Biomedical subjects

V A Starnes

Publications and source records attributed to V A Starnes.

148 records · Page 9Linked to original sources

PubMedDate not supplied

Aortic and inferior vena cava resection for renal cell carcinoma invading an aberrant renal vein.

Renal cell carcinoma which invades the renal veins is a frequent complicating factor in radical nephrectomy. In a 53-year-old patient with a left renal cell carcinoma, tumor thrombus was present in an aberrant, retroaortic left renal vein, and "en bloc" resection of the overlying aneurysmal aorta with a cuff of inferior vena cava was required. The aorta was reconstructed with a dacron bifurcation graft to the iliac arteries, and the vena cava closed primarily. The patient made an uneventful postoperative recovery. The requirement for extensive aortic and vena cava resection need not compromise attempts to cure locally advanced renal cell carcinoma.

Aorta, Abdominal↗

PubMedDate not supplied

Segmental flow-resistance relationship in pulmonary lobar transplantation: possibility for donor lobe evaluation in pediatric lung transplantation.

Pulmonary lobar transplantation is an option for pediatric lung transplantation, and it has the potential of extended applications. We compared the relationship between segmental blood flow and segmental vascular resistance of the pulmonary lobe with that of the transplanted single lung. Eight of 14 puppies received a left upper pulmonary lobe from double-weighed adult dogs, and the other six puppies received a left lung from puppies. All recipient dogs were treated with oral cyclosporine (15 mg/kg/day) and intramuscular prednisolone (1.0 mg/kg/day), after the operation. Pulmonary arterial and left atrial pressures and segmental flow of the lungs were measured at rest and while the inferior vena cava or right pulmonary artery was clamped, before and 1 hour and 2 weeks after lung transplantation. Vascular resistance of the lung segment was calculated at each hemodynamic state. Segmental resistance of the lung at rest significantly increased from pretransplantation to 1 hour after transplantation (pulmonary lobe group, 2211 +/- 42 to 2555 +/- 61 dyne.sec.cm-5; single lung group, 2126 +/- 56 to 2557 +/- 72 dyne.sec.cm-5) and recovered 2 weeks after transplantation in both groups. However, by means of partial clamp of the right pulmonary artery, segmental resistances of 1 hour after transplantation pulmonary lobe (2248 +/- 37 dyne.sec.cm-5), and single lung (2206 +/- 34 dyne.sec.cm-5) at the same segmental flow of the pretransplantation state (310 to 320 ml/min) were equivalent to those of the pretransplantation lungs. There was no significant difference in the segmental resistance at any segmental flow between the pulmonary lobe and single lung before and after lung transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

The diagnosis of obliterative bronchiolitis after heart-lung and lung transplantation: low yield of transbronchial lung biopsy.

Obliterative bronchiolitis is the most significant long-term complication of lung and heart-lung transplantation characterized by the rapid development of obstructive airway disease. It is thought to be a manifestation of chronic rejection and has been treated, with limited success, with augmentation of immunosuppression. Early detection of obliterative bronchiolitis and prompt initiation of therapy may result in an improved outcome. The role of transbronchial biopsy has been reported in the diagnosis of acute rejection and infection but not for obliterative bronchiolitis. To study this problem we retrospectively reviewed the transbronchial biopsy results of patients with advanced clinical obliterative bronchiolitis, as defined physiologically. Between January 1, 1988, and December 31, 1991, 46 "sets" of adequate transbronchial biopsy specimens were obtained from 16 patients (15 heart-lung recipients and one double lung recipient). Seven sets of transbronchial biopsy specimens (15.2%) showed obliterative bronchiolitis by pathologic study. In four patients with severe clinical obliterative bronchiolitis, only one transbronchial biopsy specimen of seven (14.3%) showed obliterative bronchiolitis. The pathologic diagnosis of obliterative bronchiolitis was confirmed in three of these patients at the time of autopsy or retransplantation. Twelve patients were still alive at the end of the study period, and all experienced further deterioration of lung function typical for obliterative bronchiolitis. We conclude that the sensitivity of transbronchial biopsy for obliterative bronchiolitis is poor. Possible explanations for these results are explored.

Adolescent↗

PubMedDate not supplied

The role of transbronchial biopsies in the management of lung transplant recipients.

We examined the utility of the transbronchial biopsy in the management of 53 lung transplant patients. One hundred thirty-three protocol biopsies were performed to ascertain the frequency and nature of abnormalities in clinically stable or asymptomatic patients; 128 diagnostic biopsies were performed in clinically ill patients to assess the morphologic abnormalities before the institution of therapy, and 105 biopsies were performed to assess the response to therapy. Histologic evidence of acute rejection was found in 24% of the protocol biopsies, and infection was found in 17%. Twenty-five patients with grade 1 or grade 2 perivascular infiltrates in protocol biopsies did not receive antirejection therapy. Follow-up biopsy in these patients showed spontaneous resolution of the infiltrates in 19% and increased infiltrates in 6. Only two of these patients became clinically ill, representing "progression" to clinical rejection in only 8% of the nontreated patients. Forty percent of the biopsies performed to rule out acute rejection or infection had histologic features of acute rejection, and another 23% had features of infection. Treatment of patients with clinical and histologic evidence of rejection was associated with rapid resolution of clinical symptoms in nearly 90% of the patients, but follow-up biopsies showed residual infiltrates compatible with ongoing or resolving rejection in 52%. Despite repeat antirejection therapy in some patients, these infiltrates persisted for an average of 30 days after the diagnostic biopsy. Follow-up biopsies also showed asymptomatic infection, usually cytomegalovirus pneumonitis, which often persisted for weeks despite the lack of symptoms. Perivascular infiltrates compatible with acute rejection were also found in 38% of biopsy specimens with evidence of infection. These perivascular infiltrates resolved with antibiotic treatment alone in nearly 50% of the patients with these features. Although perivascular mononuclear cell infiltrates are the cardinal histologic feature of acute rejection, similar infiltrates occur in patients who apparently have infection alone and other patients who have both infection and rejection; infiltrates compatible with minimal, mild, and moderate acute rejection also occur in clinically asymptomatic patients. These histologic findings are a challenge to both the pathologists' and the clinicians' skills in the management of the lung transplant patient.

Biopsy, Needle↗