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Biomedical subjects

J Au

Publications and source records attributed to J Au.

33 records · Page 2Linked to original sources
PubMed1992

Determinants of graft arteriosclerosis after heart transplantation.

Accelerated graft coronary artery disease (TxCAD) is now the most common complication limiting long-term survival after heart transplantation. This study examines its association with several potentially causative factors. The study population comprised all 73 transplants recipients at this centre between May 1985 and June 1989 who survived at least 2 years. Coronary angiography was performed in every patient at 2 years after transplantation and annually thereafter. All angiograms were retrospectively examined for any evidence of TxCAD. The number of rejection episodes and history of cytomegalovirus (CMV) infection were determined from patient records. Fasting serum triglycerides, and total and HDL cholesterol were measured at between 18 and 60 months after transplantation. Patients with advanced TxCAD (> 70% stenoses) had a mean of 1.4 +/- 1.4 rejection episodes in the first year compared with 0.5 +/- 0.8 episodes in those without TxCAD (P < 0.05). The mean number of episodes in all patients with any evidence of TxCAD was 0.8 +/- 1.1 which was not significantly different from those without TxCAD. There were no association between exposure to CMV infection and TxCAD or between hyperlipidaemia and TxCAD. We conclude that frequent episodes of allograft rejection are associated with the development of advanced TxCAD. Hyperlipidaemia is not associated with the development of TxCAD in the first 5 years after transplantation. A history of exposure to CMV is not associated with TxCAD in our patients possibly because of our routine use of anti-CMV hyperimmune globulin in CMV-mismatched patients.

Adult↗
PubMed1992

Post-infarction communication between a left ventricular aneurysm and the right atrium.

A 70-year-old patient presented with ventricular tachycardia and left ventricular failure. He was found to have a communication between a posterior left ventricular aneurysm and the right atrium. The causal myocardial infarction had been silent. This defect was satisfactorily closed at operation from which he made an uneventful recovery. This is the first report of a left ventricular-right atrial communication developing in association with ischaemic heart disease and highlights the role of transoesophageal echocardiography in the diagnosis and surgical management of such a condition.

Aged↗
PubMed1992

Paediatric cardiac transplantation with steroid-sparing maintenance immunosuppression.

In order to determine the results of steroid-sparing maintenance immunosuppression in paediatric patients who have undergone orthotopic heart transplantation (OHT), a retrospective study was undertaken in 12 children and five infants (median age 3.5 years). Preoperative diagnoses were cardiomyopathy in seven and congenital heart disease in 10 patients. Immunosuppression was induced by cyclosporin, azathioprine, methylprednisolone, and antihuman lymphocyte immune globulin. It was maintained with cyclosporin and azathioprine. After induction, five patients received no further steroids. The remainder, except one, required only pulses for rejection (13 episodes or 0.51 episodes/patient year). Long term complications included hypertension in six, and renal impairment in three children. There were no early or late deaths from infection. Actuarial survival was 94% at one year. Of the children followed up for more than one year, all demonstrated an increase in height SD scores (mean (SD) -2.15 (1.35) to -1.15 (1.16)). We conclude that a steroid-sparing maintenance immunosuppression regimen can be successfully employed in paediatric OHT, and that significant catch-up growth can be achieved postoperatively.

Azathioprine↗
PubMed1990

Effect of cardiac tamponade on atrial natriuretic peptide concentrations: influence of stretch and pressure.

1. In order to study the role of atrial pressure and atrial stretch on the release of atrial natriuretic peptide we have measured plasma atrial natriuretic peptide concentration, urine output and haemodynamic variables in eight patients during and 30 min after the relief of cardiac tamponade. This condition is characterized by high atrial pressure with little or no atrial stretch. 2. Relief of tamponade was associated with a rise in urine output (53 +/- 27.9 to 101 +/- 24.5 ml/h, mean +/- SEM; P = 0.09), systolic blood pressure (95 +/- 9.6 to 126 +/- 7.0 mmHg, P less than 0.0001), and plasma atrial natriuretic peptide concentration (369.5 +/- 70.9 to 490.3 +/- 94.7 pg/ml, P less than 0.05) despite a large fall in right atrial pressure (18.6 +/- 1.6 to 9.5 +/- 1.3 mmHg, P less than 0.001). 3. These results suggest, therefore, that an increase in atrial stretch, rather than in atrial pressure, stimulates the release of atrial natriuretic peptide.

Adult↗
PubMed1989

Percutaneous cricothyroidostomy (minitracheostomy) for bronchial toilet: results of therapeutic and prophylactic use.

In the period 1984 to 1988, 2,448 patients underwent major thoracic operations in our unit. Of these patients, 144 (5.9%) underwent percutaneous cricothyroidostomy (minitracheostomy) using a 20F pediatric silver tracheostomy tube. Minitracheostomies were performed for the treatment of sputum retention in 81 patients, prophylactically in 62 patients, and as a route for high-frequency jet ventilation in 1 patient. Minitracheostomy tubes remained in situ a median of four days. Suction function was satisfactory in 99% of patients, with only 2 patients requiring subsequent suction bronchoscopy and no occurrence of tube blockage. Ninety-four percent of minitracheostomies performed were entirely uneventful. Bleeding was the most common complication (3.5%), and no instances of subglottic stenosis have occurred. During the review period, there was a significant increase in the percentage of patients requiring major operations undergoing prophylactic, but not therapeutic, minitracheostomy (p less than 0.001). This was associated with a significant decrease in the percentage of patients requiring suction bronchoscopy (p less than 0.001). We conclude that prophylactic minitracheostomy with the 20F pediatric silver tracheostomy tube is a safe and effective procedure in the prevention of postoperative sputum retention.

Aged↗
PubMed1986

Auditory biofeedback in spastic diplegia.

Using a simple auditory feedback device that produces a continuous buzzing signal on heel contact, we studied the effects of augmented auditory biofeedback on the gait of four spastic diplegic children. The purpose of the biofeedback was to attempt to increase dorsiflexion at heel strike without causing other compensatory changes at the knee and hip, which might lead to crouch gait. We measured velocity, stride length, and thigh, knee, and ankle angles at the heel strike, midswing, and toe-off phases of gait. Four subjects, aged 5-8 years, were given a standard gait training program, supplemented with biofeedback two times per week in a clinical setting and 1 h daily in a home program over an 8-week period. Three computer video gait analyses of the sagittal plane were conducted without biofeedback in the pre- and posttraining conditions and twice with biofeedback over the course of treatment. We performed linear regression analysis of joint angles at heel strike, midswing, and toe-off as a function of days into the study for each patient. Angle-angle diagrams for a test subject before, during, and after treatment indicate changes toward a normal gait pattern with biofeedback. The linear regression analysis showed a statistically significant (p less than 0.01) shift toward dorsiflexion at heel strike with repeated exposure to biofeedback. A compensatory crouch gait was not induced. The linear regression analyses for hip and knee angles were not statistically significant (p greater than 0.25), indicating a disassociation of movement among hip, knee, and ankle.

Acoustic Stimulation↗
PubMed1984

A combination of 5-fluorouracil and thymidine in advanced colorectal carcinoma.

Concurrent administration of thymidine (TdR) has been shown to increase the antitumor activity of 5-fluorouracil (5-FU) in various experimental models. The clinical response rate, side-effects, and toxicity of 5-FU and TdR were evaluated in 27 patients with advanced colorectal carcinomas. Each 6-day treatment course consisted of an IV loading dose of TdR (405 mg/kg, over 30 min), followed by continuous IV infusions of 5-FU (7.5 mg/kg per day for 5 days), and TdR (216 mg/kg per day for 6 days); courses were repeated every 4 weeks. The overall partial response rate was 4.5%, or 16.7% in patients with no prior 5-FU chemotherapy. Short-lived stable disease was seen at an overall rate of 27.3%, half of these patients with prior 5-FU chemotherapy. Myelotoxicity occurred in 64% of the patients, but this was dose-limiting in only 20%. Gastrointestinal and neurological symptoms were mild and infrequent. There was one case of treatment-related death due to sepsis secondary to leukopenia. It is concluded that the concurrent IV administration of 5-FU and TdR does not improve the response rate over that obtained with 5-FU alone.

Adult↗
PubMedDate not supplied

Surgical management of infective endocarditis after heart-lung transplantation.

Bacterial endocarditis after heart-lung transplantation has not been described. We report Staphylococcus aureus bacterial endocarditis in a 12-year-old boy after heart-lung transplantation. He was found to have an apparently free vegetation in his left ventricle, which was surgically removed. After a stormy postoperative period, he successfully recovered and remains well after 6 months.

Acute Disease↗