Percutaneous balloon angioplasty is an accepted technique for the treatment of short segmental stenoses of the iliac and superficial femoral arteries. Some surgeons have not embraced this technique ...because of lack of training, unfamiliarity with radiologic equipment, or poor-quality fluoroscopy equipment in the operating room. A new technique, ultrasound-directed balloon angioplasty, enables the vascular surgeon to guide the catheter and evaluate the progress of the procedure without the use of radiographic imaging.
The new catheter is integrated externally into a standard duplex scanner. A spherical brass bead positioned on the catheter shaft in the middle of the balloon is covered with a piezoelectric material. This omnidirectional receiver is connected through a wire to a catheter interface system, which allows the exact position of the balloon to be represented on the screen of a duplex unit. The catheter is advanced under visual control with use of the scanner.
The system has been used to perform balloon angioplasty on 21 lesions (16 superficial femoral, 3 iliac, 2 popliteal arteries) in 17 patients. Procedures in 16 patients were performed percutaneously; in an additional patient bilateral angioplasties were performed during operation. The balloon was successfully positioned in each case with use of ultrasonography alone; each procedure was confirmed by use of angiography. Angioplasty was accomplished in 16 (76%) of 21 with the ultrasound-guided catheter alone. Supplemental use of a high-pressure balloon or atherectomy device was necessary in five patients.
This technique records physiologic and anatomic data in real time so that the progress of the angioplasty can be monitored. In three patients the inadequacy of the initial angioplasty was recognized by a persistent velocity increase but not by angiography. As a result corrective measures were taken. This new procedure allows vascular surgeons to use equipment with which they are familiar, reduces the risk of ionizing radiation and contrast nephropathy, and permits the monitoring of the angioplasty with hemodynamic parameters.
Chronic liver disease is a common complication of parenteral drug use, and liver cirrhosis is frequently seen in users of both parenteral drugs and alcohol. In 1978-83, we studied 88 parenteral drug ...users with sufficient evidence of chronic liver disease to warrant liver biopsy. Current alcohol abuse was noted in 63 (72%), and six (7%) were former alcohol abusers. Cirrhosis was found in 33 (38%). Hepatitis C antibody (anti-HCV) was detected in 86 (98%). Also, 40 of the anti-HCV positive sera were tested with recombinant immunoblot assay and all of these were reactive. All but one of the 31 patients with anti-HCV and cirrhosis were alcohol abusers. We conclude that parenteral drug users with chronic liver disease almost always have evidence of HCV infection.
Cardiac surgery using cardiopulmonary bypass (CPB) contributes to a robust systemic inflammatory process. Local intrapericardial post-surgical inflammation is believed to trigger important clinical ...implications, such as post-operative atrial fibrillation (POAF) and post-surgical intrathoracic adhesions. Immune mediators in the pericardial space may underlie such complications.
In this prospective pilot clinical study, 12 patients undergoing isolated CABG surgery were enrolled. Native pericardial fluid (PF) and venous blood samples (baseline) were collected immediately after pericardiotomy. Post-operative PF and venous blood samples were collected 48-hours post-CPB and compared to baseline. Flow cytometry determined proportions of specific immune cells, whereas multiplex analysis probed for inflammatory mediators.
Neutrophils are the predominant cells in both the pericardial space and peripheral blood post-operatively. There are significantly more CD163lo macrophages in blood compared to pericardial effluent after surgery. While there are significantly more CD163hi macrophages in native pericardial fluid compared to baseline blood, after surgery there are significantly fewer of these cells present in the pericardial space compared to blood. Post-operatively, concentration of interleukin 1 receptor antagonist, IL-6, and IL-8 were significantly higher in the pericardial space compared to blood. After surgery, compared to blood, the pericardial space has a significantly higher concentration of MMP-3, MMP-8, and MMP-9. The same trend was observed with TGFβ.
Cardiac surgery elicits an inflammatory response in the pericardial space, which differs from systemic inflammatory responses. Future work should determine whether this distinct local inflammatory response contributes to post-surgical complications and could be modified to influence clinical outcomes.
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Human immunodeficiency virus (HIV) infection has become widespread among parenteral drug abusers. We measured antibody to HIV and hepatitis B virus markers in 58 long-term, socially rehabilitated ...methadone-maintained former heroin addicts. None of the 58 had antibody to HIV, but one or more markers of hepatitis B virus infection were seen in 53 (91%). The duration of methadone maintenance was 16.9 +/- 0.5 years, and the median dose of methadone was 60 mg (range, 5 to 100 mg). Before methadone treatment, the patients had abused heroin parenterally for 10.3 +/- 1.7 years, and they had engaged in additional high-risk practices for HIV infection. We conclude that successful outcomes during methadone maintenance treatment are associated with sparing of parenteral drug abusers from HIV infection.
