Biomedical subjects

F M Wagner

Publications and source records attributed to F M Wagner.

At least 19 recordsLinked to original sources

PubMed2004

Heart transplantation in a patient with multiple sclerosis and mitoxantrone-induced cardiomyopathy.

We describe a 30-year-old man with end-stage heart failure after therapy with mitoxantrone for multiple sclerosis. A successful orthotopic heart transplantation was performed when intensified medical therapy failed to improve the patient's hemodynamics. In spite of the severe underlying disease he did well on dual immunosuppression with methylprednisone and cyclosporine. Neurologic symptoms remained stable throughout the procedure and, after 2 months, he resumed preoperative ambulatory status. Eight years after the operation, the patient is now in New York Heart Association (NYHA) Class I status. Using canes, he is able to walk short distances. Repeated urinary tract infections caused by Escherichia coli became a problem, but have been controlled by long-term oral antibiotic prophylaxis with trimethoprim.

Adult↗

PubMed2001

Young Investigator's Prizewinner 2001. Direct visualization of the influence of normothermic as opposed to hypothermic cardiopulmonary bypass on the systemic microcirculation in neonatal piglets.

The direct visualization of systemic microcirculation using intravitalmicroscopy permits the classification of proinflammatory and ischemic microvascular alterations during normothermic and hypothermic cardiopulmonary bypass in neonates. We used seven newborn piglets, on average aged 9 days, and weighing 3200g, as a control group. In addition, we studied nine piglets subjected to 60 minutes of constant nonpulsatile flow using hypothermic extracorporeal circulation at 28 degrees C, and five piglets using normothermic conditions at 37 degrees C. The microvascular network of the greater omentum and the subcutaneous tissue was directly visualized using intravitalmicroscopy. We analysed interactions between leukocytes and endothelial cells, microvascular morphology, and microrheological conditions, focussing on signs of ischemic and proinflammatory alterations. During normothermic cardiopulmonary bypass, the numbers of activated leukocytes were elevated compared to hypothermic cardiopulmonary bypass (p > 0.05). Arteriolar diameter decreased during hypothermia. Capillaries were markedly dilated during normothermia. Patterns of microvascular perfusion, for both types of cardiopulmonary bypass, showed signs of ischemic damage, revealed by a reduced functional capillary density. Perfusion dependent levels of lactate were higher during normothermic cardiopulmonary bypass (p > 0.05). This new experimental approach revealed that non-pulsatile cardiopulmonary bypass, independent of temperature, induces a proinflammatory and ischemic response compared to an unaltered control group. The markedly elevated numbers of activated adherent leukocytes, the reduced capillary density, and the high lactate levels in those undergoing bypass in normothermic conditions indicate a more pronounced inflammatory stimulus and tissue hypoperfusion compared to the possible protective effect of hypothermia for children undergoing cardiopulmonary bypass.

Animals↗

PubMed1999

Oxygen tension in transplanted mouse osteosarcomas during fractionated high-LET- and low-LET radiotherapy--predictive aspects for choosing beam quality?

PURPOSE: The lower OER of high-LET radiations, compared to conventional (low-LET) radiations, has often been put forward as an argument for using high-LET radiotherapy in the management of hypoxic tumours. Among the different neutron beams used in therapy, the reactor fission neutrons have the lowest OER. The aim of the present study is to follow the variations of tumour oxygenation status during fractionated irradiation with different radiation qualities. Little information is available so far after fractionated high-LET irradiation. In addition, the RBE of reactor fission neutrons for effects on tumours and on normal tissues are compared. MATERIAL AND METHODS: Murine OTS 64-osteosarcomas were transplanted in 102 balb-C mice and irradiated by 36 Gy of photons in fractions of 3 Gy five times a week (group P-36/3) or by 12 Gy of reactor fission neutrons in fractions of 2 Gy two times a week (group N-12/2). Irradiations started at a tumor volume of 500 to 600 mm3. A third group received no radiotherapy, but all investigations (group CG). Tumor volume and tumor oxygenation were measured once a week under therapy and during three weeks after therapy. For in vivo-evaluation of oxygen status a computerized polarographic needle electrode system (KIMOC pO2 histograph, Eppendorf) was used. The median pO2 and the hypoxic fraction (pO2 values < 5 mm Hg) of single tumors and of total groups were calculated from pooled histograms and from row data as well. RESULTS: In correlation with the increase of tumor volume, from day 1 to day 42 of follow-up the median pO2 decreased from 20 mm to 8 mm Hg and the hypoxic fraction increased from 7% to 31%. After fractionated photon therapy a growth delay of three weeks was observed. Six weeks after beginning of the irradiation the median tumor volume had been doubled again. After fission neutron therapy growth delay continued until the end of the follow-up period. In both of the irradiated groups a significant decrease of median pO2 values and an increase of the hypoxic fraction were observed under radiotherapy. Hypoxia was more intensive after neutrons with a decrease of the median pO2 from 20 mm Hg to 1 mm Hg vs. 10 mm Hg after photon therapy and with an increase of the hypoxic fraction from 7% to 78% vs. 36% respectively. Two weeks after the end of therapy the median pO2 and the hypoxic fraction of both treated groups reached the levels prior to irradiation indicating a complete reoxygenation. CONCLUSION: During fractionated irradiation of murine osteosarcomas with photons and reactor fission neutrons, a marked hypoxia was observed for both radiation qualities, but hypoxia was more intense during fractionated neutron irradiation. After irradiation, a complete reoxygenation occurred in both groups independently of the degree of hypoxia observed during the treatment. The RBE of reactor fission neutrons, after fractionated irradiation, was much higher for effects on murine osteosarcomas compared to their RBE observed for normal tissues in previous experiments. Present data are in agreement with our clinical observations on more than 300 patients treated with reactor fission neutrons for advanced and hypoxic tumours with various histologies.

Animals↗

PubMed1999

New minimally invasive surgical technique using arterial T-grafts for treatment of double-vessel coronary artery disease: experimental study.

Minimally invasive surgery has been used successfully in patients with single-vessel coronary artery disease (CAD), but there are no clinical reports of surgical techniques for the treatment of multivessel disease in this field using both internal mammary arteries (IMAs). Therefore a canine model has been established to demonstrate the feasibility of a minimally invasive surgical treatment of coronary artery double-vessel disease using both IMAs. Ten mongrel dogs underwent bilateral thoracoscopic preparation of both internal mammary arteries through small left lateral chest ports. Using the Port Access endovascular cardiopulmonary bypass system the right IMA (RIMA) was anastomosed as a free graft end-to-side to the left IMA (LIMA) as a T-graft. After induction of cardioplegic arrest the RIMA was anastomosed to the circumflex artery and the LIMA to the left anterior descending artery. All animals were weaned from cardiopulmonary bypass without inotropic support. The electrocardiogram showed sinus rhythm with no signs of ischemia. Intraoperative coronary angiography demonstrated patency of all anastomoses. The minimally invasive surgical treatment of double-vessel CAD using arterial T-grafts of both IMAs is thus feasible. Surgical trauma can be further reduced by harvesting the RIMA transmediastinally through the left lateral chest.

Anastomosis, Surgical↗

PubMed1999

Clinical experience with minimally invasive coronary artery and mitral valve surgery with the advantage of cardiopulmonary bypass and cardioplegic arrest using the Port Access technique.

To minimize surgical trauma, the use of Port Access cardiac surgery was initiated in patients (pts) with coronary artery disease (CAD) (42 pts) or mitral valve disease (MVD) (24 pts) in March 1996 at our institution. Altogether 42 pts (36 men, 6 women; age 31-75 years, median 59.0 years) with isolated lesions of the left anterior descending (LAD) artery underwent Port Access coronary artery surgery (PACAS). A small (5-9 cm) incision was done parasternally on top on the fourth rib. The left internal mammary artery (LIMA) was dissected through the minithoracotomy or by using an additional thoracoscopic approach. A total of 24 pts (12 men, 12 women; age 30-75 years, median 62 years) underwent Port Access mitral valve surgery (PAMVS). In these pts the procedure was performed through a small right thoracotomy (6-8 cm). In all cases, endovascular cardiopulmonary bypass (CPB) was instituted through femoral cannulation, and an additional endoaortic balloon catheter was introduced into the ascending aorta for aortic occlusion. In pts with PACAS the survival was 98% (41/42) and in the PAMVS group 100%. All pts but one survived the PACAS and are well today. There were no deaths in the PAMVS group. The hospital stay was reduced by 1 day on average after PACAS and 3 days after PAMVS. Thus in well selected patients Port Access cardiac surgery represents a safe and feasible minimally invasive surgical approach that avoids the potential complications of a sternotomy while offering the advantages and safety of CPB and cardioplegic arrest. This minimally invasive approach offers a shortened hospital stay and earlier rehabilitation.

Adult↗

PubMed1999

The Dresden approach for complete multivessel revascularization.

BACKGROUND: In a prospective clinical trial, a group of patients receiving less invasive surgical procedure, including minithoracotomy in combination with cardiopulmonary bypass (group 1), was compared to a group of patients receiving conventional bypass surgery (group 2) for the treatment of coronary artery disease. METHODS: Group 1 included 85 patients (71 men, 14 women, aged 39 to 82 years, median 61.1 +/- 9.0 years); group 2 included 53 patients (38 men, 15 women, aged 51 to 79 years, median 62.0 +/- 6.1 years). RESULTS: There were no perioperative deaths in the whole series of patients. Time of operation was 256 +/- 43 minutes in group 1 and 150.0 +/- 53.6 minutes in group 2. Hospitalization was 6.0 +/- 1.4 days and intensive care unit stay 1 day for both groups. Back pain assessment on postoperative day 3 showed less pain in group 1. Three-month follow-up revealed ischemia in stress electrocardiogram in 2 patients (2.5%) in group 1 and in 2 patients (4.1%) in group 2. Coronary angiograms confirmed the stress-electrocardiogram findings. CONCLUSIONS: Surgical results are equal for both techniques. Even though time of operation is longer in patients receiving less invasive procedures, intensive care unit stay and hospital stays are the same length. Early postoperative back pain is less in group 1 and combined with faster convalescence.

Adult↗

PubMed1999

New telemetric system for daily pulmonary function surveillance of lung transplant recipients.

BACKGROUND: Following lung transplantation, prompt diagnosis and therapy of acute pulmonary rejection and infection episodes relies primarily upon changes in pulmonary function and determines long-term outcome. We tested a new system that allows daily monitoring of the patient's pulmonary status even after discharge from the hospital. METHODS: Seven lung transplant recipients from our center were equipped with a telemetric monitoring device consisting of a portable flowmeter and a special modem unit. The flowmeter measures forced vital capacity (FVC), forced expiratory volume per second (FEV1), and mid expiratory flows (MEFs), encodes information like fever, cough, and dyspnea in a binary code form, and stores all values in a 32 kB memory unit. After its use, the patient positions the flowmeter onto the modem unit which automatically connects to a central computer at our center to transfer all saved data. The whole set can be used via any regular phone jack. The patient's file in the computer can be checked every day. RESULTS: All patients learned to use the unit during their postoperative stay or during later follow-up, and were able to apply the system at home. In a mean follow-up period of 10.3+/-2.2 months, 15 episodes of significant deterioration in home pulmonary function tests (PFTs) (>10%) were registered in 6 patients, which were all confirmed by in-hospital body plethysmography. They resulted in diagnoses of 4 episodes of acute rejection, 6 cases of beginning bacterial pneumonia, and 5 cases of, most likely, viral tracheobronchitis. Only 1 patient had to be admitted to the hospital. All patients PFTs returned to previous values after treatment. CONCLUSIONS: Telemetric monitoring of graft function in lung transplant recipients allows reliable early diagnosis and treatment of infection or rejection, which might help to prevent exacerbation of the pathology and reduce quantity of amounting graft dysfunction.

Forced Expiratory Volume↗

PubMed1999

Port Access surgery for congenital heart disease.

OBJECTIVES: Minimally invasive surgical techniques have been introduced into cardiac surgery in order to avoid median sternotomy related complications. Surgical trauma to the patient can be significantly reduced without compromising the safety. In addition, a small lateral chest incision results in improved cosmesis, especially in female patients. METHODS: Thirteen patients (median age 39 +/- 14 years, ranged from 17-61 years) with atrial septal defect were treated with a minimally invasive surgical method using a modified Port Access technique. In all patients access to the heart was achieved via a small (4-8 cm) right lateral chest incision in the 4th intercostal space. In these patients the selection of the Port Access system was used for cardiopulmonary bypass via the femoral vessel and for the application of cardioplegic solution. RESULTS: No deaths or intraoperative complications were observed in any of the patients. The postoperative course was uneventful and only minor complications were observed postoperatively. The median hospital stay was 8.0 +/- 1 days (median +/- SEM). CONCLUSION: This minimally invasive surgical technique for the treatment of atrial septal defects represent a safe alternative to conventional treatment of ASD using median sternotomy and standard cardiopulmonary bypass. The exposure of the right atrium via the 4th intercostal space is ideal and can be performed with excellent cosmetic results.

Adult↗

PubMed1998

Port-Access coronary artery bypass grafting with the use of cardiopulmonary bypass and cardioplegic arrest.

BACKGROUND: To reduce surgical trauma, we performed minimally invasive Port-Access (Heartport Inc, Redwood City, CA) coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest. METHODS: Thirty-six men and 6 women with a median age of 59 years (range, 31 to 75 years) and isolated lesions of the left anterior descending branch of the coronary artery underwent Port-Access coronary artery bypass grafting. A small (6- to 9-cm) incision was made parasternally on top of the fourth rib. The left internal thoracic (mammary) artery was dissected and taken down through the minithoracotomy either alone or using an additional thoracoscopic approach. Cardiopulmonary bypass was instituted through femoral cannulation, and an additional endoarterial balloon catheter (Heartport Inc) was introduced into the ascending aorta for aortic occlusion, aortic root venting, and the delivery of cold antegrade crystalloid cardioplegia. After cardioplegic arrest, the left internal mammary artery was anastomosed to the left anterior descending artery under direct vision. RESULTS: The median left internal mammary artery takedown time was 49.5 +/- 21.9 minutes, the duration of cardiopulmonary bypass was 59.5 +/- 32.8 minutes, the aortic occlusion time was 28.5 +/- 7.9 minutes, the intensive care unit stay was 1.0 +/- 3.2 days, and the total hospital stay was 5.0 +/- 2.5 days. Intraoperative angiograms were done in the first 10 patients and showed patent left internal mammary artery grafts without anastomotic complications in all cases. Two arterial dissections, including one aortic dissection, were observed in patients with preexisting peripheral vascular disease. The other complications were minor. All but 1 patient recovered well, with no major limitations in their daily activities. CONCLUSIONS: Using this minimally invasive method, sternotomy-related complications can be avoided, the hospital stay can be reduced, and a safe coronary artery bypass grafting procedure can be performed with the advantage of cardiopulmonary bypass and cardioplegic arrest as are used routinely in conventional coronary artery operations.

Adult↗

PubMed1998

Minimally invasive surgical technique for the treatment of multivessel coronary artery disease.

BACKGROUND: To avoid sternotomy-related complications after cardiac operations, we developed a minimally invasive surgical technique for the treatment of multivessel coronary artery disease. METHODS: From November 1996 to May 1997, 39 patients (age range, 50 to 78 years) with coronary artery disease were treated with the use of this technique. Through a small (6- to 9-cm) left lateral chest incision in the third intercostal space, the left internal mammary artery was harvested directly. With the use of cardiopulmonary bypass and cardioplegic arrest in all patients except 1, the left internal mammary artery was anastomosed to the left anterior descending artery. In addition, vein grafts and other arterial conduits were used for revascularization of the other coronary arteries. RESULTS: There were no intraoperative complications. All the patients survived the procedure and had an uneventful postoperative course. Wound complications occurred in 2 patients. The median (+/- standard error of the mean) hospital stay was 6 +/- 1 days. CONCLUSIONS: This technique combines minimally invasive surgical conditions with the safety standards of routine cardiac operations. With the use of this approach, even extensive coronary artery disease can be treated.

Aged↗

PubMed1998

A novel charcoal-induced model of obliterative bronchiolitis-like lesions: implications of chronic nonspecific airway inflammation in the development of posttransplantation obliterative bronchiolitis.

OBJECTIVES: In this study, we describe the development of a nonallogeneic animal model of obliterative bronchiolitis-like lesions. Furthermore, we examined whether chronic rejection alone can lead to the development of obliterative bronchiolitis or whether additional nonspecific airway inflammation is required. METHODS: Part I: Rats were intratracheally injected with 0.2 ml of activated charcoal or sorbitol solution (carrier for charcoal control). Animals were put to death beginning at 2 weeks up to 20 weeks. Part II: Animals were divided into three groups: group I, underimmunosuppressed Brown Norway to Lewis lung allografts; group II, charcoal-treated underimmunosuppressed allografts; and group III, charcoal-treated rats. Animals were put to death at 3 months after transplantation. RESULTS: Part I: In charcoal-laden bronchioles, subacute nonspecific airway inflammation was detected at 2 weeks. Slow, subclinical fibroproliferation ensued during the following weeks. Obliterative bronchiolitis-like lesions were observed in 80% of charcoal-treated animals at 12 weeks. Part II: Allografts developed extensive vascular lesions consistent with acute and chronic vascular rejection. Obliterative bronchiolitis-like lesions were scarcely detected. Charcoal-treated allografts demonstrated evidence of diffuse and severe obliterative bronchiolitis-like lesions. CONCLUSIONS: Transtracheal injection of activated charcoal into native lungs results in slowly progressive airway injury and inflammation leading to obliterative airway lesions. Inadequate immunosuppression primarily results in chronic vascular rejection but not obliterative bronchiolitis. Underimmunosuppressed allografts subjected to nonspecific airway inflammation develop obliterative airway lesions that are more prominent than in native lungs. This suggests that a cofactor to chronic rejection is likely necessary for the development of lung transplant obliterative bronchiolitis.

Animals↗

PubMed1998

Minimally invasive mitral valve surgery--clinical experiences with a PortAccess system.

OBJECTIVE: This is the initial experience with a new minimally invasive surgical technique for the treatment of mitral valve disease using a PortAccess system. METHODS: Between May 1996 and May 1997, 21 patients (nine male, 12 female, aged 30-75 years, median 64 years) underwent minimally invasive mitral valve surgery. The underlying diseases were: mitral valve insufficiency (n = 11), mitral valve stenosis (n = 5) and combined mitral valve disease (n = 5). Through a small right thoracotomy (6-8 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter (Heartport Inc., Redwood City, CA) was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (four patients) or replacement (15 patients) was performed. RESULTS: There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography. There was no postoperative study-related complication. Time of ventilation, intensive care unit and hospital-stay were comparable with the data of patients undergoing conventional mitral valve surgery. CONCLUSIONS: This technique of PortAccess mitral valve surgery combines the advantage of less invasive operative trauma with the safety of conventional mitral valve surgery.

Female↗

PubMed1998

Clinical experiences with minimally invasive mitral valve surgery using a simplified Port Access technique.

OBJECTIVE: Using the initial experiences with the Port-Access technique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures. METHODS: Twenty-nine patients (13 male, 16 female, aged 30 to 75 years, median 62.5 +/- 11.0 years) underwent minimally invasive mitral valve surgery between May 1996 and December 1997. The underlying diseases were: mitral valve insufficiency (n = 16), mitral valve stenosis (n = 7) and combined mitral valve disease (n = 6). Through a small right thoracotomy (5-7 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (five patients) or replacement (24 patients) was performed. RESULTS: There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography in three patients. There was no postoperative study-related complication. Time of ventilation and intensive care unit were comparable with the data of patients undergoing conventional mitral valve surgery but hospital stay was shorter in the last 10 consecutive cases. CONCLUSIONS: This simplified technique of mitral valve surgery combines the advantage of less invasive operative and good cosmetic results with the safety of conventional mitral valve surgery. At our institution this technique presents in well selected patients suffering from mitral valve disease the procedure of choice.

Cardiac Surgical Procedures↗

PubMed1998

[Flow cytometry controlled induction therapy with ATG and noninvasive monitoring of rejection--a modern management concept after heart transplantation].

We introduce our concept of non-invasive transplant monitoring. The introduction of individualized immunosuppression by means of flow cytometry leads to a lower incidence of acute graft rejection and preserves immuncompetence. With the simultaneous use of echocardiography and intramyocardial electrogram (IMEG) acute graft rejections can be safely identified without using any invasive method.

Adult↗

PubMed1997

Immunohistochemical characterization of inflammatory and proliferative events during chronic rejection in rat lung allografts.

BACKGROUND: Chronic rejection is assumed to be the principle cause of airway injury leading to obliterative bronchiolitis (OB) after lung transplantation (Tx). To better understand the contribution of chronic rejection in the development of OB in allografted lungs, we examined the histopathological changes and cytokine expression in inadequately immunosuppressed rat lung allografts. METHODS: Three groups of rats were studied: group I, control nontransplanted Lewis (Lew) rats (n=5); group II, syngeneic Lew-to-Lew isografts (n=25); and group III, Brown Norway-to-Lew allografts (n=25). Groups II and III received two single doses of cyclosporine on postoperative days 2-3. Transplanted animals were killed (n=5) at monthly intervals from 2 months to 6 months after Tx. Resected lungs were stained with hematoxylin and eosin, Masson's trichrome, and Van Gieson's elastin, and immunostained with antisera to interleukin (IL)-1beta, IL-8, and basic fibroblast growth factor (bFGF). The intensity of immunostaining was graded from 0 to 4 (0=no staining, 4=strong staining). RESULTS: In groups I and II, normal airways and vessels were observed. Minimal intensity and distribution of immunostaining for all markers were detected in groups I and II. Group III allografts demonstrated acute grade II-III vascular rejection with mild bronchiolar injury and inflammation at 2 months after Tx. At 6 months after Tx, all allografts demonstrated severe and diffuse chronic vascular rejection. Late airway changes consistent with OB were detected in four of five allografts, however, these lesions were expressed infrequently. Immunohistochemical findings revealed moderate to strong expression for IL-8 and bFGF over the airway epithelium, acute and chronic inflammatory cells, and fibroblasts in allografts at 2 months after Tx. Despite focal development of OB at 6 months, intensity and distribution of immunostaining significantly decreased for all three cytokine markers. CONCLUSIONS: Inadequate immunosuppression of rat lung allografts leads primarily to chronic vascular rejection but fails to induce severe and diffuse development of OB. In this animal model, cytokines IL-1beta, IL-8, and bFGF are likely to play an important role in the early inflammatory phase but not during the late proliferative events of chronic rejection.

Animals↗

PubMed1997

Oxygen tensions in rodent tumors after irradiation with neutrons.

We started investigations on intratumoral oxygen tension after irradiations with reactor fission neutrons using the Eppendorf-pO2 Histograph. Isotransplanted AT17-mammary carcinomas on C3H-mice and osteosarcomas OTS-64 on balb C-mice received 2 or 6 Gy neutrons single dose. Before and at certain points of time after treatment the pO2 values were evaluated. Some tumors with initially low median pO2 values showed a short-lasting increase between 2 and 24 h after irradiation. In those tumors with relatively high pretherapeutic pO2 values the pO2 decreased to the range of hypoxia. A third group of tumors showed no marked changes after irradiation. No tumor stopped growth during the observation period.

Animals↗

PubMed1996

Oxygen tension in mouse mammary carcinomas and osteosarcomas after irradiation with reactor fission neutrons.

Investigations were made on intratumoral oxygen tension after irradiations with reactor fission neutrons using the Eppendorf-pO2-Histograph. Isotransplanted AT17-mammary carcinomas on C3H-mice and osteosarcomas OTS-64 on Balb c-mice received 2 or 6 Gy neutrons single dose. Before and at certain points of time after treatment the pO2-values were evaluated. Some tumors with initially low median pO2-values showed a short-lasting increase between 2 and 24 hours after irradiation. In the tumors with relatively high median pO2-values before irradiation the pO2 decreased to hypoxic range. A third group of tumors showed no significant changes after irradiation. None of the tumors stopped growth during the observation period.

Adenocarcinoma↗

PubMed1995

A new concept for successful long-term pulmonary preservation in a dog model.

We developed a dextran-glucose-based extracellular perfusion solution (DGX) that supports limited aerobic metabolism to maintain cellular integrity of an inflated donor lung during long-term ischemia and a storage temperature of 10 degrees C. In a dog model, we compared respiratory and hemodynamic function of orthotopically transplanted left lungs preserved using this method (DGX, group I, n = 6) with function of those preserved with EuroCollins solution (EC) stored at a temperature of 4 degrees C (group II, n = 6). All lungs were inflated with room air and stored for 12 hr. Pulmonary function was monitored for 5 hr of reperfusion. Values expressed below are group means with standard deviation. Statistical significance was calculated using a two-tailed t test. For PO2 (mmHg) (FiO2 = 0.4), group I (EC): control = 193 +/- 8, 30 min p.o. = 87 +/- 20*, 300 min p.o. = 174 +/- 13*; and group II (DGX): control = 217 +/- 28, 30 min p.o. = 184 +/- 46*, 300 min p.o. = 248 +/- 5*. For pulmonary vascular resistance (dynes), group I: control = 389 +/- 22, 30 min p.o. = 1209 +/- 301, 300 min p.o. = 1025 +/- 204*; and group II: control = 401 +/- 31, 30 min p.o. = 522 +/- 129, 300 min p.o. = 458 +/- 137* (*P < 0.05 DGX vs. EC). Gas analysis performed on air samples taken from the ischemic donor lung immediately after harvest and after 12-hr storage showed (calculated as group means) a significant decrease of PO2 and a significant increase of PCO2, respectively. Histology of the lungs after 5 hr of reperfusion showed essentially normal-appearing lungs in the DGX group, whereas lungs in the EC group showed thickening of the intra-alveolar septi, marked cellular infiltration, and accumulation of protein-like material in the alveoli. In this study, preservation with DGX resulted in satisfactory respiratory and hemodynamic function of the transplanted lung even after 12 hr of ischemia. It does not cause an increase of pulmonary vascular resistance as seen after preservation with EC. Data from the intrabronchial air analysis of the donor lung suggest that aerobic metabolism continues even under preservation conditions.

Animals↗