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Biomedical subjects

M Yacoub

Publications and source records attributed to M Yacoub.

At least 379 records · Page 21Linked to original sources
PubMedDate not supplied

Medium-term results of combined heart and lung transplantation for emphysema.

Between December 1983 and April 1989, 222 combined heart and lung transplant operations were performed for treatment of pulmonary vascular disease and parenchymal lung disease at Harefield Hospital. Seventeen of these patients had emphysema, and 11 of them were followed up for a minimum of 1 year. There were nine male and two female patients. Their mean age was 39 (range, 32 to 54) years. Seven had alpha 1-antitrypsin deficiency. Six patients were receiving continuous oxygen therapy, and two patients were dependent on a ventilator. Postoperatively, the patients' lungs were ventilated for a median of 3 days (range, 24 hours to 2 weeks). Two patients subsequently required further periods of ventilation. Immunosuppression consisted of azathioprine and cyclosporine. Three patients also received low-dose oral steroids. There was one early death, which occurred on the second postoperative day. The remaining patients were followed up for 12 to 53 (mean, 22) months. One patient had cytomegalovirus pneumonitis 6 weeks postoperatively that responded to treatment. There was one late death at 14 months after reoperation for treatment of obliterative bronchiolitis. The overall survival was 91% at 1 year. All survivors achieved an excellent level of rehabilitation. It is concluded that the medium-term results of heart and lung transplantation for treatment of emphysema are good and that patients with alpha 1-antitrypsin deficiency may undergo transplant procedures without substitution therapy.

Adult↗
PubMedDate not supplied

Differential effect of hypothermia on the vascular tone and reactivity of the human coronary artery and graft vessels.

Hypothermia may contribute to vascular spasm during bypass surgery. The effect of cooling on the reactivity of the human coronary artery (CA), saphenous vein (SV) and internal mammary artery (IMA) was studied in vitro. In CA and IMA cooling diminished the resting tension and the contraction to potassium, noradrenaline and 5-hydroxytryptamine. In contrast, in SV the contraction to noradrenaline and 5-hydroxytryptamine was augmented by cooling. The effect of cold was reversible. These results demonstrate different effects of hypothermia in CA and the graft vessels. Thus, hypothermia augments the receptor-mediated contraction in SV but depresses it in IMA which thereby resembles CA. The difference is most marked in the contractile response to 5-hydroxytryptamine, which may accumulate during surgery. This may contribute to spasm in the saphenous vein grafts and may be involved in the mechanisms responsible for the inferior patency of SV compared to IMA as a graft vessel.

Adolescent↗
PubMedDate not supplied

Factors influencing the development of hypertension after heart transplantation.

In this study we investigated the factors influencing the development of hypertension in 488 consecutive heart transplant recipients. The cumulative probability of hypertension (blood pressure persistently above 150/95 mm Hg) developing was 52% at 1 year, 67% at 2 years, 73% at 3 years, and 77% at 4 years after transplantation. The incidence was higher in patients receiving cyclosporine and azathioprine compared with those receiving prednisone and azathioprine immunosuppression. The dose of cyclosporine used did not appear to influence the development of hypertension. Intermittent steroid exposure did not increase the incidence in the cyclosporine group. Male transplant recipients and those older than 20 years appeared more prone to the development of hypertension. A family history of cardiovascular disease also increased the incidence. Preoperative and postoperative kidney dysfunction and transplantation because of ischemic heart disease did not appear to affect the incidence of hypertension. Donor characteristics, including the use of hearts from donors who weighed more than the recipients and from patients dying of spontaneous intracranial hemorrhage, did not appear to increase the incidence of hypertension after heart transplantation.

Adult↗
PubMedDate not supplied

[Occupational lead poisoning in potters].

Eleven potters working in the different workshops have been explored in search of case of occupational lead intoxication linked with the excessive use of a lead based varnich. The finding confirm biological exposure of the eleven potters working in the craft industry named "MOTLI" and so despite a poor clinical symptomatology. In conclusion the authors emphasize the need to respect elementary prevention measures.

Adult↗
PubMedDate not supplied

The influence of acute preoperative pulmonary infarction on the results of heart transplantation.

The presence of acute pulmonary infarction is not uncommon in severely ill patients and is considered by some to be a contraindication to heart transplantation. It has been our policy to accept these patients for operation. The purpose of this investigation is to examine the results of this policy in patients receiving immunosuppression with cyclosporine A and azathioprine. Between September 1982 and April 1985, eight patients undergoing heart transplantation demonstrated clinical and radiographic evidence of acute preoperative pulmonary infarction. These patients represented 5.5% of our heart transplantation population during this period (total = 145). The age range in these eight patients was from 22 to 55 years. Congestive cardiomyopathy was present in four patients, and four patients had ischemic cardiomyopathy. All patients were New York Heart Association functional status class IV. Five of the eight patients were on inotropic support, and one patient had associated renal failure. Pulmonary infarcts were located in the right, middle, or lower lung field in seven patients and in the left lower lung field in one patient. All patients were treated perioperatively by intensive physiotherapy and specific antibiotics. In four patients the lesions resolved on medical treatment alone. Three patients developed extensive empyema and required chest drainage with or without decortication. Two of these patients survived with complete resolution of the lung lesions, and one patient died from prolonged renal failure and sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗