Biomedical subjects

A G Rose

Publications and source records attributed to A G Rose.

148 records · Page 9Linked to original sources

PubMedDate not supplied

Regression of Kaposi's sarcoma after reduction of immunosuppressive therapy in a heart transplant patient.

The de novo development of Kaposi's sarcoma, confirmed by lymph node biopsy 17 months after heart transplantation in an 18-year-old patient, is described. Constitutional symptoms and axillary and inguinal lymphadenopathy were the presenting features. Surveillance for systemic involvement was negative, and the tumor seemed to be confined to the lymphoreticular system alone. Chemotherapy with vincristine and cyclophosphamide resulted in severe leukopenia and was discontinued. Immunosuppressive therapy, consisting of cyclosporine and methylprednisolone, was gradually reduced, resulting in regression of symptoms and lymphadenopathy. One year later the patient was symptom free, and only one extremely small inguinal lymph node was palpable. Microscopic examination of this node, however, revealed persistent Kaposi's sarcoma. The patient's immunosuppressed state would now appear to be sufficient to prevent acute rejection and yet insufficient to lead to growth and spread of the tumor.

Adolescent↗

PubMedDate not supplied

Is pulmonary ischemia a factor in the reperfusion response? An experimental study in the chacma baboon.

A reimplantation or reperfusion response has been described in both the experimental animal and the human patient after various procedures involving pulmonary ischemia. We have investigated this phenomenon in a primate model. Ten chacma baboons were placed on cardiopulmonary bypass and cooled to 20 degrees C. Circumferential segments of the right main bronchus and pulmonary artery were denuded of all surrounding tissue. Each structure was then cross-clamped, which rendered the lung ischemic, during which time the organ was immersed in cold saline solution. Ischemia was maintained for 1.5 to 5 hours; after reperfusion and discontinuation of bypass, the right lung was biopsied and the chest closed. Chest radiographs, lung biopsies, and arterial blood gases were taken at intervals for up to 16 to 28 days. Right lung shadowing on chest radiography with concomitant histopathologic changes, indicative of a reperfusion reaction, were seen in only one animal, which had undergone lung ischemia for 1.5 hours. In one other animal that was ischemic for 5 hours, patchy opacification of the lung was seen on two occasions (days 8 and 15) with concomitant mild histopathologic changes. In conclusion, therefore, a major reperfusion response after pulmonary ischemia in the chacma baboon is possible but unusual. This would suggest that the appearance of pulmonary opacification on chest radiography within the first 4 weeks after heart-lung transplantation in humans is most likely attributable to some other condition, such as isolated lung rejection or infection.

Animals↗

PubMedDate not supplied

Does the electrocardiogram detect early acute heart rejection.

Changes in electrocardiographic parameters, particularly a reduction of the voltage of the QRS complex, have been held to indicate acute rejection of a transplanted heart. In a series of heterotopic heart recipients, changes in electrocardiographic parameters were correlated with histopathological evidence of acute rejection seen on endomyocardial biopsies obtained by the percutaneous transvenous technique. No statistically significant correlation was found between the electrocardiographic changes and the histopathological features. The electrocardiogram appears to be an unreliable predictor of early acute rejection in patients with heterotopic heart transplants.

Adolescent↗

PubMedDate not supplied

The value of recipient heart assistance during severe acute rejection following heterotopic cardiac transplantation.

Acute rejection remains a major complication of cardiac transplantation. One of the advantages of heterotopic as opposed to orthotopic heart transplantation is that the recipient heart remains in situ, and may provide valuable support for the circulation if donor heart function is severely reduced during an acute rejection episode. Details are presented of 11 patients who underwent acute rejection severe enough to cause loss of significant function of the donor heart, during which time life was maintained by the patient's own diseased heart. In 5 cases the acute rejection proved reversible, with patient survival extending from 10 weeks to 61/2 years, though only 2 remain alive today. In 6 cases rejection was irreversible; 4 of these patients underwent a second heart transplant, but only 1 remains alive today.

Adult↗