A study was conducted to evaluate the ability of a dental rinse to remove dental plaque. The hypothesis was tested that plaque, as a complex soil comprising microorganisms, cell debris, salivary deposits and other ill-defined organic and inorganic components, would be susceptible to removal by a rinse with high detersive action. A rinse was prepared based on the principles applied to formulation of products for cleansing biologic surfaces, including anionic and nonionic surfactants, sodium benzoate, and auxiliary cleansing agents. Subjects randomly selected from a dental clinic population were scored for plaque area on the lingual and buccal surfaces of the Ramfjord teeth using the Turesky modification of the Quigley-Hein Index. The subjects then rinsed 30 seconds with 15 ml of product, and stainable plaque area was scored again. The rinsing reduced average plaque scores by an average of 13-20%, a very high level of significance. A placebo rinse and a conventional mouthwash removed 2.0% and 1.3% stainable plaque, respectively. The experimental rinse substantially increased the number of surfaces that were totally free of plaque.

Adult↗

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Methotrexate therapy for complex graft rejection in pediatric heart transplant recipients. The Pediatric Heart Transplant Team--Loma Linda.

BACKGROUND: We retrospectively reviewed all pediatric heart transplant recipients at Loma Linda University Medical Center between January 1990 and September 1993 to evaluate the efficacy and safety of methotrexate when it is used for the treatment of graft rejection. METHODS: Twenty-eight of 156 patients (18%) received methotrexate therapy. The dose used for recurrent rejection was 10 mg/m2/week given every 12 hours for three doses. Rejection history, complete blood counts, liver function tests, and infectious complications were reviewed. RESULTS: Eighteen patients were treated for recurrent rejection. Methotrexate was begun at a median of 115 days (13 to 1093 days). Older patients were more likely to receive methotrexate (p < 0.01). Efficacy was assessed as rejection episodes (mean +/- standard deviation) occurring in the 2 months before methotrexate administration compared with the 2 months after methotrexate administration and fell from 2.0 +/- 0.2 to 0.6 +/- 0.2 episodes (p < 0.001). The rejection rate (rejections per patient-month) fell in treated patients to a rate similar to patients who did not receive methotrexate. Two patients (11%) died while receiving methotrexate. An additional nine patients were treated for acute rejection with hemodynamic compromise, and one was treated for graft-versus-host disease. The incidence of significant infections was 50% (but no deaths were due to infection) during methotrexate therapy in all patients treated (n = 28). The minimum white blood cell count in the first month of methotrexate therapy occurred at 2 weeks (median of 2700 to 3500 x 10(6) cells/L). Only one patient had elevated transaminase levels. CONCLUSION: Methotrexate is an effective and safe adjunct in the management of chronic pediatric cardiac graft rejection.

Adolescent↗

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Donor shortage: use of the dysfunctional donor heart.

The cause of brain death and the physiologic sequelae of brain death may impair heart function. Pharmacologic attempts to maintain donor viability may further jeopardize myocardial performance and could only be justified if dysfunctional donor organs subsequently prove to recover normal function after transplantation. Survival data on heart transplantation with organs donated from infants with sudden infant death syndrome indicate that prolonged ischemia (cardiopulmonary resuscitation up to 60 minutes) and metabolic abnormalities a priori do not increase the risk of graft failure. To provide a donor organ to infants in immediate peril, we have used donor hearts with documented dysfunction (left ventricular shortening fraction [LVSF] < 28%, wall motion abnormalities, and mitral regurgitation). The results of heart transplantation with use of dysfunctional donor hearts (n = 22, LVSF = 24.5% +/- 3%) were compared with donors with normal left ventricular function (n = 133, LVSF > 28%). Early death (< 30 days) was similar for the dysfunctional donor group (14%) and normal function donor group (11%). Postoperative inotropic support was equally frequent in both groups. Graft function on echocardiography was normal at 30 days after transplantation for both types of donor organs. We conclude that donor hearts with decreased left ventricular function (LVSF 15% to 28% and/or asymmetric wall motion), despite massive inotropic support, can function normally in the recipient. Significant donor mitral regurgitation was seen in grafts that ultimately failed after transplantation. Research into the reversible mechanisms of myocardial dysfunction associated with brain death could enlarge the donor pool.

Brain Death↗

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Growth and neurodevelopmental outcome of infants undergoing heart transplantation.

The purpose of this study was to examine the long-term growth and developmental outcome of infants undergoing heart transplantation. We studied weight, length, and head circumference from birth to 12 months after surgery in 110 infant recipients less than 6 months of age. Forty-eight early transplant recipients (0 to 30 days) were compared with 62 late transplant recipients (31 to 180 days). Late transplant recipients showed less growth in all parameters at the time of transplant. However, by 6 months after transplantation, there were no differences between the two groups. Growth in 20 infants, now 3 to 7 years old, appears normal. Neurodevelopmental outcome was evaluated prospectively in 57 infants. Four months after transplantation, 11 infants (19%) had abnormal neurologic examinations, with generalized hypotonia (64%) being the most common finding. The Bayley Scale of Infant Development was administered to 48 of 57 infants. The Mental Developmental Index averaged 87 (+/- 21) and the Psychomotor Developmental Index averaged 90 (+/- 21). Of 140 infants who have undergone heart transplantation, transient postoperative seizures occurred in 23 survivors (21%) and 10 nonsurvivors (33%). Our findings suggest that growth, neurologic outcome, and development are normal in the majority of infants who undergo transplantation before 6 months of age.

Child↗

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Rejection management and long-term surveillance of the pediatric heart transplant recipient: the Loma Linda experience.

At Loma Linda University Medical Center, 210 heart transplant procedures have been performed on 207 newborns, infants, and children since 1985. Actuarial survival rate at 5 years is 72% for the entire population and 82% for those receiving a transplant during the first month of life. These patients have been managed with a regimen that minimizes long-term steroid use and emphasizes the noninvasive diagnosis of rejection. This article describes in some detail the mechanics of this process. In addition, the rejection history of 154 children undergoing transplantation from 1989 through 1992 was reviewed. The average number of rejection episodes was 1.67 (standard deviation 1.65; median, 1; mode, 0). The vast majority of rejections occur in the first 3 months after transplantation. Long-term freedom from rejection was 19% for newborn recipients, 42% for infants, 25% for older children. Donor/recipient mismatch for gender, race, blood type, Rh factor, and HLA typing did not correlate with rejection history. Older age at transplantation and cytomegalovirus disease were correlated with more frequent rejection episodes. Five patients had posttransplantation coronary artery disease. This was strongly correlated with greater rejection frequency and death from rejection. In addition, there was a trend toward less posttransplantation coronary artery disease with antibody induction therapy, younger age at transplantation, and absence of cytomegalovirus disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

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