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1/7. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms.

    This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site in the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.
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keywords = animal
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2/7. Nonlinear theophylline pharmacokinetics. A preventable cause of iatrogenic theophylline toxic reactions.

    When theophylline is used for the treatment of patients with obstructive pulmonary diseases, most clinicians attempt to maintain serum levels between 55 and 110 mumol/L because higher levels are associated with an increased risk of serious toxic effects. Nonlinear theophylline kinetics are known to occur in animals, in some pediatric patients, and at very high toxic levels in adults. However, within the usual therapeutic range of serum levels, first-order kinetics are assumed to operate, and, thus, a one-compartment model or a model-independent approach is routinely used for dose adjustments. We have recently encountered two adult patients in whom nonlinear theophylline kinetics existed within the subtherapeutic and therapeutic range of serum levels. In both cases this was not immediately recognized by the clinician, resulting in prolonged use of subtherapeutic doses of theophylline. In addition, in one case our empiric attempts to achieve therapeutic serum levels resulted in serious theophylline toxicity. We present only the data from this latter patient to be used as a case study. Based on this example and a review of the literature, we propose that to avoid such a potentially fatal complication the following steps should be taken when dealing with a patient in whom serum theophylline levels fail to rise as expected with increasing oral doses: (1) supervised administration of oral theophylline to rule out noncompliance; (2) discontinuation of further empirical increases of the oral dose of theophylline; (3) obtention of steady-state serum levels on at least two different oral doses of theophylline; and (4) calculation of the appropriate maintenance dose of theophylline for that individual patient using any of the methods cited in this report.
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keywords = animal
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3/7. Obstructive sleep apnea following bilateral carotid body resection.

    A patient who had undergone bilateral carotid body resection five years earlier for palliation of chronic airflow obstruction was found to have severe obstructive sleep apnea. He presented with hypercapnic respiratory failure, which improved after tracheostomy. A physiologic mechanism is proposed to explain this association. Previously reported studies of anesthetized animals suggest that loss of peripheral chemoreceptor activity could selectively decrease neural output to the genioglossus, the main protrusor muscle of the tongue, predisposing the upper airway to inspiratory occlusion.
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keywords = animal
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4/7. Infections caused by Rhodochrous.

    Organisms conforming to "rhodochrous taxon" were isolated from three immunocompromised patients, suggesting a pathogenic role for the organisms. The organisms are partially acid-fast, gram-positive catalase positive rods which form orange or red colonies aerobically in three or four days on Sabouraud, Mueller-Hinton and Middlebrook 7H-10 agars. They are differenitated from nocardia by morphology and ability to degrade ethylene glycol in 7H-10 media. Two of these clinical isolates and a reference strain were injected intraperitoneally into guinea pigs, half of which received methylprednisolone intramuscularly beginning three days prior to inoculation. Steroid-treated animals exhibited clinical illness, diffuse peritonitis and recovery of inoculated organisms whereas one of three nonsteroid-treated animals exhibited a localized abscess without recovery of organisms. This study suggests that rhodochrous may be pathogenic under conditions of immune compromise.
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keywords = animal
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5/7. pasteurella multocida pneumonia and bacteremia.

    A 76-year-old man with chronic obstructive pulmonary disease who developed P multocida pneumonia and bacteremia has been described. The infection was treated with antibiotics, and the patient recovered. pasteurella multocida is known to infect many species of animals. The instances of human infection due to this organism are frequently associated with exposure to animals. Pulmonary infection occurs principally in patients with underlying chronic bronchopulmonary disease.
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keywords = animal
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6/7. The role of neutrophils in inflammation.

    It has long been noted that inflammation underlies asthma. It is now recognized that there is marked heterogeneity in the stimuli that can cause or aggravate this inflammation, the cells that are involved in the response and the consequences in terms of both pathology and symptoms. The prime role of eosinophilic inflammation in the pathogenesis of asthma is acknowledged in this paper, but the potential role of neutrophilic inflammation to underlie symptoms and physiological changes that are characteristic of asthma is highlighted. A minority group of patients appear to have asthma from clinical signs, but their airway secretions do not contain eosinophils. Their response to treatment is unlike that of patients with typical eosinophilic airway inflammation in that they do not respond to steroid therapy. Published data from in vitro and animal work provide a conceptual framework to explain these observations. The refinement of the technique of examining sputum cellular content to assess airway inflammation provides an opportunity to identify and study this subgroup of patients.
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7/7. Pulmonary reactions after exposure to 3-methylfuran vapour, a fungal metabolite.

    A case of obstructive pulmonary reaction with flu-like symptoms after exposure to 3-methylfuran is described. This compound is produced by fungi, and can be found in buildings with mould growth. Previous studies have shown that exposure to the substance might increase the prevalence of respiratory symptoms, and is pneumotoxic to animals at high concentrations.
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keywords = animal
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