Masoud Mirzaie

Miniaturized HIA microdiagonal pump as left ventricular assist device in a sheep model.

We evaluated the newly developed miniaturized HIA microdiagonal blood pump (MDP) as a continuous flow left ventricular assist device. In a sheep model (n = 6), the MDP was implanted through left lateral thoracotomy and placed paracorporeally with inflow conduit to left atrium and outflow conduit to descending aorta. The sheep were pumped at a mean flow rate of 2.5 L/min for 7 days. Anticoagulation was applied by intravenous heparin administration. Postoperatively, activated clotting time was held stable with values of 200 seconds. During follow-up, blood samples (creatinine kinase, creatinine, glutamic-oxaloacetic transaminase (aspartate aminotransferase) (GOT), glutamate dehydrogenase (GLDH), gamma-GT, plasma-free hemoglobin, and hemoglobine) were taken daily. After 7 days, the sheep were killed for macroscopic examination. Systemic artery pressures remained stable during the whole test period. Because of operative reasons, the hemoglobin value (7.5 ± 0.61 g/dl) decreased perioperatively, but recovered within the test period, whereas creatinine kinase increased initially after thoracotomy, but decreased to normal within days. Renal and liver functions were slightly impaired perioperatively, indicated by temporarily enhanced values of GOT, gamma-GT, GLDH, and creatinine. The MDP did not produce significant hemolysis as measured by plasma-free hemoglobin levels. Wound infections did not occur. We conclude that the MDP ran successfully as an left ventricular assist device for 7 days in sheep has potential for long-term support, and may serve as an alternative to current technologies. Presented data were not obtained in a clinical trial; however, the results are promising enough to proceed with longer duration animal studies.

Molecular cytogenetic analysis of two primary squamous cell carcinomas of the lung using multicolor fluorescence in situ hybridization

Abstract. To fully characterize the numerous chromosomal aberrations in two human squamous cell carcinomas (SCCs) of the lung, molecular cytogenetic characterization was carried out utilizing conventional banding analysis and multicolor fluorescence in situ hybridization (mFISH), providing simultaneous color discrimination of all 24 human chromosomes. Both tumors displayed complex aneuploid karyotypes with a host of numerical and structural chromosome abnormalities. Structural aberrations common to both SCCs included rearrangements of chromosomes 1, 3p, 7q, and 8q, contributing to net loss of chromosomal sequences on 1p, 3p, and 8p, and a net gain of 8q. The recently introduced mFISH technique enabled the disclosure of cryptic translocations and the chromosomal composition of previously unrecognized marker chromosomes. Furthermore, mFISH greatly enhanced the ability to delineate chromosomal breakpoints when integrating banding information from conventional banding analysis. Eventually, the application of mFISH as a powerful approach to refine complex tumor karyotypes is expected to result in a more detailed and complete picture of cytogenetic events associated with the development and progression of solid tumors.

Hypothermic Renal Protection Using Cold Histidine–Tryptophan–Ketoglutarate Solution Perfusion in Suprarenal Aortic Surgery

We examined data of 21 patients who were treated with selective perfusion of both renal arteries with 500 mL of 8 degrees C histidine-tryptophan-ketoglutarate (HTK) solution each for renal protection during aortic surgery. Only the data from aortic surgeries with unavoidable suprarenal aortic cross-clamping for juxtarenal or suprarenal abdominal aortic aneurysms (AAAs) or high Leriche syndrome accompanied with stenosis of renal arteries are presented. Five patients underwent immediate surgery because of perforation of an AAA; the other 16 patients went through elective surgeries. In three cases (14%) stenosis of the renal arteries was diagnosed; nevertheless, implantation of an aortorenal bypass was necessary in seven patients. In total, 14 aortorenal bypasses were implanted (five venous grafts and nine prosthesis grafts). Four (19%) patients needed catecholaminergic support to establish stable circulatory conditions; in two (9%) of these cases additional ischemia of the colon was observed and sigmoidectomy was performed. All of these four patients underwent immediate surgery, and one died after surgery because of severe sepsis. In four cases postsurgical renal insufficiency was observed. Three of these patients were admitted for emergency surgery because of their hemodynamic situation due to perforation of the AAA. None of the patients needed chronic dialysis after surgery. Whereas in all patients who underwent elective surgery the renal function remained stable as judged by postoperative serum creatinine values, in five out of seven patients with aortorenal bypass surgery the renal function improved. Perfusion with cold HTK solution offers an additional procedure to protect renal function in patients undergoing elective surgery with suprarenal cross-clamping of the aorta.

Expression rate of vinculin isoforms in human aortocoronary saphenous vein grafts

Aortocoronary bypass conduits derived from saphenous veins usually develop diffuse intimal thickening, one of the major causes of haemodynamically relevant graft stenosis. To elucidate the role of smooth muscle cell proliferation in late graft failure, specimens from highly stenotic or occluded vein grafts implanted into the arterial circulation for more than 5 years were tested for their expression rate of meta-vinculin. Since the cytoskeletal protein meta-vinculin is present exclusively in contractile smooth muscle cells, the determination of the relative amounts of meta-vinculin (150 kDa) and its low-molecular weight isoform vinculin (130 kDa) allows characterization of the phenotypic status of smooth muscle cells. Using immunoblotting techniques, the quantitative relation of meta-vinculin in tissue samples obtained from autoptic vein grafts (n=10) was measured and compared with those of native saphenous veins (n=6). In vein grafts, the fractional meta-vinculin content of the total vinculin immunoreactivity ranged from 32%-46% (mean 39.6%), whereas the range was 39%-53% (mean 46.7%) in native veins. By applying Students t-test, a statistical significance was not demonstrated suggesting that the majority of smooth muscle cells in intimal thickenings consisted of a contractile phenotype. Immunohistochemically, the vinculin immunoreactivity in the intimal layer of vein grafts was reduced as compared to native saphenous veins. The distribution of vinculin in grafted veins closely resembled that in arteriosclerotic coronary arteries with intimal thickening. Hence, our biochemical data demonstrate parallels between the pathogenesis of late vein graft stenosis and degenerative arteriosclerotic lesions.

Influence of glutaraldehyde fixation on the detection of SLA-I and II antigens and calcification tendency in porcine cardiac tissue.

Objective - Immunological effects have been addressed as key factors for the long-term results of biological porcine aortic prostheses. In this study we investigated the influence of glutaraldehyde fixation on the expression of SLA (swine leucocyte antigens) and the calcification of porcine cardiac tissue. Design - Deparaffinized sections obtained from porcine aortic tissue were fixed in a buffered glutaraldehyde solution for 1, 2, 3, 24 and 72 hours, respectively, and finally immunostained with monoclonal anti-SLA class I antibody 2.27-3a and anti-SLA-II antibody MSA3. Sixteen samples from fixed porcine cardiac tissue and, for comparison, 8 samples from leaflets of Toronto-SPV® and Freestyle® valves were implanted subcutaneously in 10 Wistar rats for 12 weeks and their calcium content was measured by atomic absorption spectrophotometry. Results - SLA-I epitopes were no longer detectable using anti-SLA-I antibodies after fixation for 3 h. The SLA-II antigens remained detectable after longer fixation period. Short-time fixation resulted in marked calcification of the porcine cardiac tissue and to destruction of the SLA-I epitopes, whereas, even after longer fixation time, the epitopes of the SLA-II antigen remain unaffected. Conclusion - Chelate formation due to glutaraldehyde treatment provides protection against calcification. Short-time fixed porcine cardiac tissue has a tendency towards a greater degree of calcification than longer fixation periods. Based on the present results, it is pointless to set the length of fixation to switch off the immunogenicity.OBJECTIVE Immunological effects have been addressed as key factors for the long-term results of biological porcine aortic prostheses. In this study we investigated the influence of glutaraldehyde fixation on the expression of SLA (swine leucocyte antigens) and the calcification of porcine cardiac tissue. DESIGN Deparaffinized sections obtained from porcine aortic tissue were fixed in a buffered glutaraldehyde solution for 1, 2, 3, 24 and 72 hours, respectively, and finally immunostained with monoclonal anti-SLA class I antibody 2.27-3a and anti-SLA-II antibody MSA3. Sixteen samples from fixed porcine cardiac tissue and, for comparison, 8 samples from leaflets of Toronto-SPV and Freestyle valves were implanted subcutaneously in 10 Wistar rats for 12 weeks and their calcium content was measured by atomic absorption spectrophotometry. RESULTS SLA-I epitopes were no longer detectable using anti-SLA-I antibodies after fixation for 3 h. The SLA-II antigens remained detectable after longer fixation period. Short-time fixation resulted in marked calcification of the porcine cardiac tissue and to destruction of the SLA-I epitopes, whereas, even after longer fixation time, the epitopes of the SLA-II antigen remain unaffected. CONCLUSION Chelate formation due to glutaraldehyde treatment provides protection against calcification. Short-time fixed porcine cardiac tissue has a tendency towards a greater degree of calcification than longer fixation periods. Based on the present results, it is pointless to set the length of fixation to switch off the immunogenicity.

Expression of porcine major histocompatibility antigens in cardiac tissue

In this study we have used monoclonal antibodies directed against antigens of the major histocompatibility complex (MHC) class I and class II to reveal the detailed cellular distribution of swine lymphocyte alloantigens (SLA) in cardiac tissue. By applying a sensitive immunophosphatase staining reaction we detected the ubiquitous expression of SLA class I and class II on the vascular endothelium. Endothelial cells of capillaries and blood vessels were intensely stained structures in the examined swine hearts. Similar staining patterns were observed in control experiments with anti‐von Willebrand factor serum and Dolichus biflorus lectin used as immunohistochemical markers for endothelial cells. The luminal layer of studied pulmonary valves exhibited a strong staining reaction with anti‐SLA class I and class II antibodies. In contrast, normal cardiac myocytes failed to express immunodetectable amounts of either of the SLA determinants. Intercalated discs in porcine heart tissue did not react with either anti‐SLA class I or class II antibodies. Our data showing the abundant expression of SLA molecules on endothelial cells in normal swine heart may have physiological implications in cell‐mediated rejection occurring in xenotransplanted hearts.

Norman Edward Shumway – Pionier der Herzchirurgie (9. Februar 1923 bis 10. Februar 2006)

ZusammenfassungAm 10. Februar 2006 verstarb der amerikanische Herzchirurg Norman Edward Shumway 1 Tag nach seinem 83. Geburtstag in Palo Alto, Kalifornien, USA, an den Folgen eines Lungenkrebsleidens.Norman E. Shumway, Pionier der Herzchirurgie, trug maßgeblich dazu bei, Herztransplantationen von Mensch zu Mensch zu ermöglichen. Bereits Anfang der 60er Jahre führte er bahnbrechende experimentelle Arbeiten zur Entwicklung einer Transplantationstechnik an Hunden durch, die er in Zusammenarbeit mit seinem Team, allen voran mit dem Kollegen Richard R. Lower, in den folgenden Jahren Schritt für Schritt kontinuierlich weiterentwickelte. Nach diesen umfangreichen tierexperimentellen Vorarbeiten stand er im Jahre 1967 mit seinem herzchirurgischen Team der Stanford University an der Schwelle, die weltweit erste Herztransplantation von Mensch zu Mensch durchzuführen, allerdings kamen ihm der Südafrikaner Christiaan Neethling Barnard sowie sein New Yorker Kollege Adrian Kantrowitz zuvor.AbstractAfter a fulfilled life, Norman E. Shumway, the great pioneer of cardiac transplantation, died of lung cancer 1 day after his 83rd birthday in Palo Alto, California, USA.Already at the beginning of the 1960s, he and his colleague Richard R. Lower did revolutionary experimental work on developing and establishing the technique of orthotopic cardiac transplantation in dogs. Several studies on cardiac transplantation were carried out in his department and a few years later, Shumway and his team were on their way to perform the worldwide first human-to-human cardiac transplantation. On December 3, 1967, Christiaan Neethling Barnard, a cardiac surgeon from South Africa, forestalled Shumway and performed this operation in Cape Town, South Africa. This event initiated a global boom of cardiac transplantations in the following years.” Many heart centers started their own cardiac transplant programs but high mortality rates led again to stagnancy of transplant activities. Shumway remained stable in believing in good results of cardiac transplantation and continued his program steadily. At the beginning of the 1970s, he and his group were responsible for most cardiac transplantations worldwide.

[Norman Edward Shumway - pioneer of cardiac surgery (February 9, 1923 to February 10, 2006)].

ZusammenfassungAm 10. Februar 2006 verstarb der amerikanische Herzchirurg Norman Edward Shumway 1 Tag nach seinem 83. Geburtstag in Palo Alto, Kalifornien, USA, an den Folgen eines Lungenkrebsleidens.Norman E. Shumway, Pionier der Herzchirurgie, trug maßgeblich dazu bei, Herztransplantationen von Mensch zu Mensch zu ermöglichen. Bereits Anfang der 60er Jahre führte er bahnbrechende experimentelle Arbeiten zur Entwicklung einer Transplantationstechnik an Hunden durch, die er in Zusammenarbeit mit seinem Team, allen voran mit dem Kollegen Richard R. Lower, in den folgenden Jahren Schritt für Schritt kontinuierlich weiterentwickelte. Nach diesen umfangreichen tierexperimentellen Vorarbeiten stand er im Jahre 1967 mit seinem herzchirurgischen Team der Stanford University an der Schwelle, die weltweit erste Herztransplantation von Mensch zu Mensch durchzuführen, allerdings kamen ihm der Südafrikaner Christiaan Neethling Barnard sowie sein New Yorker Kollege Adrian Kantrowitz zuvor.AbstractAfter a fulfilled life, Norman E. Shumway, the great pioneer of cardiac transplantation, died of lung cancer 1 day after his 83rd birthday in Palo Alto, California, USA.Already at the beginning of the 1960s, he and his colleague Richard R. Lower did revolutionary experimental work on developing and establishing the technique of orthotopic cardiac transplantation in dogs. Several studies on cardiac transplantation were carried out in his department and a few years later, Shumway and his team were on their way to perform the worldwide first human-to-human cardiac transplantation. On December 3, 1967, Christiaan Neethling Barnard, a cardiac surgeon from South Africa, forestalled Shumway and performed this operation in Cape Town, South Africa. This event initiated a global boom of cardiac transplantations in the following years.” Many heart centers started their own cardiac transplant programs but high mortality rates led again to stagnancy of transplant activities. Shumway remained stable in believing in good results of cardiac transplantation and continued his program steadily. At the beginning of the 1970s, he and his group were responsible for most cardiac transplantations worldwide.

Norman Edward Shumway – Pionier der Herzchirurgie (9. Februar 1923 bis 10. Februar 2006)@@@Norman Edward Shumway – Pioneer of Cardiac Surgery (February 9, 1923 to February 10, 2006)

ZusammenfassungAm 10. Februar 2006 verstarb der amerikanische Herzchirurg Norman Edward Shumway 1 Tag nach seinem 83. Geburtstag in Palo Alto, Kalifornien, USA, an den Folgen eines Lungenkrebsleidens.Norman E. Shumway, Pionier der Herzchirurgie, trug maßgeblich dazu bei, Herztransplantationen von Mensch zu Mensch zu ermöglichen. Bereits Anfang der 60er Jahre führte er bahnbrechende experimentelle Arbeiten zur Entwicklung einer Transplantationstechnik an Hunden durch, die er in Zusammenarbeit mit seinem Team, allen voran mit dem Kollegen Richard R. Lower, in den folgenden Jahren Schritt für Schritt kontinuierlich weiterentwickelte. Nach diesen umfangreichen tierexperimentellen Vorarbeiten stand er im Jahre 1967 mit seinem herzchirurgischen Team der Stanford University an der Schwelle, die weltweit erste Herztransplantation von Mensch zu Mensch durchzuführen, allerdings kamen ihm der Südafrikaner Christiaan Neethling Barnard sowie sein New Yorker Kollege Adrian Kantrowitz zuvor.AbstractAfter a fulfilled life, Norman E. Shumway, the great pioneer of cardiac transplantation, died of lung cancer 1 day after his 83rd birthday in Palo Alto, California, USA.Already at the beginning of the 1960s, he and his colleague Richard R. Lower did revolutionary experimental work on developing and establishing the technique of orthotopic cardiac transplantation in dogs. Several studies on cardiac transplantation were carried out in his department and a few years later, Shumway and his team were on their way to perform the worldwide first human-to-human cardiac transplantation. On December 3, 1967, Christiaan Neethling Barnard, a cardiac surgeon from South Africa, forestalled Shumway and performed this operation in Cape Town, South Africa. This event initiated a global boom of cardiac transplantations in the following years.” Many heart centers started their own cardiac transplant programs but high mortality rates led again to stagnancy of transplant activities. Shumway remained stable in believing in good results of cardiac transplantation and continued his program steadily. At the beginning of the 1970s, he and his group were responsible for most cardiac transplantations worldwide.

Manejo cirúrgico de doença oclusiva aorto-ilíaca na presença de rim em ferradura: relato de um caso

Coexistence of aortoiliac arteriosclerosis with horseshoe kidney in a 57-year-old man is presented. Diagnosis of this unusual combination was made shortly before surgery. Magnetic resonance angiography is the most important preoperative diagnostic tool for surgical planning. A transabdominal approach provides excellent exposure of the abdominal aorta in patients with a horseshoe kidney without risk of injury to renal accessory arteries or to a ureter in an anomalous position. Implantation of an aorto-bifemoral Y prosthesis was made using a Dacron bifurcation. By diffuse atherosclerotic lesion and in presence of horseshoe kidney, an end-toside proximal anastomosis of the aorta was carried out.