No abstract available.

The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.
Female ; Heart Septal Defects, Atrial* ; Humans ; Hypertension, Pulmonary* ; Receptors, Endothelin* ; Sulfonamides

STUDY DESIGN: Mechanical study of polymethylmetacrylate (PMMA) mixed with blood as a filler. PURPOSE: An attempt was made to modify the properties of PMMA to make it more suitable for percutaneous vertebroplasty (PVP). OVERVIEW OF LITERATURE: The expected mechanical changes by adding a filler into PMMA included decreasing the Young's modulus, polymerization temperature and setting time. These changes in PMMA were considered to be more suitable and adaptable conditions in PVP for an osteoporotic vertebral compression fracture. METHODS: Porous PMMA were produced by mixing 2 ml (B2), 4 ml (B4) and 6 ml (B6) of blood as a filler with 20 g of regular PMMA. The mechanical properties were examined and compared with regular PMMA(R) in view of the Young's modulus, polymerization temperature, setting time and optimal passing-time within an injectable viscosity (20-50 N-needed) through a 2.8 mm-diameter cement-filler tube. The porosity was examined using microcomputed tomography. RESULTS: The Young's modulus decreased from 919.5 MPa (R) to 701.0 MPa (B2), 693.5 Mpa (B4), and 545.6 MPa (B6). The polymerization temperature decreased from 74.2degrees C (R) to 59.8degrees C (B2), 54.2degrees C (B4) and 47.5degrees C (B6). The setting time decreased from 1,065 seconds (R) to 624 seconds (B2), 678 seconds (B4), and 606 seconds (B6), and the optimal passing-time decreased from 75.6 seconds (R) to 46.6 seconds (B2), 65.0 seconds (B4), and 79.0 seconds (B6). The porosity increased from 4.2% (R) to 27.6% (B2), 27.5% (B4) and 29.5% (B6). A homogenous microstructure with very fine pores was observed in all blood-mixed PMMAs. CONCLUSIONS: Blood is an excellent filler for PMMA. Group B6 showed more suitable mechanical properties, including a lower elastic modulus due to the higher porosity, less heating and retarded optimal passing-time by the serum barrier, which reduced the level of friction between PMMA and a cement-filler tube.
Elastic Modulus ; Fractures, Compression ; Friction ; Heating ; Hot Temperature ; Polymerization ; Polymers ; Polymethyl Methacrylate ; Porosity ; Vertebroplasty ; Viscosity ; X-Ray Microtomography

STUDY DESIGN: This is a mechanical study of polymethylmetacrylate(PMMA) mixed with blood as a filler. OBJECTIVE: We tried to change the properties of PMMA so that it is more suitable to use for percutaneous vertebroplasty (PVP). SUMMARY OF THE LITERATURE REVIEW: The mechanical changes by adding a filler into PMMA were expected to decrease the Young's modulus, the polymerization temperature and the setting time. These changes of PMMA were considered to be more suitable and adaptable conditions for PVP for treating osteoporotic vertebral compression fracture. MATERIALS AND METHODS: Porous PMMA was produced by mixing 2 ml (B2), 4 ml (B4) and 6 ml (B6)-blood as a filler, and the mechanical properties were investigated in comparison with regular PMMA(R) in view of Young's modulus, the polymerization temperature, the setting time and the optimal passing-time within the injectable viscosity (20~50N-needed) through a 2.8mm-diameter cement-filler tube. Porosity was inspected by performing microcomputated tomography (micro-CT). RESULTS: Young's modulus was decreased from 919.5 MPa (R) to 701 MPa (B2), 693.5 MPa (B4) and 545.6 MPa (B6) in each group. The polymerization temperature decreased from 74.2degrees C (R) to 59.8degrees C (B2), 54.2degrees C (B4) and 47.5degrees C(B6), respectively. The setting time decreased from 1065sec (R) to 624sec (B2), 678sec(B4) and 606sec (B6), respectively, and the optimal passing-time decreased from 75.6sec (R) to 46.6sec (B2), 65.0sec (B4) and 79.0sec(B6), respectively. The porosity increased from 4.2%(R) to 27.6%(B2), 27.5%(B4) and 29.5%(B6), respectively. A homogenous microstructure with very fine pores was seen on inspection of all the blood-mixed PMMAs. CONCLUSION: Blood mixed with PMMA was considered as an excellent filler that was easy to make and had good biocompatibility. The 6ml blood-mixed PMMA (B6) showed more suitable mechanical properties, including a decreased elastic modulus due to more porosity, less heating and a retarded optimal passing-time by the serum barrier, which diminished the friction between the PMMA and a cement-filler tube.
Elastic Modulus ; Fractures, Compression ; Friction ; Heating ; Hot Temperature ; Polymerization ; Polymers ; Polymethyl Methacrylate ; Porosity ; Vertebroplasty ; Viscosity