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Biomedical subjects

D Lepley

Publications and source records attributed to D Lepley.

At least 19 recordsLinked to original sources
PubMed2007

Subclinical acute antibody-mediated rejection in positive crossmatch renal allografts.

Subclinical antibody-mediated rejection (AMR) has been described in renal allograft recipients with stable serum creatinine (SCr), however whether this leads to development of chronic allograft nephropathy (CAN) remains unknown. We retrospectively reviewed data from 83 patients who received HLA-incompatible renal allografts following desensitization to remove donor-specific antibodies (DSA). Ten patients had an allograft biopsy showing subclinical AMR [stable SCr, neutrophil margination in peritubular capillaries (PTC), diffuse PTC C4d, positive DSA] during the first year post-transplantation; 3 patients were treated with plasmapheresis and intravenous immunoglobulin. Three patients had a subsequent rise in SCr and an associated biopsy with AMR; 5 others showed diagnostic or possible subclinical AMR on a later protocol biopsy. One graft was lost, while remaining patients have normal or mildly elevated SCr 8-45 months post-transplantation. However, the mean increase in CAN score (cg + ci + ct + cv) from those biopsies showing subclinical AMR to follow-up biopsies 335 +/- 248 (SD) days later was significantly greater (3.5 +/- 2.5 versus 1.0 +/- 2.0, p = 0.01) than that in 24 recipients of HLA-incompatible grafts with no AMR over a similar interval (360 +/- 117 days), suggesting that subclinical AMR may contribute to development of CAN.

Adult↗
PubMed1996

Diet intervention for modifying cancer risk.

Considerable evidence suggests that dietary differences between populations account for a significant proportion of the variation in cancer occurrence in different parts of the world. A major problem has been identifying the particular dietary components which predispose or protect individuals against cancer. For example, the high rates of breast and colon cancer in the United States have been associated with numerous dietary patterns including high fat, high dietary energy, and low fruit and vegetable intakes. Our laboratories have attempted to identify mechanisms whereby diet may modify cancer and it is anticipated that future studies will determine which of these potential mechanisms may be relevant in humans. A promising lead in understanding the mechanism of high dietary fat/high dietary energy promotion of cancer was the impact of these diets on cellular protein kinase C (PKC). PKC is important in cellular signaling events which are critical to tumor promotion. Our studies demonstrated increased PKC activity and/or protein expression observed in epidermis and pancreatic epithelial cells of rodents fed high fat/energy diets. The inverse association between cancer at a number of sites and fruit and vegetable intake may be due to both micronutrient and non-nutrient components of fruits and vegetables. We have studied the prevention of skin tumor promotion by apigenin, a plant flavonoid. Apigenin may block several points in the process of tumor promotion, including inhibiting kinases, reducing transcription factors and regulating cell cycle. The complexity of our diets and the multitude of potential dietary effects which may be important in cancer development make this a fertile area for future study.

Anticarcinogenic Agents↗
PubMed1981

Ten-year follow-up in aortic valve replacement using the Björk-Shiley prosthesis.

An in-depth statistical analysis of early and late results of aortic valve replacement using the Björk-Shiley tilting-disc prosthesis is presented. Our experience with this prosthesis indicates that replacement carries a low surgical risk, a low incidence of complications (embolization, infection, or hemorrhage due to long-term use of anticoagulants), and good long-term survival. Coexisting coronary artery disease increases surgical mortality significantly, and simultaneous, complete revascularization is essential. Patients undergoing isolated aortic valve replacement did significantly better than those requiring other simultaneous procedures or those who had had previous operations. Earlier operation is imperative since progress of aortic valve disease is unpredictable by duration of symptoms, and patients in New York Heart Association Functional Class II have a low surgical risk and a greatly increased survival. It would appear from this study that additional criteria, such as increasing ventricular dilatation and hypertrophy determined by echocardiographic studies and gated nuclear studies showing deterioration of ejection fraction on exercise, should be used to help determine time of surgical intervention rather than symptomatology alone.

Adult↗
PubMed1981

Left ventricular myotomy. Physiologic approach to surgical therapy for IHSS.

Twenty patients were operated on for idiopathic hypertrophic subaortic stenosis (IHSS) between 1966 and 1980. All were in New York Heart Association functional class 3 or 4, and 17 had overt congestive failure. The mean resting gradient across the left ventricular (LV) outflow tract preoperatively was 78 mm Hg. Seventeen patients underwent transaortic LV myotomy, one had mitral valve replacement (MVR), and two patients with rheumatic mitral insufficiency (MI) and IHSS underwent myotomy and MVR. There was one operative death (5 percent). Mean follow-up was 5.8 years. Eighteen of 19 survivors were improved to class 1 or 2. One patient whose gradient and symptoms were not relieved by myotomy was improved by myectomy and MVR. The MI was abolished or reduced by myotomy in ten of 13 patients. There were six late deaths, five of which are known or assumed to be cardiac related. We concluded that LV myotomy is a safe and effective technique for surgical management of IHSS. Left ventricular myectomy, MVR, or both are indicated in selected cases.

Adolescent↗
PubMed1980

Management of long-standing cardiocutaneous fistulas after resection of left ventricular aneurysms.

Cardiocutaneous fistulas arising from pledgets used in the closure of resected left ventricular aneurysms are rare but have serious implications. The case histories of four patients, each managed in a somewhat different manner, are presented. From this experience we recommend an aggressive approach to remove the infected pledgets once scar formation is complete and before erosion of the pledgets into the left ventricular cavity can occur.

Adult↗
PubMed1979

A comparative synchronous coronary surgery survival study.

Utilizing patient criteria published by the Veterans Administration Cooperative (VAC) Study, a cohort of 229 surgically treated patients was retrieved from the Milwaukee Cardiovascular Data Registry. These patients were all operated on by one surgeon during 1972 to 1974. Four-year survival of this group was compared with that of the medically treated cohort of 310 patients from the VAC Study. Operative mortality was included in all surgical groups. The cumulative 4-year survival of both groups revealed a 95 to 85% advantage for surgical therapy. In patients with three-vessel disease, the cumulative survival favored surgical therapy--94% compared with 80% in the medically terated cohort--and in patients with triple-vessel disease and a normal left ventricle, surgical therapy again showed better results: 100% compared with 88%. Patients with two-vessel disease and a normal left ventricle who underwent surgical intervention had slightly better 4-year survival than those who had medical treatment--100% versus 95%--and those with two-vessel disease and an abnormal left ventricle had a 93% survival after surgical treatment compared with 84% for those with medical treatment. For patients with single-vessel disease, there was no difference in survival between the surgical and medical cohorts.

Adult↗
PubMed1979

The spectrum of clinical manifestation of anomalous origin of the left coronary artery and surgical management.

Intercoronary collaterals play a major role in determining whether patients with the symptoms of anomalous left coronary artery will suffer infarction early in life with resultant complications or will survive to an older age before becoming symptomatic with angina. We believe that the definitive surgical treatment should be performed at the earliest age possible to avoid further damage to myocardial muscle.

Angina Pectoris↗
PubMed1978

Selection of patients for coronary bypass surgery.

We have tried to present a rational approach to selection of patients for coronary bypass surgery. An evaluation of both the anatomic and the clinical status of a patient in whom coronary arteriography has been performed, along with consideration of known results of medical and surgical forms of treatment of coronary artery disease in large series, determines which therapy is preferable. In all instances, the goal of treatment is threefold: relief of pain, preservation of myocardium and prolongation of life. In properly selected patients, pain can be relieved by surgery 90% of the time. Preservation of myocardium is a reality in some groups of patients treated surgically. Current data indicate that prolongation of life by coronary bypass surgery occurs in patients with left main coronary or triple-vessel disease, and as more data are collected, other subgroups may be included.

Coronary Artery Bypass↗
PubMed1978

Effect of intra-aortic balloon pumping on nutrient coronary flow in normal and ischemic myocardium.

The effects of intra-aortic balloon pumping (IABP) on myocardial flow distribution were studied in 50 dogs. Cardiac output was controlled by right heart bypass. In each dog the following parameters were measured with and without IABP during normal coronary perfusion and after regional ischemia was induced by anterior descending coronary vein flow by timed collection, and endocardial/epicardial flow ratios by a previously reported thermal washout technique. In nonischemic myocardium, IABP significantly (p less than 0.05) increased mean coronary sinus flow 11.5 percent +/- 5.8 percent (S.D.) and the mean endocardial/epicardial ratio, 17.3 percent +/- 0.28 percent. In the regionally ischemic myocardium, IABP significantly (p less than 0.05) increased mean segmental coronary vein flow 13.9 percent +/- 1.23 percent but decreased the endocardial/epicardial ratio 29.9 percent +/- 1.1 percent. We conclude that in the dog, IABP enhances subendocardial blood flow in perfused but not in ischemic myocardium. Contrary to common suppositions, the increase in collateral blood flow with IABP preferentially supplies epicardial layers in segmental ischemic zones, but may be shunted from the subendocardium.

Animals↗
PubMed1977

Late evaluation of patients undergoing valve replacement with the Björk-Shiley prosthesis.

This study analyzes 484 patients who survived mitral, aortic, or mitral and aortic valve replacement using the Björk-Shiley prosthesis from January, 1970, through December 31, 1974. Long-term follow-up of 1 1/2 to 6 1/2 years (mean, 3.67 yr) was done on 435 patients (98.2%). Eighty to 85% of the patients have improved noticeably. Thromboembolic problems occurred in 6.9%, representing 1.5 emboli per 1,000 patient-months. Anticoagulant bleeding problems occurred in 6.4% of the patients; late mortality was 15%. Actuarial survival curves showed patients at risk to 6 years having a 79% chance of survival. The same analysis according to preoperative New York Heart Association Functional Classification showed a striking reduction in survival in class IV patients. The Björk-Shiley prosthesis is a good choice for valve replacement today. Earlier diagnosis and treatment are needed to obtain better long-term survival.

Adolescent↗
PubMed1977

Prognostic considerations in the management of left ventricular aneurysms.

This report summarizes a four-year experience with 60 patients who had left ventricular aneurysm (LVA) resection and bypass of all significantly diseased coronary arteries, with an operative and late mortality of 3.3 and 8.3%, respectively. Their cardiac catheterizations were reviewed, and the only values that seemed to reflect prognosis were preoperative cardiac index and the presence of absence of septal motion. The lower the cardiac index, the less likely the patient was to do well postoperatively. There were now survivors who had lacked septal motion by left anterior oblique ventriculogram. Patients without septal motion are therefore no longer considered surgical candidates. If septal motion is present, resection of LVA carries no more risk than myocardial revascularization without LVA.

Adult↗
PubMed1977

Coronary artery surgery without global ischemia.

A simple technique for local occlusion of the coronary artery without aortic cross-clamping during the distal anastomosis has been developed. The use of this internal coronary artery occluder, which we developed, represents another step forward in myocardial protection during coronary bypass procedures.

Coronary Artery Bypass↗
PubMed1976

Atherosclerosis of the internal mammary artery.

To better evaluate the incidence of atherosclerosis in the internal mammary artery (IMA), 215 IMA segments from routine postmortem examinations were evaluated microscopically. Significant atherosclerotic narrowing was seen in 9 patients (4.2%). No patient had more than a 50% reduction in lumen diameter. The degree of incipient atherosclerosis correlated well with age, hypertension, diabetes, and peripheral vascular disease.

Adult↗