Background and aims: Aortic injuries are rare and associated with high early mortality challenging the surgical services both from a technical as well as organisational point of view, especially in countries with low incidence of trauma. A Finnish experience in the management of aortic injuries is reported with special emphasis on outcome after early involvement of cardiothoracic surgeons.
Material and methods: Retrospective analysis of hospital records identified 36 consecutive patients with aortic injuries arriving alive to the hospital during a 32-year period of 1967-98.
Results: Of the 19 thoracic aortic injuries, 17 (89%) were caused by blunt trauma, 8 (42%) of the patients arrived in shock, 7 (37%) died before repair could be attempted, 11 (58%) underwent repair with prosthesis and one (5%) with sutures, with an overall mortality rate of 9/19 (47%). Of the 17 patients with abdominal aortic injuries (15 penetrating), 13 (76%) arrived in shock, 3 (18%) died before repair, 13 (76%) were repaired with sutures and one (6%) with prosthesis, with an overall mortality rate of 8/17 (47%). Fourteen (82%) of the 17 non-survivors died within 24 hours from the injury, 13 from exsanguination and one from associated brain injury.
Conclusions: Abdominal aortic injuries are usually penetrating, diagnosed intraoperatively and amenable to suture repair with good results indicating that stable and unstable patients with potential aortic injuries after penetrating abdominal trauma can safely be managed in hospitals with experienced general surgeons on call. In contrast, stable patients with suspected thoracic aortic injuries could benefit from early transfer to a hospital with cardiothoracic surgical facilities and personnel.
Background and aims: Gene therapy has been suggested as a novel approach against pancreatic cancer, a disease with a grim prognosis with current modes of therapy. Despite recent advances in in vitro and experimental in vivo studies, there is no data available concerning gene transfer efficiency in intrapancreatic tumours in immunocompetent animal models.
Material and methods: In in vitro studies rat pancreatic carcinoma cells (DSL-6A/C1) were transduced with replication-deficient adenovirus carrying Escherichia Coli beta-galactosidase (lacZ) gene. Gene transfer efficacy was assessed at different multiplicities of infection (MOIs). Pancreatic tumours were induced by inoculating cultured DSL-6A/C1 cancer cells into Lewis rat pancreases. Established tumours were transduced and three days post-transduction, pancreatic tumours as well as other intra-abdominal organs were harvested and processed for histological analyses, including staining for marker gene expression.
Results and conclusions: In vitro assays showed that DSL-6A/C1 cells were transduced efficiently, even at low MOIs. In vivo gene transfer was successful in all animals, and all pancreatic samples showed reporter gene expression. Positive cells were detected in the peritumoural areas as well as to a lesser extent within the tumours. The transgene activity was not evenly distributed and the gene transfer efficiency varied from a few detectable blue cells to 11% per field. Our studies demonstrated safe in vivo gene transfer into intrapancreatic tumours, suggesting that pancreatic tumours are potential targets for in vivo delivery of therapeutic genes.