RESUMEN
OBJECTIVES: Compare the outcome of distal (bypass to the crural arteries) versus ultradistal (bypass to the pedal arteries) bypasses in patients with critical leg ischaemia (CLI). DESIGN: Retrospective analysis of prospectively collected data of patients with CLI undergoing infra-popliteal bypass surgery is performed. MATERIALS AND METHODS: Patients undergoing infra-popliteal bypass at a single institution between 2004 and 2010 are included. Patency rates at 1-year and amputation-free survival at 12 and 48 months are analysed. RESULTS: Two hundred and thirty bypasses were performed in 209 consecutive patients (156 men, median age; 76 years, range; 19-96 years). One hundred and seventy nine (78%) bypass were classified as distal and 51 (22%) as ultradistal. The incidence of diabetes mellitus was significantly higher in the ultradistal group (p=0.0025). At 1-year, the distal group primary, assisted-primary and secondary patency rates were 61.7%, 83.1% and 87.4% compared to 61.9%, 87.4% and 87.4% in the ultradistal group respectively. Amputation-free survival at 12 and 48 months was 82.9% and 61.5% in the distal group compared to 83.0% and 64.9% in the ultradistal group. CONCLUSIONS: This study show that both distal and ultradistal bypass have comparable outcome regardless of the co-morbidities. The authors believe that elderly patients should be offered ultradistal bypass if indicated to avoid major amputation.
Asunto(s)
Amputación Quirúrgica , Arteriopatías Oclusivas/cirugía , Isquemia/cirugía , Extremidad Inferior/irrigación sanguínea , Injerto Vascular/métodos , Grado de Desobstrucción Vascular , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/mortalidad , Arteriopatías Oclusivas/fisiopatología , Distribución de Chi-Cuadrado , Comorbilidad , Enfermedad Crítica , Supervivencia sin Enfermedad , Femenino , Humanos , Isquemia/mortalidad , Isquemia/fisiopatología , Estimación de Kaplan-Meier , Recuperación del Miembro , Londres , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Injerto Vascular/efectos adversos , Injerto Vascular/mortalidad , Adulto JovenRESUMEN
INTRODUCTION: The aim of this study is to analyse the role of cerebral oximetry in combination with awake testing in detecting cerebral ischaemia in patients undergoing carotid endarterectomy (CEA) under local anaesthesia (LA). METHODS: One hundred consecutive patients scheduled for CEA under LA were investigated. Regional oxygen saturation (rSO(2)) was measured with a cerebral oximeter. Cerebral ischaemia was assessed by awake testing in conjunction with rSO(2). Shunting was based solely on deterioration in conscious state assessed by awake testing. The correlation between awake testing and percentage fall in rSO(2) levels was statistically analysed. RESULTS: Patients requiring general anaesthesia were excluded from analysis (n = 17). Seven patients developed deterioration in conscious state and an immediate drop in rSO(2) ≥20% following carotid cross-clamping. Two patients requiring shunting for non-neurological reasons were excluded from analysis. Two patients had a drop in rSO(2) ≥20%, but remained conscious and were not shunted. There were no permanent neurological deficits postoperatively. Statistical analysis showed a sensitivity of 100% with a specificity of 96% yielding a positive predictive value of 81% and negative predictive value of 100% for a ≥19% drop in rSO(2). CONCLUSION: Cerebral oximetry using a cut off ≥19% drop in rSO(2) has a high sensitivity and specificity when compared with awake testing.
Asunto(s)
Anestesia Local/métodos , Isquemia Encefálica/diagnóstico , Arteria Carótida Interna , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/métodos , Monitoreo Intraoperatorio/métodos , Oximetría/métodos , Anciano , Isquemia Encefálica/metabolismo , Isquemia Encefálica/prevención & control , Estenosis Carotídea/metabolismo , Estenosis Carotídea/fisiopatología , Circulación Cerebrovascular , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
Pyrithiones are widely used as bactericides, fungicides, or algicides in a variety of products such as shampoos, metal working fluids, adhesives, sealants, and coatings. This broad antimicrobial activity, along with low water solubility and favorable environmental chemistry, makes zinc pyrithione and copper pyrithione potentially ideal replacements for TBT in marine antifouling paints. Several studies on the toxicity and environ- ⢠mental fate of these pyrithiones have been conducted in freshwater and saltwater systems. Environmental fate studies show that pyrithiones rapidly degrade in the water column to less toxic compounds. Sediment accumulation is also prevented by the facile reduction of a critical functional group under anaerobic conditions. Modeling programs were used to calculate the predicted environmental concentration (PEC) for pyrithione. Comparison of PECs calculated for more persistent antifoulants with actual measured concentrations provided a measure of the bias inherent to the models. The results indicate a pyrithione risk quotient (PEC/PNEC) < 1. The findings are consistent with the absence of ecological effects during the long history of the use of zinc pyrithione as an antidandruff agent.
RESUMEN
1. The metabolism of the thiocarbamate herbicide SUTAN (butylate) was studied after administration of single oral doses of [isobutyl-1-14C]SUTAN to male and female rats. 2. The radiolabelled dose was rapidly absorbed and excreted, with 79% of the dose excreted in the urine in 72 h. The small percentages of radioactivity excreted in the faeces and as 14CO2 were significantly higher (P less than or equal to 0.05) in males than in females. 3. SUTAN was extensively metabolized, and no unmetabolized SUTAN was found in the urine. A total of 18 of the 29 urinary metabolites were identified, and identified metabolites represented 83-88% of the urinary radioactivity. 4. Diisobutylamine was the major urinary metabolite in both males and females, averaging 51% of the urinary radioactivity. 5. Other significant urinary metabolites included primary hydroxylated and tertiary hydroxylated diisobutylamines and a series of mercapturic acid pathway metabolites, including an S-glucuronide and several hydroxylated and unhydroxylated mercapturates. 6. Oxidations at the three alkyl groups produced a variety of minor urinary metabolites, and hydroxylation of the primary or tertiary carbon on the isobutyl groups, followed by an intramolecular reaction, generated a series of minor cyclized metabolites.