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PubMedDate not supplied

Grade 2 cellular heart rejection: does it exist?

According to the International Society for Heart and Lung Transplantation, a single focus of lymphocytic infiltration associated with myocyte injury in a cardiac allograft endomyocardial biopsy is focal moderate cellular rejection (Grade 2). We reviewed 115 endomyocardial biopsy specimens that were completely negative (n = 17), had a Quilty A (n = 17) or Quilty B (n = 46) lesion, or had a lesion fulfilling the criteria of grade 2 rejection (n = 35). By studying step sections (mean = 18) or sections stained for elastic tissue and collagen, we showed continuity of the focus of grade 2 rejection with the endocardium in 32 of 35 cases; these results justify reclassification of these foci as Quilty B lesions, which are defined as endocardial infiltrates that encroach on the underlying myocardium and that may be associated with myocyte injury but are not generally considered to represent acute rejection. Immunohistochemical staining for T and B lymphocytes and histiocytes showed similar patterns in deeper zones of Quilty B lesions and lesions initially regarded as grade 2 rejection. Normal hemodynamics were observed with 16 of 17 completely negative biopsy specimens, 16 of 17 Quilty A biopsy specimens, 46 of 46 Quilty B biopsy specimens, and 35 of 35 grade 2 rejection biopsy specimens. No grade 2 rejection was treated; only 1 biopsy specimen progressed to grade 3A rejection in a subsequent biopsy 2 months later. Most, if not all, cases of grade 2 cellular rejection can be shown to be Quilty B lesions, are not associated with hemodynamic abnormalities, and do not require augmented immunosuppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Influence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spine surgery.

BACKGROUND AND OBJECTIVES: Although the majority of elective lumbar spine surgical procedures are performed under general anesthesia, successful use of spinal and epidural anesthesia has been reported. This study was designed to evaluate the influence of baricity on the performance of spinal anesthesia for lumbar spine surgery. METHODS: The study was performed on 53 demographically similar American Society of Anesthesiologists status 1 and 2 patients who were randomly assigned to receive spinal anesthesia with 15 mg of bupivacaine along with 0.2 mg of epinephrine as either 3 ml 0.5% plain bupivacaine (I group) or 2 ml 0.75% bupivacaine (Sensorcaine Spinal, Astra, Westborough, MA) premixed in 8.25% glucose (H group). All blocks were placed with a 22-gauge Quincke needle (Becton Dickinson, Franklin Lakes, NJ) at the L3-L4 interspace with the patient in the sitting position. Subsequent data, collected by a blinded observer, included onset of motor and sensory anesthesia, highest sensory level achieved, maximum changes in heart rate and blood pressure, need for treatment of heart rate or blood pressure decreases, failed blocks, and need for supplemental local anesthetic injection to complete incision or wound closure. RESULTS: The time to onset for complete motor and sensory block was significantly longer in the I group. The maximum sensory level achieved was higher in the H group, and the maximum drop in blood pressure and number of interventions to treat heart rate and blood pressure were greater in the H group. There were two failed blocks, which were repeated successfully, in the H group. The need for local anesthetic infiltration of the wound with incision and closure was greater in the H group. CONCLUSIONS: Plain bupivacaine is superior to hyperbaric bupivacaine for spinal anesthesia for elective lumbar spine surgery.

Adult↗