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Biomedical subjects

B J Hunt

Publications and source records attributed to B J Hunt.

At least 109 records · Page 6Linked to original sources
PubMed1994

A randomized pilot trial of low-dose combination lipid-lowering therapy following coronary artery bypass grafting.

Vein graft atherosclerosis is a common and serious complication of coronary artery bypass grafting (CABG). There is mounting evidence that lipoprotein abnormalities play an equally important role in the development of lesions in saphenous vein grafts after CABG as in native coronary vessel disease. The potential benefit of low-dose lipid lowering combination therapy in these patients has not been investigated. In a randomized, double-blind, placebo-controlled study, we compared the efficacy and safety of a low-dose combination of colestipol 10 g and simvastatin 10 mg/day (CS) to colestipol 10 mg and bezafibrate 400 mg/day (CB) for 2 months in 33 patients with serum total cholesterol > 6.5 mmol/l and triglyceride < 4.5 mmol/l who had undergone CABG for severe coronary artery disease. In the CS group, total cholesterol decreased by 29% and low-density lipoprotein (LDL) cholesterol by 42%; similarly, CB reduced total cholesterol by 17%, LDL cholesterol by 23%, triglyceride by 19%, and increased high-density lipoprotein (HDL) cholesterol by 14%. Lipoprotein (a) and hemostatic factors were unaffected by either therapy in this study. Both combination therapies were well tolerated with no significant clinical or biochemical side effects. We conclude that low-dose combinations of colestipol and simvastatin or colestipol and bezafibrate are effective and well tolerated in the management of moderate hyperlipidemia in patients who had undergone CABG.

Analysis of Variance↗
PubMed1994

Cutaneous necrosis associated with the antiphospholipid syndrome and mycosis fungoides.

The development of extensive cutaneous necrosis in a patient with tumour-stage mycosis fungoides is described. Skin biopsies showed a lymphomatous infiltrate, and thrombosis of dermal blood vessels. Investigation revealed the presence of anticardiolipin antibodies, a lupus anticoagulant, and low free protein S, which contributed to a prothrombotic state. Antiphospholipid antibodies have been detected in non-Hodgkin's lymphoma, but clinical manifestations are uncommon. Such autoantibodies may be produced by neoplastic lymphoid cells. The frequency with which antiphospholipid antibodies occur in mycosis fungoides is currently unknown.

Antiphospholipid Syndrome↗
PubMed1993

Hemostatic changes in heart transplant recipients and their relationship to accelerated coronary sclerosis.

Hemostasis was assessed in 115 steady-state heart transplant recipients (HTRs) and compared with that of 23 age-matched healthy controls and 21 age-matched patients with ischemic heart disease (IHD). Compared with the controls, the HTRs had increased levels of fibrinogen (mean and 95% confidence limits of 4.50 [4.32-4.68] g/L versus 3.47 [3.07-3.87] g/L, P < 0.001), factor VIIC (1.16 [0.98-1.21] IU/ml versus 0.99 [0.89-1.10] IU/ml, P < 0.001), and von Willebrand factor antigen (1.72 [1.58-1.88] IU/ml versus 1.00 [0.80-1.26] IU/ml, P < 0.001). HTRs had increased antithrombin III activity (P = 0.002) and protein C activity (P = 0.002), with a decrease in total protein S levels (P < 0.001) but no change in free protein S levels. Stepwise discriminant analysis of hemostatic variables showed that fibrinogen was the best discriminator of the three groups, classifying 55.6% of HTR, 40% of IHD, and 66.7% of the controls. More marked prothrombotic changes were found in HTRs transplanted for IHD than for other causes; this reached significance for prothrombin (P = 0.048), factor IX (P = 0.003), and poor fibrinolytic activity as measured by euglobulin clot lysis time (P = 0.008). The HTRs with accelerated coronary sclerosis (ACS) tended to have the most prothrombotic changes; this reached significance with factor IX (P = 0.03). In conclusion, HTRs have perturbed hemostasis; the net effects of these changes are prothrombotic. The relationship between prothrombotic changes and ACS merits further studies.

Adult↗
PubMed1993

Heparin-induced skin reaction due to two different preparations of low molecular weight heparin (LMWH)

Heparin-induced skin reaction is a recognized complication of subcutaneously administered, unfractionated heparin, and has recently been described in association with the use of two LMWH preparations, Fragmin and Fraxiparin. We describe the case of a 25-year-old woman in whom characteristic skin lesions were induced on separate occasions by unfractionated heparin, Fragmin and a third preparation of LMWH, Clexane. This case demonstrates that substitution of one preparation of heparin for another does not prevent recurrence of skin reaction in susceptible patients. Alternative anticoagulants should be considered in these cases.

Adult↗
PubMed1992

The perioperative use of blood components during heart and heart-lung transplantation.

Perioperative blood usage during 172 heart transplants (HTs) and 100 heart-lung transplants (HTLs) performed at the same center during 1986 and 1989 was reviewed. In 1986, 79 HTs were performed with a median (interquartile range) blood component use of 12 (range, 8-20) units, of which 6 (range, 4-8) constituted red cell components. The use of blood components was significantly reduced (p less than 0.05 by the Mann-Whitney U test) in 1989 to 10 (range, 8-20) units, of which red cell components constituted 5 (range, 3-7) units. Fifty HLTs in 1986 used a median (interquartile range) of 25.5 (range, 11.5-53) units of blood components. This use was significantly reduced (p less than 0.05) to a median of 18 (range, 9-29) units in 1989, of which 8 (range, 5-11) were red cell components, 4 (range, 2-8) were units of fresh-frozen plasma, and 5 (range, 0-10) were units of platelets. More blood components were used in patients who had previous cardiothoracic surgery and/or previous transplants; this reached significance in the 1986 HTs (p less than 0.001). Fresh blood was used in only one HT but in 12 (24%) of 1086 HLTs and 4 (8%) of 1989 HLTs. As the indication for fresh blood was excessive bleeding, there was a significantly greater use of blood components in 1989 HLT patients receiving fresh blood than in those not receiving fresh blood (median [range] of 163.5 [62-251] units compared to 15.5 [3-126]).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The prevalence, course, and characteristics of chronic anemia after heart and lung transplantation.

A retrospective study of the 99 surviving heart and lung transplant (HLT) recipients at one center showed that 31% had significant anemia (hemoglobin less than 100g/L) six months after transplantation. Chronic anemia persisted in 18% of HLT recipients two years posttransplantation. A similar study of 100 heart transplant recipients showed no unexplained anemic patients. The prevalence of anemia after HLT was unrelated to the original diagnosis, immunosuppression, or acute rejection. All HLT recipients appeared to be unduly sensitive to the myelosuppressive effects of azathioprine. Detailed studies in 16 representative patients showed a normochromic, anisocytotic anemia with normal reticulocyte counts, B12 and folate levels, and haptoglobin levels and appropriate erythropoietin levels--but increased ESRs, low/normal iron levels and low/normal total iron binding capacity, normal or raised ferritin levels, and autoantibodies in 4 (25%). Bone marrow aspirates in 10 patients showed dyshemopoiesis out of proportion to the degree of anemia and colonies of activated lymphoid cells. The cause for this anemia appears to be a combination of anemia of chronic disease and dyshemopoiesis, both of uncertain etiology.

Adult↗
PubMed1992

Aprotinin and heparin monitoring during cardiopulmonary bypass.

BACKGROUND: When high-dose aprotinin is used during cardiopulmonary bypass, there is a prolongation of the activated coagulation time (ACT), which is used to monitor heparinization. The aim of this study was to provide guidelines for monitoring heparin levels by the ACT if aprotinin is used during cardiopulmonary bypass. METHODS AND RESULTS: Heparinized blood from six healthy controls and nine patients on cardiopulmonary bypass was aliquoted and mixed with various concentrations of aprotinin. ACTs were performed on these samples. Activated partial thromboplastin times (APTT) were performed on the citrated plasma mixed with varying concentrations of heparin and aprotinin from the same control patients. Prothrombin times (PT) were performed on plasmas mixed with aprotinin. Aprotinin produced a dose-related prolongation of ACT and APTT but had no effect on PT. This effect occurred whatever the activating agent and in the absence of heparin. CONCLUSIONS: Aprotinin prolongs the ACT and APTT independently of heparin. If high-dose aprotinin is used during cardiopulmonary bypass, ACTs should be maintained at times > 750 seconds to allow for appropriate levels of heparin.

Aprotinin↗