Search PubMed⌕ Search

Biomedical subjects

M C Mancini

Publications and source records attributed to M C Mancini.

15 recordsLinked to original sources
PubMed1995

Current trends and considerations in the surgical treatment of coronary artery disease.

Management of coronary artery disease has changed greatly in the past three decades. Surgical treatment has improved, especially with the introduction of bypass conduits, like the internal mammary artery, which possess a patency rate far superior to that of the saphenous vein. Use of this arterial graft has so encouraged surgeons that other autologous arterial grafts are being tried. Grafts from nonautologous sources are being investigated, but none have yet been found to approach the excellent performance of the internal mammary artery. While the surgical treatment for myocardial ischemia has greatly improved, characteristics of the patient population have not. Patients presently sent for surgery are older, in worse general health, and have poorer cardiac function and coronary disease than their counterparts of several decades ago. Nevertheless, expansion of surgical options, including cardiac transplantation has allowed even the highest risk patients to be considered for surgical intervention.

Blood Vessel Prosthesis↗
PubMed1993

Complement receptors in shock and transplantation.

Over the last decade, elegant studies of the basic biologic characteristics of inflammation and tissue injury have implicated leukocyte-mediated vascular and tissue injury in the pathogenesis of a wide variety of immune and inflammatory clinical disorders, including allograft rejection, adult respiratory distress syndrome, and shock. Recognition of the importance of leukocyte adherence to the endothelium in the pathogenesis of these disorders, in combination with advances in cellular and molecular biology, have led to the development of novel therapeutic approaches to the treatment of immune and inflammatory disorders in which leukocytes contribute to vascular and tissue injury. Several of these promising new therapeutic approaches have focused on the complement system. Examples of this therapeutic approach include the use of monoclonal antibodies directed at leukocyte complement receptors and the administration of soluble complement receptors to inhibit the binding of leukocytes to the endothelium. Because of the biologic and significant potential clinical importance of these advances, in this review, we focus on the complement system and complement receptor-mediated tissue injury.

Antibodies, Monoclonal↗
PubMed1992

Serum creatine kinase activity and sensing characteristics after intraoperative arrhythmia induction using implantable defibrillator rate sensing leads.

In 29 patients (24 men, 5 woman, mean age 57 +/- 14 years) we evaluated the effect of intraoperative arrhythmia induction during implantable defibrillator (ICD) placement using alternating current (AC) applied through the epicardial rate sensing leads on acute and chronic pacing thresholds, electrogram amplitudes, slew rates and serum creatine kinase levels. In 15 patients undergoing new ICD implantation, pacing thresholds, electrogram amplitudes, slew rates, and resistances were measured before and following at least three inductions of ventricular fibrillation (VF) using AC applied through the epicardial rate sensing leads. Fourteen patients who underwent VF induction using AC through the epicardial leads during initial implant (mean time of 31 months previously) underwent ICD pulse generator replacement only with parameters measured as above before and after at least two inductions, and these compared to the values at initial implant. In all 29 patients serum creatine kinase levels were obtained before, immediately following, and at 8, 16, and 24 hours after surgery. No significant change in acute pacing threshold, electrogram amplitude, slew rate or resistance occurred. Chronically there was an expected 154% increase in pacing threshold but no significant change in electrogram amplitude or resistance. Serial serum creatine kinase and MB isoenzyme determinations demonstrated no evidence of myocardial necrosis. We conclude that intraoperative arrhythmia induction during ICD implantation using AC applied through the rate sensing leads is a safe and effective technique.

Cardiac Pacing, Artificial↗
PubMed1990

A technique for the prevention of automatic implantable cardioverter defibrillator generator migration.

In order to prevent AICD generator migration in nine patients and correct chronic painful generator migration in three patients, we placed the AICD generator in an absorbable microfibrillar collagen pouch at the time of implant to facilitate fibrous capsule formation. Over a mean follow-up period of 14 +/- 2 months for the new implants, there have been no episodes of generator erosion, migration or infection. The three patients who suffered from generator migration have been symptom free for 12 +/- 2 months. We conclude that use of a microfibrillar collagen pouch at the time of AICD implant is a safe, inexpensive, and effective method for preventing generator migration.

Abdominal Muscles↗
PubMed1986

Assessment of lung injury in the adult respiratory distress syndrome using multiple indicator dilution curves.

To assess its usefulness as an index of lung injury in critically ill patients with respiratory failure, the lung microvascular permeability surface area product for urea (14C-PSu) was measured using a multiple radioisotopic indicator dilution technique in 10 patients with the adult respiratory distress syndrome (ARDS) and in a control population of 5 patients without ARDS. The mean values for 14C-PSu and for extravascular lung water (EVLW) were both significantly elevated in patients with ARDS compared with those in control patients (14C-PSu: 18.7 +/- 4.4 versus 7.6 +/- 0.7, p less than 0.05; EVLW: 676 +/- 55 versus 269 +/- 53, p less than 0.001); 14C-PSu and EVLW were significantly correlated (R = 0.52, p less than 0.001). In the patients with ARDS, 14C-PSu and oxygenation, assessed as the alveolar-arterial oxygen difference, did not appear to be correlated. Repeated measurements of 14C-PSu were variable in the 3 control patients in whom 4 or more measurements were obtained (SD = 50, 57, and 54% of the mean values, respectively); 14C-PSu did not predict clinical outcome assessed by survival of individual patients with ARDS. These data suggest that measurement of 14C-PSu in critically ill patients is a clinically applicable parameter that reflects the degree of microvascular injury in groups of patients. However, our study did not indicate a clear advantage of 14C-PSu over EVLW in assessing lung injury in this patient population. The variability in 14C-PSu control patients also suggests that directional changes in 14C-PSu, as a measure of changes in the degree of lung microvascular dysfunction, should be interpreted with caution.

Adult↗
PubMed1985

Changes in lung vascular permeability after heart-lung transplantation.

We have employed multiple indicator dilution techniques (MID) in six patients after heart-lung transplantation to assess changes in the lung vascular permeability-surface area product for urea (PS). Serial PS values for the patients when normalized to the predicted total lung capacity (TLC) in liters, ranged between 1.04 and 6.27 ml/sec/TLC (patient 1), 0 and 2.76 ml/sec/TLC (patient 2), 0.59 and 2.88 ml/sec/TLC (patient 3), 0.13 and 1.23 ml/sec/TLC (patient 4). The elevated values for PS in patient 1 exceed the lethal range described by K.L. Brigham et al. (J. Clin. Invest. 72:339, 1983) for severe ARDS. This strongly suggests a severely increased lung microvascular permeability in this patient possibly secondary to rejection as indicated by endomyocardial biopsy. PS values for surviving patients 2-6 fell well below the corresponding lethal value for ARDS patients. We conclude that PS urea derived from MID provides an indicator of the status of lung microvascular integrity in heart-lung transplant recipients.

Capillary Permeability↗
PubMed1983

Changes in lung function after routine exposure manipulations during thoracotomy.

The effect of manual retraction and bronchial occlusion upon right lung function during a 2-hr thoracotomy was evaluated in sheep. Group 1 (seven sheep) underwent manual lung retraction. Group 2 (seven sheep) underwent right bronchial occlusion. Group 3 (seven sheep) served as controls. Radioisotopic indicators (51Cr-RBC, 125I-albumin, [14C]urea, 3H2O) were used to assess changes in capillary permeability-surface area product (PS-urea), extravascular lung water (VE), and intravascular blood volume (Vv). Lung water was further quantified by gravimetric technique. Pulmonary vascular resistance increased following thoracotomy in both groups (34% Group 1, 66% Group 2) and compliance decreased (16% Group 1, 33% Group 2). Mean right lung shunt increased in Group 1 from 17 to 37% (P less than 0.05) and for Group 2 from 18 to 36% (P less than 0.02). A reduction (greater than 25%) in both groups for PS-urea and VE occurred (P less than 0.05). The fall in PS-urea and VE and the increase in PVR indicate a reduction in the right lung perfusion for both groups. It is concluded that a similar marked reduction in ventilation, perfusion, and V/Q occurred after reexpansion whether the lung was retracted or the bronchus occluded.

Animals↗
PubMedDate not supplied

Nocturnal eating syndrome: a case report with therapeutic response to dexfenfluramine.

A woman with nocturnal eating syndrome responsive to dexfenfluramine (DXF) is reported. Eating consisted of nightly ingestion of large amounts of high-calorie meals and often sloppy meal consumption or preparation. Amnesia for the episodes was total. Anorexigenic medications produced partial control of her daytime carbohydrate craving and no nocturnal eating change. DXF stopped her eating behavior completely. Nocturnal eating herein meets all 4 DSM-III-R diagnostic criteria for binge eating disorder. 5-HT role in neural process controlling sleep-wakefulness (SW) has been widely shown. A 5-HT agonist like DXF could determine changes in the SW processes producing the therapeutic outcome reported herein. However, a specific DXF effect on the behavioral control of carbohydrate ingestion can not be dismissed.

Adult↗
PubMedDate not supplied

Assessment of pulmonary vascular injury.

The assessment of pulmonary injury in experimental and clinical situations remains a challenge. A method of quantifying pulmonary vascular aberrations in animal models and human clinical situations is described. A multiple-indicator dilution technique is employed to assess changes in lung capillary permeability--surface area product, extravascular lung water, and cardiac output. A mixture of 51Cr-RBC, 125I-albumin, tritiated water, and [14C]urea is injected into a central vein. Samples of the subject's blood are collected at timed intervals and counted for beta and gamma activity. Time concentration curves for each isotope are constructed. The capillary permeability--surface area product is calculated from the extraction pattern for [14C]urea. Extravascular lung water is calculated from the extraction pattern of tritiated water and cardiac output is calculated from the inverse of the area under the 51Cr curve. Normal reference curves are constructed for all subject groups. Significant changes occurred in capillary-permeability surface area product and extravascular lung water in various experimental models producing injury, in the patient population manifesting adult respiratory distress syndrome, and in those patients who have received cardiopulmonary transplants. The multiple-indicator dilution technique represents a sensitive tool for evaluating pulmonary vascular changes.

Animals↗
PubMedDate not supplied

Dactylaria infection of a human being: pulmonary disease in a heart transplant recipient.

We describe a case of pulmonary abscess caused by Dactylaria constricta in a heart transplant recipient. A 30-year-old man with a 1-month history of fever and cough was found by computed tomographic scan to have a cavitary lesion in the lingular segment in the upper lobe of his left lung. Culture of a needle biopsy specimen yielded a pure culture of D. constricta. The patient was successfully treated with systemic amphotericin B therapy, which resulted in resolution of the clinical symptoms and of the cavitary lesion.

Adult↗
PubMedDate not supplied

Successful treatment of acute humoral rejection in a heart transplant patient.

Eight months after undergoing orthotopic heart transplantation, a patient had hypotension and biventricular heart failure. Endomyocardial biopsy specimens showed a modest cellular infiltrate, predominantly of plasma cells, and progressive myocyte injury, suggesting a humoral rejection process. The patient was treated with Minnesota antilymphoblast globulin and aggressively with plasmapheresis, resulting in evidence of myocyte repair, improved hemodynamics, and long-term survival.

Acute Disease↗