Biomedical subjects

J Jamart

Publications and source records attributed to J Jamart.

At least 127 records · Page 7Linked to original sources

PubMed1995

Peroperative hemodynamic study of left internal mammary artery grafts.

The present study was undertaken to analyse hemodynamic features of an arterial graft and to determine parameters which influence primarily flow and velocity. A total of 284 consecutive patients having isolated coronary bypass surgery underwent peroperative hemodynamic assessment by pulsed Doppler ultrasonics of a left internal mammary artery bypass graft implanted onto the left anterior descending artery. Internal mammary artery free flow was 109.2 +/- 3.7 ml/min and flow in the internal mammary artery measured after completion of the distal anastomosis was 70.9 +/- 2.7 ml/min. All values quoted are mean +/- standard error of the mean. Mean velocity was 21.2 +/- 0.6 cm/sec, internal diameter was 2.65 +/- 0.04 mm and pulsatility index was 2.24 +/- 0.12. Resistance was expressed as mmHg/(ml . min-1) and averaged 1.65 +/- 0.13 for total resistance, 0.87 +/- 0.05 for graft resistance, and 0.73 +/- 0.13 for coronary resistance. From a set of 35 variables, stepwise multiple regression analysis selected two parameters influencing independently flow in internal mammary artery (R2 = 0.8762): flow velocity (p < 10(-4)) and internal diameter (p < 10(-4)). Variables influencing velocity (R2 = 0.3071) were: pulsatility index, which is a dimensionless expression of peripheral resistance (p < 10(-4)), and free internal mammary artery flow (p = 0.0007). Furthermore, a significant correlation between internal diameter and total resistance was observed (R = -0.5363, p < 10(-4), Y = 1.676X-1.545), and the exponentially fitted regression line was characterized by a marked increase of resistance at diameters less than 2 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Operative risk assessment in coronary artery bypass surgery, 1990-1993: evaluation of perioperative variables.

Patient characteristics and the results of cardiac surgery change with time. To achieve the best possible treatment a continual analysis of results is necessary. The present study analyzes 1225 consecutive patients undergoing isolated aortocoronary bypass surgery for the four-year period ending September 1993. Average age was 63 years (range 32-86 years), 927 (75.7%) patients were male and 298 (24.3%) were female. Hospital mortality was 2.2% (17/787) for elective surgery, 6.3% (21/336) for urgent surgery, and 9.8% (8/82) for emergency surgery. Intraoperative variables increasing independently operative mortality as evidenced by multivariate analysis were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0012), absence of bilateral use of internal mammary artery (p = 0.0035). Likewise, intraoperative variables influencing major adverse outcome (operative mortality and/or need for intra-aortic balloon pulsation) were the following: prolonged aortic cross-clamping time (p < 0.0001), absence of cold-blood cardioplegia (p = 0.0360). In conclusion, global ischemic time was the dominant variable in predicting operative outcome. Furthermore, a protective effect of cold blood cardioplegia and bilateral internal mammary artery grafting was evidenced.

Anesthesia, General↗

PubMed1995

Effect of erythromycin on gastric motility in mechanically ventilated critically ill patients: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: To document the action of erythromycin on gastric emptying and motility in mechanically ventilated patients. DESIGN: Crossover, double-blind, randomized, placebo-controlled study. SETTING: General intensive care unit in a university hospital. PATIENTS: Ten patients, mechanically ventilated, in a stable hemodynamic condition. INTERVENTIONS: Erythromycin (200 mg i.v. over 30 mins) and placebo were infused at mid-morning, on two consecutive days, in a random order. Pressure changes in the gastric antrum were recorded by means of a multi-lumen manometric tube (perfused catheter technique) over a period of 300 mins, beginning with the institution of the erythromycin or placebo infusion. Gastric emptying was simultaneously assessed by the kinetics of the absorption of acetaminophen delivered into the stomach (1 g with 20 mL of water) immediately before the infusion. MEASUREMENTS AND MAIN RESULTS: Motility was quantified by determining the number of contractions, the amplitude of contractions, and the Motility Index (Motility Index = natural logarithm [sum of amplitude x number of contractions] + 1). Comparison between placebo and erythromycin was made for the first hour after the infusion and for the whole recording session. The maximal acetaminophen concentration, the time to reach the peak acetaminophen concentration, and the area under the concentration-time curve at 60 mins were obtained from serial determinations of plasma acetaminophen concentrations. Compared with placebo, the mean number of contractions (104 +/- 34 vs. 5 +/- 8; p = .003), the mean amplitude of contractions (52 +/- 16 vs. 20 +/- 17 mm Hg; p = .005), and the Motility Index (13.06 +/- 0.95 vs. 4.45 +/- 3.54; p = .004) were significantly increased during the first hour after erythromycin infusion compared with placebo. Number of contractions (p = .017) and Motility Index (p < .001) after erythromycin infusion remained significantly higher when values throughout the whole recording session were considered. The following data were noted after erythromycin was infused: a) the time to reach the peak acetaminophen concentration was shorter (32 +/- 8 vs. 171 +/- 93 mins; p = .007); b) the maximal acetaminophen concentration was higher (22.09 +/- 6.23 vs. 5.38 +/- 3.80 micrograms/mL; p = .007); and c) the area under the concentration-time curve at 60 mins increased markedly (730 +/- 269 vs. 72 +/- 42 micrograms/min/mL; p = .002) as compared with placebo. CONCLUSION: In mechanically ventilated patients, intravenous erythromycin (200 mg over 30 mins) increases indices of antral motility and accelerates gastric emptying as assessed by the kinetics of acetaminophen absorption.

Acetaminophen↗

PubMed1995

HMPAO single-photon emission computed tomography in posterior circulation infarcts.

The sensitivity of single-photon emission computed tomography (SPECT) in evaluating posterior circulation infarcts compared with that of computed tomography (CT) or magnetic resonance imaging (MRI) remains unknown. In a hospital-based population, the authors studied SPECT, CT, and MRI in 35 consecutive patients presenting with acute infarction clinically localized in the thalamus (7), posterior cerebral artery (PCA) territory (15), brainstem (19), and cerebellum (3). Multiple infarcts were noted in 8 patients. Overall, the SPECT sensitivity was lower than that of MRI (21% vs 93%, p = 0.004) and CT (42% vs 65%, p = 0.046). The SPECT and CT sensitivities were not significantly different (67% vs 73%) for PCA infarcts. Performed within 24 hours, SPECT showed a relevant hypoperfusion in all PCA infarcts. For brainstem infarcts, CT (33%, p = 0.074) and MRI (91%, p = 0.004) were more sensitive than SPECT, which showed no hemispheric hypoperfusion. The sensitivity of the three imaging techniques was 100% for large cerebellar infarcts. For the small group of thalamic infarcts, the SPECT, CT, and MRI sensitivities were 14, 71, and 100%, respectively. Thus, SPECT compared to CT and MRI is not helpful in the subacute phase to localize PCA and cerebellar infarcts and is of limited value for thalamic infarcts. In the first hours, the absence of cerebral hypoperfusion in brainstem infarcts may help to differentiate them from hemispheric infarcts usually associated with profound hypoperfusion.

Aged↗

PubMed1995

Acute myeloid leukemia: lack of predictive value of sequential quantitative MR imaging during treatment.

PURPOSE: To assess the use of magnetic resonance (MR) imaging in monitoring treatment response in patients with acute myeloid leukemia (AML). MATERIALS AND METHODS: Bulk T1 and T2 were determined with at least four MR imaging examinations (strictly timed) during the first 6 weeks of treatment in 29 patients with AML (age range, 16-75 years; 15 female, and 14 male). Bulk T1 and T2 in responder (n = 22) and nonresponder (n = 7) patients were compared. RESULTS: Relative to pretreatment bulk T1 values, bulk T1 had increased a mean of 11% at week 1 and had decreased a mean of 7% and 39% at weeks 2 and 6, respectively. Values in nonresponder patients were not statistically significantly different (+11%, -14%, -38%). CONCLUSION: MR imaging of lumbar bone marrow in patients with AML demonstrated statistically significant changes in bulk T1 during treatment that correlated with changes in cellularity. However, neither the early increase in bulk T1 nor the rate or magnitude of the subsequent decrease in bulk T1 were indicative of a positive response to treatment.

Adolescent↗

PubMed1995

Comparative correlations of HMPAO SPECT indices, neurological score, and stroke subtypes with clinical outcome in acute carotid infarcts.

BACKGROUND AND PURPOSE: The prognostic value of single-photon emission computed tomography (SPECT) remains controversial. The aim of this study was to compare the prognostic value of stroke severity, stroke subtypes, and SPECT indices and to determine which predictive factors have an independent effect on clinical outcome. METHODS: We studied 55 consecutive patients with acute (< 12 hours) carotid infarct within 36 hours of symptom onset with SPECT. Clinical presentation was assessed by the Canadian Neurological Scale and stroke subtypes. SPECT indices were the degree and size of hypoperfusion and crossed cerebellar diaschisis as assessed by a semiquantitative analysis. Outcome was evaluated by the functional status and mortality (Rankin Scale score at 1 month). RESULTS: The Rankin Scale score correlated with the degree (r = .580; P < .00001) and size (r = .616; P < .00001) of hypoperfusion. The mean degree and size of hypoperfusion were significantly higher in patients with poor outcome. Crossed cerebellar diaschisis had no significant predictive value. Statistical analysis determined threshold values for the Canadian Neurological Scale score and the degree and size of hypoperfusion for the functional status and mortality. The degree and size of hypoperfusion had no higher performance than the Canadian Neurological Scale score. The negative predictive value was excellent for both clinical and SPECT indices. Multivariate analysis selected only the size of hypoperfusion as an independent predictor for the functional status (P = .004) and the Canadian Neurological Scale score for mortality (P = .009). CONCLUSIONS: SPECT performed within 36 hours of onset predicts clinical outcome, but different clinical and SPECT indices with threshold values should be chosen according to the relevant outcome end point.

Aged↗

PubMed1995

Prevalence of occupational asthma due to latex among hospital personnel.

Latex has been documented as causing immediate hypersensitivity reactions ranging from contact urticaria to severe anaphylaxis. Latex proteins may also act as airborne allergens causing rhinitis and asthma. The prevalence of occupational asthma due to latex gloves among health care workers is unknown. We surveyed the employees of a primary care hospital including nurses (n = 201), members of the cleaning staff (n = 50), and laboratory technologists (n = 38). In the initial part of the study, a questionnaire and skin-prick tests with latex and common inhalant allergens were administered to 273 of 289 (94%) members of the target population. Thirteen of the 273 subjects (4.7%; 95% CI: 2.6 to 8.1%) showed skin reactivity to latex. All latex-sensitive subjects reported glove-related urticaria, which was associated with rhinoconjunctivitis in 12 subjects and asthma in five subjects. No subject had a history suggestive of occupational asthma among those who had negative skin tests to latex. In the second part of the study, a histamine inhalation challenge was performed on 12 of 13 latex-sensitive subjects, including the five subjects with a history of occupational asthma. These 12 subjects demonstrated significant bronchial hyperresponsiveness. All underwent specific inhalation challenges with latex gloves in the laboratory. Seven subjects developed a significant bronchial response (four immediate and three dual reactions) to latex glove exposure. We conclude that occupational asthma due to latex occurred in 2.5% (95% CI: 1.0 to 5.2%) of hospital employees. Widespread use of latex gloves should therefore be considered a significant risk to the respiratory health of hospital employees.

Adult↗

PubMed1995

Association between stroke and atrial septal aneurysm assessed by transesophageal echocardiography in a cardiologic population.

Atrial septal aneurysm (ASA) is now recognized as a source of emboli. Its prevalence in a general population remains controversial. We assessed, in a cardiologic population, the prevalence of ASA, the association with cerebrovascular events, the role of associated interatrial shunting and age. Four hundred and ninety-four consecutive patients were referred for transesophageal echocardiography with contrast. The prevalence of ASA in two groups, with (A) and without (B) cerebrovascular events were compared. In group A, we studied the prevalence of ASA according to the clinical presentation (stroke, TIA and peripheral emboli in limbs). An ASA was found in 38 patients (8%). The prevalence of ASA was higher in group A (16%) than in group B (4%) (p < 10(-5)). Prevalence of ASA was not significantly different in stroke, TIA and peripheral emboli subgroups. There was no difference in prevalence of ASA in stroke or TIA subgroups according whether age was < 55 years or > or = 55 years. Prevalence of all types of vascular events was increased when ASA was associated with an interatrial shunt. Our results support the assumption that ASA is a potential source of cerebrovascular events, whatever the clinical presentation or age. Presence of interatrial shunt increases the risk of stroke in subjects with ASA.

Adult↗

PubMed1995

[Spontaneous pneumothorax. Results of pleural talc therapy using thoracoscopy].

The aim of this retrospective study is to evaluate the advantage of thoracoscopy and the efficacy of talcage in the treatment of spontaneous pneumothorax (SP). Two hundred cases have been analyzed with a follow-up of 1 to 8 years after the occurrence of the disorder. The ratio man/woman is 4/1. One hundred and forty two pneumothorax are considered as being of idiopathic origin and 58 are associated to bronchopneumopathy, with a mean age of 33 and 56 years, respectively. The percentage of smokers is 69.5% with a mean smoking of 14 packets/years. The endoscopic aspect of pleura is either normal (30%) or shows adhesions (23.5%), blebs (17%) or bullaes (29.5%). Thoracoscopy allowed talc poudrage in 191 patients and allowed to indicate the need for surgery in nine patients. The immediate success rate of talcage is 93.7%. In the group of immediate failure (6.3%), unexpected bullous structures (8/12) are found at tomodensitometry (TDM), as well as during surgery. Late recurrence is reported in 2 cases (1%) at 20 and 25 months. Radiological sequelaes are minimum (9%). Lung function testing in patients with idiopathic pneumothorax (n = 64) shows, before talc poudrage, signs of pulmonary hyperdistension (total lung capacity (TLC) at 116% of predicted values), reflecting the illness pathology, 3 months after talcage a discrete restrictive syndrome (TLC 93%) and one year after the partial recovery of the lost volume (TLC 105%). Tomodensitometry revealed to be complementary to thoracoscopy in secondary SP and very instructive in idiopathic SP after immediate failure of talc poudrage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Pulmonary sequestration. Visualization of an enlarged azygos system by CT.

The purpose of this study was to determine the prevalence of enlargement of the azygos system in the case of lung sequestration and its potential usefulness in the differential diagnosis of lower lobe opacities. Seven consecutive adult cases of pulmonary sequestrations were retrospectively enrolled; 4 sequestrations were proved surgically and all 7 angiographically. A group of 50 consecutive patients with a normal chest CT were used as controls. Another group consisted of 25 consecutive patients identified on the basis of an opacity in a posterobasal location on chest CT. For the 3 groups, the maximum diameter of the azygos and hemiazygos veins was measured, the level of measurement located between the upper poles of the kidneys and the confluence of inferior pulmonary veins into the left atrium. The diameter of the azygos veins (mean 10.4 +/- 5.1 mm) and of the hemiazygos veins (mean 7.1 +/- 3.0 mm) in the sequestration group was significantly larger than the diameter of the azygos and hemiazygos veins in the control group (mean 5.7 +/- 2.5 mm, and 3.4 +/- 2.4 mm, respectively), as well as in the study group (mean 5.9 +/- 2.6 mm and 3.3 +/- 2.6 mm, respectively). Our results suggest that enlargement of the azygos system in association with a posterobasal chest opacity, although nonspecific, may be a useful additional CT sign of sequestration.

Adolescent↗

PubMed1995

CO2 laser and Gianturco stent for endoscopic treatment of tracheal stenosis.

The self-expandable Gianturco stent was used in eleven cases of tracheal stenosis treated from September 92 to July 94. The stent is placed through a 9 mm outside diameter bronchoscope under optical control after cross-section and dilation of the stenosis with the CO2 laser according to the Shapshay technique. The follow-up varies from 3 to 22 months with a mean of 12 +/- 6 months. Pulmonary function tests (PFTs) show a mean improvement of the PEF (peak expiratory flow). Complications have been corrected in three patients with a second endoscopic procedure: the first case for malposition, the second for granuloma at the superior end of the prosthesis, and the third for the development of a mucous membrane webbing between the two loops of the stent. Owing to the lack of long-term follow-up, we reserve this technique for the treatment of severe tracheal stenosis with cartilage impairment in patients contraindicated when external reconstructive surgery is contraindicated.

Aged↗

PubMed1995

Effect of 1-28 alpha-h atrial natriuretic peptide on acute renal failure in cadaveric renal transplantation.

The efficacy and safety of (1-28) alpha-human ANP in preventing acute tubular necrosis (ATN) in cadaveric renal transplantation was tested by comparing ANP infusion with a maximal hydration (MH) regimen which we previously reported as effective in lowering the incidence of ATN (1, 2). Since the production of endogenous ANP increases with volume overloading (3), we hypothesized that increased endogenous ANP production may contribute to the beneficial effects of MH in renal transplant recipients. We thus conducted an open randomized study comparing the effect on early renal allograft function of MH (control group) versus moderate hydration plus ANP infusion (ANP group). Forty patients were blindly paired in two groups of 20 according to the duration of cold ischemia time (mean +/- 2 h). The demographic characteristics of donors and recipients were similar. Using a Swan-Ganz catheter, hemodynamic parameters were monitored for 4 h after transplantation. The group receiving ANP and moderate hydration was perfused to a mean pulmonary arterial pressure (PAP) of < or = 20 mmHg. The PAP in patients receiving MH was driven to > or = 25 mmHg. In the ANP group, a bolus of 100 micrograms of ANP was infused into the graft's renal artery at the time of unclamping, followed by 24 h of continuous intravenous infusion at 0.03 microgram/kg/min. Thereafter, the patients received ANP at a rate of 0.01 microgram/kg/min until the serum creatinine reached < 2 mg/dl. As a consequence of the hydration regimen, the PAP at unclamping was lower in the ANP group than in the control group; 20 +/- 3 and 26 +/- 4 mmHg, respectively (p < 0.05). The ANP plasma levels were significantly higher during the first 3 d in the ANP group (p < 0.001). The median recovery rate of renal function was similar in both groups. No patients in the ANP group experienced ATN while 4 patients (20%) in the control group did (p = 0.125). The need for hemodialysis was markedly reduced in the ANP group compared to the control group (1 ANP-treated patient required dialysis once whereas 5 patients from the control group underwent dialysis a total of 26 times; p = 0.068). ANP administration was well-tolerated and no hypotensive episodes were reported. This preliminary study suggests that ANP infusion is at least as effective as maximal hydration in preventing ATN and represents an efficient alternative for transplantation centers which do not use maximal hydration as a standard regimen in managing kidney allograft recipients.

Acute Kidney Injury↗

PubMed1995

Endonasal dacryocystorhinostomy: indications, technique and results.

Dacryocystorhinostomy (DCR) allows an obstructed lachrymal drainage system to be drained into the nasal fossa. Since the development of endonasal microsurgical techniques, the endonasal approach presents itself as an alternative choice to the conventional external approach. It is far less traumatic, yet as efficacious as the conventional approach, and avoids the need for a skin incision and the disruption of the medial canthal structures. Twenty-six patients suffering from lachrymal system obstruction underwent 28 endonasal dacryocystorhinostomies under microscopical (n = 25) or endoscopic control (n = 3). Pre-operative assessment included clinical symptoms (sac swelling, purulent secretions, epiphora) and outflow obstruction on X-rays (conventional dacryocystography and/or subtraction macrodacryocystography). Post-operatively, 23 DCR were free of symptoms. Two presented occasional epiphora and three were unsuccessful. The presence of pre-operative purulent secretions was significantly correlated with post-operative success and with lachrymal sac patency, which is also confirmed by X-ray examination (p<0.001). Thus in cases of purulent secretion with epiphora, X-ray examination is redundant and may be avoided. On the contrary, when epiphora is an isolated symptom, X-rays must be performed in order to determine where the obstruction is located and to provide information on lachrymal sac morphology.

Adolescent↗

PubMed1994

Liver procurement without in situ portal perfusion. A safe procedure for more flexible multiple organ harvesting.

The outcome after liver transplantation when grafts were retrieved from the donor by the classical aortic and portal cooling (APC) method was compared with the outcome when exclusively aortic in situ perfusion (AC) was used. Retrospectively, 163 donor hepatectomies performed over a 20-month period were reviewed to analyze overall graft (APC n = 78, AC n = 85) and patient outcome. The global graft and patient survival rates were not significantly lower in the APC group, except for 3-month graft survival (APC 72%, AC 87%; P = 0.015). However, this could be unrelated to the technique. In a subgroup of 140 cases (APC n = 64, AC n = 76), a more detailed analysis was performed. Populations of donors and recipients were similar. The graft injury and the immediate graft function were not significantly different between both groups. A multivariate analysis shows that low donor weight (P = 0.007), donor hypernatremia (P = 0.014), and in situ portal perfusion (P = 0.045) were significant determinants of a higher postoperative peak of glutamic pyruvic transaminase. In summary, in this series, routine human liver procurement using exclusive aortic perfusion seemed to be at least as safe as using a combined aortic and portal perfusion technique. This simplified method may also represent some advantages for combined pancreas and intestinal harvesting in the future.

Adenosine↗

PubMed1994

Intraoperative assessment of coronary artery bypass grafts using a pulsed Doppler flowmeter.

A pulsed Doppler flowmeter was used in a series of 352 consecutive patients undergoing isolated coronary artery bypass grafting. Doppler flow measurements were available on 909 single terminolateral bypass grafts (327 internal mammary arteries and 582 saphenous veins) and 58 sequential bypass grafts anastomosed to combinations of arteries. Flow (mL/min) categorized as a function of the recipient artery was distributed as follows: left anterior descending coronary artery, 69.9 +/- 2.5; right coronary artery, 68.0 +/- 5.0; diagonals, 61.0 +/- 4.1; obtuse marginals, 55.9 +/- 2.2; and posterior descending coronary artery, 53.3 +/- 3.0 (p < 0.001). Graft outflow obstruction resulting from torsion of the graft pedicle or anastomotic stricture was identified in 7 patients (2%). After graft revision, flow increased from 9 +/- 4 mL/min to 69 +/- 13 mL/min (p = 0.023), and velocity rose from 4.6 +/- 1.1 cm/s to 18.1 +/- 2.4 cm/s (p = 0.009). In conclusion, the system was adequate for operative use and allowed identification and correction of technical errors.

Adult↗

PubMed1994

Duodenal motor response to continuous enteral feeding is impaired in mechanically ventilated critically ill patients.

In order to investigate the duodenal motor response to continuous enteral feeding during critical illness, we recorded the duodenal contractions of 12 mechanically ventilated critically ill patients during a 4 h fasting period immediately followed by another 4 h period of continuous (100 kcal/h) nasogastric feeding with a polymeric diet. Duodenal motility was recorded by manometry (perfused catheter technique) and the migrating motor complexes (MMC) were identified by their activity front (period of high frequency, regular contractions). The incidence and the mean duration of activity fronts as well as the mean duration of the MMC (time interval separating two successive activity fronts) recorded during both periods were compared. The incidence of activity fronts (fasting: median: 2.5, interquartile range: 5.5; feeding: median: 2, interquartile range: 3.5), their duration (fasting: 6.2 +/- 1.6 min; feeding: 5.8 +/- 1.6 min), and the mean duration of the MMC (fasting: 50.9 +/- 24.7 min; feeding: 49.1 +/- 20.3 min) were similar during both periods. We conclude that in these patients, the fasting pattern of motility is not interrupted by the continuous nasogastric administration of a polymeric diet. Since the activity fronts of the MMCs are highly propulsive, we suggest that their abnormal persistence during feeding may play a role in the pathophysiology of unexplained diarrhoea in some critically ill patients.

Journal Article↗

PubMed1994

Preformed antibody and complement rebound after plasma exchange: analysis of immunoglobulin isotypes and effect of splenectomy.

UNLABELLED: Splenectomy (Sx) has been proposed to attenuate post-PE (plasma exchange) rebound of isoagglutinins and xenogenic (XG) antibody (Ab) in both ABO-incompatible allografts and discordant xenografts. This study analyses the qualitative nature and kinetics of serum immunoglobulins as well as complement resynthesis after PE in sham-operated (PE) and splenectomized (PE+Sx) syngeneic LOU/C rats; non-PE sham-operated or splenectomized animals were used as controls. PE was performed in unanesthetized, unheparinized rats. Immunoglobulin isotypes and subclasses (IgM, IgG1, IgG2 alpha, IgG2b) of total circulating Ab were measured pre-PE and up to 21 days post-PE, using ELISA (enzyme-linked immunosorbent assay) and specific mouse antirat monoclonal Ab. Antiguinea-pig (GP) XG Ab (IgM, IgG2a) serum levels were measured using cellular ELISA with cultured GP endothelial cells as targets. Sx alone significantly reduced XG IgM serum levels (p < 0.0001). Maximal rebound of total and XG IgM was observed on day 3 post-PE, reaching 674% and 187% of the pre-PE levels, respectively; these overshoots were entirely suppressed by Sx (p < 0.005 for total IgM; p < 0.0001 for XG IgM). Total IgG2a, IgG2b and IgG1 as well as XG IgG2a serum levels did not show significant overshoot post-PE. The activity of the complement classical pathway (mean +/- SD), assessed by CH50, was decreased at 51 +/- 19% of basal value 15 minutes after PE, and had returned to baseline level by day 2 post-PE with or without Sx. IN CONCLUSION: (1) Six alone significantly reduced XG IgM serum levels; (2) early post-PE Ab rebound was mainly observed for IgM; (3) both total and XG IgM rebound was inhibited by Sx. This suggests that Sx probably removes a significant proportion of IgM producing cells undergoing post-PE stimulation. These data provide a rationale for combining PE with Sx in ABO-incompatible and discordant XG transplantation.

Animals↗

PubMed1994

Doppler flow measurement in coronary artery bypass grafts and early postoperative clinical outcome.

The present investigation attempts to correlate flow measurements made intraoperatively in coronary bypass grafts with clinical outcome. A total of 352 consecutive patients undergoing isolated coronary artery surgery underwent hemodynamic assessment of their bypass grafts (328 internal thoracic artery and 582 saphenous vein grafts) at the end of cardiopulmonary bypass (CPB) by using a 8 MHz pulsed Doppler ultrasound flowmeter. The total patient population was divided into three groups of distinct outcome (A: normal, 228 patients; B: complicated, 106 patients; C: poor, 18 patients) on the basis of a combination of the following parameters: difficult weaning from bypass, use of inotropic drugs, reduced left-ventricular stroke work index, myocardial infarction, intraaortic balloon counterpulsation, and death of cardiac origin. Univariate analysis has shown clinical outcome to be influenced by preoperative clinical condition and not by flow in bypass grafts (average flow per graft [ml/min] was 60 +/- 2 [mean +/- SEM] in group A, 58 +/- 3 in group B and 43 +/- 6 in group C: NS by analysis of variance). Multivariate analysis (Fisher linear discriminant analysis) selected only the two following factors leading to normal (group A) or adverse (groups B and C) outcome: unstable angina (p = 0.026) and duration of additional CPB after unclamping the aorta (p < 10(-5). To conclude, clinical outcome was not influenced by flow as measured in well-functioning bypass grafts by pulsed Doppler technique.

Blood Flow Velocity↗