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Zeckey C, Frink M, Wilhelmi M, Mommsen P, Brunnemer U, Probst C, Krettek C, Hildebrand F. [Injury to the subclavian and vertebral arteries in childhood following blunt force trauma]. Unfallchirurg 2010; 113:673-5. [PMID: 20411229 DOI: 10.1007/s00113-010-1782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Injuries of great vessels, such as the subclavian or vertebral arteries in childhood are rare. More frequent and therefore better described are dissections of the vertebral artery, which frequently occur following low energy trauma. The combination of dissection of the vertebral and subclavian arteries described in this case study led to sensory affections of the left arm. Therapeutic anticoagulation is the therapy of choice to avoid possible ischemic insults. The therapeutic approach of injuries to the subclavian artery remains unclear and is in the focus of discussions.
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Jarius S, Probst C, Borowski K, Franciotta D, Wildemann B, Stoecker W, Wandinger K. Standardized method for the detection of antibodies to aquaporin-4 based on a highly sensitive immunofluorescence assay employing recombinant target antigen. J Neurol Sci 2010; 291:52-6. [DOI: 10.1016/j.jns.2010.01.002] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 01/06/2010] [Accepted: 01/06/2010] [Indexed: 01/01/2023]
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78
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Dewald O, Vlajnic D, Bernhardt C, Herberg U, Doll U, Schirrmeister J, Esmailzadeh B, Probst C, Heinze I, Thees C, Schmitz C, Welz A, Breuer J. Norwood operation with a RV-PA conduit preserves growth of pulmonary arteries. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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79
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Schiller W, Muders T, Probst C, Vodermayer B, Rieke C, Baumgarten G, Schmid T. First in vivo results with the DLR-VAD in calves. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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80
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Probst C, Kovacs A, Krämer C, Mellert F, Kolvenbach I, Welz A, Schiller W. Follow up in patients after repair of acute type-A aortic dissection – clinical results and anatomical findings using MDCT. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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81
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Probst C, Schulthess F, Cotty PJ. Impact of Aspergillus section Flavi community structure on the development of lethal levels of aflatoxins in Kenyan maize (Zea mays). J Appl Microbiol 2009; 108:600-10. [PMID: 19674186 DOI: 10.1111/j.1365-2672.2009.04458.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the potential role of fungal community structure in predisposing Kenyan maize to severe aflatoxin contamination by contrasting aflatoxin-producing fungi resident in the region with repeated outbreaks of lethal aflatoxicosis to those in regions without a history of aflatoxicosis. METHODS AND RESULTS Fungi belonging to Aspergillus section Flavi were isolated from maize samples from three Kenyan provinces between 2004 and 2006. Frequencies of identified strains and aflatoxin-producing abilities were assessed, and the data were analysed by statistical means. Most aflatoxin-producing fungi belonged to Aspergillus flavus. The two major morphotypes of A. flavus varied greatly between provinces, with the S strain dominant in both soil and maize within aflatoxicosis outbreak regions and the L strain dominant in nonoutbreak regions. CONCLUSIONS Aspergillus community structure is an important factor in the development of aflatoxins in maize in Kenya and, as such, is a major contributor to the development of aflatoxicosis in the Eastern Province. SIGNIFICANCE AND IMPACT OF THE STUDY Since 1982, deaths caused by aflatoxin-contaminated maize have repeatedly occurred in the Eastern Province of Kenya. The current study characterized an unusual fungal community structure associated with the lethal contamination events. The results will be helpful in developing aflatoxin management practices to prevent future outbreaks in Kenya.
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Gethmann J, Hüttner K, Heyne H, Probst C, Ziller M, Beer M, Hoffmann B, Mettenleiter T, Conraths F. Comparative safety study of three inactivated BTV-8 vaccines in sheep and cattle under field conditions. Vaccine 2009; 27:4118-26. [DOI: 10.1016/j.vaccine.2009.04.072] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 04/17/2009] [Accepted: 04/25/2009] [Indexed: 12/01/2022]
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83
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Knobloch K, Wagner S, Haasper C, Probst C, Krettek C, Vogt P, Otte D, Richter M. Retraction notice to "Sternal fractures are frequent among polytraumatised patients following high deceleration velocities in a severe vehicle crash" [Injury 39 (2008) 36-43]. Injury 2009; 40:571. [PMID: 19418609 DOI: 10.1016/j.injury.2009.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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84
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Meyer C, Probst C, Strunk H, Schiller W, Wilhelm K. Second-Generation Amplatzer Vascular Plug (AVP) for the Treatment of Subsequent Subclavian Backflow Type II Endoleak After TEVAR. Cardiovasc Intervent Radiol 2009; 32:1264-7. [PMID: 19280256 DOI: 10.1007/s00270-009-9517-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 12/22/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
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85
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Liodakis E, Hildebrand F, Frink M, Mommsen P, Krettek C, Probst C. [Heparin-induced thrombocytopenia and liver hemorrhage following polytrauma]. Chirurg 2009; 80:872-4. [PMID: 19212729 DOI: 10.1007/s00104-009-1671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Up to 3% of patients receiving unfractioned heparin develop heparin-induced thrombocytopenia (HIT). We report on a polytrauma patient who developed severe HIT with bilateral pulmonary embolism. Lepirudin treatment resulted initially in rapid improvement. Ten days after discharge the patient complained of abdominal pain. A large subcapsular hepatic hematoma was diagnosed, requiring repeat surgery and ending in secondary sclerosing cholangitis. This process can potentially be avoided by regular tests of lepirudin concentration and coagulation.
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Probst C, Schiller W, Strach K, Sommer T, Welz A, Mellert F. Is what we measure really what we measure? – Planing of transapical valve procedure using MDCT and transesophageal echo. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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87
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Haasper C, Otte D, Probst C, Müller CW, Panzica M, Frink M, Hesse E, Stübig T, Richter M, Hüfner T, Krettek C. [Injury situation of novice drivers in road traffic--a medical and technical analysis]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2008; 146:747-53. [PMID: 19085724 DOI: 10.1055/s-2008-1038977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Novice drivers are at high risk for crash involvement. We performed an analysis of causations, injury patterns and distributions of novice drivers in cars and on motorcycles in road traffic as a basis for proper measurements. METHOD Data of accident and hospital records of novice drivers (licence < 2 years) were analysed focusing on the following parameters: injury type, localisation and mechanism, abbreviated injury scale (AIS), maximum AIS (MAIS), delta-v, collision speed and other technical parameters and compared with those of experienced drivers. RESULTS In 18 352 accidents in the area of Hannover (years 1985-2004), 2602 novice drivers and 18 214 experienced drivers were recorded as having an accident. Novice car drivers were more often and more severely injured whereas on motorcycles the experienced drivers were at higher risk. Novice drivers of both groups sustained more often extremity injuries. 4.5 % of the novice car drivers were not restrained by seatbelts as compared to 3.7 % of the experienced drivers and 6.1 % of the novice motorcycle drivers did not wear a proper helmet (versus 6.5 %). Severe injuries were sustained in 20 % at collision speeds below 30 km/h and in 80 % at collision speeds above 50 km/h. Novice car drivers drove significantly older cars. The risk profile of novice drivers is similar to that of drivers older than 65. CONCLUSION Structural protection and special lectures like skidding courses could be proper measurements next to harder punishment of violations.
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Probst C, Richter M, Haasper C, Lefering R, Otte D, Oestern HJ, Krettek C, Hüfner T. [Trauma and accident documentation in Germany compared with elsewhere in Europe]. Chirurg 2008; 79:650-6. [PMID: 18351306 DOI: 10.1007/s00104-008-1498-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of trauma documentation has grown continuously since the 1970s. Prevention and management of injuries were adapted according to the results of many analyses. Since 1993 there have been two different trauma databases in Germany: the German trauma registry (TR) and the database of the Accident Research Unit (UFO). Modern computer applications improved the data processing. Our study analysed the pros and cons of each system and compared them with those of our European neighbours. METHODS We compared the TR and the UFO databases with respect to aims and goals, advantages and disadvantages, and current status. Results were reported as means +/- standard errors of the mean. The level of significance was set at P<0.05. RESULTS There were differences between the two databases concerning number and types of items, aims and goals, and demographics. The TR documents care for severely injured patients and the clinical course of different types of accidents. The UFO describes traffic accidents, accident conditions, and interrelations. The German and British systems are similar, and the French system shows interesting differences. DISCUSSION The German trauma documentation systems focus on different points. Therefore both can be used for substantiated analyses of different hypotheses. Certain intersections of both databases may help to answer very special questions in the future.
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Probst C, Schiller W, Welz A, Kovacs A. Intimal flap movement in aortic Stanford type-A dissection visualized by 64-slice computed tomography. Eur J Cardiothorac Surg 2008; 34:452. [PMID: 18524613 DOI: 10.1016/j.ejcts.2008.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 04/16/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022] Open
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90
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Tschernatsch M, Klotz M, Probst C, Hosch J, Valtorta F, Diener M, Gerriets T, Kaps M, Schäfer K, Blaes F. Synaptophysin is an autoantigen in paraneoplastic neuropathy. J Neuroimmunol 2008; 197:81-6. [DOI: 10.1016/j.jneuroim.2008.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 03/21/2008] [Accepted: 03/25/2008] [Indexed: 11/28/2022]
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Probst C, Esmailzadeh B, Schiller W, Wilhelm K. Emergent antegrade endovascular stent placement in a patient with perforated Stanford B dissection via right axillary artery. Eur J Cardiothorac Surg 2008; 33:1148-9. [DOI: 10.1016/j.ejcts.2008.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 11/28/2022] Open
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92
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Mirzayan MJ, Probst C, Krettek C, Samii M, Pape HC, van Griensven M, Samii A. Systemic effects of isolated brain injury: an experimental animal study. Neurol Res 2008; 30:457-460. [DOI: 10.1179/174313208x276907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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93
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Prasse A, Probst C, Bargagli E, Rottoli P, Zissel G, Müller-Quernheim J. Serum CCL18 Konzentrationen haben einen prognostischen Wert bei der Idiopathischen Lungenfibrose. Pneumologie 2008. [DOI: 10.1055/s-2008-1074430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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94
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Oszwald M, Probst C, Bader C, Krettek C. [Accidental abdominal needlestick injury incurred while discarding a disposal container]. Unfallchirurg 2008; 111:455-8. [PMID: 18389200 DOI: 10.1007/s00113-007-1374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Needlestick injuries routinely occur in everyday clinical practice. Adequate instruction of employees in health care and correct prophylaxis against exposure could conspicuously reduce the incidence. Successful prevention of chronic infectious diseases comprises strict vaccination plans and substantial knowledge of post-exposure prophylaxis. The introduction of self-securing cannulas and injection instruments represents an important technological advance.
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Damoiseaux J, Dähnrich C, Rosemann A, Probst C, Komorowski L, Stegeman CA, Egerer K, Hiepe F, van Paassen P, Stöcker W, Schlumberger W, Tervaert JWC. A novel enzyme-linked immunosorbent assay using a mixture of human native and recombinant proteinase-3 significantly improves the diagnostic potential for antineutrophil cytoplasmic antibody-associated vasculitis. Ann Rheum Dis 2008; 68:228-33. [DOI: 10.1136/ard.2007.086579] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Antineutrophil cytoplasmic antibodies (ANCA) with a C-ANCA or P-ANCA pattern are detected in ANCA-associated vasculitis (AAV). While in most patients with AAV a C-ANCA pattern is due to reactivity with proteinase-3 (PR3)-ANCA, some C-ANCA-positive sera do not react with PR3.Objective:The development and evaluation of a direct enzyme-linked immunosorbent assay (ELISA) for PR3-ANCA with increased sensitivity.Methods:A mixture of human native (hn) and human recombinant (hr) PR3 was used as antigen coating. The resulting ELISA (anti-PR3-hn-hr) was compared with ELISAs using directly coated hn-PR3 or hr-PR3, as well as with a hn-PR3 capture ELISA. Assay characteristics were determined in patients with AAV (n = 248), with special attention for those patients with C-ANCA (n = 132), as well as disease controls (n = 585) and healthy controls (n = 429). Additionally, for prediction of relapses serial samples of 46 patients with PR3-AAV were analysed.Results:At a predefined specificity of 99% both ELISAs containing hr-PR3 revealed a substantial increase in sensitivity. For the prediction of relapses by rises in PR3-ANCA titres the capture ELISA was most optimal (odds ratio 12.5). With an odds ratio of 8.9 the novel anti-PR3-hn-hr ELISA was second best.Conclusions:Owing to the very high sensitivity of the novel anti-PR3-hn-hr ELISA for the detection of PR3-ANCA in C-ANCA-positive samples of patients with AAV this assay has an excellent diagnostic performance. This feature is combined with a good predictability of clinical relapses in patients with PR3-AAV. These characteristics challenge the dogma that, for detection of PR3-ANCA, capture ELISAs are superior for diagnosis and follow-up.
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Probst C, Hildebrand F, Frink M, Mommsen P, Krettek C. [Prehospital treatment of severely injured patients in the field: an update]. Chirurg 2008; 78:875-84. [PMID: 17882391 DOI: 10.1007/s00104-007-1410-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Life or extremity threatening injuries have to be diagnosed and treated rapidly by emergency physicians during prehospital care for severely injured patients. The cooperation with other rescue services, the fire brigade and the police must be coordinated and early transportation has to be organized. Rapid sequence intubation by trained personnel for correct indications, such as head injury or severe chest trauma is recommended as well as prehospital chest tube placement in cases of severe or penetrating thoracic injury. Crystalloids and colloidal solutions remain the first choice for intravenous volume replacement. The amount of fluid depends on the individual response, such as palpable peripheral and central pulse for blunt or penetrating trauma. Ultrasound or near infrared spectroscopy could not be routinely implemented for extended prehospital diagnostic procedures. Transportation to the closest appropriate hospital has to be accomplished as early as possible. Helicopters show positive outcomes if the destination is a level I trauma center, even if secondary alarm calls or more extensive measures prolong the prehospital interval.
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Rudorf H, Spiegel K, Schmid T, Probst C, Flacke S, Kovacs A, Liepsch D, Oertel H, Welz A, Schiller W. Numerical flow simulation of the left heart as basis for operation planning for left ventricular repair procedures. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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98
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Probst C, Kovacs A, Schiller W, Wilhelm K, Welz A. Noninvasive imaging for planning endovascular aortic procedures. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1038060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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99
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Schiller W, Rudorf H, Welzel CB, Kiderlen MJ, Probst C, Dewald O, Welz A. Sutureless anastomoses of rabbit carotid arteries with BioGlue. J Thorac Cardiovasc Surg 2007; 134:1513-8. [PMID: 18023675 DOI: 10.1016/j.jtcvs.2007.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 07/24/2007] [Accepted: 08/30/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sutureless anastomoses for coronary artery surgery are being investigated for a minimally invasive setup because they are easy to perform and less time-consuming than are sutured anastomoses. The short-term effects of the biocompatible adhesive BioGlue on vascular tissue have been described as potentially unfavorable. The present study investigates the medium-term macroscopic and histologic effects associated with the use of BioGlue on rabbit carotid arteries. METHODS Thirty-four carotid arteries of 17 New Zealand White rabbits were available. Nine carotid arteries were left unmanipulated and free of glue, 9 carotid arteries had BioGlue applied as a control, and 16 carotid arteries were transected and reanastomosed with the aid of BioGlue and an endovascular balloon. Of the 16 transected arteries, 4 had to be excluded from further evaluation. Angiographic scanning was performed 60 days postsurgery, after which the animals were euthanized and tissue samples were obtained for macroscopic and histologic examination. RESULTS The application of BioGlue resulted in a marked invasion of inflammatory cells. The glue partially degraded and was replaced with connective tissue. Obvious calcification of the arterial wall and the capsule that had formed around the glue was present. Stenoses, thrombi, and pseudoaneurysms were predominantly noted in the glued anastomosis group. CONCLUSION The results of this study raise concerns about the safety of BioGlue in coronary artery surgery. In light of our results, the use of BioGlue in large-vessel vascular surgery should be considered with great care for each individual patient.
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Schiller W, Rudorf H, Tiemann K, Probst C, Mellert F, Welz A. Detection of coronary arteries and evaluation of anastomoses with a commercially available 15-MHz, broadband, linear array transducer. Heart Surg Forum 2007; 10:E387-91. [PMID: 17855204 DOI: 10.1532/hsf98.20071061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In coronary artery bypass surgery the detection of the target vessels can be difficult due to their intramural location, coverage by adipose tissue, calcification, or fibrous tissue formation. Their identification is especially critical during off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) surgeries. Our objectives were to identify whether (1) the epimyocardial use of the broadband linear array transducer CL15-7 allows a clear and rapid identification of the target artery during on-pump coronary bypass (CPB), OPCAB and MIDCAB surgeries; and (2) if this transducer is helpful in investigating the anastomotic morphology with 2D and color flow Doppler. METHODS Thirty-two patients without a visually identifiable left anterior descending artery (LAD) were included in the study and epimyocardial ultrasonography was performed. Stabilization of the beating heart was used in 19 patients; in 13 patients, the surgery was carried out with CPB on the arrested heart. Two-dimensional ultrasound alone, or in combination with color Doppler, was used to identify the affected vessel as well as a suitable anastomosis site. Pulsed wave Doppler had to be used occasionally to differentiate between artery and vein. Patency of the anastomoses was established with color Doppler immediately after reinitiating blood flow. An evaluation of the distal graft diameter, its length, and the quality of the anastomosis was made with 2D and color Doppler. Transit-time Doppler flow was used to confirm patency. RESULTS The LAD could be identified ultrasonographically in all 32 patients at a depth of 3 to 15 mm. The right coronary artery (RCA) was located at a depth of 3 to 10 mm in the 5 patients where this vessel was to be bypassed. The coronary arteries located on the lateral or posterior aspect of the heart could not be reached due to the shape and rigidity of the transducer handle. The intended anastomosis sites of the LAD and RCA were identified with ultrasound according to their topography and morphology. In all cases the vessel could be dissected and bypassed without undue damage or bleeding. In one OPCAB patient, the LAD was identified in close proximity to the overlying vein along the whole of the anterior wall. This resulted in conversion to CPB, thus facilitating secure exposure of the LAD. The ultrasonographic visibility of the left internal mammary artery to LAD and saphenous vein graft to RCA anastomoses was excellent, and patency correlated well with the transit time flow measurements. CONCLUSION The CL15-7 transducer gives excellent near field visibility of the LAD and RCA. This is extremely valuable for the safe dissection of these vessels, especially during off-pump coronary surgery. The anatomical morphology of the anastomoses can be identified but, due to the shape of the transducer handle, only the coronary arteries on the anterior surface of the heart can be evaluated. A flexible, rather than a rigid, hockey stick-shaped handle would eliminate this problem. Training is essential to obtain reliable results.
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