Biomedical subjects
Publications and source records attributed to N M Vo.
The first case of tumor emboli trapped in a popliteal aneurysm and the longest survivor for this condition are reported. The characteristics of 25 cases reported in the literature since 1940 and the mechanism of tumor spread are reviewed. Tumor emboli represent the late stage of a malignancy and treatment does not seem to affect long-term survival.
Two cases of mycotic emboli of the peripheral vessels are presented, and 42 additional cases from the literature are analyzed. Male patients predominate 3:1. Candida and Aspergillus are the usual pathogens. Initial presentation as large vessel peripheral emboli is characteristic (77%), with emboli originating from either the aortic or mitral valves. Cerebral emboli may proceed of follow the peripheral embolization. Predisposing factors include open-heart surgery, antibiotic therapy, concomitant infection, and intravenous drug abuse. Early symptoms of fungemia are nonspecific, with blood cultures positive in only 43% of cases. The overall mortality rate was 84%-73% in patients who did not undergo previous open-heart surgery, and 96% in patients who underwent previous open-heart surgery. Patients with Candida infection seem to do better than those with Aspergillus endocarditis (19% survival versus 5%). Aggressive therapy, including embolectomy, early valve replacement, and prolonged antifungal drug therapy, is advised.
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The purpose of this study was to evaluate the effectiveness of aspirin (ASA) and porcine endothelial cell seeding in improving the patency rate of vena cava grafts. Thirty-nine dogs underwent infrarenal vena cava replacement by 10 cm lengths of 8 mm I.D. ringed polytetrafluoroethylene grafts. Thirty-one grafts were seeded with 1-1.5 x 10(6) porcine aortic endothelial cells while eight were not (GIII). Of the seeded group, 16 animals received no ASA (GI), while 15 others (GII) were given ASA (325 mg) daily starting two days preoperatively and continuing until sacrifice. Venograms were performed on the fourth postoperative day. Grafts were harvested 32 days after insertion and evaluated for patency rate and endothelialized surfaces. The 32-day patency rate was significantly higher for GII than for GI and III animals (67% vs. 13 and 25% respectively). Endothelialized surface was higher in GII than Gi and III (67% vs. 16% and 18% respectively). We conclude that endothelial cell seeding alone does not prevent graft closure and that a combination of ASA and cell seeding significantly increases the patency rate of vena cava grafts.
This study evaluated the effect of whole blood preclotting (WB), fibronectin (FB) and "Cell Tak" (CT) precoating on the patency rate of seeded vena cava grafts. Ten cm x 8 mm ID ringed PTFE grafts were implanted in the vena-cavae of 29 dogs. Aspirin (325 mg po qd) was administered pre-operatively and continued post-operatively. After preclotting or precoating, all grafts were seeded with porcine endothelial cells. The 32 day patency rates were: 67%, 67% and 37% for WB, FB and CT, respectively (p less than 0.5 CT vs FB, WB). Endothelialized surfaces ranged from 67 +/- 35, 43 +/- 41 to 28 +/- 45% respectively for WB, FB and CT (p less than 0.05 CT vs WB). Preclotting time was shortest for WB technique. We conclude that: 1) FB and WB grafts have the highest patency rate with WB preclotting being a more cost effective and less time consuming technique; 2) endothelial seeding and Aspirin may make vena cava grafting possible.
A simple means of evaluating the immune function of critically ill patients has been designed. This system uses 22 input data that are derived from an assessment of humoral and cellular immunity and of the various factors known to influence the immune status. The profile allows quantification of the degree of immune depression as well as follow-up of the progression of the immune status.
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