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Biomedical subjects

N Zuhdi

Publications and source records attributed to N Zuhdi.

At least 19 recordsLinked to original sources
PubMed1992

Donor organ availability.

As the results of organ transplantation show steady improvement, we have seen a marked increase in the number of potential organ recipients. During this time however, the number of donor organs becoming available has remained little changed. The reasons for this phenomenon and some potential solutions for improving the supply of donor organs are reviewed.

Attitude to Health↗
PubMed1991

Triiodothyronine in the recovery of stunned myocardium in dogs.

Two groups of dogs were subjected to a 15-minute period of regional myocardial ischemia by snaring the left anterior descending coronary artery proximal to its first diagonal branch. After release of the snare, the dogs were given either placebo (group 1: n = 7) or triiodothyronine (T3) therapy (group 2: n = 6). The dose of T3 given was 0.2 microgram/kg at 30-minute intervals to a total of six doses. Plasma free T3 level fell significantly during the ischemic period in both groups and continued to fall after reperfusion in group 1. In both groups, cardiac function deteriorated significantly during the period of ischemia and rapidly returned to control level after reperfusion. After 90 minutes of reperfusion, however, deterioration of left ventricular function was observed in group 1 and was significantly worse than in group 2, in which hemodynamic function was maintained and, in fact, improved to levels superior to control. It is suggested that T3 therapy may be worthy of trial in patients in whom reperfusion of the myocardium takes place after a relatively short ischemic period (the "stunned myocardium").

Animals↗
PubMed1991

Diagnostic assessment of macrophage phenotypes in cardiac transplant biopsies.

Forty-one endomyocardial biopsies of the right interventricular septum have been investigated in 24 immunosuppressed patients after orthotopic heart transplantation. Monoclonal antibodies 27E10, 25F9, and RM3/1, which react with different macrophage phenotypes, and antisera MRP-8 and MRP-14, specific for proteins expressed on endothelial and monocyte cell surfaces in inflammation as well as markers for CD4+ and CD8+ T-lymphocytes, were employed in an indirect immunoperoxidase staining technique. This methodology permits more physiological recognition of the inflammatory process within the myocardium. It was possible to verify and to distinguish acute early, late and down-regulatory stages of inflammation in 33 biopsies (80%). No evidence of inflammation was found in seven biopsies (17%). Conventional histopathology with haematoxylin-eosin and Masson's trichrome was performed simultaneously, and demonstrated inflammation to be present in 23 of 41 biopsies (56%). An important findings is that CD4+ and CD8+ lymphocytes were absent in 15 of 41 specimens (37%) although there was inflammation proven by the presence of different macrophage phenotypes. The results indicate the necessity of long-term serial investigations of the physiological role of specific inflammatory macrophage phenotypes during the rejection process. It is concluded that the phenotyping of macrophage and endothelial cell differentiation antigens offers a sensitive approach to assess diagnosis of myocardial inflammation as a consequence of ongoing rejection in cardiac allografts.

Antibodies, Monoclonal↗
PubMed1991

The gastrointestinal management of patients undergoing heart transplantation.

Between March 1985 and December 1989, 86 patients underwent heart (80) or heart-lung (6) transplantation. Thirty-seven (43%) developed one or more significant gastrointestinal problems. Dyspepsia and gallbladder disease were common, but easily managed. Cytomegalovirus disease occurred in 25 patients (29%) and required aggressive investigation and early therapy with ganciclovir; all patients so treated responded satisfactorily. Features of acute peritonitis were seen in 6 patients and required exploratory laparotomy in 4. Non-Hodgkin's lymphoma of the stomach in one patient has regressed following a combination of reduction in immunosuppressive therapy and a course of chemotherapy. The development of hepatitis or severe liver dysfunction of unknown cause has been associated with significant morbidity and mortality. Since this study was undertaken, the incidence of gastrointestinal complications has been greatly reduced by modifications to our immunosuppressive and anti-infection prophylactic drug protocols. Nevertheless, such complications still occur and it is important that the gastroenterologist should understand the need for urgent and intensive investigation and therapy.

Female↗
PubMed1990

Improved cardiac allograft function following triiodothyronine therapy to both donor and recipient.

Brain death is associated with neuroendocrine changes, in particular with a significant reduction of plasma-free triiodothyronine (T3) that results in impaired aerobic metabolism. Myocardial energy stores are reduced and tissue lactate increased. Cardiac function deteriorates. Similar metabolic changes are seen in patients undergoing open-heart surgery on cardiopulmonary bypass, including those undergoing heart transplantation. Therapy with T3 leads to a reversal of these metabolic changes, resulting in improved cardiac function. One hundred and sixteen consecutive potential donors have been so treated, as have 70 of the recipients. Immediate posttransplant cardiac function was good in all but 3, and these hearts recovered to normal within a maximum of 24 hr of mechanical support. In 2 small randomized trials in patients undergoing myocardial revascularization on cardiopulmonary bypass, postoperative T3 therapy was associated with a reduced need for inotropic support and diuretic therapy in the first study and improved cardiac output in the second study.

Adenosine Triphosphate↗
PubMed1990

Experience with cardiorespiratory support devices in patients undergoing heart and heart-lung transplantation.

During the 2-year period 1987 through 1988, 124 patients were assessed for heart or heart-lung transplantation. Sixty were accepted for heart transplantation, of whom 49 received transplants. Nine required pretransplant intra-aortic balloon pump support (+/- positive-pressure ventilation) for periods ranging from 2 to 15 days (mean 5 days). One patient was supported successfully by a pneumatic biventricular assist device for 70 days pretransplant. The 30-day survival in this group of 10 critically unstable patients was 100% and the 6-month survival 90% (one death). This experience compares well with survival rates of 100% at 30 days and 92% at 6 months in the 39 patients who required no form of pretransplant circulatory support. The biventricular assist device also has been used in 2 other patients; one did not survive to transplant and the other was deemed unsuitable by virtue of cerebral injury. Extracorporeal membrane oxygenation supported 2 posttransplant patients (one heart and one heart-lung) with grossly impaired pulmonary function for periods of 5 and 2 days respectively, but both died before lung function had recovered.

Adult↗
PubMed1989

Experience with endomyocardial biopsy in 23 patients with heart transplants.

In the 33-month period April 1985 to December 1987, endomyocardial biopsy was performed 314 times in 23 patients with orthotopic (21) or heterotopic (2) heart transplants at Baptist Medical Center. The technique is described. Adequate tissue was obtained in 99% of cases and there was only one complication from the procedure. Mild to severe acute rejection was seen in 105 specimens (33%). The histopathological interpretation has proved invaluable in the care of patients with heart transplants.

Biopsy↗