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Biomedical subjects

M Hakim

Publications and source records attributed to M Hakim.

At least 37 records · Page 2Linked to original sources
PubMed1987

Heart and lung transplantation in patients with end stage lung disease.

Combined heart and lung transplantation was used to treat seven patients with end stage lung disease. All were severely disabled, and their disease carried a poor prognosis. Six patients were well four to 33 months after transplantation. One patient died after 44 days from a primary cytomegalovirus pneumonia transmitted from the donor. All the survivors had normal exercise tolerance and greatly improved lung function. It is concluded that heart and lung transplantation is a suitable treatment for selected patients with end stage chronic lung disease.

Adult↗
PubMed1987

Distant procurement of organs for clinical heart-lung transplantation using a single flush technique.

A more widespread application of combined heart-lung transplantation (HLT) for the treatment of pulmonary vascular disease has been limited by the lack of a simple and inexpensive method for preserving donor organs for transplantation from distant hospitals. Of the 12 HLT patients treated at Papworth Hospital, the last 7 involved distant procurement of donor organs. For this, a single flush hypothermic system was used, with a Ringer's solution containing albumin, mannitol, prostacyclin, and heparin. This was preceded by a prostacyclin infusion into the donor's pulmonary artery. A retrospective comparison has been made of the post-operative pulmonary function between the HLT patients with distant procurement, those with near procurement of organs, and a group of patients who underwent coronary artery bypass graft (CABG) over the same time span. The mean ischemic time for distant-procurement patients was 110 (+/- 10) min, compared with 50 (+/- 0.5) min for near procurement. During the initial 18 hr postoperatively, the alveolar-arterial oxygen gradients (A-aDO2) for both groups of HLT patients and the CABG patients were closely comparable. Two near-procurement patients died: 1 from tracheal dehiscence, and 1 from cytomegalovirus (CMV). One distant-procurement patient died of CMV. All the others recovered fully and are alive and well at home. No patient developed a classical reimplantation response, and pulmonary function in the distant-procurement group compared closely with the CABG patients. These observations suggest that a simple single flush preservation system can effectively extend the pulmonary ischemic time so facilitating distant organ procurement.

Coronary Artery Bypass↗
PubMed1986

Broad spectrum antibiotics as short term prophylaxis for elective abdominal hysterectomy: comparison of mezlocillin, cefazolin and placebo.

A prospective randomized placebo controlled double-blind study was conducted in order to evaluate the effect of short term perioperative antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. Fifty-two patients received 3 doses of 0.5 g cefazolin, 54 patients received 3 doses of 1 g mezlocillin and 53 patients received placebo. Postoperative infectious morbidity and the rate of pelvic cellulitis were significantly lower in either antibiotic group in comparison to the placebo group, but neither drug proved to be superior in this respect. The fever index was significantly lower in the mezlocillin group in comparison to both cefazolin and placebo groups. It was thus concluded that antibiotic prophylaxis has a beneficial effect on patients undergoing abdominal hysterectomy and both drugs--cefazolin and mezlocillin--seem to be equally effective.

Cefazolin↗
PubMed1986

Empyema thoracis and infected pneumonectomy space: case for cyclical irrigation.

Between January, 1974, and July, 1984, 63 cases of pleural empyema were treated at Papworth Hospital, Cambridge. Twenty-one of these patients had cyclical irrigation of the empyema cavity, and 23 patients underwent decortication. The two groups were comparable in age and sex distribution. There was no significant difference in the duration of empyema between the two groups (7 and 10.4 weeks for the patients having irrigation and decortication, respectively) (p greater than 0.05). There was no correlation between the duration of empyema and the length of hospital stay in either group (r = 0.007 and 0.005 for the irrigation and decortication groups, respectively). However, both the mean duration of tube drainage (7 and 13.5 days) and the length of hospital stay (12.3 and 17.3 days) were significantly shorter in the irrigation than in the decortication group (p less than 0.01). There were two failures in the decortication group and three in the irrigation group. Cyclical irrigation was also used in 4 patients with infected pneumonectomy space with satisfactory results. We conclude that cyclical irrigation is an effective, simple, and time-saving technique that does not preclude the use of other procedures if it fails.

Adolescent↗
PubMed1986

Transvenous lung biopsy in the pig.

At present there is no satisfactory technique for repeated lung biopsy in recipients of heart-lung transplants. A new technique for lung biopsy, which might be adopted for this purpose, has been developed. A Teflon sheath is inserted through the jugular vein into the pulmonary artery with the aid of a balloon catheter. A flexible biopsy forceps is then introduced through the sheath into the pulmonary arterial tree and advanced into the periphery of the lung, where biopsy samples are taken. The procedure was attempted in 14 pigs. Initially crocodile jaw (two pigs) and fenestrated cups forceps (five pigs), which are currently in use for transbronchial lung biopsy, were used. Subsequently the biopsy forceps was modified and the jaws were replaced by a cutting needle mechanism (six pigs). Out of the 13 animals in which the procedure was technically possible, lung parenchyma was obtained from nine and pulmonary arterial wall from 11. One animal died shortly after the procedure. The cause of death could not be determined with certainty at postmortem examination. There was, however, a small tear on the surface of the lung, which could have produced a tension pneumothorax. The other 12 animals recovered from the procedure. They were killed 24 hours later and postmortem examination was carried out. One animal in which the crocodile jaw forceps had been used had a haematoma in the lower lobe (3 X 3 X 4 cm) and 100 ml of blood in the pleural cavity. In the other 11 animals, in which the fenestrated cups or the cutting needle forceps had been used, the intrapulmonary haematomas were 1-2 cm in diameter and the pleural surface was intact. It is concluded therefore that transvenous lung biopsy is feasible and that this procedure might find an application in monitoring rejection in recipients of heart-lung transplants.

Animals↗
PubMed1985

The value of laparoscopy in women with chronic pelvic pain and a "normal pelvis".

During the period January 1976--December 1982 laparoscopy was performed on 186 women complaining of pelvic pain of at least 6 months' duration. In all these cases, the routine pelvic examination and other medical and laboratory tests were negative. Laparoscopy revealed pelvic pathology in only 8.2%: in the vast majority (91.8%) entirely normal pelvic organs were seen. Evidence from the literature is compiling as to the psychogenic origin of most cases of chronic pelvic pain. Recently, it has been shown that laparoscopically negative pelvic pain can be relieved or abolished by psychological intervention. Since pathological findings on laparoscopy are of very low percentage and since the pain is psychogenic in most cases, the value of routine laparoscopy in chronic pelvic pain is very low. We propose that all women with chronic pelvic pain and normal pelvic examination should undergo psychological assessment and treatment if necessary. Laparoscopy should then be reserved for only those cases who show no amelioration on psychological intervention. Our estimation is that this approach would reduce the rate of laparoscopies performed for chronic pelvic pain by about 90%.

Adult↗
PubMed1985

Short-term prophylactic antibiotic for elective abdominal hysterectomy: how short?

A prospective double-blind study was conducted in order to evaluate the effect of antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. In the first stage of the study, 116 patients received, on call to the operating room and subsequently 8 and 16 h post-operatively, cefazolin sodium or placebo. In the second stage of the study, 90 patients received the same antibiotics, but treatment was extended to 6 doses, 8 h apart. Of the 53 women who received placebo, 27 (50.9%) became morbid, while only 15 of the 63 (23.8%) who received 24 h prophylaxis were classified as morbid (p less than 0.005). By extending the prophylactic treatment to 48 h further reduction of the morbidity was achieved. Of the 90 patients only 11 (12.2%) became morbid (P less than 0.005). When morbidity rates were compared between different ethnic groups, over-weight and normal weight patients, pre- and post-menopausal women, it was not possible to define a group which is at a higher risk for post-operative morbidity. It was thus concluded that prophylactic antibiotics should be administered routinely to all patients undergoing abdominal hysterectomy, preferably for 48 h.

Adult↗
PubMed1985

Role of automatic staplers in the aetiology of bronchopleural fistula.

The incidence of bronchopleural fistula in 130 patients who had pneumonectomies has been reviewed. Patients were divided into two groups according to the type of automatic stapler used to close the bronchus. From January 1979 to February 1982 the parallel jaw stapler (TA-55) was used in 71 patients (group 1). The new hinged jaw stapler (Premium TA-55) was used in 59 patients from March 1982 to April 1984 (group 2). The incidence of bronchopleural fistula was 4.2% in group 1 and 15.2% in group 2 (p less than 0.05). The two staplers were tested on a cadaveric bronchial preparation. Radiographs were subsequently taken of the stapled segments. These showed that with the Premium TA-55 closure of staples was not uniform, being incomplete near the hinge unlike the old style TA stapler, which achieves complete and uniform closure of the staples. It is concluded that this undoubtedly contributes to the significantly higher incidence of bronchopleural fistula, and that the new hinged jaw stapler in its present design is not recommended for use during pneumonectomy.

Bronchial Fistula↗
PubMed1985

Haemodialysis and haemofiltration on cardiopulmonary bypass.

Over a three year period we have used haemodialysis and haemofiltration in parallel with cardiopulmonary bypass in 26 patients. Impaired renal function and excessive fluid retention have been the main indications. Patients on haemodialysis programmes for end stage renal failure did not require further dialysis until at least the third postoperative day, when they could tolerate the haemodynamic disturbance of dialysis. In the other patients these techniques proved valuable in reversing the effects of haemodilution and in controlling the concentration of serum potassium. Our experience has confirmed that haemodialysis and haemofiltration in parallel with cardiopulmonary bypass are useful adjuncts in the perioperative management of patients with impaired renal function undergoing open heart surgery. The techniques are also effective in correcting the fluid retention and biochemical imbalance in patients with congestive cardiac failure, including those with heart transplants.

Adolescent↗
PubMed1985

Significance of donor transmitted disease in cardiac transplantation.

Infectious complications constitute a major cause of morbidity and mortality after heart transplantation. Those infections transmitted with the transplanted heart are potentially avoidable. Cytomegalovirus infections and toxoplasmosis occupy a prominent position in this category. The outcome of transplanting hearts from donors previously exposed to these infections depends largely on the existing immune status of the recipient. This paper is a retrospective study on the incidence of Toxoplasma gondii and cytomegalovirus infections in patients undergoing heart and heart-lung transplantation at Papworth Hospital, Cambridge.

Adolescent↗
PubMed1985

Is cyclosporine's nephrotoxicity related to its immunosuppressive effectiveness?

A fatal early acute rejection occurred in a heart allograft recipient immunosuppressed with Cyclosporine. This failure to prevent rejection in spite of satisfactory plasma levels of Cyclosporine was associated with total absence of renal impairment. The latter has always been present in our experience. The absence of immune and nephrotoxic effects raises the question of a biological defect in this patient, possibly a lack of specific receptors for Cyclosporine.

Cyclosporins↗
PubMed1984

Is serum free estriol measurement essential in the management of hypertensive disorders during pregnancy?

A prospective study of antepartum fetal evaluation of 306 randomized hypertensive pregnancies was carried out. One hundred and fifty-four patients (group 1) were managed in accordance with a protocol (protocol A) which included non-stress test (NST), oxytocin challenge test (OCT), serum unconjugated (free) estriol measurements (E3), and ultrasound measurement of the fetal head-to-abdomen circumference ratio (H/A c.r.). A second group (group 2), composed of 152 patients, was managed using another protocol (protocol B) which included the NST, OCT and ultrasound measurement of the fetal head-to-abdomen circumference ratio (H/A). We found a good correlation between the serial normal tests and the outcome of pregnancies. We obtained good results in patients with abnormal NST-OCT and meconium-stained amniotic fluid and in patients with repeated abnormal NST-OCT with clear amniotic fluid due to active management by early deliveries ignoring fetal lung maturity. This management increased the rate of cesarean section and prematurity. There was a low correlation between patients with abnormal serum free estriol as the only antepartum pathological test and the appearance of intrapartum fetal distress, low birth weight and perinatal morbidity and mortality. The contribution of serum free estriol (E3) measurements in such patients was only of value in cases of intra-uterine fetal growth retardation, but its prediction rate was less than that of ultrasound measurement of head-to-abdomen circumference ratio. Our results indicate that hypertensive pregnancy management without serum free estriol measurement may be valuable and safe.

Estriol↗