DPA1*02012: a DPA1*0201-related Mhc class II allele in west Africa.
Explore the source record for details and available documents.
Africa, Western↗
Biomedical subjects
J May
Publications and source records attributed to J May.
The prevalence of gut translocation in humans.
BACKGROUND/AIMS: Gut translocation of enteric organisms across the intact intestinal mucosa has been postulated as a potential source of sepsis in susceptible patients. However, little is known of its occurrence or significance in humans. The aim of this study was to determine the prevalence of gut translocation of bacteria in humans and attempt to identify any predisposing factors to its occurrence. METHODS: A consecutive series of 267 general surgical patients were examined for evidence of bacterial translocation by bacterial analysis of intestinal serosa and mesenteric lymph nodes taken at the time of surgery. RESULTS: Translocation occurred in 10.3% of patients overall. Both aerobic and anaerobic bacteria translocated. Excluding patients with distal intestinal obstruction and those with inflammatory bowel disease in whom translocation was more common, the prevalence was 5%. Neither jaundice, nutritional status, nor total parenteral nutrition predisposed to translocation. Similarly, mucosal atrophy did not predispose to this phenomenon. The development of postoperative septic complications was twice as common in patients with translocation as in those without, but mortality was unaffected. CONCLUSIONS: Translocation occurs as a spontaneous event in humans, but its clinical significance remains to be defined.
Bacterial Infections↗
Treatment of complex abdominal aortic aneurysms by a combination of endoluminal and extraluminal aortofemoral grafts.
PURPOSE: The purpose of this study was to test the hypothesis that abdominal aortic aneurysms (AAA) whose morphology makes them unsuited for repair with an endoluminal tube graft can be treated by a combination of a transluminally placed aortofemoral graft and a femorofemoral crossover graft. In addition the technique involves either ligation or balloon occlusion of the contralateral common iliac and internal iliac arteries in such a manner that excludes the AAA from the circulation. METHODS: We report the use of this technique in three male patients with 6.4 to 7.0 cm diameter AAA. Two had renal impairment and cardiac function too poor to permit open repair, and the third had an unfavorable abdomen caused by previous surgery and the presence of a permanent colostomy. Each patient had an individually tailored Dacron tube graft constructed on the basis of preoperative arteriograms and computed tomography scans. The grafts were delivered transluminally into the aorta through a sheath in the iliac arteries and anchored proximally with a stainless steel stent under radiographic control. The grafts were then anastomosed distally to the femoral artery. RESULTS: Recovery was complicated by a midgraft stenosis corrected by percutaneous balloon dilation in one patient, an episode of pulmonary edema in the second and an unexplained pyrexia in the third. Follow-up with duplex scanning confirmed normal flow through the grafts and the presence of thrombus between the prosthetic graft and the aneurysmal sac. CONCLUSIONS: We conclude that transluminal placement of an aortofemoral graft combined with a femorofemoral crossover graft is feasible in patients who are unsuited to repair with an endoluminal tube graft. The outcome with this technique is not known and requires further careful evaluation.
Aged↗
External carotid endarterectomy for amaurosis fugax in the presence of internal carotid artery occlusion.
Two patients with occlusion of the internal carotid artery who were experiencing repeated episodes of transient monocular blindness in the ipsilateral eye were successfully treated with external carotid endarterectomy. The mechanisms for the production of symptoms in the presence of an internal carotid occlusion are discussed, including the anatomical pathways for embolization through collaterals between the internal and external carotid arteries. The indications, technique and results of external carotid endarterectomy are reviewed.
Aged↗
Isolated limb perfusion with urokinase in the treatment of extensive vascular thrombosis of the lower limbs.
Isolated limb perfusion with urokinase was used in combination with balloon catheter embolectomy in three patients with extensive vascular thrombosis in the lower limbs after conventional methods of treatment failed to restore perfusion to the lower limb. The technique and its results are described and discussed. It is suggested that isolated limb perfusion with urokinase is safe and is worthy of further investigation in the treatment of critically ischaemic lower limbs.
Aged↗
A new nonstented balloon-expandable graft for straight or bifurcated endoluminal bypass.
PURPOSE: The aim of this study was to determine the feasibility of endoluminal grafting of aneurysms using a new design of nonstented endograft. METHODS: Initial studies were undertaken in bench models and by implantation of endografts into animal vessels. Between May 1992 and June 1994, endoluminal repair of aneurysms was undertaken in 47 patients (44 male, 3 female). A new balloon-expandable endoluminal graft was developed and has now been studied in 25 of these 47 cases. This graft does not require adjunctive use of a vascular stent because of its unique construction, which incorporates metallic implants (graft attachment device or "GAD") into the graft material. The design is applicable to endovascular grafting of occlusive arterial disease, as well as aneurysms. All patients were investigated by duplex scan, calibrated angiogram, and angio-CT scan and then allocated into groups that we defined according to the following criteria: group I, considered suitable for transfemoral implantation of a straight tube graft (n = 12); group II, unsuitable for transfemoral tube graft because of short neck of aneurysm, absent distal neck, or diseased iliac arteries (n = 10); and group III, peripheral aneurysms (n = 3). All patients were followed by clinical examination, duplex scan, and CT scan, with selective use of angiography. RESULTS: Intraluminal deployment of the graft was achieved in all 25 patients; however, 3 patients from group II subsequently required conversion to open procedures because of the following complications: (1) partial graft thrombosis resulting from inadvertent omission of systemic anticoagulation during deployment (n = 1); and (2) unsuccessful deployment of the contralateral limb of a bifurcated graft in the iliac artery (n = 2). Successful endoluminal repair was achieved in 100% of patients in groups I and III, compared to 70% in group II. CONCLUSIONS: These preliminary results (in a series of high-risk patients) have demonstrated that endoluminal abdominal aortic aneurysms repair with this graft can be achieved reliably and with low morbidity in patients who fulfill the selection criteria (group I) and in peripheral aneurysms (group III) but the results were less satisfactory in aneurysms that do not have a good proximal or distal neck or in patients with diseased iliac arteries (group II). Further modification of the bifurcated version in this graft design, together with improvements in access techniques and graft materials, is required for successful endoluminal grafting in a wider range of patients.
Aneurysm↗
Endoluminal grafting of abdominal aortic aneurysms: causes of failure and their prevention.
PURPOSE: The aim of this study was to analyze the causes of failure of endoluminal grafting for abdominal aortic aneurysms (AAA) and to put forward proposals for preventing these failures. METHODS: Since May 1992, endoluminal repair of aneurysms was undertaken in 47 patients. Forty-three of these patients had AAAs and are the basis of this study. All procedures were nonurgent and were performed in the operating room with the patient draped for an open repair in the event of failed endoluminal repair. Radiographic guidance was used to pass the endografts into the aorta via a delivery sheath introduced through the femoral or iliac arteries. The configuration of the endografts was tubular (n = 28), tapered aortoiliac/aortofemoral (n = 11), and bifurcated (n = 4). RESULTS: Successful endoluminal repair was achieved in 34 of 43 (79%) patients. The remaining nine were terminated in favor of an open repair. The causes of failure were problems with access (2), balloon malfunction (1), stent dislodgment (3), graft thrombosis (1), and inability to deploy the contralateral limb of a bifurcated graft (2). All failed endoluminal repairs proceeded to successful open repair. There was no perioperative mortality in patients undergoing endoluminal repair or in those whose endoluminal repair was converted to open operation. CONCLUSIONS: The failures of endoluminal grafting have been analyzed. Methods of avoiding access problems, balloon malfunction, and stent dislodgment have been defined and recommendations made.
Aged↗
Close to home. Interview by Terese Hudson.
The hospital is an integral part of the community, according to James May, CEO and president of Legacy Portland (OR) Hospitals. May has put this principle to work concretely by loaning employees money for initial costs on homes near Emanuel Hospital and Health Center in northeast Portland. Now in its second year, the program has already helped 25 employees purchase homes in a 19-square-mile area targeted for redevelopment. Loans of up to $5,000 for homes with a purchase price of $65,000 or lower are available. The loans can be used for down payments, pre-paid reserves or closing costs. Legacy forgives 20 percent of a loan's outstanding balance each year to employees in good standing. This encourages employees to stay for at least five years. Only the interest payments on the outstanding balance are paid back to Legacy. May spoke recently with Senior Editor Terese Hudson about the program's genesis.
Community-Institutional Relations↗
Randomized trial of drainage of colorectal anastomosis.
A prospective randomized trial was carried out to determine whether use of a high-pressure closed-suction intraperitoneal drain was associated with a reduction in morbidity rate after colorectal resection and to examine the influence of drainage on postoperative fluid collections. A consecutive series of 148 patients who underwent colonic or colorectal resection were randomized to receive no drain (n = 51) or a high-pressure closed-suction drain for either 3 (n = 47) or 7 (n = 47) days. Three patients were excluded. All patients underwent abdominal ultrasonography on days 3 and 7 and those undergoing left-sided colorectal resection (n = 96) received a water-soluble contrast enema on day 7. The three groups of patients were similar in age, sex, diagnosis and the numbers of sutured and stapled anastomoses. The presence of a drain did not influence the postoperative morbidity or mortality rate. If the anastomosis leaked, neither faeces nor pus emerged from the drain. Ultrasonographic detection of a fluid collection was of no value: such collections bore no relationship to radiological or clinical leaks or the postoperative course. Routine use of a high-pressure suction drain after colorectal resection appears to be unnecessary.
Aged↗
Translocation of enteric bacteria in humans.
Explore the source record for details and available documents.
Adult↗
Does the addition of pre-operative skin preparation with povidone-iodine reduce groin sepsis following arterial surgery?
Sixty-four consecutive patients undergoing elective vascular surgery involving exposure of the femoral artery at the groin were randomized to one of two groups. Group A (N = 34) received twice-daily skin preparation with 10% aqueous povidone-iodine for 48 h preoperatively, while group B (N = 30) did not. Both groups were examined on a daily basis following surgery and any discharge from the wound was recorded and sent for bacteriological culture. The groups were well matched for age, sex and the type of vascular graft material used. In group A there were six (18.7%) groin wound infections and in group B there were five (17.2%). In this series of patients the addition of preoperative skin preparation with 10% povidone-iodine to standard peri-operative prophylaxis had no effect on the incidence of postoperative groin wound sepsis.
Adult↗
Isolated limb perfusion with urokinase for acute ischemia.
PURPOSE: Isolated limb perfusion with urokinase was used to salvage an acutely ischemic lower limb. METHODS: Isolated limb perfusion with urokinase over a 90-minute period was used in the treatment of a 69-year-old female patient with acute ischemia of the left leg after thrombosis of a femoral artery bypass graft. Previous balloon embolectomy and heparin therapy had failed. The flow rate was able to be increased progressively without rise in the line pressure during the course of the perfusion, indicating an increase in capacity of the peripheral arterial bed. Fibrinogen and plasminogen levels in the isolated circulation remained low throughout the perfusion. The concentration of cross-linked fibrin degradation particles (d. dimer) rose progressively in the isolated circulation but remained at normal levels in the systemic circulation during perfusion. RESULTS: Completion angiography demonstrated clearance of thrombus in the popliteal artery and appearance of arteries not seen on preperfusion films. Clinical improvement paralleled the angiographic appearances, with restoration of limb viability. CONCLUSION: We concluded that isolated limb perfusion with use of urokinase is safe and worthy of further investigation.
Acute Disease↗
[Value of bronchoalveolar lavage in the diagnosis of pulmonary involvement in storage diseases].
A 17 years old female with hepatosplenomegaly and pulmonary infiltrates since the age of four is presented. Sea-blue histiocyte disease, a sphingolipidosis, was diagnosed by liver biopsy, bone marrow aspirate and bronchoalveolar lavage. The relevance of bronchoalveolar lavage as a diagnostic method in cases of systemic diseases with pulmonary involvement is emphasized.
Adolescent↗
Iatrogenic vascular trauma associated with intra-aortic balloon pumping: identification of risk factors.
The most important noncardiac consequence of use of the intra-aortic balloon pump (IABP) is associated iatrogenic vascular trauma. A retrospective analysis was undertaken of all patients at our institution (n = 90, mean age 60 years) who had insertion of an IABP over a 10-year period to assess the possibility of preoperative identification of patients at high risk of IABP associated vascular injury. Catheters were introduced via the common femoral artery (n = 84; 30 percutaneous, 4 open Seldinger technique, 50 via a dacron sleeve), external iliac artery (n = 2), and ascending aorta (n = 4). Thirty patients (33.3%) developed one or more complications, with 25 vascular complications, six major septic complications, and four deaths. Variables identified as significant risk factors for IABP complications were female gender (P < 0.01) and concomitant peripheral vascular disease (P < 0.05). Site of insertion, method or difficulty of insertion, age, duration of counterpulsation, and use of anticoagulation and antibiotics did not significantly affect the incidence of vascular complications (P > 0.05). In conclusion, prior to cardiac surgery, we recommend screening for peripheral vascular disease to identify patients at increased risk of complications should IABP counterpulsation be required. Ankle/brachial systolic pressure indices may be used to detect subclinical disease.
Adult↗
Transluminal placement of a prosthetic graft-stent device for treatment of subclavian artery aneurysm.
A 78-year-old man was seen with an expanding 5 cm false aneurysm of the right subclavian artery. This was treated by an intraluminal graft-stent device introduced through the brachial artery via a 16 F sheath. The graft was constructed from two polytetrafluoroethylene patches of 0.4 mm thickness and anchored in the subclavian artery by an 8 mm stainless steel stent. The procedure was monitored by an image intensifier. Completion arteriography and postoperative duplex scanning confirmed normal flow through the subclavian artery with no communication between the lumen and the aneurysmal sac. The patient recovered without complication.
Aged↗
Modified anastomotic technique for 1 millimeter internal diameter polytetrafluoroethylene arterial grafts in the rat.
Reported patency rates after standard end-to-end anastomoses for microvascular prosthetic grafts have been inconsistent and usually disappointing. A modified anastomotic technique is described in which the prosthetic graft is invaginated inside the arterial lumen. In this study of 6 cm lengths of 1 mm internal diameter polytetrafluoroethylene femoro-femoral bypass grafts in the rat, 6 (40%) of 15 grafts with standard anastomoses were patent at 6 months compared to 28 (90%) of 31 grafts using the modified anastomotic technique (P < 0.001). With invagination of the prosthetic graft inside the arterial lumen, reliable high patency rates can be achieved with microvascular prostheses long enough for potential clinical applications.
Anastomosis, Surgical↗
Hemangiopericytoma of the hand: a literature review and case study.
We present a case of hemangiopericytoma of the hand. We also attempt to differentiate hemangiopericytoma from glomus tumor with a summary of the history and a comprehensive review of the literature demonstrating the malignant character of the neoplasm, and we offer some guidelines for treatment.
Angiography, Digital Subtraction↗
Bilateral mycotic axillary artery false aneurysms in an intravenous drug user: unsuspected broken needle-tips pose a risk to the treating personnel.
Mycotic false aneurysms due to local arterial injury from attempted intravenous injections in drug addicts are increasing in frequency. The high incidence of HIV and hepatitis B virus in parenteral drug users may present a considerable risk to the treating personnel. This paper reports the unsuspected presence of broken needle-tips in the subcutaneous tissues of an intravenous drug abuser, in association with bilateral mycotic aneurysms of the axillary arteries. Broken needle-tips have the potential to cause needlestick injury to the operating team and the nursing staff, with the associated risk of transmission of HIV and hepatitis B virus infection. The presence of broken needle-tips should be suspected in drug users presenting with false aneurysms associated with local arterial injection injury and a specific history of needle-breakage should be sought. Preoperative plain radiographs should be performed of the planned operative field to exclude the presence of such needle-tips. Any soft tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management.
Adult↗