Biomedical subjects

L A Lantieri

Publications and source records attributed to L A Lantieri.

6 recordsLinked to original sources

PubMed1996

Local irrigation with tissue factor pathway inhibitor inhibits intimal hyperplasia induced by arterial interventions.

OBJECTIVE: To evaluate the capacity of local irrigation with tissue factor pathway inhibitor (TFPI) to inhibit vessels from neointimal lesion formation following intimectomy or balloon angioplasty. DESIGN: The common carotid arteries in New Zealand white rabbits were subjected to either intimectomy or balloon angioplasty. INTERVENTION: Before restoring blood flow, the lumina of the vessels were irrigated with 1 mL of Dulbecco phosphate-buffered saline either with TFPI (100 micrograms/mL [TFPI group, n = 10]) or without TFPI (control group, n = 10). MAIN OUTCOME MEASURES: The area of neointimal formation and the ratio of the intimal to medial areas (I/M) were determined from elastin-stained sections. RESULTS: The area of neointima and the I/M ratio were not significantly different at 2 weeks postoperatively. However, at 4 weeks, TFPI-treated vessels demonstrated a significant reduction in the neointimal lesion and the I/M ratio compared with those of controls, following both angioplasty and intimectomy. Transmission electron microscopy showed a lack of platelet aggregation and thrombus formation at the intimal surface in the TFPI-treated vessels. CONCLUSIONS: Local irrigation with TFPI at the time of arterial interventional therapy inhibits intimal hyperplasia following either balloon angioplasty or intimectomy. We hypothesize that TFPI binds to the injured vessel surface and inhibits the cascade of thrombotic events that promote intimal hyperplasia.

Angioplasty, Balloon↗

PubMed1996

Stabilized resection arthroplasty by an anterior approach in trapeziometacarpal arthritis: results and surgical technique.

Resection arthroplasties were performed through a carpal tunnel incision in 72 hands of 57 patients with trapeziometacarpal joint arthritis and coexistent pathology of the anterior hand or wrist. Sixty-nine hands were followed for an average of 44 (range, 12-74 months). Pain relief was excellent in 60 hands, good in 7, and fair in 2, and thumb motion was satisfactory in 64 hands. Mean strength increase was 30%. Scaphometacarpal space loss was 0.5 mm each year, and residual space averaged 3.1 mm at 60 months. There were two failures. The study corroborated the frequent coexistence of other pathology of the anterior area of the hand and wrist, specifically, carpal tunnel syndrome and flexor carpi radialis tenosynovitis. Furthermore it demonstrated the possibility of an anterior approach to treat these conditions via the same incision. After 5 years, functional results remained good despite progressive collapse of the scaphometacarpal space.

Aged↗

PubMed1996

Prevention of microvascular thrombosis by topical application of recombinant tissue factor pathway inhibitor.

Tissue factor pathway inhibitor is a naturally occurring protein inhibitor of factor X and the tissue factor-factor VII complex of the extrinsic pathway of coagulation. The potential of tissue factor pathway inhibitor as a topical antithrombotic agent was evaluated in a rabbit model of thrombosis that combined intimal injury, anastomosis, and a twisted pedicle. In 207 rabbit ears, a near-complete amputation was performed, preserving the central ear artery and vein. The central ear artery was transected, the intima was removed mechanically over a 1-cm length, the artery was anastomosed, and the ear was twisted 360 degrees, wrapping the intact vein around the artery. Before recirculation, the lumen was irrigated on a blinded, randomized basis with either hirudin (100 or 500 units/ml), heparin (50 or 100 units/ml), tissue factor pathway inhibitor (10, 40, 125, or 250 microgram/ml), heparin and tissue factor pathway inhibitor together, or vehicle (control). Upon arterial reflow, the ears were observed for 7 days. Patency rates after 7 days were as follows: hirudin, 30 and 55 percent; heparin, 43 and 50 percent; tissue factor pathway inhibitor, 75 and 90 percent; heparin and tissue factor pathway inhibitor, 75 percent; and vehicle, 6 percent. The higher concentrations of tissue factor pathway inhibitor led to significantly higher patency rates than heparin, hirudin, or control solutions. Electron microscopic evaluation of specimens irrigated with gold- labeled tissue factor pathway inhibitor revealed the inhibitor bound to the injured intimal surface for at least 3 days postoperatively. Coagulation studies showed no change in the clotting profile upon intravascular infusion with tissue factor pathway inhibitor even at the highest dose used topically. We conclude that tissue factor pathway inhibitor is a more effective topical antithrombotic agent than either heparin or hirudin.

Administration, Topical↗

PubMed1995

Topical tissue factor pathway inhibitor improves free-flap survival in a model simulating free-flap errors.

Free flap failure is frequently due to tension, twisting, kinking, or compression of the vascular pedicle after the anastomosis is completed. A rabbit model simulating these errors was used to evaluate the capacity of topically-applied tissue factor pathway inhibitor (TFPI) to prevent microvascular thrombosis. The rabbit ear was isolated on the central artery and vein. The artery was transected, shortened, repaired, and twisted 360 degrees around the vein. Immediately following the anastomosis. TFPI in concentrations of 1, 4, 10, or 40 micrograms/ml was irrigated across the lumen. Topically-applied control buffer and heparin (50 U/ml) were compared to TFPI. Treatment with control buffer resulted in a 20 percent survival rate. Topically-applied heparin improved the survival rate to 60 percent (p < 0.05). In contrast, TFPI in concentrations of 4, 10, and 40 micrograms/ml yielded survival rates of 89, 100, and 97 percent, respectively. This was significantly greater than the heparin-treated ears (p < 0.05). TFPI in a concentration of 40 micrograms/ml was effective in preventing arterial thrombosis when applied for as little as 30 sec; 4 micrograms/ml was effective in preventing thrombosis when applied for 10 min. These results support the use of TFPI as a topical irrigation solution to help prevent microvascular arterial thrombosis in free-flap surgery.

Administration, Topical↗

PubMed1995

The expanded scapular flap.

The scapular fasciocutaneous flap is a very reliable free tissue transfer, but its size and/or thickness may limit its use in some patients. Scapular fasciocutaneous flaps were expanded for 6 to 12 weeks prior to transfer in 14 patients. The flaps ranged in size from 96 to 1885 cm2 and were used to cover chronic soft-tissue defects. Twelve were transferred as free flaps to distant sites, while two were transferred as pedicled flaps to the ipsilateral extremity. The pedicled flaps were designed across the entire back to incorporate both scapular territories but were rotated on a single vascular pedicle. All flaps survived, but three had marginal distal necrosis not related to the microvascular anastomoses. Two flaps transferred by microsurgical technique developed arterial thromboses requiring revision of the anastomoses. Three patients developed partial donor wound dehiscence after transfer of large flaps that healed by secondary intention in two cases and required a split-thickness skin graft for donor-site closure in the third. Flap expansion produces a delay phenomenon that augments blood supply and increases the area of skin that can survive on a single vascular pedicle. This technique may be useful in selected patients in whom a large, thin fasciocutaneous flap is required and there is sufficient time to allow flap expansion prior to transfer.

Adolescent↗

PubMed1993

Wrist and hand injuries in platform diving.

To permit a smooth entry into the water, platform divers assume a special position with their hands. An older method consists of hitting the water with both fists closed while holding one thumb in the palm of the other hand. In a newer technique fingers and wrists are hyperextended, the forearms pronated, and the hands overlapped. In this series of 21 divers, the injuries included 2 fractures and 5 sprains treated by conservative methods. Two divers required surgery: one with loose bodies in the radiocarpal articulation, the other with chronic rupture of the trapeziometacarpal ligament and synovitis of both extensor pollicis brevis and longus. Eighteen divers complained of pain caused by the impact of the hand with the water. A kinetic analysis with a video imaging system explains the mechanism and forces of water penetration.

Adult↗