESWL) of calyceal diverticular stone.

    Science.gov (United States)

    Oh, Mi Mi; Kim, Jin Wook; Kim, Jong Wook; Chae, Ji Yun; Yoon, Cheol Yong; Park, Hong Seok; Park, Min Gu; Moon, Du Geon

    2013-02-01

    Most calyceal diverticula are asymptomatic but symptoms occur when there is urinary stasis leading to infection and calculi. Septic shock after ESWL of calyceal stone occurs rarely. A 24-year-old woman had septic shock due to after extracorporeal shock-wave lithotripsy (ESWL) of asymptomatic calyceal diverticular stone.

  16. Extracorporeal shock waves lithotripsy of urinary organs in patients with one kidney

    Directory of Open Access Journals (Sweden)

    Zogović Jezdimir

    2002-01-01

    Full Text Available Extracorporeal Shock Waves Lithotripsy (ESWL is a method of choice in the treatment of lithiasis. Surgical treatment is reduced to minimum, which in our case means 1-2%. Contraindications for using this method are: blood coagulation disorders, manifest tuberculosis, pregnancy, over obesity. Thanks to appropriate indications and technique which is used in an adequate way as well as to various endurological manipulations, removal of a stone by this method is safe, trauma is minimised, which is very important for patients with one kidney. During the last three years, usually in hospital conditions, 57 patients were treated in this way. Removal of a stone was performed by Extracorporeal Shock Waves Lithotripsy as mono therapy in 30 (53% patients; Extracorporeal Shock Waves Lithotripsy by using Double-J catheter in 16 (28% patients; Extracorporeal Lithotripsy with urine derivation by percutaneous nephrostome in 11 (19% patients. Endurological methods were used in 27 patients. Disintegration of stone was performed in the proper way. Full success was reached. Two patients had incrustation of ureteral catheter which had to be removed by surgery. In two other patients with inferior function of one kidney, after brief obstruction, hemodialisis was performed. Our results confirm that this method is nonaggressive, tech nically perfect for disintegration of urineorgans stone on all levels followed by small complications which are often solved by endoscopie manipulations.

  17. Diagnostic imaging for preparation of extracorporeal shockwave lithotripsy of gallbladder stones

    International Nuclear Information System (INIS)

    Brandstetter, K.; Golder, W.; Neuhaus, H.

    1991-01-01

    Extracorporeal shockwave lithotripsy can be applied as a non-invasive treatment of patients with predominantly cholesterol-type gallstones. As for this treatment, gall bladder contractility and patency of the ductus cysticus must be guaranteed, CT and sonography are applied to check these conditions, and also to determine the size and number of gallstones. (DG) [de

  18. Hemibody irradiation

    International Nuclear Information System (INIS)

    Schen, B.C.; Mella, O.; Dahl, O.

    1992-01-01

    In a large number of cancer patients, extensive skeletal metastases or myelomatosis induce vast suffering, such as intolerable pain and local complications of neoplastic bone destruction. Analgetic drugs frequently do not yield sufficient palliation. Irradiation of local fields often has to be repeated, because of tumour growth outside previously irradiated volumes. Wide field irradiation of the lower or upper half of the body causes significant relief of pain in most patients. Adequate pretreatment handling of patients, method of irradiation, and follow-up are of importance to reduce side effects, and are described as they are carried out at the Department of Oncology, Haukeland Hospital, Norway. 16 refs., 2 figs

  19. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure.

    Science.gov (United States)

    Peek, Giles J; Clemens, Felicity; Elbourne, Diana; Firmin, Richard; Hardy, Pollyanna; Hibbert, Clare; Killer, Hilliary; Mugford, Miranda; Thalanany, Mariamma; Tiruvoipati, Ravin; Truesdale, Ann; Wilson, Andrew

    2006-12-23

    An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced. While extracorporeal membrane oxygenation is proven to result in improved outcome when compared to conventional ventilation in neonates with severe respiratory failure, there is currently no good evidence from randomised controlled trials to compare these managements for important clinical outcomes in adults, although evidence from case series is promising. The aim of the randomised controlled trial of Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR) is to assess whether, for patients with severe, but potentially reversible, respiratory failure, extracorporeal membrane oxygenation will increase the rate of survival without severe disability ('confined to bed' and 'unable to wash or dress') by six months post-randomisation, and be cost effective from the viewpoints of the NHS and society, compared to conventional ventilatory support. Following assent from a relative, adults (18-65 years) with severe, but potentially reversible, respiratory failure (Murray score >/= 3.0 or hypercapnea with pH service will minimise by type of conventional treatment centre, age, duration of high pressure ventilation, hypoxia/hypercapnea, diagnosis and number of organs failed, to ensure balance in key prognostic variables. Extracorporeal membrane oxygenation will not be available for patients meeting entry criteria outside the trial. 180 patients will be recruited to have 80% power to be able to detect a one third reduction in the primary outcome from 65% at 5% level of statistical significance

  20. Use of minimal invasive extracorporeal circulation in cardiac surgery: principles, definitions and potential benefits. A position paper from the Minimal invasive Extra-Corporeal Technologies international Society (MiECTiS)

    NARCIS (Netherlands)

    Anastasiadis, Kyriakos; Murkin, John; Antonitsis, Polychronis; Bauer, Adrian; Ranucci, Marco; Gygax, Erich; Schaarschmidt, Jan; Fromes, Yves; Philipp, Alois; Eberle, Balthasar; Punjabi, Prakash; Argiriadou, Helena; Kadner, Alexander; Jenni, Hansjoerg; Albrecht, Guenter; van Boven, Wim; Liebold, Andreas; de Somer, Fillip; Hausmann, Harald; Deliopoulos, Apostolos; El-Essawi, Aschraf; Mazzei, Valerio; Biancari, Fausto; Fernandez, Adam; Weerwind, Patrick; Puehler, Thomas; Serrick, Cyril; Waanders, Frans; Gunaydin, Serdar; Ohri, Sunil; Gummert, Jan; Angelini, Gianni; Falk, Volkmar; Carrel, Thierry

    2016-01-01

    Minimal invasive extracorporeal circulation (MiECC) systems have initiated important efforts within science and technology to further improve the biocompatibility of cardiopulmonary bypass components to minimize the adverse effects and improve end-organ protection. The Minimal invasive

  1. Application of extracorporeal shock wave on bone: preliminary report.

    Science.gov (United States)

    Ikeda, K; Tomita, K; Takayama, K

    1999-11-01

    We have studied the effect of extracorporeal shock waves (ESW) on bone. ESW emitted by the new powerful generator provides three to six times greater energy than a common lithotriptor. Because the ESW causes fracture of rabbit femurs and induces new bone formation, we have called this treatment as ESWIB (ESW-induced bone formation). The purpose of this study is to confirm the effect of ESWIB on a canine model, which is more similar to clinical cases, and to apply ESWIB on nonunion of clinical cases. In our basic research, ESWIB was applied on six canine femurs as follows: group I with 100, 500, 1,000 shots and group II with 100, 500, 1,000 shots. A femur was extracted immediately after ESWIB in group I and 2 months after ESWIB in group II. Blood tests, including blood cell counts and blood chemistry studies, were performed before and after ESWIB in group II. In our clinical research, we applied ESWIB to six patients of delayed or nonunion of the fracture. The sites of the ESWIB application were three tibiae, one radius, one femur, and one humerus. Average age of the patients, the period from the previous surgery, and the period until fusion was achieved were 38.6 years, 14.0 months, and 4.3 months, respectively. In our basic research, group I, 500 or more shots caused periosteum detachment. In addition, small fractures of the inner surface of the cortex were observed. However, gross fracture with displacement was not observed. In group II, 500 or more shots caused callus formation beneath the detached periosteum. Subcutaneous hemorrhage was seen in all dogs, and the degree of bleeding was directly proportional to the number of the shots. The blood was absorbed within a week. The level of serum creatine kinase was significantly high 2 days after ESWIB, but it recovered in a week. In our clinical research, four of the patients achieved union without any complications except mild subcutaneous bleeding. We predict that ESWIB will be one of the tactics for treatment of

  2. Extracorporeal membrane oxygenation in a Scottish intensive care unit.

    Science.gov (United States)

    Berryman, Sean

    2010-01-01

    I reflected on the training I had on an extraordinary treatment for profound respiratory failure. The result of training enabled us to successfully treat a young female with the influenza A virus with extracorporeal membrane oxygenation (ECMO). I report the positive outcome that occurred, while continuing to run a busy general intensive care unit (ICU). She was the first of six patients who were all successfully treated with ECMO. Ten trained and experienced critical care nurses and two doctors attended the ECMO training course provided by the national centre in the UK. Five patients had already received ECMO therapy in the Scottish specialist unit (over the period of 8 years). As our Scottish specialist unit purchased exactly the same equipment as the national centre, it was easier for the multidisciplinary team to utilize their new-found knowledge and treat future patients with ECMO. With the predicted swine flu (H1N1) pandemic and the subsequent demand for critical care beds, funding was obtained to facilitate ECMO training. The potential need for increased provision of ECMO therapies was highlighted by recent events in Australia and New Zealand. Their most recent winter produced 68 patients requiring ECMO, whereas the previous year had manifested only three. Using our new equipment and adapted protocols from the national centre, we used these new skills to treat our first patient in October 2009. Johns' reflective practice tool was used to evaluate the care provided. Our patient was on ECMO for 9 days. She went on to make a remarkable recovery and was discharged from the ICU 1 week after ECMO was discontinued. She was discharged to the cardiothoracic high-dependency unit, where she was successfully rehabilitated. We were able to successfully treat a young lady, while providing the care for all other patients. This was a complex treatment, one that uses many resources including time and finance. Now that we have all the equipment, the necessary training and the

  3. Trough Concentrations of Vancomycin in Patients Undergoing Extracorporeal Membrane Oxygenation.

    Directory of Open Access Journals (Sweden)

    So Jin Park

    Full Text Available To investigate the appropriateness of the current vancomycin dosing strategy in adult patients with extracorporeal membrane oxygenation (ECMO, between March 2013 and November 2013, patients who were treated with vancomycin while on ECMO were enrolled. Control group consisted of 60 patients on vancomycin without ECMO, stayed in medical intensive care unit during the same study period and with the same exclusion criteria. Early trough levels were obtained within the fourth dosing, and maintenance levels were measured at steady state. A total of 20 patients were included in the analysis in ECMO group. Sixteen patients received an initial intravenous dose of 1.0 g vancomycin followed by 1.0 g every 12 hours. The non-steady state trough level of vancomycin after starting administration was subtherapeutic in 19 patients (95.00% in ECMO group as compared with 40 patients (66.67% in the control group (p = 0.013. Vancomycin clearance was 1.27±0.51 mL/min/kg, vancomycin clearance/creatinine clearance ratio was 0.90 ± 0.37, and elimination rate constant was 0.12 ± 0.04 h-1. Vancomycin dosingfrequency and total daily dose were significantly increased after clinical pharmacokinetic services of the pharmacist based on calculated pharmacokinetic parameters (from 2.10 ± 0.72 to 2.90 ± 0.97 times/day, p = 0.002 and from 32.54 ± 8.43 to 42.24 ± 14.62mg/kg, p = 0.014 in ECMO group in contrast with those (from 2.11 ± 0.69 to 2.37 ± 0.86 times/day, p = 0.071 and from 33.91 ± 11.85 to 31.61 ± 17.50 mg/kg, p = 0.350 in the control group.Although the elimination rate for vancomycin was similar with population parameter of non ECMO patients, the current dosing strategy of our institution for vancomycinin our ICU was not sufficient to achieve the target trough in the initial period in most patients receiving ECMO.

  4. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    Energy Technology Data Exchange (ETDEWEB)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-08-15

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm.

  5. Piezoelectric extracorporeal lithotripsy of gallbladder stones: New inclusion criteria

    International Nuclear Information System (INIS)

    Han, Joon Koo; Choi, Byung Ihn; Shin, Yong Moon; Yoon, Yong Kyu; Yoon, Yong Bum; Park, Yong Hyun; Kim, Chu Wan; Han, Man Chung

    1994-01-01

    To establish the optimal inclusion criteria for the patients with gallbladder stones to extracorporeal shock wave lithotripsy(ESWL) by retrospectively analyzed our current results. Data obtained from 201 patients with gallbladder stones treated with ESWL and oral chemolytic agent from November 1988 to July 1992 were retrospectively analyzed. Ninety-six had radiolucent stones and 105 had radiopaque stones. We used piezoelectric lithotriptor(EDAP LT. 01) and there were no limitation in number of sessions or total number of shock waves. ESWL was repeated until the size of the largest fragment is smaller than 4 mm. Follow up ultrasound was done in every three months after the successful fragmentation. Average length of the follow up was 205 days. We analyzed the rate of successful fragmentation, number of shock waves needed to achieve successful fragmentation according to the size, number of stones as well as the presence of the calcification. Stone-free rate after 6 months was also calculated from all subgroups and compared to each other. The rate of successful fragmentation was 76.2% for radiolucent stones and 65.6% for radiopaque stones(p> 0.05) after 46,731 and 56,111 shock wave respectively(p > 0.05) The rate of successful fragmentation was highest in patients with single, radiolucent stone smaller than 2 cm(91.7%) followed by single radiolucent stone larger than 2 cm(83.3%), multiple calcified stones smaller than 2 cm (77.4%) and single calcified stone smaller than 2 cm(72.1%). The rate of complete stone clearance after 6 month follow-up was highest in patients with single radiolucent stone smaller than 2 cm (63.3%) and followed by multiple calcified stones smaller than 2 cm(37.3%), single calcified stone smaller than 2 cm(33.9%)(p < 0.05). To obtain better results with ESWL in patients with gallbladder stone, the authors propose a more strict inclusion criteria, which is the patient with a single, radiolucent stone smaller than 2 cm

  6. Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

    Directory of Open Access Journals (Sweden)

    A. G. Angoules

    2013-01-01

    Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

  7. Histological comparison of autograft, allograft-DBM, xenograft, and synthetic grafts in a trabecular bone defect: an experimental study in rabbits.

    Science.gov (United States)

    Athanasiou, Vasilis T; Papachristou, Dionysios J; Panagopoulos, Andreas; Saridis, Alkis; Scopa, Chrisoula D; Megas, Panagiotis

    2010-01-01

    Different types of bone-graft substitutes have been developed and are on the market worldwide to eliminate the drawbacks of autogenous grafting. This experimental animal study was undertaken to evaluate the different histological properties of various bone graft substitutes utilized in this hospital. Ninety New Zealand white rabbits were divided into six groups of 15 animals. Under general anesthesia, a 4.5 mm-wide hole was drilled into both the lateral femoral condyles of each rabbit, for a total of 180 condyles for analysis. The bone defects were filled with various grafts, these being 1) autograft, 2) DBM crunch allograft (Grafton), 3) bovine cancellous bone xenograft (Lubboc), 4) calcium phosphate hydroxyapatite substitute (Ceraform), 5) calcium sulfate substitute (Osteoset), and 6) no filling (control). The animals were sacrificed at 1, 3, and 6 months after implantation and tissue samples from the implanted areas were processed for histological evaluation. A histological grading scale was designed to determine the different histological parameters of bone healing. The highest histological grades were achieved with the use of cancellous bone autograft. Bovine xenograft (Lubboc) was the second best in the histological scale grading. The other substitutes (Grafton, Ceraform, Osteoset) had similar scores but were inferior to both allograft and xenograft. Bovine xenograft showed better biological response than the other bone graft substitutes; however, more clinical studies are necessary to determine its overall effectiveness.

  8. Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors.

    Science.gov (United States)

    Janssen, Rob P A; du Mée, Arthur W F; van Valkenburg, Juliette; Sala, Harm A G M; Tseng, Carroll M

    2013-09-01

    Analysis of long-term clinical and radiological outcomes after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors. A prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4-strand hamstring tendon autografts with a standardized accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA, USA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions. RESULTS CLINICAL OUTCOME: A significant improvement (p test, IKDC score and one-leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50%) patients and correlated with lower levels of activity (p test. Transtibial ACL reconstruction with 4-strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At 10-year follow-up, radiological signs of OA were present in 53.5 % of the subjects. Risk factors for OA were meniscectomy prior to or at the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction. II.

  9. Food irradiation

    International Nuclear Information System (INIS)

    Mercader, J.P.; Emily Leong

    1985-01-01

    The paper discusses the need for effective and efficient technologies in improving the food handling system. It defines the basic premises for the development of food handling. The application of food irradiation technology is briefly discussed. The paper points out key considerations for the adoption of food irradiation technology in the ASEAN region (author)

  10. Food irradiation

    International Nuclear Information System (INIS)

    Matsuyama, Akira

    1990-01-01

    This paper reviews researches, commentaries, and conference and public records of food irradiation, published mainly during the period 1987-1989, focusing on the current conditions of food irradiation that may pose not only scientific or technologic problems but also political issues or consumerism. Approximately 50 kinds of food, although not enough to fill economic benefit, are now permitted for food irradiation in the world. Consumerism is pointed out as the major factor that precludes the feasibility of food irradiation in the world. In the United States, irradiation is feasible only for spices. Food irradiation has already been feasible in France, Hollands, Belgium, and the Soviet Union; has under consideration in the Great Britain, and has been rejected in the West Germany. Although the feasibility of food irradiation is projected to increase gradually in the future, commercial success or failure depends on the final selection of consumers. In this respect, the role of education and public information are stressed. Meat radicidation and recent progress in the method for detecting irradiated food are referred to. (N.K.) 128 refs

  11. Irradiation proctitis

    International Nuclear Information System (INIS)

    Minami, Akira

    1977-01-01

    Literatures on late rectal injuries are discussed, referring to two patients with uterine cervical cancer in whom irradiation proctitis occurred after telecobalt irradiation following uterine extirpation. To one patients, a total of 5000 rads was irradiated, dividing into 250 rads at one time, and after 3 months, irradiation with a total of 2000 rads, dividing into 200 rads at one time, was further given. In another one patient, two parallel opposing portal irradiation with a total of 6000 rads was given. About a year after the irradiation, rectal injuries and cystitis, accompanying with hemorrhage, were found in both of the patients. Rectal amputation and proctotoreusis were performed. Cystitis was treated by cystic irradiation in the urological department. Pathohistological studies of the rectal specimen revealed atrophic mucosa, and dilatation of the blood vessels and edema in the colonic submucosa. Incidence of this disease, term when the disease occurs, irradiation dose, type of the disease, treatment and prevention are described on the basis of the literatures. (Kanao, N.)

  12. Irradiation proctitis

    Energy Technology Data Exchange (ETDEWEB)

    Minami, A [Osaka Kita Tsishin Hospital (Japan)

    1977-06-01

    Literatures on late rectal injuries are discussed, referring to two patients with uterine cervical cancer in whom irradiation proctitis occurred after telecobalt irradiation following uterine extirpation. To one patients, a total of 5000 rads was irradiated, dividing into 250 rads at one time, and after 3 months, irradiation with a total of 2000 rads, dividing into 200 rads at one time, was further given. In another one patient, two parallel opposing portal irradiation with a total of 6000 rads was given. About a year after the irradiation, rectal injuries and cystitis, accompanying with hemorrhage, were found in both of the patients. Rectal amputation and proctotoreusis were performed. Cystitis was treated by cystic irradiation in the urological department. Pathohistological studies of the rectal specimen revealed atrophic mucosa, and dilatation of the blood vessels and edema in the colonic submucosa. Incidence of this disease, term when the disease occurs, irradiation dose, type of the disease, treatment and prevention are described on the basis of the literatures.

  13. Symptomatic gallbladder stones. Cost-effectiveness of treatment with extracorporeal shock-wave lithotripsy, conventional and laparoscopic cholecystectomy

    NARCIS (Netherlands)

    Go, P. M.; Stolk, M. F.; Obertop, H.; Dirksen, C.; van der Elst, D. H.; Ament, A.; van Erpecum, K. J.; van Berge Henegouwen, G. P.; Gouma, D. J.

    1995-01-01

    In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy

  14. Food irradiation

    International Nuclear Information System (INIS)

    Kobayashi, Yasuhiko; Kikuchi, Masahiro

    2009-01-01

    Food irradiation can have a number of beneficial effects, including prevention of sprouting; control of insects, parasites, pathogenic and spoilage bacteria, moulds and yeasts; and sterilization, which enables commodities to be stored for long periods. It is most unlikely that all these potential applications will prove commercially acceptable; the extend to which such acceptance is eventually achieved will be determined by practical and economic considerations. A review of the available scientific literature indicates that food irradiation is a thoroughly tested food technology. Safety studies have so far shown no deleterious effects. Irradiation will help to ensure a safer and more plentiful food supply by extending shelf-life and by inactivating pests and pathogens. As long as requirement for good manufacturing practice are implemented, food irradiation is safe and effective. Possible risks of food irradiation are not basically different from those resulting from misuse of other processing methods, such as canning, freezing and pasteurization. (author)

  15. Irradiation damage

    Energy Technology Data Exchange (ETDEWEB)

    Howe, L.M

    2000-07-01

    There is considerable interest in irradiation effects in intermetallic compounds from both the applied and fundamental aspects. Initially, this interest was associated mainly with nuclear reactor programs but it now extends to the fields of ion-beam modification of metals, behaviour of amorphous materials, ion-beam processing of electronic materials, and ion-beam simulations of various kinds. The field of irradiation damage in intermetallic compounds is rapidly expanding, and no attempt will be made in this chapter to cover all of the various aspects. Instead, attention will be focused on some specific areas and, hopefully, through these, some insight will be given into the physical processes involved, the present state of our knowledge, and the challenge of obtaining more comprehensive understanding in the future. The specific areas that will be covered are: point defects in intermetallic compounds; irradiation-enhanced ordering and irradiation-induced disordering of ordered alloys; irradiation-induced amorphization.

  16. Irradiation damage

    International Nuclear Information System (INIS)

    Howe, L.M.

    2000-01-01

    There is considerable interest in irradiation effects in intermetallic compounds from both the applied and fundamental aspects. Initially, this interest was associated mainly with nuclear reactor programs but it now extends to the fields of ion-beam modification of metals, behaviour of amorphous materials, ion-beam processing of electronic materials, and ion-beam simulations of various kinds. The field of irradiation damage in intermetallic compounds is rapidly expanding, and no attempt will be made in this chapter to cover all of the various aspects. Instead, attention will be focused on some specific areas and, hopefully, through these, some insight will be given into the physical processes involved, the present state of our knowledge, and the challenge of obtaining more comprehensive understanding in the future. The specific areas that will be covered are: point defects in intermetallic compounds; irradiation-enhanced ordering and irradiation-induced disordering of ordered alloys; irradiation-induced amorphization

  17. Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study.

    Science.gov (United States)

    Schmidt, Matthieu; Stewart, Claire; Bailey, Michael; Nieszkowska, Ania; Kelly, Joshua; Murphy, Lorna; Pilcher, David; Cooper, D James; Scheinkestel, Carlos; Pellegrino, Vincent; Forrest, Paul; Combes, Alain; Hodgson, Carol

    2015-03-01

    To describe mechanical ventilation settings in adult patients treated for an acute respiratory distress syndrome with extracorporeal membrane oxygenation and assess the potential impact of mechanical ventilation settings on ICU mortality. Retrospective observational study. Three international high-volume extracorporeal membrane oxygenation centers. A total of 168 patients treated with extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from January 2007 to January 2013. We analyzed the association between mechanical ventilation settings (i.e. plateau pressure, tidal volume, and positive end-expiratory pressure) on ICU mortality using multivariable logistic regression model and Cox-proportional hazards model. We obtained detailed demographic, clinical, daily mechanical ventilation settings and ICU outcome data. One hundred sixty-eight patients (41 ± 14 years old; PaO2/FIO2 67 ± 19 mm Hg) fulfilled our inclusion criteria. Median duration of extracorporeal membrane oxygenation and ICU stay were 10 days (6-18 d) and 28 days (16-42 d), respectively. Lower positive end-expiratory pressure levels and significantly lower plateau pressures during extracorporeal membrane oxygenation were used in the French center than in both Australian centers (23.9 ± 1.4 vs 27.6 ± 3.7 and 27.8 ± 3.6; p Protective mechanical ventilation strategies were routinely used in high-volume extracorporeal membrane oxygenation centers. However, higher positive end-expiratory pressure levels during the first 3 days on extracorporeal membrane oxygenation support were independently associated with improved survival. Further prospective trials on the optimal mechanical ventilation strategy during extracorporeal membrane oxygenation support are warranted.

  18. Extracorporeal life support for cardiac arrest in a 13-year-old girl caused by Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Song, Kyoung Hwan; Lee, Byung Kook; Jeung, Kyung Woon; Lee, Dong Hun

    2015-10-01

    Generally, Wolff-Parkinson-White (WPW) syndrome presents good prognosis. However, several case reports demonstrated malignant arrhythmia or sudden cardiac death as WPW syndrome's first presentation. Cardiopulmonary resuscitation using extracorporeal life support is a therapeutic option in refractory cardiac arrest. We present a WPW syndrome patient who had sudden cardiac arrest as the first presentation of the disease and treated it using extracorporeal life support with good neurologic outcome.

  19. Design and testing of a rotating, cooled device for extra-corporate treatment of liver cancer by BNCT in the epithermal neutron beam at the HFR Petten

    International Nuclear Information System (INIS)

    Moss, Ray; Nievaart, Sander; Pott, Lucien; Wittig, Andrea; Sauerwein, Wolfgang

    2006-01-01

    As part of the joint project on extra-corporal treatment of liver cancer by BNCT between JRC Petten and the University Hospital Essen, a facility has been designed and built to contain the liver during its irradiation treatment at the HFR Petten. The design consists of a rotating spheroid shaped PMMA holder, manufactured to open at the equator and closed by screwing together, surrounded by PMMA and graphite blocks. A validation exercise has been performed regarding both the nuclear conditions and the physical conditions. For the former, activation foil sets of Au, Cu and Mn, were irradiated at positions inside the liver holder filled with water, whilst a second measurement campaign has been performed using gel dosimetry. For the physical test, it is required to operate (rotate) the facility for up to 4 hours and to maintain the liver at approximately 4degC. The latter test was performed using 'cold gun sprays' that inject cold air near the liver holder. Both the nuclear and physical validation tests were performed successfully. (author)

  20. Comparison of the effectiveness of local corticosteroid injection and extracorporeal shock wave therapy in patients with lateral epicondylitis.

    Science.gov (United States)

    Beyazal, Münevver Serdaroğlu; Devrimsel, Gül

    2015-12-01

    [Purpose] This study aimed to determine and compare the effectiveness of extracorporeal shock wave therapy and local corticosteroid injection in patients with lateral epicondylitis. [Subjects and Methods] Sixty-four patients with lateral epicondylitis were randomly divided into extracorporeal shock wave therapy and steroid injection groups. Patients were evaluated using hand grip strength, visual analog scale, and short-form McGill pain questionnaire at baseline and at 4 and 12 weeks post-treatment. [Results] Both groups showed statistically significant increase in hand grip strength and decreases on the visual analog scale and short form McGill pain questionnaire overtime. There was no statistically significant difference in the percentage of improvement in hand grip strength and on the short-form McGill pain questionnaire between groups at 4 weeks post-treatment, whereas the extracorporeal shock wave therapy group showed better results on the visual analog scale. The percentages of improvements in all 3 parameters were higher in the extracorporeal shock wave therapy group than in the injection group at 12 weeks post-treatment. [Conclusion] Both the extracorporeal shock wave therapy and steroid injection were safe and effective in the treatment of lateral epicondylitis. However, extracorporeal shock wave therapy demonstrated better outcomes than steroid injection at the long-term follow-up.

  1. A novel approach to the management of critically ill neonatal Ebstein's anomaly: Veno-venous extracorporeal membrane oxygenation to promote right ventricular recovery.

    Science.gov (United States)

    Bauser-Heaton, Holly; Nguyen, Charles; Tacy, Theresa; Axelrod, David

    2015-01-01

    This is the first report of the use of veno-venous extracorporeal membrane oxygenation in a neonate with severe Ebstein's anomaly. The report suggests the use of veno-venous extracorporeal membrane oxygenation in the immediate neonatal period may be a useful therapy in severe Ebstein's anomaly. By providing adequate oxygenation independent of the patient's native pulmonary blood flow, veno-venous extracorporeal membrane oxygenation allows the pulmonary vascular resistance to decrease and may promote right ventricular recovery.

  2. Food irradiation

    International Nuclear Information System (INIS)

    Hetherington, M.

    1989-01-01

    This popular-level article emphasizes that the ultimate health effects of irradiated food products are unknown. They may include vitamin loss, contamination of food by botulism bacteria, mutations in bacteria, increased production of aflatoxins, changes in food, carcinogenesis from unknown causes, presence of miscellaneous harmful chemicals, and the lack of a way of for a consumer to detect irradiated food. It is claimed that the nuclear industry is applying pressure on the Canadian government to relax labeling requirements on packages of irradiated food in order to find a market for its otherwise unnecessary products

  3. Food irradiation

    International Nuclear Information System (INIS)

    Luecher, O.

    1979-01-01

    Limitations of existing preserving methods and possibilities of improved food preservation by application of nuclear energy are explained. The latest state-of-the-art in irradiation technology in individual countries is described and corresponding recommendations of FAO, WHO and IAEA specialists are presented. The Sulzer irradiation equipment for potato sprout blocking is described, the same equipment being suitable also for the treatment of onions, garlic, rice, maize and other cereals. Systems with a higher power degree are needed for fodder preserving irradiation. (author)

  4. Successful correction of tibial bone deformity through multiple surgical procedures, liquid nitrogen-pretreated bone tumor autograft, three-dimensional external fixation, and internal fixation in a patient with primary osteosarcoma: a case report.

    Science.gov (United States)

    Takeuchi, Akihiko; Yamamoto, Norio; Shirai, Toshiharu; Nishida, Hideji; Hayashi, Katsuhiro; Watanabe, Koji; Miwa, Shinji; Tsuchiya, Hiroyuki

    2015-12-07

    In a previous report, we described a method of reconstruction using tumor-bearing autograft treated by liquid nitrogen for malignant bone tumor. Here we present the first case of bone deformity correction following a tumor-bearing frozen autograft via three-dimensional computerized reconstruction after multiple surgeries. A 16-year-old female student presented with pain in the left lower leg and was diagnosed with a low-grade central tibial osteosarcoma. Surgical bone reconstruction was performed using a tumor-bearing frozen autograft. Bone union was achieved at 7 months after the first surgical procedure. However, local tumor recurrence and lung metastases occurred 2 years later, at which time a second surgical procedure was performed. Five years later, the patient developed a 19° varus deformity and underwent a third surgical procedure, during which an osteotomy was performed using the Taylor Spatial Frame three-dimensional external fixation technique. A fourth corrective surgical procedure was performed in which internal fixation was achieved with a locking plate. Two years later, and 10 years after the initial diagnosis of tibial osteosarcoma, the bone deformity was completely corrected, and the patient's limb function was good. We present the first report in which a bone deformity due to a primary osteosarcoma was corrected using a tumor-bearing frozen autograft, followed by multiple corrective surgical procedures that included osteotomy, three-dimensional external fixation, and internal fixation.

  5. Early Activation of Children Operated on under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    P. R. Dudov

    2008-01-01

    Full Text Available Objective: to study the safety and clinical and economic efficiency of early activation of children operated on under extracorporeal circulation (EC. Subjects and methods. Sixty-eight children aged 4—14 years (8.6±0.4 years operated on under EC for congenital heart diseases (CHD were examined. In accordance with the time of switching to spontaneous respiration and tracheal extubation, 2 groups were identified: 1 those who received postoperative artificial ventilation (AV for 2.9±0.2 hours (a study group; 2 those who had AV for 8.7±0.7 hours (a control group. Both groups did not differ in age, cardiac diseases, their severity, anthropometric characteristics, EC duration, aortic ligation time, and abnormality pattern. In the study group, anesthesia was maintained with fentanyl (5.3±0.1 ^g/kg/hr, diazepam (0.15±0.01 mg/kg/hr, and inhaled ftorotan or enflurane. Diazepam was discontinued in the postperfusion period. The control group received fentanyl (7.6±0.4 ^Bg/kg/hr, diazepam (0.3±0.02 mg/kg/hr, droperidol (0.4±0.04 mg/kg/hr, and/or sodium oxybutyrate (81±5 mg/kg/hr. Myoplegia was provided by pancuronium or pipecuronium that was continuously infused until EC was completed in Group 1 and intermittently injected until the end of surgery in Group 2. Results. There were no indications for tracheal reintubation in both groups of patients. The early postoperative period was uncomplicated in 97.2% of the children in the study group and in 28.1% in the control group (p<0.05. The incidence of pulmonary complications was 2.8 and 46.9%, respectively (p<0.05. In the children from Groups 1 and 2, the duration of a resuscita-tive period was 44.2±1.7 and 77.3±4.9 hours, respectively (p<0.05, and that of the whole postoperative period was 12.6±0.3 and 18.0±1.1 days (p<0.05. In the study group, the total final expenditures, including the cost of anesthesia and treatment for postoperative complications, decreased by 127.5% as compared to the control

  6. Food irradiation

    International Nuclear Information System (INIS)

    Paganini, M.C.

    1991-06-01

    Food treatment by means of ionizing energy, or irradiation, is an innovative method for its preservation. In order to treat important volumes of food, it is necessary to have industrial irradiation installations. The effect of radiations on food is analyzed in the present special work and a calculus scheme for an Irradiation Plant is proposed, discussing different aspects related to its project and design: ionizing radiation sources, adequate civil work, security and auxiliary systems to the installations, dosimetric methods and financing evaluation methods of the project. Finally, the conceptual design and calculus of an irradiation industrial plant of tubercles is made, based on the actual needs of a specific agricultural zone of our country. (Author) [es

  7. Food irradiation

    International Nuclear Information System (INIS)

    Anon.

    1984-01-01

    Food preservation by irradiation is one part of Eisenhower's Atoms for Peace program that is enjoying renewed interest. Classified as a food additive by the Food, Drug, and Cosmetic Act of 1958 instead of a processing technique, irradiation lost public acceptance. Experiments have not been done to prove that there are no health hazards from gamma radiation, but there are new pressures to get Food and Drug Administration approval for testing in order to make commercial use of some radioactive wastes. Irradiation causes chemical reactions and nutritional changes, including the destruction of several vitamins, as well as the production of radiolytic products not normally found in food that could have adverse effects. The author concludes that, lacking epidemiological evidence, willing buyers should be able to purchase irradiated food as long as it is properly labeled

  8. Fruit irradiation

    International Nuclear Information System (INIS)

    Anon.

    1977-01-01

    Food spoilage is a common problem when marketing agricultural products. Promising results have already been obtained on a number of food irradiating applications. A process is described in this paper where irradiation of sub-tropical fruits, especially mangoes and papayas, combined with conventional heat treatment results in effective insect and fungal control, delays ripening and greatly improves the quality of fruit at both export and internal markets

  9. Tissue irradiator

    International Nuclear Information System (INIS)

    Hungate, F.P.; Riemath, W.F.; Bunnell, L.R.

    1975-01-01

    A tissue irradiator is provided for the in-vivo irradiation of body tissue. The irradiator comprises a radiation source material contained and completely encapsulated within vitreous carbon. An embodiment for use as an in-vivo blood irradiator comprises a cylindrical body having an axial bore therethrough. A radioisotope is contained within a first portion of vitreous carbon cylindrically surrounding the axial bore, and a containment portion of vitreous carbon surrounds the radioisotope containing portion, the two portions of vitreous carbon being integrally formed as a single unit. Connecting means are provided at each end of the cylindrical body to permit connections to blood-carrying vessels and to provide for passage of blood through the bore. In a preferred embodiment, the radioisotope is thulium-170 which is present in the irradiator in the form of thulium oxide. A method of producing the preferred blood irradiator is also provided, whereby nonradioactive thulium-169 is dispersed within a polyfurfuryl alcohol resin which is carbonized and fired to form the integral vitreous carbon body and the device is activated by neutron bombardment of the thulium-169 to produce the beta-emitting thulium-170

  10. Blood irradiation

    International Nuclear Information System (INIS)

    Chandy, Mammen

    1998-01-01

    Viable lymphocytes are present in blood and cellular blood components used for transfusion. If the patient who receives a blood transfusion is immunocompetent these lymphocytes are destroyed immediately. However if the patient is immunodefficient or immunosuppressed the transfused lymphocytes survive, recognize the recipient as foreign and react producing a devastating and most often fatal syndrome of transfusion graft versus host disease [T-GVHD]. Even immunocompetent individuals can develop T-GVHD if the donor is a first degree relative since like the Trojan horse the transfused lymphocytes escape detection by the recipient's immune system, multiply and attack recipient tissues. T-GVHD can be prevented by irradiating the blood and different centers use doses ranging from 1.5 to 4.5 Gy. All transfusions where the donor is a first degree relative and transfusions to neonates, immunosuppressed patients and bone marrow transplant recipients need to be irradiated. Commercial irradiators specifically designed for irradiation of blood and cellular blood components are available: however they are expensive. India needs to have blood irradiation facilities available in all large tertiary institutions where immunosuppressed patients are treated. The Atomic Energy Commission of India needs to develop a blood irradiator which meets international standards for use in tertiary medical institutions in the country. (author)

  11. Food irradiation

    International Nuclear Information System (INIS)

    Migdal, W.

    1995-01-01

    A worldwide standard on food irradiation was adopted in 1983 by codex Alimentarius Commission of the Joint Food Standard Programme of the Food and Agriculture Organization (FAO) of the United Nations and The World Health Organization (WHO). As a result, 41 countries have approved the use of irradiation for treating one or more food items and the number is increasing. Generally, irradiation is used to: food loses, food spoilage, disinfestation, safety and hygiene. The number of countries which use irradiation for processing food for commercial purposes has been increasing steadily from 19 in 1987 to 33 today. In the frames of the national programme on the application of irradiation for food preservation and hygienization an experimental plant for electron beam processing has been established in Inst. of Nuclear Chemistry and Technology. The plant is equipped with a small research accelerator Pilot (19 MeV, 1 kW) and industrial unit Electronika (10 MeV, 10 kW). On the basis of the research there were performed at different scientific institutions in Poland, health authorities have issued permissions for irradiation for; spices, garlic, onions, mushrooms, potatoes, dry mushrooms and vegetables. (author)

  12. Food irradiation

    International Nuclear Information System (INIS)

    1991-01-01

    Processing of food with low levels of radiation has the potential to contribute to reducing both spoilage of food during storage - a particular problem in developing countries - and the high incidence of food-borne disease currently seen in all countries. Approval has been granted for the treatment of more than 30 products with radiation in over 30 countries but, in general, governments have been slow to authorize the use of this new technique. One reason for this slowness is a lack of understanding of what food irradiation entails. This book aims to increase understanding by providing information on the process of food irradiation in simple, non-technical language. It describes the effects that irradiation has on food, and the plant and equipment that are necessary to carry it out safely. The legislation and control mechanisms required to ensure the safety of food irradiation facilities are also discussed. Education is seen as the key to gaining the confidence of the consumers in the safety of irradiated food, and to promoting understanding of the benefits that irradiation can provide. (orig.) With 4 figs., 1 tab [de

  13. [Extracorporeal ventriculoatrial shunt with the use of one-way ball valve].

    Science.gov (United States)

    Kubo, Shigeki; Takimoto, Hiroshi; Hosoi, Kazuki; Toyota, Shingo; Takakura, Shuji; Hayashi, Yasuhiro; Ueno, Masato; Morisako, Toshitaka; Karasawa, Jun; Ninaga, Hideo; Yoshimine, Toshiki

    2002-04-01

    We developed a simple system of an "extracorporeal" ventriculoatrial (VA) shunt using a one-way ball valve (Acty valve II, Kaneka Medix) to release the patient from postoperative constraint during the ventricular drainage. The system is constructed in such a way that the ventricular drainage tube is connected to the central venous catheter via a one-way valve. The CSF is regulated by using the valve and is diverted into the systemic circulation as in the conventional ventriculoatrial shunt. After 2 or 3 weeks of CSF diversion through the extracorporeal VA shunt, a ventriculoperitoneal shunt is placed if hydrocephalus is apparent by temporary occlusion of the system. We applied this system to 4 patients with hydrocephalus, and we found it useful and free from adverse effects. The patient was freed from physical constraint involved in conventional ventricular drainage and an effective program of early rehabilitation was able to be started.

  14. Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation

    Directory of Open Access Journals (Sweden)

    Amine Tarmiz

    2017-01-01

    Full Text Available Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient’s hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.

  15. Normothermic extracorporeal perfusion of isolated porcine liver after warm ischaemia: a preliminary report.

    Science.gov (United States)

    Bellomo, Rinaldo; Suzuki, Satoshi; Marino, Bruno; Starkey, Graeme K; Chambers, Brenton; Fink, Michael A; Wang, Bao Zhong; Houston, Shane; Eastwood, Glenn; Calzavacca, Paolo; Glassford, Neil; Skene, Alison; Jones, Daryl A; Jones, Robert

    2012-09-01

    Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors. However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers. We conducted proof-of-concept experiments using a DCD model in the pig to assess the short-term (4 hours) feasibility and functional efficacy of NELP. Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation. Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.

  16. Role of Epinephrine and Extracorporeal Membrane Oxygenation in the Management of Ischemic Refractory Ventricular Fibrillation

    Directory of Open Access Journals (Sweden)

    Jason A. Bartos, MD, PhD

    2017-06-01

    Full Text Available Summary: Extracorporeal membrane oxygenation (ECMO is used in cardiopulmonary resuscitation (CPR of refractory cardiac arrest. The authors used a 2 × 2 study design to compare ECMO versus CPR and epinephrine versus placebo in a porcine model of ischemic refractory ventricular fibrillation (VF. Pigs underwent 5 min of untreated VF and 10 min of CPR, and were randomized to receive epinephrine versus placebo for another 35 min. Animals were further randomized to left anterior descending artery (LAD reperfusion at minute 45 with ongoing CPR versus venoarterial ECMO cannulation at minute 45 of CPR and subsequent LAD reperfusion. Four-hour survival was improved with ECMO whereas epinephrine showed no effect. Key Words: advanced cardiopulmonary life support, cardiac arrest, cardiopulmonary resuscitation, ECMO, extracorporeal membrane oxygenation, ischemic refractory ventricular fibrillation, ST-segment elevation myocardial infarction, ventricular fibrillation

  17. Growing experience with extracorporeal membrane oxygenation as a bridge to lung transplantation.

    Science.gov (United States)

    Shafii, Alexis E; Mason, David P; Brown, Chase R; Vakil, Nakul; Johnston, Douglas R; McCurry, Kenneth R; Pettersson, Gosta B; Murthy, Sudish C

    2012-01-01

    Extracorporeal membrane oxygenation (ECMO) is rarely used as a bridge to lung transplantation (BTT) because of its associated morbidity and mortality. However, recent advancements in perfusion technology and critical care have revived interest in this application of ECMO. We retrospectively reviewed our utilization of ECMO as BTT and evaluated our early and midterm results. Nineteen patients were placed on ECMO with the intent to transplant of which 14 (74%) were successfully transplanted. Early and midterm survival of transplanted patients was 75% (1 year) and 63% (3 years), respectively, with the most favorable results observed in interstitial lung disease patients supported in the venovenous configuration. Extracorporeal membrane oxygenation-bridged transplant survival rates were equivalent to nonbridged recipients, but early morbidity and mortality are high and the failure to bridge to transplant is significant. Overall, successfully bridged patients can derive a tangible benefit, albeit with considerable consumption of resources.

  18. Extracorporeal Circulation Causes Release of Neutrophil Gelatinase-Associated Lipocalin (NGAL

    Directory of Open Access Journals (Sweden)

    Per Jönsson

    1999-01-01

    Full Text Available Extracorporeal circulation (ECC used during cardiac surgery causes activation of several inflammatory systems. These events are not fully understood but are responsible for complications during the immediate postoperative period. Neutrophil gelatinase-associated lipocalin (NGAL, a member of the expanding lipocalin family, has recently been described as an inflammatory protein. In this study, the release of NGAL into the circulation in 41 patients undergoing heart surgery with ECC was evaluated. A 4- to 5-fold elevation of the concentration of NGAL in plasma was observed during the immediate postoperative course with a rapid elimination during the first postoperative day. Four patients undergoing lung surgery (without ECC were also studied. The plasma concentration of NGAL only increased with a factor of 1.1-2.2 over the operation. We conclude that NGAL is released into the circulation during heart surgery, probably as a result of the inflammatory activation of leukocytes initiated by the extracorporeal circulation.

  19. Effects of extracorporeal shock wave lithotripsy on the kidney and perinephric tissues: CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Song, Kounn Sik; Kim, Kun Sang; Kim, Sae Chul [College of Medicine, Chung-Ang University, Seoul (Korea, Republic of)

    1987-12-15

    Since the first successful treatment of the patient with renal stone by extracorporeal shock wave lithotripsy at the Institute for Surgical Research, West Germany, on February 7, 1980, extracorporeal shock wave lithotripsy (ESWL) has been a non-invasive technique for the treatment of the renal and ureteral calculi. In spite of the fact that the acoustic energy of the focused shock waves must pass through the soft tissues of back, perinephric tissues and renal parenchyme before reaching calculi, little is known about the effects of ESWL in the renal parenchyme and perinephric soft tissues. So we analyzed a pre and post-ESWL computed tomography scans of the kidneys in 130 patients treated at our hospital during a three month period to evaluate the effects of ESWL on the kidney and perinephric soft tissues.

  20. The efficacy of extracorporeal shock wave lithotripsy on single dense calcified gallstones according to computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Takao (Mie Univ., Tsu (Japan). School of Medicine); Shimono, Kazuko; Moriyama, Shigeru; Masuda, Touru; Ikeda, Tetsuya; Umegae, Satoru; Nagata, Norikazu

    1993-05-01

    The efficacy and complications of extracorporeal shock wave lithotripsy (ESWL) for single gallstones were compared between 15 patients with a CT-lucent stone and 18 patients with a dense calcified stone. In all of five patients with a stone smaller than 10 mm in diameter, complete or sufficient clearance was observed, regardless of calcification. However, in 28 patients with a stone larger than 11 mm in diameter, the rates of complete or sufficient clearance were lower in those with a dense calcified stone (64%) than in those with a computed tomography (CT) lucent stone (93%). There was no difference in the rate of complications between patients with a CT-lucent stone and those with a dense calcified stone. These results thus suggest that extracorporeal shock wave lithotripsy may be safely employed for patients with a single calcified gallstone. (author).

  1. Effects of extracorporeal shock wave lithotripsy on the kidney and perinephric tissues: CT evaluation

    International Nuclear Information System (INIS)

    Song, Kounn Sik; Kim, Kun Sang; Kim, Sae Chul

    1987-01-01

    Since the first successful treatment of the patient with renal stone by extracorporeal shock wave lithotripsy at the Institute for Surgical Research, West Germany, on February 7, 1980, extracorporeal shock wave lithotripsy (ESWL) has been a non-invasive technique for the treatment of the renal and ureteral calculi. In spite of the fact that the acoustic energy of the focused shock waves must pass through the soft tissues of back, perinephric tissues and renal parenchyme before reaching calculi, little is known about the effects of ESWL in the renal parenchyme and perinephric soft tissues. So we analyzed a pre and post-ESWL computed tomography scans of the kidneys in 130 patients treated at our hospital during a three month period to evaluate the effects of ESWL on the kidney and perinephric soft tissues

  2. Endoscopic Resection of Tracheal Tumor in an Elderly Woman Under Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Yi-Ying Chiang

    2011-03-01

    Full Text Available Anesthetic management of patients with difficult airway is challenging, especially in patients who present with near total occlusion of the airway. Tracheal tumors occur more frequently in elderly patients who are more prone to hypoxic injury. Reliable ventilation and oxygenation are mandatory for a safe and sound intervention. Herein, we report on a 71-year-old woman with a large tracheal tumor occluding approximately 90% of the tracheal lumen. Extracorporeal membrane oxygenation under local anesthesia was used during electrocautery resection of the tumor because of the possibility of fatal airway collapse due to the degree of occlusion and location of the tumor. After the tumor had been successfully resected by means of bronchoscopy, an endotracheal tube was inserted, and the patient was weaned from extracorporeal membrane oxygenation.

  3. Current Applications for the Use of Extracorporeal Carbon Dioxide Removal in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Luigi Camporota

    2016-01-01

    Full Text Available Mechanical ventilation in patients with respiratory failure has been associated with secondary lung injury, termed ventilator-induced lung injury. Extracorporeal venovenous carbon dioxide removal (ECCO2R appears to be a feasible means to facilitate more protective mechanical ventilation or potentially avoid mechanical ventilation in select patient groups. With this expanding role of ECCO2R, we aim to describe the technology and the main indications of ECCO2R.

  4. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature

    OpenAIRE

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    2009-01-01

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment; and to identify topics for further research. Methods: A computerised search of the Medline and Embase databases was conducted on 1 August 2007, to identify studies dealing with the effectiveness of...

  5. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures

    Directory of Open Access Journals (Sweden)

    Rajasekhar Gali

    2016-01-01

    Full Text Available Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a the ease of access for retrieval, reimplantation and fixation of the proximal segment; b the postoperative approach related complications; c the adequacy of anatomical reduction and stability of fixation; d the occlusal changes; and the e TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby

  6. In Vivo Testing of Extracorporeal Membrane Ventilators: iLA-Activve Versus Prototype I-Lung.

    Science.gov (United States)

    Kischkel, Sabine; Bergt, Stefan; Brock, Beate; von Grönheim, Johan; Herbst, Anne; Epping, Marc-Jonas; Matheis, Georg; Novosel, Esther; Schneider, Joerg; Warnke, Philipp; Podbielski, Andreas; Roesner, Jan P; Lelkes, Peter I; Vollmar, Brigitte

    A side-by-side comparison of the decarboxylation efficacy of two pump-driven venovenous extracorporeal lung assist devices, i.e., a first prototype of the new miniaturized ambulatory extracorporeal membrane ventilator, I-lung versus the commercial system iLA-activve for more than a period of 72 hours in a large animal model. Fifteen German Landrace pigs were anesthetized and underwent mechanical hypoventilation to induce severe hypercapnia. Decarboxylation was accomplished by either the I-lung or the iLA-activve via a double lumen catheter in the jugular vein. Sham-operated pigs were not connected to extracorporeal devices. Cardiovascular, respiratory, and metabolic parameters were continuously monitored, combined with periodic arterial blood sampling for subsequent clinical blood diagnostics, such as gas exchange, hemolysis, coagulation parameters, and cytokine profiles. At the termination of the studies, lung tissue was harvested and examined histologically for pulmonary morphology and leukocyte tissue infiltration. Both extracorporeal devices showed high and comparable efficacy with respect to carbon dioxide elimination for more than 72 hours and were not associated with either bleeding events or clotting disorders. Pigs of both groups showed cardiovascular and hemodynamic stability without marked differences to sham-operated animals. Groups also did not differ in terms of inflammatory and metabolic parameters. We established a preclinical in vivo porcine model for comparative long-term testing of I-lung and iLA-activve. The I-lung prototype proved to be safe and feasible, providing adequate decarboxylation without any adverse events. Once translated into the clinical treatment, the new miniaturized and transportable I-lung device might represent a promising tool for treating awake and mobilized patients with decompensated pulmonary disorders.

  7. Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures.

    Science.gov (United States)

    Gali, Rajasekhar; Devireddy, Sathya Kumar; Venkata, Kishore Kumar Rayadurgam; Kanubaddy, Sridhar Reddy; Nemaly, Chaithanyaa; Dasari, Mallikarjuna

    2016-01-01

    Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial

  8. Extracorporeal gas exchange with the DeltaStream rotary blood pump in experimental lung injury.

    Science.gov (United States)

    Dembinski, Rolf; Kopp, Rüdger; Henzler, Dietrich; Hochhausen, Nadine; Oslender, Nicole; Max, Martin; Rossaint, Rolf; Kuhlen, Ralf

    2003-06-01

    In most severe cases of the acute respiratory distress syndrome, veno-venous extracorporeal membrane oxygenation (ECMO) can be used to facilitate gas exchange. However, the clinical use is limited due to the size and the concomitant risk of severe adverse events of conventionally-used centrifugal blood pumps with high extracorporeal blood volumes. The DeltaStream blood pump is a small-sized rotary blood pump that may reduce extracorporeal blood volume, foreign surfaces, contact activation of the coagulation system, and blood trauma. The aim of the present study was to test the safety and efficacy of the DeltaStream pump for ECMO in animals with normal lung function and experimental acute lung injury (ALI). Therefore, veno-venous ECMO was performed for 6 hours in mechanically ventilated pigs with normal lung function (n=6) and with ALI induced by repeated lung lavage (n=6) with a blood flow of 30% of the cardiac output. Gas flow with a FiO2 of 1.0 was set to equal blood flow. With a mean activated clotting time of 121 +/- 22 s, no circulatory impairment or thrombus formation was revealed during ECMO. Furthermore, free plasma Hb did not increase. In controls, hemodynamics and gas exchange remained unchanged. In animals with ALI, hemodynamics remained stable and gas transfer across the extracorporeal oxygenators was optimal, but only in 2 animals was a marked increase in PaO2 observed. CO2 removal was efficacious in all animals. We concluded that the DeltaStream blood pump may be used for veno-venous ECMO without major blood damage or hemodynamic impairment.

  9. Left Atrial Decompression by Percutaneous Left Atrial Venting Cannula Insertion during Venoarterial Extracorporeal Membrane Oxygenation Support

    Directory of Open Access Journals (Sweden)

    Ha Eun Kim

    2016-06-01

    Full Text Available Patients with venoarterial extracorporeal membrane oxygenation (ECMO frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.

  10. Development of an Accident Reproduction Simulator System Using a Hemodialysis Extracorporeal Circulation System

    OpenAIRE

    Nishite, Yoshiaki; Takesawa, Shingo

    2016-01-01

    Background Accidents that occur during dialysis treatment are notified to the medical staff via alarms raised by the dialysis apparatus. Similar to such real accidents, apparatus activation or accidents can be reproduced by simulating a treatment situation. An alarm that corresponds to such accidents can be utilized in the simulation model. Objectives The aim of this study was to create an extracorporeal circulation system (herein...

  11. Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management.

    Science.gov (United States)

    Labanaris, Apostolos P; Kühn, Reinhard; Schott, Günter E; Zugor, Vahudin

    2007-09-17

    Extracorporeal shock wave lithotripsy (ESWL) is nowadays accepted as the treatment of choice for the majority of patients with renal or proximal ureteral calculi. Although, a relatively noninvasive modality with low morbidity, minor or major complications can be noted. A relative severe complication for the patient and confusing for the treating physician is the perirenal hematoma. With review the literature and an example of perirenal hematoma induced by ESWL in a patient treated in our department, we describe its therapeutic management.

  12. Measurements of Pressure of Extracorporeal Shock Wave Lithotripter Using Pressure-Sensitive Papers

    Science.gov (United States)

    Inose, Naoto; Ide, Masao

    1993-05-01

    This paper describes measurements of pressures at the focal region of the extracorporeal shock wave lithotripter (ESWL) using pressure-sensitive papers. At the focal region of ESWL, ordinary hydrophones are quickly damaged, because of very high pressures. Recently, measurements of pressure at the focal region of ESWL using pressure-sensitive paper have been advised. Therefore, we have studied the effectiveness of pressure-sensitive papers in the measurement of high acoustic pressures at the focal region of ESWL.

  13. Roller and Centrifugal Pumps: A Retrospective Comparison of Bleeding Complications in Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Halaweish, Ihab; Cole, Adam; Cooley, Elaine; Lynch, William R; Haft, Jonathan W

    2015-01-01

    Centrifugal pumps are increasingly used for extracorporeal membrane oxygenation (ECMO) rather than roller pumps. However, shear forces induced by these types of continuousflow pumps are associated with acquired von Willebrand factor deficiency and bleeding complications. This study was undertaken to compare adverse bleeding complications with the use of centrifugal and roller pumps in patients on prolonged ECMO support. The records of all adult ECMO patients from June 2002 to 2013 were retrospectively reviewed using the University of Michigan Health System database and the Extracorporeal Life Support Organization registry, focusing on patients supported for at least 5 days. Ninety-five ECMO patients met criteria for inclusion (48 roller vs. 47 centrifugal pump). Indications included pulmonary (79%), cardiac (15%), and extracorporeal cardiopulmonary resuscitation (6%), without significant difference between the two groups. Despite lower heparin anticoagulation (10.9 vs. 13.7 IU/kg/hr) with centrifugal pumps, there was a higher incidence of nonsurgical bleeding (gastrointestinal, pulmonary, and neurological) in centrifugal pump patients (26.1 vs. 9.0 events/1,000 patient-days, p = 0.024). In conclusion, in our historical comparison, despite reduced anticoagulation, ECMO support using centrifugal pumps was associated with a higher incidence of nonsurgical bleeding. The mechanisms behind this are multifactorial and require further investigation.

  14. Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

    Science.gov (United States)

    Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

    2007-07-01

    Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

  15. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    Science.gov (United States)

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  16. Mechanisms of lymphocytotoxicity induced by extracorporeal photochemotherapy for cutaneous T cell lymphoma

    International Nuclear Information System (INIS)

    Marks, D.I.; Rockman, S.P.; Oziemski, M.A.; Fox, R.M.

    1990-01-01

    Extracorporeal photochemotherapy is an effective treatment for cutaneous T cell lymphoma but its mode of action is uncertain. The reduction in viability of patients' photoirradiated buffy coat lymphocytes was correlated with a 35% increase in DNA single-strand breaks and marked decreases in cellular ATP and NAD levels (to 58 and 34% of control, respectively) immediately after photoirradiation. Complementary in vitro studies were conducted with normal human peripheral blood lymphocytes using a Therakos ultraviolet A (UVA) light box. UVA light was cytotoxic on its own but was potentiated by 8-methoxysporalen. 3-aminobenzamide, a poly (ADP-ribose) synthetase inhibitor, mitigated the cytotoxic effect of ultraviolet A light in the presence of 8-methoxypsoralen in lymphocytes and reduced the amount of nucleotide depletion they caused. 10 J/cm2 of UVA light in the presence of 300 ng/ml 8-methoxypsoralen increased the poly (ADP-ribose) synthetase activity of peripheral blood lymphocytes. Exposing lymphocytes to deoxycoformycin and deoxyadenosine was found to induce biochemical and physical effects similar to those of photochemotherapy. In summary, we have shown that the lymphocytotoxic effect of extracorporeal photochemotherapy for cutaneous T cell lymphoma is apparently mediated by DNA damage, subsequent poly (ADP-ribosyl)ation and adenine nucleotide depletion. It is not known how the DNA damage and resultant biochemical effects relate to the possible immunological mechanism of extracorporeal photochemotherapy; however, it is possible that its effects can be mimicked by other DNA-damaging agents

  17. Hemodynamic deterioration during extracorporeal membrane oxygenation weaning in a patient with a total artificial heart.

    Science.gov (United States)

    Hosseinian, Leila; Levin, Matthew A; Fischer, Gregory W; Anyanwu, Anelechi C; Torregrossa, Gianluca; Evans, Adam S

    2015-01-01

    The Total Artificial Heart (Syncardia, Tucson, AZ) is approved for use as a bridge-to-transplant or destination therapy in patients who have irreversible end-stage biventricular heart failure. We present a unique case, in which the inferior vena cava compression by a total artificial heart was initially masked for days by the concurrent placement of an extracorporeal membrane oxygenation cannula. This is the case of a 33-year-old man admitted to our institution with recurrent episodes of ventricular tachycardia requiring emergent total artificial heart and venovenous extracorporeal membrane oxygenation placement. This interesting scenario highlights the importance for critical care physicians to have an understanding of exact anatomical localization of a total artificial heart, extracorporeal membrane oxygenation, and their potential interactions. In total artificial heart patients with hemodynamic compromise or reduced device filling, consideration should always be given to venous inflow compression, particularly in those with smaller body surface area. Transesophageal echocardiogram is a readily available diagnostic tool that must be considered standard of care, not only in the operating room but also in the ICU, when dealing with this complex subpopulation of cardiac patients.

  18. Delayed Tibial Osteomyelitis after Anterior Cruciate Ligament Reconstruction with Hamstrings Autograft and Bioabsorbable Interference Screw: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Kevin S. Weiss

    2017-01-01

    Full Text Available Osteomyelitis following arthroscopically assisted anterior cruciate ligament (ACL reconstruction has rarely been reported in the literature. We report a case of a 20-year-old female who had delayed tibial osteomyelitis and a pretibial cyst with culture-positive, oxacillin sensitive Staphylococcus epidermidis 15 months after an ACL reconstruction with hamstring autograft. Soft tissue fixation within the tibial tunnel was with a poly-L-D-lactic acid (PLDLA bioabsorbable interference screw. The patient underwent surgical treatment with curettage, debridement, hardware removal, and bone grafting of the tibial tunnel followed by a course of intravenous antibiotics. Arthroscopic evaluation demonstrated an intact ACL graft without any evidence of intra-articular infection. The patient returned to collegiate athletics without any complications. While the most common biologic complications include pretibial cysts, granuloma formation, tunnel widening, and inflammatory reactions, infection is exceedingly rare. Late infection and osteomyelitis are also rare but can occur and should be considered in the differential diagnosis.

  19. A protocol of rehabilitation after ACL reconstruction using a hamstring autograft in the first month after surgery--a preliminary report.

    Science.gov (United States)

    Biernat, Ryszard; Wołosewicz, Mariusz; Tomaszewski, Wiesław

    2007-01-01

    The purpose of this paper is to present a protocol of rehabilitation after ACL reconstruction using a hamstring autograft in the first month after surgery. The program enables the patient to return early to everyday activities (school, sedentary work) without crutches or a stabilizer. The program has been developed in accordance with rehabilitation protocols employed at Karolinska Institute in Sweden and Prof. Shelbourne's Clinic in the USA. The study group included 31 patients (18 men and 13 women). Patients rehabilitated in the Department according to our program achieved stable gait patterns and were able to step up and down within four to seven weeks. Early patient mobilization after ACL reconstruction is possible and does not cause any negative effects provided that the patient, doctor and physiotherapist cooperate very closely.

  20. Flow cytometric detection of growth factor receptors in autografts and analysis of growth factor concentrations in autologous stem cell transplantation: possible significance for platelet recovery

    DEFF Research Database (Denmark)

    Schiødt, I; Jensen, Charlotte Harken; Kjaersgaard, E

    2000-01-01

    In order to improve prediction of hematopoietic recovery, we conducted a pilot study, analyzing the significance of growth factor receptor expression in autografts as well as endogenous growth factor levels in blood before, during and after stem cell transplantation. Three early acting (stem cell......-CSF receptor positive, CD34+ progenitor cells were measured by flow cytometry in the leukapheresis product used for transplantation in a subgroup of 15 patients (NHL, n = 8, MM, n = 7). Three factors were identified as having a significant impact on platelet recovery. First, the level of Tpo in blood...... at the time of the nadir (day +7). Second, the percentage of re-infused thrombopoietin receptor positive progenitors and finally, the percentage of Flt3 receptor positive progenitors. On the other hand, none of the analyzed factors significantly predicted myeloid or erythroid recovery. These findings need...

  1. Injury to the Infrapatellar Branch of the Saphenous Nerve during ACL Reconstruction with Hamstring Tendon Autograft: A Comparison between Oblique and Vertical Incisions

    Directory of Open Access Journals (Sweden)

    Hamid Mousavi

    2018-01-01

    Full Text Available Background: Injury to the infrapatellar branch of the saphenous nerve (IPBSN is common after arthroscopic ACLreconstruction with hamstring tendon autograft, as reported in up to 88% of the cases. Due to close relationshipbetween the IPBSN with pes anserine tendons insertion skin incision may sever IPBSN while harvesting gracillis andsemitendinous tendons. As the IPBSN course at the anterior of knee is oblique, we hypothesized a parallel skin incisionwith nerve passage may decrease nerve injury.Methods: Vertical and oblique incisions were compared in 79 patients in this clinical trial. The sensory loss area andpatients’ complain of numbness were measured at 2 and 8 weeks as well as 6 months after surgery.Results: Both the sensory loss area and patients’ complain of numbness decreased significantly in the oblique incisiongroup (P

  2. Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma : clinical communication

    Directory of Open Access Journals (Sweden)

    G.S. Irvine-Smith

    2006-06-01

    Full Text Available Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.

  3. Application of the cultured epidermal autograft "JACE(®") for treatment of severe burns: Results of a 6-year multicenter surveillance in Japan.

    Science.gov (United States)

    Matsumura, Hajime; Matsushima, Asako; Ueyama, Masashi; Kumagai, Norio

    2016-06-01

    In the 1970s, Green et al. developed a method that involved culturing keratinocyte sheets and used for treatment of burns. Since then, the take rate of cultured epidermal autograft (CEA) onto fascia, granulation tissue, or allografts has been extensively reported, while that on an artificial dermis in a large case series is not. Moreover, the contribution of CEA to patient survival has not been analyzed in a multicenter study. We conducted a 6-year multicenter surveillance on the application of the CEA "JACE(®") for treatment of burns >30% total body surface area (TBSA) across 118 Japanese hospitals. This surveillance included 216 patients and 718 graft sites for efficacy analysis. The CEA take rate at 4 weeks after grafting was evaluated, and safety was monitored until 52 weeks. In addition, the survival curve obtained in this study and the data obtained from the Tokyo Burn Unit Association (TBUA) were compared. The mean CEA take rates at week 4 were 66% (sites) and 68% (patients), and the rate on the artificial dermis was 65% for 226 sites. CEA application combined with wide split-thickness auto or patch autograft increased the CEA take rate. On comparison with the data obtained from the TBUA, which included data on individuals with burns of the same severity, CEA application was found to contribute to patient survival until 7 weeks after burn. We reported the take rate of CEA based on a 6-year multicenter surveillance. From our results, we found that the application of CEA is a useful treatment for the patients with extensive burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  4. Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data.

    Science.gov (United States)

    O'Brien, Ciaran; Monteagudo, Julie; Schad, Christine; Cheung, Eva; Middlesworth, William

    2017-06-01

    It is currently unclear whether centrifugal pumps cause more hemolysis than roller pumps in extracorporeal membrane oxygenation (ECMO) circuits. The aim of this study was to help answer that question in pediatric patients. A limited deidentified data set was extracted from the international multicenter Extracorporeal Life Support Organization (ELSO) registry comprising all reported ECMO runs for patients 18years or younger between 2010 and 2015. Logistic regression was used to evaluate a possible association between hemolysis and pump type, controlling for patient demographics, circuit factors, and complications. 14,776 ECMO runs for 14,026 patients had pump type recorded. Centrifugal pumps were employed in 60.4% of ECMO circuits. Hemolysis was a reported complication for 1272 (14%) centrifugal pump runs and for 291 (5%) roller pump runs. 1755 (20%) centrifugal pump runs reported kidney injury as compared to 797 (14%) roller pump runs. In the full logistic regression, the odds of hemolysis were significantly greater for runs using centrifugal pumps (OR 3.3, 95% CI 2.9-3.8, ppumps was associated with increased rates of hemolysis, hyperbilirubinemia, and kidney injury. Retrospective cohort study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Irradiation device

    International Nuclear Information System (INIS)

    Suzuki, Toshimitsu.

    1989-01-01

    In an irradiation device for irradiating radiation rays such as electron beams to pharmaceuticals, etc., since the distribution of scanned electron rays was not monitored, the electron beam intensity could be determined only indirectly and irradiation reliability was not satisfactory. In view of the above, a plurality of monitor wires emitting secondary electrons are disposed in the scanning direction near a beam take-out window of a scanning duct, signals from the monitor wires are inputted into a display device such as a cathode ray tube, as well as signals from the monitor wires at the central portion are inputted into counting rate meters to measure the radiation dose as well. Since secondary electrons are emitted when electron beams pass through the monitor wires and the intensity thereof is in proportion with the intensity of incident electron beams, the distribution of the radiation dose can be monitored by measuring the intensity of the emitted secondary electrons. Further, uneven irradiation, etc. can also be monitored to make the radiation of irradiation rays reliable. (N.H.)

  6. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009 - a Randomized Trial

    Directory of Open Access Journals (Sweden)

    Joest Beatrice

    2010-10-01

    Full Text Available Abstract Background Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. Methods/Design Study design: Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. Analysis: Intention-to-treat. Outcome parameters: a Photonumeric severity scale, b Nürnberger Score, c circumference measurements, d capillary blood flow, e tissue oxygen saturation, f postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal strength exercise training. Control group: Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks at both gluteal and thigh regions plus a specific gluteal

  7. Food irradiation

    International Nuclear Information System (INIS)

    Beishon, J.

    1991-01-01

    Food irradiation has been the subject of concern and controversy for many years. The advantages of food irradiation include the reduction or elimination of dangerous bacterial organisms, the control of pests and insects which destroy certain foods, the extension of the shelf-life of many products, for example fruit, and its ability to treat products such as seafood which may be eaten raw. It can also replace existing methods of treatment which are believed to have hazardous side-effects. However, after examining the evidence produced by the proponents of food irradiation, the author questions whether it has any major contribution to make to the problems of foodborne diseases or world food shortages. More acceptable solutions, he suggests, may be found in educating food handlers to ensure that hygienic conditions prevail in the production, storage and serving of food. (author)

  8. Vinca irradiator

    International Nuclear Information System (INIS)

    Eymery, R.

    1976-10-01

    The development programme of the VINCA radiosterilisation centre involves plans for an irradiator capable of working in several ways. Discontinuous operation. The irradiator is loaded for a certain period then runs automatically until the moment of unloading. This method is suitable as long as the treatment capacity is relatively small. Continuous operation with permanent batch loading and unloading carried out either manually or automatically (by means of equipment to be installed later). Otherwise the design of the apparatus is highly conventional. The source is a vertical panel submersible in a pool. The conveyor is of the 'bucket' type, with 4 tiers to each bucket. The batches pass successively through all possible irradiation positions. Transfert into and out of the cell take place through a maze, which also provides access to the cell when the sources are in storage at the bottom of the pool [fr

  9. Irradiance gradients

    International Nuclear Information System (INIS)

    Ward, G.J.; Heckbert, P.S.; Technische Hogeschool Delft

    1992-04-01

    A new method for improving the accuracy of a diffuse interreflection calculation is introduced in a ray tracing context. The information from a hemispherical sampling of the luminous environment is interpreted in a new way to predict the change in irradiance as a function of position and surface orientation. The additional computation involved is modest and the benefit is substantial. An improved interpolation of irradiance resulting from the gradient calculation produces smoother, more accurate renderings. This result is achieved through better utilization of ray samples rather than additional samples or alternate sampling strategies. Thus, the technique is applicable to a variety of global illumination algorithms that use hemicubes or Monte Carlo sampling techniques

  10. Long-term retrospective study on the placement of the cementless acetabular cup and clinical outcomes in patients undergoing femoral head autografting for hip dysplasia and total hip arthroplasty.

    Science.gov (United States)

    Ozden, Vahit Emre; Dikmen, Goksel; Beksac, Burak; Tozun, Ismail Remzi

    2018-05-01

    Placement of acetabular cup in the dysplastic hip is a challenging procedure. Using bulk femoral head autograft to increase the bony coverage of the cup is one of the techniques, which have been described. The impact of cup position on cup and autograft survival is a controversial issue. We aimed to determine whether the position of cementless acetabular cup used in conjunction with femoral head autograft in dysplastic hips affected the autograft-host incorporation with its final radiographic appearance and the cup survivorship into the second decade. Thirty-eight dysplastic hips with varying Crowe types in 31 patients (30 women and one man) were included. The mean age was 47 years (range, 29-64 years) and the mean follow-up was 20.3 years (range, 14.8-25.9 years). The initial postoperative and final radiographs were evaluated. The survival rate of the cups was analysed using Kaplan-Meier statistics and the log-rank test. Multivariate analysis was used to evaluate the effect of variables (Crowe type, radiographic initial host bone coverage over the cup and position of the cup) on survivorship. The acetabular cups were positioned anatomical in 27/38 hips according to Ranawat measurement technique. Trabecular bridging at graft-host interface was seen in all cases at an average 22.1 months. Neither acetabular cup position nor initial host bone coverage over acetabular cup less than 50% had any significant effect on either cup survival or final radiographic appearance of the graft. The 20-year cup survival rate without aseptic revision was 66% (95 CI, 52%-84%). No revision was performed due to graft resorption. Twenty-year survival rate of the cementless cup combination with femoral head autograft showed no significant differences whether it was placed at high or anatomic hip centre. The final radiographic appearance of the autograft was not affected from either the cup location or the initial radiographic horizontal host bone coverage. Copyright © 2018 The Japanese

  11. ion irradiation

    Indian Academy of Sciences (India)

    Swift heavy ions interact predominantly through inelastic scattering while traversing any polymer medium and produce excited/ionized atoms. Here samples of the polycarbonate Makrofol of approximate thickness 20 m, spin coated on GaAs substrate were irradiated with 50 MeV Li ion (+3 charge state). Build-in ...

  12. Fish irradiation

    International Nuclear Information System (INIS)

    Kovacs, J.; Tengumnuay, C.; Juangbhanich, C.

    1970-01-01

    Chub-mackerel was chosen for the study because they are the most common fish in Thailand. Preliminary investigations were conducted to determine the maximum radiation dose of gamma-rays by organoleptic tests. The samples were subjected to radiation at various doses up to 4 Mrad. Many experiments were conducted using other kinds of fish. The results showed that 1 Mrad would be the maximum acceptable dose for fish. Later, the influence of the radiation dose from 0.1-1 Mrad was studied in order to find the optimum acceptable dose for preservation of fish without off-flavour. For this purpose, the Hedonic scale was used. It was found that 0.2 and 0.5 Mrad gave the best result on Chub mackerel. The determinations of optimum dose, organoleptic, microbiological and trimethylamine content changes were done. The results showed that Chub mackerel irradiated at 0.2, 0.5 and 1 Mrad stored at 3 0 C for 71 days were still acceptable, on the contrary the untreated samples were found unacceptable at 14 days. The trimethylamine increment was significantly higher in the untreated samples. At 15 days storage, trimethylamine in the non-irradiated Chub-mackerel was about 10 times higher than the irradiated ones. At 51 and 79 days storage, about 13 times higher in the control samples than the irradiated samples except 0.1 Mrad. Only 2 times higher was found for the 0.1 Mrad. The microbiological results showed that the irradiation above 0.2 Mrad gave favorable extension of shelf-life of fish

  13. Chapter 2: Irradiators

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2018-04-01

    The chapter 2 presents the subjects: 1) gamma irradiators which includes: Category-I gamma irradiators (self-contained); Category-II gamma irradiators (panoramic and dry storage); Category-III gamma irradiators (self-contained in water); Category-IV gamma irradiators (panoramic and wet storage); source rack for Category-IV gamma irradiators; product transport system for Category-IV gamma irradiators; radiation shield for gamma irradiators; 2) accelerators which includes: Category-I Accelerators (shielded irradiator); Category-II Accelerators (irradiator inside a shielded room); Irradiation application examples.

  14. Lung contusion and cavitation with exudative plural effusion following extracorporeal shock wave lithotripsy in an adult: a case report

    Directory of Open Access Journals (Sweden)

    Nouri-Majalan Nader

    2010-08-01

    Full Text Available Abstract Introduction Among the complications of extracorporeal shock wave lithotripsy are perinephric bleeding and hypertension. Case presentation We describe the case of a 31-year-old Asian man with an unusual case of hemoptysis and lung contusion and cavitation with exudative plural effusion due to pulmonary trauma following false positioning of extracorporeal shock wave lithotripsy. Differential diagnoses included pneumonia and pulmonary emboli, but these diagnoses were ruled out by the uniformly negative results of a lung perfusion scan, Doppler ultrasound, and culture of bronchoalveolar lavage and plural effusion, and because our patient showed spontaneous improvement. Conclusions False positioning of extracorporeal shock wave lithotripsy can cause lung trauma presenting as pulmonary contusion and cavitation with plural effusion.

  15. Food irradiation: An update

    International Nuclear Information System (INIS)

    Morrison, Rosanna M.

    1984-01-01

    Recent regulatory and commercial activity regarding food irradiation is highlighted. The effects of irradiation, used to kill insects and microorganisms which cause food spoilage, are discussed. Special attention is given to the current regulatory status of food irradiation in the USA; proposed FDA regulation regarding the use of irradiation; pending irradiation legislation in the US Congress; and industrial applications of irradiation

  16. Industrial irradiation

    International Nuclear Information System (INIS)

    Stirling, Andrew

    1995-01-01

    Production lines for rubber gloves would not appear to have much in common with particle physics laboratories, but they both use accelerators. Electron beam irradiation is often used in industry to improve the quality of manufactured goods or to reduce production cost. Products range from computer disks, shrink packaging, tyres, cables, and plastics to hot water pipes. Some products, such as medical goods, cosmetics and certain foodstuffs, are sterilized in this way. In electron beam irradiation, electrons penetrate materials creating showers of low energy electrons. After many collisions these electrons have the correct energy to create chemically active sites. They may either break molecular bonds or activate a site which promotes a new chemical linkage. This industrial irradiation can be exploited in three ways: breaking down a biological molecule usually renders it useless and kills the organism; breaking an organic molecule can change its toxicity or function; and crosslinking a polymer can strengthen it. In addition to traditional gamma irradiation using isotopes, industrial irradiation uses three accelerator configurations, each type defining an energy range, and consequently the electron penetration depth. For energies up to 750 kV, the accelerator consists of a DC potential applied to a simple wire anode and the electrons extracted through a slot in a coaxially mounted cylindrical cathode. In the 1-5 MeV range, the Cockcroft-Walton or Dynamitron( R ) accelerators are normally used. To achieve the high potentials in these DC accelerators, insulating SF6 gas and large dimension vessels separate the anode and cathode; proprietary techniques distinguish the various commercial models available. Above 5 MeV, the size of DC accelerators render them impractical, and more compact radiofrequency-driven linear accelerators are used. Irradiation electron beams are actually 'sprayed' over the product using a magnetic deflection system. Lower energy beams of

  17. Food irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Beerens, H [Lille-1 Univ., 59 - Villeneuve-d' Ascq (France); Saint-Lebe, L

    1979-01-01

    Various aspects of food treatment by cobalt 60 or caesium 137 gamma radiation are reviewed. One of the main applications of irradiation on foodstuffs lies in its ability to kill micro-organisms, lethal doses being all the lower as the organism concerned is more complex. The effect on parasites is also spectacular. Doses of 200 to 300 krad are recommended to destroy all parasites with no survival period and no resistance phenomenon has ever been observed. The action of gamma radiation on macromolecules was also investigated, the bactericide treatment giving rise to side effects by transformation of food components. Three examples were studied: starch, nucleic acids and a whole food, the egg. The organoleptic aspect of irradiation was examined for different treated foods, then the physical transformations of unpasteurized, heat-pasteurized and radio-pasteurized eggs were compared. The report ends with a brief analysis of the toxicity and conditions of application of the treatment.

  18. Irradiation device

    International Nuclear Information System (INIS)

    Ransohoff, J.A.

    1984-01-01

    Carriers, after being loaded with product to be irradiated, are transported by an input-output conveyor system into an irradiation chamber where they are received in a horizontal arrangement on racks which may support different sizes and numbers of carriers. The racks are moved by a chamber conveyor system in an endless rectangular path about a radiation source. Packers shift the carriers on the racks to maintain nearest proximity to the radiation source. The carriers are shifted in position on each rack during successive rack cycles to produce even radiation exposure. The carriers may be loaded singly onto successive racks during a first cycle of movement thereof about the source, with loading of additional carriers, and/or unloading of carriers, onto each rack occurring on subsequent rack cycles of movement

  19. Food irradiation

    International Nuclear Information System (INIS)

    Roberts, P.B.

    1997-01-01

    Food can be provided with extra beneficial properties by physical processing. These benefits include a reduced possibility of food poisoning, or an increased life of the food. We are familiar with pasteurisation of milk, drying of vegetables, and canning of fruit. These physical processes work because the food absorbs energy during treatment which brings about the changes needed. The energy absorbed in these examples is heat energy. Food irradiation is a less familiar process. It produces similar benefits to other processes and it can sometimes be applied with additional advantages over conventional processing. For example, because irradiation causes little heating, foods may look and taste more natural. Also, treatment can take place with the food in its final plastic wrappers, reducing the risk of re-contamination. (author). 1 ref., 4 figs., 1 tab

  20. Food irradiation

    International Nuclear Information System (INIS)

    Beerens, H.; Saint-Lebe, L.

    1979-01-01

    Various aspects of food treatment by cobalt 60 or caesium 137 gamma radiation are reviewed. One of the main applications of irradiation on foodstuffs lies in its ability to kill micro-organisms, lethal doses being all the lower as the organism concerned is more complex. The effect on parasites is also spectacular. Doses of 200 to 300 krad are recommended to destroy all parasites with no survival period and no resistance phenomenon has ever been observed. The action of gamma radiation on macromolecules was also investigated, the bactericide treatment giving rise to side effects by transformation of food components. Three examples were studied: starch, nucleic acids and a whole food, the egg. The organoleptic aspect of irradiation was examined for different treated foods, then the physical transformations of unpasteurized, heat-pasteurized and radio-pasteurized eggs were compared. The report ends with a brief analysis of the toxicity and conditions of application of the treatment [fr

  1. Endolymphatic irradiation

    International Nuclear Information System (INIS)

    Galvao, M.M.; Ianhez, L.E.; Sabbaga, E.

    1982-01-01

    The authors analysed the clinical evolution and the result of renal transplantation some years after irradiation in 24 patients (group I) who received endolymphatic 131 I as a pre-transplantation immunesuppresive measure. The control group (group II) consisted of 24 non-irradiated patients comparable to group I in age, sex, primary disease, type of donor and immunesuppressive therapy. Significant differences were observed between the two groups regarding such factors a incidence and reversibility of rejection crises in the first 60 post-transplantation days, loss of kidney due to rejection, and dosage of azathioprine. The authors conclude that this method, besides being harmless, has prolonged immunesuppressive action, its administration being advised for receptores of cadaver kidneys, mainly those who show positive cross-match against HLA antigens for painel. (Author) [pt

  2. Establishment of extracorporeal circulation of artificial liver support system in high altitude region

    Directory of Open Access Journals (Sweden)

    Ming-sen ZHANG

    2011-01-01

    Full Text Available Objective To establish extracorporeal circulation in big animal suitable for the research on artificial liver support system in high altitude region.Methods Under the anesthesia of ketamine hydrochloride/diazepam IV,cannulation of common carotid artery/external jugular vein(n=3 and inferior vena cava via the left external jugular vein/right external jugular vein(n=3,was respectively performed on six healthy Chang-Bai piglets adapted to native environment(altitude 3700m.One day after that,the extracorporeal circulation was performed at a progressively elevated blood current velocity,and the general condition of the animals,blood pressure,HR,bleeding tendoncy of the experimental pigs and coagulation in the cannulae were observed.Results On the premise that the hemodynamics was not influenced,the highest blood current velocity was 133.33±28.87ml/min,the lowest heparin maintaining speed amounted to 138.67±12.22mg/h,and the bleeding tendency and blood coagulation in the cannula was significant in the group of common carotid artery/external jugular vein intubation.While the highest blood current velocity was 400ml/min,the lowest heparin maintaining speed was 26.67±9.24mg/h,no bleeding tendency or obvious cannular blood coagulation were observed in the group of cannulation of inferior vena cava via the left external jugular vein/right external jugular vein.These untoward results were significantly less or slight than that of the former group(P < 0.01.Conclusion It is suitable to perform research of artificial liver support system on piglets in high altitude region by establishing extracorporeal circulation by the way of inferior vena cava with cannulation passing through the left external jugular vein/right external jugular vein with the blood current velocity of 400ml/min.

  3. Linezolid extracorporeal removal during haemodialysis with high cut-off membrane in critically ill patients.

    Science.gov (United States)

    Villa, Gianluca; Cassetta, Maria Iris; Tofani, Lorenzo; Valente, Serafina; Chelazzi, Cosimo; Falsini, Silvia; De Gaudio, Angelo Raffaele; Novelli, Andrea; Ronco, Claudio; Adembri, Chiara

    2015-10-01

    Continuous venovenous haemodialysis with high cut-off membrane (HCO-CVVHD) is often used in critically ill septic patients with acute kidney injury (AKI) to sustain renal function and to remove circulating inflammatory mediators. The aim of this study was to analyse the extracorporeal removal of linezolid and related alterations in pharmacokinetic/pharmacodynamic (PK/PD) parameters during HCO-CVVHD. Three critically ill septic patients with AKI, treated with linezolid and HCO-CVVHD, were prospectively observed. To calculate the extracorporeal clearance of linezolid and the PK parameters, effluent, pre-filter and post-filter samples were contemporaneously collected before linezolid infusion, just after 1-h infusion (maximum serum concentration; C(max)), at 3 h and 6 h after dosing, and before the next dose (trough serum concentration; C(min)). Linezolid C(max) and C(min) (pre-filter) ranged from 10.4-23.5 mg/L and from 2.9-10.3 mg/L. The dialysate saturation coefficient was 0.66-0.85 and the extracorporeal clearance with a diffusive dose of 35 m L/kg/h ranged from 2.1-2.5 L/h. Total linezolid clearance was between 1.7 L/h and 6.3 L/h. The total area under the plasma concentration-time curve (AUC0-∞) ranged from 95.1 mgh/L to 352.9 mgh/L, in accordance with the different clinical conditions. AUCfree/MIC ratios were always linezolid total clearance, the clinical features of critically ill septic patients appear to be mainly responsible for the high variability of linezolid serum concentrations. Copyright © 2015. Published by Elsevier B.V.

  4. Development of Extracorporeal Shock Wave Therapy for the Treatment for Ischemic Cardiovascular Diseases

    Science.gov (United States)

    Shimokawa, Hiroaki

    Cardiovascular diseases, such as coronary artery disease and peripheral artery disease, are the major causes of death in developed countries, and the number of elderly patients has been rapidly increasing worldwide. Thus, it is crucial to develop new non-invasive therapeutic strategies for these patients. We found that a low-energy shock wave (SW) (about 10% of the energy density that is used for urolithiasis) effectively increases the expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. Subsequently, we demonstrated that extracorporeal cardiac SW therapy with low-energy SW up-regulates the expression of VEGF, enhances angiogenesis, and improves myocardial ischemia in a pig model of chronic myocardial ischemia without any adverse effects in vivo. Based on these promising results in animal studies, we have subsequently developed a new, non-invasive angiogenic therapy with low-energy SW for cardiovascular diseases. Our extracorporeal cardiac SW therapy improved symptoms and myocardial perfusion evaluated with stress-scintigraphy in patients with severe coronary artery disease without indication of percutaneous coronary intervention or coronary artery bypass surgery. Importantly, no procedural complications or adverse effects were noted. The SW therapy was also effective in ameliorating left ventricular remodeling after acute myocardial infarction in pigs and in enhancing angiogenesis in hindlimb ischemia in animals and patients with coronary artery disease. Furthermore, our recent experimental studies suggest that the SW therapy is also effective for indications other than cardiovascular diseases. Thus, our extracorporeal cardiac SW therapy is an effective, safe, and non-invasive angiogenic strategy for cardiovascular medicine.

  5. Extracorporeal treatment for theophylline poisoning: systematic review and recommendations from the EXTRIP workgroup.

    Science.gov (United States)

    Ghannoum, Marc; Wiegand, Timothy J; Liu, Kathleen D; Calello, Diane P; Godin, Melanie; Lavergne, Valery; Gosselin, Sophie; Nolin, Thomas D; Hoffman, Robert S

    2015-05-01

    The Extracorporeal Treatments in Poisoning workgroup was created to provide evidence-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Here, the workgroup presents its systematic review and recommendations for theophylline. After a systematic review of the literature, a subgroup reviewed articles, extracted data, summarized findings, and proposed structured voting statements following a pre-determined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and the RAND/UCLA Appropriateness Method was used to quantify disagreement. Anonymous votes were compiled, returned, and discussed. A second vote determined the final recommendations. 141 articles were included: 6 in vitro studies, 4 animal studies, 101 case reports/case series, 7 descriptive cohorts, 4 observational studies, and 19 pharmacokinetic studies, yielding a low-to-very-low quality of evidence for all recommendations. Data on 143 patients were reviewed, including 10 deaths. The workgroup concluded that theophylline is dialyzable (level of evidence = A) and made the following recommendations: ECTR is recommended in severe theophylline poisoning (1C). Specific recommendations for ECTR include a theophylline concentration [theophylline] > 100 mg/L (555 μmol/L) in acute exposure (1C), the presence of seizures (1D), life-threatening dysrhythmias (1D) or shock (1D), a rising [theophylline] despite optimal therapy (1D), and clinical deterioration despite optimal care (1D). In chronic poisoning, ECTR is suggested if [theophylline] > 60 mg/L (333 μmol/L) (2D) or if the [theophylline] > 50 mg/L (278 μmol/L) and the patient is either less than 6 months of age or older than 60 years of age (2D). ECTR is also suggested if gastrointestinal decontamination cannot be administered (2D). ECTR should be continued until clinical improvement is apparent or the [theophylline] is poisoning is amenable to ECTRs. The workgroup recommended

  6. Local experience with extracorporeal membrane oxygenation in children with acute fulminant myocarditis.

    Directory of Open Access Journals (Sweden)

    Botao Ning

    Full Text Available To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO in children with acute fulminant myocarditis, we retrospectively analyzed the data of five children with acute fulminant myocarditis in the intensive care unit (ICU at the Affiliated Children's Hospital, Zhejiang University from February 2009 to November 2012. The study group included two boys and three girls ranging in age from 9 to 13 years (median 10 years. Body weight ranged from 25 to 33 kg (mean 29.6 kg. They underwent extracorporeal membrane oxygenation (ECMO through a venous-arterial ECMO model with an average ECMO supporting time of 89.8 h (40-142 h. Extracorporeal circulation was established in all five children. After treatment with ECMO, the heart rate, blood pressure, and oxygen saturation were greatly improved in the four children who survived. These four children were successfully weaned from ECMO and discharged from hospital machine-free, for a survival rate of 80% (4/5. One child died still dependent on the machine. Cause of death was irrecoverable cardiac function and multiple organ failure. Complications during ECMO included three cases of suture bleeding, one case of acute hemolytic renal failure and suture bleeding, and one case of hyperglycemia. During the follow-up period of 4-50 months, the four surviving children recovered with normal cardiac function and no abnormal functions of other organs. The application of ECMO in acute fulminant myocarditis, even in local centers that experience low incidence of this disease, remains an effective approach. Larger studies to determine optimal timing of placement on ECMO to guide local centers are warranted.

  7. Central Hemodynamics and Oxygen Transport in Various Activation of Patients Operated On Under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    Ye. V. Dzybinskaya

    2009-01-01

    Full Text Available Objective: to study central hemodynamics, the determinants of myocardial oxygen balance, and the parameters of oxygen transport in various activation of patients after surgery under extracorporeal circulation. Subjects and methods. Thirty-four patients aged 57.8±2.5 years who had coronary heart disease were divided into 2 groups: 1 those with late activation (artificial ventilation time 157±9 min and 2 those with immediate activation (artificial ventilation time 33±6 min. Group 2 patients were, if required, given fentanyl, midazolam, or myorelaxants. Results. During activation, there were no intergroup differences in the mean levels of the major parameters of cardiac pump function, in the determinants of coronary blood flow (coronary perfusion gradients and myocardial oxygen demand (the product of heart rate by systolic blood pressure, and in the parameters of oxygen transport, including arterial lactatemia. After tracheal extubation, the left ventricular pump coefficient was increased considerably (up to 3.8±0.2 and 4.4±0.2 gm/mm Hg/m2 in Groups 1 and 2, respectively; p<0.05 with minimum inotropic support (dopamine and/or dobutamine being used at 2.7±0.3 and 2.4±0.3 mg/kg/min, respectively. In both groups, there were no close correlations between the indices of oxygen delivery and consumption at all stages of the study, which was indicative of no transport-dependent oxygen uptake. Conclusion. When the early activation protocol was followed up, the maximum acceleration of early activation, including that using specific antagonists of anesthetics, has no negative impact on central hemodynamics, the determinants of myocardial oxygen balance and transport in patients operated on under extracorporeal circulation. Key words: early activation, surgery under extracorporeal circulation, tracheal extubation in the operating-room, central hemodynamics, oxygen transport.

  8. Labral reconstruction with iliotibial band autografts and semitendinosus allografts improves hip joint contact area and contact pressure: an in vitro analysis.

    Science.gov (United States)

    Lee, Simon; Wuerz, Thomas H; Shewman, Elizabeth; McCormick, Frank M; Salata, Michael J; Philippon, Marc J; Nho, Shane J

    2015-01-01

    Labral reconstruction using iliotibial band (ITB) autografts and semitendinosus (Semi-T) allografts has recently been described in cases of labral deficiency. To characterize the joint biomechanics with a labrum-intact, labrum-deficient, and labrum-reconstructed acetabulum in a hip cadaveric model. The hypothesis was that labral resection would decrease contact area, increase contact pressure, and increase peak force, while subsequent labral reconstruction with ITB autografts or Semi-T allografts would restore these values toward the native intact labral state. Controlled laboratory study. Ten fresh-frozen human cadaveric hips were analyzed utilizing thin-film piezoresistive load sensors to measure contact area, contact pressure, and peak force (1) with the native intact labrum, (2) after segmental labral resection, and (3) after graft labral reconstruction with either ITB autografts or Semi-T allografts. Each specimen was examined at 20° of extension and 60° of flexion. Statistical analysis was conducted through 1-way analysis of variance with post hoc Games-Howell tests. For the ITB group, labral resection significantly decreased contact area (at 20°: 73.2%±5.38%, P=.0010; at 60°: 78.5%±6.93%, P=.0063) and increased contact pressure (at 20°: 106.7%±4.15%, P=.0387; at 60°: 103.9%±1.15%, P=.0428). In addition, ITB reconstruction improved contact area (at 20°: 87.2%±12.3%, P=.0130; at 60°: 90.5%±8.81%, P=.0079) and contact pressure (at 20°: 98.5%±5.71%, P=.0476; at 60°: 96.6%±1.13%, P=.0056) from the resected state. Contact pressure at 60° of flexion was significantly lower compared with the native labrum (P=.0420). For the Semi-T group, labral resection significantly decreased contact area (at 20°: 68.1%±12.57%, P=.0002; at 60°: 67.5%±6.70%, P=.0002) and increased contact pressure (at 20°: 105.3%±3.73%, P=.0304; at 60°: 106.8%±4.04%, P=.0231). Semi-T reconstruction improved contact area (at 20°: 87.9%±7.95%, P=.0087; at 60°: 92.9%±13

  9. [Traumatic tricuspid valve insufficiency with right-to-left shunt: bridging using extracorporeal venovenous membrane oxygenation].

    Science.gov (United States)

    Weber, S U; Hammerstingl, C; Mellert, F; Baumgarten, G; Putensen, C; Knuefermann, P

    2012-01-01

    The case of a young male motor vehicle driver is reported who suffered multiple trauma in a car accident with pulmonary and cardiac contusions. In the course of severe pneumonia and traumatic tricuspid valve insufficiency a right-to-left shunt with refractory hypoxemia developed across a pre-existing atrial septal defect (ASD). The patient could be successfully treated by the combination of extracorporeal membrane oxygenation for bridging, interventional ASD occlusion and in the long-term by operative reconstruction of the tricuspid valve.

  10. Decreased renal function and hypertension are long-term complications of extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Williams, C.M.; Kaude, J.V.; Newman, R.C.; Peterson, J.C.; Thomas, W.C.

    1987-01-01

    Quantitative radionuclide renography performed in 21 patients 17-21 months after extracorporeal shock wave lithotripsy showed a significant decrease in the percentage of effective renal plasma flow (%ERPF) of the treated kidney; in five (24%) patients the %ERPF had decreased by more than 5 percentage units. In seven (8%) of 91 patients sustained hypertension developed that required pharmacologic treatment after lithotripsy. Decreased %ERPF of a treated kidney and hypertension may be related to a Page kidney or similar process resulting from renal trauma and hemorrhage occurring as a side effect of lithotripsy. Hypertension is an important complication of lithotripsy in about 8% of patients

  11. Radiation Dose Assesment And Risk Estimation During Extracorporeal Shock Wave Lithotripsy

    International Nuclear Information System (INIS)

    Sulieman, A.; Ibrahim, A.A.; Osman, H.; Yousef, M.

    2011-01-01

    Extracorporeal shockwave lithotripsy (ESWL) is considered the gold standard for calculi fragmentation. The aims of this study are to measure the entrance surface dose (ESD) using thermo-luminescence dosimeter (TLDs) and to estimate the probability of carcinogenesis during ESWL procedure. The study was carried out at two centers (Group A, 50 patients) and (Group B, 25 patients). The mean ESD and effective doses were 36 mGy and 34 mSv. The results show that the probability of carcinogenesis is a tiny value 100 per million patients) but the main biological effect is occurring due to the accumulative impact of radiation.

  12. Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee.

    Science.gov (United States)

    Wang, Ching-Jen; Cheng, Jai-Hong; Chou, Wen-Yi; Hsu, Shan-Ling; Chen, Jen-Hung; Huang, Chien-Yiu

    2017-01-01

    We assessed the pathological changes of articular cartilage and subchondral bone on different locations of the knee after extracorporeal shockwave therapy (ESWT) in early osteoarthritis (OA). Rat knees under OA model by anterior cruciate ligament transaction (ACLT) and medial meniscectomy (MM) to induce OA changes. Among ESWT groups, ESWT were applied to medial (M) femur (F) and tibia (T) condyles was better than medial tibia condyle, medial femur condyle as well as medial and lateral (L) tibia condyles in gross osteoarthritic areas (posteophyte formation and subchondral sclerotic bone (psubchondral bone repair in all ESWT groups compared to OA group (p T(M+L) > F(M) in OA rat knees.

  13. Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

    Directory of Open Access Journals (Sweden)

    Edward Gologorsky

    2010-01-01

    Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  14. Extracorporeal shock-wave lithotripsy as an adjunct to biliary interventional procedures

    International Nuclear Information System (INIS)

    Zeman, R.K.; Garra, B.S.; Matsumoto, A.H.; Teitelbaum, G.P.; Barth, K.H.; Cattau, E.L.; Davros, W.J.; McClennan, B.L.; Picus, D.; Paushter, D.M.

    1989-01-01

    This paper reviews the records of nine patients undergoing extracorporeal shock wave lithotripsy (ESWL) of bile duct stones as an adjunct to other biliary intervention. Lithotripsy was successful in producing fragmentation in seven of nine patients. Keeping the duct mildly distended with contrast medium, distributing the shock waves over the stone(s) by taking advantage of respiratory excursion, and pinning stone fragments with balloon catheters facilitated fragmentation. Six patients underwent duct manipulation (stricture dilation, fragment extraction) within 24 hours of ESWL, suggesting that immediate instrumentation is safe in conjunction with lithotripsy

  15. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite

    Directory of Open Access Journals (Sweden)

    Schlaudraff KU

    2014-05-01

    Full Text Available Kai-Uwe Schlaudraff,1 Maren C Kiessling,2 Nikolaus BM Császár,2 Christoph Schmitz21Concept Clinic, Geneva, Switzerland; 2Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, GermanyBackground: Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI, weight, and/or height.Methods: Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast® device (Electro Medical Systems, S.A., Nyon, Switzerland. Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right, totaling eight treatments on the selected side. Treatment was performed at 3.5–4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area. Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires.Results: The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades. Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0

  16. Low-intensity extracorporeal shockwave therapy in the treatment of postprostatectomy erectile dysfunction

    DEFF Research Database (Denmark)

    Frey, Anders; Sønksen, Jens; Fode, Mikkel

    2016-01-01

    OBJECTIVE: The objective was to investigate the effect and feasibility of low-intensity extracorporeal shockwave therapy (LI-ESWT) as a treatment for erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (RP). MATERIALS AND METHODS: Patients who had undergone robot......-assisted bilateral nerve-sparing RP more than a year before entering this pilot study, had no preoperative ED and were suffering from mild to severe postoperative ED were invited to participate. Six treatments were given over a 6 week period, using the Duolith® SD1 T-Top machine. The effect of the treatment...

  17. Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae [Yeouido St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-09-15

    Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL.

  18. Emphysematous pyelonephritis: A rare life-threatening complication after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Kim, Su Ho; Chung, Dong Jin; Yeo, Dong Myung; Sonh, Dong Wan; Hahn, Sung Tae

    2015-01-01

    Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL

  19. Early Activation of Patients after Surgery for Coronary Heart Disease under Extracorporeal Circulation

    Directory of Open Access Journals (Sweden)

    I. A. Kozlov

    2008-01-01

    Full Text Available Objective: to analyze the safety and clinical efficiency of early activation of patients operated on for coronary heart disease under extracorporeal circulation. Subjects and methods. The data available in the case histories of 673 patients aged 29—76 years, operated on in 1995, 2004, and 2006, were analyzed. The study excluded patients with severe intraoperative complications (acute myocardial infarction, a need for extracorporeal circulation, and surgical bleeding. Early activation was made on an operating table if there were no contraindications. Some sections of the study were performed in the matched patient groups. Results. With early activation, the dosages of fentanyl were reduced by 2.5-3 times as compared with the 1995 data; the use of ketamine and diazepam was stopped. Instead of the latter, the currently available inhalational agents are coming into use: midazolam has been introduced and the rate of propofol use has increased. The higher activation rate required the use of flumazenil, naloxone, and proserin. The goal-oriented study of central hemodynamics with emphasis on early activation has indicated that lower dosages of fentanyl have no negative impact on cardiac pump function or myocardial oxygen balance. When the trachea was extubated on the operating table, there was appropriate central hemodynamic stabilization. It was found that the incidence of postoperative myocardial infarctions did not depend on the rate of activation. The frequency of cardiovascular complications was 38.8±5.9% and 22.9±5.0% in the prolonged artificial ventilation (AV and early activation groups, respectively (p<0.05; that of pulmonary complications was 16.4±4.5% and 5.7±2.8%, respectively (p<0.05. Early activation halved the length of stay at an intensive care unit (p<0.05 and reduced postoperative hospitalization at surgery units by 5 days (p< 0.05. Introduction of early activation caused a decrease in the duration of postoperative AV in the

  20. [Bone and Calcium Research Update 2015. Clinical update of urolithiasis--ESWL (extracorporeal shock wave lithotripsy)].

    Science.gov (United States)

    Iguchi, Taro; Nakatani, Tatsuya

    2015-01-01

    ESWL (extracorporeal shock wave lithotripsy) is widely used for upper urinary stones and successfully treats most patients with uncomplicated kidney stones. ESWL is still of high strategic importance despite ureteroscopy and PNL occupy an essential place in the treatment of urinary stones by technologic advancements. However ESWL is just one of treatment tool and the best procedure should be selected for the patients. Moreover urolithiasis is one of lifestyle-related diseases and should be treated as systemic illness in the daily medical practice.

  1. Usefulness of Early Extracorporeal Shock Wave Lithotripsy in Colic Patients with Ureteral Stones

    OpenAIRE

    Choi, Hyeung Joon; Jung, Jin-Hee; Bae, Jungbum; Cho, Min Chul; Lee, Hae Won; Lee, Kwang Soo

    2012-01-01

    Purpose To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. Materials and Methods A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time betw...

  2. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon

    2013-07-01

    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  3. Computed tomography after extra-corporeal shock wave lithotripsy (ESWL) of the kidneys. Pt. 1

    International Nuclear Information System (INIS)

    Schaub, T.; Kunisch, M.; Stadtbaeumer, M.; Schild, H.; Thelen, M.; Stoerkel, S.; El-Damanhoury, H.; Hennes, H.J.

    1991-01-01

    In an experimentel study on pigs, 28 stone-free kidneys were treated with a second generation lithotripter. Histologically, acute bleeding was seen after ESWL in 23 (82 %) of the 28 treated kidneys. CT studies before and after contrast were correct in 20/28 (74%) cases. It was shown that extracorporeal shock waves cause renal bleeding that is only partially detected by computed tomography. It can be concluded that the CT findings seen in a high percentage of renal stone patients after ESWL represent bleeding. The incidence of renal bleeding after ESWL and thus the possible risk of hypertension has obviously been underestimated so far in clinical studies. (orig.) [de

  4. Morphological alterations of the gall-bladder following extracorporeal shock-wave lithotripsy

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Zoeller, A.; Swobodnik, W.; Janowitz, P.

    1990-01-01

    The present study reports on 51 patients with symptomatic cholecystolithiasis, who accordingly underwent extracorporeal shock-wave lithotripsy (ESWL). In all cases, computed tomography (CT) was performed prior to and after the therapeutic procedure to delineate changes in gall-bladder morphology. Slight edematous thickening of the gall-bladder wall was found in 15 patients. One patient presented a rupture of the gall-bladder with formation of a bilioma in the adjacent liver tissue. In case of calcific concrements, CT revealed a characteristic pattern of fragment distribution following shock-wave treatment, and fragments of various sizes exhibited distinct adhesion to the gall-bladder wall. (orig.) [de

  5. Variation of Pressure Waveforms in Measurements of Extracorporeal Shock Wave Lithotripter

    Science.gov (United States)

    Inose, Naoto; Ide, Masao

    1993-05-01

    In this paper, we describe measurement of variation in pressure waveforms of the acoustic field of an extra-corporeal shock-wave lithotripter (ESWL). Variations in the measured acoustic fields and pressure waveform of an underwater spark-gap-type ESWL with an exhausted spark plug electrode have been reported by researchers using crystal sensors. If the ESWL spark plugs become exhausted, patients feel pain during kidney, biliary stone disintegration. We studied the relationship between exhaustion of electrodes and the variation of pressure waveforms and shock-wave fields of the ESWL using a newly developed hydrophone.

  6. Surface dose of X rays to patients during extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Jiang Qingqi; Weng Zhigeng; Feng Ming; Wang Guomin.

    1990-01-01

    During extracorporeal shock wave lithotripsy (ESWL), the fluoroscopy must be made to show the location and size of the stone thus the patient has to be exposed to X rays. The surface dose to patients during ESWL was measured in an investigation on 134 cases of renal lithiasis admitted in a certain hospital of Shanghai. The results show that the average skin dose equivalent for these patients was 162 mSv and the magnitude of doses was depended upon some factors such as the size and location of the stone

  7. Role of US in the evaluation of patients after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Nadel, S.N.; St Amour, T.E.; McClennan, B.L.; Ling, D.; Clayman, R.V.

    1986-01-01

    Five hundred patients underwent extracorporeal shock wave lithotripsy (ESWL) during a 9-month period and 343 were evaluated afterward with high-resolution realtime US. US examinations were correlated with the clinical course, other imaging studies, and patient outcome. US was as sensitive as but less specific than plain radiography for the detection of fragmented calculi. US successfully graded hydronephrosis, imaged fluid collections, and facilitated placement of percutaneous nephrostomy tubes. The limitations of US included loss of detail secondary to indwelling catheters, ileus, reflections from adjacent bowel, and operator or machine dependence

  8. Patient exposure and micronucleus assay during extracorporeal shock wave lithotripsy (ESWL) for kidney stones

    International Nuclear Information System (INIS)

    Shao, M.

    1992-01-01

    This study reports results of radiation exposure to 20 patients with kidney stones during Extracorporeal Shock Wave Lithotripsy (ESWL). A domestically made JT-ESWL-I Lithotripter was used. Data indicated that the amount of radiation exposure is related to the numbers, size, location and radiodensity of the stone, and also the number of shock wave and the time of fluoroscopy exposure given to the patients. The results of the micronucleus frequency of lymphocytes assay in the human peripheral blood are reported. This effect increased with increasing radiation exposure doses. (author). 4 refs., 2 tabs

  9. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months.

    Science.gov (United States)

    Schulz, Arndt P; Lange, Vivien; Gille, Justus; Voigt, Christine; Fröhlich, Susanne; Stuhr, Markus; Jürgens, Christian

    2013-01-01

    Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24-36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15-58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3-38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5-10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17-100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2-7) compared to a mean value of 4.16 (2-7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65-100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. ACL reconstruction using a bone plug-free quadriceps tendon

  10. Processing of gamma irradiated bone allografts for treatment of injuries in a nuclear scenario

    International Nuclear Information System (INIS)

    Singh, Durgeshwer; Singh, Antaryami; Singh, Rita; Shah, Om

    2014-01-01

    Bone allografts fill an important void in the surgical practice of orthopaedic surgery, and their use to replace and reconstruct musculoskeletal structures following injury or disease has gained increasing acceptance by orthopaedic surgeons. Serious mechanical injuries in a nuclear scenario involving compression, displacement and missile hit will lead to high incidence of various kinds of bone fractures, spinal injuries and joint injuries apart from lethality, lung damage and eardrum rupture. Bone allografts can be employed for repairing fracture defects, filling in destroyed regions of bone, management of open fractures and joint injuries. Autologous bone grafts, though ideal, have the drawback of secondary surgery for autograft retrieval, complications of infection and donor site morbidity. Bone allografts eliminate additional incision necessary for acquiring an autograft and consequently reduce operating time, blood loss as well as hospital and medical costs. However, disease transmission and bacterial infection in bone allograft transplantation is of significant concern. Sterilization by gamma irradiation is a definitive method for eliminating microorganisms and can prevent life-threatening allograft associated infections. The present study was carried out with the aim of bioburden assessment, radiation sterilization and clinical evaluation of bone allografts processed from femoral heads obtained from living donors. Femoral heads were obtained during surgery at Department of Orthopaedic Surgery, SN Medical College, Jodhpur and processed as freeze-dried bone allografts. Bioburden of bone allografts was found to be in the range of 2.26 to 3.59 log CFU/g. Verification dose for different batches of processing was 7.24±1.27 kGy. Radiological data of processed gamma irradiated bone grafts used in clinical cases of trauma surgery was recorded and has shown successful graft incorporation in allogenic recipients. (author)

  11. A novel approach to the management of critically ill neonatal Ebstein′s anomaly: Veno-venous extracorporeal membrane oxygenation to promote right ventricular recovery

    Directory of Open Access Journals (Sweden)

    Holly Bauser-Heaton

    2015-01-01

    Full Text Available This is the first report of the use of veno-venous extracorporeal membrane oxygenation in a neonate with severe Ebstein′s anomaly. The report suggests the use of veno-venous extracorporeal membrane oxygenation in the immediate neonatal period may be a useful therapy in severe Ebstein′s anomaly. By providing adequate oxygenation independent of the patient′s native pulmonary blood flow, veno-venous extracorporeal membrane oxygenation allows the pulmonary vascular resistance to decrease and may promote right ventricular recovery.

  12. Extracorporeal circulation for rewarming in drowning and near-drowning pediatric patients.

    Science.gov (United States)

    Coskun, Kasim Oguz; Popov, Aron Frederik; Schmitto, Jan Dieter; Hinz, José; Kriebel, Thomas; Schoendube, Friedrich Albert; Ruschewski, Wolfgang; Tirilomis, Theodor

    2010-11-01

    Drowning and near-drowning is often associated with severe hypothermia requiring active core rewarming.We performed rewarming by cardiopulmonary bypass(CPB). Between 1987 and 2007, 13 children (9 boys and 4 girls) with accidental hypothermia were rewarmed by extracorporeal circulation (ECC) in our institution. The average age of the patients was 3.2 years. Resuscitation was started immediately upon the arrival of the rescue team and was continuously performed during the transportation.All patients were intubated and ventilated. Core temperature at admission ranged from 20 to 29°C (mean 25.3°C). Connection to the CPB was performed by thoracic (9 patients) or femoral/iliac means (4 patients). Restoration of circulation was achieved in 11 patients (84.6%). After CPB termination two patients needed an extracorporeal membrane oxygenation system due to severe pulmonary edema.Five patients were discharged from hospital after prolonged hospital stay. During follow-up, two patients died(10 and 15 months, respectively) of pulmonary complications and one patient was lost to follow-up. The two remaining survivors were without neurological deficit.Modes of rewarming, age, sex, rectal temperature, and serum electrolytes did not influence mortality. In conclusion,drowning and near-drowning with severe hypothermia remains a challenging emergency. Rewarming by ECC provides efficient rewarming and full circulatory support.Although nearly half of the children may survive after rewarming by ECC, long-term outcome is limited by pulmonary and neurological complications.

  13. Extracorporeal membrane oxygenation (ECMO as salvage treatment for pulmonary Echinococcus granulosus infection with acute cyst rupture

    Directory of Open Access Journals (Sweden)

    Sören L. Becker

    2017-11-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully for the treatment of patients with respiratory failure due to severe infections. Although rare, parasites can also cause severe pulmonary disease. Tapeworms of the genus Echinococcus give rise to the development of cystic structures in the liver, lungs, and other organs. Acute cyst rupture leads to potentially life-threatening infection, and affected patients may deteriorate rapidly. The case of a young woman from Bulgaria who was admitted to hospital with severe dyspnoea, progressive chest pain, and haemoptysis is described. Computed tomography of the chest was pathognomonic for cystic echinococcosis with acute cyst rupture. Following deterioration on mechanical ventilation, she was cannulated for veno-venous ECMO. The patient’s condition improved considerably, and she was weaned successfully from ECMO and mechanical ventilation. Following lobectomy of the affected left lower lobe, the patient was discharged home in good condition. This appears to be the first report of the successful use of ECMO as salvage treatment for a severe manifestation of a helminthic disease. Due to recent migration to Western Europe, the number of patients presenting with respiratory failure due to pulmonary echinococcosis with cyst rupture is likely to increase. Keywords: Extracorporeal membrane oxygenation (ECMO, Infection, Echinococcosis, Echinococcus granulosus, Hydatid disease, Infection

  14. [EFFECTIVENESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN PATIENTS WITH UROLITHIASIS OF A SOLITARY KIDNEY].

    Science.gov (United States)

    Parshenkova, I G; Dutov, V V; Rumjancev, A A; Mamedov, E A

    2015-01-01

    The article presents results of extracorporeal shock wave lithotripsy (ESWL) in 62 patients with urolithiasis of a solitary kidney. In 50 (80.6%) patients calculi were located in the kidney and in 12 (19.4%) patients in the ureter. Effectiveness of ESWL at 3 month follow-up was 85.5%, which is somewhat lower than in patients with two healthy kidneys due to the choice of sparing low-energy modes of lithotripsy. The effectiveness of ESWL depended on the size of the original calculi (ppre-drainage of the kidney before a session of ESWL in patients with large and multiple calculi. There was no correlation between the occurrence of complications during treatment and the clinical form of a solitary kidney (p>0.05). In patients with stones larger than 1 cm and a moderate baseline abnormalities of the upper urinary tract urodynamics ESWL was less effective (pcalculus (p=0.504). Extracorporeal shock wave lithotripsy is a highly effective and safe treatment of stones of a solitary kidney. Rational choice of indications and contraindications for the use of ESWL in a specific clinical situation is of great importance.

  15. Efficacy of extracorporeal shock wave therapy in the treatment of lateral epicondylitis.

    Science.gov (United States)

    Bayram, Korhan; Yesil, Hilal; Dogan, Erdal

    2014-01-01

    Lateral epicondylitis is one of the widely seen lesions of the arm characterized by pain localized over lateral epicondyle which is the insertion site of the wrist extensors, and extensor muscles of the forearm. It is easy to diagnose lateral epicondylitis but treatment involves some inherent drawbacks. Conservative management includes non-steroidal anti-inflammatory drugs, ultrasound therapy, steroid injections, functional bracing, laser therapy and extracorporeal shock wave therapy, however none of these modalities have been shown to be really effective based on evidence-based data. Our study is aimed to determine the efficacy of extracorporeal shock wave therapy (ESWT) therapy in the treatment of lateral epicondylitis. A total of 12 patients with the diagnosis of lateral epicondylitis were included in the study and 3 sessions of ESWT were applied (1 session per week). Maximum grip strength and pain scores were assessed before and at 1. month after the treatment. Spesific tests for lateral epicondylitis were utilized and Turkish version of the Patient Rated Tennis Elbow Evaluation (PRTEE-T) questionnaire was administered and data obtained were analyzed. Visual analog scale (VAS) scores were significantly lower (plateral epicondyilitis was found to be effective on reducing pain, and improving functional activities and quality of life.

  16. SMART Tubing Presents an Increased Risk of Disconnection During Extracorporeal Circulation

    Science.gov (United States)

    Newling, Ross; Morris, Richard

    2005-01-01

    Abstract: A number of products exhibiting biocompatible features have been developed for use in extracorporeal blood circuits during cardiopulmonary bypass procedures. While attention has been focused on biocompatibility features of the blood-circuit interface, a number of issues applicable in clinical use of these circuits have arisen. Surface Modifying Additive Technology (SMART; Cobe Cardiovascular, Arvarda, CO) is one such technology. In this product, the structure of normal polyvinylchloride (PVC) tubing is altered through the blending of two copolymers to give a more biocompatible blood to plastic interface. In this study, we examined the in vitro mechanical ability of random samples (n = 10) of SMART and standard PVC tubing to withstand axial tension when the tubing was placed over a single barb of a connector. The tension required to remove the SMART tubing from the connector (83.3 ± 7.3 [SD] N), was significantly less than standard PVC tubing (115.6 ± 15.9 N; p tubing exhibited a 28% reduction in tubing to connector adhesion, which may have a significant effect on extracorporeal circuit disconnection and overall patient safety. PMID:16524161

  17. Extracorporeal life support for critical enterovirus 71 rhombencephalomyelitis: long-term neurologic follow-up.

    Science.gov (United States)

    Lee, Hsiu-Fen; Chi, Ching-Shiang; Jan, Sheng-Ling; Fu, Yun-Ching; Huang, Fang-Liang; Chen, Po-Yen; Wang, Chung-Chi; Wei, Hao-Ji

    2012-04-01

    Enterovirus 71 rhombencephalomyelitis with cardiopulmonary dysfunction has become an endemic problem in Taiwan since an epidemic outbreak in 1998. Such cases frequently involve significant morbidity and mortality. From October 2000-June 2008, we collected 10 consecutive patients diagnosed with enterovirus 71 rhombencephalomyelitis complicated by left heart failure, with or without pulmonary edema, and surviving more than 3 months after receiving extracorporeal life support. Follow-up neurologic outcomes were analyzed prospectively. The median duration of neurologic follow-up was 7 years and 2 months. Significant morbidities included bulbar dysfunction, respiratory failure, and flaccid quadriparesis. Eight patients exhibited bulbar dysfunction, and feeding tubes could be removed from four patients (median, 15.5 months). Respiratory failure was observed in seven patients. Three patients were gradually withdrawn from their tracheostomy tube (median period, 30 months). Intelligence tests revealed four patients with normal cognitive function, one with borderline cognitive function, and one with mild mental retardation. Four were bedridden survivors. Extracorporeal life support for critical enterovirus 71 rhombencephalomyelitis demonstrated decreased neurologic sequelae during long-term follow-up, allowing for decannulation of feeding and tracheostomy tubes, and resulting in improved cognitive function. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Emerging indications for extracorporeal membrane oxygenation in adults with respiratory failure.

    Science.gov (United States)

    Abrams, Darryl; Brodie, Daniel

    2013-08-01

    Recent advances in technology have spurred the increasing use of extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure. However, this accounts for only a small percentage of patients with respiratory failure. We envision the application of ECMO in many other forms of respiratory failure in the coming years. Patients with less severe forms of acute respiratory distress syndrome, for instance, may benefit from enhanced lung-protective ventilation with the very low tidal volumes made possible by direct carbon dioxide removal from the blood. For those in whom hypercapnia predominates, extracorporeal support will allow for the elimination of invasive mechanical ventilation in some cases. The potential benefits of ECMO may be further enhanced by improved techniques, which facilitate active mobilization. Although ECMO for these and other expanded applications is under active investigation, it has yet to be proven beneficial in these settings in rigorous controlled trials. Ultimately, with upcoming and future technological advances, there is the promise of true destination therapy, which could lead to a major paradigm shift in the management of respiratory failure.

  19. Quantification of extracorporal platelet deposition in cardiopulmonary bypass: Effects of ZK 36374, a prostacyclin analogue

    Energy Technology Data Exchange (ETDEWEB)

    Martin, W.; Spyt, T.; Wheatley, D.J.; Thomas, I.; Davidson, J.F.

    1989-03-01

    The degree of extracorporal platelet sequestration in 32 patients undergoing cardiopulmonary bypass has been assessed using /sup 111/In labelled platelets and both a shadow shield whole body monitor and a standard gamma camera. The effects of ZK 36374, a prostacyclin analogue, on deposition of platelets in the oxygenator and atrial line filter were also investigated. Total platelet deposition in the placebo group ranged from 2.2% to 31.7%, mean 13.9+-7.8%; n=15, and was significantly higher than the deposition in the treatment group, range 0.7% to 9.4%, mean 3.9+-2.6%; n=16, P < 0.001. There was also a highly significant correlation between the gamma camera and whole body monitor measurements, r=0.99, P < 0.001, with no systematic difference between the techniques. This study demonstrates that accurate quantitative assessment of platelet deposition can be achieved with either the gamma camera or whole body monitor. In addition, significant reduction in platelet sequestration in the extracorporal circuit can be achieved by using ZK 36374 during the bypass operation.

  20. [Extracorporeal gas exchange--an alternative to ventilation of the premature newborn infant with respiratory insufficiency].

    Science.gov (United States)

    Schmidt, S; Dudenhausen, J W; Langner, K; Laiblin, C; Saling, E

    1984-01-01

    In spite of improvements in its prophylaxis and therapy the membrane syndrome is still one of the main causes of morbidity and mortality in newborns. In many perinatal centers in the United States extracorporeal gas exchange via an artificial lung is the ultimate step in therapy for this group of patients today. As a result of our own research work we are able to introduce an extracorporeal circulation system which is especially suited to the particular situation of the immature newborn and which enables a complete immobilization of the lung to avoid baro-trauma with alveolar oxygen diffusion and CO2-removal through the membrane lung. Using appropriate dimensions the system can be housed in a newborn incubator. With low total resistance the perfusion in the newborn is performed via an arterio-venous shunt of the umbilical vessels alternatively with and without a mechanical pump. We tested this perfusion system on premature lambs with a gestational age of 128 to 130 days. During a test period of from 6 to 8 hours at a low blood flow rate (200 ml/min) we achieved a sufficient CO2-removal via the membrane lung with enough oxygen supply through the non-ventilated lung. By means of suitable materials, and using CO2 gas priming procedure and employing prostacyclin analogons to inhibit thrombocyte aggregation, it was possible to lower the heparine dosage to a minimum.

  1. Mobile Extracorporeal Membrane Oxygenation Teams: The North American Versus the European Experience.

    Science.gov (United States)

    Nwozuzu, Adambeke; Fontes, Manuel L; Schonberger, Robert B

    2016-12-01

    To evaluate differences in the inclusion of anesthesiologists in mobile extracorporeal membrane oxygenation (ECMO) teams between North American and European centers. A retrospective review of North American versus European mobile ECMO teams. The search terms used to identify relevant articles were the following: "extracorporeal membrane transport," "mobile ECMO," and "interhospital transport." MEDLINE review of articles. None. None. Between 1986 and 2015, 25 articles were published that reported the personnel makeup of mobile ECMO teams in North America and Europe: 6 from North American centers and 19 from European centers. The included articles reported a total of 1,329 cases: 389 (29%) adult-only cohorts and 940 (71%) mixed-age cohorts. Among North American studies, 0 of 6 (0%) reported the presence of an anesthesiologist on the mobile ECMO team in contrast to European studies, in which 10 of 19 (53%) reported the inclusion of an anesthesiologist (Fisher exact p for difference = 0.05). In terms of number of cases, this discrepancy translated to 543 total cases in North America (all without an anesthesiologist) and 499 cases in Europe (37%) including an anesthesiologist on the team (Fisher exact p for difference<0.001). This study demonstrated significant geographic discrepancies in the inclusion of anesthesiologists on mobile ECMO teams, with European centers more likely to incorporate an anesthesiologist into the mobile ECMO process compared with North American centers. Copyright © 2016. Published by Elsevier Inc.

  2. MRI-guided therapeutic ultrasound: Temperature feedback control for extracorporeal and endoluminal applicators

    Science.gov (United States)

    Salomir, Rares

    2005-09-01

    Therapeutic ultrasound is a mini-invasive and promising tool for in situ ablation of non-resectable tumors in uterus, breast, esophagus, kidney, liver, etc. Extracorporeal, endoluminal, and interstitial applicators have been successfully tested to date. Magnetic resonance imaging (MRI) is the only available technique providing non-invasive temperature mapping, together with excellent contrast of soft tissue. Coupling of these two technologies offers the advantage of both: (1) on line spatial guidance to the target region, and (2) thermal dose control during the treatment. This talk will provide an overview of the author's experience with automatic, active feedback control of the temperature evolution in tissues, which has been demonstrated with MRI compatible extracorporeal transducers (focused beam) or endoluminal applicators (plane waves). The feedback loop is based on fast switching capabilities of the driving electronics and real time data transfer out of the MR scanner. Precision of temperature control was typically better than 1°C. This approach is expected to improve the efficacy of the treatment (complete tumor ablation) and the thermal security of the critical regions crossed by the acoustic beam. It also permits one to reach an under-lethal heating regime for local drug delivery using thermosensitive liposomes or gene expression control based on hsp promoters.

  3. [Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

    Science.gov (United States)

    Liu, Yan; Cui, Hu-jun; Tao, Liang; Chen, Xu-fa

    2011-04-01

    To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

  4. First experience using cultured epidermal autografts in Taiwan for burn victims of the Formosa Fun Coast Water Park explosion, as part of Japanese medical assistance.

    Science.gov (United States)

    Matsumura, Hajime; Harunari, Nobuyuki; Ikeda, Hiroto

    2016-05-01

    On June 27, 2015, a flammable starch-based powder exploded at Formosa Fun Coast in Taipei, Taiwan, injuring 499 people, and more than 200 people were in critical condition with severe burns. Although a cultured epidermal autograft (CEA) was not approved or used in clinical practice, the Taiwan Food and Drug Administration requested a Japanese CEA manufacturer to donate CEA for the burn victims as part of international medical assistance. The authors cooperated in this project and participated in the patient selection, wound bed management for CEA, and technical assistance for CEA use. Here, we provide an overview of the project. Nine patients were enrolled, and two patients were excluded from the skin biopsy; seven skin biopsies were collected approximately 1 month after the disaster. The average TBSA% burned was 81.0%, and the mean age was 20.1 years. CEA was grafted in five patients; wound closure had been obtained in one patient, and one patient was severely ill at the time of grafting. The CEA was combined with a wide split auto mesh graft or patch graft. The mean re-epithelization rate at 4 weeks after the grafting was 84.2% by patient, and all of the patients survived. Although this project had many obstacles to overcome, CEA grafting was successful and contributed to wound closure and survival. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  5. Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

    Directory of Open Access Journals (Sweden)

    L. Baverel

    2017-01-01

    Full Text Available Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months, the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.

  6. Bone tunnel change develops within two weeks of double-bundle anterior cruciate ligament reconstruction using hamstring autograft: A comparison of different postoperative immobilization periods using computed tomography.

    Science.gov (United States)

    Shimizu, Ryo; Adachi, Nobuo; Ishifuro, Minoru; Nakamae, Atsuo; Ishikawa, Masakazu; Deie, Masataka; Ochi, Mitsuo

    2017-10-01

    The purpose of this study was to evaluate bone tunnel changes following anterior cruciate ligament (ACL) reconstruction during the early postoperative period using computed tomography (CT), and to understand the impact of postoperative immobilization on these changes. Twenty patients who underwent double-bundle ACL reconstruction using hamstring tendon autografts were included. We subcategorized patients into two groups: patients who underwent isolated ACL reconstruction and had three days of knee immobilization (Group A, n=10); and patients with concomitant meniscus injuries who underwent ACL reconstruction and meniscus repair simultaneously (Group B, n=10) had their knees immobilized for two weeks after surgery. Bone tunnel enlargement was evaluated using CT imaging at one to three days, two weeks, one month, three months and six months after surgery. The cross-sectional area of the femoral and tibial tunnels was measured, and enlargement rate was calculated. The tunnel center location at two weeks after surgery was also evaluated. The mean cross-sectional area adjacent to the joint space of the femoral and tibial tunnels significantly increased immediately after surgery, especially in the first month (P0.01). There was no significant difference in tunnel enlargement rate between group A and B. Tunnel center location changed even in the first two weeks. Bone tunnel enlargement following double-bundle ACL reconstruction occurred at an earlier time point after surgery than anticipated. Postoperative immobilization could not prevent bone tunnel enlargement, but might prevent tunnel migration. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Oxygenation and hemodynamics in left and right cerebral hemispheres during induction of veno-arterial extracorporeal membrane oxygenation.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Liem, D.; Hopman, J.C.W.; Staak, F.H.J.M. van der; Sengers, R.C.A.

    2004-01-01

    OBJECTIVE: Oxygenation and hemodynamics in the left and right cerebral hemispheres were measured during induction of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). STUDY DESIGN: Using near infrared spectrophotometry, effects of right common carotid artery (RCCA) and right internal

  8. Growing Up After Critical Illness: Verbal, Visual-Spatial, and Working Memory Problems in Neonatal Extracorporeal Membrane Oxygenation Survivors

    NARCIS (Netherlands)

    Madderom, M.J.; Schiller, R.M.; Gischler, S.J.; Heijst, A.F.J. van; Tibboel, D.; Aarsen, F.K.; Ijsselstijn, H.

    2016-01-01

    OBJECTIVES: To assess neuropsychologic outcome in 17- and 18-year-old neonatal extracorporeal membrane oxygenation survivors. DESIGN: A prospective longitudinal follow-up study. SETTING: Follow-up program at the Erasmus MC-Sophia Children's Hospital in Rotterdam, The Netherlands. PATIENTS: Thirty

  9. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season : A randomized clinical trial

    NARCIS (Netherlands)

    Zwerver, Johannes; Hartgens, Fred; Verhagen, Evert; van der Worp, Henk; van den Akker-Scheek, Inge; Diercks, Ronald

    Background: Patellar tendinopathy is a common overuse injury among jumping athletes. No evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment but its effectiveness has not been studied in athletes with patellar tendinopathy who have

  10. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy : A pilot study

    NARCIS (Netherlands)

    Zwerver, J.; Dekker, F.; Pepping, G.J.

    2010-01-01

    Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be

  11. An exploratory study with an adaptive continuous intravenous furosemide regimen in neonates treated with extracorporeal membrane oxygenation

    NARCIS (Netherlands)

    M.M.J. van der Vorst (Maria); J. den Hartigh (Jan); E.D. Wildschut (Enno); D. Tibboel (Dick); J. Burggraaf (Jacobus)

    2007-01-01

    textabstractIntroduction: The objective of the present study was to explore a continuous intravenous furosemide regimen that adapts to urine output in neonates treated with extracorporeal membrane oxygenation (ECMO). Methods: Seven neonates admitted to a paediatric surgical intensive care unit for

  12. Use of Extracorporeal Membrane Oxygenation in a Fulminant Course of Amniotic Fluid Embolism Syndrome Immediately after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Jae Ha Lee

    2016-08-01

    Full Text Available Amniotic fluid embolism is rare but is one of the most catastrophic complications in the peripartum period. This syndrome is caused by a maternal anaphylactic reaction to the introduction of fetal material into the pulmonary circulation. When amniotic fluid embolism is suspected, the immediate application of extracorporeal mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (ECMO or cardiopulmonary bypass should be considered. Without the application of extracorporeal mechanical circulatory support, medical supportive care might not be sufficient to maintain cardiopulmonary stabilization in severe cases of amniotic fluid embolism. In this report, we present the case of a 36-year-old pregnant woman who developed an amniotic fluid embolism immediately after a cesarean section. Her catastrophic event started with the sudden onset of severe hypoxia, followed by circulatory collapse within 8 minutes. The veno-arterial mode of extracorporeal membrane oxygenation was initiated immediately. She was successfully resuscitated but with impaired cognitive function. Thus, urgent ECMO should be considered when amniotic fluid embolism syndrome is suspected in patients presenting acute cardiopulmonary collapse.

  13. Unexpected difficulties in randomizing patients in a surgical trial: A prospective study comparing extracorporeal shock wave lithotripsy with open cholecystectomy

    NARCIS (Netherlands)

    P.W. Plaisier; M.Y. Berger (Marjolein); R.L. van der Hul (René); H.G. Nijs (Huub); R. den Toom (Rene); O.T. Terpstra (Onno); H.A. Bruining (Hajo); S.M. Strasberg (S.)

    1994-01-01

    textabstractShortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the

  14. Veno-venous extracorporeal membrane oxygenation using an innovative dual-lumen cannula following implantation of a total artificial heart.

    Science.gov (United States)

    Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

    2017-01-01

    We report our first clinical use of the new Protek Duo TM cannula for peripheral veno-venous extra-corporeal life support (ECLS). A 53-year-old male patient underwent implantation of a total artificial heart (TAH) for biventricular failure. However, due to the development of post-operative respiratory dysfunction, the patient required ECLS for six days.

  15. Ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation: effects on cerebral oxygenation and hemodynamics.

    NARCIS (Netherlands)

    Heyst, A.F.J. van; Staak, F.H.J.M. van der; Hopman, J.C.W.; Tanke, R.B.; Sengers, R.C.A.; Liem, K.D.

    2003-01-01

    OBJECTIVE: To investigate the effect on cerebral oxygenation and hemodynamics of a patent ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation in a lamb model. DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a

  16. Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction: A systematic review.

    Science.gov (United States)

    Dashe, Jesse; Parisien, Robert L; Cusano, Antonio; Curry, Emily J; Bedi, Asheesh; Li, Xinning

    2016-06-18

    To evaluate whether anterior cruciate ligament (ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate. A literature search was conducted using PubMed, Cochrane, and Google. The following search terms were used: "Gamma irradiation AND anterior cruciate ligament AND allograft" with a return of 30 items. Filters used included: English language, years 1990-2015. There were 6 hits that were not reviewed, as there were only abstracts available. Another 5 hits were discarded, as they did not pertain to the topic of interest. There were 9 more articles that were excluded: Three studies were performed on animals and 6 studies were meta-analyses. Therefore, a total of 10 articles were applicable to review. There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft. Of note, low dose irradiation is considered less than 2.0 Mrad, moderate dose is between 2.1-2.4 Mrad, and high dose is greater than or equal to 2.5 Mrad. Based upon the results of the literature search, the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures. The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion. Utilization of higher dose (≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction. Allograft ACL graft gamma irradiated with less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age.

  17. Biology of food irradiation

    International Nuclear Information System (INIS)

    Murray, D.R.

    1990-01-01

    The author presents his arguments for food scientists and biologists that the hazards of food irradiation outweigh the benefits. The subject is discussed in the following sections: introduction (units, mutagenesis, seed viability), history of food irradiation, effects of irradiation on organoleptic qualities of staple foods, radiolytic products and selective destruction of nutrients, production of microbial toxins in stored irradiated foods and loss of quality in wheat, deleterious consequences of eating irradiated foods, misrepresentation of the facts about food irradiation. (author)

  18. Correcting Effect of Therapeutic Doses of Optical Radiation on Hematological Parameters of Blood Irradiated In Vivo

    Science.gov (United States)

    Zalesskaya, G. A.; Laskina, O. V.

    2017-07-01

    We studied the effect of therapeutic doses of optical radiation on the hematological parameters of blood irradiated in vivo: hemoglobin concentration, hematocrit, and the number of erythrocytes in the peripheral blood of patients during courses of extracorporeal, overvein, and intravenous blood irradiation and after treatment. The reversible changes during the procedures were found to differ from the changes obtained after treatment completion. At the end of the treatment course, the hematological parameters had changed in different directions and became higher, the same, or lower than the initial parameters depending on the initial parameters and photoinduced changes in blood oxygenation. A compensatory effect was found for photohemotherapy on oxygen-dependent processes altering the oxygen inflow into cells as well as the generation of active oxygen species and their inhibition by antioxidant systems.

  19. Comparison of extra-corporeal knot-tying suture and metallic endo-clips in laparoscopic appendiceal stump closure in uncomplicated acute appendicitis

    Directory of Open Access Journals (Sweden)

    M. Nadeem

    2016-01-01

    Conclusion: The use of metallic endoclip for appendix stump closure is safe and less time consuming but costs higher. Because of the simplicity of the technique it's a useful alternative to the extracorporeal knotting especially for learners.

  20. Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery.

    Science.gov (United States)

    Bartko, Philipp E; Wiedemann, Dominik; Schrutka, Lore; Binder, Christina; Santos-Gallego, Carlos G; Zuckermann, Andreas; Steinlechner, Barbara; Koinig, Herbert; Heinz, Gottfried; Niessner, Alexander; Zimpfer, Daniel; Laufer, Günther; Lang, Irene M; Distelmaier, Klaus; Goliasch, Georg

    2017-07-28

    Extracorporeal membrane oxygenation following cardiac surgery safeguards end-organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk-prediction models in this vulnerable patient cohort. Of 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60-74), and 74 patients were male. During a median follow-up of 27 months (interquartile range 16-63), 75 patients died. Fifty-one patients died within 30 days, 75 during long-term follow-up (median follow-up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function ( P <0.001 for receiver operating characteristics comparisons). Specifically, RV free-wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score-3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24-0.68; P =0.001) for 30-day mortality and 0.48 (95%CI 0.33-0.71; P <0.001) for long-term mortality for a 1-SD (SD=-6%) change in RV free-wall strain. Combined assessment of the additive EuroSCORE and RV free-wall strain improved risk classification by a net reclassification improvement of 57% for 30-day mortality ( P =0.01) and 56% for long-term mortality ( P =0.02) compared with the additive EuroSCORE alone. RV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves

  1. Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

    Science.gov (United States)

    Ghannoum, Marc; Yates, Christopher; Galvao, Tais F.; Sowinski, Kevin M.; Vo, Thi Hai Vân; Coogan, Andrew; Gosselin, Sophie; Lavergne, Valery; Nolin, Thomas D.; Hoffman, Robert S.

    2014-01-01

    Abstract Context. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence and consensus-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Objectives. To perform a systematic review and provide clinical recommendations for ECTR in carbamazepine poisoning. Methods. After a systematic literature search, the subgroup extracted the data and summarized the findings following a pre-determined format. The entire workgroup voted via a two-round modified Delphi method to reach a consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote determined the final recommendations. Results. Seventy-four articles met inclusion criteria. Articles included case reports, case series, descriptive cohorts, pharmacokinetic studies, and in-vitro studies; two poor-quality observational studies were identified, yielding a very low quality of evidence for all recommendations. Data on 173 patients, including 6 fatalities, were reviewed. The workgroup concluded that carbamazepine is moderately dialyzable and made the following recommendations: ECTR is suggested in severe carbamazepine poisoning (2D). ECTR is recommended if multiple seizures occur and are refractory to treatment (1D), or if life-threatening dysrhythmias occur (1D). ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation are present (2D) or if significant toxicity persists, particularly when carbamazepine concentrations rise or remain elevated, despite using multiple-dose activated charcoal (MDAC) and supportive measures (2D). ECTR should be continued until clinical improvement is apparent (1D) or the serum carbamazepine concentration is below 10 mg/L (42 the μ in μmol/L looks weird.) (2D). Intermittent hemodialysis is the preferred ECTR (1D), but both intermittent hemoperfusion (1D) or continuous

  2. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite.

    Science.gov (United States)

    Schlaudraff, Kai-Uwe; Kiessling, Maren C; Császár, Nikolaus Bm; Schmitz, Christoph

    2014-01-01

    Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height. Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires. The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, Pcellulite grade at baseline, BMI, weight, height, or age. Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight

  3. Lung transplantation for idiopathic pulmonary arterial hypertension on intraoperative and postoperatively prolonged extracorporeal membrane oxygenation provides optimally controlled reperfusion and excellent outcome.

    Science.gov (United States)

    Moser, Bernhard; Jaksch, Peter; Taghavi, Shahrokh; Muraközy, Gabriella; Lang, Georg; Hager, Helmut; Krenn, Claus; Roth, Georg; Faybik, Peter; Bacher, Andreas; Aigner, Clemens; Matilla, José R; Hoetzenecker, Konrad; Hacker, Philipp; Lang, Irene; Klepetko, Walter

    2018-01-01

    Lung transplantation for idiopathic pulmonary arterial hypertension has the highest reported postoperative mortality of all indications. Reasons lie in the complexity of treatment of these patients and the frequent occurrence of postoperative left ventricular failure. Transplantation on intraoperative extracorporeal membrane oxygenation support instead of cardiopulmonary bypass and even more the prolongation of extracorporeal membrane oxygenation into the postoperative period helps to overcome these problems. We reviewed our experience with this concept. All patients undergoing bilateral lung transplantation for idiopathic pulmonary arterial hypertension on intraoperative extracorporeal membrane oxygenation with or without prophylactic extracorporeal membrane oxygenation prolongation into the postoperative period between January 2000 and December 2014 were retrospectively analysed. Forty-one patients entered the study. Venoarterial extracorporeal membrane oxygenation support was prolonged into the postoperative period for a median of 2.5 days (range 1-40). Ninety-day, 1-, 3- and 5-year survival rates for the patient collective were 92.7%, 90.2%, 87.4% and 87.4%, respectively. When compared with 31 patients with idiopathic pulmonary arterial hypertension transplanted in the same period of time without prolongation of extracorporeal membrane oxygenation into the postoperative period, the results compared favourably (83.9%, 77.4%, 77.4%, and 77.4%; P = 0.189). Furthermore, these results are among the best results ever reported for this particularly difficult patient population. Bilateral lung transplantation for idiopathic pulmonary arterial hypertension with intraoperative venoarterial extracorporeal membrane oxygenation support seems to provide superior outcome compared with the results reported about the use of cardiopulmonary bypass. Prophylactic prolongation of venoarterial extracorporeal membrane oxygenation into the early postoperative period provides

  4. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months

    Directory of Open Access Journals (Sweden)

    Schulz AP

    2013-11-01

    Full Text Available Arndt P Schulz,1 Vivien Lange,2 Justus Gille,1 Christine Voigt,3 Susanne Fröhlich,4 Markus Stuhr,1 Christian Jürgens5 1Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany; 2Department of Rehabilitation, Sana Regio Klinikum, Wedel, Germany; 3Department of Sports Medicine and Arthroscopy, Diakoniekrankenhaus Friederikenstift, Hannover, Germany; 4Department of Orthopedics, University of Rostock, Rostock, Germany; 5Department of Orthopedics, Trauma, and Sports Medicine, BG Trauma Hospital Hamburg, Hamburg, Germany Introduction: Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods: The study population included 55 patients, of whom 24 were female (43.6%. The mean age at the index procedure was 31.7 years (15–58 years. All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months after the index procedure. The International Knee Documentation Committee (IKDC subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results: Graft harvesting was possible in all cases

  5. Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning

    DEFF Research Database (Denmark)

    Roberts, Darren M; Yates, Christopher; Megarbane, Bruno

    2015-01-01

    in Poisoning workgroup aimed to develop evidence-based consensus recommendations for extracorporeal treatment in methanol poisoning. DESIGN AND METHODS: Utilizing predetermined methods, we conducted a systematic review of the literature. Two hundred seventy-two relevant publications were identified...... to methanol: coma, seizures, new vision deficits, metabolic acidosis with blood pH ≤7.15, persistent metabolic acidosis despite adequate supportive measures and antidotes, serum anion gap higher than 24 mmol/L; or, serum methanol concentration 1) greater than 700 mg/L (21.8 mmol/L) in the context...... of fomepizole therapy, 2) greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment, 3) greater than 500 mg/L or 15.6 mmol/L in the absence of an alcohol dehydrogenase blocker; in the absence of a methanol concentration, the osmolal/osmolar gap may be informative; or, in the context of impaired...

  6. Central extracorporeal membrane oxygenation requiring pulmonary arterial venting after near-drowning.

    Science.gov (United States)

    Kimura, Mitsutoshi; Kinoshita, Osamu; Fujimoto, Yoshifumi; Murakami, Arata; Shindo, Takahiro; Kashiwa, Koichi; Ono, Minoru

    2014-02-01

    Extracorporeal membrane oxygenation (ECMO) is an effective respiratory and circulatory support in patients in refractory cardiogenic shock or cardiac arrest. Peripheral ECMO sometimes requires left heart drainage; however, few reports state that pulmonary arterial (PA) venting is required during ECMO support. We present a case of a 14-year-old boy who required PA venting during ECMO support after resuscitation from near-drowning in freshwater. A biventricular assist device with an oxygenator implantation was intended on day 1; however, we were unable to proceed because of increasing of pulmonary vascular resistance from the acute lung injury. Central ECMO with PA venting was then performed. On day 13, central ECMO was converted to biventricular assist device with an oxygenator, which was removed on day 16. This case suggests that PA venting during ECMO support may be necessary in some cases of respiratory and circulatory failure with high pulmonary vascular resistance after near-drowning.

  7. Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Luke Cameron Northey

    2015-01-01

    Full Text Available Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE. A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient′s hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

  8. Radiologic contribution to the extracorporeal lithotripsy treatment of calyceal diverticular calculi

    International Nuclear Information System (INIS)

    Papanicolaou, N.; Pfister, R.C.; Stafford, S.A.

    1987-01-01

    The authors reviewed the radiologic studies in 19 patients with calyceal diverticular calculi treated with extracorporeal lithotripsy (EL) in order to establish criteria predicting successful outcome. Pre-EL imaging was performed to evaluate the size of calculus in relation to the diverticular cavity, and the width of the connection of the diverticulum to the adjacent calyx. Post-EL studies were performed to assess fragmentation and passage of fragments. EL fragmented calculi in 15 diverticula with cavities larger than stone volume. Complete passage of fragments was shown in five patients and partial passage in two, all with wide diverticular necks. No passage was seen in eight diverticular with fragmented calculi, five of which had narrow or nondemonstrable necks. The radiologic demonstration of large diverticular correlates well with effective EL fragmentation, and a wide neck results in satisfactory fragment passage. Calculi in tight, narrowly communicating diverticula are unlikely to respond to EL

  9. Variables influencing radiation exposure during extracorporeal shock wave lithotripsy. Review of 298 treatments

    International Nuclear Information System (INIS)

    Carter, H.B.; Naeslund, E.B.R.; Riehle, R.A. Jr.

    1987-01-01

    Retrospective review of 298 extracorporeal shock wave lithotripsy (ESWL) treatments was undertaken to determine the factors which influence radiation exposure during ESWL. Fluoroscopy time averaged 160 seconds (3-509), and the average number of spot films taken per patient was 26 (5-68). The average stone burden was 19.3 mm (3-64). Average calculated skin surface radiation exposure was 17.8 R per treatment. Radiation exposure increased with increasing stone burden and patient weight. Stones treated in the ureter resulted in a higher average patient radiation exposure than for renal stones (19 R vs 16 R), even though the average size of these ureteral stones (11.3 mm) was significantly less than the mean. However, type of anesthetic (general or regional) used was not a significant factor. Operator training, experience, and familiarity with radiation physics should significantly decrease the amount of imaging time and consequent patient radiation exposure during ESWL

  10. Clinical experience with the mini-extracorporeal circulation system: an evolution or a revolution?

    Science.gov (United States)

    Remadi, Jean-Paul; Marticho, Paul; Butoi, Irina; Rakotoarivelo, Zava; Trojette, Faouzi; Benamar, Amar; Beloucif, Sadek; Foure, Dominique; Poulain, Henri J

    2004-06-01

    We studied a cohort of 150 patients operated on with a new cardiopulmonary bypass (CPB) system. This is the mini-extracorporeal circulation (MECC) system. The MECC is a fully heparin coated closed-loop CPB system that includes a centrifugal pump and has a priming volume of 450 mL. Between March 2001 and September 2002, 150 consecutive patients were operated on using the mini-CPB (MECC) method. This includes 105 coronary artery bypass graft and 45 aortic valve replacement patients. The median age was 66.7 +/- 10.7 years with a gender ratio of 3.27 males to 1 female. The 30-day operative mortality was 1.3%. The hemoglobin concentration was stable and perioperative transfusion was needed in only 6% of all patients. The renal and neuropsychiatric complications were less than 1%. In our experience, the MECC system is a reliable new concept for CPB with good clinical results.

  11. Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases

    Directory of Open Access Journals (Sweden)

    Dushyant Nadar

    2000-01-01

    Full Text Available Objective: Use of extracorporeal shock waves in the treatment of tendinopathy and other orthopedic diseases. Patients and methods: 35 patients received shock wave therapy using Econolith 2000 lithotripter 19 patients had isolated lateral epicondylitis, 12 medical epicondylitis and 4 plantar fascitis. A total of 120 shock waves were given in the first sitting. Each patient received a total of three sittings with a gap of one week between each of them. Results: Based on the patients′ self-assessment, about 75% pain relief was observed in 60% of the patients. Fur-ther, in patients having isolated tendinopathies, the pain relief was better. Conclusion: The study indicated that the application of shock waves is not restricted to the fragmentation of urinary calculi. The shock waves can be effectively used for the pain relief in the common orthopedic diseases. Thus, the urologists can widen the application of lithotripters, in a cost-effective manner, to the other medical speciali-ties.

  12. The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

    Directory of Open Access Journals (Sweden)

    Ju-Hee Park

    2016-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

  13. Practice Trends in the Use of Extracorporeal Treatments for Poisoning in Four Countries

    DEFF Research Database (Denmark)

    Ghannoum, Marc; Lavergne, Valery; Gosselin, Sophie

    2016-01-01

    Extracorporeal treatments (ECTRs) such as hemodialysis (HD), enhance the elimination of a small number of toxins. Changes in overdose trends, prescribing practices, antidotes, and dialysis techniques may alter the indications and rates of ECTR use over time. This study analyzed trends in ECTR...... for poisonings in four countries. A retrospective study of national poison center databases from the United States, Denmark, United Kingdom, and five regional databases within Canada was performed. All cases of patients receiving an ECTR were included. ECTR cases were totalled annually and reported as annual......; Denmark, salicylates. A high number of ECTRs were performed for atypical toxins such as acetaminophen and benzodiazepines. These data demonstrate a growing use of HD for poisoning with significant regional variations in the overall rates and indications....

  14. Can a dual-energy computed tomography predict unsuitable stone components for extracorporeal shock wave lithotripsy?

    Science.gov (United States)

    Ahn, Sung Hoon; Oh, Tae Hoon; Seo, Ill Young

    2015-09-01

    To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (penergy values (p<0.001). DECT improved the characterization of urinary stone components and was a useful method for identifying uric acid and calcium oxalate monohydrate stones, which are unsuitable for ESWL.

  15. Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Young Kun Lee

    2015-08-01

    Full Text Available Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN, for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.

  16. Retrograde intrarenal stone surgery for extracorporeal shock-wave lithotripsy-resistant kidney stones

    DEFF Research Database (Denmark)

    Jung, Helene; Nørby, Bettina; Osther, Palle Jörn

    2006-01-01

    OBJECTIVE: The newer flexible ureteroscopes, 150-200-microm holmium YAG laser fibres and superflexible Dormia baskets have made it possible to reach and treat stones in all parts of the kidney. The object of this evaluation was to study the outcome of retrograde intrarenal stone surgery (RIRS......) for extracorporeal shock-wave lithotripsy (ESWL)-resistant kidney stones. MATERIAL AND METHODS: A total of 38 consecutive patients (18 males, 20 females) participated in the study. All patients had undergone ESWL prior to RIRS without success. In all cases the stones could be reached with the endoscope. Calculi...... ranged in size from 3 to 20 mm (mean 9 mm). In 32 cases the stones were fragmented using a holmium YAG laser and in six the stones could be extracted using zero-tip Dormia baskets without fragmentation. Sixteen patients had lower calyceal calculi and eight had an abnormal anatomy of the upper urinary...

  17. H3N2 Virus as Causative Agent of ARDS Requiring Extracorporeal Membrane Oxygenation Support

    Directory of Open Access Journals (Sweden)

    Adriano Peris

    2014-01-01

    Full Text Available Pandemic influenza virus A(H1N1 2009 was associated with a higher risk of viral pneumonia in comparison with seasonal influenza viruses. The influenza season 2011-2012 was characterized by the prevalent circulation of influenza A(H3N2 viruses. Whereas most H3N2 patients experienced mild, self-limited influenza-like illness, some patients were at increased risk for influenza complications because of age or underlying medical conditions. Cases presented were patients admitted to the Intensive Care Unit (ICU of ECMO referral center (Careggi Teaching Hospital, Florence, Italy. Despite extracorporeal membrane oxygenation treatment (ECMO, one patient with H3N2-induced ARDS did not survive. Our experience suggests that viral aetiology is becoming more important and hospitals should be able to perform a fast differential diagnosis between bacterial and viral aetiology.

  18. Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

    Directory of Open Access Journals (Sweden)

    Syed Omar Kazmi

    2018-01-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is a life-saving technique that is widely being used in centers throughout the world. However, there is a paucity of literature surrounding the mechanisms affecting cerebral physiology while on ECMO. Studies have shown alterations in cerebral blood flow characteristics and subsequently autoregulation. Furthermore, the mechanical aspects of the ECMO circuit itself may affect cerebral circulation. The nature of these physiological/pathophysiological changes can lead to profound neurological complications. This review aims at describing the changes to normal cerebral autoregulation during ECMO, illustrating the various neuromonitoring tools available to assess markers of cerebral autoregulation, and finally discussing potential neurological complications that are associated with ECMO.

  19. The Inflammatory Response to Miniaturised Extracorporeal Circulation: A Review of the Literature

    Directory of Open Access Journals (Sweden)

    Hunaid A. Vohra

    2009-01-01

    Full Text Available Conventional cardiopulmonary bypass can trigger a systemic inflammatory response syndrome similar to sepsis. Aetiological factors include surgical trauma, reperfusion injury, and, most importantly, contact of the blood with the synthetic surfaces of the heart-lung machine. Recently, a new cardiopulmonary bypass system, mini-extracorporeal circulation (MECC, has been developed and has shown promising early results in terms of reducing this inflammatory response. It has no venous reservoir, a reduced priming volume, and less blood-synthetic interface. This review focuses on the inflammatory and clinical outcomes of using MECC and compares these to conventional cardio-pulmonary bypass (CCPB. MECC has been shown to reduce postoperative cytokines levels and other markers of inflammation. In addition, MECC reduces organ damage, postoperative complications and the need for blood transfusion. MECC is a safe and viable perfusion option and in certain circumstances it is superior to CCPB.

  20. Extracorporeal shock wave treatment for shoulder calcific tendonitis: a systematic review

    International Nuclear Information System (INIS)

    Mouzopoulos, G.; Tzurbakis, M.; Stamatakos, M.; Mouzopoulos, D.

    2007-01-01

    The treatment of patients with calcific tendonitis is typically conservative, including physical therapy, iontophoresis, deep friction, local or systemic application of noninflammatory drugs, needle irrigation-aspiration of calcium deposit, and subacromial bursal steroid injection. If the pain becomes chronic or intermittent after several months of conservative treatment, arthroscopic and open procedures are available to curette the calcium deposit, and additional subacromial decompression can be performed if necessary. As an alternative, minimally invasive extracorporeal shock wave therapy (ESWT) has been postulated to be an effective treatment option for treating calcific tendinitis of the shoulder, before surgery. Herein we discuss the indications, mechanism of therapeutic effect, efficacy of treatment, and complications after ESWT application. (orig.)