[Aneurysmectomy and revascularization in high-grade ventricular insufficiency following myocardial infarct].

A 58-year-old man sustained an anterior-wall myocardial infarction (without significant prodromal symptoms) and, two weeks later, a re-infarction with development of an extensive anterior-wall aneurysm. Rapidly progressive myocardial insufficiency with massive impairment of left-ventricular ejection fraction (7%), coronary angiography demonstrating triple vessel disease, necessitated resection of the aneurysm and double aortocoronary bypass. The patient was well enough for transfer to the rehabilitation unit on the 11th postoperative day.

Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery.

The objective of this study was to compare the efficacy of one to six doses of cefazolin as prophylaxis in general thoracic surgery using a randomized, double-blind design. Two-hundred eight consecutive patients admitted to a regional thoracic surgery unit for elective thoracotomy and lung resection were eligible for the trial. There were no wound infections in the one-dose group and two in the six-dose group (95% confidence intervals [CI]: -0.

Effects of the immunosuppressant cyclosporine on the circulation of heart transplant recipients.

The effect of cyclosporine on the systemic circulation and on heart rate is unknown for heart transplant recipients. Thirty-four heart transplant recipients were studied by right-sided cardiac catheterization after endomyocardial biopsy. A direct linear relation was found between systemic and pulmonary vascular resistance and cyclosporine trough blood levels, which were negatively related to heart rate.

Action of synthetic atrial natriuretic factor on contractility and coronary perfusion in isolated working rat hearts.

The effects of atrial natriuretic factor were studied in isolated working rat hearts. Increasing concentrations, from 0.1 to 100 nM, of a synthetic rat-ANF (atrial natriuretic factor) were added to the perfusate.

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.

Effects of hypoxia and fatty acids on the distribution of metabolites in rat heart.

The effects of exogenous fatty acids and hypoxia on cardiac energy metabolism were studied by measuring mitochondrial and cytosolic adenine nucleotides as well as CoA and carnitine esters using a tissue fractionation technique in non-aqueous solvents. During normoxia, the administration of 0.5 mM palmitate caused a considerable increase in acyl-CoA and acylcarnitine, particularly in mitochondria.

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.

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema thoracis is described. Initial thoracoscopy using a laparoscope under general anaesthesia enabled adequate debridement and breakdown of loculi within the empyema cavity under direct vision. Following this procedure irrigation of the cavity with two tubes was started and continued until three consecutive cultures of drained irrigation fluid became sterile.

Pseudohallucinations in diabetic eye disease: a natural Rorschach test?

In diabetic eye disease, worsening vision may lead to the phenomenon of pseudohallucinations. Illustrated by a case history, a hypothesis is proposed which views this phenomenon as a kind of deprivation. This deprivation has implications for treatment, since reassurance and explanation seem more appropriate than pharmacological action.

The management of cardiac surgical patients in a general surgical recovery ward.

A suitable combination of anaesthetic and surgical techniques has allowed the safe management of post-operative cardiac surgical patients to be conducted in a surgical recovery area rather than in the intensive care ward. The results of the first 103 patients so managed (aged 49 +/- 10.7 years) are presented.

The importance of cytomegalovirus in heart-lung transplant recipients.

The first 33 heart-lung transplant recipients in our series were studied for evidence of CMV infection. CMV infection was diagnosed by a change in the serologic status, viral culture, or histology of lung tissue. Of 18 patients who were preoperatively negative for CMV antibody, eight received organs from CMV antibody-positive donors.

Immunophenotyping to detect and characterize acute lymphocytic leukemia in testicular biopsies.

This study establishes the utility of immunophenotyping testicular biopsy specimens in patients with acute lymphoid leukemia. The value of immunophenotyping in detecting or excluding leukemic testicular infiltration is demonstrated in six children with acute lymphocytic leukemia. A panel of monoclonal antibodies was employed on snap-frozen testicular biopsies, allowing both detection and immunologic characterization of four neoplastic lymphocytic infiltrates.

Heart-lung transplantation at Papworth Hospital.

Combined heart-lung transplantation has been performed in 51 patients since 1984. A pulmonary preservation fluid preceded by prostacyclin infusion has allowed distant procurement. Early organ function has been good in all cases.

Effects of sulfhydryl-containing compounds on nitroglycerin-induced coronary dilatation in isolated working rat hearts.

The effects of various compounds on the time course of the coronary dilating response to nitrovasodilators were studied in working rat hearts. Continuous administration of 100 microM glyceryl trinitrate (GTN) to the perfusate induced a rapid increase in coronary flow. The flow decreased to about 40% of the initial flow rise within 20 min and remained constant during the following 40 min.

Histologic changes in heart-lung transplant recipients during rejection episodes and at routine biopsy.

In our experience a lung biopsy specimen taken by means of a fiberoptic bronchoscope is a useful, safe technique for the diagnosis of rejection in heart-lung transplant recipients. To determine that the histologic features associated with rejection can be identified in transbronchial biopsy specimens, 35 biopsy specimens (group A) taken when retrospective review confirmed a clinical diagnosis of rejection without evidence of infection were identified from a total of 107 biopsy specimens. These were compared with 14 biopsy specimens (group B) taken when the patients were well.

Transbronchial biopsy has eliminated the need for endomyocardial biopsy in heart-lung recipients.

Between April 1984 and August 1987, 27 patients have received heart-lung transplantations at Papworth Hospital. In the first 17 patients endomyocardial biopsies were performed routinely in accordance with the practice for heart transplant recipients. It became apparent that in contrast to heart transplant recipients, heart-lung transplant recipients show little evidence of cardiac rejection.

Clinical experience in the management of pulmonary opportunist infection and rejection in recipients of heart-lung transplants.

The main clinical problems that follow heart-lung transplantation are opportunist infections of the lungs and pulmonary rejection. Of 23 patients undergoing heart-lung transplantation, eight had opportunist infections and 12 had at least one episode of pulmonary rejection. Cardiac rejection occurred in only one patient, who did not need treatment.

Heart-lung transplantation for cystic fibrosis.

13 patients with severe lung disease and cor pulmonale from cystic fibrosis were accepted for heart-lung transplantation (HLT). 6 have had the operation, of whom 5 are well, with normal lung function, 3-29 months after operation. 1 patient died from adult respiratory distress syndrome after reoperation to control persistent chest-wall bleeding: at necropsy, this patient proved to have cirrhosis.