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Biomedical subjects

J C West

Publications and source records attributed to J C West.

At least 55 records · Page 3Linked to original sources
PubMed1995

Laparotomy after using the gastroepiploic artery graft: retrogastric versus antegastric route.

BACKGROUND: Most cardiac surgeons prefer the antegastric route for the right gastroepiploic artery (RGEA) graft. When placed anterior to the stomach, the RGEA pedicle may adhere to the greater omentum, or to the anterior abdominal wall, and may be injured during future abdominal operations. METHODS: To avoid this potentially lethal complication, we prefer to place the RGEA graft behind the stomach and the left lobe of the liver. In our experience with 144 patients in whom the retrogastric route was used, 7 patients required an abdominal operation (2 had cholecystectomy, 2 had a partial colectomy, 1 had repair of paraesophageal hernia, and 2 had repair of abdominal wall complications). There was no need to dissect the RGEA graft in any of these patients. RESULTS: There was no evidence of myocardial ischemia or other complications during or after the operation in any patient. CONCLUSIONS: Based on our experience and the fact that any injury to the RGEA graft may have catastrophic consequences, we strongly advocate the retrogastric route to minimize the risk of injury to the RGEA graft during a subsequent laparotomy.

Adult↗
PubMed1994

Long-term efficacy and safety of cyclosporine in renal-transplant recipients.

BACKGROUND AND METHODS: The safety of long-term immunosuppression with cyclosporine in renal-transplant recipients is not well understood. This drug may cause a progressive toxic nephropathy, but it also preserves renal function because it prevents rejection. To determine the effect of cyclosporine on renal function and graft rejection, we conducted a retrospective analysis of data on 1663 renal-transplant recipients at six centers. RESULTS: The rate of graft survival was 78 percent (median follow-up, 36 months). Grafts were was lost in 279 patients (17 percent), mostly because of acute rejection (68 patients) or chronic graft dysfunction that was unresponsive to a reduction in the dose of cyclosporine (125 patients); 92 patients died with functioning grafts. The median change in the serum creatinine concentration in all patients after transplantation was less than 0.001 mg per deciliter per month (< 0.09 mumol per liter per month). Patients who had episodes of rejection had decreased rates of long-term graft function and survival. Eight percent of patients with functioning grafts at one year had first episodes of rejection more than one year after transplantation. These late first rejections were associated with noncompliance with therapy (in 34 percent), blood cyclosporine concentrations that were marginally lower than those of patients who had no episodes of rejection, and a low rate of successful reversal of rejection (77 percent, vs. 97 percent in patients with rejection during the first year; P < 0.001). CONCLUSIONS: The majority of renal-transplant patients tolerate long-term cyclosporine therapy without evidence of progressive toxic nephropathy. Graft failure is most often due to rejection.

Adult↗
PubMed1992

Small bowel transplantation in the mouse: development of a model.

The rat has been used as a model to study the significance of graft and host interactions in small bowel transplantation (SBTX). A mouse model of SBTX would allow investigators to apply the knowledge of the well-defined genetics in the mouse to this field of study. Therefore, we have developed a mouse model of heterotopic SBTX using syngeneic C57BL6/J mice. Animals were anesthetized with a combination of ketamine and xylazine. Donor animals underwent midline laparotomy, with isolation of a segment of bowel as an isograft for transplantation to a recipient animal. The bowel was flushed in situ prior to removal of the graft with a Carrel patch of aorta and portal vein. The recipient animal underwent midline laparotomy and preparation of its infrarenal aorta and inferior vena cava for end-to-side anastomosis of the graft with 10-0 nylon. After vascular reperfusion of the graft the ends of the isografted bowel were brought out as stomata. Successful grafts were later assessed for viability by laparotomy or histological examination at the time of sacrifice. Areas of technical difficulty in this model and issues that might improve the experimental results are discussed. This model should allow investigators to apply the well-defined genetics of the mouse to probe the challenging field of intestinal transplantation.

Anastomosis, Surgical↗
PubMed1992

Length of time on dialysis prior to renal transplantation is a critical factor affecting patient survival after allografting.

Within the past year at our transplant center we have had the experience of performing renal allografts in two patients older than 65 years, each of whom had been on hemodialysis more than 10 years. Both resulted in patient mortality within 90 days of transplant (one due to myocardial infarction, the other due to visceral ischemia with infarction). This prompted us to review retrospectively our own data (n = 204) and the national (UNOS) data (n = 10,971) regarding transplant outcome, patient age, and length of time on dialysis prior to renal transplantation. This review revealed that patient mortality after transplant increased with the length of end-stage renal disease (dialysis, regardless of type) independent of age, the greatest mortality occurring within the first 6 months of transplant (and not thereafter); graft survival was similar for all age cohorts analyzed. Our review of the literature reveals a paucity of articles pertaining to post-transplant mortality and length of time on dialysis prior to transplant. Our results indicate the following possible conclusions. (1) The length of time of end-stage renal disease therapy prior to renal transplantation is a significant and independent risk factor for post-transplant mortality. (2) Higher priority should be given to this factor when formulating strategies for allocation of scarce resources. (3) Patients on dialysis for extended periods of time who are elderly may be at particularly high risk. (4) Patients being considered for renal transplant should be informed of their individual risk factors for mortality post-transplant based on length of ESRD therapy. (5) Renal transplantation should be considered as early as possible in patients with ESRD (or imminent ESRD).

Adolescent↗
PubMed1992

Utilization of trauma-related deaths for organ and tissue harvesting.

A randomized retrospective analysis of patients who suffered trauma-related deaths over 36 months (May 1987-April 1990) was performed to study their utilization as candidates for organ and tissue harvesting. There were a total of 108 patients: 79 males, 29 females. The average age was 46.2 years; 38 (36%) of these patients were 65 years of age or older. Over 50% of fatalities were the result of motor vehicle crashes. There were 61 potential tissue donors. Forty-three were lost without documentation of a request for organ procurement. There were 23 patients with potentially salvageable organs: one candidate was lost without documentation of a request for organ procurement. Twenty-eight (26%) of the patients had support withdrawn; 16 were 65 years old or older. Brain death protocol was instituted in 17 (20%); organs were obtained from 70% of these patients. Reasons for failure of procurement after request by a physician included family refusal in seven cases, cardiopulmonary arrest during brain death protocol in two cases, and religious bias in one candidate. Twelve patients were organ donors: 10 patients were tissue donors. We conclude that the greatest source of underutilization lies in the failure to request tissue for harvesting, since there were no isolated tissue donors. Pertinent information should be more widely distributed to physicians regarding candidacy for tissue donation. Further consideration of the adequacy of organs or tissue in relation to the candidates' age should be given, since patients aged 65 years and older can be a significant source of potential donor candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Arterial insufficiency in hemodialysis access procedures: correction by "banding" technique.

Arterial insufficiency distal to an antecubital access is fortunately an infrequent but disturbing and often debilitating complication resulting in suboptimal access. During an 8 1/2-year period, 335 vascular access procedures were performed, 108 of which were antecubital brachiocephalic Gore-Tex conduits. Of these Gore-Tex conduits, 1.8% (2/108) had developed symptoms of vascular insufficiency 2 to 3 1/2 months after such access surgery. As previously published, arterial steal after the creation of an AV fistula could be corrected by the placement of an interposition Gore-Tex loop that would cure the problem and save the access. We have presented a procedure to correct a steal syndrome once a Gore-Tex conduit is already in place. Proximal banding and distal ligation with division of the cephalic vein below an end-to-side Gore-Tex loop is a simple surgical solution. It is not only curative but the procedure also maintains the existing Gore-Tex graft as a sustained avenue for access.

Aged↗
PubMed1988

Management of children with hypertension from reflux or obstructive nephropathy.

During a ten-year period, 35 children presenting with vesicoureteral reflux, ureteropelvic junction obstruction, or a "small kidney" were found to be hypertensive. Of these, 15 subsequently underwent surgical procedures for relief of hypertension. Seven were "cured," six were "improved," and two were "unchanged." The severity of hypertension could not be correlated with the degree of reflux nor with the degree of obstructive uropathy. However, all children with reflux in our study who were hypertensive had some degree of calicectasis noted preoperatively on intravenous pyelogram. Also it was noted that hypertension may occur several years after successful anti-reflux surgery. Children with vesicoureteral reflux, ureteropelvic junction obstruction, or a small kidney need to have blood pressure determinations at regular intervals, even if all previous readings had been in the normotensive range and whether or not they were followed up medically or post surgically. We suggest that blood pressure determinations be made every three months for the first year after diagnosis of reflux or ureteropelvic junction obstruction, and at least once a year thereafter.

Adolescent↗
PubMed1987

Arterial insufficiency in hemodialysis access procedures: reconstruction by an interposition polytetrafluoroethylene graft conduit.

The interposition polytetrafluoroethylene graft conduit has found many uses in the armamentarium of the surgeon who performs vascular access for hemodialysis: when resection of aneurysm or pseudoaneurysm is required, or when an extension loop is required, either to simply lengthen the amount of graft or to circumvent an infected segment after resection. Herein, we have presented yet another use for the interposition polytetrafluoroethylene graft conduit, based on physiologically sound principles and a now proved successful outcome, namely as a surgical alternative for the patient with a hemodynamically unstable hemodialysis fistula resulting in arterial insufficiency. Poiseuille's Law regarding flow of liquids through a tube supports the concept on which our interposition graft is based: v = pi X P X R4/8 X 1 X n where v is the volume escaping per second, P the difference of pressure at the ends of the tube, R its radius, l the length of the tube, and n the coefficient of viscosity. Given the maintenance of all other parameters, if one increases the length of the tube through which blood is flowing, the volume of flow through said tube is simultaneously decreased, and the ischemic symptoms caused by arterial insufficiency are thereby ameliorated.

Blood Vessel Prosthesis↗