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Biomedical subjects

D Steed

Publications and source records attributed to D Steed.

13 recordsLinked to original sources
PubMed1998

The experience of an academic medical center with endovascular treatment of abdominal aortic aneurysms.

BACKGROUND: Endovascular repair of abdominal aortic aneurysms (AAA) is gaining momentum although it is not yet approved in the United States by regulatory agencies. The Endovascular Grafting System (EGS), the first device to enter clinical trials in 1993, is now in phase III testing. METHODS: We reviewed the first 50 patients to undergo an EGS repair of AAA over 24 months at our institution. Results were compared with 69 patients who underwent open repair during the same time period by the same surgeon. RESULTS: Devices were successfully implanted in 47 of 50 (94%) patients. Three were converted to standard repair. Although length of stay was shorter, costs were similar. Follow-up was 3 to 24 months. Perigraft flow was noted in 33% at discharge; 73% of those stopped either spontaneously or with coiling. Three graft limbs occluded, requiring thrombolytic therapy. CONCLUSIONS: The EGS repair of AAA is feasible and effective. Cooperation between surgery and radiology is important for the success of a new endovascular program.

Aged↗
PubMed1996

Revision total hip arthroplasty with a retroperitoneal approach to the iliac vessels.

Although vascular complications during revision total hip arthroplasty are rare, the results can be devastating. Reports in the literature describe staged operations, with the first procedure being abdominal to remove cement and/or the acetabular component followed by a second joint reconstruction procedure. A protocol was developed that combines a retroperitoneal approach with revision total hip arthroplasty in one operative procedure in patients at risk for vascular injury. The patient first undergoes a retroperitoneal incision and the iliac artery and vein are dissected free of surrounding tissue. A silicone loop is placed around the iliac artery and vein and brought out through the wound. The wound is temporarily closed using staples. Revision total hip arthroplasty then proceeds in the usual fashion. If hemorrhage is encountered, bleeding can be rapidly controlled by tensioning the abdominal vessel loops and opening the incision for exposure to the vessels. No complications have been encountered in 23 patients when using this approach.

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PubMed1991

Clinical trials with purified platelet releasate.

Clinical trials of PDWHF are ongoing and the final results are not yet available; however early lessons learned have allowed us to modify these trials. It is anticipated that the patient accrual will be completed within the next six months, and the last patient will complete the trial within the next year. At that time, we hope to have new insight into the role of PDWHF in the treatment of lower extremity ulcers. At this time, we are encouraged by the early improvement seen in patients entering the PDWHF versus saline trial. Preliminary results suggest that PDWHF improves the healing of diabetic ulcers of the lower extremity.

Blood Platelets↗
PubMed1989

Cryopreserved venous homografts as vascular conduits in canine carotid arteries.

In this study we evaluated the histologic condition, prostacyclin production, and compliance of morphologically intact cryopreserved venous homografts (CVH) and autografts 3, 6, and 9 months after arterial implantation. Eighteen external jugular veins were cryopreserved and implanted into the carotid arteries of mongrel dogs. All grafts were patent at the time of excision. Electron microscopy documented a disrupted endothelium in the homografts at 3 months that was intact at 9 months. The cellular infiltrate, suggestive of rejection, in the 3-month homografts resolved by 9 months. Prostacyclin production at 3 months was 8.7 +/- 3.2 pg/ml/cm2 compared with 24.1 +/- 9.6 pg/ml/cm2 (p less than 0.025) in the adjacent carotid artery. The prostacyclin production in the 6-month homografts was 21.7 +/- 12.4 pg/ml/cm2, not significantly different from the adjacent carotid artery. The return of prostacyclin paralleled the return of an intact endothelium. Compliance of fresh vein was diminished by cryopreservation, from 1.57 +/- 0.39% radial change/mm Hg (10(-2] to 0.79 +/- 0.21% radial change/mg Hg (10(-2] (p less than 0.02). The compliance of CVH at 3 months (1.7 +/- 1.0) and at 6 months (1.1 +/- 0.42) was not significantly different from cryopreserved veins. These data showed that CVH remained patent in dogs for 9 months, without loss of compliance for 6 months, and developed a morphologically intact and functional endothelium that paralleled the resolution of the inflammatory infiltrate.

Animals↗
PubMed1985

Small-bowel obstruction caused by intraluminal migration of prosthetic grafts.

Two patients who had undergone prosthetic grafting in the venous system presented with small-bowel obstruction. The first had undergone mesocaval shunting with a Dacron graft and the second, replacement of the inferior vena cava with a polytetrafluoroethylene graft after an extensive resection of retroperitoneal tumor. In both instances the grafts were within the lumen of the small bowel, causing a mechanical obstruction. No evidence of retroperitoneal bleeding subsequent to detachment of the grafts was noted.

Adult↗
PubMed1984

Cardiovascular evaluation of the young athlete.

Heart murmurs and cardiovascular defects, elevated blood pressure, and arrhythmias cause considerable concern to many physicians evaluating or certifying students for competitive athletic participation. The purpose of this article is to present a practical approach to the evaluation and management of these problems.

Adolescent↗
PubMed1980

Superiority of blood cardioplegia over asanguinous cardioplegia--an experimental and clinical study.

This study compares experimental and clinical results using both an asanguinous and sanguinous vehicle for delivering the cardioplegic solution. Animals receiving blood cardioplegia had better left ventricular function after unclamping, significantly less post-ischemic myocardial edema, and a better ability to augment flow and oxygen consumption. Patients receiving blood cardioplegia had also better myocardial performance with high cardiac outputs and lower left atrial pressure, and showed less evidence of myocardial damage. We conclude that oxygenation of the cardioplegic solution provides superior myocardial protection to that seen when the same solution is used in an asanguinous vehicle.

Animals↗
PubMedDate not supplied

Alpha-1-antitrypsin deficiency in aneurysmal disease.

alpha 1-Antitrypsin (alpha 1-AT) deficiency may play a role in arterial aneurysmal disease by allowing increased proteolysis of arterial structural proteins. Alpha 1-AT levels are influenced by variation at the PI (protease inhibitor) locus. PI phenotypes were determined in 173 patients with abdominal aortic aneurysms (77 from Pittsburgh, 96 from London) and in 72 patients with intracranial aneurysms (26 from Pittsburgh, 46 from London). No excess of PI deficiency alleles was observed in either of the aortic aneurysm data sets or in the Pittsburgh intracranial aneurysm data. The PI*Z deficiency allele frequency in the London intracranial aneurysm data was 8-fold higher than in controls; however, this was not significant after correcting for multiple comparisons. PI phenotype had no effect on aneurysm age-at-diagnosis within any of the data sets. Smoking history had an effect on aneurysm age-at-diagnosis only within the Pittsburgh intracranial-aneurysm data.

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