ABSTRACT
BACKGROUND: Dutch patients with an implantable cardioverter defibrillator (ICD) are restricted from driving for two months after implantation or shocks. This requires significant lifestyle adjustments and is one of the primary concerns of ICD patients. Previous studies indicated that compliance with the driving restrictions is poor, but insight in socio-demographic, clinical and psychological factors associated with compliance is limited. Hence, this study aimed to explore compliance with the driving restrictions and associated factors in a large sample of Dutch ICD patients. METHOD: Dutch ICD patients (N = 313) completed an elaborative set of questionnaires at time of implantation and at four months after implantation, assessing socio-demographic, psychological and driving-related characteristics. Clinical data were collected from the patients' medical records. RESULTS: A substantial subgroup (28%) of the patient sample (median age 64 (interquartile range = 55-71), 81% male) reported to have been noncompliant with the driving restrictions. Univariate analysis indicated that noncompliant patients more often considered refusing the ICD due to the restrictions, compared to compliant patients (19% versus 10%, p = 0.02). Multivariate analysis showed that the feeling of understanding the reason behind the driving restrictions was associated with better compliance (odds ratio = 2.16, 95% confidence interval 1.02-4.56, p = 0.04). No other socio-demographic, clinical, psychological or driving-related factors were associated with compliance. CONCLUSION: A large number of ICD patients does not comply with the driving restrictions after implantation. This study emphasised the importance of the patient's feeling of understanding the reason behind the restrictions.
ABSTRACT
A technique was developed to isolate the hepatic circulation from the general circulation using a double lumen intracaval shunt. Low flow normothermic perfusion of the liver was performed for 1 hr 25 min in pigs. All pigs survived the procedure. The isolated liver perfusion without chemotherapy (n = 11) was well tolerated as monitored by hepatic enzymes and histologic examination during and after the operation. Mild transient elevations of SGOT and LDH returned to normal values within 1 week. No significant pathological alterations were found in the liver biopsies. Twenty-two pigs were subjected to isolated liver perfusion with 20, 40, or 80 mg 5-FU/kg. Up to four times the conventional dose of the drug could safely be administered when a washout was performed. To evaluate the efficacy of the isolation a method for leakage detection was developed, using tracer quantities of 99mTc-labeled red blood cells. This method was sensitive and permitted continuous monitoring of leakage. Negligible leakage was found during 15 isolated liver perfusions. The described technique of isolated liver perfusion was a reliable and technically feasible method, and has been adapted for clinical use to evaluate its value in the treatment of hepatic metastases.
