Search PubMed⌕ Search

Biomedical subjects

A N Rahman

Publications and source records attributed to A N Rahman.

34 records · Page 2Linked to original sources
PubMed1995

Necrotic, ulcerative bronchitis, the presenting feature of lymphoproliferative disease following heart-lung transplantation.

Following heart-lung transplantation two of 21 patients who survived more than 100 days developed post-transplant lymphoproliferative disease. Both presented with localised ulcerative bronchitis documented at flexible bronchoscopy four months after transplantation. Histological examination showed necrosis with acute inflammation and ulceration. Case 2 demonstrated lymphoproliferative disease from biopsies subsequently taken at rigid bronchoscopy. Case 1 later developed lung nodules and a monoclonal high grade B cell non-Hodgkin's lymphoma was confirmed by an open lung biopsy. The bronchoscopic features described should alert clinicians to post-transplant lymphoproliferative disease as an underlying diagnosis and suggest that bronchus associated lymphoid tissue is the initial site for clonal proliferation in the disease.

Adult↗
PubMed1994

Postpneumonectomy chylothorax.

Over a period of 22 years, chylothorax developed in 9 of 1,800 patients who underwent pneumonectomy. Two groups were identified. In group I (n = 5), accelerated opacification of the pneumonectomy space was noted, but the mediastinum remained shifted to the pneumonectomy site. No hemodynamic problems developed and their course was no different from that of other patients who had undergone pneumonectomy. In the second group (group II; n = 4), rapid opacification of the pneumonectomy space was accompanied by mediastinal shift away from the pneumonectomy site and by major hemodynamic and respiratory embarrassment. All 4 patients required surgical intervention to control the chylous leak.

Chylothorax↗
PubMed1993

An alternative surgical technique in orthotopic cardiac transplantation.

Forty patients underwent orthotopic cardiac transplantation at Wythenshawe Hospital between May 1991 and November 1992. Twenty patients had transplantation using an alternative technique that preserves the shape of the left atrium and leaves the right atrium intact (group A). The remaining twenty had conventional transplantation using the technique described by Lower and Shumway (group B). The patients were randomized to either the new or the conventional technique on an alternate basis. There was no mortality in group A, but two patients in group B developed right ventricular failure and died. Two patients in each group developed nodal rhythm and all four recovered sinus rhythm. Echocardiography and Doppler velocimetry at the transvalvular level confirmed normal atrial function in group A with erratic atrial contraction wave in group B. There was also slightly lower incidence of mitral and tricuspid valve regurgitation in group A than in group B. The improved atrial function in group A may play a part in the prevention of right sided failure following cardiac transplantation.

Echocardiography↗
PubMed1992

Regression of left ventricular hypertrophy in a transplanted heart.

A woman with advanced coronary artery disease underwent heart transplantation. The donor heart had left ventricular hypertrophy. The electrocardiographic and echocardiographic evidence, of left ventricular hypertrophy regressed during follow up; estimated left ventricular mass decreased from 393 g to 171 g. The adaptation of myocardial mass and performance after transplantation is not fully understood. This case illustrates the potential for regression of left ventricular hypertrophy in response to altered loading conditions.

Adaptation, Physiological↗
PubMed1991

Coronary ostial stenosis: surgical considerations.

To investigate the clinical significance of coronary ostial stenosis, we reviewed eight patients with such lesions, including three with isolated stenosis at the orifice of the coronary artery. There were five male and three female patients, with an average age of 46.25 years (range 32-69 years). Their symptoms consisted mainly of angina (6 patients), with dyspnoea and palpitation being the presenting features in the remaining two patients. All patients underwent preoperative coronary angiography which confirmed stenosis at the level of the orifice with absence of reflux of contrast medium into the sinus of Valsalva as the main features. Delay in the appreciation of stenosis of the orifice of the right coronary artery resulted in the death of two patients, whose diagnosis was confirmed at post mortem examinations. Stenosis of the orifice of the right coronary artery was present in seven patients, with two patients also having stenosis of the orifice of the left coronary artery. The remaining patient had isolated stenosis of the left coronary arterial orifice. Coronary artery bypass grafting was performed in five patients, including two who had patch angioplasty to the right coronary artery. The patient with isolated stenosis of the orifice of the left coronary artery had patch angioplasty only. Follow-up of up to three years in the surviving patients showed good functional results. The ease with which it is possible to miss right coronary ostial stenosis is emphasized and angiographic features are reviewed.

Adult↗
PubMed1989

Aortic valve replacement with combined myocardial revascularisation.

Early and late outcome was studied in 630 patients who underwent aortic valve replacement between 1974 and 1982. Group 1 (506 patients) did not have important coronary artery disease, group 2 (69 patients) had coronary artery disease and underwent coronary artery bypass grafting, and group 3 (55 patients) had coronary artery disease but did not undergo myocardial revascularisation. Early mortality (within 30 days of operation) was significantly lower for group 1 (6%) than for group 2 (13%) and for group 3 (16%). Operative mortality in all three groups was lower in patients operated on more recently. The three year survival of patients in group 1 (83%) was significantly higher than that of patients in group 3 (62%) but not than that of patients in group 2 (76%). The findings of this study suggest that the presence of coronary artery disease increases the risk of aortic valve replacement whether or not coronary artery grafting is performed. Myocardial revascularisation, however, seems to return patients with aortic valve and coronary artery disease to a survival curve similar to that of patients with isolated aortic valve disease.

Actuarial Analysis↗
PubMed1988

Actuarial analysis of late results after closed mitral valvotomy.

The long-term results of closed mitral valvotomy performed between 1978 and 1985 in 198 patients with noncalcific mitral stenosis were analyzed. Follow-up data were available on 185 patients (93%); 1 patient died in the postoperative period, and 12 foreign patients were lost to follow-up. At the 4-year and 8-year intervals, 91% and 80% of patients, respectively, were event free (not in need of further operative procedures). By multivariate analysis, the factor preoperative mild mitral regurgitation showed a tendency to influence the event-free period. By univariate analysis, postoperative mitral regurgitation significantly reduced the event-free period. Twenty-one patients subsequently underwent mitral valve replacement; 8 for mitral regurgitation, 10 for mitral stenosis, and 3 for mixed mitral regurgitation and stenosis. By multivariate analysis, the reason for reoperation significantly influenced the length of the event-free period. The patients with mitral regurgitation required mitral valve replacement sooner than those with mitral stenosis. Advanced age, sex, previous valvotomy, preoperative New York Heart Association Functional Class, low mitral valve leaflet excursion, and pulmonary hypertension had no influence on the long-term result.

Actuarial Analysis↗
PubMed1986

Infection of cardiac mural thrombus associated with left ventricular aneurysm.

Infection is a rare complication of cardiac mural thrombus and may prove difficult to diagnose and treat. We describe a patient with infected thrombus associated with a left ventricular aneurysm, involving Salmonella typhimurium. Cross-sectional echocardiography proved helpful in establishing the diagnosis.

Echocardiography↗
PubMedDate not supplied

Scarlet fever, Toxic-shock syndrome and the Staphylococcus.

A case of scarlet fever studied in 1959 and caused by Staphylococcus aureus, phage type 52/52a/80 infection of a surgical burn is reported. The literature is reviewed and data are presented which indicate the distinct antigenicity of the erythrogenic toxins of staphylococci and group A streptococci. The patient developed neutralizing antibodies to staphylococcal toxin which disappeared ten months after infection. The similarity of the rashes and desquamation of the skin of several diseases caused by staphylococci indicate at least one common toxin.

Adult↗
PubMedDate not supplied

Re-operation for recurrent coronary artery and graft disease. A review of 73 patients in a group of 2573 consecutive first operations.

Between January 1980 and December 1986, 2573 patients underwent simple first time coronary artery bypass grafting, of whom 73 (65 males and 8 females) aged 34-69 years (mean 51.3 yrs) had repeat bypass grafts at Wythenshawe Hospital, Manchester. Of these 73 patients, 15 had a previous myocardial infarction, 5 hyperlipidaemia, 4 systemic hypertension, and 12 had a strong family history of ischemic heart disease. There was an overall deterioration of left ventricular function at the time of reoperation. The interval between the two operations was 5-131 months (mean 34.2 mths); recurrence of angina occurred earlier (mean 18.4 mths). Vessels grafted at the first operation were LAD (59), RCA (46), circumflex (41) and diagonal (13). The corresponding data at reoperation were LAD (55), RCA (46), circumflex (28) and diagonal (10). Blocked grafts were seen in 67 patients and new lesions noticed in 29. Reoperation was done using saphenous vein (129), internal mammary artery (5), arm veins (2) and tubular Gortex grafts (2). One patient had concurrent excision of a left ventricular aneurysm. Coronary anastomoses were performed with elective ventricular fibrillation (47) or cardioplegic arrest (91). Aortic cross clamp time varied from 0-92 minutes. Seven patients required intra-aortic balloon support. These patients died in the first 30 days, an operative mortality rate of 4.1%, and two 18 months after surgery. Sixty-eight percent of patients seen at 1 year were totally symptom free. We conclude that reoperation for coronary artery disease can be done with a low mortality and good immediate relief of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Retrograde pulmonaryplegia for lung preservation in clinical transplantation: a new technique.

Pulmonary artery flush with modified Euro-Collins solution is currently used by many centers for lung preservation. Two limitations with this technique have been that pulmonary artery vasoconstriction necessitates pretreatment of the donor with a prostaglandin and that bronchial circulation, which supplies important nutrients to the intrapulmonary airways, has been ignored. Retrograde pulmonaryplegic solution delivered through the left atrium can perfuse the dual bronchial and pulmonary circulation; furthermore, pulmonary arterial constriction will not affect distribution and may actually enhance it. The technique was used in three successive patients who underwent heart-lung transplantation. Postoperative oxygenation remained excellent; no implantation response occurred, and all three patients were extubated in less than 24 hours. Retrograde pulmonaryplegia offers a simple technique of perfusing both the pulmonary and the bronchial circulation.

Adolescent↗