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Biomedical subjects

H Kambic

Publications and source records attributed to H Kambic.

12 recordsLinked to original sources

Biodegradable pericardial implants for bladder augmentation: a 2.5-year study in dogs.

Bladder augmentation using biodegradable pericardial tissue was evaluated in canine bladders. Acetic acid and acetic anhydride treated pericardial tissue grafts were stored in 75% ethanol for 18 to 27 months before implant. Ten dogs weighing 20 to 25 kg. were subjected to a 50% partial cystectomy. After careful separation of the mucosa, bladder muscle and adventitial layers a pericardial graft volumetrically equivalent to the portion of the bladder removed was sutured to the bladder remnant in 2 layers. In 1 control dog the bladder was opened, 50% of the bladder was removed and the bladder was closed primarily. In another control dog the excised bladder was replaced with fresh chemically treated patch material that was never subjected to ethanol storage. Excretory urography and cystography were performed on all dogs. Urodynamics with filling pressures and bladder volumes measured before and after the operation at intervals of up to 36 months confirmed that adequate bladder capacity was achieved. There were no operative complications. Postmortem histological evaluations revealed a smooth epithelialized inner surface with no traces of any surface irregularities or suture lines. The bladder apex showed an intact epithelium and the absence of a smooth muscle layer. The biodegradable acetylated tissue provides an intact structural reservoir for urine and serves as a template for epithelial regeneration. This permits volumetric bladder enlargement while the graft is progressively reabsorbed with time.

Animals

Characterization of rehydrated gelatin gels.

Five percent glutaraldehyde cross-linked gels have shown excellent blood compatibility as coatings for cardiac prostheses. A method was developed for producing thin dehydrated coatings using a proprietary dehydration procedure and ethylene oxide (EO) sterilization. The swollen surfaces of rehydrates versus wet (original) gels were compared. Within 30 min of saline rehydration, dry 30-50-microns films on textured surfaces became smooth, uniform, and comparable to original gelatin gels. Mechanical test results after rehydration showed values for strain remain unchanged (39.3 + 10.0 to 40.0 + 7.8%), but stress increased (2.79 + 1.21 to 4.22 + 1.60 dyne/cm2; p less than 0.01). The contact angle data reported gamma C values of 26.1 and 30.4 dyne/cm for original and rehydrated gels. Using a coulometric titrimeter, the measured water content of original gels was reduced from 85 to 3.4% after drying. Dried and saline rehydrated gels had a 73.2% moisture content. Gels shrank 8.8% of their original length after rehydration; however, the thickness of all pump coatings remained stable. Two-hour incubations with bovine platelet rich plasma showed no differences in platelet reactivity or morphology when compared to original gels. Light microscopy and scanning electron microscopy (SEM) showed no evidence of gel cracking or surface defects after pump endurance testing for 3 and 5 weeks. The process of dehydration eliminates the wet storage and sterility problems of such hydrogels and provides a stable film coating for a variety of blood-contacting substrates.

Biocompatible Materials

Biological performance of TiNi shape memory alloy vascular ring prostheses: a two year study.

A method was developed for the noninvasive insertion of a vascular ring prostheses aimed at preserving arterial patency and preventing restenosis following angioplasty. Using a specially designed 7F catheter 22 nitinol (TiNi) wire prostheses (I.D. 5 mm; 0.25 mm thickness) were torsion reduced in diameter and inserted under fluoroscopy into both carotid (n = 2) and iliac-femoral arteries (n = 20) of dogs. Aspirin (650 mg BID) and Persantin (200 mg BID) were given for only 30 days postoperatively. Angiography of all rings at 1, 6, 12 months exhibited excellent biocompatibility and long term patency 91% (20/22) as reported in Trans ASAIO 32:30, 1986. Four rings inserted in the right and left common iliac arteries and femoral artery were followed for up to 2 years and exhibited 100% patency. Angiography demonstrated that the anchorage of the prostheses was stable and the lumen was uniformly covered by a thin neointimal layer of endothelial like cells. The prostheses were patent with no evidence of thrombosis or inflammation. In view of the problem of recurrent stenosis occurring during the healing period after balloon angioplasty (PTA or PTCA), this approach may lead to a new means of clinical intervention in atherosclerosis.

Alloys

Experimental bladder substitution using a biodegradable graft of natural tissue.

A controlled canine experimental study has been performed to test the application of a biodegradeable graft to vesical augmentation. The graft, after providing initial bladder enlargement, is progressively reabsorbed while serving as a foundation for the regeneration and healing of the layers of the bladder remnant. Follow-up studies at 1 year revealed no urinary infection, calculi, extravasation of urine, or rejection of the material. Normal bladder capacities were maintained throughout the study and the reconstructed bladders functioned normally. The biodegradable graft was equally successful when applied either to a histologically normal bladder remnant, or to a pathological bladder of intramural fibrosis. These results suggest that this material may be well suited to clinical bladder substitution in humans.

Animals

Application of aldehyde treatments to cardiovascular devices.

Biolized natural and synthetic materials represent a new class of materials. Aldehyde treatment of natural tissue creates cross-links in the collagen molecules while retaining mechanical strength and collagen structure. Synthetic polymers can also be biolized by the addition of protein and aldehyde treatment. Cross-linked materials such as these are resistant to degradation by proteolytic enzymes. The procedure for the aldehyde treatment of natural tissue and protein polymer composites has been established, and in vivo and in vitro studies have demonstrated an improved blood compatibility. Long-term survival with TAH and LVAD implanted animals has shown the successful application of these materials without the use of anticoagulants. Pseudoneointima growth occurs on these surfaces, and results to date indicate growth stabilization within 2 wks of impalntation. Studies are currently underway to fully characterize the pseudoneointima formed on the biolized surfaces of cardiac prostheses.

Aldehydes

A biological extracorporeal metabolic device for hepatic support.

The results from OCTOPUS-I indicate that combined metabolic activities could be maintained under the optimal conditions provided for a prolonged period of time, but most effectively up to 14 hrs. The results of OCTOPUS-II and -III are lower than those in OCTOPUS-I. However, the activity in these systems is still higher than those previously reported((18)), which had urea production of 0.47 mg/Gm of liver. As imposed by any mass transfer device rate limitation, 60% efficacy of OCTOPUS-I brought into OCTOPUS-II, calculated by urea level, is acceptable. What is required for further improvement is mainly oriented to device rather than procurement andpreparation stages. The obstacles in the OCTOPUS-II and -III were, 1) the long time consumed for mounting the slices and assembling the devices before initiation of incubation, 2) inadequate control of incubation media, particularly blood, for oxygenation and pH, which was only for a short period of time but in the critical early stage of operation, 3) possible inadequate flow geometry in the device resulting in mass transfer resistance between the medium and the slices, 4) decrease in effective surface area of the slices, especially in OCTOPUS-III in which only one side of the slice faced the blood, and 5) in OCTOPUS-II, sagging of the slices due to the vertical position of the frames, with eventual reduction of effective surface area. Could a hepatic assist device utilizing liver slices be practical? Daily excretion of urea in dogs is 0.3-0.5 Gm/Kg((31)). Should the urea productivity in OCTOPUS-I(7.2 mg/Gm of liver/24 hrs) be successfully incorporated in a system, 600 Gm of slices can produce the amount of urea equivalent to the daily excretion in a 15 Kg dog. This volume of slices should not be considered unrealistic. Even though it is realized that in the practical situation 60% efficiency is expected, substitution of liver functions does not appear impossible. Further exploration for optimal conditions and practical considerations for improvement of devices will bring the goal closer to reality.

Animals

Compliance effect on patency of small diameter vascular grafts.

The compliance mismatch hypothesis as a cause of failure of small diameter grafts was investigated using 4 mm internal diameter, 5 cm long Biolized polyurethane grafts. The luminal surface of 0.5 mm thick Biomer sponge grafts was covered with 100 microns of crosslinked gelatin. Compliance matched, and noncompliant grafts had in vivo compliance values of 13.5 +/- 2.89 and 1.0 +/- 0.7 X 10(-2%) per mmHg, respectively. In vivo compliance defined as 2 X dD/dP X 1/Do was measured in situ using the ultrasonic Hokanson probe. Compliance values of compliant grafts equaled that of the canine carotid artery at 100 mmHg mean arterial pressure. Grafts were implanted using an end-to-end anastomosis in 14 dogs for 6 wk. Patency rates for compliant vs. noncompliant grafts were 64% (9/14) and 50% (7/14). Compliance values for compliant grafts decreased to a mean of 7.14 X 10(-2%) per mmHg. Anastomotic intimal hyperplasia at the proximal and distal ends of compliant and noncompliant grafts measured 239.9 +/- 128, 197 +/- 129 microns, 338.9 +/- 273.6, and 304.3 +/- 179.3 microns, respectively. There were no significant differences in localized anastomotic intimal hyperplasia at either graft end for either graft type. This study did not show any positive effects of graft compliance.

Anastomosis, Surgical