Biomedical subjects

S M Augustine

Publications and source records attributed to S M Augustine.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Gastrointestinal complications in heart and in heart-lung transplant patients.

Gastrointestinal complications after heart and heart-lung transplantation are being recognized and reported more frequently in the literature as a cause of significant morbidity. Between July 1983 and December 1989, 131 consecutive patients underwent 133 heart or heart-lung transplant procedures at The Johns Hopkins Hospital. Immunosuppression consisted of either cyclosporine and prednisone or cyclosporine, prednisone, and azathioprine. Twenty-eight patients (21%) had 38 gastrointestinal complications, including visceral perforations (n = 6), gastrocutaneous fistula (n = 1), retroperitoneal abscess (n = 1), cholecystitis (n = 5), gastric atony (n = 1), perianal abscess (n = 1), gastrointestinal bleeding (n = 4), esophagitis (n = 2), pancreatitis (n = 2), pancreatic abscess (n = 2), hepatitis (n = 2), cytomegalovirus infection (n = 3), and diarrhea (n = 8). Among this group of 28 patients, 17 operative procedures were needed by 13 patients (46%), for an incidence of major abdominal procedures in the entire transplant cohort of 10% (13/131). Operations included cholecystectomy (n = 5), colon resection with colostomy (n = 3), closure of perforated gastroduodenal ulcer (n = 3) and repair of gastrocutaneous fistula (n = 1), drainage of pancreatic abscess (n = 2), pyloroplasty (n = 1) and incision and drainage of perianal abscess (n = 1). The operative mortality rate was 8% (1/13). Overall survival in patients with gastrointestinal complications was no different than that in the entire transplant population. Age, gender, race, and number of rejection episodes did not correlate with the presence of gastrointestinal complications. Patients with gastrointestinal pathologic conditions necessitating surgery often had atypical presentations, with subtle clinical findings but with common general surgical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗

PubMedDate not supplied

Results of heart transplantation for active lymphocytic myocarditis.

To determine whether the heart-specific immunoreactivity associated with active myocarditis affects outcome after heart transplantation, we retrospectively analyzed the outcome of 12 patients with active lymphocytic myocarditis in their explanted native hearts identified by the Registry of the International Society for Heart Transplantation. The patients were 38 +/- 10 years of age and predominantly female (75%). In nine patients (75%), endomyocardial biopsy showed active myocarditis before transplant; eight of these patients also received immunosuppression before transplant. Recipient hemodynamic study before transplantation demonstrated an ejection fraction of 0.18 +/- 0.06, cardiac index of 1.7 +/- 0.4 L/min/m2, pulmonary artery pressure of 41 +/- 6/23 +/- 6 mm Hg, and mean pulmonary capillary wedge pressure of 30 +/- 5 mm Hg. Left ventricular end-diastolic dimension by echocardiography was 6.0 +/- 1.4 cm. Four of the patients were dependent on intravenous inotropes, and six required mechanical assistance. Over a 36-month follow-up period, 2.9 +/- 2.4 episodes of rejection occurred per patient. Sixty percent of the first episodes occurred within 2 weeks of transplantation. These patients experienced a 2.2 +/- 1.1-fold increase in rejection compared with institutional average rejection rates. Survival was significantly shorter than that of age-matched or female control subjects. This study is limited by its retrospective nature and the unusual pretransplant characteristics of the subjects. It indicates that active myocarditis may predispose patients to early severe rejection and a high mortality rate after heart transplantation.

Adult↗

PubMedDate not supplied

Use of theophylline for treatment of prolonged sinus node dysfunction in human orthotopic heart transplantation.

Sinus node dysfunction may complicate heart transplantation in over 50% of cases, leading to prolonged bradyarrhythmias in 20% of recipients. Permanent pacemaker implantation, the standard treatment for such persistent rhythm disturbances, can result in significant complications in this setting. A protocol with theophylline, a methylxanthine known to reverse the sinus node electrophysiologic abnormalities observed in transplant patients, was initiated at our institution in October 1989 to treat posttransplantation bradyarrhythmias and to reduce the need for pacemaker implantation. Patients with sinus or nodal bradycardia or sinus arrest were given theophylline orally; the drug was initiated in 15 of 38 patients (39.5%), 3 to 24 days after transplantation. Mean duration of treatment was 57.4 days (range, 20 to 105 days). Normal sinus rhythm with a rate of more than 90 beats/min was restored in 14 of 15 patients (93.3%). Permanent pacing was required in one patient. Transplant recipients before October 1989 (group 1, n = 112) were compared with subsequent transplant recipients (group 2, n = 38). These groups did not differ significantly in incidence of bradyarrhythmias or potential risk factors for posttransplantation sinus node dysfunction, though a greater preoperative use of amiodarone occurred in group 2. Permanent pacemaker requirement was significantly reduced from 16.1% in group 1 to 2.6% in group 2 (p < 0.05) with the introduction of theophylline. Theophylline is effective treatment for posttransplantation bradyarrhythmias, thereby resulting in a reduced need for pacemaker implantation.

Adult↗

PubMedDate not supplied

Aortic dissection in a cardiac allograft recipient: a case report.

Ascending aortic dissection is rare in cardiac allograft recipients. Only two patients with dissection arising from the native aorta have been reported previously and, unfortunately, the diagnosis was made postmortem in each instance. We report the first case of successful surgical treatment of aortic dissection confined to the donor aorta in a recipient of an orthotopic cardiac allograft.

Aortic Dissection↗