Search PubMed⌕ Search

Biomedical subjects

A Pomerance

Publications and source records attributed to A Pomerance.

At least 19 recordsLinked to original sources
PubMed1991

Response of recurrent giant cell myocarditis in a transplanted heart to intensive immunosuppression.

A 35-year-old man developed giant cell myocarditis resulting in severe congestive cardiac failure. He needed urgent orthotopic cardiac transplantation despite maximal doses of inotropes and augmentation with an intra-aortic balloon pump. The patient presented with rhythm disturbances and echocardiographically diminished ventricular function at subsequent follow-up. Biopsies then taken revealed recurrence of myocarditis in the transplanted heart. Investigations revealed no obvious cause for the myocardial granulomas nor any evidence of systemic granulomatous disease. The patient received, in addition to maintenance cyclosporin A and azathioprine, high doses of corticosteroids which resulted in complete resolution of the inflammatory process and no recurrence has been detected to date. This case shows that giant cell myocarditis can recur in the transplanted heart despite routine immunosuppression with azathioprine and cyclosporin A and that additional treatment with high dose corticosteroids is effective in causing regression of the inflammatory process.

Adult↗
PubMed1991

Demonstration by western blotting of antiheart antibodies before and after cardiac transplantation.

Western blotting has been used to detect antiheart antibodies in two groups of patients: two who required retransplantation for hyperacute rejection, and 22 consecutive patients, whose serum was tested at monthly intervals for three months following transplantation. Pretransplant and posttransplant serum samples were tested for IgM and IgG reactivity against the patients own heart and donor heart. In all patients the pretransplant lymphocytic crossmatch had been negative. In the two patients requiring retransplantation, both had multiple bands of strong IgM and IgG against their own heart prior to transplantation as well as antibodies against the donor heart. The study of 22 consecutive patients revealed that (1) the presence of strong antibody prior to transplantation is associated with unusually severe or frequent rejection episodes, (2) 20/22 patients made antiheart antibody following transplantation, but in 12 patients it was IgM only, and (3) most of the antiheart antibodies made posttransplant were not specific for the donor heart. Comparison of Western blotting with immunofluorescent detection of antibodies on frozen sections revealed that the Western blotting procedure is more sensitive and results are easier to interpret.

Adolescent↗
PubMed1990

Pulmonary lymphangioleiomyomatosis and steroid receptors. An immunocytochemical study.

Estrogen and progesterone receptors were demonstrated immunocytochemically in the lung tissue of two cases of pulmonary lymphangioleiomyomatosis. In one case both receptors were localized in the proliferative smooth muscle nodules and diffusely in the interstitial tissue in close proximity to the muscle. The pulmonary tissue in the other case contained the estrogen receptor only. The authors conclude that the response to hormonal treatment seen in this disease might be optimized in the future by monitoring for the presence of steroid hormone receptors.

Adult↗
PubMed1986

Expression of class I and class II major histocompatibility antigens in normal and transplanted human heart.

The expression of monomorphic determinants of class I and class II histocompatibility antigens in human heart before and after cardiac transplantation was examined using monoclonal antibodies and an immunoperoxidase technique. Thirty-five biopsy specimens were examined. Seven were from nontransplanted hearts and 28 were from patients who had received orthotopic cardiac transplantation 5-270 days previously. In normal hearts no class I was found on the surface of the myocardium, but intercalated discs were occasionally stained and interstitial structures (blood vessels and discrete mononuclear cells) strongly expressed the antigen. In contrast, of the 28 specimens from transplanted patients, 24 expressed class I antigen strongly on the outer surface and intercalated discs of the myocardium as well as on the interstitial structures. Class II antigen was not found on the myocardium of normal heart. It was present on small capillaries, the endothelia of some large capillaries, and discrete mononuclear cells. In 20 of 25 samples from transplant patients there was increased expression of class II antigen on interstitial structures but not on myocardium. The increased expression of class I antigen on the myocardium following transplantation may make it a potential target for cytotoxic T cells. The relevance of increased expression of class I and class II antigens in response to transplantation is discussed.

Adolescent↗
PubMed1985

Conduction system defects in three perinatal patients with arrhythmia.

The cardiac conduction systems of three patients who died in the perinatal period were studied histologically. Rhythm disturbances were observed in these patients immediately before death. The sinus node was notably hypoplastic without increase in fibrous content in all cases. The atrioventricular node was smaller than expected in all, and the entire atrioventricular conduction axis was small in two cases. This study supports the need for a detailed examination of the cardiac conduction system so as to provide a better understanding of the clinicoanatomical relation in the context of fatal perinatal arrhythmias.

Arrhythmias, Cardiac↗
PubMed1985

Heart transplant pathology: the British experience.

An account of human heart transplantation as seen by the histopathologists involved at the two UK transplant centres is presented. Between January 1979 and July 1984 179 patients received 186 hearts and 124 are still alive up to four years after operation. Cyclosporin A based immunosuppression has been used in the last 120 patients. Four patients developed neoplastic lesions. The commonest reason for transplantation was ischaemic heart disease (63%), followed by congestive cardiomyopathy (35%). The seven retransplants were for acute or chronic rejection. The monitoring of rejection by endomyocardial biopsies is described, and the causes of death and necropsy findings are presented.

Biopsy↗
PubMed1979

The clinical pathology of heart failure and atrial fibrillation in old age.

The factors associated with the development of heart failure and of atrial fibrillation in elderly patients were studied in a prospective clinico-pathological series of 171 cases. Multiple logistic analyses allowed the contributions of multiple factors to be assessed simultaneously. Senile cardiac amyloidosis, ischaemic heart disease and atrial fibrillation were significantly associated with heart failure and had additive effects. Senile cardiac amyloidosis, ischaemic heart disease, mitral valve ballooning and higher age were significantly associated with atrial fibrillation but their additive effects were modified by significant interactions between ischaemic heart disease and mitral valve ballooning (whose effects were multiplicative) and senile cardiac amyloidosis and age (the age effect being confined to those without amyloidosis).

Aged↗
PubMed1978

Valvular calcification in the elderly: possible pathogenic factors.

Calcification of the mitral ring and of the aortic valve cusps was studied in an unselected autopsy series of 219 patients over 60, dying in a department of geriatric medicine. Possible correlations with age, sex, heart size, systolic and diastolic blood pressures, bone density and serum calcium, phosphate and alkaline phosphatase were examined. There were no significant findings for aortic valve calcification though there was a weak association with advanced age. Mitral ring calcification was significantly associated with higher age, female sex and with increased heart weight after correction for body size. These findings suggest that mechanical factors, rather than changes in mineral metabolism, are implicated in the development of mitral ring calcification.

Age Factors↗
PubMed1977

The surgical pathology of thoracic aortic aneurysms.

In 63 resected thoracic aortic aneurysms, the commonest histological finding (45 cases, 71.4%) was cystic medionecrosis. These cases formed two groups, 29 with widespread fragmentation and loss of elastic tissue (elastopathy) and 16 cases without elastopathy who were older and included most of the 18 cases of dissecting aneurysms. Thirteen patients had the Marfan syndrome, 10 showing cystic medionecrosis with elastopathy, indistinguishable from the cases with no Marfan stigmata although partial 'dissections' were mainly found in the Marfan patients, Histological appearances ranged from normal to complete loss of media. Cystic changes in muscle fibres apparently preceded elastic fragmentation. Fourteen cases (22%) had aortitis: 4 were syphilitic and 3 of other known aetiology. In 7 patients the aetiology of the inflammatory process was unknown and appearances included granulomatous infarct-like lesions and necrotizing aortitis or changes indistinguishable histologically from syphilis.

Adult↗
PubMed1977

Homograft replacement of aortic valve and ascending aorta in a patient with non-specific giant cell aortitis.

A case of giant cell aortitis causing ascending aortic aneurysm associated with aortic regurgitation is reported. The aneurysm was excised and the aortic valve replaced using a fresh homograft. The patient has been followed up for three and a half years. There is good evidence of correction of the haemodynamic lesion and no evidence of further arteritis or aneurysmal formation. The pathological and clinical problem of this disease are discussed.

Aorta↗
PubMed1977

Pathological validation of auscultation of the elderly heart.

Systolic murmurs present in 129 geriatric patients followed to post-mortem were assessed as mitral or aortic in origin by simple clinical assessment alone. Post-mortem examination contradicted clinical findings in only 2% of cases. Mitral valve pathology, mostly post-inflammatory scarring or mucoid degeneration, was present in 50% of the cases with murmurs. There was a significant correlation between the presence of murmurs, particularly mitral murmurs, and congestive cardiac failure, and there was also a significant correlation with age. A tendency for aortic systolic murmurs to be associated with a higher mean systolic blood pressure was not significant and there was no significant association between systolic murmurs and ischaemic heart disease.

Aged↗
PubMed1977

The clinical significance of senile cardiac amyloidosis: a prospective clinico-pathological study.

The heart was screened for amyloid deposits in an unselected post-mortem series of 244 patients over 60 who had been admitted to a geriatric department. Cardiac amyloidosis was found in 121 cases (49-6 per cent) but was limited to minor atrial involvement in 55 (22-5 per cent). The prevalence and severity of cardiac amyloidosis were significantly related to age and sex, females having the higher prevalence (56 per cent compared with 37 1/2 per cent). Cardiac amyloidosis was also significantly correlated with the occurrence of atrial fibrillation and of cardiac failure during the period of admission to hospital. Cardiac amyloidosis showed no significant correlations with other factors studied which included ECG evidence of left ventricular hypertrophy, ischaemia and bundle branch block, pathological evidence of cardiac enlargement or ischaemia, diagnosis of malignant disease, generalized wasting and the occurrence of digitalis toxicity.

Age Factors↗