Publications by authors named "Amir Ashrafi"

18 Publications

  • Page 1 of 1

Management of Congenital Diaphragmatic Hernia Treated With Extracorporeal Life Support: Interim Guidelines Consensus Statement From the Extracorporeal Life Support Organization.

ASAIO J 2021 02;67(2):113-120

Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston and Children's Memorial Hermann Hospital, Houston, Texas.

The management of infants with congenital diaphragmatic hernia (CDH) receiving extracorporeal life support (ECLS) is complex. Significant variability in both practice and prevalence of ECLS use exists among centers, given the lack of evidence to guide management decisions. The purpose of this report is to review existing evidence and develop management recommendations for CDH patients treated with ECLS. This article was developed by the Extracorporeal Life Support Organization CDH interest group in cooperation with members of the CDH Study Group and the Children's Hospitals Neonatal Consortium.
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http://dx.doi.org/10.1097/MAT.0000000000001338DOI Listing
February 2021

Bis(2,2'-bipyridil)Copper(II) Chloride Complex: Tyrosinase Biomimetic Catalyst or Redox Mediator?

Materials (Basel) 2020 Dec 29;14(1). Epub 2020 Dec 29.

Department of Chemistry and Biochemistry, Mendel University in Brno, CZ-613 00 Brno, Czech Republic.

In this article, construction of amperometric sensor(s) based on screen-printed carbon electrodes covered by thin layers of two types of carbon nanomaterials serving as amplifiers, and containing [Cu(bipy)Cl]Cl∙5HO complex is reported. Their performance and biomimetic activity towards two selected neurotransmitters (dopamine and serotonin) was studied mainly using flow injection analysis (FIA). The important parameters of FIA such as working potential, flow rate, and pH were optimized. The mechanism of the catalytic activity is explained and experimentally confirmed. It reveals that presence of hydrogen peroxide plays a crucial role which leads to answer the title question: can presented complex really be considered as a tyrosinase biomimetic catalyst or only as a redox mediator?
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http://dx.doi.org/10.3390/ma14010113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795177PMC
December 2020

Label-Free DNA Biosensor Using Modified Reduced Graphene Oxide Platform as a DNA Methylation Assay.

Materials (Basel) 2020 Nov 3;13(21). Epub 2020 Nov 3.

Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1665/1, 613 00 Brno, Czech Republic.

This work reports the use of modified reduced graphene oxide (rGO) as a platform for a label-free DNA-based electrochemical biosensor as a possible diagnostic tool for a DNA methylation assay. The biosensor sensitivity was enhanced by variously modified rGO. The rGO decorated with three nanoparticles (NPs)-gold (AuNPs), silver (AgNPs), and copper (CuNPs)-was implemented to increase the electrode surface area. Subsequently, the thiolated DNA probe (single-stranded DNA, ssDNA-1) was hybridized with the target DNA sequence (ssDNA-2). After the hybridization, the double-stranded DNA (dsDNA) was methylated by M.SssI methyltransferase (MTase) and then digested via a HpaII endonuclease specific site sequence of CpG (5'-CCGG-3') islands. For monitoring the MTase activity, differential pulse voltammetry (DPV) was used, whereas the best results were obtained by rGO-AuNPs. This assay is rapid, cost-effective, sensitive, selective, highly specific, and displays a low limit of detection (LOD) of 0.06 U·mL. Lastly, this study was enriched with the real serum sample, where a 0.19 U·mL LOD was achieved. Moreover, the developed biosensor offers excellent potential in future applications in clinical diagnostics, as this approach can be used in the design of other biosensors.
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http://dx.doi.org/10.3390/ma13214936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663213PMC
November 2020

Postoperative Outcomes and Advantages of Hand-Sewn Laparoscopic One-Anastomosis Gastric Bypass: Experience on 805 Patients.

Obes Surg 2021 Feb 13;31(2):627-633. Epub 2020 Oct 13.

Department of Surgery, Laparoscopic Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: One-anastomosis gastric bypass (OAGB) is a novel laparoscopic approach. The anastomosis of OAGB can be sewn either with a stapler or manually. The aim of this study is to determine the outcome of hand-sewn OAGB.

Materials And Methods: A total of 805 consecutive patients were retrospectively enrolled in this study. Data collection included change in weight, body mass index (BMI), symptoms, and complications before surgery and continued during annual follow-up visits up to 5 years. Inclusion criteria were patients with a BMI of higher than 40 kg/m or higher than 35 kg/m with one severe comorbidity. Patients with BMI > 50 kg/m were referred to dieticians.

Results: The follow-up rate ranged from 93 to 50% at the 1-year and 5-year visits after surgery, respectively. Mean weight and BMI of patients before surgery were 121.93 kg (± 22.92) and 44.79 kg/m (± 6.07), respectively. Mean of annual BMI in 5 years of follow-up were 27.83, 27.26, 28.90, 29.45, and 29.56 kg/m. Excess weight loss (EWL) in 5 years of follow-up were 85.7%, 89.5%, 78.9%, 77.7%, and 76.0%. Reflux was present in 202 patients (25.1%) before surgery and resolved in 153 cases (75.7%) 1 year after surgery. Procedure-specific early complication was an anastomosis leak in one patient, which led to death. Two cases of malnutrition necessitating reversal and two severe reflux disorders leading to Roux-en-Y bypass surgery were remarkable late complications.

Conclusion: Hand-sewn anastomosis could represent an efficient and safe technique in the management of patients undergoing OAGB surgery with acceptable outcomes and rare adverse complications.
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http://dx.doi.org/10.1007/s11695-020-04981-8DOI Listing
February 2021

An Investigation on the Electrochemical Behavior and Antibacterial and Cytotoxic Activity of Nickel Trithiocyanurate Complexes.

Materials (Basel) 2020 Apr 10;13(7). Epub 2020 Apr 10.

Faculty of Electrical Engineering and Communication, Department of Microelectronics, Brno University of Technology, Technicka 3058/10, CZ-616 00 Brno, Czech Republic.

The electrochemical redox behavior of three trinuclear Ni(II) complexes [Ni(abb)(HO)(µ-ttc)](ClO) (), [Ni(tebb)(HO)(µ-ttc)](ClO)·HO (), and [Ni(pmdien)(µ-ttc)](ClO) (), where abb = 1-(1H-benzimidazol-2-yl)-N-(1H-benzimidazol-2-ylmethyl)methan-amine, ttcH = trithiocyanuric acid, tebb = 2-[2-[2-(1H-benzimidazol-2-yl)ethylsulfanyl]ethyl]-1H-benzimidazole, and pmdien = N,N,N',N″,N″-pentamethyldiethylenetriamine is reported. Cyclic voltammetry (CV) was applied for the study of the electrochemical behavior of these compounds. The results confirmed the presence of ttc and nickel in oxidation state +2 in the synthesized complexes. Moreover, the antibacterial properties and cytotoxic activity of complex was investigated. All the complexes show antibacterial activity against and to different extents. The cytotoxic activity of complex and ttcNa were studied on G-361, HOS, K-562, and MCF7 cancer cell lines. It was found out that complex possesses the cytotoxic activity against the tested cell lines, whereas ttcNa did not show any cytotoxic activity.
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http://dx.doi.org/10.3390/ma13071782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179009PMC
April 2020

Application of the Enzymatic Electrochemical Biosensors for Monitoring Non-Competitive Inhibition of Enzyme Activity by Heavy Metals.

Sensors (Basel) 2019 Jul 3;19(13). Epub 2019 Jul 3.

Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic.

The inhibition effect of the selected heavy metals (Ag, Cd, Cu, and Hg) on glucose oxidase (GOx) enzyme from (EC 1.1.3.4.) was studied using a new amperometric biosensor with an electrochemical transducer based on a glassy carbon electrode (GCE) covered with a thin layer of multi-wall carbon nanotubes (MWCNTs) incorporated with ruthenium(IV) oxide as a redox mediator. Direct adsorption of multi-wall carbon nanotubes (MWCNTs) and subsequent covering with Nafion layer was used for immobilization of GOx. The analytical figures of merit of the developed glucose (Glc) biosensor are sufficient for determination of Glc in body fluids in clinical analysis. From all tested heavy metals, mercury(II) has the highest inhibition effect. However, it is necessary to remember that cadmium and silver ions also significantly inhibit the catalytic activity of GOx. Therefore, the development of GOx biosensors for selective indirect determination of each heavy metal still represents a challenge in the field of bioelectroanalysis. It can be concluded that amperometric biosensors, differing in the utilized enzyme, could find their application in the toxicity studies of various poisons.
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http://dx.doi.org/10.3390/s19132939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651500PMC
July 2019

Preparation and Characterization of Carbon Paste Electrode Bulk-Modified with Multiwalled Carbon Nanotubes and Its Application in a Sensitive Assay of Antihyperlipidemic Simvastatin in Biological Samples.

Molecules 2019 Jun 13;24(12). Epub 2019 Jun 13.

Department of Microelectronics, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 3058/10, CZ-616 00 Brno, Czech Republic.

Determination of an antihyperlipidemic drug simvastatin (SIM) was carried out using a carbon paste electrode bulk-modified with multiwalled carbon nanotubes (MWCNT-CPE). Scanning electrochemical microscopy (SECM), scanning electron microscopy (SEM), and atomic force microscopy (AFM) were used for the characterization of the prepared electrodes. Different electrodes were prepared varying in mass percentage of MWCNTs to find out the optimum amount of MWCNTs in the paste. The MWCNT-CPE in which the mass percentage of MWCNTs was 25% () was found as the optimum. Then, the prepared electrode was used in a mechanistic study and sensitive assay of SIM in pharmaceutical dosage form and a spiked human plasma sample using differential pulse voltammetry (DPV). The prepared electrode shows better sensitivity compared to the bare carbon paste and glassy carbon electrode (GCE). The detection limit and the limit of quantification were calculated to be 2.4 × 10 and 8 × 10, respectively. The reproducibility of the electrode was confirmed by the low value of the relative standard deviation (RSD% = 4.8%) when eight measurements of the same sample were carried out. Determination of SIM in pharmaceutical dosage form was successfully performed with a bias of 0.3% and relative recovery rate of 99.7%. Furthermore, the human plasma as a more complicated matrix was spiked with a known concentration of SIM and the spiking recovery rate was determined with the developed method to be 99.5%.
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http://dx.doi.org/10.3390/molecules24122215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6630724PMC
June 2019

An Investigation on the Application of Pulsed Electrodialysis Reversal in Whey Desalination.

Int J Mol Sci 2019 Apr 18;20(8). Epub 2019 Apr 18.

MemBrain s. r. o. (Membrane Innovation Center), Pod Vinicí 87, 471 27 Stráž pod Ralskem, Czech Republic.

Electrodialysis (ED) is frequently used in the desalination of whey. However, the fouling onto the membrane surface decreases the electrodialysis efficiency. Pulsed Electrodialysis Reversal (PER), in which short pulses of reverse polarity are applied, is expected to decrease the fouling onto membrane surface during ED. Three (PER) regimes were applied in the desalination of acid whey (pH ≤ 5) to study their effects on the membrane fouling and the ED efficiency. The PER regimes were compared to the conventional ED as the control. For each regime, two consecutive runs were performed without any cleaning step in-between to intensify the fouling. After the second run, the membranes were subjected to the Scanning electron microscope (SEM) imaging and contact angle measurement to investigate the fouling on the membrane surface in different regimes. The ED parameters in the case of conventional ED were almost the same in the first and the second runs. However, the parameters related to the ED efficiency including ED capacity, ash transfer, and ED time, were deteriorated when the PER regimes were applied. The contact angle values indicated that the fouling on the diluate side of anion exchange membranes was more intensified in conventional ED compared to the PER regimes. The SEM images also showed that the fouling on the diluate side of both cation and anion exchange membranes under PER regimes was reduced in respect to the conventional ED. However, the back transfer to the diluate compartment when the reverse pulse was applied is dominant and lowers the ED efficiency slightly when the PER is applied.
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http://dx.doi.org/10.3390/ijms20081918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515537PMC
April 2019

Left ventricular cardiac output is a reliable predictor of extracorporeal life support in neonates with congenital diaphragmatic hernia.

J Perinatol 2019 05 5;39(5):648-653. Epub 2019 Mar 5.

CHOC Children's Hospital, Division of Neonatology, Orange, CA, USA.

Objective: Congenital diaphragmatic hernia (CDH) is a treatable condition but despite optimal management, some patients require extracorporeal life support (ECLS). This study evaluates the association of left ventricular (LV) cardiac output and the need for ECLS.

Study Design: Single center, retrospective chart review from 1/1/2012 through 7/1/2018. Twenty-seven patients met criteria for evaluation with six patients (22%) requiring ECLS. Echocardiography was used to assess ventricular function.

Results: There was a statistically significant decrease in LV cardiac index of 1.33 L /min/m vs 1.80 L /min/m (p = 0.04) for patients requiring ECLS and non-ECLS, respectively. There was no difference between the 2 groups with regards to vasoactive medication use, surfactant use, iNO use, severity of pulmonary hypertension, or right ventricular (RV) function.

Conclusion: In newborns with CDH, decreased LV cardiac output is more strongly associated with need for ECLS than severity of pulmonary hypertension or RV dysfunction.
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http://dx.doi.org/10.1038/s41372-019-0348-3DOI Listing
May 2019

Management strategies for the preemie ductus.

Curr Opin Cardiol 2019 01;34(1):41-45

Division of Neonatology, Cook Children's Medical Center, Fort Worth, Texas, USA.

Purpose Of Review: Patent ductus arteriosus (PDA) remains the most common cardiovascular condition afflicting neonates. Despite 5 decades of scientific inquiry pediatric cardiologists and neonatologists still cannot answer the simple question of which PDAs should be treated.

Recent Findings: Although the volume of the shunt is difficult to calculate, echocardiography, biochemical markers, and clinical exam can provide clues to the magnitude and physiologic consequences of the shunt. Epidemiologic data exists showing a positive relationship between a PDA and numerous morbidities. As a result, for most of the 20th and early 21st century, nearly all PDAs where indiscriminately considered to be hemodynamically significant and attempts to close it where initiated shortly after birth. However, no randomized trials of PDA closure have been able to show significant differences between affected and unaffected groups. In fact, surgical ligation has repeatedly been associated with increased morbidities and worse long-term neurodevelopmental outcomes. As a result, most clinicians favor a strategy of watchful waiting.

Summary: In this review, we aim to summarize the scientific literature, along with some of the contemporary biases, that exist with regards to the pathophysiology, genetics, and treatment strategies for the neonatal PDA.
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http://dx.doi.org/10.1097/HCO.0000000000000580DOI Listing
January 2019

MUSCLE-SPARING VERSUS STANDARD POSTEROLATERAL THORACOTOMY IN NEONATES WITH ESOPHAGEAL ATRESIA.

Arq Bras Cir Dig 2018 2;31(2):e1365. Epub 2018 Jul 2.

Department of Neonatalogy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khouzestan, Iran.

Background: The muscle-sparing thoracotomy (MST) has not yet been thoroughly studied and assessed in comparison to the traditional thoracotomy method in newborns.

Aim: To compare the outcomes of MST and standard posterolateral thoracotomy (PLT) in newborns.

Methods: Randomized, controlled, double-blind trial on 40 neonates with esophageal atresia, comparing the time of beginning a surgery until seeing the pleura, the duration of hospitalization in the neonatal intensive care unit, the time in ventilator, the time of returning the shoulder function, the time of returning the Moro reflex, and the mortality between the two techniques.

Results: The data showed no differences between the two groups in basic information (weight, height, gender, numbers of prematurity neonates and caesarean). The results on the size of the scar in the MST group was significantly lower than in the PLT group. Also, the time of returning the shoulder function in MST group was earlier than in PLT group. There were no significant differences in the duration since the beginning the surgery to see the pleura, the time of being hospitalized in intensive unit, the time that the infant required ventilator, returning time of the Moro reflex in 1st and 3rd months after the operation, and the mortality rates between MST and PLT groups.

Conclusion: It seems that the advantages of using MST over PLT procedure in neonates include the earlier shoulder function recovery and also superior cosmetic results.
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http://dx.doi.org/10.1590/0102-672020180001e1365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6044202PMC
February 2019

Effect of pump type on outcomes in neonates with congenital diaphragmatic hernia requiring ECMO.

Perfusion 2018 05;33(1_suppl):71-79

1 Department of Surgery, University of California, Irvine Medical Center, Irvine, CA, USA.

Purpose: With the exception of neonatal respiratory failure, most centers are now using centrifugal over roller-type pumps for the delivery of extracorporeal membrane oxygenation (ECMO). Evidence supporting the use of centrifugal pumps specifically in infants with congenital diaphragmatic hernia (CDH) remains lacking. We hypothesized that the use of centrifugal pumps in infants with CDH would not affect mortality or rates of severe neurologic injury (SNI).

Methods: Infants with CDH were identified within the ELSO registry (2000-2016). Patients were then divided into those undergoing ECMO with rollertype pumps or centrifugal pumps. Patients were matched based on propensity score (PS) for the ECMO pump type based on pre-ECMO covariates. This was done for all infants and separately for each ECMO mode, venovenous (VV) and venoarterial (VA) ECMO.

Results: We identified 4,367 infants who were treated with either roller or centrifugal pumps from 2000-2016. There was no difference in mortality or SNI between the two pump types in any of the groups (all infants, VA-ECMO infants, VV-ECMO infants). However, there was at least a six-fold increase in the odds of hemolysis for centrifugal pumps in all groups: all infants (odds ratio [OR] 6.99, p<0.001), VA-ECMO infants (OR 8.11, p<0.001 and VV-ECMO infants (OR 9.66, p<0.001).

Conclusion: For neonates with CDH requiring ECMO, there is no survival advantage or difference in severe neurologic injury between those receiving roller or centrifugal pump ECMO. However, there is a significant increase in red blood cell hemolysis associated with centrifugal ECMO support.
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http://dx.doi.org/10.1177/0267659118766729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294336PMC
May 2018

Can We Confidently Define "Normal" for Our Neonatal Patients?

J Am Soc Echocardiogr 2017 03;30(3):233-234

Division of Pediatric Cardiology, CHOC Children's Specialists, Orange County, California.

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http://dx.doi.org/10.1016/j.echo.2017.01.006DOI Listing
March 2017

Trace level voltammetric determination of lead and cadmium in sediment pore water by a bismuth-oxychloride particle-multiwalled carbon nanotube composite modified glassy carbon electrode.

Talanta 2015 Mar 13;134:640-649. Epub 2014 Dec 13.

University of Pardubice, Department of Analytical Chemistry, Faculty of Chemical Technology, Studentská 573, 532 10 Pardubice, Czech Republic.

Two multiwalled carbon nanotubes-based composites modified with bismuth and bismuth-oxychloride particles were synthesized and attached to the glassy carbon electrode substrate. The resultant configurations, Bi/MWCNT-GCE and BiOCl/MWNT-GCE, were then characterized with respect to their physicochemical properties and electroanalytical performance in combination with square-wave anodic stripping voltammetry (SWASV). Further, some key experimental conditions and instrumental parameters were optimized; namely: the supporting electrolyte composition, accumulation potential and time, together with the parameters of the SWV-ramp. The respective method with both electrode configurations has then been examined for the trace level determination of Pb(2+) and Cd(2+) ions and the results compared to those obtained with classical bismuth-film modified GCE. The different intensities of analytical signals obtained at the three electrodes for Pb(2+) and Cd(2+) vs. the saturated calomel reference electrode had indicated that the nature of the modifiers and the choice of the supporting electrolyte influenced significantly the corresponding stripping signals. The most promising procedure involved the BiOCl/MWCNT-GCE and the acetate buffer (pH 4.0) offering limits of determination of 4.0 μg L(-1) Cd(2+) and 1.9 μg L(-1) Pb(2+) when accumulating for 120 s at a potential of -1.20 V vs. ref. The BiOCl/MWCNT electrode was tested for the determination of target ions in the pore water of a selected sediment sample and the results agreed well with those obtained by graphite furnace atomic absorption spectrometry.
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http://dx.doi.org/10.1016/j.talanta.2014.12.002DOI Listing
March 2015

Stripping voltammetric determination of mercury(II) at antimony-coated carbon paste electrode.

Talanta 2011 Oct 29;85(5):2700-2. Epub 2011 Jul 29.

Department of Analytical Chemistry, University of Pardubice, Studentská 573, CZ-532 10 Pardubice, Czech Republic.

A new procedure was elaborated to determine mercury(II) using an anodic stripping square-wave voltammetry at the antimony film carbon paste electrode (SbF-CPE). In highly acidic medium of 1M hydrochloric acid, voltammetric measurements can be realized in a wide potential window. Presence of cadmium(II) allows to separate peaks of Hg(II) and Sb(III) and apparently catalyses reoxidation of electrolytically accumulated mercury, thus allowing its determination at ppb levels. Calibration dependence was linear up to 100 ppb Hg with a detection limit of 1.3 ppb. Applicability of the method was tested on the real river water sample.
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http://dx.doi.org/10.1016/j.talanta.2011.07.078DOI Listing
October 2011

Salivary gland tumors in maxillofacial region: a retrospective study of 130 cases in a southern Iranian population.

Patholog Res Int 2011 3;2011:934350. Epub 2011 Jul 3.

Departments of Otolaryngology and Maxillofacial Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Tumors of the salivary glands are uncommon head and neck neoplasia. We conducted a retrospective study of 392 cases over the last 6 years in Shiraz, south of Iran, to investigate the clinicopathological features of these tumors in Iranian population. The age of the patients ranged from 8 to 85 years, with the mean age 44.57 ± 14.65 years and male-to-female (M : F) ratio was 1.02 : 1. For benign tumors, there was a propensity towards females, whereas the malignant tumor was more common in males. The ratio of benign tumors to malignancies was 2.19 : 1. Pleomorphic adenoma (PA) was the most common tumor and accounted for 85% of all benign tumors, followed by Warthin's tumor (8.6%). Of the 125 malignancies, adenoid cystic carcinoma (40%), mucoepidermoid carcinoma (24%) and invasive squamous cell carcinoma (16%) were the most common histological types. Most of the salivary gland tumors (75%) originated from major salivary glands and the remained (25%) originated from minor glands. The parotid gland was the most common site both in benign and malignant tumors. Most of our findings were similar to those in the literature, with some variations. The salivary tumors slightly predominated in males. Adenoid cystic carcinoma and mucoepidermoid carcinoma constituted the most common malignancies.
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http://dx.doi.org/10.4061/2011/934350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137991PMC
November 2011

Kawasaki disease: four case reports of cardiopathy with an institutional and literature review.

Pediatr Dev Pathol 2007 Nov-Dec;10(6):491-9

Department of Pediatrics, Children's Healtcare of Atlanta, Atlanta, GA 30322, USA.

Kawasaki disease (KD) is a systemic vasculitis condition with a relatively unknown etiology. First described in 1967 by Tomisaku Kawasaki in Japan, KD has come to be widely diagnosed in every region of the world. The disease has a high prevalence in children ages 6 months to 5 years, particularly in those of Japanese descent. Patients often present with a high fever, rash, lymphadenopathy, and conjunctival injections, but there is no diagnostic test for KD. This paper presents data from our Kawasaki registry including 99 patients with emphasis on Kawasaki cardiopathy. Three patients died from complications of KD, and 1 patient underwent heart transplant for massive aneurysmal dilatation. The 4 explanted hearts showed a spectrum of pathological findings (acute thrombosis, vasculitis, and myocarditis), and 1 patient showed the long-term sequelae of vasculitis in the form of massive aneurysmal dilatation. Among the survivors, 30% showed aneurysmal dilatation. This paper reviews the most recent information regarding Kawasaki cardiopathy and underlying molecular mechanisms.
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http://dx.doi.org/10.2350/06-10-0172.1DOI Listing
December 2007

Treatment of limb-threatening ischemia with percutaneous intentional extraluminal recanalization: a preliminary evaluation.

J Vasc Surg 2003 Jul;38(1):29-35

Surgical Care Center, Veterans Administration Salt Lake City Health Care System, Salt Lake City, Utah 84148, USA.

Objective: We assessed the technical success, safety, and short-term effectiveness of percutaneous intentional extraluminal recanalization (PIER) in patients with limb-threatening ischemia and no autologous vein or with a major contraindication to surgery.

Methods: From 1999 through 2002, 25 patients with femoropopliteal occlusion and rest pain or tissue loss underwent PIER. Thirteen patients had undergone one or more failed bypass surgeries in the treated lower extremity, and no patient had suitable vein for bypass grafting. In four patients the ejection fraction was less than 15%; four patients had severe nonreconstructable coronary artery disease; and two patients with metastatic cancer refused amputation. All patients underwent subintimal wire placement, followed by percutaneous transluminal angioplasty and intracoil stent placement. Occlusions ranged in length from 6 to 18 cm, and 1 to 10 stents were placed. Technical success required no residual stenosis greater than 30% on arteriography, velocity ratio less than 1.5 on duplex ultrasound scanning, and improvement in ankle-brachial index of 0.15 or greater. Follow-up duplex scanning was performed every 3 months.

Results: Initial success was obtained in 23 of 25 patients (92%), with ankle-brachial index improvement of.31 to.54. All successful procedures resulted in symptomatic improvement. Mean follow-up was 13.3 months (range, 4-30 months). During follow-up, 10 patients died and 2 arteries demonstrated recurrent occlusion. With life table analysis, success rate was 92% at 12 months. Of the 4 patients in whom the procedure failed, 3 required major amputation and symptoms persisted in one. Complications occurred after two procedures, one myocardial infarction and one groin hematoma.

Conclusions: PIER is technically possible in patients with femoropopliteal occlusion, and the procedure is associated with a low complication rate. Most procedures provide at least short-term clinical success and have enabled successful wound healing and pain relief in patients without other effective options. Further studies and longer follow-up are required to determine long-term success and the role of PIER in treatment of femoropopliteal occlusion.
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http://dx.doi.org/10.1016/s0741-5214(03)00080-6DOI Listing
July 2003