Failure of whole blood cyclosporine levels to provide a reliable measure of immunosuppression in clinical heart and heart/lung transplantation.
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Cyclosporins↗
Biomedical subjects
J Hutter
Publications and source records attributed to J Hutter.
[Heart-lung transplantation. Experience of Papworth Hospital. Apropos of 24 surgical cases].
Between April 5, 1984 and May 9, 1987, 24 patients underwent heart-lung transplantation for a variety of vascular and pulmonary diseases. Graft procurement being usually distant, the cardiopulmonary protection used was based on a simple hypothermic flush technique performed in donors prepared with prostacyclin. There was no primary graft deficiency and no intra-operative death. 17 patients are alive after a follow-up period of 1 to 41 months. The actuarial survival rate at 1 year was 77 p. 100. Late mortality was mainly due to cytomegalovirus infections. Immunosuppression relied on cyclosporine A and azathioprine with peri-operative use of antilymphocyte serum and corticosteroids. Early graft rejection episodes were treated with bolus intravenous methylprednisone. These episodes were detected from combined clinical, radiological, spirometric and histological data. Transbronchial lung biopsy was the reference examination for an objective diagnosis of lung rejection. In this series there was only one case of obliterative bronchiolitis (4 p. 100). This must be credited to the strategy used to detect rejection which seems to be the main factor of occurrence of this dangerous complication.
Adolescent↗
Immunologic complexity of lymphoblastic lymphoma.
Twelve patients with a histologic diagnosis of lymphoblastic lymphoma (LBL) were studied immunologically using the methodologic refinement of comparative serial section immunochemistry. By this means, we demonstrate complex LBL phenotypic profiles, revealing 3 major immunologic subtypes: immature T cell, 7 cases; intermediate or mature T cell, 3 cases; immature B cell (pre-pre-B), 2 cases. This phenotypic diversity challenges the basic belief that all LBL are the same. Our immature T-cell cases with frequent simultaneous Leu 2/3/6/9/CALLA/Tdt expression correspond to cortical thymic phenotypes; our mature T-cell phenotypes with Leu 9/la expression and absent L6/Tdt correspond either to medullary thymocytes or post-thymic T cells; our pre-pre-B phenotypes with simultaneous Tdt/CALLA/B4 expression correspond to common acute lymphocytic leukemia (ALL) phenotypes. Mature T-LBL phenotypes are similar to "novel" peripheral T-cell lymphoma phenotypes. Scant or absent Tdt expression in mature LBL is not an isolated antigenic change but a complete phenotypic profile difference from immature T-LBL. The major T- and B-cell phenotypes of LBL might have therapeutic significance. Treatment among LBL phenotypes may need to vary as with acute lymphocytic leukemia phenotypes. Further study is needed; in the meantime, comparative serial section immunotyping promises substantial utility in revealing the immunologic complexity of the lymphomas.
Adolescent↗
Neonatal necrotizing enterocolitis. Evolution of new principles in management.
Over a three-year period, we have operated on 30 infants with necrotizing enterocolitis. Because of the increased experience with this lesion, we have evolved reliable guidelines for both early diagnosis and operative treatment of necrotizing enterocolitis. Initial therapy was nonsurgical in most cases and included gastrointestinal tract decompression, systemic antibiotics, and correction of fluid, electrolyte, and metabolic abnormalities. Absolute indications for surgery and thought to be prima facie evidence for bowel necrosis were (1) cellulitis of the anterior abdominal wall, (2) free intraperitoneal air, (3) a single dilated intestinal segment present on serial roentgenograms, (4) clinical deteioration in the presence of appropriate medical therapy, and (5) persistent abdominal tenderness. Although all 30 patients operated on had necrotic bowel proved at histologic examination, 21 survived (70%). All patients listed as survivors, with the exception of two, have had intestinal tract continuity reestablished and are doing well.
Age Factors↗
Laparoscopic cholecystectomy for patients who have had previous abdominal surgery.
This paper reports 121 laparoscopic cholecystectomies (LC) in patients who had had previous abdominal surgery between June 1990 and August 1992. There were 93 cases with lower abdominal scar (LS) and 28 with upper or umbilicus midline scar (US). For insertion of the laparoscope in the scarred abdomen we use the conventional laparoscopic approach (CLA), the peritoneum perforation under vision approach (PP), and the open laparoscopic approach (OLA). One hundred twenty scarred abdomens were completed successfully. Conversion to an open procedure was required in one case with previous LS, because of injury of the jejunum. One postoperative intraabdominal hematoma was noted and treated with percutaneous catheter drainage. No reoperation was required and no further complications were noted. Patients who had a previous laparotomy had no substantially longer operative time or postoperative hospital stay. Revealing a total complication rate of 1.6%, this study shows that previous abdominal surgery should no longer be considered a contraindication to LC.
Cholecystectomy, Laparoscopic↗