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Biomedical subjects

D K Cooper

Publications and source records attributed to D K Cooper.

At least 289 records · Page 16Linked to original sources
PubMed1980

Long-term survival after orthotopic and heterotopic cardiac transplantation.

Five long-term survivors of heart transplantation were reinvestigated. Two patients had undergone orthotopic heart transplantation over 11 and 9 years earlier and constitute two of the world's longest-surviving patients after this procedure. Three patients had undergone heterotopic heart transplantation (one left heart bypass alone and two biventricular bypass) four to six years earlier. Four of the five patients had had only one or no documented acute rejection episodes. Three had been given blood transfusions. None had had particularly good tissue matching in relation to the donor on HLA typing. All five patients were leading full and active lives. At review two patients had significant coronary artery disease, one severe, presumably due to chronic immune-complex deposition. Heart transplantation remains a major undertaking, but it can offer the patient many years of good-quality life.

Adult↗
PubMed1980

Recent experience with heart transplantation.

The major factors contributing to the recommencement of clinical heart transplantation in the United Kingdom last year were the steadily improving results from Stanford University, the clarification of the diagnosis of brain death, and advances in preserving donor hearts. Twelve men aged 16 to 52 years received heart transplants at Papworth Hospital from January 1979 to July 1980. Six had cardiomyopathies and six ischaemic heart disease. The donors were aged 16 to 35 (mean 21) years. A combination of road and air transport was used to transport the heart to Papworth in seven cases. The total donor heart ischaemic time ranged from 108 to 171 minutes (mean 151), and early graft function was satisfactory in all cases. Postoperative management was directed towards preventing rejection and infection. Equine antihuman thymocyte globulin, prednisolone, and azathioprine were used for immunosuppression. Endomyocardial biopsy was performed every 10 to 14 days during the early postoperative period. There were three deaths: one at 17 days from brain damage and two at 59 and 76 days from rejection. Of the remaining nine patients six left hospital and three returned to work. The number of patients who might benefit from heart transplantation is large, but the cost is high. The cost would fall if an effective non-toxic immunosuppressive agent were developed. Meanwhile, a careful evaluation of the benefits of heart transplantation should continue.

Adolescent↗
PubMed1979

The surgical management of malignant tumours of the oesophagus and cardia: a review of the results in 292 patients treated over a 15-year period (1961--75).

Of 292 patients, excision of the tumour with replacement by stomach or jejunum was carried out in 216 in whom the lesion was considered operable on both technical and general grounds, intubation was performed in 45 and the remaining 31 were managed without operation. Of the 216 in whom resection was performed, only 20 per cent were free from local spread, lymph node involvement or secondary deposits at the time of operation. Hospital mortality was 18 per cent and did not significantly differ between one 5-year period and another. Survival at 1 year was 54 per cent, at 2 years 25 per cent and at 5 years 14 per cent. The average length of survival following intubation was 2.6 months and following non-operative management 2.8 months. The poor average survival of between 3.5 and 5 months obtained in those patients with secondary deposits at the time of resection suggests that resection is of questionable value in this group. There was a marked difference in survival following Roux loop procedures compared with upper partial gastrectomy for tumours of the lower third and cardia in patients without lymph node involvement or secondary deposits, strongly suggesting that upper partial gastrectomy, although a rather simpler and quicker operation, is not the operation of choice in these patients. On 31 December 1976, after a minimum follow-up of 1 year, there were only 22 patients still alive of the original 292 (7.5 per cent).

Adult↗
PubMed1979

Factors contributing to the mortality associated with open-heart surgery in infants.

About 40% of children born with congenital heart disease die within the first year of life unless treated surgically. The results of surgery have improved with increasing experience. Currently, the mortality rate of open-heart procedures performed during the first year of life have decreased to about 25%. The present study analyses the causes of death in 53 infants who underwent open heart surgery at the Hospital for Sick Children, Great Ormond Street, London between 1973--1977. Fifty-three deaths represented 25% of the total 212 operated infants. Causes of death and possible contributing factors are discussed under the following headings: Inoperable lesions (18), poor preoperative condition (8), mistake in pre-, intra- and postoperative management (15), infection (2) and unclear (10). It is suggested that earlier diagnosis and operation may improve the results. The purpose of this study was to identify problems in the management of critically ill infants with congenital heart disease and thus improve their prognosis in future.

Age Factors↗
PubMed1978

Collagen diseases as a cause of constrictive pericarditis.

Seven patients with constrictive pericarditis associated with collagen disease underwent pericardiectomy with good results in all but one. The collagen disease was confirmed as rheumatoid arthritis in five patients, but in two its nature remained obscure. In one case the illness was marked by a persistent eosinophilia and eosinophilic infiltration of the pericardium. The association of constrictive pericarditis with rheumatoid arthritis and other collagenoses is briefly discussed.

Adolescent↗
PubMed1977

The Haematoxylin-basic Fuchsin-picric acid staining reaction as a test of myocardial viability in resuscitated and preserved hearts.

In the field of the transplantation of organs, there is a great need for an in vitro test of viability which would confirm that the organ was capable of performing its normal in vivo functions. Such a test should ideally be simple, rapid and reproducible. Preliminary studies using the Haematoxylin-Basic Fuchsin-picric acid (HBFP) staining reaction to assess myocardial ischaemia in resuscitated and preserved hearts would suggest that this test meets many of the requirements of a viablility assay. The test has been employed in hearts which have been in a state of anoxic arrest for 30 min and then resuscitated and preserved as an autoperfusing heart-lung preparation. The 'positive' response after 30 min anoxic arrest reverts to a 'negative' response after 2 h myocardial perfusion. In hearts which have been preserved as an autoperfusing heart-lung preparation with no interim period of anoxic arrest the HBFP stain response remains 'negative' throughout, confirming satisfactory myocardial perfusion.

Animals↗
PubMed1976

Acute massive mitral regurgitation from prosthetic valve dysfunction.

Two cases of prosthetic valve dysfunction resulting in acute massive mitral regurgitation are reported; emergency operation was successful in both cases. Survival following complete dislodgement of the occluder of a disc valve, as occurred in one case, does not appear to have been reported before. The diffculty in diagnosis of sudden cardiac decompensation in patients with prosthetic valves is stressed, as is the need for urgent operation.

Adult↗
PubMed1976

Conservative surgery for bronchial adenomata.

Fifteen patients with bronchial adenomata have undergone surgical treatment and have been followed up for periods of one to 25 years. Management consisted of bronchotomy with local excision in six cases, segmental resection in two, lobectomy in six, and pneumonectomy in one case. One patient who underwent lobectomy subsequently died of an unrelated cause (gastric haemorrhage) in the early postoperative period; of the remaining 14, there have been no cases of recurrence, and all patients have remained sympton-free with normal chest radiographs. These results strongly support a conservative surgical approach where the clinical and histological diagnosis of carcinoid tumour is definite.

Adenoma↗
PubMed1975

Haemodynamic studies during short-term preservation of the autoperfusing heart-lung preparation.

Preservation of the donor heart in a viable state for even a few hours would greatly facilitate clinical cardiac transplantation. The autoperfusing heart-lung preparation has been investigated for periods of 2 to 6 has a means of short-term preservation of the heart. Its functional capability has been assessed by observations of a number of haemodynamic parameters, including those parameters believed to give an indication of the state of myocardial contractility. Although conversion of the normal circulation to that of the preparation was accompanied by considerable falls in max dP/dt and its derivative max dP/dt/P, there was a subsequent stabilization or improvement in these parameters during the period of autoperfusion. Haematoxylin-basic fuchsin-picric acid staining of the myocardium showed no evidence of myocardial ischaemia during the perfusion period. These observations, together with other haemodynamic and histological observations, suggested that myocardial perfusion by this technique was satisfactory. The effects of a coronary dilator such as dipyridamole have been observed, and its value in approximating the coronary and pulmonary blood flows in such a preparation is discussed. These studies would suggest that the autoperfusing heart-lung preparation can provide a simple and satisfactory form of short-term storage of the heart and, with further experience, may prove of value in clinical cardiac transplantation.

Animals↗
PubMed1975

Donor heart resuscitation and storage.

At the present time, simple hypothermia or regional or total body perfusion probably afford the best means of myocardial protection of the donor heart. However, the potential of either technique is extremely limited, and a combination of hypothermia with some form of perfusion system will probably enable considerably longer periods of storage of the donor organ. Such a perfusion system has not yet been conclusively developed, though considerable advances have been made. It is doubtful whether or not the addition of hyperbaric oxygen to hypothermia greatly prolongs the storage period. Metabolic inhibition by a chemical agent is an attractive method of preservation, possibly associated with hypothermia, but the search for the perfect agent continues. Actual freezing of the organ may prove feasible in the future, but recent work in the field of cryobiology has proved almost uniformly disappointing. The use of the autoperfusing heart-lung preparation as a short term storage system deserves further study, but its value as a really long term system of storage of the heart seems unlikely at the present time. Xenobanking has been encouragingly successful in experimental situations, but its clinical application will prove to be expensive and difficult.

Animals↗
PubMed1975

A simple method of resuscitation and short-term preservation of the canine cadaver heart.

A simple technique of resuscitation of the canine cadaver heart is described. The method includes internal manual cardiac massage and positive-pressure ventilation of the lungs after isolation of the heart-lung preparation from the rest of the systemic circulation. This techniqle proved successful in 20 of 25 cases after periods of anoxic cardiac arrest ranging from 15 to 128 minutes (average 35 minutes). An evaluation of the state of the myocardium in the postresuscitation period was made by a number of hemodynamic, electrocardiographic, blood chemistry, and histopathological observations, with particular note being taken of those relating to left ventricular contractility and to hematoxylin-basic fuchsin-picric acid (HBFP) staining.

Animals↗