The Organ Procurement and Transplantation Network (OPTN) collects intermittent survey data on immunosuppressive medication use that are studied frequently as research measures. Pharmacy billing claims may provide an accurate measure of immunosuppression use over time. Herein is characterized the agreement of Medicare pharmacy claims for immunosuppressive medications with OPTN reports.
View Article and Find Full Text PDFBackground: The relative benefit versus safety of induction therapy in live-donor renal transplant recipients is controversial. This paper presents observational data of live-donor recipients who received Thymoglobulin induction and standard maintenance immunosuppressive therapy.
Methods: Review and analysis of clinic records and electronic databases of live-donor renal transplants that received Thymoglobulin induction from May 1996 through 2003.
Introduction: Isolated iliac artery aneurysms (IAA) are rare. The rupture risk, however, is high and the diagnosis can be difficult. The aim of this study was to report the frequency, morphology and outcome of these lesions.
View Article and Find Full Text PDFPraxis (Bern 1994)
January 2001
The history and physical examination are extremely important in the management of vascular surgical patients because a correct diagnosis can usually be made on the basis of information obtained from these two modalities. The severity of the chronic occlusive process leads to characteristic symptoms in the extremity: claudication, rest pain, skin ulcerations and gangrene. Chronic progressive lesions permit enlargement of collateral blood supply which, for a time, minimizes the severity of symptoms.
View Article and Find Full Text PDFAcute traumatic rupture of the thoracic aorta (ATRRA) is mainly a consequence of high-speed travel or fall from great altitude. Most of the victims die at the accident scene. Only 10-20% reach the hospital alive.
View Article and Find Full Text PDFProblems of the diabetic foot are frequent. The magnitude of the clinical picture and morbidity mirrors the severity and complexity of the underlying pathobiology. The three pathogenetic mechanism involved are ischemia, neuropathy and infection.
View Article and Find Full Text PDFIn the present study the influence of gender in peripheral arterial reconstructions was evaluated. Between 1986 and 1990 we performed 173 infrainguinal vein bypass procedures in 117 men and 56 women. All procedures were carried out for chronic critical leg ischaemia.
View Article and Find Full Text PDFIn the time between 1984 and 1991 we have performed 136 infrainguinal arterial reconstructions to the supragenicular popliteal artery for lower extremity ischemia. We inserted in 98 cases the greater saphenous vein and in 38 cases a PTFE-prosthesis. Life-table primary patency rate at 5 years was 88% for the vein and 60% for the PTFE-grafts.
View Article and Find Full Text PDFA 38-year-old polytoxicomanic male patient developed an occlusion of both popliteal arteries associated with an aneurysm of the right common iliac artery. A septic cause was suspected and an antimycotic therapy was instituted, but the diameter of the aneurysm increased to 3 cm during 6 months. Moreover, multiple periarterial abscesses occurred.
View Article and Find Full Text PDFPurpose: Description of special techniques for retrograde angioplasty of cerebral arteries with protection of the brain.
Material And Method: During the last 3 years, 51 dilatations of cerebral vessels were carried out in 45 patients; in 8, special techniques were required. In cases with particular operative risks, angioplasty of cerebral vessels can be performed using various techniques (double catheter [8 cases], retrograde PTA [8 cases], kissing balloon technique [3 cases]).
The treatment of varicose veins comprises conservative and active options. Every patient with varices has to be informed on the conservative modalities and should apply them in daily life. Compression therapy, as the most important part of the conservative treatment, should be considered individually for any patient according to the varicose-type, the grade of chronic venous insufficiency and the compliance of the patient.
View Article and Find Full Text PDFAcute mesenteric ischemia (AMI) is still associated with a high mortality rate. Early diagnosis and treatment are mandatory since irreversible bowel damage occurs within a few hours of total ischemia. Reactive vasoconstriction, high postoperative vascular reocclusion rate and the release of toxic substances from the damaged bowel followed by bacterial translocation are all part of the disease process.
View Article and Find Full Text PDFDuring the last five years 54 patients (mean age 69 years) have undergone a unilateral, transgenicular (through-knee) amputation, instead of an impending amputation through the thigh. The indication for surgery was a chronic, or an acute critical ischemia of the leg. In 32 and 22 cases respectively, amputations have been preceded by a multitude of reconstructive measures.
View Article and Find Full Text PDFSeveral patients with chronic critical limb ischemia show angiographically an isolated popliteal segment (IPS) and a single calf vessel (SCV) with no direct communication to the former. In this situation a bypass can be inserted from the common femoral artery to the IPS or to the SCV. The results of 73 bypass procedures--40 to an isolated popliteal segment and 33 to a single calf vessel for limb salvage--were prospectively evaluated.
View Article and Find Full Text PDFObjective: To assess the power of operative flow measurements in the prediction of outcome after infrainguinal bypass operations for critical ischaemia
Design: Open study
Setting: University department of vascular surgery
Subjects: 197 patients operated on for critical ischaemia between 1 January 1982 and 31 December 1989 under the care of one surgeon.
Interventions: Standard operative angiography and measurement of flow of distal runoff
Main Outcome Measures: Patency and limb salvage
Results: All patients were followed up prospectively until 31 March 1991 or death. The estimated 5 year rates of primary patency and limb salvage were 0.
Second-look laparotomy is not always routinely performed after mesenteric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular disease. We developed a minimally invasive technique for second-look laparoscopy with the aim of decreasing the operative morbidity.
View Article and Find Full Text PDFEur J Cardiothorac Surg
April 1995
Pleural empyema is a disease which is not always recognized. Despite consecutive treatment and antibiotics its mortality rate is still high, especially in older patients with concomitant disease or in the case of delayed treatment. We report our experience with early video-assisted thoracoscopic surgery of pleural empyema in 13 patients, where chest tube drainage had failed.
View Article and Find Full Text PDFAt our institution operative repair was undertaken for 67 popliteal aneurysms in 45 patients between 1986 and 1991. In 24 cases emergency surgery was necessary: acute critical ischemia due to thrombosis or embolism in 22 cases, and rupture of the aneurysm in 2 cases. Two patients died within the first 30 postoperative days.
View Article and Find Full Text PDFThe objective of this study was to assess the benefits of intraoperative thrombolysis (IOL) on patients with acute leg ischaemia. This study was conducted in the Department of Cardiovascular Surgery, Inselspital, Berne, Switzerland. IOL was prospectively assessed in 25 patients with infrainguinal limb-threatening ischaemia due to acute thrombosis of atherosclerotic lesions and aneurysms (44%), occluded grafts (32%), arterial injuries (12%), delayed embolism (8%) and trash foot (8%).
View Article and Find Full Text PDFQuantitative and qualitative assessment of intraoperative aspiration and reinfusion of autologous blood with the Solcotrans was carried out in 11 males (52-79 years) undergoing elective resection of abdominal aortic aneurysms. Hematology, blood chemistry, coagulation parameters and complement activation were studied in the patient's blood at the following time points: preoperatively, before and after heparinisation, after retransfusion of the first and last Solcotrans, 6 and 20 hours postoperatively. In addition the same quality control was performed in the first and last Solcotrans blood.
View Article and Find Full Text PDFIn this prospective study we evaluated if atherosclerosis of crural and pedal arteries differs in diabetic and non-diabetic patients suffering from chronic ischemia. We performed intraoperative angiography after completion of a femoro-popliteal or femoro-distal bypass. No statistically significant difference was found between the two groups (25 diabetic and 44 non-diabetic patients) concerning the severity and localisation of the arteriosclerosis in the three crural arteries and the pedal arch.
View Article and Find Full Text PDFAortic diseases in particular aneurysms may be accompanied by spinal ischemia occurring either spontaneously or as complications of surgical interventions. Surgery of the abdominal or thoraco-abdominal aorta is followed in 5 to 15% by ischemia of the spinal cord, in exclusively abdominal interventions in 1.5%.
View Article and Find Full Text PDFCardiovasc Intervent Radiol
December 1992
In a group of 26 patients percutaneous transluminal (balloon) angioplasty (PTA) and stents (Wallstents) were applied and in another 26 matched patients PTA alone was used as primary treatment for femoropopliteal occlusions of 3 cm or longer. Five patients with stents showed early thrombosis necessitating catheter thrombolysis and/or thrombus aspiration. Ten patients had recurrent stenoses within 12 months, mostly due to neointimal hyperplasia.
View Article and Find Full Text PDFBackground: Unsuccessful vascular repair may further preexisting limb ischemia and thus increase the risk of revascularization procedures.
Methods: The results of 94 primary major amputations (group A) have been analyzed and compared with 112 secondary ablations (group B) carried out after failed revascularization efforts. All patients suffered from chronic critical ischemia (grades III and IV) of the lower extremities.
In a retrospective study we evaluated the data regarding 126 patients (96 male/30 female) hospitalized with rib fractures between 1986 and 1989. Fifty percent of the subjects had been in a traffic accident. Eighty-five percent of the patients had 2-7 broken ribs.
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