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Biomedical subjects

B W Shaw

Publications and source records attributed to B W Shaw.

220 records · Page 13Linked to original sources
PubMedDate not supplied

Aspergillus endocarditis in patients without prior cardiovascular surgery: report of a case in a liver transplant recipient and review.

Aspergillus flavus mural endocarditis was diagnosed after death in a 19-year-old man who had undergone orthotopic liver transplantation 4 months before death. His course was complicated by severe acute graft rejection, which required additional transplants 2 and 4 months, respectively, after the first. Review of the medical literature documented an additional 28 cases of aspergillus endocarditis in patients without prior cardiac surgery. The majority of the patients were immunosuppressed. The most common presenting feature was fever, and embolic phenomena occurred in half of the patients during illness. No blood cultures yielded Aspergillus species. Laboratory findings were nonspecific. The diagnosis was made before death in only seven cases. It was based on histologic examination of either embolectomy tissue (four patients) or skin biopsy tissue (one patient) and on echocardiographic demonstration of vegetations (two patients). Echocardiography failed to show vegetations in five of nine cases tested. Two patients survived. Aspergillus endocarditis should be considered in an immunocompromised host who presents with fever and embolic phenomena, with or without a cardiac murmur, and whose blood cultures are sterile.

Adult↗
PubMedDate not supplied

Liver transplantation therapy for children: Part 2.

End-stage liver disease affects nearly 300 children annually in the United States. Based upon the annual birth rate in the United States of 3.1 million, the incidence of the most prominent causes of liver disease in children (biliary atresia, alpha 1-antitrypsin deficiency, Wilson's disease, and neonatal hepatitis), and the frequency of end-stage liver disease in each disorder. Liver transplantation now offers these children at least a 65%, and in some series as high as 85%, chance of surviving at least 2 years postoperatively. Much of this improvement is attributable to advances in immunosuppression. However, one must not underestimate the importance of the tremendous knowledge that has been gained in the care of a large number of these patients over the last decade. The major barriers standing in the way of wider application of liver transplantation include the reluctance of primary care physicians to refer patients for early consideration, the growing crisis in the availability of donor organs, and the lack of adequate numbers of centers involved in performing adequate numbers of procedures. The major hurdles to overcome in order to affect further improvements in results include more specific immunosuppression, more accurate means of diagnosing rejection, better techniques of organ preservation, and further optimization of the care of both candidates preoperatively and recipients after transplantation.

Child↗
PubMedDate not supplied

Bronchoalveolar lavage in liver transplant patients.

Because immunosuppression is required to control rejection, liver allograft recipients are susceptible to a variety of opportunistic pathogens. A total of 191 bronchoalveolar lavage (BAL) specimens from 89 patients (53 adults and 36 children) who underwent orthotopic liver transplantation was reviewed. One case each of cytomegalovirus (CMV), staphylococcal and Enterobacter pneumonia was diagnosed with the aid of pretransplant BAL. The pretransplant BAL in 62 patients showed rare yeasts in 24.2%; these probably represent oropharyngeal contaminants since the patients involved had no symptoms of Candida pneumonia. Among 54 patients who developed respiratory symptoms and underwent posttransplant BAL, 23 (42.6%) were infected with opportunistic pathogens, including Pneumocystis carinii (22.2%), CMV (22.2%) and herpes simplex virus (HSV) (7.4%). Frequently, infection with multiple organisms was present. Adults constituted 100% of the HSV-infected group, 69.2% of the CMV-infected group and 16.6% of the group infected with P carinii. The diagnosis of these infections was aided by a combination of cytology, microbial culture and in situ hybridization techniques. Although BAL permitted the diagnosis and treatment of opportunistic infections, high mortality (62.5%) occurred with CMV and HSV pneumonia. Further studies into methods that permit earlier diagnoses of these infections are necessary.

Adult↗