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Biomedical subjects

M W Sebastian

Publications and source records attributed to M W Sebastian.

8 recordsLinked to original sources
PubMed2000

Treatment of iatrogenic femoral arterial pseudoaneurysms: comparison of US-guided thrombin injection with compression repair.

PURPOSE: To evaluate and compare the treatment of iatrogenic femoral arterial pseudoaneurysms by using ultrasonographically (US) guided direct thrombin injection with US-guided compression repair. MATERIALS AND METHODS: Twenty-six patients with iatrogenic femoral arterial pseudoaneurysms were treated with direct thrombin injection. With US guidance, a 22-gauge needle was placed into the pseudoaneurysm flow lumen and thrombin (mean volume, 0.35 mL; range, 0.10-0.60 mL) was injected with continuous color Doppler US guidance. Demographics, clinical variables, pseudoaneurysm characteristics, and results in these patients were compared with those in 281 consecutive patients who underwent US-guided compression repair. RESULTS: The success rate of thrombin injection was 96% (25 of 26 patients), which was significantly higher than that of compression, 74% (209 of 281 patients) (P =.013). Twenty of 26 (77%) patients required a single injection, and six (23%) required two injections. Mean thrombosis time for thrombin injection was 6 seconds, compared with 41.5 minutes for compression. For thrombin injection, there were no complications, foot pulses did not change and no patients required conscious sedation. Follow-up US at 24 hours showed no recurrent pseudoaneurysms. CONCLUSION: For the treatment of iatrogenic femoral arterial pseudoaneurysms, thrombin injection with US guidance appears to be superior to compression repair.

Aged↗
PubMed1999

Improved graft patency and altered remodeling in infrainguinal vein graft reconstruction for aneurysmal versus occlusive disease.

PURPOSE: This study attempted to determine whether autogenous vein used for infrainguinal reconstruction in patients with aneurysmal disease might demonstrate an altered adaptive response compared with those patients who underwent reconstructive surgery for occlusive disease, potentially altering graft patency. METHODS: From 1974 to 1997, 43 patients underwent vein grafting for 60 popliteal artery aneurysms (PAA). RESULTS: In an attempt to monitor early vein graft adaptation, serial graft surveillance by Duplex ultrasound scan was performed in a statistically valid subset of age-, sex-, and distal anastomotic site-matched patients with PAA and patients with occlusive disease (OD; n = 8 PAA; n = 8 OD). Compared with an age-matched and sex-matched cohort of patients (n = 60 grafts in each group) with occlusive disease and who had femoral below-knee bypass grafts (FBP) only, patients undergoing infrainguinal reconstruction for PAA had a higher 5-year primary graft patency (92% +/- 4% for PAA vs 66% +/- 7% for FBP; P <.01). Duplex surveillance demonstrated a progressive increase in arterialized vein graft diameter in the PAA group versus the OD group. In univariant analysis, aneurysmal disease was a significant predictor of final follow-up diameter (P =.002). In a linear regression model, controlling for diameter at first follow-up after bypass grafting, first follow-up diameter was also predictive of final follow-up diameter. CONCLUSION: These data suggested altered remodeling of vein grafts in patients with popliteal artery aneurysm, which may have a beneficial effect on patency.

Adult↗
PubMed1998

Blunt vascular injuries of the head and neck: is heparinization necessary?

BACKGROUND: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined. METHODS: The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient. RESULTS: Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge. CONCLUSION: BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.

Adolescent↗
PubMed1998

Multiple laparotomies for severe intra-abdominal infection.

BACKGROUND: Mortality rates for patients with severe peritoneal infection are high. The present study was undertaken in order to examine mortality rates in patients with severe peritoneal infection who were managed by planned re-laparotomy. METHODS: Retrospective analysis of patients presenting at the King Faisal Specialist Hospital and Research Centre between 1992 and 1994 with severe peritoneal infection was undertaken. RESULTS: A total of 52 patients underwent either single (n = 30) or multiple (n = 22) peritoneal lavage, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores and predicted mortality rates were calculated for these patients. The predicted mortality rate for patients undergoing a single washout was 42.4%, actual mortality: 23%. The predicted mortality for patients undergoing multiple washouts was 55.6%, actual mortality: 36.3%. No patient with a predicted mortality of < 30% who underwent multiple washouts died. Of nine patients with a predicted mortality between 31 and 60%, one died (11.1%). For a predicted mortality of 61-80%, five of six patients died (83.3%), and for patients with a predicted mortality of > 80%, two of three died (66.7%). CONCLUSIONS: The utilization of planned re-look laparotomy and peritoneal lavage in patients with severe peritonitis may result in a significant decrease in mortality as predicted by APACHE II scoring.

Adult↗
PubMed1997

Traumatic thoracic fistulas.

This article considers the wide range of fistulas that can result from blunt and penetrating trauma. The mechanisms, physical signs, diagnostic techniques, and nonoperative and operative management strategies for fistulas of the thorax are reviewed. Emphasis is placed on the requirement for a high index of suspicion in specific types of injury in which thoracic fistulas can occur.

Arteriovenous Fistula↗
PubMed1995

Multiple CTL specificities against autologous HIV-1-infected BLCLs.

The cellular immune response to HIV-1 has been well studied but, in many respects, remains incompletely defined. Although CTL specificities against highly conserved HIV-1 determinants as dictated by vaccinia/HIV-1 vector constructs have been described, much less is known regarding patient cellular reactivities against autologous cells infected with HIV-1. One of the main obstacles in characterizing this cellular reactivity has been the absence of a targeting system which accurately represents the HIV infected cell in vivo and is, at the same time, adaptable for in vitro assays. Through the use of two separate strategies aimed at increasing cellular CD4 expression, we were able to infect B-lymphocyte cell lines (BLCLs) with multiple strains of HIV-1. HIV-1-infected BLCLs were recognized by autologous effector cells with cytolytic specificities against env, gag, or pol determinants. In addition, HIV-1-infected BLCLs were capable of eliciting in vitro CTL reactivities directed against env-, gag-, and pol-expressing targets. This cellular reactivity was mediated by CD8+ cells and was MHC Class I restricted, suggesting a classical CTL response. Since multiple antigens are recognized, an HIV-1-infected BLCL is a more natural representation of an in vivo cellular target than other available testing systems and should permit a more representative analysis of CTL responses during infection or following vaccination.

B-Lymphocytes↗