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Biomedical subjects

R M Vetto

Publications and source records attributed to R M Vetto.

At least 37 records · Page 2Linked to original sources
PubMed1984

The island cheek flap: repair of cervical esophageal stricture and new extended indications.

Seven patients had reconstruction with an island cheek flap based on the facial vein and artery. The flap carries a swatch of buccal mucosa that can be rotated inferiorly as far as the superior mediastinum and superiorly to the oral cavity. Five patients had repair of cervical esophageal strictures and fistulas. In four, results were very successful. One patient had diminished but persistent dysphagia which was shown to be secondary to a carcinomatous polyneuropathy; however, he had complete resolution of aspiration after correction of his mechanical obstruction and tracheoesophageal fistula. Morbidity was minimal. Parotiditis developed in one patient who had Stensen's duct ligated. Minor numbness of the lip and a single case of Frey's syndrome were also observed. In another patient, reconstruction of the floor of the mouth preserved normal speech and swallowing. Finally, a permanent speech fistula was also created but was substantially taken down because of functional dissatisfaction. Other potential applications need to be explored.

Aged↗
PubMed1984

The mechanism of antigen presentation by endothelial cells.

Endothelial cells line the vessels and lymphatics forming a barrier between circulating T cells and the extravascular tissue site of antigen. We have suggested that circulating T cells recognize antigen on the surface of endothelial cells, resulting in the activation of the endothelium such that the endothelial cells then release the key mediators of a cell-mediated immune response. To test this hypothesis, we have evaluated the extent to which endothelial cells can signal antigen-specific T cell activation. We have shown that cultured endothelial cells are as effective as macrophages in lymphocyte activation and that this activation is HLA-DR restricted. In additional experiments we have established that endothelial cells synthesize both Ia and IL-1 early in the signaling process. To eliminate any possible contribution of other cell types participating in the T cell-endothelial cell interaction, we have shown that cloned endothelial cells present antigen to cloned T cells. Moreover, there appeared to be a preference of selected T-cell populations for different types of antigen presenting cells. These experiments document that endothelial cells are independently competent antigen presenting cells.

Antigen-Presenting Cells↗
PubMed1983

Efficacy of oral and systemic antibiotic prophylaxis in colorectal operations.

A cooperative Veterans Administration study of the septic complication rate during large-bowel surgery was undertaken in two groups of patients. The first group received oral neomycin and erythromycin base plus parenteral placebo; the second, the oral antibiotics plus parenteral cephalothin sodium. During a five-year period, 1,128 patients were studied. The overall septic complication rate was 7.8% in patients receiving only oral antibiotics, and 5.7% in patients receiving both oral and parenteral antibiotics. This difference was not significant. The only significant finding was a greater incidence of fever of unknown origin in patients receiving only oral antibiotics. None of those patients were treated with additional antibiotics, and all fevers cleared spontaneously. There seems to be no discernible benefit from adding parenteral antibiotic prophylaxis when performing elective colon surgery if appropriate mechanical cleansing and oral neomycin and erythromycin therapy are employed.

Administration, Oral↗
PubMed1983

Percutaneous abdominal abscess drainage. Portland area experience.

After reviewing 21 patients who have had percutaneous abdominal abscess drainage, we believe that the procedure should be considered for those abscesses that are unilocular without septations, with safe access being a key variable dictating the use of percutaneous abdominal abscess drainage rather than surgery. A computerized tomographic scan of the abdomen should be employed at some stage of the percutaneous abdominal abscess drainage procedure to facilitate safe access to the abscess and to distinguish a synchronous abscess where present. In addition, we believe that percutaneous abdominal abscess drainage should be considered for postsurgical abscesses only and not those that are spontaneous in nature or where the original abnormality cannot be accurately surmised. With regard to catheter management, frequent irrigation of the catheter must be carried out at least every 4 to 6 hours, with high levels of antibiotics present in the blood before irrigation. This must be done to obviate the most frequent and potentially lethal complication of the procedure, namely sepsis. Percutaneous abdominal abscess drainage, although safe for the most part, is capable of inducing considerable morbidity. Our data suggest that percutaneous abdominal abscess drainage is not as efficacious as previous reports have suggested. Traditional surgical drainage techniques are best utilized for those abscesses that are multiple, highly viscous, inaccessible, spontaneous, or unresponsive to percutaneous abdominal abscess drainage.

Abdomen↗
PubMed1982

Free jejunal mucosal patch graft reconstruction of the oropharynx.

We used microvascular anastomoses to transpose free pedicle jejunal mucosal patch grafts in seven patients. The procedure has been particularly helpful in rebuilding large intra-oral mucosal defects created by extensive resections for advanced carcinomas. Some of the benefits of this technique have included a one-stage procedure, which requires two to three weeks for healing; abundant donor tissue with characteristics similar to oral mucosa; near-normal facial appearance; and preservation of maximum tongue function. An unexpected benefit has been relief of annoying xerostomia by the jejunal mucous secretion. The most severe complication, which resulted in one death, was the excessive oral jejunal mucous secretion in the early postoperative period. It led to significant aspiration pneumonitis. To prevent this problem, we recommend a routine tracheostomy combined with rigorous pulmonary care whenever a jejunal patch graft is used.

Aged↗
PubMed1982

Flow cytofluorometric detection of tumor-specific rosette-forming cells in patients with squamous cell carcinoma of the head and neck.

Tumor-specific rosette-forming cells reactive to solubilized tumor antigens conjugated to autologous erythrocytes were quantitated by flow cytofluorometry. Leukocytes from a high frequency of the patients (greater than 70%) with squamous cell carcinoma of the head and neck (SQCC) formed rosettes to the conjugated SQCC tumor antigens but not to other histologically distinct tumor antigens (melanoma and colon carcinoma). Healthy control subjects or tumor patients with other cancers were mostly unreactive to the SQCC tumor extract [1 to 21 (5%) and 1 of 14 (7%) for controls and tumor patients, respectively]. Rosette-forming activity was observed in SQCC patients with primary cancers [22 of 30 (73%)] or in remission [5 of 6 (83%)], whereas patients with tumor recurrence were uniformly unresponsive [0 to 9 (0%)]. Tumor-specific rosette formation was mediated predominantly by monocytes, as identified by histochemical techniques and physiological properties. Rosette formation in reactive patients was abrogated by short-term culture, but the abated response could be restored by incubation with autologous serum or sera from other rosette-forming cell-positive patients. However, responsiveness of nonreactive patients with SQCC recurrence could not be constituted by rosette-forming cell-positive sera. These observations suggested the presence of tumor-reactive monocytes in a high frequency of patients with primary cancer or in remission but not in patients with recurrent disease.

Aged↗
PubMed1981

Antethoracic jejunal esophagoplasty. An alternate method of repair.

Antethoracic jejunal esophageal reconstruction is an effective alternative method of repair and should be considered when difficulty is expected with the standard approaches. The primary difficulty with this mode of repair is related to the vascular supply of the jejunum. However, with careful evaluation and management of the pedicle, ischemia of the graft may be avoided. If vascularity appears less than optimal, the proximal anastomoses should be delayed and the graft placed in the subfascial tunnel. If the cervical jejunal portion becomes necrotic, this space may be bridged later with an isoperistaltically positioned free graft utilizing microvascular techniques.

Aged↗
PubMed1981

Endothelial cell presentation of antigen to human T cells.

Activation of human T cells requires presentation of antigen by Ia (HLA-DR in man) bearing cells of the mononuclear phagocytic series (macrophages, MO, and more recently Langerhans cells, dendritic cells, and vascular endothelial cells. Since T cells must cross endothelial barriers to enter extravascular tissues during immune reactions, we investigated the role of endothelial cells in antigen presentation. Endothelial cells were cultured from human umbilical veins and identified by classic morphology and specific markers (factor VIII related antigen, and so on). Antigen-pulsed endothelial cells were used to present antigen to MO-depleted human T cells; activation was assessed by 3H-thymidine uptake. The HLA-DR compatible endothelial cells were as effective as MO in reconstituting MO-depleted T-cell responses. The endothelial cell reconstituted responses were antigen specific, HLA-DR restricted, and blocked by monoclonal antibodies to HLA-DR framework structures. Moreover, the T-cell responses were clonal with respect to HLA-DR. A monoclonal antibody completely eliminated MO reconstitution of the MO-depleted response without diminution of endothelial cell reconstitution of the same response. Fibroblasts and smooth muscle cells cultured from the same umbilical veins could not reconstitute the MO-depleted T-cell response. These data indicate that endothelial cells play an important and distinctive role in lymphocyte triggering.

Antigens↗
PubMed1980

Hand infections in hospitalized patients.

Two hundred hospital admissions for hand infections are reviewed with regard to the causes of infection, modes of effective therapy and causes of residual impairment. Patients with human bite injuries and those who delayed seeking treatment most frequently had severe injuries. Appropriate antibiotics and prompt surgical therapy of hand abscesses are essential.

Adult↗
PubMed1980

Experience with total pancreatectomy.

Total pancreatectomy for benign disease should be considered only in highly selected patients and then only after lesser surgical procedures have failed. At present, truncal vagotomy and adequate gastrectomy should be part of the operation to prevent marginal ulceration. A multitude of undesirable problems, many requiring reoperation, may arise postoperatively and can compromise an otherwise excellent outcome with regard to pain control.

Adult↗
PubMed1980

Experience with colovesical fistula.

Experience with 37 patients with adult colovesical fistula over the past 19 years is reviewed. Specific guidelines for treatment of adult colovesical fistula are influenced by the location and cause of the fistula, the patient's general condition, the presence of a pelvic abscess and the presence of colonic obstruction. When criteria are met, a one-stage procedure is safe. The two-stage approach should enjoy wider application, with the three-stage approach reserved for patients who are unprepared or who have a large pelvic abscess. In patients with colovesical fistula due to cancer, the extent of tumor should be carefully evaluated and resection carried out whenever possible. Colovesical fistulas due to trauma, inflammatory bowel disease and iatrogenic causes are often unusual in location; thus treatment must be individualized.

Colonic Diseases↗
PubMed1979

Immune response to melanoma extracts in three melanoma-prone families.

Immune reactivity to melanoma extracts was measured by the leukocyte adherence inhibition (LAI) test in 40 members of 3 melanoma-prone families. The melanoma patients had a wide range of responsiveness to the extract, the highest responder being a 10-year survivor. As a group, family members (including spouses) without disease had significantly elevated LAI responses compared to those of unrelated controls (P less than 0.01). Within the families, members with close exposure to melanoma patients for 10 years or more had a significantly higher response to melanoma antigen than did members with 0-5 years of close exposure (P less than 0.05). Responses of spouses and members at high risk of developing melanoma (B-K mole syndrome) also correlated with length of exposure to patients, which suggests that the elevated LAI response was not genetically determined. The high frequency of positive responses to melanoma antigens in these families, particularly in spouses, suggests the presence of transmissible melanoma-associated material capable of immunizing persons in contact with melanoma patients.

Antigens, Neoplasm↗