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Biomedical subjects

P Lang

Publications and source records attributed to P Lang.

At least 361 records · Page 20Linked to original sources
PubMed1984

Results of the Senning operation for transposition of the great arteries with intact ventricular septum in neonates.

In spite of an adequate balloon atrial septostomy, some neonates (less than 28 days of age) with transposition of the great arteries and intact ventricular septum (TGA, IVS) remain hypoxemic and acidotic and require operative treatment. Our entire experience with the Senning operation in neonates with TGA, IVS is reviewed. From March 1978 to March 1983 there were 104 infants who underwent the Senning operation for TGA, IVS. Of these, 19 were neonates (18%). The mean age at operation was 12 days (2 to 24) and mean weight was 3.52 kg (3 to 4.38). Two died early (10%) and one died late (5%). The last 16 are alive and well. Causes of early mortality were sepsis and severe obstruction of the superior vena cava. The cause of late mortality was severe pulmonary venous obstruction. Among the 16 survivors, postoperative courses, both early and late, have been remarkably benign. Ten patients have undergone postoperative cardiac catheterization (mean follow up 17 months). Two (12%) had severe pulmonary venous obstruction (one diagnosed by two-dimensional echocardiography), but both were successfully repaired. Atrial shunt was noted in two patients (12%), one of which underwent elective repair. Five infants have dynamic subvalvular pulmonary stenosis of various gradients (9 to 93 mm Hg). One infant has mild tricuspid regurgitation. There are no cases of superior vena caval obstruction or right ventricular dysfunction. Twenty-four hour electrocardiographic monitoring (mean follow-up 25 months) showed predominant normal sinus rhythm in 15 infants and predominant junctional rhythm in one.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1983

Two-dimensional echocardiographic assessment of caval and pulmonary venous pathways after the senning operation.

This study reports the 2-dimensional echocardiographic appearance of the caval and pulmonary venous pathways after the Senning procedure in 28 patients and establishes normal values for the caval and pulmonary venous pathway dimensions. Eighteen patients had no caval or pulmonary venous obstruction or tricuspid regurgitation at catheterization; 2 had isolated superior vena caval obstruction, 3 had isolated pulmonary venous obstruction, 4 patients had severe tricuspid regurgitation, and 1 had a large residual ventricular septal defect. The caval and pulmonary venous pathways were imaged in modified 4-chamber and transverse views, and the narrowest dimension of each pathway in each view was measured by 2 independent observers. Dimension measurements were then normalized to the cube root of body surface area. Caval and pulmonary venous pathway "dimension products" were obtained by multiplying the normalized dimension in the 4-chamber view by the normalized dimension in the transverse view. All patients with catheterization-proven caval or pulmonary venous obstruction or tricuspid regurgitation had caval or pulmonary venous pathway dimension products outside the normal range, defined by our measurements in the 18 patients with no caval or pulmonary venous obstruction or tricuspid regurgitation. Thus, 2-dimensional echocardiography can provide both quantitative and qualitative information about the caval and pulmonary venous pathways after the Senning procedure.

Child↗
PubMed1983

2-dimensional echocardiographic appearance of complete left-sided juxtaposition of the atrial appendages.

This report describes the 2-dimensional (2-D) echocardiographic appearance of left-sided juxtaposition of the atrial appendages (JAA). From January 1, 1978, to June 30, 1979, 2 infants had the diagnosis of left-sided JAA at autopsy. Both patients had previously been examined by subxiphoid 2-D echocardiography. On review of these studies, the septum secundum was found to be oriented posteriorly in the transverse view of the atria. From July 1979 to June 1981, prospective evaluation of all infants for the presence of this finding revealed 2 more patients. Left-sided JAA was confirmed at surgery in 1 case and by selective right atrial angiography in the other. The diagnosis of left-sided JAA has important implications for both atrial baffle operations and for the Fontan procedure.

Echocardiography↗
PubMed1983

Expression of OKT 8 antigen and Fc gamma receptors by suppressor cells mediating specific unresponsiveness between recipient and donor in renal-allograft-tolerant patients.

Renal allograft tolerant patients show specific unresponsiveness in mixed-lymphocyte culture assays when confronted with donor stimulating cells. Separation of posttransplant peripheral blood lymphocytes into Fc gamma + and Fc gamma - by rosetting and into OKT8+, OKT8- by cytofluorometry enabled the demonstration of normal responses by Fc gamma - and OKT8- cells, whereas the proliferation of OKT8+ and Fc gamma + cells was depressed specifically in the presence of donor cells. Using mixing experiments, we showed that OKT8+ and Fc gamma + posttransplant lymphocytes exert a suppressive effect specific to the donor-recipient pair on the proliferative response of the pretransplant lymphocytes.

Adult↗
PubMed1983

Spontaneous long-term acceptance of RT-1-incompatible liver allografts in inbred rats. Analysis of the immune status.

In several combinations of inbred rats, liver allografts are spontaneously tolerated, and after a few weeks liver tolerant rats are in a state of donor-specific transplantation tolerance. In vivo and in vitro experiments were conducted to analyze the immunological status of LEW or BN rats with spontaneously tolerated (LEW X BN) F1 liver allografts several months after transplantation. Acute rejection of secondary donor-specific heart allografts retransplanted from liver-tolerant rats to normal syngeneic hosts suggests that the state of tolerance in liver-tolerant rats is related to an active modification of the immune system of the rat and not to a reduced immunogenicity of the graft. No cytotoxic antibodies or cells were found in liver-tolerant rats. Reactivity in mixed lymphocyte culture was normal or slightly reduced. Arguments for the presence of splenic suppressor cells were found in LEW tolerant rats using a local graft-versus-host assay, but these could not be found in BN rats, or when attempting to transfer or to break the tolerance state. A nonspecific humoral blocking factor was found in vitro in liver-tolerant rats but transfer of serum from liver-tolerant rats to normal syngeneic hosts did not permit a significant prolongation of donor-specific heart allografts. These results suggest that more than one mechanism may be involved at the maintenance phase of liver allograft tolerance.

Animals↗
PubMed1983

Hemodynamic assessment after palliative surgery for hypoplastic left heart syndrome.

Ten patients with hypoplastic left heart syndrome underwent cardiac catheterization to assess the effectiveness of palliative surgery designed to prepare them for a modified Fontan procedure. The objectives of palliation were to establish unobstructed systemic blood flow, normalize pulmonary blood flow and pressure, and relieve pulmonary venous obstruction. In the first four patients, systemic blood flow from the right ventricle was established by means of a conduit from either the right ventricular free wall or the proximal main pulmonary artery to the thoracic aorta. Pulmonary blood flow was limited by pulmonary artery banding and ligation of the ductus arteriosus in three patients and by a Blalock-Taussig shunt in one. Conduit obstruction of systemic blood flow developed in two of these infants, and pulmonary vascular abnormalities precluded reparative surgery in the other two. In the other six patients, systemic blood flow was established by direct anastomosis of the proximal main pulmonary artery to the ascending aorta and aortic arch. The pulmonary vasculature was protected by providing pulmonary flow through a central or Blalock-Taussig shunt. The interatrial communication was enlarged by atrial septectomy or balloon atrial septotomy. One infant had progressive tricuspid regurgitation necessitating valve replacement. One, in whom balloon atrial septotomy had been performed, developed an obstructive interatrial communication necessitating late atrial septectomy. These six patients were candidates for physiologic correction. To date, three patients have undergone a modified Fontan procedure; two are clinically well at 9 and 12 months after surgery. Three patients await this procedure.

Blood Circulation↗
PubMed1983

Reparative operations for interrupted aortic arch with ventricular septal defect.

From January, 1975, through September, 1982, 24 infants underwent primary or staged repair of interrupted aortic arch (IAA) with ventricular septal defect (VSD). Seven patients had IAA type A and 17 patients had type B. Eleven of the patients, median age 5 days, underwent staged operations and 13 infants, median age 6 days, underwent primary repair. Palliation was by tube graft interposition (six), subclavian-aortic anastomosis (three), left carotid-aortic anastomosis (one), or end-to-side aortic anastomosis (one) combined with pulmonary artery banding (eight) or early VSD closure. With palliation, there were three (27%) early deaths among the eleven patients and one (13%) late death among the eight remaining. Delayed repair at 5 days to 14 months (median 7 months) in seven patients incurred three (43%) early and no late deaths. Primary repair in 13 patients consisted of VSD closure combined with graft interposition (12) or end-to-side aortic anastomosis (one), with three (23%) early and no late deaths. Nine of 14 survivors had hemodynamic evaluation by catheterization 1 to 3 years following repair. None had a significant residual VSD or pressure gradients between the ascending and thoracic aorta. Six had subaortic stenosis, two mild (gradient less than 20 mm Hg) and four severe (gradient greater than 50 mm Hg), necessitating operation. Results of operations in neonates with IAA continue to improve. Essential in management is an awareness that subaortic stenosis and hypocalcemia may be accompaniments of this anomaly. Based on these data, we prefer primary repair for IAA with VSD.

Aorta, Thoracic↗
PubMed1983

[Whole-body retention of 99mTc-methylene diphosphonate in skeletal diseases].

The 24 h-whole-body retention (WBR), determined by a whole-body counter, may be used to quantify exactly bone seeking properties of a radiopharmaceutical. The 24h-WBR of 99mTc-methylene-diphosphonate was determined in 200 patients and was found to be independent of kidney function if this function was normal or only slightly diminished. The 24h-WBR was slightly dependent on age since it decreased up to 20 years of age, reaching a minimum at 20-25 years, and then increased with increasing age. Normal values of 24h-WBR for individuals of more than 20 years of age were 31.8 +/- 5% of injected dose. Not more than two focal accumulations, i.e. skeletal metastases, failed to elevate the 24h-WBR significantly (p less than 0.1). However, a highly significant (p less than 0.001) difference to normals was found in patients with multiple metastases (24h-WBR: 38.2 +/- 7%), with diffuse osseous involvement as in primary hyperparathyroidism (24h-WBR: 49 +/- 11.7%, p less than 0.001) or with osteoporosis (24h-WBR: 45%). The 24h-WBR was found to be very sensitive in grading diffuse osseous involvement. This was shown in single-tumor patients by follow-up as the 24h-WBR in addition to bone scans was useful to describe progression or remission. Moreover, the 24h-WBR correlated closely with results of bone marrow biopsies in a small group of patients with malignancies of the lymphoreticular system.

Adolescent↗
PubMed1983

Evaluation of the preterm infant for patent ductus arteriosus.

As a first step in a multicenter, collaborative project to study the role of indomethacin in the management of patent ductus arteriosus in premature infants, a diagnostic scheme was developed, on an a priori basis, by a consensus of the participating neonatologists and pediatric cardiologists. The scheme, which utilizes clinical and noninvasive findings, was designed to detect infants with a "hemodynamically significant" patent ductus arteriosus (PDA). Among 1,689 infants with birth weight less than 1,750 g who were monitored during the first year of the study, 342 (20.2%) met the criteria for PDA. Rates were higher for smaller infants (42% with birth weight less than 1,000 g) than for larger infants (7% with birth weight 1,500 to 1,750 g). Although study protocol did not require a direct procedure to confirm the diagnosis of PDA, a marked decrease in the presence of most criteria was noted following surgical ligation of the ductus. Although the echocardiographic criterion (ratio of left atrium to aorta [LA/Ao] greater than or equal to 1.15) proved to have a low specificity for PDA, the data suggest that the overall scheme led to a very low rate of false-positive diagnosis. Following the application of the scheme for 1 year at 13 clinical centers, it has been shown to be a highly acceptable means of detecting infants with PDA.

Clinical Trials as Topic↗
PubMed1983

Depressed polymorphonuclear leukocyte functions associated with normal cytotoxic functions of T and natural killer cells during chronic hemodialysis.

The cytotoxic capacities of T lymphocytes and natural killer (NK) cells and the phagocytic functions of polymorphonuclear leukocytes were determined in a group of 20 patients with end stage disease who were being maintained on hemodialysis. The mononuclear cells from these patients were able to mediate normal T-cytotoxic functions in a xenogeneic cell-mediated lympholysis assay and normal NK cytotoxic capacity when tested against K562 target cells. Contrarily, polymorphonuclear functions in these patients were severely impaired. The reduction of Nitroblue tetrazolium in dark formazan (NBT test) and the direct phagocytosis of 2 pyogenic strains (Staphylococcus aureus and Salmonella typhimurium) were equally and deeply depressed in almost all patients. This defect was not restored either by 4 hr of hemodialysis nor by 12 months of treatment. This study confirms a major role for a defect of polymorphonuclear cell functions in the depressed defence of patients on chronic hemodialysis against infections.

Adult↗
PubMed1983

Echocardiographic characteristics of premature infants with patient ductus arteriosus.

As part of a multicenter collaborative study, M-mode echocardiograms were obtained shortly after birth on 3,559 premature infants with birth weight less than or equal to 1,750 g. Of these infants, 1,496 did not develop a cardiac murmur or other signs of a "hemodynamically significant" patent ductus arteriosus (PDA). Echocardiographic parameters from this "normal" group were compared with results obtained from 415 infants in whom PDA was diagnosed on the basis of clinical findings alone, irrespective of the echocardiogram (PDA group). The best discrimination between the two groups, when considering a single parameter, was provided by a left atrial to aortic root ratio (LA/AO) of 1.40, a left ventricular to aortic root ratio (LV/AO) of 2.10, or a left ventricular systolic time interval ratio (LPEP/LVET) of 0.27. Multivariate analysis demonstrated that better separation between the two groups occurred when the left atrial to aortic root ratio and the left ventricular systolic time interval ratio were considered jointly. Because of a large degree of overlap of all echocardiographic variables between the normal group and the group with PDA, the echocardiogram alone was not a good indicator of PDA. However, when used in conjunction with a priori estimates of the probability of PDA (based, for example, on birth weight and degree of respiratory disease), use of echocardiographic data was found to improve the detection of hemodynamically significant patent ductus arteriosus in premature infants.

Age Factors↗
PubMed1983

Management of infants with left ventricular outflow obstruction by conduit interposition between the ventricular apex and thoracic aorta.

On the basis of experience with older children, creation of a double-outlet ventricle by interposition of a valved conduit between the apex of the left ventricle and the thoracic aorta appeared to be an option for treating life-threatening left ventricular outflow tract obstruction even in the small heart of the infant. Over the recent 3 year period, nine infants ranging in age from 3 days to 13 months with various forms of left ventricular outflow tract obstruction underwent placement of an apical-aortic conduit to decompress the hypertensive left ventricle. There were two early and two late deaths. Five patients are clinically well and developing normally 5 to 23 months following the operation. This series demonstrates that this operation permits normal growth and development in infants previously failing to thrive. Echocardiographic and cardiac catheterization data suggest that left ventricular function need not be adversely affected by placement of a stent in the small infant ventricle; rather, ventricular function can be markedly improved. Although the mortality in this series is appreciable, it appears that apical-aortic conduit interposition can provide significant palliation for infants with otherwise lethal left ventricular outflow tract obstruction.

Aorta, Thoracic↗
PubMed1983

Repair of double-outlet right ventricle: early and late results.

Fifty-seven patients underwent reparative surgery between 1973 and 1981 for various forms of double-outlet right ventricle. Pulmonic stenosis was present in 35 (61%), 15 (43%) of whom required a valved conduit for repair. Subaortic stenosis was present in six patients (11%). Hospital mortality was 12% (7/57), with three of the deaths among five patients with associated defects of the atrioventricular valves. During a mean follow-up of 3.6 years (range 2 months to 9 years), there have been no late deaths. Repeat cardiac catheterization in 28 of 50 survivors (56%) showed a residual ventricular septal defect (Qp/Qs greater than 1.5) in six patients, residual pulmonic stenosis (gradient greater than 35 mm Hg) in six patients, and subaortic obstruction (gradient greater than 50 mm Hg) in two patients: The indications for reoperation in 12 of 50 survivors was a residual ventricular septal defect in five patients, atrioventricular valve regurgitation in three patients, subaortic or subpulmonic obstruction in three patients, and aortic valve regurgitation in one patient. None of the patients died after repeat surgery. Our results indicate that surgical risk is related to the anatomic complexity of the malformation. Although a good hemodynamic outcome was achieved at initial surgery in the majority of patients, a residual abnormality was present in 24% needing surgery. When present, significant defects can be repaired with low mortality and morbidity.

Adolescent↗
PubMed1982

Pediatric arterial catheterization using a 3.2 French catheter.

Retrograde arterial catheterization was performed in 105 infants and small children (median age 6 mo) using a 3.2 French pigtail catheter made of ultrathin walled white Teflon. Three catheter lengths were used, (40, 50, and 65 cm). Pressure recordings and ease of sampling were judged excellent in all. All 118 angiograms (60 ventricular) were performed without complication except for two episodes of external catheter rupture. Angiographic quality was rated excellent in 41%, good in 39%, fair in 18%, and poor in only 2%. Among the 81 patients in whom only this catheter was used percutaneously, pedal pulses were lost in 5%. Postcatheterization testing identified ranges of volume and flow-rate characteristics which included 8 ml at 15 ml/sec (40 cm length), at 11 ml/sec (50 cm length), and at 9 ml/sec (65 cm catheter). We conclude that this small catheter is relatively safe and satisfactory for retrograde catheterization of infants and small children.

Cardiac Catheterization↗
PubMed1982

Early assessment of hemodynamic status after repair of tetralogy of Fallot: a comparison of 24 hour (intensive care unit) and 1 year postoperative data in 98 patients.

Hemodynamic data obtained in the intensive care unit, immediately after repair of tetralogy of Fallot, were compared with measurements obtained at 1 year postoperative catheterization in 98 infants and children. Eight of 12 patients who had pulmonary artery oxygen saturation of 80% or greater in the intensive care unit had a pulmonary to systemic flow ratio greater than 1.5 at catheterization; all 79 patients who had a pulmonary artery oxygen saturation of ess than 80% in the intensive care unit had a pulmonary to systemic flow ratio of 1.5 or less at catheterization. Five of six patients who had a right ventricular outflow tract pressure gradient greater than 40 mm Hg in the intensive care unit had a gradient greater than 40 mm Hg at catheterization; 7 of 61 patients who had a right ventricular outflow tract gradient of 40 mm Hg or less in the intensive care unit had a gradient greater than 40 mm Hg at catheterization. The addition of measurements of right ventricular pressure and the right ventricular to systemic arterial pressure ratio in the intensive care unit did not improve sensitivity in identifying patients with a right ventricular outflow tract gradient greater than 40 mm Hg at catheterization. Intensive care unit measurement of pulmonary artery oxygen saturation is valuable for determining the presence or absence of a significant left to right shunt after repair of tetralogy of Fallot and should be considered an adjunct to patient management. Intensive care unit measurement of the right ventricular outflow tract gradient identifies patients with a significant right ventricular outflow tract gradient at catheterization but is not highly sensitive.

Blood Pressure↗