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Ming C Lee - One of the best experts on this subject based on the ideXlab platform.
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porcine partial liver transplantation a novel model of the small for size liver graft
Liver Transplantation, 2004Co-Authors: Dympna Kelly, Jake A Demetris, John J Fung, Amadeo Marcos, Yue Zhu, Vladimir Subbotin, Lu Yin, Eishi Totsuka, Tomohiro Ishii, Ming C LeeAbstract:Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the “small-for-size” graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular Injury was inversely proportional to graft size and appeared to be the survival-limiting Injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal Vein Injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular Injury. (Liver Transpl 2004;10:253–263.)
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porcine partial liver transplantation a novel model of the small for size liver graft
Liver Transplantation, 2004Co-Authors: Dympna Kelly, Jake A Demetris, John J Fung, Amadeo Marcos, Yue Zhu, Vladimir Subbotin, Lu Yin, Eishi Totsuka, Tomohiro Ishii, Ming C LeeAbstract:Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the "small-for-size" graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular Injury was inversely proportional to graft size and appeared to be the survival-limiting Injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal Vein Injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular Injury.
P Desgranges - One of the best experts on this subject based on the ideXlab platform.
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endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes
Journal of Vascular Surgery, 2015Co-Authors: M Raux, J Marzelle, Hicham Kobeiter, Gilles Dhonneur, Eric Allaire, Frederic Cochennec, J P Becquemin, P DesgrangesAbstract:Background Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC. Methods Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission Results At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 ( P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment—open vs endovascular repair—did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava Injury, 3 left renal Vein injuries, 1 left renal artery Injury, 1 pancreaticoduodenal Vein Injury, and 2 splenectomies), but no EBO-related complication was noted ( P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1. Conclusions Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
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endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes
Journal of Vascular Surgery, 2015Co-Authors: M Raux, J Marzelle, Hicham Kobeiter, Gilles Dhonneur, Eric Allaire, Frederic Cochennec, J P Becquemin, P DesgrangesAbstract:Background Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC. Methods Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission Results At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 ( P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment—open vs endovascular repair—did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava Injury, 3 left renal Vein injuries, 1 left renal artery Injury, 1 pancreaticoduodenal Vein Injury, and 2 splenectomies), but no EBO-related complication was noted ( P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1. Conclusions Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
Dympna Kelly - One of the best experts on this subject based on the ideXlab platform.
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porcine partial liver transplantation a novel model of the small for size liver graft
Liver Transplantation, 2004Co-Authors: Dympna Kelly, Jake A Demetris, John J Fung, Amadeo Marcos, Yue Zhu, Vladimir Subbotin, Lu Yin, Eishi Totsuka, Tomohiro Ishii, Ming C LeeAbstract:Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the “small-for-size” graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular Injury was inversely proportional to graft size and appeared to be the survival-limiting Injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal Vein Injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular Injury. (Liver Transpl 2004;10:253–263.)
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porcine partial liver transplantation a novel model of the small for size liver graft
Liver Transplantation, 2004Co-Authors: Dympna Kelly, Jake A Demetris, John J Fung, Amadeo Marcos, Yue Zhu, Vladimir Subbotin, Lu Yin, Eishi Totsuka, Tomohiro Ishii, Ming C LeeAbstract:Increasing shortage of cadaveric grafts demands the utilization of living donor and split liver grafts. The purpose of this study was to 1) define the "small-for-size" graft in a pig liver transplant model 2) evaluate pathological changes associated with small-for-size liver transplantation. Pigs were divided into four groups based on the volume of transplanted liver: (a) control group (n=4), 100% liver volume (LV) (b) group I (n=8), 60% LV (c) group II (n=8), 30% LV (d) group III (n=15), 20% LV. Tacrolimus and methyl prednisone were administered as immunosuppression. Animals were followed for 5 days with daily serum biochemistry, liver biopsies on day 3 and 5 for light microscopy, and tissue levels of thymidine kinase (TK) and ornithine decarboxylase (ODC). Liver grafts were weighed pretransplant and at sacrifice. All the recipients of 100%, 60%, and 30% grafts survived. Transplantation of 20% grafts (group III) resulted in a 47% mortality rate. Group III animals showed significantly prolonged prothrombin times (p<0.05), elevated bilirubin levels (p<0.05), and ascites. The rate of regeneration, as indicated by TK activity and graft weight was inversely proportional to the size of the transplanted graft. The severity of the microvascular Injury was inversely proportional to graft size and appeared to be the survival-limiting Injury. Frank rupture of the sinusoidal lining, parenchymal hemorrhage, and portal Vein Injury were prominent in group III animals 1 hour following reperfusion. This study established a reproducible large animal model of partial liver grafting; it defined the small-for-size syndrome in this model and described the associated microvascular Injury.
M Raux - One of the best experts on this subject based on the ideXlab platform.
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endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes
Journal of Vascular Surgery, 2015Co-Authors: M Raux, J Marzelle, Hicham Kobeiter, Gilles Dhonneur, Eric Allaire, Frederic Cochennec, J P Becquemin, P DesgrangesAbstract:Background Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC. Methods Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission Results At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 ( P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment—open vs endovascular repair—did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava Injury, 3 left renal Vein injuries, 1 left renal artery Injury, 1 pancreaticoduodenal Vein Injury, and 2 splenectomies), but no EBO-related complication was noted ( P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1. Conclusions Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
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endovascular balloon occlusion is associated with reduced intraoperative mortality of unstable patients with ruptured abdominal aortic aneurysm but fails to improve other outcomes
Journal of Vascular Surgery, 2015Co-Authors: M Raux, J Marzelle, Hicham Kobeiter, Gilles Dhonneur, Eric Allaire, Frederic Cochennec, J P Becquemin, P DesgrangesAbstract:Background Proximal aortic control by endovascular balloon occlusion (EBO) is an alternative to conventional aortic cross-clamping (CAC) in hemodynamically unstable patients presenting with a ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to evaluate the potential clinical benefit of EBO over CAC. Methods Data from 72 patients with rAAA treated at our institution from 2001 to 2013 were retrospectively analyzed. All patients were hemodynamically unstable (mean arterial blood pressure at admission Results At admission, 72 patients were unstable. CAC was performed in 40 and EBO in 32. Intraoperative mortality was 43% in group 1 vs 19% in group 2 ( P = .031). In group 1, the approach for CAC (thoracotomy [n = 23] vs laparotomy [n = 17]) did not influence intraoperative mortality (43% vs 41%). There was no significant difference in 30-day (75% vs 62%) and in-hospital (77% vs 69%) mortality rates between groups. After EBO, the treatment—open vs endovascular repair—did not influence the intraoperative mortality rate (31% vs 43%; P = .5). Eight surgical complications were secondary to CAC (1 vena cava Injury, 3 left renal Vein injuries, 1 left renal artery Injury, 1 pancreaticoduodenal Vein Injury, and 2 splenectomies), but no EBO-related complication was noted ( P = .04). Differences in colon ischemia (15% vs 28%) and renal failure (12% vs 9%) were not statistically significant. Abdominal compartment syndrome occurred in four patients in group 2 and in no patients in group 1. Conclusions Compared with CAC, EBO is a feasible and valuable strategy and is associated with reduced intraoperative mortality of unstable rAAA patients, but not in-hospital mortality, in this retrospective study.
Gregory A Magee - One of the best experts on this subject based on the ideXlab platform.
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isolated iliac vascular injuries and outcome of repair versus ligation of isolated iliac Vein Injury
Journal of Vascular Surgery, 2018Co-Authors: Gregory A Magee, Jayun Cho, Kazuhide Matsushima, Aaron Strumwasser, Kenji Inaba, Omid Jazaeri, Charles J Fox, Demetrios DemetriadesAbstract:Abstract Objective The incidence of morbidity and mortality for iliac vascular injuries in the literature are likely overestimated owing to associated injuries. Data for isolated iliac vascular injuries are very limited. No large studies have reported the incidence of morbidity for repair versus ligation of isolated iliac Vein injuries. Methods Patients in the National Trauma Data Bank (NTDB; 2007-2012) with at least one iliac vascular Injury were analyzed. Isolated iliac vessels were defined as cases with Abbreviated Injury Scale severity score of greater than 3 for extraabdominal injuries and an Organ Injury Scale grade of greater than 3 for intraabdominal injuries. Results Overall, 6262 iliac vascular injuries (2809 penetrating, 3453 blunt) were identified in 271,076 patients with abdominal trauma (2.3%). There were 3379 patients (1841 penetrating, 1538 blunt) with isolated iliac vascular injuries (1.2%) and 557 patients (514 penetrating, 43 blunt) with combined iliac artery and Vein injuries (0.2%). The 30-day mortality rate was 16.5% for isolated iliac Vein Injury, 19.3% for isolated iliac artery Injury, and 48.7% for combined isolated iliac artery and Vein Injury. The 30-day mortality rate was 23.4% for isolated iliac vascular injuries compared with 39.0% for nonisolated iliac vascular injuries ( P P = .875), pulmonary embolism (repair, 1.8%; ligation, 0.5%; P = .38), fasciotomy (repair, 9.3%; ligation, 14.6%; P = .094), amputation (repair, 1.8%; ligation, 2.6%; P = .738), acute kidney Injury (repair, 5.8%; ligation, 4.7%; P = .627). Multivariate logistic regression demonstrated that ligation of isolated iliac Vein injuries had an odds ratio of 2.2 for mortality compared with repair (95% confidence interval, 1.08-4.66). Conclusions Isolated iliac vascular injuries are associated with a high incidence of mortality, especially for combined venous and arterial Injury, but mortality is significantly lower than in patients with nonisolated iliac vascular injuries. In patients with isolated iliac Vein injuries, mortality was higher in patients who underwent ligation compared with repair; however, the rates of deep venous thrombosis, pulmonary embolism, fasciotomy, amputation, and acute kidney Injury were not different between the treatment groups. These data lend credence to the assessment that repair of iliac Vein injuries is preferable to ligation whenever feasible.
