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Biomedical subjects

T A English

Publications and source records attributed to T A English.

At least 91 records · Page 5Linked to original sources
PubMed1975

Double outlet right ventricle with 1-malposition of the aorta.

Four patients are described with a recently recognized variant of double outlet right ventricle. Clinical examination favoured tetralogy of Fallot, but the chest X-ray suggested corrected transposition. Catheterization and angiocardiography showed that the aorta was to the left of the main pulmonary artery, and both arose from a normally positioned morphological right ventricle. Egress of blood from the left ventricle was through a subaortic ventricular septal defect. In all patients severe pulmonary stenosis was present and the right coronary artery ran an anomalous course anterior to the pulmonary valve ring. Two children had successful total correction, and one a palliative Blalock-Taussing shunt. Necropsy material from the fourth patient allowed confirmation of the ventricular morphology and the conducting tissued was examined. In corrective surgery, blood from the left ventricle was rerouted into the aorta by an intraventricular baffle. Pulmonary stenosis was relived by infundibulectomy and outflow tract patch.

Adolescent↗
PubMed1975

The trochanteric approach to the hip for prosthetic replacement.

A new lateral operative approach to the hip was used for the insertion of 222 total hip prostheses for arthritis. The trochanter is cut off more deeply and more vertically than hitherto, with all of its muscle attachments, including the vastus lateralis, intact. The inclusion of the vastus lateralis stabilizes the fragment by counteracting the gluteus medius; together they generate an inward-acting muscle force on the fragment. Reattachment was by wire in 120 cases and directly to the femoral implant by bolt and graft in 102 cases. In the bolt attachment operation a new type of femoral component was used in conjunction with a variable-thickness bone graft. The method of trochanteric attachment was thought to contribute to the quality of bone repair by eliminating tensile forces and generating compressive forces. In all patients early mobilization and full weight-bearing were encouraged.

Arthritis↗
PubMed1972

Surgical aspects of bacterial endocarditis.

Forty patients with a previous history of bacterial endocarditis were treated surgically between December 1967 and August 1971. Of 28 patients who had elective valve replacements there were four hospital deaths and one late death. Seven patients underwent emergency operation for intractable heart failure before completion of antibiotic treatment, six survived operation and there was one late death. Six patients had operations for infection on pre-existing valve substitutes, of whom three were treated as emergencies. There were two hospital and no late deaths. 78% of all patients were alive and well four years to nine months after operation.These results confirm that in addition to elective valve replacement surgery has an important role both in the treatment of intractable heart failure during the infective stage of bacterial endocarditis and in the eradication of infection on cardiac prostheses.

Adolescent↗
PubMedDate not supplied

Some prognostic factors for the development of transplant-related coronary artery disease in human cardiac allografts.

The study of endomyocardial biopsy specimens taken in the first 130 days after transplantation has yielded no histologic features predictive of later development of transplant-related coronary artery disease. This study, however, indicated that a combination of the following factors might be predictive in cyclosporine-treated patients: untreated histologically proven episodes of rejection, infection with cytomegalovirus or reactivation of infection, ischemic heart disease in the recipient as the reason for heart transplantation, and possibly HLA-B5 or -B8 mismatch.

Adult↗
PubMedDate not supplied

Malignant tumors after heart transplantation.

Three hundred-thirteen heart transplant procedures were performed in 303 patients in the 10 years between January 1979 and December 1988. The incidence, histologic type, and site of malignant disease have been analyzed in the 275 patients (91%) who survived more than 1 month after heart transplantation. Four immunosuppressive regimens have been used during this period. Patients 1 through 29 received azathioprine and steroids with 28 days of intravenous antithymocyte globulin. Patients 30 through 89 received cyclosporine and low-dose steroids; the next 61 patients were randomized between cyclosporine and low-dose steroids and cyclosporine and azathioprine; and after patient 150 we have used triple therapy. All cyclosporine-based regimens have included a short course of prophylactic antithymocyte globulin. Eleven malignant tumors have been diagnosed, between 2 months and 6 years after the transplant procedure, and these have been treated by a variety of means. These tumors were two squamous cell carcinomas of the skin; a malignant anal wart that recurred after excision and radiotherapy and necessitated abdominoperineal resection: two small-cell carcinomas of the lung: one squamous cell carcinoma of the esophagus and one of the larynx; two carcinomas of the kidney were found at postmortem examinations; and there were two malignant lymphomas, one of which disseminated rapidly, whereas the other has had prolonged remissions with reduction in immunotherapy with acyclovir. These 11 tumors were responsible for four deaths. No relationship has been demonstrated between type of immunosuppression and tumor development. All patients who are immunosuppressed remain at increased risk for malignant changes. Close surveillance is needed to detect tumors at an early stage.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Management of rejection in heart transplant recipients: does moderate rejection always require treatment?

Triple-drug immunosuppression with cyclosporine, azathioprine, and steroids was introduced at Papworth Hospital in 1986. The management of rejection episodes in the first 40 patients receiving this regimen was reviewed for a minimal follow-up period of 18 months. Routine endomyocardial biopsy specimens were taken and classified into nil, minimal, mild, moderate, and severe rejection categories. Management was dependent on the biopsy result, in addition to the clinical state of the patient. In the early postoperative period (day 0 to 30) 2% of biopsy results showed severe rejection and 27% showed moderate rejection; all but one of the latter patients received augmentation of immunosuppression. In the intermediate period (days 31 to 90) severe rejection was present in 1% and moderate rejection in 36 (31%) of biopsies. Immunosuppression was augmented in 13 symptomatic patients, but in 23 asymptomatic patients additional therapy was withheld and the biopsy was repeated in 5 to 7 days. If moderate rejection was still present (11 cases), immunosuppression was augmented. Later (3 to 12 months) augmentation of immunosuppression was given on only four occasions. When the histologic criteria for diagnosis of moderate rejection are present during the early period after transplantation, we recommend augmented immunosuppression. In cases of later rejection we suggest that the decision be based on the biopsy result and the clinical condition of the patient; however, a prospective controlled trial will be required to confirm that this policy is correct.

Adolescent↗
PubMedDate not supplied

'Rejection or infection' predictive value of T-cell subject ratio, before and after heart transplantation.

Peripheral T-cell subsets were monitored in ten heart and two heart-lung recipients pre- and up to one year post-operatively. Prior to transplantation four patients had T-helper/T-cytotoxic suppressor ratios (TH/TS-C) above the range for normal healthy controls and all required treatment for rejection episodes, as compared with three of eight patients whose pre-transplantation ratios were within the normal range. No patient with high TH/TS-C ratios developed cytomegalovirus infection as compared with all of the eight patients with normal ratios. Post-transplantation cytomegalovirus infection was the major cause of alterations in TH/TS-C ratios. T-cell subset inversion always preceded the diagnostic rise in cytomegalovirus antibody titre in both primary and secondary cytomegalovirus infections. Inversion was also noted with Pneumocystis carinii infection. Reversal of the TH/TS-C ratio was due to a major increase in the absolute numbers of TS-C cells and was usually followed by a rise in the number of cells expressing a natural killer cell phenotypic marker (Leu-7). All patients with primary cytomegalovirus and two of four cases with secondary cytomegalovirus retained inversion throughout follow-up and showed significantly increased numbers of TS-C and Leu-7 bearing cells. However, the absolute numbers of TH fell by 200 days after transplantation in all patients irrespective of their TH/TS-C ratio. Although TH/TS-C ratio inversion was a predictor of cytomegalovirus infection, no association was found between changes in T-cell subsets after transplantation and rejection episodes.

Adult↗
PubMedDate not supplied

Storage and transport of heart and heart-lung donor organs with inflatable cushions and eutectoid cooling.

A system that uses a chemical method of cooling has been developed for the storage and transport of heart and heart-lung donor organs. This provides a precisely controlled environmental temperature without the use of ice, with its attendant problems of availability and potential contamination with pathogens. Storage and preservation solutions are transported to the donor hospital within the temperature-controlled polyurethane container, and the organs are returned in the same container, within an inflatable cushion. We have used this method for the distant procurement of over 260 hearts and for the most recent 30 heart-lung organ blocks. The mean ischemic time for hearts is 2.5 hours (1.5 to 4.2 hours) and for heart-lung blocks 2.2 hours (1.2 to 4.1 hours). Most donors give multiple organs such as kidney, liver, and pancreas. One patient received heart and kidney grafts from the same donor, and another received combined heart-lung and liver grafts. In relation to primary donor organ failure, there have been four deaths of patients who have had heart transplantations and no deaths of patients who received heart-lung organ blocks. We believe that the method offers advantages over the more conventional methods of organ storage with regard to convenience, temperature control, and sterility.

Cardioplegic Solutions↗