A correlation between various spirometric variables and peripheral leucocyte count.
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Biomedical subjects
Publications and source records attributed to S Aziz.
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Four cases of effort-related axillosubclavian thrombosis are described. The pathogenesis of this disorder is related to an anatomic constriction of the vein by the clavicle and first rib complex associated with repetitive trauma to the vein and resultant changes in the vein wall itself. Therapy must, therefore, not only address the superimposed thrombosis but must also provide a reliable correction of the constricting mechanism and the resultant lesion in the proximal subclavian vein. Our operative approach resulted in a full return to daily activities and no recurrence or persistence of symptoms in our series. Although early intervention is advisable, patients who present with long-standing venous occlusion should also be considered for operation. Medical therapy, consisting either of anticoagulation or thrombolytic therapy, results in an unsatisfactory clinical outcome because it does not correct the underlying mechanical abnormality.
Satisfactory extended preservation of the lung has been difficult to obtain. This study investigated the influence of different total volumes and flow rates during flush-perfusion of the lung, and their effect on pulmonary artery pressure, flow distribution, regional lung temperature and functional performance of the lungs following transplantation after 24 hours. Fifteen mongrel dogs served as donors of the heart and lung block. Cold modified Euro-Collins solution was used as flush perfusate. Pulmonary artery and perfusion-line pressures were measured. The regional lung temperature was measured at one minute intervals with 5 myocardial temperature probes. Flow distribution was determined with micro-aggregated albumin labelled with Technetium 99. The heart-lung block was harvested, the right lung removed, and samples taken for gamma-counting. The left lung was stored in cold Euro-Collins solution and then transplanted. The inspired oxygen fraction (FiO2) was set at 0.4 and was kept constant throughout the procedure and the entire postoperative course. There were 3 groups of 5 animals each. In group A, the flush perfusate was administered at a total volume of 20 cc/kg over a period of 6 minutes. In group B the same volume of perfusate was administered at a pulmonary artery pressure (PAP) of 18 to 20 mmHg, resulting in a considerably shorter perfusion time (1.3 minutes). In group C 60 cc/kg of perfusate were given at the same flow rate as in group B, also resulting in PAP of 18 to 20 mmHg, but the perfusion time was increased to 4 minutes. Thus, groups B and C investigated the effect of increased pressure and volume of perfusate, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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The Mantoux test was done on 181 tuberculous patients, of which 124 were sputum-positive. In 102 (93%) sputum positive cases the tuberculin reaction was between 10 and 19 mm. and in only 2 cases was the reaction less than 6 mm. In the sputum negative cases 7 (12%) were Mantoux negative and 5 (9%) had reactions of less than 10 mm. In some of the sputum-negative cases the diagnosis of tuberculosis may have been incorrect.
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In a review of 176 patients who died after either cardiac or cardiopulmonary transplantation, 15 cases of pancreatitis were identified. The diagnosis was clinically inapparent in 11 of the 15 cases of pancreatitis. A high index of suspicion should therefore be maintained when these patients are cared for. A variety of factors may have contributed to the occurrence of pancreatitis in these patients. These include infection, steroids, azathioprine, low-flow states, extracorporeal circulation, vasopressors, renal failure, and rejection.
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Mucormycosis in two patients with multiple-organ failure appeared as a cutaneous lesion and spread rapidly. In the first case, wet mounts and potassium hydroxide preparations were unhelpful, but a punch biopsy specimen established the diagnosis. Prompt and extensive debridement and amphotericin B administration arrested the infection. In the second case, virulent progression of the lesion occurred despite limited amputation, debridement, transfer factor, and amphotericin B, but finally responded to further amputation. Diagnosis was made by histologic examination of infected tissue. Both patients shared the following predisposing factors: sepsis, low blood flow, acidosis, multiple-organ failure, and multiple-antibiotic therapy. Although the mucormycosis was controlled, as confirmed in the first case at autopsy and in the second case by clear margins following reamputation, the outcome was fatal in both cases due to other features of multiple-organ failure.
An experimental model for limb transplantation as a composite tissue transfer has been developed using two genetically well defined strains of rats, BUF and LEW. The study shows that cyclosporin A (CyA) is very effective as an immunosuppressive agent in preventing rejection of transplanted limbs in rats. It is found to suppress rejection of the homotransplants as long as treatment is continuous. No untoward side effects have been noted at the current experimental dosage of the medication. CyA is superior to the conventional agents, such as azathioprine and prednisolone, which allow rejection of the limbs while treatment is in progress. There is a period of immune tolerance following CyA treatment; however, this period becomes shorter as the length of the treatment is increased. This may indicate that CyA treatment should be continuous and not pulsed at the dosage used in this experimental model. Additional experiments are underway to further elucidate this phenomenon.
Tc-99m pyrophosphate (PPi) uptake has been measured in a rat model of heterotopic heart transplant at 5 days after transplantation. comparison of tracer uptake, as a ratio between the heterotopic transplanted heart and the recipient's native heart, was made in four groups of animals. Group 1, with transplants between animals of isogeneic strain showed a lower ratio, significantly different from the ratio in Group 2 in which transplants were between nonisogeneic animals. The ratio of uptake after transplantation between nonisogeneic animals treated with 10 mg/kg-day of cyclosporine (Group 3), was not significantly different from Group 1. In contrast, the ratio of uptake between nonisogeneic animals treated with subtherapeutic doses of cyclosporine (Group 4), was not significantly different from Group 2. In Groups 1, 2, and 3 there was a correlation between the histology of the transplanted hearts, graded 1 to 5 according to the severity of rejection, compared with the uptake of Tc-99m PPi. This agent can therefore be used to diagnose cardiac rejection in a rat model, and the results correlate well with the severity of rejection as assessed histologically.
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Spontaneous rupture of the liver during pregnancy seems to represent an extreme vascular complication of toxemia. The very high mortality rate has generally been attributable to uncontrolled hemorrhage. However, control of the hemorrhage may not be sufficient to achieve recovery. Hepatic dysfunction may proceed to necrosis associated with multiple organ failure, even after successful hemostasis. Although ligation of the hepatic artery has been successful in controlling hemorrhage in hepatic trauma, this maneuver may contribute to injury in patients with this lesion in whom there is a preexisting hepatic abnormality. In this brief review, the relationship of the underlying pathology to a variety of therapeutic measures in the context of a catastrophic complication of pregnancy are discussed.
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