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Biomedical subjects

J Stark

Publications and source records attributed to J Stark.

At least 19 recordsLinked to original sources
PubMed1992

Pulmonary artery sling.

Eighteen patients who underwent surgical treatment of pulmonary artery sling at this institution since 1969 were reviewed. Four of them had associated tracheal stenoses produced by complete cartilaginous rings (stovepipe trachea). All patients underwent operation. The median age at operation was 180 days (range, 27 days to 54 months). In the 14 patients with isolated pulmonary sling, the operation consisted of division of left pulmonary artery and reimplantation into the main pulmonary artery anterior to the trachea. In the 4 patients with stovepipe trachea, the stenotic tracheal segment was resected on cardiopulmonary bypass and the left pulmonary artery was brought anterior to the trachea before the latter was reanastomosed to the main pulmonary artery. There were no early deaths. One patient died late. The pulmonary artery anastomosis was patent in all 14 patients investigated postoperatively. Three patients have residual tracheobronchial problems. One patient is mentally retarded and is institutionalized. All other patients are symptom-free and growing normally and have normal chest radiographs.

Child, Preschool↗
PubMed1992

Surgical treatment of persistent ductus arteriosus complicated by bacterial endocarditis.

A seven-year-old girl with persistent ductus arteriosus developed acute bacterial endocarditis with large vegetations in the ductus and the left pulmonary artery. Conservative management was not successful: repeated embolisation to the lungs necessitated operation during the acute endocarditis. Details of the operative technique are presented and discussed.

Child↗
PubMed1992

Minimisation of priming volume and blood saving in paediatric cardiac surgery.

We started a programme of donor blood reduction for open heart surgery in children in 1983. At first, only meticulous surgical and perfusion techniques were used. Later, increased haemodilution was added. Miniaturisation of the perfusion circuit and introduction of blood taken prior from the patient further decreased donor blood requirements. In 1989, we used 0.89 l per patient compared to 3.2 l per patient in 1983. Miniaturisation of the circuit was tested in a pilot study on 30 children undergoing the Senning operation in 1988. Priming volume was reduced from 661 +/- 72 ml to 421 +/- 62 ml. In 1989, 167 out of 194 children (86%) received a clear prime. Ninety-seven of 100 children whose weight was over 15 kg received a clear prime: 55 did not require subsequent transfusion. Prime miniaturisation and autotransfusion can considerably reduce blood requirements for open heart surgery.

Blood Donors↗
PubMed1992

The impact of respiratory infections on asthma.

It is apparent that the effects of viral respiratory infections on the development of airway hyperresponsiveness are multiple and interrelated and involved the production of viral specific IgE, upregulation of leukocyte inflammatory activity, enhancement of the factors involved in the generation of late phase allergic responses, altered beta-adrenergic and cholinergic nervous system activity, and damage to the airway epithelium. The summation of these effects is the development of airway inflammation rather than a direct effect on bronchial smooth muscle, per se. An understanding of this pathogenesis underscores the relative importance of anti-inflammatory rather than antimicrobial therapy in viral-induced exacerbations in asthma symptoms.

Adolescent↗
PubMed1992

Radiosensitivity and responsiveness to recombinant interleukin-2 of effector cells of graft vs. host disease and mixed lymphocyte reaction in mice.

Synergistic effects of recombinant interleukin-2 (IL-2) or irradiated spleen cells were investigated in vivo and in vitro. Irradiated (750 cGy) C57BL/6 spleen cells infused to sublethally irradiated (500 cGy) BALB/c mice treated with IL-2 (1,000 U 3 times/day) caused graft vs. host-like disease (GVHD) in 3 of 11 mice. Similarly irradiated allogenic spleen cells caused no GVHD in irradiated recipients not administered IL-2. No sign of autologous GVHD was found in mice that received irradiated syngeneic spleen cells with IL-2. Addition of recombinant IL-2 in vitro to mixed lymphocyte reactions (MLR) using irradiated (500 cGy) allogeneic responder spleen cells augmented the 3H-TdR uptake fourfold compared to cultures without IL-2, but was 44-fold below the allogeneic response of nonirradiated C57BL/6 spleen cells. Il-2-induced cell proliferation was also noted in syngeneic MLR, but did not lead to GVHD in in vivo experiments. The data suggest that IL-2 may potentiate GVHD and alloreactivity induced by an adequate number of irradiated, nondividing but viable allogeneic spleen cells and/or that secretion of IL-2 by alloactivated T lymphocytes, supplied exogenously in the present study, may play a role in the GVHD syndrome. Since neither viable but nonreplicating T cells nor IL-2 alone caused GVHD, it is suggested that endogenously produced IL-2 by alloactivated T lymphocytes may be important in the development of the GVHD syndrome, independent of its main function of enhancing T lymphocyte proliferation. On the other hand, the lack of GVHD following administration of high numbers of irradiated or nonirradiated syngeneic spleen cells with IL-2 implies that allogeneic T lymphocytes and not IL-2 activated MHC-nonrestricted cytotoxic cells play a role in inducing the GVHD syndrome in vivo.

Animals↗
PubMed1991

Current surgical technique to repair Fallot's tetralogy with absent pulmonary valve syndrome.

The experience with surgical repair of Fallot's tetralogy and absent pulmonary valve syndrome is reviewed. Twenty-two patients aged 1 day to 8 years were treated between 1982 and 1989 using one surgical technique. This consisted of resection of the main pulmonary artery and large parts of the anterior wall of the right and left pulmonary artery. The ventricular septal defect was closed with a patch, and an aortic or pulmonary homograft (size, 8 to 24 mm) was interposed between the right ventricle and the pulmonary artery. Two of the 8 infants operated on died; there was one late death. All 14 older children survived the operation. All survivors are well up to 7 years follow-up (mean follow-up, 3.6 years). We recommend early treatment of infants; older children can be treated electively. The technique used in our series gives excellent results.

Child↗
PubMed1991

Pulmonary hypertensive crises following surgery for congenital heart defects in young children.

In this clinical study, 20 high risk infants and neonates were monitored to identify and characterize pulmonary hypertensive crises following surgery for congenital cardiac defects. Monitoring included right ventricular or pulmonary artery pressure catheters and transcutaneous oximetry. Eleven patients also had continuous analog recording of hemodynamic data so that antecedents of crises and the sequence of events following treatment could be reconstructed. Eleven of the 20 patients had one or more crises. Six of these ultimately died whereas 5 patients survived with aggressive vasodilator therapy. Four patients without crises but with episodic pulmonary hypertension benefitted from pulmonary vasodilator therapy to ease weaning from ventilatory support. Typically, each crisis was associated with a stress event. Crises were difficult to ablate if not rapidly treated and multiple crises would often cluster following an initial event. High dose narcotic (fentanyl) analgesia was found to be important in the postoperative management. Tolazoline and oxygen were the most consistently useful vasodilators, but isoproterenol and nitrates also played a role. Five of the children who died were examined post mortem: histologically, there was increased pulmonary arterial muscularization in 2, in none were there changes of fixed pulmonary vascular disease. The postoperative management must be individualized on the basis of monitored responses of pulmonary circulation.

Biopsy↗
PubMed1991

Surgical treatment of aortico-left ventricular tunnel.

Thirteen children (age range 6 h-11 years, median 4 months) operated upon for aortico-left ventricular tunnel since 1971 are reported. All patients had systolic and diastolic murmurs, 4 of 5 neonates were in severe congestive heart failure. Twelve children had left ventricular hypertrophy on ECG with an ischaemic pattern in the neonates. Chest X-ray revealed cardiomegaly with a broad upper mediastinal shadow from the enlarged aorta. Echocardiography (2DE) revealed a tubular communication between the aorta and the left ventricle bypassing the aortic valve and massive regurgitation through this tunnel demonstrated by Doppler sonography. In 8 patients, the diagnosis was confirmed by angiography. The tunnel arose from the right coronary sinus in 12 and from the left coronary sinus in 1 patient. The tunnel was closed at both ends in 8, at the aortic end only in 3 and at the ventricular end in the remaining 2 cases. One 6-day-old infant, operated upon in 1971 died postoperatively. There was 1 non-cardiac related late death due to a brain tumour. Echocardiographic analysis of left ventricular size and function was carried out in 9 children up to 39 months after surgery. Mild to moderate aortic incompetence was detected during the follow-up period in 2 of 12 patients. All surviving children are leading normal lives.

Aorta↗
PubMed1991

The use of the right atrial flap in total cavopulmonary connection.

A technical modification of total cavopulmonary anastomosis (TCPC) is described. Inferior vena cava (IVC) channel is constructed from the right atrial wall in a fashion similar to Senning's operation. The use of Gore-TexR (W.L. Gore & Associates, Inc.) patch or tube is avoided. We have used the technique in 11 patients between 1988 and 1991 (six complex transpositions or double outlets with one hypoplastic ventricular chamber and/or straddling of the atrioventricular (AV) valve, four double inlet ventricles with pulmonary stenosis, and one tricuspid atresia). Superior vena cava (SVC)/IVC to pulmonary artery gradient was less than 2 mmHg in all patients. SVC/IVC pressure was 10-15 mmHg (mean 12.3 mmHg), transpulmonary gradient 5-8 mmHg (mean 6.4 mmHg). We have not observed any adverse effects such as arrhythmias or increased pleural drainage when we compared those patients with 85 children in whom the TCPC was performed with Gore-TexR patch/tube. The presented technique is simple, avoids the use of anticoagulants, and may have a possible long-term advantage in allowing growth of the IVC channel.

Anastomosis, Surgical↗
PubMed1991

Continuous infusion of interleukin-2 and cyclophosphamide as treatment of advanced cancers: a National Biotherapy Study Group Trial.

We have evaluated the effect of Interleukin-2 [IL-2] after Cyclophosphamide (C) chemotherapy in 41 patients with metastatic cancer. IL-2 was given as a continuous infusion priming cycle 36 hours after C at 1 gm/m2 intravenously. In 39 evaluable patients, there were no complete remissions [CR], 2 partial remissions [PR], and 1 had a minor response [MR]. Stable disease for 30 days was seen in 16 patients whereas 20 progressed. The durations of partial and minor responses were brief, ranging from 1-6 months. Grade 3-4 neutropenia was seen in 41%. This was more severe than seen with IL-2 alone or IL-2 combined with lower doses of C. The marrow suppression was due to the chemotherapy. This combination of IL-2 and C appears to be reasonably well tolerated by patients, but toxicity is greater and the response rate is no better than results achieved by IL-2 alone. Responses of 26 patients with renal cancer appear to be inferior to our historical data using IL-2/LAK cells without C. Immune monitoring demonstrated changes expected with C chemotherapy (i.e., a non-selective decline in immune function). C induced no further differences in IL-2 induced changes in immune function.

Adult↗
PubMed1990

Management of major tracheal hemorrhage after repair of complex congenital heart defects.

Two patients with complex congenital heart defects (a 4-year-old with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction and a 3 1/2-year-old with double-outlet right ventricle, subpulmonary stenosis, and complete atrio-ventricular septal defect) suffered multiple major hemorrhages from the tracheobronchial tree (28 and 7 bleeding events, respectively). Successful management included tracheostomy, sedation and paralysis, systemic hypotension, and systemic hypothermia for a period of seven days. Both patients survived.

Anesthesia↗
PubMed1990

Successful surgical treatment of tracheal compression following right pneumonectomy in infancy. Long-term follow-up.

Two patients (aged 10 and 16 months) underwent right pneumonectomy: one for an oesophageal bronchus, the other for a hypoplastic right lung with sequestration. Both patients subsequently developed severe stridor. The heart rotated to the right and the aortic arch compressed the trachea. This unusual vascular compression was treated by a bypass graft between the ascending and descending aorta and division of the aortic arch between the left carotid and left subclavian artery at the age of 5 years and 4 months, and 20 months respectively. The postoperative recovery was uneventful in the first patient. The second patient required 7 weeks of ventilatory support. Both patients are well (14 and 7 years after surgery). Cardiac catheterisation and angiography in the first patient and Doppler echocardiography in the second demonstrated unrestricted flow through the graft into the descending aorta. Pulmonary function studies showed a restrictive defect with some obstruction in both children. Despite this finding, both patients enjoy a normal life with some sporting activities. The long-term results suggest the effectiveness of this procedure in the treatment of this rare but severe complication of pneumonectomy in infancy.

Aorta↗
PubMed1990

Paralysed diaphragm after cardiac surgery in children: value of plication.

Over a 2-year period (1987-1988), 31 children (3% of 960 operations) were found to have a paralysed diaphragm following cardiac surgery. The median age was 5 months with 65% less than 1 year of age. In the 31 patients, 38 paralysed diaphragms were identified. The phrenic nerve injury was on the right in 8 cases, the left in 16, bilateral in 7 and 40% were related to modified Blalock Taussig shunts. The time to extubation was analysed for each patient in two separate groups: Group A: (greater than 1 year): 11 children of whom 5 were extubated without difficulty, 4 had non-respiratory reasons for prolonged ventilation and only 2 were plicated--both were extubated within 4 days. Group B: (less than 1 year): 20 infants of whom 16 were plicated and 4 were not. Three of the children who were plicated died from cardiac causes. Of the 13 survivors, there were 3 who had other reasons for prolonged ventilation. Thus 10 infants required prolonged ventilation (mean 11 days) because of respiratory difficulties. All underwent plication and were extubated at a mean of 2.4 days postoperatively. The 4 who were not plicated were extubated at a mean of 11 days postoperatively. In infants in whom there is no cardiac cause for failure to wean from ventilation, diaphragmatic paralysis should be suspected and plication performed if not extubated 2 weeks after operation.

Anastomosis, Surgical↗
PubMed1990

Influence of blood withdrawal and anticoagulant on clotting activity, hematologic data, and certain rheologic measurements.

The influence of blood withdrawal (vacuum or slow aspiration) and anticoagulants (ethylenediaminetetraacetic acid [EDTA]; heparin; citrate; a mixture of citrate, theophylline, adenosine, and dipyridamole [CTAD]; and D-phenylalanyl-L-prolyl-L-arginine chloromethyl ketone [PPACK]) on clotting activity, hematologic data, and rheologic measurements (whole blood and plasma viscosity, red cell filtration in one study) were investigated. No difference was found between the two blood withdrawal techniques on the basis of the affected measurements. EDTA appeared to be the best anticoagulant with regard to blood cell preservation and showed the lowest whole blood viscosity over a wide range of shear rates (0.1 to 87.0 sec-1). PPACK was the most potent inhibitor of clotting activity as monitored by fibrinopeptide A concentration. The results suggest that EDTA is probably a reasonable choice for rheologic studies of whole blood and should be combined with PPACK when plasma properties are studied.

Adenosine↗
PubMed1985

Long-term results of the "palliative" Mustard operation.

A long-term follow-up study after 41 palliative Mustard operations for transposition of the great arteries and pulmonary vascular obstructive disease is presented. The operations were performed from 1973 to 1980. Mean pulmonary arteriolar resistance was 13.96 +/- 6.7 Um2. A ventricular septal defect was not closed in 34 patients; in 7 it was created at operation. There were three hospital and two late deaths. Survivors were followed up for 3 to 10 years (mean 76.7 +/- 22.8 months). Before operation 4 children were in New York Heart Association functional class IV and 33 were in class III. Mean hemoglobin concentration was 19.43 +/- 3.14 g/dl and arterial oxygen saturation was 63.44 +/- 11.29%. After operation 18 patients were in functional class I, 17 in class II and only 1 in class III. Hemoglobin level decreased to 14.19 +/- 2.3 g/dl and arterial oxygen saturation improved to 89.12 +/- 7.25%. Cardiac catheterization in 21 survivors confirmed no change in pulmonary artery pressure and resistance. Effective pulmonary blood flow improved from 1.39 +/- 0.39 before to 2.6 +/- 0.78 liters/min per m2 after operation. The palliative Mustard operation carries a low risk and provides excellent symptomatic improvement up to 10 years in patients with transposition of the great arteries and pulmonary vascular disease.

Adolescent↗