Serum glycosyl transferases and carcinoembryonic antigen in patients with colorectal carcinoma in different stages.
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Carcinoembryonic Antigen↗
Biomedical subjects
C Blanche
Publications and source records attributed to C Blanche.
An update on transplantation in the geriatric heart transplant patient.
Discussions of the ethics involved in allocating scarce resources often proceed without a grounding in factual experience. This study explored whether there was statistical evidence to support the use of set age limits in patient selection criteria for heart transplantation. Many transplant teams have selection criteria that include age limits, excluding patients more than 60 or 65 years of age from being considered as transplant candidates. The hypothesis was made that patients in the age bracket of 60-69 should have a comparable success rate with transplantation to that of younger recipients when selected by using the same medical and psychiatric criteria. Based on their clinical observations, the authors postulated that the elderly would report better quality of life postoperatively than younger control subjects.
Adolescent↗
Cytokine expression and endothelial cell and lymphocyte activation in human cardiac allograft rejection: an immunohistochemical study of endomyocardial biopsy samples.
We used monoclonal antibodies and immunohistochemical staining of frozen tissue sections to study the expression of cytokines in human cardiac allograft rejection. The 113 endomyocardial biopsy samples were stained for interleukin (IL)-2, IL-6, and interferon-gamma. The findings were compared to expression of the endothelial cell adhesion molecule ICAM-1, and the lymphocyte receptor for the adhesion molecule VCAM-1, VLA-4. Four biopsy samples from patients with idiopathic cardiomyopathy served as controls. IL-2 was not expressed in lymphocytes of controls and only occasionally in mild or moderate cellular rejection, humoral rejection, and Quilty lesions. IL-2 expression was prominent in severe cellular rejection. Interferon-gamma expression increased in proportion to the severity of cellular rejection and was not expressed in other conditions. IL-6 staining, which was only observed in occasional cases, was mild. Cytokine and adhesion molecule expression tended to increase with the severity of cellular rejection. This study shows that cytokine expression can be documented in human allograft endomyocardial biopsy samples with immunohistochemical techniques. The findings support the concept of an important role for cytokines in human cardiac allograft rejection.
Antigens, CD↗
Expression of cell adhesion molecules in human cardiac allograft rejection.
Adhesion of leukocytes to vascular endothelial cells is a critical step in a variety of inflammatory conditions. We studied the expression and distribution of intercellular adhesion molecule-1 (ICAM-1) and endothelial leukocyte adhesion molecule-1 (ELAM-1) in frozen sections of 83 endomyocardial biopsy specimens from human allograft hearts using monoclonal antibodies and an avidin-biotin complex-alkaline phosphatase staining technique. Cases with cellular or humoral rejection and Quilty lesions were studied. Staining was graded from 0 to 3+ in lymphocytes and in capillary, arterial, venular, and endocardial endothelial cells. Expression of ICAM-1 in capillaries increased with the severity of cellular rejection and was prominent in humoral rejection. ICAM-1 was also expressed in lymphocytes in proportion to the degree of rejection. Little or no ELAM-1 expression was noted. In Quilty lesions the intensity of ICAM-1 expression was similar to that of mild-to-moderate rejection. Thus adhesion molecule expression can be identified in endomyocardial biopsy specimens of patients with rejection, suggesting a role for adhesion molecules in the process of rejection. These findings may prove useful in monitoring rejection and its response to therapy and in developing specific antisera directed against these molecules.
Capillaries↗
Bradyarrhythmias requiring pacemaker implantation after orthotopic heart transplantation: association with rejection.
Patients with severe sinus-node dysfunction that required pacemaker implantation after orthotopic heart transplantation were reviewed. During a 21-month period, 42 transplantations were performed in 41 patients. Five patients (12.2%) required a permanent pacemaker because of severe dysrhythmias. Three patients had moderate-to-severe cellular and/or humoral (vascular) rejection, and two of the five patients (40%) died. In the remaining two patients, bradyarrhythmias were due most likely to trauma to the sinus node during harvesting of the donor heart, and these patients have shown no evidence of significant rejection on repeated biopsies. A strong relationship was found between moderate or severe rejection and the development of significant bradyarrhythmias that required the placement of a permanent pacemaker. The development of severe dysrhythmias during the early or late posttransplantation period should be considered a manifestation of an ongoing rejection episode until proven otherwise. In our experience this evidence of rejection may imply a poor prognostic sign because it is associated with high mortality rates.
Adult↗
Giant emphysematous bullae: surgical treatment using the median sternotomy approach.
Seven patients were operated for simultaneous excision of giant emphysematous bullae through a median sternotomy. They were all symptomatic and with a history of alcohol and/or drug abuse. Preoperative evaluation included bilateral chest tomograms and complete pulmonary function test. Surgical technique included bilateral resection of giant bullae and pleurodesis with minimal postoperative morbidity and no mortality. No correlation was found between symptomatic clinical improvement and measured postoperative pulmonary function. The median sternotomy approach is indeed the method of choice for bilateral giant emphysematous bullae.
Adult↗
Long-term results of surgery for coronary artery fistulas.
This report describes our long-term result of surgery for coronary artery fistula in 12 patients. Follow-up range was from one year to 15 years, and with one exception they were all congenital in origin. Diagnosis was confirmed with angiography in all cases, showing single fistulous tract in four patients and multiple in eight patients. All but one patient were operated on by cardiopulmonary bypass with no mortality and with complete resolution of symptoms and no recurrence of the fistula. We conclude that surgery for coronary artery fistula can be accomplished safely with excellent long-term results and should be recommended for all patients to prevent life-threatening complications that may develop.
Adolescent↗
Technical aspects of valvular replacement with the St. Jude prosthesis.
Technical aspects for the implantation of the St. Jude Medical prosthesis are discussed. In our experience with 588 implants, the most important considerations are removal of residual calcium and preparation of annular and subvalvular areas, correct assessment of annular size, selection of proper prosthetic size, and placement of the sutures avoiding the use of pledgets on the ventricular side of the prosthesis. A special valve orientation is not needed in the great majority of patients, but necessary guidelines for individual patients were discussed. Using these technical guidelines, implantation of this prosthesis is simple, results in a low incidence of complications, and avoids damage to the prosthesis during implantation.
Heart Valve Prosthesis↗
The use of absorbable microfibrillation collagen to control sternal bone marrow bleeding.
Because of the fact that bone wax plays a significant role in delayed healing of the sternum an alternative technique for the control of sternal bone marrow bleeding has been devised. It consists of the application of fashioned strips of absorbable microfibrillar collagen to the cut surface of the sternal marrow after the sternum is divided and/or prior to its closure. This initial clinical experience has been excellent.
Absorption↗
Acquired left coronary artery to left atrium fistula: unusual complication of aortocoronary bypass.
This report describes a very unusual complication of aortocoronary bypass graft surgery. It consists of the formation of an acquired fistula between the left circumflex coronary artery and the left atrium in a patient who was operated two years prior to its clinical presentation. Significant coronary steal gave rise to disabling angina and prompted a second operation to close the fistula. The diagnosis was made with selective arteriogram that clearly delineated the fistulous tract and surgery was accomplished without extracorporeal circulation.
Coronary Angiography↗
Combined antiviral and immunoglobulin therapy as prophylaxis against cytomegalovirus infection after heart transplantation.
BACKGROUND: Cytomegalovirus is a frequent cause of infection and morbidity after heart transplantation, especially in patients treated with antilymphocytic drugs where the incidence may be as high as 50%. METHODS: To determine the efficacy of combined antiviral and intravenous immune globulin therapy for prevention of cytomegalovirus disease in transplant recipients receiving OKT3 and to compare two different antiviral drug regimens, we reviewed 115 transplant recipients from December 1988 to December 1993 who survived for more than 30 days. Of these, 29 received oral acyclovir for 3 months (group A) and 86 received intravenous ganciclovir for 2 weeks followed by oral acyclovir up to 3 months (group G); all received six infusions of 5% intravenous immune globulin over 2 months. All patients had OKT3 for 10 to 14 days and triple-drug immunosuppression. RESULTS: Cytomegalovirus disease (pneumonitis, gastroenteritis, or leukopenia with fever) occurred in 10% of patients (12 of 115 patients) and was confirmed by positive culture, typical microscopic inclusions, or polymerase chain reaction. In 91 seropositive recipients, there was a trend to less cytomegalovirus disease in group G (3.0%, 2 of 67 patients) than in group A (12.5%, 3 of 24 patients) (p = 0.11), which was more apparent in recipients with seropositive donors where the incidence was reduced from 16.7% (group A) to 2.4% (group G; p = 0.08). In 24 seronegative recipients, cytomegalovirus disease incidence was higher overall and not significantly less in group G (26%, 5 of 19 patients) than in group A (40%, two of five patients) (p = Not significant). CONCLUSIONS: Prophylaxis with combined antiviral and immune globulin therapy produces a low (10%) incidence of cytomegalovirus disease in OKT3-treated heart transplant recipients. In seropositive recipients treated with combined therapy, ganciclovir may be more effective than acyclovir. Larger trials and more aggressive prophylactic strategies are needed in seronegative patients who receive hearts from seropositive donors.
Acyclovir↗
Donors with a history of cocaine use: effect on survival and rejection frequency after heart transplantation.
The frequency of cocaine use among donors is currently unknown. Cocaine has cardiotoxic effects and could affect the outcome of heart transplantation. To examine the frequency of nonintravenous cocaine use in organ donors and the outcome of heart transplantation with such donors, we retrospectively analyzed the clinical, biopsy, and donor information on 112 consecutive patients who underwent transplantation between December 1988 and August 1993. Ten patients were excluded because of incomplete information regarding the donor's cocaine status. Of the remaining 102 patients, 16 (16%) had a positive donor history for nonintravenous cocaine use (cocaine group) and 86 patients (84%) had a negative history (noncocaine group). Survival, frequency of cellular rejection (grade > or = 1B), and humoral rejection were compared between the two groups. Survival rates at 30 days (100% versus 97% +/- 2%) and at 1 year (93 +/- 7% versus 89 +/- 3%) were similar (p = not significant, cocaine versus noncocaine group). Freedom from rejection was similar at 30 days (81% +/- 10% versus 79% +/- 4% cellular rejection-free, 33% +/- 14% versus 60% +/- 6% humoral-free) and 6 months (34% +/- 12% versus 55% +/- 5% cellular-free, 16% +/- 11% versus 36% +/- 6% humoral-free) (p = not significant). No significant difference was found in donor inotropic support before procurement, ischemic time, length of stay in intensive care unit, or total stay in the hospital. In conclusion, a high incidence of nonintravenous cocaine use exists among donors. The outcome of patients who receive transplanted hearts obtained from nonintravenous cocaine users is favorable, suggesting that the use of such hearts is safe.
Adult↗
Heart transplantation in corrected transposition of the great arteries.
Orthotopic heart transplantation was successfully performed in a patient with corrected transposition of the great arteries (L-type) who had end-stage cardiomyopathy. Technical modifications for the transplantation procedure were made accordingly. The cardiac allograft was implanted with an alternative technique consisting of bicaval and pulmonary venous anastomoses. Postoperative hemodynamics were normal, and the patient was well 9 months after transplantation.
Cardiac Catheterization↗
Serum cytokine levels in heart allograft recipients: correlation with findings on endomyocardial biopsy.
The ability to detect rejection of human cardiac allografts depends on endomyocardial biopsy diagnosis. Because cytokines are known to mediate allograft rejection events, we chose to examine serum levels of specific cytokines and receptors (interleukin-2 [IL-2], IL-2 receptor [IL-2R], and tumor necrosis factor alpha [TNF-alpha]) and to correlate those levels with findings on endomyocardial biopsy. Sequential sera samples from 23 cardiac allograft recipients were examined for the cytokine levels mentioned, and data correlated with findings on endomyocardial biopsy. Briefly, no statistically correlation of serum cytokine or receptor levels with the stage of allograft rejection was found. When sequential serum cytokine levels were determined in patients experiencing humoral and cellular allograft rejection events, the levels of TNF-alpha appeared to correlate well with endomyocardial biopsy findings. IL-2 and IL-2R levels in two patients who never experienced rejection were elevated on occasion, but TNF-alpha levels were always negative. In summary, measurement of serum cytokine (IL-2, IL-2R) levels in cardiac allograft recipients does not appear to correlate with findings on endomyocardial biopsy; however, elevated levels of TNF-alpha appear to predict more severe humoral allograft rejection episodes and may be helpful in this regard.
Adolescent↗
Pathogenesis of Quilty lesion in cardiac allografts: relationship to reduced endocardial cyclosporine A.
BACKGROUND: Endocardial lymphocytic infiltrates, known as Quilty effect, are a common finding of uncertain pathogenesis in cardiac allografts. Quilty effect was not observed before the use of cyclosporine A for immunosuppression and is not generally regarded as a manifestation of rejection. We hypothesized that the endocardial localization of Quilty effect may be related to a relative absence of cyclosporine A in this region. METHODS: We used an indirect immunofluorescence staining method with rabbit polyclonal anti-cyclosporine A antibodies to detect cyclosporine A in fresh frozen sections of 27 cardiac allograft endomyocardial biopsies. Staining was graded 0 to +3. Negative controls were from untreated transplant candidates and from biopsies with the primary antibody omitted. RESULTS: On comparison of endocardial and myocardial fluorescence in biopsy specimens from patients treated with cyclosporine A, there was less endocardial (0.7 +/- 1.1, p < 0.0001) than myocardial (2.2 +/- 0.5) staining. However, in biopsy specimens with Quilty effect (n = 12), this difference was significantly greater (endocardial = 0.2 +/- 0.6 versus myocardial = 2.3 +/- 0.5; p = 0.005) than in specimens without Quilty effect (n = 10) (endocardial = 1.4 +/- 1.2 versus myocardial = 2.1 +/- 0.6; p = 0.7). Endocardial thickness as measured by ocular micrometry was significantly greater in regions with (32 +/- 19 microns) than without (7 +/- 4 microns) Quilty effect, with involved regions showing increased connective tissue (p < 0.0001). In patients with and without Quilty effect, no differences in donor or recipient demographics, prevalence of diabetes, or plasma cyclosporine A levels were found. CONCLUSIONS: Although it has been postulated that Quilty effect is due to the presence of cyclosporine A in cardiac tissue (toxic effect or immunologic reaction), these data suggest that Quilty effect is related to reduced endocardial presence of cyclosporine A, leading to localized, contained, and usually not clinically significant endocardial rejection.
Adult↗