Biomedical subjects

S Bhuta

Publications and source records attributed to S Bhuta.

At least 37 records · Page 2Linked to original sources

PubMed1991

Cardiac preservation in patients undergoing transplantation. A clinical trial comparing University of Wisconsin solution and Stanford solution.

Recent laboratory investigations have shown significantly improved donor heart preservation and function when the University of Wisconsin solution (UW) is used for arrest and storage. These findings prompted us to compare UW to Stanford solution in a clinical trial. After giving informed consent, patients were blindly randomized to receive a heart arrested and stored in UW or a heart arrested in Stanford solution and stored in normal saline. Orthotopic transplants were performed in a routine manner. Fourteen patients with a mean age of 54 years were randomized to UW, and 15 patients with a mean age of 51 years were randomized to Stanford solution. Mean donor ages (UW 27 years, Stanford 24 years) and ischemic times (UW 150 minutes, Stanford 135 minutes) were similar. Several differences were observed intraoperatively. At end ischemia, mean adenosine triphosphate (UW 5.87 mmol/gm wet weight, Stanford 4.75 mmol/gm) and creatine phosphate (UW 9.26 mmol/gm, Stanford 4.75 mmol/gm) levels were higher in the UW hearts (p less than 0.05). Defibrillation requirements (UW 14% [2/14], Stanford 53% [8/15]) were significantly less in the UW group (p = 0.05). The number of patients requiring temporary intraoperative pacing also showed a significant difference with 7% (1/14) of UW patients versus 47% (7/15) of Stanford patients requiring pacing (p less than 0.05). Intraoperative requirement for inotropic support showed a trend in favor of the UW group. End-ischemic and postreperfusion histologic characteristics were similar between the two groups. No differences in hemodynamics or ejection fractions were noted postoperatively, but trends toward improved rhythm and decreased inotropic support were present in the UW group. Overall 6-month survival rates were similar (UW 86% [12/14], Stanford 93% [14/15]). No preservation-related deaths occurred. We conclude: (1) UW is a safe and effective preservation solution for human cardiac transplantation; (2) considering the improved end-ischemic adenosine triphosphate and creatine phosphate levels, decreased defibrillations, decreased intraoperative pacing, and trend toward decreased requirement for inotropic support in the UW group, UW appears to be superior to Stanford solution for donor heart preservation.

Adenosine Triphosphate↗

PubMed1990

Adenovirus hepatitis in two successive liver transplants in a child.

Adenoviruses can produce severe disease, especially in patients who are immunosuppressed. We present a unique case in which adenovirus type 5 was demonstrated retrospectively, by using immunohistochemical methods, in the appendix of a liver transplant donor. The donor had intussusception, which has been associated with adenovirus infection. Both the initial and a second liver transplant in the recipient were severely damaged by adenovirus type 5. These findings were demonstrated immunohistochemically, as well as on electron microscopy. The recipient died due to the infection and ensuing complications.

Adenoviridae Infections↗

PubMed1990

Amyloidoma of the skull base.

Localized amyloid tumors of the central nervous system are rare. We present the case of a 59-year-old white man with a large expansile amyloidoma at the base of the skull. To our knowledge this is the second reported case of localized amyloid tumor involving the skull.

Amyloidosis↗

PubMed1989

Improved neonatal heart preservation with an intracellular cardioplegia and storage solution.

The optimal conditions for preservation of the neonatal heart for transplantation remain uncertain. An isolated, working neonatal piglet heart model was used to compare a standard extracellular-like cardioplegic solution followed by storage at 4 degrees C in normal saline for 12 hr (n = 8) to cardioplegia and storage at 4 degrees C for 24 hr in an intracellular-like solution (n = 7). Seven of eight hearts in the 12-hr Extracellular Group failed to regain function, with a maximum stroke work index (SWI), developed at a left ventricular end-diastolic pressure (LVEDP) of 9 mm Hg of 0.91 +/- 0.30 x 10(3) erg/g (mean +/- standard error of the mean), 7.1% of nonpreserved control hearts. In contrast, all hearts arrested and stored for 24 hr in the intracellular solution regained function with a maximum SWI, again at a LVEDP of 9 mm Hg of 9.51 +/- 1.98 X 10(3) erg/g, 73.7% of control (P less than 0.05). Ultrastructural changes seen by electron microscopy paralleled the functional results. We conclude that an intracellular arrest and storage solution may be superior to conventional solutions for extended preservation of the neonatal heart.

Animals↗

PubMed1989

Malignant islet cell tumor with rhabdomyosarcomatous differentiation.

We present a widely metastatic islet cell tumor of the pancreas with focal areas resembling rhabdomyosarcoma. To our knowledge, this is the first reported case of islet cell/carcinoid tumor exhibiting such differentiation. Desmin was localized to the rhabdoid areas by immunohistochemistry. Cross striations were not seen by light microscopy, but Z-lines and thick filaments were seen on electron microscopy.

Adenoma, Islet Cell↗

PubMed1989

Prevention of reperfusion injury in the neonatal heart with leukocyte-depleted blood.

Activated leukocytes release oxygen free radicals and cause microvascular occlusion. This experiment tests the hypothesis that reperfusion with leukocyte-depleted blood reduces injury after extended ischemic preservation. An in vitro model consisting of an isolated, working neonatal piglet heart and an adolescent support pig was used. Hearts were arrested with a cold crystalloid cardioplegic solution, excised, and stored in 4 degrees C saline for 12 hours. Two groups were compared. In group 1 piglets (n = 8), reperfused with whole blood, the maximum stroke work index was 0.91 +/- 0.29 x 10(3) erg/gm (mean +/- standard error of the mean). Group 2 piglets (n = 6), reperfused with blood depleted of leukocytes by a polyester filter, had a maximum stroke work index of 11.6 +/- 1.0 x 10(3) erg/gm. This difference was highly significant (p less than 0.0001). Group 1 exhibited severe injury with myofibrillar necrosis, mitochondrial disruption, nuclear chromatin clumping, and moderate interstitial edema. Group 2 had normal ultrastructure on electron microscopic examination. We conclude that reperfusion with leukocyte-depleted blood prevents reperfusion injury and results in excellent myocardial function after long-term heart preservation.

Animals↗

PubMed1988

Oncocytic carcinoid of the kidney associated with periodic Cushing's syndrome.

An oncocytic carcinoid of the kidney producing a periodic Cushing's syndrome in an adolescent is described. The tumor displayed gross, histologic, and ultrastructural features similar to renal oncocytoma, another unusual renal neoplasm. A review of renal carcinoids and possible associations between oncocytic change and periodic hormone production are discussed.

ACTH Syndrome, Ectopic↗

PubMed1988

Two human tumors with high basement-membrane-producing potential.

Two human tumors, an adenoid cystic carcinoma and a yolk sac tumor, were found by immunocytochemical, ultrastructural, and biochemical studies to contain abundant basement membrane matrix in contrast to the vast majority of human tumors which contained either an absent or scant basement membrane matrix. These tumors were established as xenografts in athymic (nude) mice. Both xenografts maintained characteristic histologic features, immunocytochemical localization of basement membrane components, and reasonable yields of native laminin and Type IV collagen throughout three successive transplant generations. Although only a small fraction of the yield of that of the murine Engelbreth-Holm, Swarm (EHS) sarcoma, the yield of the human basement membrane-producing tumors could be increased by rendering the mice lathyritic. The human basement membrane proteins so extracted were identical on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) to their murine counterparts. These human tumors then represent a potential source of human basement membrane proteins.

Animals↗

PubMed1988

Fine-needle aspiration cytology of histiocytosis X: a case report.

The cytologic features of a case of histiocytosis X diagnosed by fine-needle aspiration biopsy of a right cervical lymph node in a 15-mo-old girl are reported. Characteristic reticuloendothelial cells with abundant cytoplasm and grooved nuclei were observed. Electron microscopy of the aspiration-derived specimen revealed Birbeck granules. The cytologic pattern and electron microscopic demonstration of Birbeck granules allowed definite diagnosis of lymph node involvement by histiocytosis X, negating the need for open biopsy. The cytologic differential diagnosis and current diagnostic criteria for histiocytosis X are discussed.

Biopsy, Needle↗

PubMed1988

Quantitative alterations in cutaneous Langerhans cells during the evolution of malignant melanoma of the skin.

Melanomas are associated with a T-cell predominant infiltrate that may cause their regression. Langerhans cells (LC) are essential for initiation and maintenance of specific T-cell-mediate responses in the skin. Therefore, a change in this antigen-presenting LC population may alter the host response. To determine whether the LC population varies during the evolution of primary cutaneous melanoma 32 melanocytic lesions, nevi, and cutaneous melanomas were studied by quantitative immunohistology. The monoclonal antibody, Leu-6, and the avidin biotin complex immunoperoxidase method were used to identify LC. Compared with histologically normal melanoma-adjacent skin, epidermal LC were depleted above "deeply invasive" melanomas but were relatively unchanged above nevi, "early invasive" melanomas, and cutaneous metastatic melanoma nodules. Dermal LC were significantly increased around in situ and "early invasive" melanomas but not around "deeply invasive" melanomas or cutaneous metastatic nodules. Dermal LC are thus associated with early transformed melanocytes and may present neoantigens to T lymphocytes in situ or after LC maturation in the draining lymph node. Melanoma-associated LC decline in number as melanoma progresses.

Cell Count↗

PubMed1988

Effects of acute hypoxia and reoxygenation in a blood-perfused neonatal heart model.

Newborn (less than 4-day old) piglet hearts (n = 7) were isolated and perfused with blood from a support pig. With use of a reservoir and membrane oxygenator, each heart was perfused for 90 minutes with blood at an O2 saturation of 40% and a pH of 7.4-7.5, at a left atrial pressure of 9 mm Hg, and at an aortic root pressure of 80 mm Hg. Blood saturation was increased to 100%, and the left atrial pressure decreased to 6 mm Hg for 60 minutes. Minute work indexes were calculated for each heart before hypoxia, every 30 minutes during hypoxia, and at 30 and 60 minutes of reoxygenation. Control hearts (n = 8) were treated in an identical fashion, but O2 saturation was maintained at 100%. Myocardial function decreased in the neonatal hearts exposed to hypoxia and reoxygenation. Control hearts did not suffer any significant decrease in function. Nucleotide levels were similar in both groups at the completion of the experiment. Anaerobic metabolism was demonstrated in the hypoxic hearts by net release of lactic acid during the period of hypoxia. This model can be used to study methods of intervention in the working hypoxic neonatal heart.

Acute Disease↗

PubMed1988

Long-term neonatal heart preservation.

UNLABELLED: Donor availability is a major limiting factor in neonatal heart transplantation. Prolonging donor heart preservation would facilitate distant heart procurement. Forty-two neonatal (1 to 5 days) piglet hearts in seven groups were arrested with cold cardioplegic solutions, stored for 12 hours at 4 degrees C in storage solutions, and reperfused with blood from an adult support pig. The cardioplegic solutions used were a crystalloid solution with potassium chloride 30 mEq/L and bicarbonate (Stanford), the Stanford cardioplegic solution with the addition of calcium (1.2 mmol/L), or an intracellular solution (Sacks) with added glucose. Storage solutions were normal saline, Sacks II, or Sacks II with glucose 20 gm/L. Reperfusion was done with normal blood or modified blood for 20 minutes with superoxide dismutase, catalase, aspartate, glutamate, citrate-phosphate-dextrose, potassium, tromethamine, and 50% dextrose followed by normal blood. Evaluation of stroke work index after 60 minutes of recovery (as percent of control) was performed using the isolated, blood perfused, working heart preparation in all groups: Group I (Stanford cardioplegia, saline storage, normal blood reperfusion) had a recovery of 11%; group II (Stanford + calcium, saline, normal blood) 8%; group III (Stanford + calcium, saline, modified blood, superoxide dismutase 35,000 U/L, catalase 35,000 U/L) 37%; group IV (Stanford + calcium, Sacks II, modified blood, superoxide dismutase 35,000 U/L, catalase 35,000 U/L), 47%; group V (Stanford + calcium, Sacks + glucose, modified blood, superoxide dismutase 35,000 U/L, catalase 105,000 U/L) 89%; group VI (Stanford + calcium, Sacks + glucose, modified blood, superoxide dismutase 150,000 U/L, catalase 150,000 U/L) 107%; group VII (Sacks + glucose, Sacks + glucose, modified blood, superoxide dismutase 35,000 U/L, catalase 105,000 U/L) 115%. CONCLUSIONS: The neonatal heart stored hypothermically for 12 hours tolerates normal blood reperfusion poorly. Modified blood reperfusion markedly improves the recovery. Complete functional recovery was achieved by the intracellular Sacks plus glucose storage solution and modified blood reperfusion with oxygen-derived free radical scavengers (high catalase). Extended preservation of the neonatal heart is feasible.

Animals↗

PubMed1987

Desmoplastic basal cell carcinomas possess unique basement membrane-degrading properties.

Desmoplastic basal cell carcinomas (fibrosing or morphea types) were studied ultrastructurally, immunocytochemically, and biochemically for basement membrane-degrading activity and compared with the common varieties of basal cell (superficial and nodular-ulcerative types). Whereas the latter lesions demonstrated intact basement membranes as evidenced by extracellular laminin and type IV collagen immunoreactivity and the presence of an unusually thickened basal lamina, desmoplastic basal cell carcinomas showed large defects and absences in basal lamina and basement membrane immunoreactivity. Intense tumor cytoplasmic immunoreactivity for type IV collagenase was present in 13 of 15 cases of desmoplastic basal cell but absent in the superficial and nodular-ulcerative varieties. Whereas explant cultures of all the types of basal cell carcinoma studied gave rise to high levels of interstitial (type I) collagenase activity in conditioned media, only the desmoplastic variety exhibited high type IV collagenase activity. These findings suggest that the mechanisms by which the desmoplastic and the common varieties of basal cell carcinoma infiltrate host tissues may be fundamentally different.

Basement Membrane↗

PubMed1987

Pharmacokinetics of orally administered tizanidine in healthy volunteers.

The pharmacokinetics of tizanidine, a new centrally acting muscle relaxant, have been studied in 18 normal male volunteers who received orally a single 5 mg dose, a single 20 mg dose, or repeated administration of 4 mg every 8 hr for 13 doses of [14C]tizanidine. Serial blood and breath samples and complete urine and feces were collected and analyzed for total radioactivity as well as intact tizanidine. Tizanidine was rapidly and almost completely absorbed from the gastrointestinal tract, although the estimated bioavailability was only 21% due to extensive first-pass metabolism. The pharmacokinetics of tizanidine appeared to be linear in the 0-20 mg dose range, as indicated by the dose-proportional blood levels of total radioactivity as well as of parent drug. Absorbed tizanidine was almost completely metabolized before excretion, the major excretory route being via the kidneys. The terminal half-lives of tizanidine and radioactivity were ca 3 hr and 61 hr, respectively, and 76%-77% of the administered radioactivity was recovered within 120 hr. Repeated administration of [14C]tizanidine resulted in no apparent change in pharmacokinetic characteristics. During the 4 mg q 8 hr regimen, blood levels of tizanidine reached steady state after only 2 or 3 doses, whereas those of total radioactivity approached steady state after approximately 4 days. The degree of accumulation of radioactivity, unlike that of parent drug, was inconsistent with the terminal half-life, but instead implied a shorter effective half-life of ca. 16 hr. It appears that the terminal phase of the blood radioactivity profile represents a metabolite that is reversibly bound to and slowly released from a specific tissue depot, and that this binding involves a finite amount of drug regardless of the dose. The oral administration of [14C]tizanidine prescribed in the present study was safe and well tolerated.

Administration, Oral↗

PubMed1987

Relationship between human T cell leukemia virus-II and atypical hairy cell leukemia: a serologic study of hairy cell leukemia patients.

Human T cell leukemia virus (HTLV-II) is an infrequently encountered human T cell leukemia virus first isolated from a patient with atypical hairy cell leukemia. Recently, we identified a second patient infected with HTLV-II who had a similar clinical syndrome of atypical hairy cell leukemia associated with peripheral T cell lymphocytosis. HTLV-II was detected by molecular hybridization studies, and more recently, by electron microscopy, in cell lines derived from the patient. Both patients came from the Los Angeles area and had spent several years in Alaska. As opposed to our two patients, 21 patients with more typical cases of hairy cell leukemia were seronegative for HTLV-II. Two additional cases of unusual T cell malignancy linked to HTLV-II have been described by other investigators and bear limited similarity to our index cases. Further studies are necessary to define the spectrum of malignancies linked to HTLV-II and to identify infected individuals for prospective study.

Antibodies, Viral↗

PubMed1987

Myocardial protection in the neonatal heart. A comparison of topical hypothermia and crystalloid and blood cardioplegic solutions.

UNLABELLED: Myocardial protection achieved during 2 hours of ischemic arrest was evaluated in 45 isolated, blood perfused, neonatal (1 to 5 days) piglet hearts. Comparisons were made among five methods of myocardial protection: Group I, topical cooling; Group II, hyperosmolar (450 mOsm) low-calcium (0.5 mmol/L) crystalloid cardioplegia; Group III, St. Thomas' Hospital cardioplegia; Group IV, cold blood cardioplegia with potassium (21 mmol/L), citrate-phosphate-dextrose (calcium level 0.6 mmol/L), and tromethamine; and Group V, cold blood cardioplegia with potassium alone (16 mmol/L) (calcium level 1.2 mmol/L). Hemodynamic recovery (percent of the preischemic stroke work) after 30 and 60 minutes of reperfusion was 82.9% and 86.7% in Group I, 35.7% (p less than 0.0001) and 43.7% (p less than 0.0001) in Group II, 76.1% and 77.7% in Group III, 67.4% (p less than 0.05) and 60.6% (p less than 0.05) in Group IV, and 110.7% and 100.6% in Group V. CONCLUSIONS: Topical cooling is an effective method of myocardial protection in the neonate. Cold blood cardioplegia with potassium alone and a normal calcium level provides optimal functional recovery. The improved protection obtained with both crystalloid and blood cardioplegia with normal calcium levels suggests an increased sensitivity of the neonatal heart to the calcium level of the cardioplegic solution.

Animals↗

PubMed1986

The extracellular matrix of pulmonary scar carcinomas is suggestive of a desmoplastic origin.

Pulmonary scar carcinomas and noncarcinomatous apical scars were subjected to collagen extraction, ultrastructural, and immunocytochemical studies designed to investigate the nature of their extracellular matrix. These studies revealed marked differences in both cellular and biochemical composition of scar carcinomas, compared with apical scars. Myofibroblasts, identified by antimyosin antibodies and confirmed by electron microscopy, constituted over 90% of the stromal cells of the scar carcinomas, compared with 0-10% in the apical scars. Collagen extraction studies revealed both an absolute and relative increase in Type V collagen in the scar carcinomas, compared with that found in the apical scars. The extracellular matrix of the pulmonary scar carcinomas was, however, identical to that of scirrhous carcinomas of the breast. These findings suggest that pulmonary scar carcinomas are probably desmoplastic carcinomas, rather than scar-arising tumors.

Adenocarcinoma↗

PubMed1986

Myxoid malignant melanoma. A previously undescribed histologic pattern noted in metastatic lesions and a report of four cases.

Four patients are presented with malignant melanoma in which the stroma showed a prominent myxoid change. Since this peculiar feature had not been previously reported, metastatic lesions with this change caused considerable diagnostic confusion with other more commonly encountered myxoid tumors. On the basis of light microscopy, special stains, and electron microscopy, we demonstrated the melanomatous nature of the metastases and that the myxoid matrix is derived from reactive stromal cells rather than from the melanoma cells themselves. Three of the four patients had a history of primary melanoma; the longest interval between the primary lesion and the metastasis was 24 years.

Adult↗