Clinical experience with intraaortic balloon pumps.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
M Deutsch
Publications and source records attributed to M Deutsch.
The role of the p53 gene in the malignant transformation of pleomorphic adenomas of the parotid gland.
Pleomorphic adenoma (PA), the most common neoplasm of the parotid gland in adults, undergoes malignant transformation in only two to six percent of cases. In order to determine whether or not the p53 gene is involved in the malignant transformation of PA of the parotid gland, we have analyzed archival specimens from four patients with carcinoma ex-pleomorphic adenoma (CEPA) by immunohistochemistry and sequencing of the amplified DNA. Tissue specimens from each patient contained both the CEPA and the precursor PA. Immunostaining revealed that while all CEPA were p53 positive, only one of the four precursor PA was positive for p53. In this case, DNA was isolated from both the PA and CEPA and exons five through eight were amplified using the polymerase chain reaction. The same p53 mutation (single base substitution) was found in both the PA and the CEPA at codon 248. Adjacent normal tissue contained the wild-type p53 sequence. To our knowledge, this is the first report of the same p53 point mutation in both a PA and the associated CEPA of the parotid. These results strongly suggest a role for p53 gene mutation in the malignant transformation of some PA of the parotid gland.
Adenocarcinoma↗
Artificial heart driven by an automatic driving system.
Thrombi formation within artificial ventricles is caused by the effects of biomaterials, stagnation areas, and major turbulences. During systolic and diastolic cycles, stagnation area increase in hearts that are properly designed. Stagnation areas may also occur in properly designed artificial hearts that are not working with a maximum stroke volume. The ellipsoid heart avoids stagnation areas and major turbulences because all the inside surfaces have an adequate washout with blood. The optimum washout of these surfaces is obtained by driving the heart with a constant maximum stroke volume. The cardiac output is regulated according to Starling's law by adjusting the frequency according to the venous return.
Animals↗
Eight years of clinical endothelial cell transplantation. Closing the gap between prosthetic grafts and vein grafts.
After years of in vitro studies and non human primate implantations, the authors commenced their clinical program of autologous in vitro endothelialization of polytetrafluoroethylene (ePTFE) grafts in 1989. Based on the successful 3 year results of a pilot study (Phase I) with 49 patients (1:2 randomization, assigning 33 patients to the endothelialized group and 16 to the control group), the authors offered in vitro endothelialized grafts to all patients who did not have a suitable saphenous vein available from June 1993 onward (Phase II). Another 72 patients received 81 successfully endothelialized ePTFE grafts in this second phase of the transplantation program. In the Phase I randomized trial, the Kaplan-Meier survivorship analysis showed a primary 3 year patency rate of 84.7% for endothelialized grafts and 55.4% for control grafts. After 5 years, it was 73.8% for the endothelialized group and 20.8% for the controls. At the end of the 7 year follow-up period, the primary patency rate for endothelialized grafts remained high at 73.8%, whereas that for the control grafts dropped to zero (log-rank test; p = 0.001 and Wilcoxon test; p = 0.003). The subsequent Phase II routine clinical implantation of endothelialized ePTFE grafts showed a 3 1/2 year primary patency rate of 72.9% for all femoropopliteal reconstructions. The authors' overall 7 year follow-up with endothelialized femoropopliteal ePTFE grafts (n = 108) shows a patency of 66.0%. When pretreated with fibronectin (n = 43), the 7 year patency was 72.1%. In the above-knee group, the 7 year patency for fibronectin treated grafts was as high as 75.8% (n = 36). After 8 years of clinical endothelial cell transplantation, the authors conclude that in vitro endothelialization of ePTFE grafts results in a patency rate of arterial prostheses comparable with that of vein grafts.
Animals↗
The Windkesselventricle with guiding balloon as a new approach for assisted circulation.
A simple method was developed to aid the patient with low cardiac output syndrome following cardiac surgery. The concept was shown to be feasible in electric circulatory analog studies and verified in 20 dog experiments. A Dacron graft (end-to-side) through the right second intercostal space connects the ascending aorta to the subcutaneously implanted, ellipsoidal-shaped artifical ventricle. A spherical polyurethane balloon is positioned in the aorta distal to the Dacron graft via the femoral artery. The ventricle and balloon are pneumatically driven synchronously with the ECG. In natural systole the balloon is inflated, occluding the aorta, and the artificial ventricle sucks the entire stroke volume. In natural diastole the balloon deflates and the artificial ventricle ejects the blood into the peripheral arteries. With this system it is possible to maintain a normal systemic pressure and have high hemodynamic efficiency. The left ventricular systolic pressure is 85 percent unloaded. The systolic wave is turned 180 degrees to the natural. After treatment, the device can be removed without thoracotomy.
Animals↗