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Biomedical subjects

M W Flye

Publications and source records attributed to M W Flye.

At least 199 records · Page 11Linked to original sources
PubMed1985

Vascular thrombosis in acute hepatic allograft rejection: scintigraphic appearance.

Hepatobiliary imaging with 99mTc diisopropyl iminodiacetic acid was employed serially in a patient with an hepatic allograft, in order to follow the function of the transplant. Initially improving liver uptake and biliary excretion was observed; however, 12 days postoperative with clinical deterioration the scintigrams revealed an absence of uptake ("phantom" liver), due to thrombosis of the hepatic artery related to acute rejection. Hepatobiliary imaging can be helpful in the study of hepatic allografts.

Biliary Tract↗
PubMed1985

Growth and function of transplanted fetal rat intestine: effect of cyclosporine.

After transplantation of fetal rat small intestine in rat strains with major genetic differences, the effectiveness of cyclosporine (CyA) as an immunosuppressive agent and its effect on intestinal function were evaluated. Substrate absorption, disaccharidase activity, DNA concentration, and histologic appearance were measured and compared with those of fetal intestine transplanted in syngeneic animals. Sixteen of 20 grafts survived in the control (syngeneic) group and 14 of 20 grafts survived in the nonsyngeneic group when treated with CyA (25 mg/kg/day). None of the 10 nonsyngeneic grafts survived when no CyA was administered. Absorption of 14C-galactose in the syngeneic transplants was 0.70 +/- 0.70 mumol/cm2 intestine compared with 1.03 +/- 0.16 mumol/cm2 intestine in the nonsyngeneic transplants treated with CyA. Absorption of 14C-glycine in the respective groups was 1.63 +/- 0.22 mumol/cm2 intestine (syngeneic group) and 1.75 +/- 0.20 mumol/cm2 intestine (nonsyngeneic group treated with CyA). DNA concentration was 410 +/- 43 micrograms/mg intestine mucosa (syngeneic group) and 477 +/- 27 micrograms/mg intestine mucosa (nonsyngeneic group). There was a significant decrease in maltase and sucrase activity in the group treated with CyA but lactase activity was comparable in both groups. Evidence of mild to moderate cellular rejection was seen in only 25% of the nonsyngeneic grafts treated with CyA. When this rat fetal intestine transplant model is used, CyA appears to be an effective immunosuppressive agent and does not significantly impair growth and development of the intestine.

Animals↗
PubMed1984

Treatment of the totally occluded carotid artery.

Thirty-four patients, each with a totally occluded common or internal carotid artery, were treated over a 15-year period. Seventeen patients were treated nonsurgically, 17 underwent surgery. There were four patients in the nonsurgical group and six patients in the surgical group who were followed up until death. The average time span from diagnosis of carotid occlusion until death was 4.75 years in the nonsurgical group and 4.52 years in the surgical group. In the nonsurgical group, recurrent symptoms of cerebrovascular accident (CVA) developed in 60% of the patients available for extended follow-up. In contrast, 14% of the patients operated on and available for follow-up had recurrent symptoms, and no CVAs occurred postoperatively. From our data, we concluded that the stroke-free interval is improved, whereas survival is unaffected in the surgically treated patient. Endarterectomy of a contralateral stenotic carotid artery is particularly successful in achieving this reduction in morbidity.

Adult↗
PubMed1984

Aggressive pulmonary resection for metastatic osteogenic and soft tissue sarcomas.

From July, 1974, to July, 1979, 36 patients with osteogenic sarcoma and 25 patients with soft tissue sarcoma underwent a total of 95 thoracotomies for resection of isolated pulmonary metastases. In only 6 patients could all palpable disease not be resected, although it was certain that microscopic disease remained in some patients. Twenty-six patients underwent more than 1 thoracotomy. The pulmonary lesions were found not to be metastases in 4 patients with osteogenic sarcoma and 4 with soft tissue sarcoma. The four-year survival for patients with nonsynchronous metastases from osteogenic sarcoma was 44%, not significantly different from a survival of 35% for patients with soft tissue sarcoma. The 6 patients with synchronous osteogenic sarcoma metastases all died within 16 months. Survival following thoracotomy did not correlate statistically with time from primary tumor resection to lung recurrence, unilateral versus bilateral disease, or number of nodules. For the 33 patients in whom tumor doubling time could be calculated, survival with either type of sarcoma was significantly better in patients with a tumor doubling time greater than 40 days versus a tumor doubling time less than or equal to 40 days. Any patient with metastatic osteogenic sarcoma or soft tissue sarcoma confined to the lungs should be considered for resection in conjunction with chemotherapy.

Adult↗
PubMed1984

Treatment of the persistent sciatic artery.

The persistent sciatic artery is a rare vascular anomaly, with only 37 reported cases in the world literature. Estimates of incidence, based on angiographic series, range from 0.04 to 0.06%. It may pose a threat to the viability of the lower extremity, for the pathologic character of the persistent sciatic artery is such that it is especially prone to atheromatous degeneration, thrombosis, distal thromboembolization, aneurysmal formation, and rupture. Although rare, the possibility of such an anomaly must be borne in mind with certain clinical presentations, during orthopedic procedures on the hip, and during angiographic studies of the leg. Successful surgical correction of the problem necessitates excluding the anomalous artery from the circulation while revascularizing the lower extremity.

Aneurysm↗
PubMed1984

Traumatic false aneurysm of the vertebral artery.

A case of an enlarging asymptomatic pseudoaneurysm of the left vertebral artery, resulting from a gunshot wound, illustrates the dilemma of proper treatment selection. This case was treated by ligation of the involved third portion of the vertebral artery.

Adult↗
PubMed1983

Serum B2-microglobulin determinations in patients bearing soft tissue sarcomas.

To determine whether serum beta 2-microglobulin values could be useful as a tumor marker in patients with soft tissue sarcomas, 31 preoperative sera stored in our serum bank were assayed by radioimmunoassay for beta 2-microglobulin levels. Sera were selected from patients known to have large bulky tumors, but no evidence of other major systemic disorders. Thirty-one sera of sex and age matched controls were assayed for comparison. The laboratory range for normal serum beta 2-microglobulin values was 1.1-2.4 mg/l. Our control patients had values ranging from 0.7-1.7 mg/l. Values in tumor patients ranged from 0.7-2.5 mg/l. No markedly elevated values were observed in any single patient. Four age groups, 20-29, 30-39, 40-49, and 50-59 years, revealed no significant differences. This observation differs from previously reported data. Serum beta 2-microglobulin appears to have no value as a tumor marker in patients with soft tissue sarcomas. We were unable to substantiate findings by others that there is a significant increase in values of normal subjects corresponding to advancing age.

Adult↗
PubMed1983

Aortic graft-enteric and paraprosthetic-enteric fistulas.

Gastrointestinal hemorrhage is often a late manifestation of an aortoenteric fistula. Warning symptoms may include back or abdominal pain, fever, anemia, hematochezia, or melena. This entity results from erosion of the gastrointestinal tract by an adjacent vascular prosthesis. A paraprosthetic-enteric fistula represents a step in the formation of a true aortoenteric communication. Aggressive diagnostic studies, including endoscopy, aortography, barium contrast, computerized axial tomography, and radionuclide scanning, may allow earlier diagnosis and correction than have occurred in the past. Treatment should include graft excision, closure of the bowel defect, appropriate antibiotic therapy, and extraanatomic revascularization if collateral flow is not adequate. Our experience with 21 patients has illustrated the high mortality rate (74 percent) when operative treatment is delayed until massive hemorrhage occurs.

Aged↗
PubMed1983

Inability of thoracic duct drainage to prevent hyperacute rejection.

Serum and lymph albumin and Ig levels were measured during 6 weeks of lymphocyte depletion by thoracic duct drainage (TDD) in 21 patients prior to renal allotransplantation. In ten of these patients, the amount of protein lost from all sources (blood sampling, dialysis, and lymph centrifugation) was measured. The total amount of albumin lost was significantly greater than the amount of IgG lost. However, serum IgG declined at a faster rate and to a greater extent than albumin. Hyperacute or acute humoral rejection occurred in 14 grafts in 10 patients prepared by TDD despite negative crossmatch tests. These data suggest that removal of lymphocytes by TDD, rather than protein loss alone, affects IgG levels. On the other hand, TDD and IgG depletion do not prevent hyperacute or acute humoral rejection. This is most likely due to the inability of currently employed crossmatch tests to predict accurately which patients will manifest antibody-mediated graft rejection.

Drainage↗
PubMed1983

Failure of hemodialysis to diminish psychotic behavior in schizophrenia: behavioral and psychophysiological evaluation.

In a double-blind sham replacement study, eight drug-free schizophrenic patients underwent 10 active and 10 sham hemodialysis for 20 weeks. At the end of the 10 active dialyses, none of the patients appeared to be improved in psychotic, affective, or social symptoms. Active dialysis was associated with a "startle" response in heart rate and skin conductance to auditory stimuli, while sham dialysis was associated with an "orienting" response. Night-recorded sleep electroencephalography was unaffected by active dialysis. Spinal fluid beta-endorphin-like immunoreactivity levels were unchanged after active treatment. The behavioral improvements reported in other studies may be related to "stress," psychotherapeutic support, spontaneous remissions, neuroleptic withdrawal, denial of symptoms, or diagnostic differences. This study did not confirm the claims for hemodialysis as a specific therapeutic intervention in schizophrenia.

Adult↗
PubMed1983

Management of congenital arteriovenous malformations.

Twenty-five patients with congenital arteriovenous malformations (AVMs) involving the head, neck, trunk, or extremities were treated over a 10-year period. In patients with more extensive lesions, selective angiography was essential to delineate the extent of the AVM and its vascular anatomy. AVMs that produced congestive heart failure, hemorrhage, pain, or cosmetic embarrassment were excised if possible. Intra-arterial embolization is useful in the reduction of vascularity before operation or as the primary treatment for unresectable lesions. Incomplete excision or embolization of the AVM often results in a recurrence. However, nonsymptomatic lesions may be observed, and extremity varicosities can be treated by external compression.

Adolescent↗
PubMed1982

Histological evaluation of the nodules resected in the treatment of pulmonary metastatic disease.

During an 18 month period, 41 patients who had previously had a primary tumor removed, underwent 60 operations for resection of newly detected radiographic pulmonary nodules. Primary tumors included 16 osteogenic sarcomas, 9 malignant melanomas, 12 soft tissue sarcomas, 1 Ewing's sarcoma, 2 adenocarcinomas of the rectum, and 1 testicular teratocarcinoma. One hundred and eight-one pulmonary specimens were submitted for pathologic examination and 149 discrete nodules were found in these specimens by the pathologist (83%). Metastases represented 76-100% of nodules removed in 68% of the operations, 51-75% of nodules in 12%, 26-50% of nodules in 14%, and less than 25% of nodules in 6% of the cases. Metastatic disease was found in 90% of cases where nodules were greater than or equal of 0.5 cm in diameter, while metastases were found in on 33% of cases where the largest nodules removed were less than 0.5 cm. In only two cases did the histology of the pulmonary metastases differ from that of the primary tumor. We conclude that although benign lesions cannot be distinguished from metastases except by resection, nodules less than 0.5 cm in diameter probably should be observed for a further increase in size prior to operation.

Adenocarcinoma↗
PubMed1982

Successful surgical treatment of anuria caused by renal artery occlusion.

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.

Adolescent↗
PubMed1982

Factors affecting the results of below knee amputation in patients with and without diabetes.

During a five year period, 113 below knee amputations were performed upon 100 patients. Multiple factors were examined for the effects on wound complication and reamputation rates. Healing without reamputation occurred in 91.9 per cent of those in the diabetic group and in 76.5 per cent of those in the nondiabetic group, p less than 0.05. Cellulitis of the foot did not significantly affect healing below the knee in patients with diabetes, 82.5 per cent with cellulitis versus 87.5 per cent without cellulitis, p greater than 0.05, but did affect healing in those in the nondiabetic group, 81.8 per cent success versus 66.7 per cent, p less than 0.05, and affected their minor wound complication rate, 50.0 per cent with cellulitis versus 26.5 per cent without cellulitis. Absence of femoral pulses uniformly predicted a nonhealing below the knee amputation in patients with cellulitis, whereas in patients without cellulitis, healing occurred in 85 per cent. Hemoglobin levels were inversely proportional to success rates only in patients with diabetes and cellulitis, 10.54 +/- 1.68 versus 12.85 +/- 2.30 grams per deciliter for failures, p = 0.016. Elevated white blood counts were predictive of failure to heal below the knee amputations only in those in the nondiabetic group without cellulitis, 10,110 +/- 3,200 cells per millimeter3 for success versus 13,750 +/- 3,300 cells per millimeter3 for failures, p = 0.018. Use of wound drains correlated with a 55.0 per cent wound complication rate versus 16.1 per cent when drains were not used. Wound complications were minimized when amputations were closed with subcuticular suture and skin tapes.

Amputation, Surgical↗