Deployment performance and retrievability of the Cook Celect vena cava filter.

PURPOSE: To test the safety, performance, and retrievability of the Cook Celect vena cava filter. MATERIALS AND METHODS: Twenty female or castrated male sheep were implanted with two Celect filters in series, in the inferior vena cava. The animals were divided into five groups of four animals according to day of filter retrieval. Filter retrieval occurred at approximately 30, 60, 90, 180, and 360 days after implantation. At each time point, two sheep underwent retrieval attempts of both the cranial and caudal filters. These animals were recovered for 30 days, at which time healing was assessed. In two additional sheep at each time point, retrieval of only the cranial filter was attempted and the caudal filter was left in situ. These sheep were euthanized after retrieval, and the segment of vena cava encompassing the sites of both the retrieved filter and the filter left in situ was excised for gross and histopathologic analysis. RESULTS: Retrieval attempts occurred at 34, 62, 90, 188, and 393 days after implantation. All retrievals were successful (30 of 30). Tilt was detected in eight filters at implantation; six had self-centered before retrieval. At retrieval, no filter migration or deformation was reported. All filters were retrieved with acceptable levels of force. At each time point, there was evidence of mild intimal hyperplasia at the filter anchoring sites and no evidence of vena cava injury. CONCLUSIONS: The Celect vena cava filter was safely used as a retrievable filter for up to 393 days in an ovine model.

Transcatheter placement of a low-profile biodegradable pulmonary valve made of small intestinal submucosa: a long-term study in a swine model.

OBJECTIVE: We sought to investigate a placement of a percutaneous low-profile prosthetic valve constructed of small intestinal submucosa in the pulmonary position in a swine model. METHODS: Twelve female farm pigs were stented at the native pulmonary valve to induce pulmonary insufficiency. Once right ventricular dilation occurred, the small intestinal submucosa valve was implanted. The pigs were followed up with transthoracic echocardiographic Doppler scanning. One animal died of heart failure before valve replacement. Animals were euthanized at 1 day, 1 month, 3 months, 6 months, and 12 months after valve implantation. RESULTS: The small intestinal submucosa pulmonary valve showed effective reversal of pulmonary regurgitation. There were no misplacements during deployment. There were no embolizations. One-year echocardiographic follow-up showed minimal regurgitation and no stenosis for a valve/vessel ratio of 0.78 or greater. Histologic examination demonstrated intensive remodeling of the small intestinal submucosal valve. Within 1 month, the surface was covered by endothelium, and fibroblasts invaded the interior. Over the following months, the small intestinal submucosal valve remodeled without apparent graft rejection. CONCLUSION: The small intestinal submucosa valve has the potential for graft longevity without the need for anticoagulation or immunosuppression. Histologic remodeling of the valve tissue provides a replacement capable of resembling a native valve that can be placed percutaneously with low-profile delivery systems.

Atopic dermatitis: an overview for the nurse practitioner.

PURPOSE: To provide the primary care provider (PCP) with a review of the clinical presentation, aggravating factors, and basic options for treatment of atopic dermatitis (AD). DATA SOURCES: Selected scientific literature and clinical experiences of the author. CONCLUSIONS: AD is a common, chronic skin condition that is frequently seen in both children and adults. Although AD can be challenging to treat, a number of therapeutic options exist to help alleviate the pruritus and rash that accompany the disorder. IMPLICATIONS FOR PRACTICE: The PCP can manage AD in most patients by prescribing avoidance measures, good skin care, antihistamines, and conservative topical medications. Patients with more severe disease may require aggressive therapies such as phototherapy, balneo-phototherapy, or systemic agents.