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Report of the case of a 1-year infant, weighing 4 kgs, with a right pulmonary artery branching from the aorta combined with a wide patent ductus arteriosus. Reimplantation of this artery in the pulmonary artery trunk under extracorporeal circulation was followed by a spectacular result.
After several unsuccessful surgical procedures, a case of megaduodenum in a 29-year-old woman was treated successful with duodenal resection and reimplantation of the ampulla with a Roux en Y limb of jejunum. Alternate approaches to this complicated condition are discussed.
An extensive intramedullary lesion of the femur was diagnosed as a Grade I chondrosarcoma in 1986. At definitive surgery, four fifths of the femoral diaphysis were resected, autoclaved, and reimplanted. The reconstruction, after stabilization with AO plates, was supplemented with allogeneic bone matrix to induce new bone formation. No autografts were used. Despite subsequent infection and sequestration of the autoclaved tumorous segment, the reconstructed area was gradually enveloped by new bone. Three years after primary surgery, the infection persisted. The AO-plated and autoclaved sequestered bone was excised. Six years after the operation, the patient walks bearing full weight and works full time. There are no signs of tumor recurrence.
Lung transplantation has become a therapeutic option for a number of end-stage pulmonary disorders. Lung transplant recipients experience more complications due to acute and chronic allograft rejection as compared to recipients of other solid organs. We postulated that the generation of TNF-alpha plays a significant role in the pathogenesis of acute lung allograft rejection. To test our hypothesis, we used a RT1-incompatible rat lung allograft model and demonstrated the time course, cellular source(s), and major compartment(s) of TNF production during the course of lung allograft rejection. This model allowed for immunogenetic standardization and reproducibility of lung allograft rejection across disparate major histocompatibility barriers. TNF production was characterized at the whole animal, organ, cellular, and molecular levels, and was found to be compartmentalized and expressed in a bimodal fashion from the lung allograft during lung allograft reimplantation and maximal rejection. Lung allograft rejection was significantly attenuated in animals pretreated with neutralizing TNF antisera as compared to animals receiving control sera. These findings may provide interesting insight into the use of novel and specific therapeutic intervention(s) during periods of acute lung allograft rejection.
Until now, reimplantation response (RR) has been thought to be a transient dysfunction of the transplanted lung in single lung transplantation. How does RR influence on the native lung in single lung transplantation? We studied the influence of RR to the native lung with 20 dogs which were divided separated into 3 groups. In group I (6 dogs) and II (6), left lung allotransplantation without immunosuppression was performed. In group II, PGI2 was administered to the donors at 1 microgram/kg/min for 60 minutes iv drip infusion during lung extraction and super oxide dismutase (SOD) was administered to the recipients at 20 mg/kg just before reperfusion of the transplanted lung. In group III (8), allotransplantation with immunosuppression (CYA 20 mg/kg, AZ 4 mg/kg) was done using PGI2 and SOD in the same way as group II. In all groups doppler flow probes were attached to the ascending aorta and left pulmonary artery. For over 1 week, pulmonary hemodynamics was evaluated. In group I pulmonary arterial pressure increased up to 38.7 +/- 19.7 mmHg on 3 postoperative day, which showed significant difference (p < 0.05) from group II. An increase in vascular resistance of the transplanted lung was recognized right after transplantation in the both groups (0.212 +/- 0.058 mmHg/ml/kg to 0.487 +/- 0.114 in group I, 0.207 +/- 0.072 to 0.407 +/- 0.172 in group II). However, vascular resistance of the right lung increased in group I against group II right after transplantation (0.182 +/- 0.116 to 0.367 +/- 0.195 in group I, 0.183 +/- 0.116 to 0.214 +/- 0.149 in group II), which showed significant difference (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Permanent pacemakers were implanted and reimplanted in a total of 511 patients (mostly men) during a period of about 7 yr. Mean age was 67.9 yr. The cephalic route was used in nearly every case, with subclavicular implantation of the generator. Mean hospital stay was 7.6 days. Ventricular inhibition pacemakers were used in over 84% and fixed-frequency models in 7%. Mean pacemaker life was 24.1 months, with longer periods in the last months of the period of observation. The evaluation of battery run-down and recent and long-term complications is discussed, together with a particular type of decubitus of electrolytic origin. Hospital mortality was 2%. Survival was 91% at 1 yr and 54% at 6 yr. Emphasis is placed on the fact that subjects continue to be heart patients. Their well-being depends on psychological and general medical care, together with help from their, families and society, quite apart from cardiological attention.
A study of two-stage pulmonary autotransplantation was performed on 29 dogs; 12 dogs died after the first stage, which was always a right lung reimplantation, and 17 dogs underwent the second stage after varying intervals of time. In the group of six dogs operated upon with very short intervals between stages (2 to 8 days) there were no survivors. There were seven long-term survivors in the subgroup with an interval longer than 4 weeks, and they constitute the largest published series obtained with this particular procedure. The interval between operative stages was the only significant controlled variable, as only minor technical or operative differences were allowed to occur. Ischemia times of the lungs were usually quite short. The surviving animals were utilized for studies of the regeneration of the afferent pulmonary nerves (Hering-Breure reflex and effects of capsaicin) as permitted by a long follow-up period of up to 3 years.
We performed aortic valve sparing operation in two cases of annulo-aortic ectasia combined with Type A aortic dissection. Marfan syndrome was found in one case and the dissection was acutely evolving in another case. The aortic valves were observed as normal configuration in both cases and then reimplanted within the synthetic grafts along with the David's procedure. No aortic regurgitation was found in the acute case but slight regurgitation was checked out in the Marfan case at the discharge. The aortic valve preserving operation for annulo-aortic ectasia was considered much effective in cases with aortic dissection in order to expect the thrombolization in the pseudo lumen.
OBJECTIVE: This study compares auditory performance between original and replacement cochlear implants. STUDY DESIGN AND SETTING: Data from 18 U.S. cochlear implant programs were obtained by retrospective chart review. Patients received and returned subjective questionnaires. PATIENTS: Twenty-eight adults with once-functioning Nucleus 22 cochlear implants that failed received replacement Nucleus 22 cochlear implants in the same ears. MAIN OUTCOME MEASURES: Objective measures included sentence (CID Everyday Sentences or Iowa Sentences) and monosyllabic word (NU-6 Words or CNC Words) speech discrimination scores. Patients also rated and compared performance using subjective scales. RESULTS: Thirty-seven percent of patients had significantly higher sentence or word scores with their replacement cochlear implants than with their original implants, 26% had no significant change, and 37% had significantly poorer scores. Subjectively, 57% of patients reported that the performance of their replacement device was better or the same and 43% reported that it was poorer. There was no correlation between performance with the replacement cochlear implant and cause of the original device failure, duration of original device use before failure, surgical complications with either implantation, changes in electrode insertion depths, or preoperative variables, such as age, etiology, or duration of deafness. CONCLUSIONS: Speech recognition ability with a replacement cochlear implant may significantly increase or decrease from that with the original implant. Experienced cochlear implant patients facing reimplantation must be counseled regarding the possibility of differences in sound quality and speech recognition performance with their replacement device.
We report a case of a 59-year-old woman with bilateral ureterovaginal and vesicovaginal fistulas after radical total hysterectomy and bilateral salphingo-oophorectomy who failed transvesical repair of the vesicovaginal fistula. The bladder was extensively scarred, half of which had to be excised. This was replaced with an ileal cystoplasty with an antireflux ileal nipple valve into which the ureters were reimplanted. Continuity of the urinary tract was re-established without a urinary diversion or stoma.
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