A comparison of 50 initial endoluminal endograft repairs for abdominal aortic aneurysm with 50 concurrent open repairs.

Purpose: To review the results of our initial experience with endovascular repair of abdominal aortic aneurysm (AAA) with respect to morbidity and mortality and to compare these outcomes with those of transabdominal repair.

Methods: We reviewed the first 50 consecutive endovascular AAA repairs performed at our institution from November 1999 to January 2002. Pre-operative risk factors, intraoperative variables and post-operative outcomes were assessed.

Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery.

A 32-year-old man, who was previously healthy, had acute abdominal pain without peritonitis. Diffuse mesenteric and portal vein thrombosis were shown by means of a computed tomography scan. A protein s deficiency was found by means of an extensive workup for hypercoagulable state.

Elective bedside surgery in critically injured patients is safe and cost-effective.

Objective: The success of elective minimally invasive surgery suggested that this concept could be adapted to the intensive care unit. We hypothesized that minimally invasive surgery could be done safely and cost-effectively at the bedside in critically injured patients.

Summary Background Data: This case series, conducted between October 1991 and June 1997 at a Level I trauma center, examined bedside dilatational tracheostomy (BDT), percutaneous endoscopic gastrostomy (PEG), and inferior vena cava (IVC) filter placement.

Duplex-directed vena caval filter placement: report of initial experience.

Background: Fluoroscopy, cost, and patient transport contribute to difficulties occasionally associated with the placement of vena caval filters. Follow-up data in the literature document the use of duplex ultrasonography in visualizing the filter and determining caval patency. Filter placement at the bedside or in the vascular laboratory with duplex ultrasonography may simplify this common procedure.

Aortoiliac occlusive disease and gastrointestinal malignancy: changing therapeutic options.

Treatment of gastrointestinal malignancy encountered unexpectedly during procedures involving the abdominal aorta continues to be debated. Previously, simultaneous vascular procedures with intra-abdominal malignancy were rare. Most underwent vascular reconstruction followed by a delayed aortic procedure.

Cost-effective method for bedside insertion of vena caval filters in trauma patients.

Background: The need for patient transport for inferior vena cava (IVC) filter placement impacts patient safety, comfort, charges, and nursing care. Bedside, ultrasound-guided IVC filter placement may offer an acceptable, cost-effective alternative.

Methods: Prospective cohort study of 55 consecutive trauma patients requiring IVC filter placement.

Technical complications of endovascular abdominal aortic aneurysm repair.

Purpose: Results from 34 endovascular repairs of abdominal aortic aneurysms are reviewed to identify technical complications and relate them to anatomic and technical features of the operation.

Methods: Twenty-one patients underwent attempted tube graft repair (mean follow-up, 13 months). Thirteen patients underwent placement of a bifurcated graft (mean follow-up, 7.

Severe intraoperative coagulopathy following routine aortobi-iliac bypass with knitted Dacron graft.

Coagulopathy associated with aortic operation is generally described in patients undergoing supraceliac aortic clamping or ruptured abdominal aortic aneurysm repair. This intraoperative complication is managed with component blood replacement and occasional use of aminocaproic acid. The presence of intraoperative coagulopathy associated with aortic reconstruction for occlusive disease is not described.

Limb ischemia: surgical therapy in acute arterial occlusion.

Mortality and amputation rates from acute arterial occlusion are reported from 7 to 37 per cent and 10 to 30 per cent, respectively. Recent data from thrombolysis or peripheral arterial surgery suggest no significant differences between initial management with surgical or thrombolytic therapy. Mortality and amputation rates were in the above ranges.

Expanding the physician care team: its effect on patient care, resident function, and education.

Recent attempts to improve surgical resident working conditions have taken many forms. We evaluated a system in which a well-trained physician extender had been hired to assist residents taking call on a busy cardiothoracic teaching service. The physician extender ("night nurse," NN) helped with perioperative care using well-defined protocols.

Selective intraportal hepatocyte transplantation in analbuminemic and Gunn rats.

Although significant progress has been achieved in isolated hepatocyte transplantation, the optimal site of cell implantation has not yet been determined. We have developed a novel experimental method of intraportal hepatocyte transplantation that allows easy assessment of the morphology and function of transplanted hepatocytes. Donor hepatocytes were harvested from Sprague-Dawley rats by in situ EDTA/collagenase perfusion.

Fibroblast transplantation in rats: transduction and function of foreign genes.

The purpose of this study was to develop a method of transduction of normal skin fibroblasts with a retroviral vector expressing the human factor IX (hF-IX) gene and transplantation of the transduced cells into rats. A retroviral vector containing the hF-IX gene, as well as a selectable marker (hygromycin B resistance; HB), was used to transduce cultured normal skin (rat and human) fibroblasts. Transduced fibroblasts were selected with HB; resistant clones were propagated and assessed for expression of active hF-IX in vitro.

Development of a hybrid bioartificial liver.

Objective: The authors developed an extracorporeal liver support system and tested its efficacy in experimental animals with liver failure. The first clinical use of this system to treat a patient with liver failure is reported.

Summary Background Data: Multiple attempts have been made, ranging from plasma exchange to use of charcoal columns, to develop liver support systems for treating patients with acute severe liver failure.

Use of a novel bioartificial liver in a patient with acute liver insufficiency.

We have developed a bioartificial liver support system (BAL) using porcine hepatocytes attached to microcarriers and placed on the outer surface of hollow fibers. The BAL system was attached to a plasmapheresis device that was then used to treat the plasma of a patient with acute liver failure. Our aim was to test the efficacy and safety of this system after a single short treatment period.

In vivo regional delivery of retrovirally mediated foreign genes to rat liver cells: need for partial hepatectomy for successful foreign gene expression.

A novel surgical technique was developed to deliver retroviral gene vectors directly to a rat liver lobe in vivo. It was observed that viral infection efficiency was enhanced by inducing hepatocyte DNA synthesis by prior partial hepatectomy. Two retroviral vectors were used to integrate specific bacterial genes: an amphotropic virus expressing the hph gene for hygromycin B phosphotransferase and an ecotropic virus expressing the lac-Z gene for beta-galactosidase.

Development of a bioartificial liver: properties and function of a hollow-fiber module inoculated with liver cells.

We have developed a bioartificial liver support system utilizing hollow-fiber bioreactor, plasmapheresis and microcarrier cell culture technologies. Liver cells were obtained through portal vein perfusion with ethylenediaminetetraacetate or ethylenediaminetetraacetate/collagenase. A mathematical model of mass transport in a hollow-fiber module, at various plasma flow velocities and system configurations, was developed.

A model for directed foreign gene delivery to rat liver cells in vivo.

A novel technique for directed delivery of retroviral genes to rat liver cells in vivo is described. Vascular isolation of the liver was achieved in situ and perfusate containing retrovirus expressing the bacterial gene conferring resistance to Hygromycin-B was delivered selectively to the posterior liver lobes. After 15 min, normal blood flow to the liver was restored.

Immunoreactivity assay for labeled anti-melanoma monoclonal antibodies.

A convenient, rapid, and reproducible assay was developed to evaluate the immunoreactivity of radiolabeled monoclonal antibodies against three different human melanoma-associated antigens, p97, a proteoglycan and a GD3 ganglioside. A cloned melanoma cell line (M 2669 CL 13) was selected as the target and, when fixed with paraformaldehyde, showed binding as good as or better than that obtained with live cells for the three antigens. Fixed cells retained good binding properties stored at 4 degrees C for over 6 mo.