The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform
Joseph M. Serletti - One of the best experts on this subject based on the ideXlab platform.
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medicinal leeches for surgically uncorrectable Venous Congestion after free flap breast reconstruction
Microsurgery, 2014Co-Authors: Christopher J. Pannucci, Jonas A. Nelson, Cyndi U. Chung, John P. Fischer, Suhail K. Kanchwala, Stephen J. Kovach, Joseph M. SerlettiAbstract:Background: Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable Venous Congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable Venous Congestion after free flap breast reconstruction using medicinal leech therapy. Methods: We queried our prospectively maintained institutional database for all patients with Venous Congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative Venous Congestion. We compared patients with surgically correctable Venous Congestion and surgically uncorrectable Venous Congestion requiring medicinal leech therapy. Results: Twenty-three patients had post-operative Venous Congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 6 3.6 days vs. 6.5 6 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P 5 0.32 and P 5 0.43, respectively). Conclusions: In patients with surgically uncorrectable Venous Congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When Venous Congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy. V C 2014 Wiley Periodicals, Inc. Microsurgery 00:000‐000, 2014.
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Medicinal leeches for surgically uncorrectable Venous Congestion after free flap breast reconstruction
Microsurgery, 2014Co-Authors: Christopher J. Pannucci, Jonas A. Nelson, Cyndi U. Chung, John P. Fischer, Suhail K. Kanchwala, Stephen J. Kovach, Joseph M. SerlettiAbstract:Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable Venous Congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable Venous Congestion after free flap breast reconstruction using medicinal leech therapy. We queried our prospectively maintained institutional database for all patients with Venous Congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative Venous Congestion. We compared patients with surgically correctable Venous Congestion and surgically uncorrectable Venous Congestion requiring medicinal leech therapy. Twenty-three patients had post-operative Venous Congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 ± 3.6 days vs. 6.5 ± 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P = 0.32 and P = 0.43, respectively). In patients with surgically uncorrectable Venous Congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When Venous Congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy. © 2014 Wiley Periodicals, Inc.
Benjamin D. Levine - One of the best experts on this subject based on the ideXlab platform.
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vasoconstriction during Venous Congestion effects of venoarteriolar response myogenic reflexes and hemodynamics of changing perfusion pressure
American Journal of Physiology-regulatory Integrative and Comparative Physiology, 2005Co-Authors: Kazunobu Okazaki, Emily R. Martini, Robin P. Shook, Colin Conner, Rong Zhang, Craig G. Crandall, Benjamin D. LevineAbstract:We dissected the relative contribution of arterioVenous hemodynamics, the venoarteriolar response (VAR), and the myogenic reflex toward a decrease in local blood flow induced by Venous Congestion. ...
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Vasoconstriction during Venous Congestion: effects of venoarteriolar response, myogenic reflexes, and hemodynamics of changing perfusion pressure
American journal of physiology. Regulatory integrative and comparative physiology, 2005Co-Authors: Kazunobu Okazaki, Emily R. Martini, Robin P. Shook, Colin Conner, Rong Zhang, Craig G. Crandall, Benjamin D. LevineAbstract:We dissected the relative contribution of arterioVenous hemodynamics, the venoarteriolar response (VAR), and the myogenic reflex toward a decrease in local blood flow induced by Venous Congestion. Skin blood flow (SkBF) was measured in 12 supine subjects via laser-Doppler flowmetry 1) over areas of forearm and calf skin, in which the VAR was blocked by using eutectic mixture of local anesthetics (EMLA sites) and 2) over the contralateral forearm or calf skin (control sites), using two different techniques: limb dependency of 23-37 cm below the heart and cuff inflation to 40 mmHg. During limb dependency, SkBF decreased at the control sites, whereas it remained unchanged at the EMLA sites. In contrast, during cuff inflation, SkBF decreased at the control sites and also decreased at the EMLA sites. The percent change in SkBF from baseline was greater during cuff inflation than limb dependency at both the control sites and the EMLA sites. Estimated skin vascular resistance remained unchanged at the EMLA sites during cuff inflation, as well as limb dependency. Thus the decrease in SkBF during Venous Congestion with cuff inflation is not solely due to the cutaneous VAR but also to a reduction in local perfusion pressure. The VAR is therefore most specifically quantified by Venous Congestion induced by limb dependency, rather than cuff inflation. Finally, from both techniques, we calculated that during Venous Congestion induced by limb dependency (calf), approximately 45% of the nonbaroreflex vasoconstriction is induced by the VAR and approximately 55% by the myogenic reflex.
Christopher J. Pannucci - One of the best experts on this subject based on the ideXlab platform.
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medicinal leeches for surgically uncorrectable Venous Congestion after free flap breast reconstruction
Microsurgery, 2014Co-Authors: Christopher J. Pannucci, Jonas A. Nelson, Cyndi U. Chung, John P. Fischer, Suhail K. Kanchwala, Stephen J. Kovach, Joseph M. SerlettiAbstract:Background: Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable Venous Congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable Venous Congestion after free flap breast reconstruction using medicinal leech therapy. Methods: We queried our prospectively maintained institutional database for all patients with Venous Congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative Venous Congestion. We compared patients with surgically correctable Venous Congestion and surgically uncorrectable Venous Congestion requiring medicinal leech therapy. Results: Twenty-three patients had post-operative Venous Congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 6 3.6 days vs. 6.5 6 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P 5 0.32 and P 5 0.43, respectively). Conclusions: In patients with surgically uncorrectable Venous Congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When Venous Congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy. V C 2014 Wiley Periodicals, Inc. Microsurgery 00:000‐000, 2014.
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Medicinal leeches for surgically uncorrectable Venous Congestion after free flap breast reconstruction
Microsurgery, 2014Co-Authors: Christopher J. Pannucci, Jonas A. Nelson, Cyndi U. Chung, John P. Fischer, Suhail K. Kanchwala, Stephen J. Kovach, Joseph M. SerlettiAbstract:Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable Venous Congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable Venous Congestion after free flap breast reconstruction using medicinal leech therapy. We queried our prospectively maintained institutional database for all patients with Venous Congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative Venous Congestion. We compared patients with surgically correctable Venous Congestion and surgically uncorrectable Venous Congestion requiring medicinal leech therapy. Twenty-three patients had post-operative Venous Congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 ± 3.6 days vs. 6.5 ± 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P = 0.32 and P = 0.43, respectively). In patients with surgically uncorrectable Venous Congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When Venous Congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy. © 2014 Wiley Periodicals, Inc.
Kazunobu Okazaki - One of the best experts on this subject based on the ideXlab platform.
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vasoconstriction during Venous Congestion effects of venoarteriolar response myogenic reflexes and hemodynamics of changing perfusion pressure
American Journal of Physiology-regulatory Integrative and Comparative Physiology, 2005Co-Authors: Kazunobu Okazaki, Emily R. Martini, Robin P. Shook, Colin Conner, Rong Zhang, Craig G. Crandall, Benjamin D. LevineAbstract:We dissected the relative contribution of arterioVenous hemodynamics, the venoarteriolar response (VAR), and the myogenic reflex toward a decrease in local blood flow induced by Venous Congestion. ...
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Vasoconstriction during Venous Congestion: effects of venoarteriolar response, myogenic reflexes, and hemodynamics of changing perfusion pressure
American journal of physiology. Regulatory integrative and comparative physiology, 2005Co-Authors: Kazunobu Okazaki, Emily R. Martini, Robin P. Shook, Colin Conner, Rong Zhang, Craig G. Crandall, Benjamin D. LevineAbstract:We dissected the relative contribution of arterioVenous hemodynamics, the venoarteriolar response (VAR), and the myogenic reflex toward a decrease in local blood flow induced by Venous Congestion. Skin blood flow (SkBF) was measured in 12 supine subjects via laser-Doppler flowmetry 1) over areas of forearm and calf skin, in which the VAR was blocked by using eutectic mixture of local anesthetics (EMLA sites) and 2) over the contralateral forearm or calf skin (control sites), using two different techniques: limb dependency of 23-37 cm below the heart and cuff inflation to 40 mmHg. During limb dependency, SkBF decreased at the control sites, whereas it remained unchanged at the EMLA sites. In contrast, during cuff inflation, SkBF decreased at the control sites and also decreased at the EMLA sites. The percent change in SkBF from baseline was greater during cuff inflation than limb dependency at both the control sites and the EMLA sites. Estimated skin vascular resistance remained unchanged at the EMLA sites during cuff inflation, as well as limb dependency. Thus the decrease in SkBF during Venous Congestion with cuff inflation is not solely due to the cutaneous VAR but also to a reduction in local perfusion pressure. The VAR is therefore most specifically quantified by Venous Congestion induced by limb dependency, rather than cuff inflation. Finally, from both techniques, we calculated that during Venous Congestion induced by limb dependency (calf), approximately 45% of the nonbaroreflex vasoconstriction is induced by the VAR and approximately 55% by the myogenic reflex.
Graham A Macgregor - One of the best experts on this subject based on the ideXlab platform.
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maximization of skin capillaries during intravital video microscopy in essential hypertension comparison between Venous Congestion reactive hyperaemia and core heat load tests
Clinical Science, 1999Co-Authors: Tarek F T Antonios, Fraser E M Rattray, Donald R J Singer, Nirmala D Markandu, P S Mortimer, Graham A MacgregorAbstract:Intravital capillary video-microscopy is a dynamic method for studying skin capillaries. The technique of direct intravital microscopy (without dyes) depends on the presence of red blood cells inside capillaries for their identification. The aim of the present study was to compare different techniques to try to establish the best method for maximizing the number of visible perfused capillaries during intravital capillary microscopy. We compared the effects of Venous Congestion with those of post-occlusive reactive hyperaemia (Study 1). We also investigated Venous Congestion followed first by post-occlusive reactive hyperaemia and then by a core heat load test (Study 2). Finally we investigated Venous Congestion followed by post-occlusive reactive hyperaemia combined with Venous Congestion (Study 3). In Study 1, capillary density increased with Venous Congestion from a baseline value of 74±2 (mean±S.E.M.) per field to 82±3 per field ( P P = 0.01). With both reactive hyperaemia and core heat load, the apparent density was 62±4 per field. In Study 3 the baseline density was 70±2 per field, and this increased significantly with Venous Congestion to 80±3 per field ( P P = 0.328 compared with Venous Congestion alone). The results show that Venous Congestion at 60 mmHg for 2 min is the most effective method for visualization of the maximal number of perfused skin capillaries during intravital video-microscopy.
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Maximization of skin capillaries during intravital video-microscopy in essential hypertension: comparison between Venous Congestion, reactive hyperaemia and core heat load tests.
Clinical science (London England : 1979), 1999Co-Authors: Tarek F T Antonios, Fraser E M Rattray, Donald R J Singer, Nirmala D Markandu, P S Mortimer, Graham A MacgregorAbstract:Intravital capillary video-microscopy is a dynamic method for studying skin capillaries. The technique of direct intravital microscopy (without dyes) depends on the presence of red blood cells inside capillaries for their identification. The aim of the present study was to compare different techniques to try to establish the best method for maximizing the number of visible perfused capillaries during intravital capillary microscopy. We compared the effects of Venous Congestion with those of post-occlusive reactive hyperaemia (Study 1). We also investigated Venous Congestion followed first by post-occlusive reactive hyperaemia and then by a core heat load test (Study 2). Finally we investigated Venous Congestion followed by post-occlusive reactive hyperaemia combined with Venous Congestion (Study 3). In Study 1, capillary density increased with Venous Congestion from a baseline value of 74+/-2 (mean+/-S.E.M.) per field to 82+/-3 per field (P
