ABSTRACT
Trichotillomania (compulsive pulling out of hair) is a disorder belonging in the group of obsessive-compulsive disorders, the frequency of which is underestimated. It is a complex clinical condition comprising both compulsive and impulsive elements, which makes it anything but easy to treat. Currently, the best documented treatment options are behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors.
Subject(s)
Trichotillomania , Adolescent , Adult , Antidepressive Agents/therapeutic use , Behavior Therapy , Child , Child, Preschool , Female , Humans , Infant , Male , Prevalence , Self-Help Groups , Sex Factors , Trichotillomania/diagnosis , Trichotillomania/drug therapy , Trichotillomania/epidemiology , Trichotillomania/etiology , Trichotillomania/psychology , Trichotillomania/therapyABSTRACT
PURPOSE: Comparison of the efficacy of VasoSeal and a mechanical compression system (Compressar) for percutaneous hemostasis after femoral arterial catheterization of patients with arterial occlusive disease. MATERIALS AND METHODS: 60 patients underwent either diagnostic angiography or interventional procedures. The level of anticoagulation, blood pressure, and activation clotting time were recorded, and the time to hemostasis after sheath removal was measured. VasoSeal application was considered "successful" if the compression time was less than two minutes. On the subsequent day as well as 4 months later, color coded Doppler ultrasound was performed to register treatment success and potential (late) complications. RESULTS: 57 patients qualified for inclusion in this study. In 21 of the 26 patients who underwent the procedure with the VasoSeal, immediate hemostasis was achieved within 1.75 minutes. In all 31 patients who had the Compressar applied, hemostasis was successful with a mean compression time of 17.4 minutes. Thus, VasoSeal significantly reduced hemostasis time irrespective of anticoagulation status, but it had a much higher incidence of minor local complications (bleeding, hematoma) compared to the control group (34.6 % vs. 5.8 %). The technical success was lower with VasoSeal than with Compressar (81 % vs. 100 %). Both groups had no severe or late complications. CONCLUSION: According to our results, VasoSeal does not provide a suitable alternative compared to the effective, safe and cheap application of Compressar as a hemostatic device.
Subject(s)
Angiography , Catheterization, Peripheral , Collagen/administration & dosage , Femoral Artery/surgery , Hemostatic Techniques/instrumentation , Punctures , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Humans , Male , Middle Aged , Pressure , Prospective Studies , Treatment OutcomeABSTRACT
PURPOSE: The purpose of this study was to investigate in vivo the long-term development, differentiation, and proliferation of the subendothelial tissue on Dacron prostheses seeded with microvascular cells (MVC). METHODS: Autologous MVC from omental adipose tissue were seeded on 4 mm Dacron prostheses and the prostheses interposed in the carotid arteries of mongrel dogs for 5, 13, and 26 weeks. RESULTS: Light and electron microscopic evaluation of patent seeded prostheses demonstrated an almost complete monolayer of endothelial cells and well-organized subendothelial tissue, whereas patent control prostheses were mainly covered by red and white thrombi, which were partially replaced by organized tissue with increased implantation time. The measurements of the thickness of the luminal cell layer in seeded and control grafts showed no statistically significant increase between 5 and 26 weeks of implantation. The subendothelial tissue of seeded prostheses demonstrated a time-dependent maturation of highly synthesizing myofibroblasts embedded in a collagen matrix to cells with features of smooth muscle cells located in a collagen-elastin matrix. In control grafts examined after 26 weeks the spontaneous endothelialization was accompanied by a delayed or incomplete maturation of subendothelial tissue. CONCLUSIONS: Our study indicates that MVC seeded onto Dacron prostheses are able to generate a vascular wall that does not continue to proliferate after prolonged implantation and that increasingly resembles the wall of a normal artery in cell differentiation and intercellular matrix.
Subject(s)
Blood Vessel Prosthesis , Carotid Arteries/cytology , Endothelium, Vascular/cytology , Polyethylene Terephthalates , Animals , Capillary Permeability , Carotid Arteries/surgery , Cell Differentiation , Cell Division , Dogs , Endothelium, Vascular/transplantation , Endothelium, Vascular/ultrastructure , Microscopy, Electron, Scanning , Microscopy, Electron, Scanning Transmission , Surface Properties , Time FactorsABSTRACT
Seeding of small-diameter vascular prostheses (ID less than or equal to 6 mm) with autologous microvascular cells (AMVC) results in a complete endothelial cell layer on the luminal surface. The purpose of this study was to examine the influence of the blood flow velocity (due to 4 or 6 mm ID) and the structure of inner graft surface (crimped, uncrimped) on the endothelialization. AMVC were harvested from omental adipose tissue (mean: 0.56 X 10(6) cells/g tissue) from 10 mongrel dogs (mean: 27.9 kg). During preclotting, the 4 mm uncrimped and the 6 mm crimped double velour Dacron prostheses (Meadox Medicals, Inc.) were seeded with 1.0 X 10(6) cells/cm2 graft surface. Grafts were implanted into the carotid arteries (N = 5 in each group). The animals received antiplatelet therapy. After five weeks, all seeded prostheses were patent. The thrombus free surface (TFS) of seeded prostheses was 99.9% (4 mm) and 90.5% (6 mm). Scanning electron microscopy revealed an athrombogenic layer of endothelial cells on a smooth surface. -It is concluded that in canine experiments endothelialization of 4 and 6 mm grafts after seeding with AMVC is not affected by blood flow velocity or graft structure.
Subject(s)
Blood Vessel Prosthesis , Endothelium, Vascular/pathology , Hemodynamics/physiology , Polyethylene Terephthalates , Animals , Dogs , Microscopy, Electron, Scanning , Prosthesis DesignABSTRACT
Neutrophil infiltration is known to affect the endothelial monolayer of seeded vascular grafts. The aim of this study was to develop an in vitro system allowing the monitoring of neutrophil (PMN) adherence after graft implantation. Dacron prostheses were seeded with autologous canine microvascular cells from omental adipose tissue and implanted for 35 days. In vitro, mature monolayers of canine homologous venous endothelial cells (CHVENC) were exposed to heparinized whole blood samples taken at days one and four postoperatively, followed by weekly tests. PMNs adherent to the CHVENC were counted per culture area. Results showed the feasibility of PMN monitoring, and demonstrated a late PMN adhesion, reaching its maximum about 20 days after implantation and decreasing to normal values after five weeks. It is concluded that in vitro tests can be used for noninvasive studies of host plasma factors and leukocyte activation.
