ABSTRACT
BACKGROUND: Improving patency of hemodialysis grafts is challenging. Vascular stapling creates nonpenetrating anastomoses, possibly decreasing intimal hyperplasia. We investigated patency and flow characteristics of stapled hemodialysis grafts. METHODS: Eighty-six grafts (41 stapled, 45 sewn) were placed in 84 patients (prospective, randomized). The groups had comparable demographics. RESULTS: Thirty-six grafts were functioning at the study endpoint. Complications in both groups were similar. The primary patency (stapled, 342 days versus sewn, 382 days; P = 0.67) and secondary patency (stapled, 513 days versus sewn, 507 days; P = 0.76) had no significant differences. Flow characteristics were similar between the groups. Thrombectomies per patient-year were 1.01 for stapled grafts and 1.12 for sewn grafts (not significant). Stapling decreased the average operating time by 4.5 minutes. CONCLUSIONS: Stapled and sewn anastomoses have similar primary and secondary patency and flow characteristics, with minimal operative time differences. Stapled anastomoses are safe but had no advantage over sewn anastomoses in this study.
Subject(s)
Blood Vessel Prosthesis Implantation/methods , Graft Occlusion, Vascular/prevention & control , Renal Dialysis , Surgical Stapling , Anastomosis, Surgical/methods , Female , Follow-Up Studies , Humans , Life Tables , Male , Middle Aged , Polytetrafluoroethylene , Prospective Studies , Regional Blood Flow , Suture Techniques , Time Factors , Vascular PatencyABSTRACT
A small study is described in which nurses were asked how they deal with specific management problems in schizophrenia. Their responses suggest that their approach may provide valuable information for both professionals and relatives.
Subject(s)
Adaptation, Psychological , Family , Nurse-Patient Relations , Schizophrenia/nursing , Female , Humans , Male , Nursing Staff, Hospital/psychology , Professional-Family Relations , Schizophrenic Psychology , Surveys and QuestionnairesABSTRACT
1. Twitch fibres isolated from the sartorius muscle of the frog were glycerinated (cf. Heinl, 1972) and thin fibre bundles dissected from the m. ileofibularis of the tortoise were briefly glycerinated as described by Julian (1971).2. The glycerinated fibres (length 0.3-0.5 cm) were fixed to an apparatus which performed length changes within 5 msec and recorded the time course of tension changes in the fibres.3. The fibres were suspended in a relaxing medium, containing ATP and 4 mM-EGTA. Contraction was induced by raising the calcium concentration to 4 mM-CaEGTA.4. The tension time course of activated fibres following quick length changes (0.1-1% L(0)) was studied. The tension records produced by quick releases and stretches could be resolved into four phases similar to the kind shown in Fig. 1 a.5. The phase of quick tension recovery was found to take place more rapidly in frog than in tortoise fibres: it was completed in approximately 30 msec (after stretch) and in approximately 20 msec (after release) in frog fibres (3 degrees C). The corresponding values obtained for tortoise fibres were approximately 300 and approximately 400 msec (3 degrees C).6. In tortoise fibres the size of the elastic and quick recovery phase increased with rising isometric tension (induced by raising the calcium concentration (pCa 8 to 5)), and decreased with increasing sarcomere length (2.5-4.2 mum). In fibres, in which the rigor state was induced by withdrawal of ATP, no quick tension recovery was recorded.7. It is suggested that the rotational movement of the crossbridge head on the actin filament, postulated by Huxley & Simmons (1971 b) is taking place more slowly in the tortoise than in the frog muscle. Furthermore, it is suggested that this rotational movement does not occur in the rigor state, as no quick tension recovery was recorded there.