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D E Tolman

Publications and source records attributed to D E Tolman.

At least 19 recordsLinked to original sources
PubMed1999

A randomized, multicenter comparison of tacrolimus and cyclosporine immunosuppressive regimens in cardiac transplantation: decreased hyperlipidemia and hypertension with tacrolimus.

BACKGROUND: Tacrolimus-based immunosuppression seems safe and effective in liver and kidney transplantation. To assess the safety and efficacy of tacrolimus (TAC)-based immunosuppression after cardiac transplantation as well as the relative impact of tacrolimus on immunosuppression-related side effects such as hypertension and hyperlipidemia, we conducted a prospective, randomized, open-label, multicenter study of otherwise identical tacrolimus- and cyclosporine-based immunosuppressive regimens in adult patients undergoing cardiac transplantation. METHODS: Eighty-five adult patients (pts) at six United States cardiac transplant centers, undergoing their first cardiac transplant procedure, were prospectively randomized to receive either TAC-based (n = 39) or cyclosporine (CYA)-based (n = 46) immunosuppression. All pts received a triple-drug protocol with 15 pts (18%) receiving peri-operative OKT3 to delay TAC/CYA due to pre-transplant renal dysfunction. Endomyocardial biopsies were performed at Weeks 1, 2, 3, 4, 6, 8, 10, 12, 24, and 52. The study duration was 12 months. RESULTS: Patients were mostly male (87%) Caucasian (90%) with a mean age of 54 years and primary diagnoses of coronary artery disease (55%) and idiopathic dilated cardiomyopathy (41%). There were no significant demographic differences between groups. Patient and allograft survival were not different in the two groups. The probability and overall incidence of each grade of rejection, whether treated or not, and the types of treatment required did not differ between the groups. At baseline and through 12 months of follow-up, chemistry and hematology values were similar between the groups except serum cholesterol was higher in the CYA group at 3, 6, and 12 months (239 vs 205 mg/dL, 246 vs 191 mg/dL, 212 vs 186 mg/dL, respectively, p < 0.001). Likewise, LDL-cholesterol, HDL-cholesterol and triglycerides were significantly higher in the CYA group. More CYA patients received therapy for hypercholesterolemia (71% vs 41% at 12 months, p = 0.01). There were no significant differences in renal function, hyperglycemia, hypomagnesemia, or hyperkalemia during the first 12 months. More CYA patients developed new-onset hypertension requiring pharmacologic treatment (71% vs 48%, p = 0.05). The incidence of infection was the same for the two groups (2.6 episodes/pt/12 month follow-up). CONCLUSION: Tacrolimus-based immunosuppression seems effective for rejection prophylaxis during the first year after cardiac transplantation and is associated with less hypertension and hyperlipidemia and no difference in renal function, hyperglycemia or infection incidence when compared to cyclosporine-based immunosuppression.

Adult↗
PubMed1998

Fluoroscopy and selective angiography of left ventricular assist system inflow cannula as a method of detecting cannula entrapment.

Left ventricular assist systems have become an important tool as a bridge to cardiac transplantation. Malfunction of these devices often leads to clinical and hemodynamic deterioration. One potential complication is the obstruction of the inflow cannula secondary to remodeling of the left ventricular cavity. We report two cases where fluoroscopy and selective angiography were used to visualize the orientation and obstruction of the inflow cannula when echocardiographic findings were indeterminant.

Adult↗
PubMed1998

Reconstructing the human face by using the tissue-integrated prosthesis.

Reconstructing the human face with autogenous tissue is extremely difficult. A prosthetic device is often used, but retention is a problem. The tissue-integrated prosthesis has resolved this issue, however, and the technique is currently available worldwide. The tissue-integrated prosthesis--that is, a prosthesis supported (retained) by osseointegrated implants in the underlying bone--originated during the 1950s, when Brånemark began his laboratory studies of tissue healing in Sweden. The term "osseointegration" was introduced in 1977 and later was defined as "direct anchorage of an implant by the formation of bony tissue around the implant without the growth of fibrous tissue at the bone-implant interface." Early studies during the 1980s and 1990s documented the success of reconstruction of the human face with use of the tissue-integrated prosthesis. Herein we describe three cases in which this reconstructive procedure was successful.

Ear, External↗
PubMed1996

Endosseous implants in an irradiated tissue bed.

Endosseous implants have been placed at the Mayo Clinic Department of Dental Specialties for over 12 years. On the basis of the clinical success of the osseointegration program, the use of implants has been expanded to include placement into tissue beds that have been exposed to therapeutic radiation. This article details preliminary data regarding implant survival in the previously radiated tissue beds. Presurgical evaluation and surgical technique are described and postprosthetic reconstruction complications are also related. Consideration is given to the relatively small number of patients in this review. It is suggested that the results should be shared among multiple institutions to create a meaningful data bank.

Dental Implantation, Endosseous↗
PubMed1996

Disproportionate HLA matching may contribute to racial disparity in patient survival following cardiac transplantation.

The purpose of this study is to investigate the impact of recipient race as well as HLA matching upon long-term survival following heart transplantation (HTx). The study also determines whether the degree of HLA matching between Caucasians and African Americans differs. This study was a retrospective analysis of 336 males (77% Caucasians and 23% African Americans) transplanted between 1983 and 1994, all having received cyclosporine-based immunosuppression. The results showed African Americans were transplanted at a significantly younger age than Caucasians (39.1 +/- 11.2 vs. 48.2 +/- 10 yr). The composition of end stage cardiac disease was startlingly different. Caucasians demonstrated 62% CAD, 31% IDCM and 7% other, whereas African Americans exhibited 24% CAD, 69% IDCM and 7% other. The ten-year survival rate for African American male recipients was inferior to Caucasian males. Survival at 1, 3, 5, 7 and 9 yr was 83%, 73%, 63%, 51%, 46% for Caucasians and 70%, 58%, 51%, 38% and 32% for African Americans. Furthermore, African Americans received more poorly matched organs compared to Caucasians. Among Caucasians for Class I, 46%, 53% and 1% received poor, moderate and well matched hearts, respectively. In contrast, African American were allocated 65%, 33% and 0% of poor, moderate, or well matched hearts. An analysis of Class II data revealed the same pattern (63%, 35% 2% of Caucasians and 78%, 18%, and 4% of African Americans received poor, moderate or well matched hearts). Survival for Caucasians improved when moderately versus poorly matched for Class I. Class II matching did not have an effect. African Americans showed a similar trend, although statistical significance was not reached. When comparing equivalent degrees of matching, African Americans had inferior survival rate when poorly matched for Class I relative to Caucasians. No statistical difference was observed for moderate matched Class I or for Class II analysis.

Actuarial Analysis↗
PubMed1994

Maxillary antral and nasal one-stage inlay composite bone graft: preliminary report on 30 recipient sites.

A one-stage antral and nasal inlay composite bone grafting procedure is described. Preliminary statistical data (1 to 6 years experience with the procedure) is presented for 30 recipient sites in 20 patients. A complete bone-supported fixed prosthesis was used and has provided continuous function in all patients to date. Implant survival has approached that of implants placed in uncompromised maxillary or mandibular bone.

Bone Transplantation↗
PubMed1993

Tissue-integrated dental prostheses: the first 78 months of experience at the Mayo Clinic.

During a 78-month period at the Mayo Clinic, 1,778 Brånemark endosseous dental implants were placed in the edentulous or partially edentulous jaws of 353 consecutive patients who ranged in age from 8 to 82 years. The largest treatment category involved edentulous mandibles, which accounted for 53% of the total restorations. Approximately 76% of the threaded cylindrical implants supported 312 oral prostheses at the end of the study period. The implant survival rate was 97.8% in the mandible and 88.8% in the maxilla. Complications associated with this treatment included loss of implant anchorage in bone, soft tissue problems, and mechanical difficulties related to design and function of the prostheses. All complications were managed without loss of continuous function of the prostheses, except in four patients who resumed wearing a conventional removable maxillary complete denture. This experience demonstrates that Brånemark endosseous dental implants are predictable and can provide lasting integration under function when placed and loaded in accordance with the recommended protocol.

Adolescent↗
PubMed1993

The applicability of osseointegrated implants in the treatment of partially edentulous patients: three-year results of a prospective multicenter study.

Nine clinical centers using the Brånemark System participated in a prospective study of 159 partially edentulous patients between 18 and 70 years of age. Clinical parameters evaluated were Plaque Index, gingivitis, pocket depth, Bleeding Index, tooth mobility, prosthesis stability, and stomatognathic function. Change in bone height around fixtures was measured radiographically. After 3 years, 460 loaded fixtures, supporting 174 prostheses in 139 patients, remain in the study. The complications, failures, and technical problems are presented. After 3 years of this 5-year study, results suggest that implant-based treatment of partially edentulous patients may achieve a success rate comparable to that obtained in edentulous patients.

Adolescent↗
PubMed1992

Tissue-integrated prosthesis complications.

Over a 78-month period from 1983 to 1990 at the Mayo Clinic, 353 patients involving 407 jaws were restored with 1,778 Brånemark system implants supporting prostheses. Complications involved loss of implant anchorage, soft tissue problems, or mechanical problems. The most predominant complication involved soft tissues. There were 152 patients with loaded prostheses who had no complications and 37 with only one occurrence. Those seen in 160 patients with more than one occurrence were all conservatively managed, so that prosthesis use was only permanently discontinued in 4 patients, who returned to the use of a maxillary complete denture.

Adolescent↗
PubMed1992

Mandibular ridge augmentation with simultaneous onlay iliac bone graft and endosseous implants: a preliminary report.

Mandibular onlay composite grafts (autogenous iliac bone and titanium cylindrical threaded endosseous dental implants) were placed in seven patients with advanced bone resorption. All seven patients have experienced uncomplicated healing and continuous, uninterrupted prosthesis use without soft tissue or mechanical complications for 1 to 4 years. This preliminary report includes a discussion of the indications for the procedure, potential alternative management of the severely resorbed mandible, and details of the surgical procedure illustrated by two patients who received this treatment modality.

Alveolar Bone Loss↗
PubMed1991

Extraoral application of osseointegrated implants.

The use of osseointegrated implants to provide support for craniofacial prostheses has provided the clinician with another approach to the treatment of complex craniofacial reconstructive problems. The surgical technique is reviewed and the Mayo Clinic experience is presented.

Adhesives↗
PubMed1991

Management of mandibular fractures in patients with endosseous implants.

Seven patients who had previously received mandibular endosseous implants sustained mandibular fractures and were treated. Three patients had advanced bone resorption and developed stress fractures through previous endosseous implant sites. Two patients sustained fractures through implant sites via trauma. Two patients sustained fractures anatomically separated from the implants, which caused an alteration in the dental occlusion. This report describes the treatment approach for these seven patients and reviews the treatment philosophy and procedures involved. A conservative treatment approach is advised when the fracture transverses through a stable or a recently failed implant site.

Accidental Falls↗
PubMed1991

Endosseous implant placement immediately following dental extraction and alveoloplasty: preliminary report with 6-year follow-up.

The philosophy of retaining natural teeth as long as possible for the preservation of alveolar bone has been a fundamental concept of dental treatment. With the introduction of predictable osseointegrated implant-supported prostheses, placement of an implant immediately after dental extraction can be considered. This paper discusses the technique of implant placement immediately following dental extraction. Clinical experience including 61 patients with follow-up of 1 to 6 years is reported.

Alveolar Bone Loss↗
PubMed1986

Dental implants: tissue-integrated prosthesis utilizing the osseointegration concept.

As an alternative to conventional removable dentures, osseointegrated dental implants can now be used in carefully selected edentulous or partially edentulous patients. The implant consists of a dental prosthesis and an anchorage unit made up of screw-connected components. The implantation procedure is performed in two phases: fixture installation and fixture uncovering and abutment connection. After completion of these surgical procedures, the dental prosthesis is fabricated and inserted. Follow-up examinations are scheduled at 1, 3, and 6 months and then annually thereafter. During a 2-year period at the Mayo Clinic, 358 osseointegrated dental fixtures were implanted in 70 patients. The overall success rate in this consecutive series of patients was 98%, and the associated complications were minimal and easily resolved.

Aged↗