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Biomedical subjects

F Joyce

Publications and source records attributed to F Joyce.

13 recordsLinked to original sources
PubMed1997

Direct bronchial artery revascularization and en bloc double lung transplantation--surgical techniques and early outcome.

BACKGROUND: Lung transplantation including direct bronchial artery revascularization (BAR) has produced promising early results in small clinical series. METHODS: In Copenhagen primary en bloc double lung transplantation with BAR, with the left mammary artery used as conduit, has been performed in 47 patients from 1992 to the end of 1995. After introduction of the bloc into the recipient, the mammary-to-bronchial artery anastomosis is performed as the first anastomosis, allowing perfect exposure and early reperfusion. Internal mammary-bronchial artery arteriography has been performed routinely after operation. RESULTS: Bronchoscopic examination performed in all patients documented normal airway healing in 42, disturbed in two, and complicated in three. Arteriography performed in 42 patients demonstrated complete BAR in 25, incomplete in 15, and failed BAR in 2. Failed BAR was associated with complicated airway healing. The 1- and 2-year survival rate (Kaplan-Meyer) is 83%. Eleven patients have died, only one within 30 days. The total incidence of bronchiolitis obliterans syndrome at 3 years (with Kaplan-Meier technique) is 33%. Successful BAR has also been performed with an adjusted technique in a limited number of heart-lung and single lung transplantations. Our total experience of BAR in any type of lung transplantation includes 65 patients with an arteriographic BAR success rate of 94% (50 of 53 examined patients). CONCLUSIONS: Experience has improved the surgical technique and has made BAR reliable and safe, be it double lung, single lung, or heart-lung transplantation. Early results are good, but only follow-up will show if long-term results after lung transplantation will be improved by BAR. Already today, en bloc double lung transplantation with BAR is a viable alternative to sequential bilateral lung transplantation.

Anastomosis, Surgical↗
PubMed1997

Early autograft endocarditis after Ross operation: a case history.

A case of early autograft endocarditis occurring three weeks after a Ross operation is described. The origin of the infection appeared to be the proximal suture line of the autograft and the pathology included subvalvular destruction of the autograft, a pseudoaneurysm between the autograft and the left atrium, and a fistula to and a vegetation in the roof of the left atrium. The valve cusps were unaffected and there was only slight autograft insufficiency (grade I-II). The autograft was removed and successfully replaced with a homograft.

Adult↗
PubMed1996

A systematic technical approach to the Ross operation.

The Ross operation is a technically demanding procedure. The pressure on the surgeon to produce consistently good results from the very first operation is great, since he is not afforded the luxury of a very soft "learning curve", as is the case with many technically difficult operations, due to the availability of acceptable and safe alternatives for most Ross candidates. We have felt this pressure from the outset and this has motivated a commitment to the development of a systematic surgical technique in an attempt to achieve consistently excellent results. Maintenance of normal autograft spatial geometry after translocation to the aortic position is necessary to ensure proper leaflet coaptation and to avoid autograft insufficiency, and this is the underlying principle upon which this technique is based. Most Ross operations are now performed as total aortic root replacements with a free-standing autograft, However, the autograft is soft and compliant, and will adapt to the dimensions of the more solid tissue into which it is inserted, the aortic annulus proximally and ascending aorta distally, and root replacement will not guarantee that normal autograft geometry will be maintained unless there is a correct size match between the autograft and the aortic annulus and sino-tubular junction, and the autograft is not distorted in other ways. A systematic technical approach to the Ross operation so that size mismatch is avoided and autograft geometry is maintained has been developed and is described in step-by-step detail. In the first third of this series of 85 patients, two patients had moderate (2+) and three patients had mild (1+) immediate postoperative autograft insufficiency. As our understanding of the important sizing and orientation issues has increased and the systematic technique has evolved, the incidence of early autograft insufficiency has essentially been eliminated. In the latter 2/3 of the series, all patients had less than mild autograft insufficiency, except one patient who had mild (1+) insufficiency. We believe that these results validate the principles on which this systematic technical approach is based and that the methods described will help both current and future Ross surgeons perform consistently successful operations.

Anastomosis, Surgical↗
PubMed1996

Changing indications for the Ross operation.

The first Ross operation in Copenhagen was performed in 1992, and from the beginning of the series, which now numbers 80 patients, the underlying philosophy has been based on our belief that the autograft/Ross operation possesses a number of important and unique advantages compared with other alternatives, particularly for patients with complicated aortic valve disease in which alternative treatments are not satisfactory. The series includes patients of 6 weeks to 71 years of age, many with complicating conditions (endocarditis, 24 patients [native valve, 15; prosthetic valve, 9; advanced 17; active, 15; healed, 9], prosthetic valve dysfunction, 4; small aortic root, 2; ascending aortic aneurysm, 5; ventricular septum defect, 2; mitral valve disease, 7; tricuspid valve disease, 2; rheumatic heart disease, 7; aortic annular dilatation, 2; coronary artery disease, 4; extreme obesity, 1; severely reduced left ventricular function, 7; and previous heart surgery, 28). Mortality is low: hospital mortality, 3 patients (3.75%); late mortality, 1 patient (1.25%). Three patients have required reoperation, however; 1 because of autograft insufficiency and 2 because of pulmonary homograft stenosis, but autograft function is good in 73 (< or = 1+) and acceptable (< or = 2+) in 3 patients, and seems to be stable at follow-up. All in all, the early results are encouraging. We are particularly enthusiastic about the Ross operation for patients with complicated aortic valve pathology such as endocarditis, the small aortic root, combined valvular and subvalvular stenosis, and we believe that the Ross operation may be the best operation for these patients.

Adolescent↗
PubMed1995

The Ross operation: results of early experience including treatment for endocarditis.

The Ross operation has been performed for more than 25 years and its popularity has increased dramatically in recent years. We developed an interest in this procedure through a combination of a basic dissatisfaction with a device that requires life-long anticoagulation and the belief that a vital, autologous tissue valve with normal valve morphology and hemodynamics would prove to be superior to the mechanical valve, and that these advantages would outweigh the potential drawbacks related to the operation's technical difficulty and the risk of autograft or homograft dysfunction. From December 1992 to November 1994 40 Ross operations as total root replacements in a diverse group of patients between 5 and 72 years of age (median 32) were performed at Rigshospitalet. Seventeen (43%) of the patients had undergone at least one previous open heart operation. Eleven patients (28%) required surgery because of ongoing or previous endocarditis, and of these, nine had aortic annular destruction and cavity/pseudoaneurysm formation and five had prosthetic valve endocarditis. Three patients (8%) were operated because of mechanical valve dysfunction. One patient was treated for an ascending aortic aneurysm and aortic insufficiency. The remaining 25 patients were operated because of congenital or acquired aortic insufficiency, stenosis, or both. Ten patients (25%) underwent concomitant procedures. No mortality or serious complications occurred. Morbidity was limited to one case each of total atrioventricular (A-V) block, sternal pseudarthrosis, minor stroke, and deep vein thrombosis. Thirty-five patients had no or trivial, two patients mild, and three patients moderate autograft valve insufficiency during a median follow-up of 8 months (range 0-23 months). Two patients had pulmonary stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Expanding indications for the Ross operation.

During the past 2.5 years, 50 Ross operations have been performed at Rigshospitalet in Copenhagen in a broad range of patients with aortic valve disease including children and adults from 6 weeks to 71 years of age. Many patients had complicating conditions including endocarditis (n = 13, eight native, five prosthetic valve), prosthetic valve dysfunction (n = 4), subvalvular obstruction (n = 3) treated by septal myectomy (n = 1) or modified Konno operation (n = 2), ascending aortic aneurysm (n = 2), ventricular septum defect (n = 1), mitral valve disease (n = 6), rheumatic heart disease (n = 4), coronary artery disease (n = 1), and extreme obesity (n = 1). All operations were performed as free-standing total aortic root replacements. The results have been encouraging with low mortality (2%) and no major morbidity. One patient has been reoperated because of autograft insufficiency due to left coronary cusp prolapse and two additional patients have grade 2 autograft insufficiency and are being followed closely. Two patients have developed early pulmonary homograft stenosis, which has required pulmonary homograft replacement. Despite these problems, we are enthusiastic about this operation and believe it may emerge as operation of choice for most patients under 60-65 years of age with aortic valve disease and for patients with prosthetic or advanced native aortic valve endocarditis. With increasing frequency, our choice has been to proceed with a Ross operation, and currently, our only absolute contraindication is Marfan's syndrome. Based on reported recurrent disease in patients with rheumatic valve disease, the autograft should be used with caution for this indication.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The Ross operation in the treatment of prosthetic aortic valve endocarditis.

Prosthetic aortic valve endocarditis is associated with significant morbidity and mortality despite aggressive medical and surgical treatment. In most cases, surgery is the only curative treatment modality, and these operations can be extremely challenging due to often extensive perivalvular tissue destruction. The currently recommended treatment for these advanced infections is thorough debridement and aortic root replacement with a homograft, although it seems that equally good results can be achieved with composite valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of noninfective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. We have used the Ross operation as total root replacement with success in 11 patients with native or prosthetic aortic valve endocarditis. This article describes the use of this treatment modality in five of these patients between 10 and 72 years of age with prosthetic aortic valve endocarditis. Follow-up extending to 22 months shows excellent results with no mortality and no reinfection. The pulmonary autograft seems to be technically and uniquely well suited for these cases, and it has growth potential, excellent hemodynamics, and a low risk of reinfection, thrombosis, and embolic complications, without anticoagulation.

Adolescent↗
PubMed1994

The Ross operation in the treatment of native and prosthetic aortic valve endocarditis.

Bacterial endocarditis of the native or prosthetic aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when invasion of perivalvular tissue occurs. The currently recommended treatment for these advanced infections, in addition to thorough debridement, is aortic valve or root replacement with a homograft, although it appears that equally good results can be achieved with prosthetic valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. This paper describes successful use of the Ross operation as total root replacement in six young patients between 10 and 32 years of age with aortic valve endocarditis. Three of the patients had active endocarditis and five patients had advanced disease, i.e. endocarditis with perivalvular tissue invasion and destruction. Follow up extending to 18 months continues to show excellent results with no mortality and no re-infection. We conclude that the Ross operation as total root replacement may be the best procedure for young patients with aortic valve endocarditis. The pulmonary autograft appears to be technically particularly well-suited, has growth potential, excellent hemodynamics, and a low risk of re-infection, thrombosis, and embolic complications without anticoagulation. Based on the long term results of the Ross operation in non-infected patients, excellent long term results are expected in this group as well.

Adolescent↗
PubMed1990

Ultrasonically guided percutaneous implantation of iodine-125 seeds in pancreatic carcinoma.

Cancer of the pancreas is most often not diagnosed before it has reached unresectable stages. The development of effective palliative treatment for these patients and for those with recurrence after resection is clearly needed. The present study reports the results of ultrasonically guided percutaneous implantation of 125I seeds in 19 patients with cancer of the pancreas. Twelve patients had further adjuvant external radiation. Despite satisfactory seed placement and delivery of the planned radiation dose in most cases, clinical improvement was lacking or only slight and short-lived. No difference in survival or palliation was observed between patients treated with seeds alone compared with patients treated with seeds and external radiation. Survival after seed implantation was short (median 140 days, range 7-401 days). Ultrasonically guided percutaneous implantation of 125I seeds cannot be recommended in the treatment of unresectable carcinoma of the pancreas.

Adult↗
PubMed1988

Carrageenan-induced coxitis in puppies.

We studied the influence of chronic synovitis and joint effusion on the blood supply and growth of the immature femoral head in 12 puppies. Twelve weekly intraarticular injections of Carrageenan solution caused unilateral coxitis with caput magnum formation. Joint pressures in the neutral position were 0.9 kPa in the coxitis hips and -0.5 kPa in the contralateral hips. The joint capsule in coxitis showed hyperemia as measured by tracer microsphere technique. In nonmedicated, awake, standing dogs there was hyperemia of both the femoral head epiphysis and the joint capsule. In all the dogs, acetabular and proximal femoral metaphyseal blood flow was unchanged. In the control group, repeated cannulation and injection of normosaline did not change the hemodynamics, joint pressure, or femoral head size. We found no evidence of femoral head ischemia in coxitis with moderate chronic elevation of resting joint pressure.

Animals↗
PubMed1986

Fibrin sealant in bone transplantation. No effects on blood flow and bone formation in dogs.

To study bone formation and regional blood flow following the use of fibrin sealant in autologous cancellous bone transplantation, a dog model was developed. In 18 dogs, a standardized defect in both tibiae was filled with an autologous iliac crest graft. On one side, the bone chips were mixed with fibrin sealant while the other side served as control. After 1, 2 and 3 weeks the blood flow of the transplant was calculated and the new bone formed evaluated histomorphometrically. Generally, the highest blood flow rates and most intensive new bone formation were observed at 2 weeks postoperatively. Fibrin sealant did not alter blood flow or new bone formation, but a tendency to diminished new bone formation was found in some grafts. Our study does not support the application of fibrin sealant in ordinary cancellous bone grafting.

Animals↗
PubMed1985

Fixation of osteochondral fractures. Fibrin sealant tested in dogs.

Standardized osteochondral fractures in the left femoral condyle in 19 adult mongrel dogs were fixed with either fibrin sealant or Kirschner wire. Adaptation and mechanical strength after 4, 7 or 8, and 14 days were compared with an in vitro study of the initial strength of the fibrin sealant in osteochondral fractures. After 4 days, the maximum tensile strength was increased in the fibrin sealed group, whereas no difference in energy absorption at failure was found. Although the initial strength of the fibrin bond was low, the tendency to displacement was less in this group. Our results suggest that fibrin sealant can be used for fixation of small osteochondral fragments, provided that immobilisation is sufficient.

Animals↗