Retroperitoneal approach to high-risk abdominal aortic aneurysms.

During a 14-month period we used a left-flank, retroperitoneal, retrorenal approach in 23 high-risk patients with abdominal aortic aneurysm (AAA). Fourteen patients underwent suprarenal/celiac cross clamp for juxtarenal/suprarenal AAA and/or associated occlusive disease. Other indications for this approach included diminished cardiac and/or pulmonary reserve, previous extensive abdominal surgery, obesity, and inflammatory AAA.

The effect of flow on vascular endothelial cells grown in tissue culture on polytetrafluoroethylene grafts.

Vascular grafts lined with endothelial cells (EC) grown to confluence in culture before implantation may provide a thromboresistant flow surface. Growth of EC on and their adherence to currently available prosthetic materials under conditions of flow are two impediments remaining in the development of such a graft. To address these problems, 22 polytetrafluoroethylene grafts (PTFE) (5 cm by 4 mm inside diameter) were pretreated with collagen and fibronectin, seeded with 2 to 3 X 10(6) bovine aortic EC per graft, and placed in tissue culture (seeded grafts).

Randomized prospective study comparing moxalactam and cefoxitin with or without tobramycin for the treatment of serious surgical infections.

The efficacy and toxicity of moxalactam were compared with the efficacy and toxicity of cefoxitin given with or without tobramycin to 109 patients with surgical infections. A total of 66 patients could be assessed for efficacy (33 patients in each group); 13 of the cefoxitin-treated patients also received tobramycin for at least 72 h. Most patients had intraabdominal infections; 17 had peritonitis, 14 had intraabdominal abscesses, and 7 had perforation of a gangrenous appendix.

Deaths from asthma in New Zealand.

We report the first complete population based study of childhood deaths due to asthma. All deaths ascribed to asthma in New Zealand children aged 0-14 were investigated as part of a two year national study of mortality from asthma. The 16 children who died from asthma all developed asthma by the age of 4; 15 had a family history of asthma, and 12 had associated atopic disorders.

The costs of surgery for limb-threatening ischemia.

The clinical courses of 106 patients with limb-threatening ischemia were traced for as long as 5 years to determine the cost of their care. Seventy-eight patients initially treated with vascular reconstruction accrued an average of $40,769 +/- $3726 in costs over a mean follow-up period of 805 +/- 57 days, during which they had an average of 2.4 +/- 0.

Experimental Bacteroides fragilis bacteremia in a primate model: evidence that Bacteroides fragilis does not promote the septic shock syndrome.

Experimental Bacteroides fragilis bacteremia was studied in subhuman primates. Following intravenous infusion of viable B. fragilis there was an exponential clearance of organisms from the bloodstream.

Pear shaped spacer nebuhaler compared with nebulised solution for terbutaline administration in acute severe asthma.

The efficacy of terbutaline (1 mg) administered from pressurised aerosol through a nebuhaler was compared in a crossover trial with terbutaline (4 mg) as nebulised solution in 20 patients with acute severe asthma. The improvements following the nebuhaler, which did not require an electrical or pressure source, were worthwhile. In contrast to earlier experience in stable asthma, the increases in FEV1 (p = 0.

Sequential pneumatic compression for lymphedema. A controlled trial.

We examined prospectively the effect of a new compression device for lymphedema, which utilizes a short duration and high-pressure cycle, that provides a sequential milking pattern to the limb through multiple compartments. Twenty-five patients (seven patients for upper-extremity and 18 for lower-extremity problems) underwent 24 hours of treatment. All extremities showed a decrease in circumferential measurements with the maximal reduction occurring at the wrist (45%) for the upper extremities and at the mid-calf (47%) for the lower extremities.

Calf muscle adaptation to peripheral vascular disease.

130 muscle biopsies were taken from the gastrocnemius of 82 patients with different degrees of peripheral vascular disease (PVD) and 19 normal controls for histochemical analysis, and 30 patients and 7 controls for biochemical analysis of "aerobic" and "anaerobic" enzymes. The results showed that the gastrocnemius of patients with PVD did not adapt by increasing its "aerobic" potential as previously suggested. Histochemical studies showed that the cross-sectional area of both Type 1 and Type 2 muscle fibres became smaller than those from age-matched controls in the presence of PVD, and in some cases biopsies from both legs confirmed that this trend was greater in those limbs with increasing evidence of PVD.

Evaluation of arterial prostheses in a baboon ex vivo shunt: the effect of graft material and flow on platelet deposition.

Surface thrombogenicity is recognized as an important factor in the failure of small caliber vascular prostheses. The baboon ex vivo shunt was developed to study small caliber grafts under controlled conditions at different flow rates. The shunt was created by percutaneous insertion of catheters into the baboon femoral artery and vein.

Treatment of pneumonia with imipenem/cilastatin.

This pilot study assessed the efficacy, safety and tolerance of intravenously administered imipenem/cilastatin in the treatment of adults hospitalised with community acquired pneumonia. Thirteen patients were treated with 500 mg imipenem and 500 mg cilastatin eight hourly for a minimum of five days. Eleven patients (85%) had a clinical cure; (Legionella pneumophila was the pathogen in four, Streptococcus pneumoniae in one, Branhamella catarrhalis in one, no pathogen identified in five).

The interaction of blood components with PDMS (polydimethylsiloxane) and LDPE (low-density polyethylene) in a baboon ex vivo arteriovenous shunt model.

The interaction of 111Indium-labeled platelets, and other blood components with the luminal surface of polydimethylsiloxane (PDMS) and low-density polyethylene (LDPE) was determined using an ex vivo arteriovenous shunt in the baboon. Both PDMS and LDPE showed little platelet accumulation at either high (200 cc/min) flow rates. PDMS accumulated more platelets at low than at high flow.

Asthma mortality in New Zealand: a two year national study.

The epidemic of deaths from bronchial asthma in New Zealand was investigated by a two-year national review of all deaths of persons under 70 years where "asthma" appeared in part I of a death certificate or in a coroner's report of cause of death. Information about the patients, the characteristics and management of their asthma and the circumstances of the fatal episode was obtained by interviewing relatives and general practitioners and perusal of hospital records. The reviewing panel of the asthma task force of the Medical Research Council considered 271 of the 342 deaths studied were due to asthma.

Improvements in the diagnosis and management of aortoenteric fistula.

To assess the impact of an aggressive approach (early operation, graft removal, and extraanatomic bypass) adopted by us 5 years ago in patients with aortic synthetic grafts and gastrointestinal bleeding, we reviewed our 15 year experience with aortoenteric fistula in 13 patients. The courses of six patients from the recent series (1979 through 1984) were contrasted with those of seven patients from our earlier series (1968 through 1978). Twelve of 13 patients presented with gastrointestinal bleeding (usually low volume), and no patient presented in shock.

Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy.

Presently most noninvasive methods for assessing extracranial carotid disease have relied on hemodynamic change associated with significant stenosis. Recent evidence has suggested that both ulceration and/or plaque hemorrhage may frequently play an important role in the pathophysiology of carotid disease. To assess the ability of B-mode ultrasound to provide this anatomic information, in a prospective blinded manner we compared B-mode ultrasound and selective four-vessel arteriography to pathologic specimens obtained at the time of 89 carotid endarterectomies.

Ultrasound characteristics of recurrent carotid disease: hypothesis explaining the low incidence of symptomatic recurrence.

The true incidence of recurrent disease after carotid endarterectomy (CENDX) is unknown, but noninvasive hemodynamic testing shows a paradox between the incidence of hemodynamically significant recurrent stenosis (RS) and the presence of symptomatic disease. We have shown that real-time B-mode ultrasound imaging can demonstrate the gross pathology of the arterial wall and plaque and their surface characteristics. Therefore we reviewed the clinical data and B-mode studies performed 6 months to 15 years after 276 carotid endarterectomies.

Complement activation by synthetic vascular prostheses.

Morphologic evaluation of synthetic grafts (both seeded and unseeded) harvested within 2 weeks of implantation has revealed heavy infiltration with polymorphonuclear leukocytes (PMNs). Since complement-activated PMNs are known to damage endothelial cells, we hypothesized that complement activation might prove a barrier to optimal endothelial cell seeding of prosthetic grafts. To determine whether synthetic vascular prostheses activate complement and whether the type of graft material influences the degree of activation, we assayed the plasma of 10 healthy donors for complement activity following incubation with short segments of knitted Dacron and polytetrafluoroethylene (PTFE) graft material.

The time course during 36 weeks' endurance training of changes in Vo2 max. and anaerobic threshold as determined with a new computerized method.

Six healthy male subjects followed a programme of endurance training for 36 weeks. At 12 week intervals each underwent an incremental exercise test to maximum on a treadmill. Minute ventilation, cardiac frequency, expired and endtidal concentrations of oxygen and carbon dioxide, oxygen uptake and carbon dioxide output were measured continuously during each test.

A baboon flow-regulated shunt for the study of small caliber vascular grafts.

Synthetic vascular grafts often occlude when used in low-flow high-resistance reconstructions. In order to study the pathophysiology of graft failure a flow-regulated ex vivo shunt was designed for insertion into the baboon femoral artery and vein. Synthetic graft materials (4 mm i.

Physical fitness of New Zealand army personnel; correlation between field tests and direct laboratory assessments--anaerobic threshold and maximum O2 uptake.

Performance in two field tests was compared with maximum oxygen uptake (V02max) and anaerobic threshold in 42 male army staff. V02max was measured directly during incremental treadmill exercise. Anaerobic threshold was determined simultaneously from changes in ventilation and gas-exchange.

Aspirin decreases platelet uptake on Dacron vascular grafts in baboons.

The influence of a single dose of aspirin (5.4-7.4 mg/kg) on platelet uptake on 4-mm Dacron interposition grafts was studied in a baboon model using gamma camera scanning for 111-Indium labeled platelets.

Healing pattern of small caliber dacron grafts in the baboon: an animal model for the study of vascular prostheses.

Although dogs have been used widely to study the healing of large caliber synthetic grafts, hypercoagulability probably makes the dog a poor model for studies of small caliber vascular prostheses. The baboon's coagulation system is similar to man's, but large caliber baboon grafts were reported to endothelialize rapidly. In this study the healing pattern of 4 mm internal diameter Dacron carotid interposition grafts in baboons was determined using specimens harvested at time points between 2 weeks and 18 months post-implantation and examined with light and scanning electron microscopy.