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Biomedical subjects

C M Montefusco

Publications and source records attributed to C M Montefusco.

At least 19 recordsLinked to original sources
PubMed1994

Colorflow duplex ultrasonography determines the presence and nature of vasculogenic headaches.

Eighteen consecutive patients with severe headache syndromes underwent noninvasive interrogation to explore the intracranial vascular involvement in their headaches. The authors used a colorflow duplex scanner with a 2.25 MHz, tightly curved, phased-array transducer to insonate and visualize the terminal segments of the vertebral arteries; the anterior, middle, and posterior cerebral circulations; and the basilar artery. Blood flow velocities and vessel caliber were obtained during a headache-free period and during a grade 8-10 headache in all patients. Comparisons of these data indicated that 14 of the 18 patients had demonstrable arterial changes associated with their headaches. Of these 14, 4 patients were found to have marked vasospasm of at least two of the arteries in the Circle of Willis and/or the vertebrobasilar system. The remaining 10 patients had headaches associated with intracerebral vasodilation. The authors conclude that color flow duplex ultrasonography of the intracerebral arteries is capable of determining the presence and mode of vascular headache development.

Adolescent↗
PubMed1991

[The influence of left atrial cuff rejection on pulmonary hemodynamics after canine lung allotransplantation].

Several factors influence pulmonary hemodynamics after lung transplantation: reimplantation response, lung rejection reaction and imperfect anastomosis technique. In this experiment, five cases presented marked elevation of mean pulmonary artery pressure at the time or right pulmonary artery occlusion test performed two weeks postoperatively. Left atrial cuff rejection reaction arose in one case in which edema and stenosis of the pulmonary vein outflow tract were evidenced. This finding demonstrated that the changes in pulmonary hemodynamics after transplant suggest the possibility of inducement by left atrial cuff rejection reaction.

Animals↗
PubMed1988

A technique for donor lung procurement and preservation for transplantation after completion of cardiac donation.

The scarcity of donor lungs for transplantation has been caused, in part, by the belief that a single donor cannot provide usable lungs if it serves as a heart donor. However, the appropriate division of the left atrial wall provides sufficient cuffs for individual transplantation of the heart and each lung into three separate recipients. With the described technique, the results of the present studies demonstrate the feasibility of donor lung procurement and preservation for transplantation after cardiac donation. Use of this method will allow the most effective and efficient use of the limited supply of donor organs and thereby permit therapeutic single lung transplantation in selected patients. Cardiac donation should no longer preclude lung donation as it has in the past.

Animals↗
PubMed1987

Clinical and experimental aspects of single-lung transplantation.

Recent progress in immunosuppressive therapy for lung transplantation, improvements in surgical technique, advances in lung preservation methods, and appropriate management of cadaver organ donors have all improved the prospects for lung transplantation as a feasible therapeutic procedure for selected patients with end-stage pulmonary disease. The major limiting factor in the application of this operation will be the scarcity of good lung donors.

Animals↗
PubMed1986

Lung transplantation.

Over the past 20 years, many advances in surgical methods, transplantation immunology, donor organ procurement and preservation techniques, and postsurgical care regimens have influenced greatly the field of lung transplantation. The single remaining obstacle to widespread clinical success is donor lung availability. Improved methods of ex vivo lung preservation, organ donor maintenance, and donor lung retrieval after the completion of cardiac donation should help to ameliorate this problem.

Bronchi↗
PubMed1985

Obtaining consent for organ donation.

The medical, emotional, and legal environments in which consent for organ donation is pursued greatly influence the outcome of this request. Knowledge of the circumstances and facts regarding brain death are important first steps in resolving misconceptions a potential donor's family may have that might preclude a favorable decision. The attitudes of hospital staff members toward these issues, and the grief and shock experienced at these times by next-of-kin, further complicate the circumstances in which consent for organ donation is requested. Clarification of traditional religious beliefs and reconciliation of these with the concept of organ donation may also have to be addressed at this time. Significant benefit to the bereaved family as well as to the transplantation process can accrue only in an atmosphere in which all involved understand the facts of brain death, and in which organ donation is viewed positively.

Attitude of Health Personnel↗
PubMed1985

Organ selection and preservation for transplantation. Part II: liver, pancreas, skin, and bone marrow.

Transplantation of organs and tissues provides the clinician with treatment options for many types of organ failure. However, nearly all transplant efforts are limited by a relative scarcity of donor material. Donor organ and tissue availability can be increased by developing suitable preservation methods and by improving the awareness of primary health care providers as to the needs and scope of therapeutic transplantation. Donor material capable of immediate function upon implantation will become available as increasingly effective techniques of tissue and organ preservation develop. These techniques are extremely important for lung, heart, and liver transplantation, where no artificial, long-term methods of support exist, making immediate function a necessity. In Part I of this article, the authors discussed transplantation of cornea, kidney, heart, lung, and heart-lung block; Part II covers transplantation of liver, pancreas, skin, and bone marrow.

Bone Marrow Transplantation↗
PubMed1985

Revascularization of ischemic bronchial anastomoses by an intercostal pedicle flap.

Ischemia of the donor bronchus, perfused solely by retrograde collaterals from the pulmonary circulation, is an important factor in the impaired healing of the bronchial anastomosis of transplanted lungs. The healing of two experimental models of bronchial anastomotic ischemia, the bronchial segmental autograft and the postpneumonectomy bronchial autograft, was assessed in dogs. The application of a polytetrafluoroethylene wrap to the bronchial segmental autograft and the application of an intercostal pedicle flap to the postpneumonectomy bronchial autograft, with and without concomitant administration of corticosteroids, were also studied to elucidate factors that affect bronchial anastomotic healing. The bronchial segmental autograft healed normally without stricture, but isolation of this autograft from the mediastinum and lung by the polytetrafluoroethylene wrap resulted in necrosis of the autograft. All dogs that had a postpneumonectomy bronchial autograft died of bronchopleural fistulas due to autograft necrosis. Application of an intercostal pedicle flap to the autograft resulted in healing in all animals. Arteriography and Microfil injection demonstrated revascularization of the postpneumonectomy bronchial autograft by the pedicled intercostal artery. Several conclusions can be drawn: With the lung in situ the bronchial segmental autograft survives, probably as a free composite graft. In contrast, the postpneumonectomy bronchial autograft is an excellent model of bronchial anastomotic ischemia. The intercostal pedicle flap is a reliable method for providing neovascularity and mechanical reinforcement to an ischemic bronchial anastomosis. Its effect on bronchial anastomotic healing was not diminished by administration of corticosteroids. The intercostal pedicle flap may be useful in preventing bronchial anastomotic complications in clinical lung transplantation.

Bronchi↗
PubMed1985

Multiple organ procurement from one donor.

To maximize organ utilization, we assessed the feasibility of retrieving the heart and two single lungs or the heart and a separate bilateral lung block for transplantation into multiple recipients. In eight dogs the excision of the heart-lung block or of the left lung was followed by six hours of lung preservation. Four of these lungs and all eight hearts were transplanted successfully. In addition, satisfactory retrieval of the three separate organs or of the heart and a separate bilateral lung block was done in six human cadavers. An appropriate division of the left atrial wall provided suitable cuffs for individual transplantation of the three organs or for the heart and bilateral lung block. This study demonstrates the feasibility of multiple organ donation from a single donor followed by separate organ transplantation.

Animals↗
PubMed1984

Maintenance protocol for potential organ donors in multiple organ procurement.

Donor organs that are suitable for transplantation remain scarce, especially in view of the number of types of organ transplants now possible and the ever-increasing number of waiting recipients. This scarcity of donor organs can, to some extent, be ameliorated by the adoption of potential organ donor maintenance protocols that protect the organs from irreversible damage. Of key importance to the success of any such protocol is the establishment of hemodynamic adequacy and stability. Appropriate and vigorous antibiotic prophylaxis is also a major consideration, especially with regard to the pulmonary and genitourinary systems. The use of ophthalmologic preparations for protection of the corneas, attention to skin cleanliness, and the practice of rigorous sterile technique in the care of all indwelling catheters are measures that are strongly encouraged in order to provide the best possible chance of successful donation of organs that otherwise may be compromised.

Humans↗
PubMed1983

Pulmonary and hemodynamic function in dogs during exercise: effects of lung autotransplantation.

An airtight facemask/mouthpiece assembly has been devised to facilitate the performance of a wide range of pulmonary function tests during treadmill exercise in dogs. Using this appliance, data were obtained from 6 normal dogs and 3 of the same dogs after left lung autotransplantation. All measurements were made during awake, resting conditions and again after 5-7 minutes of moderate exercise. Resting values for pulmonary function tests, hemodynamic parameters, blood gases and pH from both pulmonary and systemic arterial blood samples did not differ significantly between normal dogs and those studied after left lung autotransplantation. During treadmill exercise, cardiac output doubled and pulmonary vascular resistance decreased comparably in both groups of dogs. Heart rates in both groups rose to approximately 22 b/min and blood gases and pH remained normal. These results indicate the facemask/mouthpiece assembly permits normal ventilation during treadmill exercise. In addition, these data support the view that pulmonary autotransplantation per se need not impose obligatory defects in ventilatory and hemodynamic function despite the increased demands of treadmill exercise.

Animals↗
PubMed1981

Cyclosporin A in experimental lung transplantation.

Cyclosporin A (Cy A) has been used in combination with low-dose azathioprine (2 mg/kg/day for 14 days) or other immunosuppressives to treat 13 canine lung allograft recipients. Two of five dogs treated with Cy A and azathioprine survive at 13 and 6 months, respectively, with normal lung function and no evident rejection. The other three dogs in this group survived for over 5 months despite evidence of rejection which was reversed with methylprednisolone (50 mg/kg/day for 3 to 5 days). The addition of prophylactic corticosteroids or their substitution for azathioprine resulted in decreased survival without preventing rejection better. The lung allograft rejection that occurred with Cy A was usually later in onset and more easily reversed by corticosteroids than the lung rejection that occurred with standard immunosuppression. Cy A rejection was also sometimes qualitatively different. Perivascular mononuclear cell cuffs and a proportionally greater decrease in allograft perfusion with respect to ventilation were often more prominent than in rejection with standard immunosuppression. In some instances, decreased allograft perfusion evidenced rejection while the plain chest roentgenogram and ventilation remained normal. Except for infection, which only occurred in animals receiving prophylactic corticosteroids, there was no toxicity from Cy A. These findings indicate that this drug is the safest, most effective immunosuppressive agent yet available for use in lung transplantation.

Animals↗