Biomedical subjects
Publications and source records attributed to S Raju.
Tension pneumopericardium is distinctly uncommon in the adult population. We present a case of tension pneumopericardium as a complication of lung transplantation in a 54-year-old woman with thromboembolic pulmonary hypertension who underwent single-lung transplantation.
There is a resurgence of interest in single- and double-lung transplantation for end-stage disease. An experience with six double-lung and three single-lung transplants is reported. The lungs were procured from a distance of up to 600 miles and the heart was shared with another team for transplantation in seven of nine instances. The operative mortality rate was 33%. Early transplant infections of donor origin were lethal. Late transplant pneumonitis was well tolerated and recovery was the rule. Three of nine cases had significant tracheal suture line stenosis and were managed conservatively. A technique of bronchial artery implantation using a conduit tailored from donor aorta is described. Transplant rejection was easily diagnosed and treated. Other notable complications included occasional massive pleural fluid loss, temporary space problem, and a delay in the 'resetting' of chemoreceptors resulting in moderate post-transplant hypercarbia accompanied by episodes in which the patient felt hypoxemic despite the maintenance of excellent levels of blood gases. A comprehensive rehabilitation program begun before operation is essential for success.
Six hundred forty-four legs were examined by means of descending venography in patients with chronic venous insufficiency. Three patient positions (supine, 30 degrees semierect, and 60 degrees semierect) were used with a standard angiographic technique. Patients were also studied during either normal respiration or a Valsalva maneuver. The deep venous valvular system was incompetent more often than the superficial (saphenous) venous system. Positive venograms revealed that reflux occurred into the deep venous system alone in 82%, the superficial venous system alone in only 2%, and a combination of deep and superficial systems in 16%. The authors conclude that descending venography is best performed at the more physiologic 60 degrees semierect position and with the Valsalva maneuver, which enables evaluation of the competence of valves in the closed position.
Histological features of preservation injury were studied in a dog model of total small bowel transplantation. It was remarkable that substantial microscopic injury was evident during cold ischemia, unlike in other organ systems. This was early in onset and was related to the duration of cold storage. There was further progression of injury during reperfusion, as expected. Nevertheless, the small bowel was noted to have substantial ability to recover from this storage- and reperfusion-related injury. Histological features of damage and recovery are described in detail.
A 99mTc penile scan was performed in 9 patients with priapism. The technique of the procedure is described. Penile scan is an easily obtainable modality that can differentiate between high- and low-flow forms of priapism. We believe that these scintigraphic findings facilitate management of priapism.
A total of 97 transvaginal scans were performed from 4 to 12 weeks' gestation in normal and accurately dated gestations. The sequential appearance of six structures were examined: (1) the gestational sac only was present during week 4; (2) the yolk sac appeared in week 5; (3) the fetal pole with detectable heart motion was first seen in week 6; (4) the single unpartitioned ventricle in the brain marked week 7; (5) the falx cerebri appeared during week 9; and (6) the appearance and the disappearance of the physiologic midgut herniation were seen in week 8 and week 11, respectively. Inasmuch as the time in gestation at which these structures appear characterizes the gestational age more than any measurement at this age, we propose a practical method to determine the correct gestational age in early first-trimester pregnancy.
Nutritional function following autografting of the entire small bowel was followed in 11 dogs for 12 months. Although positive nitrogen balance was recovered within a few weeks, the animals did not achieve their preoperative body weight for up to 6 months. Fat and D-xylose absorption remained depressed and never fully recovered. Hematocrit and serum iron did not normalize until the second postoperative month or later. Abnormal serum albumin and albumin/globulin ratio persisted for 12 months. When the mesenteric vein was anastomosed to the vena cava rather than to the portal vein, this group had more severe abnormalities in body weight, hematocrit, total protein, and serum albumin, in addition to a significant rise in liver enzymes. These findings represent a discouraging portent for the functional utility of small bowel transplants.
Alternative combined immunosuppressive therapy was tested in canine orthotopic bowel transplantation. Despite sporadic long-term survival, cyclosporine is still questionably effective. Triple-drug therapy (cyclosporine, azathioprine, and prednisone) combined with antilymphocyte serum or with a short segment graft was effective in reducing the early postoperative mortality due to acute rejection but did not alter the long-term survival rate. There was no apparent relationship between the serum cyclosporine levels and survival. The long-term survivors (longer than 100 days) maintained relatively low serum trough levels of cyclosporine. These suggest that orthotopic bowel transplantation in the dog, and probably in the human as well, requires improved immunosuppressive regimens.
Explore the source record for details and available documents.
It is widely accepted that transfusions are beneficial to the outcome of renal allotransplantation. Whereas some investigators suggested that transfusions may induce both specific and nonspecific suppression of the cell-mediated immune response, others disagree. To lend clarity to this discrepancy, we collected 40 serum samples before and after blood transfusion therapy of first-time cadaveric renal allograft recipients and evaluated each for T cell and B cell cytotoxic antibodies using an Amos modified complement-dependent microlymphocytotoxicity assay. When greater than 10% of the panel cells reacted with a grade 4 or better, the panel was considered significant, and when a lymphocyte specificity was lysed by antibody-rich serum greater than 50% of the time, the antibody was considered specific. Control T and B cell PRA assays employed sera from 27 normal nontransfused volunteers of similar age and sex. Survival distributions of differences in the PRA before and after blood transfusions and posttransfusion PRA levels were compared using the Gehan generalized Wilcoxon test. Other factors which influence allograft survival such as HLA-A, -B and -DR matches, number of blood transfusions, immunosuppressive therapy, age, sex, parity, previous positive crossmatch, circulating cytotoxic antibodies matching the graft, prior dialysis, length of time on the waiting list, lapse of time between transfusion and transplantation and the underlying primary diagnosis were also considered using the Gehan generalized Wilcoxon test or the chi 2 approximation. Transfusion-related B cell cytotoxic antibodies, HLA-DR monospecific or multispecific antibodies and HLA-A, -B matching extended graft survival in a significant manner. Sex influenced the production of B and T cell transfusion-related cytotoxic antibodies with females producing greater quantities of antibodies than males. Parity and the production of monospecific or multispecific antibody were associated with an increase in transfusion-related B cell cytotoxic antibody. A difference in sex was not linked to the production of monospecific or multispecific HLA-DR antibodies. The majority of males failed to respond to multiple blood transfusions with the production of B cell cytotoxic antibodies although more than half were successfully grafted. All females and males who responded with the production of B cell cytotoxic antibodies monospecific or multispecific, with the exception of 1 female, demonstrated an allograft survival of greater than 1 year. In conclusion, differences between pre- and post-transfusion B cell PRAs and monospecific or multispecific HLA-DR antibodies identified in patient sera following transfusions were good predictors of renal allograft survival in both males and females.(ABSTRACT TRUNCATED AT 400 WORDS)
Experimental small bowel transplantation has continued to be a complex procedure with high mortality. We investigated the technical aspects of small bowel transplantation in an effort to define a procedure that would result in an improved survival rate. Three methods of graft harvesting were examined in a model of canine small bowel autotransplantation. Harvesting the graft by first flushing with room-temperature lactated Ringer's followed by iced lactated Ringer's resulted in the best preservation and subsequently the best survival rate (71%). Flushing with iced lactated Ringer's alone resulted in survival rates of 22 and 50% in two additional groups. We also investigated two methods of graft reanastomosis. Although either venous drainage regimen appears to be suitable, graft venous reanastomosis to the host portal vein resulted in a slightly higher postoperative weight than reanastomosis to the host inferior vena cava. A model of small bowel transplantation with a high long-term survival rate has been developed. This model can now be applied to studies of the various physiological aspects of small bowel transplantation.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Transplantation of femoral vein grafts was performed on 33 mongrel dogs to assess graft patency and valvular function after storage in glutaraldehyde. The grafts were removed from the donor, flushed with room temperature heparinized lactated Ringer's solution, and then stored in a 0.2% glutaraldehyde solution for 16 hr. At the time of grafting, the veins were again flushed with lactated Ringer's and anastomosed orthotopically to the recipient. An arteriovenous fistula was also created. Postoperatively the animals received daily doses of aspirin (2 mg/kg) and dipyridamol (50 mg). The following groups were studied: Group I (n = 10) served as controls and received fresh autografts. Group II (n = 13) received autografts stored for 16 hr in 0.2% glutaraldehyde. Group III (n = 10) received allografts stored similarly in glutaraldehyde for 16 hr. The grafts were monitored for evidence of patency. All grafts were removed for histological evaluation when patency was no longer detected or at the end of 7 weeks. Of the fresh and glutaraldehyde-preserved autografts (Group 1), 100% were patent at 7 weeks, and generally retained valve function. Patency of allografts was only slightly inferior but valve function was disappointingly poor at 7 weeks.
Among 211 limbs with nonobstructive chronic venous insufficiency, valve reflux of the deep system was the predominant (more than 70%) pathologic condition. Superficial venous or perforator incompetence when present invariably occurred in combination with valve reflux of the deep veins, suggesting that the latter is a common denominator for symptom production. Single level-single system reflux was only occasionally symptomatic (10%), whereas the incidence of single level-multisystem reflux (25%) and multilevel-multisystem reflux (65%) in symptomatic limbs was much higher. Our experience with 107 venous valve reconstructions with a 2- to 8-year follow-up is described. Different techniques of valve reconstruction employed are detailed. The most common pathologic feature is a redundant valve with malcoaptation probably of nonthrombotic origin. Valsalva foot venous pressure elevation is a useful hemodynamic technique for assessing surgical results. Valvuloplasty may be superior to other reconstruction techniques in relieving symptoms of stasis, including stasis ulceration.
We have presented a successful case of lung transplantation in a man with pulmonary fibrosis. We believe it is the first successful attempt in the United States, following demonstration of its feasibility in Toronto, Canada. Twenty years after the first lung transplantation, several factors have evolved that help to secure a successful outcome, including a strong, dynamic organ procurement system; static, hypothermic lung preservation; omental wrapping of the bronchial anastomosis; improved immunosuppressive agents; and improved postoperative care.