Acute mycotic aneurysm of the ascending aorta following aortocoronary bypass: successful repair.

Acute mycotic aneurysms of the ascending aorta following aortocoronary bypass are exceedingly rare. To our knowledge, there have been few reports of successful management. The central location of this lesion places it apart from acute or chronic mycotic aneurysms in general and enhances its lethality. The availability of ascending and arch aortography, computerized chest tomography and the techniques of peripheral cardiopulmonary bypass, deep hypothermia and reversible circulatory arrest for prolonged periods of time permit successful management. The purpose of this report is to (1) illustrate such a problem; (2) describe its successful management; (3) review the etiology of mycotic aneurysms, historically and contemporarily; and (4) to differentiate early, acute mycotic aneurysms of the ascending aorta following aortocoronary bypass (usually lethal) from similar late chronic processes (readily reparable).

Significance of asymptomatic biliary tract disease in heart transplant recipients.

Biliary disease in conjunction with heart transplantation was encountered in 13 of 33 patients: in the past history (three patients), at pretransplant evaluation (nine patients), and appearing de novo after transplantation (one patient). Four patients with asymptomatic cholelithiasis underwent transplantation: biliary complications requiring emergency and/or urgent surgery occurred in all, with two deaths. Potentially complicating factors included (1) untoward effects of steroids on tissue healing and infection and (2) interaction between liver dysfunction and/or external bile loss and cyclosporine metabolism. Therapeutic lessons learned from this experience involve (1) selection of monoclonal antibodies over methylprednisolone for rejection control, (2) return of drained bile to the gastrointestinal tract, and (3) careful cyclosporine level and dosage monitoring. Five candidates with asymptomatic cholelithiasis underwent elective pretransplant biliary surgery; despite their compromised heart function, all patients had an uncomplicated postoperative course. We conclude that asymptomatic biliary disease is frequent in transplant candidates, can lead to serious morbidity and/or mortality after transplantation, and ideally can and should be treated before transplantation.

Vein graft arteriovenous fistula for long-term venous access in a heart transplant recipient lacking superficial veins: a case report.

Construction of a (radial artery) saphenous vein graft arteriovenous fistula for blood sampling after heart transplantation is presented as a solution to the problem of a patient with poor or sclerosed superficial arm veins. Satisfactory experience with one patient over a 12.5 month follow-up is presented.

Experience and early results following heart transplantation at the Humana Heart Institute.

Five elective and one emergency orthotopic heart transplantation were performed in six patients, 32 to 54 years of age. Postoperative complications included transient renal failure in four patients with need for dialysis in one, seizure in one, and herpes infections in four. Immunosuppression of the first three patients consisted of cyclosporine and prednisone. The last three received cyclosporine and azathioprine, with prednisone added later for control of rejection. All six patients are home and well.

Long term physiologic study of thoracic duct lymph and lymphocytes in rat and man.

Techniques for study of thoracic duct lymph and lymphocyte circulations in rats and in man are presented. Radiographic observations, measurements of lymph flow, lymphocyte output, blood lymphocyte level, intra-thoracic pressures and radioactive determinations in the lymph and blood of 51Cr labelled lymphocytes, indicate that the techniques are suitable for long-term study of thoracic duct circulations under physiologic conditions.

Surgical techniques for long-term studies of thoracic duct circulation in the rat.

Two techniques for cannulation of the thoracic duct in the rat, thoracic duct shunt and thoracic duct side fistula, are described. They give access, for repetitive sampling, to a normal thoracic duct circulation and are suited for study of the circulation under physiologic conditions. The thoracic duct shunt creates, with tubing, a shunt between the caudad and cephalad ends to the cisterna chyli. The exteriorized midportion of the shunt allows observation of the lymph. In the thoracic duct side fistula, the short arm of a T tube is placed within the cisterna and sampling is done via the long arm of the tube. Ten shunts functioned for 8-26 days and 10 side fistulas functioned for 8-30 days. Average lymph flow was 0.044 ml/min (shunts) and 0.042 ml/min (side fistulas). Average thoracic duct lymphocyte output was 1,729,000 cells/min (shunts) and 2,310,000 cells/min (side fistulas). Average blood lymphocyte count was 11,700 cells/mm3 (shunts) and 12,600 cells/mm3 (side fistulas). All parameters remained stable during the period of study. Advantages of those techniques over the Bollman end fistula are presented.

Technic of chronic thoracic duct "side fistula" for immunologic evaluation of patients with cancer.

A technic suitable for long-term study of the human thoracic duct circulation under physiological conditions is described. The results and observations obtained in ten patients studied for three to twenty-one days are presented.