Biomedical subjects

H Shennib

Publications and source records attributed to H Shennib.

95 records · Page 6Linked to original sources

PubMedDate not supplied

Diltiazem improves cyclosporine dosage in cystic fibrosis lung transplant recipients.

Maintenance of therapeutic blood levels of cyclosporine in lung transplant patients with cystic fibrosis can be challenging. In addition, total daily dosage can be high when compared with patients who do not have cystic fibrosis. We report the advantage of adding diltiazem to decrease the cyclosporine dosage and maintain adequate therapeutic levels. Diltiazem 60 mg twice daily was initiated in four patients with cystic fibrosis and in four patients who did not have cystic fibrosis. In patients with cystic fibrosis, mean dosage and mean diltiazem efficacy ratio (dose milligrams per kilograms per day/cyclosporine blood level) were significantly reduced. Dosage was reduced from 13.9 +/- 8 to 8.1 +/- 2.6 mg/kg mean +/- standard deviation). The latter was similar to patients who do not have cystic fibrosis (6.5 +/- 1.8 mg/kg). Diltiazem efficacy ratio was reduced from 85 +/- 22 to 27 +/- 4. In patients who did not have cystic fibrosis, the ratio was significantly reduced from 42 +/- 13 to 19 +/- 3. Resting blood pressure, pulse, and serum creatinine levels remained normal or normalized. Although cyclosporine dosage was not significantly reduced by adding diltiazem in patients who did have cystic fibrosis, adequate cyclosporine blood levels were achieved. We conclude that the addition of diltiazem can be useful in the maintenance of adequate cyclosporine therapy in lung transplant recipients who do or who do not have cystic fibrosis.

Adolescent↗

PubMedDate not supplied

Efficacy of OKT3 therapy for acute rejection in isolated lung transplantation.

The purpose of this study was to evaluate the efficacy of muromonal-CD3 (Orthoclone OKT3) in the treatment of acute lung rejection. Criteria for its administration were (1) steroid-resistant acute rejection, (2) first-line therapy for grade III or higher acute rejection, and (3) second relapse after tapering off steroid treatment of acute rejection. During the period between May 1990 and May 1992, 41 patients had a total of 101 episodes of acute rejection. OKT3 (5 mg/kg for 7 to 10 days) was administered to 28 patients, of whom 19 responded (68%). Nine patients had either nonresponsive episodes or relapses immediately after completion of OKT3 therapy. Age, gender, cytomegalovirus status, underlying diseases, and type of procedure did not influence the outcome. Timing of OKT3 administration, however, was important; 16 (89%) of 18 patients responded to OKT3 therapy when administered during the first 6 months after transplantation, whereas 3 (30%) of 10 patients responded only beyond 6 months (p < 0.01). Infectious complications occurred after six treatments (21%), in which high-dose steroids were used concurrently (three Aspergillus, two Pseudomonas, and one cytomegalovirus pneumonia). Two patients also taking high-dose steroids had lymphoproliferative disorders. Three allergic reactions developed: one case of edema, one case of hypotension, and one case of arthralgia-myalgia syndrome. Serum antibody titers against OKT3 were persistently negative despite repeat (up to four times) therapy. We conclude that OKT3 is an effective and relatively safe therapy for steroid-resistant, high-grade, or relapsing acute lung rejection during the first 6 months. Antimicrobial prophylaxis must be considered when OKT3 is administered.

Acute Disease↗

PubMedDate not supplied

Staple pneumoreduction with fibrin sealant application: a reliable method of transplanting oversized lungs.

Transplantation of a large lung allograft into a small chest could lead to atelectasis and hemodynamic instability. We developed a technique by which larger-sized lungs could be reduced to fit into smaller recipients. This entails multiple applications of a stapler device to progressively remove excessive lung tissue until the lung fits adequately into the recipient's chest cavity. An experimental animal model was used to test the applicability and safety of this technique. Because air leak from the resected margins was anticipated, we further examined the feasibility of reducing the latter by application of fibrin glue. Eight small mongrel dogs (20 to 25 kg) received left lung allotransplants from eight larger-sized dogs (35 to 40 kg) with the staple pneumoreduction technique. This group was further stratified to receive (group 1A; n = 4) or not receive application of fibrin sealant (group 1B; n = 4) to the stapled resection margins. Group 2 received lungs from similar-sized animals (20 to 25 kg; n = 4 each). Group 3 consisted of size-mismatched animals without pneumoreduction (n = 2). Recipient dogs were compared for facility of chest closure, gas exchange, and hemodynamic stability. The ability of the newly implanted lung to support respiratory function was also assessed by ligation of the opposite pulmonary artery at 4 hours. No difference was noted between groups 1 and 2 in terms of these variables. In sharp contrast, group 3 animals showed a rapid and profound drop in blood pressure after chest closure.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗

PubMedDate not supplied

Exercise performance after lung transplantation.

Heart-lung, double lung, and single lung transplantation have been shown to be effective in the treatment of patients with advanced cardiopulmonary disorders. An overlap in indications occurs for the different procedures, and in many situations the factors that are important in selecting the best operation for a given patient have not been clearly elucidated. To determine whether the anticipated exercise capacity should be an important consideration in the selection of the optimal procedure for a given patient, we compared exercise performance in patients who had undergone the different lung transplantation procedures in the preceding year and were otherwise well. Eleven heart-lung, six double lung, and 16 single lung recipients and 28 control subjects underwent maximal symptom-limited incremental exercise tests using a cycle ergometer. At peak exercise, transplant recipients reached maximum oxygen uptakes in the range of 40% to 60% of predicted values; no significant differences existed between the means of the different transplant groups. Ventilatory factors did not appear to limit exercise in any group. The exercise responses in the transplant subjects were characterized by reduced aerobic capacity and diminished oxygen pulse, factors indicating abnormal cardiovascular performance. Our data indicate that moderate levels of exercise can be anticipated early after heart-lung, double lung, and single lung transplantation. In the absence of substantial differences in exercise capacity, other considerations would appear to be more important in guiding the selection of the optimal lung replacement procedure for an individual patient.

Adult↗

PubMedDate not supplied

Single lung transplantation for cystic fibrosis: is it an option? Cystic Fibrosis Transplant Study Group.

A 15-year-old girl with end-stage lung disease from cystic fibrosis underwent a bilateral lung transplantation. Infarction of the left lung allograft required its removal on day 10. The patient went on to have an uneventful recovery except for a prolonged air leak from the right allograft of approximately 29 days. The left pleural cavity opacified with time with no clinical or radiologic evidence of empyema. The patient was discharged on day 35 in good condition. On a follow-up examination 6 months after transplantation, she appeared to be functioning extremely well with a single lung allograft. This case report challenges the conventional wisdom that bilateral pneumonectomy and single lung transplantation are not an option to be considered for patients with cystic fibrosis or bronchiectasis.

Adolescent↗