Renal function of transplanted kidneys harvested during cardiopulmonary bypass with profound hypothermia.
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Biomedical subjects
Publications and source records attributed to P Lang.
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Twenty-eight children who underwent corrective cardiac surgery in early infancy had developmental evaluations to explore whether cardiopulmonary bypass perfusion variables are associated with later cognitive function. All had transposition of the great arteries repaired by the arterial switch operation using deep hypothermic circulatory arrest. The mean duration of deep hypothermic circulatory arrest was 64 +/- 10 minutes (mean +/- SD). Median age at repair was 4 days (range 1 to 125 days). Tests of development were administered at age 7 to 53 months: Bayley Scales for children younger than 30 months of age (n = 18) and McCarthy Scales for older children (n = 10). Overall cognitive development score was 101.2 +/- 11.1. Duration of deep hypothermic circulatory arrest was not associated with performance. However, for core cooling periods of less than 20 minutes' duration, shorter cooling periods were associated with lower scores (r = .85, n = 11, P less than .001). These data suggest that patients undergoing relatively long periods of deep hypothermic circulatory arrest may require some minimum time of cardiopulmonary bypass cooling to avoid central nervous system injury.
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We studied 129 AIDS patients with suspected or proved intracranial manifestations of the disease. The purpose of this study was to compare the diagnostic sensitivity of unenhanced and contrast enhanced CT and unenhanced T2-weighted MR. In 35/129 patients CT and MR findings were normal. In 37/129 patients equivalent findings were obtained with both methods. Although CT and MR demonstrated intracranial pathology in 25 cases, MR was clearly superior. Six of these cases had solitary lesions in CT, while MR demonstrated multiple lesions. MR detected more foci than CT. In 24 patients with normal CT, MR detected intracranial manifestations of AIDS, namely solitary lesions in 8, multiple lesions in 12 and meningeal alterations in 4 patients. In only 8 patients with normal MR findings, CT revealed pathological contrast enhancement in 2 and parenchymal calcifications in 6 patients. Thus, in 20% of our patients MR but not CT was diagnostic. In another 20% MR provided additional diagnostic information. In conclusion, MR is recommended as the imaging modality of choice in AIDS patients with non-conclusive cranial CT.
14 patients with orthotopic liver transplantation were prospectively studied with MR imaging. MR imaging demonstrated a perivascular collar surrounding central portal venous branches in 14 patients. The perivascular collar had low signal intensity on T1-weighted and high signal intensity on T2-weighted images. In 10 of the 14 patients, a perivascular collar was also observed around peripheral portal venous branches. The perivascular collar is probably caused by intraoperative interruption of hepatic lymph vessels and resultant impaired lymph drainage. It is a normal postoperative phenomenon in hepatic transplants. MR imaging is particularly useful in the distinction of postoperative hematoma from other intra- and extrahepatic fluid collections and may provide a noninvasive assessment of liver transplant rejection.
The in vitro and in vivo influence of interleukin-2 (IL-2) on 2',5'-oligoadenylate (2-5A) synthetase activity and natural killer (NK) activity of peripheral mononuclear blood cells (PBMCs) was investigated. Incubation of PBMCs in vitro with IL-2 resulted in a considerable secretion of interferon-gamma (IFN-gamma) and in a significant elevation of 2-5A synthetase activity, as well as NK activity. Neutralizing monoclonal anti-IFN-gamma antibodies inhibited the elevation of 2-5A synthetase activity, but not the IL-2-induced augmentation of NK activity. Additionally, 2-5A synthetase and NK activity of PBMCs was measured in a child with neuroblastoma that was treated with recombinant IL-2 by continuous intravenous application. During the treatment, NK activity against the NK-sensitive cell line K 562 and against autologous tumor cells was not augmented. However, a significant increase of 2-5A synthetase activity in PBMCs was observed during IL-2 treatment, whereas there was no detectable serum level of IFN-gamma. We conclude that measuring 2-5A synthetase activity in patients treated with IL-2 may be helpful in monitoring the immunomodulatory effects of IL-2 on immune effector cells.
This study compared the depressive symptoms of 36 ICU nurses to 23 non-ICU nurses. The study was conducted in a pediatric setting where critically ill children may present unique demands. The ICU nursing staff had a significantly higher frequency (28%) of symptoms consistent with a depressive disorder than either the age group norm (12%) or the non-ICU nurses (13%). This finding suggests a continued need for investigation into the stresses associated with the delivery of critical care.
Segmental spinal instability was evaluated with magnetic resonance (MR) imaging, computed tomography (CT), and conventional radiography in 33 patients who had undergone surgical spinal fusion. In 16 of the 19 patients who had a diagnosis of solid fusion, the immobilized vertebral bodies demonstrated areas of high signal intensity on images with short repetition time (TR) and echo time (TE). The signal intensity of these areas was either less intense or normal on images with long TR and TE. In 10 of the 14 patients with segmental instability at the fusion site, subchondral vertebral bands of low signal intensity were shown on short TR/TE images, which demonstrated high signal intensity on long TR/TE images. All but two of the patients showed vertebral signal changes 12 or more months past fusion or onset of clinical symptoms. The vertebral MR signal intensity in solid lumbar fusions might be related to marrow composition changes resulting from decreased biomechanical stress, while the vertebral signal intensities in patients with unstable fusions might be related to reparative granulation tissue, inflammation, edema, and hyperemic changes. Magnetic resonance imaging appears to be unique in its assessment of functional fusion stability. Magnetic resonance may be most useful in patients symptomatic of fusion pseudarthrosis in whom conventional radiography and CT fail to demonstrate anatomic disruption.
Salivary components (proteins, albumin, IgA1, IgA2, IgG, IgM, beta 2-microglobulin, neopterin and peroxidase) were investigated in 3 adult types of primary glomerulonephritis (PGN): IgA mesangial glomerulonephritis (IgAGN; n = 14); idiopathic membranous glomerulonephritis (n = 8); idiopathic nephrotic syndrome (INS; n = 14), and a control group (n = 11). Salivary IgA1 levels were significantly increased in all these PGN whereas salivary IgA2 levels were only higher than controls in INS. Albumin and proteins did not differ between PGN and controls, while the IgA1 + IgA2/protein ratio was significantly increased in these 3 PGN. Salivary neopterin levels were enhanced in the 3 types of PGN, whereas beta 2-microglobulin levels were not. The other salivary components did not differ from controls. These results demonstrate the nonspecificity of the IgA increase at mucosal sites previously found in IgAGN and raise the hypothesis of an activation of mucosal immunity of PGN or of a disturbed isotypic network or lymphokine secretion in these diseases.
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Authors report on a foot deformity, that can be considered as literary rarity and on its operative treatment. The alteration described was unusual because of the flexion contracture beside the valgus position of the hallux. The aim of the operative procedure described was the correction of the position of the hallux and the improvement of the metatarsalgia, causing nearly complete inability of walk.
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The present study was undertaken to determine whether a correlation exists between localized magnetic resonance image (MRI) signal behavior and specific histopathologic features of femoral head osteonecrosis. Contiguous, 5-mm coronal MRI sections were compared with corresponding histologic sections from six surgically excised femoral heads. After identifying specific areas of interest on the images, signal intensity was evaluated, both subjectively and objectively, and T1 and T2 relaxation times were calculated. Mean values for these data were compared among the following histologic categories: normal bone, unrepaired dead bone and marrow, unrepaired dead bone with marrow replaced by amorphous debris, and zones of repair. For each type of tissue, MRI signal intensity on T1- and intermediately T2-weighted images behaved in a distinctive fashion. Active repair tissue could be differentiated from both necrotic bone and normal bone by a tendency for the signal to increase in intensity on intermediately T2-weighted images. These findings suggest that MRI may provide a noninvasive means of quantitatively analyzing the volume and spacial distribution of repair tissue in osteonecrotic femoral heads. In clinical practice, such analysis may lead to improvements in disease staging and treatment planning.
22 patients with intrathoracic malignant tumors suspected of invading the chest wall were examined with CT and MRI. Chest wall invasion was operatively confirmed in 19 cases and excluded in the other 3 cases. CT showed tumor infiltration of the chest wall in 14/19 cases, no morphological changes in 5/19 cases. Thoracic wall invasion was demonstrated by MR in all 19 cases. Typical MR finding of malignant invasion was local lesion within the chest wall showing high signal intensity in post-Gd T1-weighted images and in T2-weighted images. Reactive inflammatory changes as well as malignant infiltration of the pleura showed high signal intensity on enhanced T1-weighted images and on T2-weighted images.