Safety and immunogenicity of LC16m8, an attenuated smallpox vaccine in vaccinia-naive adults.

Introduction: LC16m8 is an attenuated cell culture-adapted Lister vaccinia smallpox vaccine missing the B5R protein and licensed for use in Japan.

Methods: We conducted a phase I/II clinical trial that compared the safety and immunogenicity of LC16m8 with Dryvax in vaccinia-naive participants. Adverse events were assessed, as were electrocardiography and laboratory testing for cardiotoxicity and viral culturing of the vaccination sites.

Effect of rapamycin therapy on coronary artery physiology early after cardiac transplantation.

Background: Rapamycin has been shown to reduce anatomical evidence of cardiac allograft vasculopathy, but its effect on coronary artery physiology is unknown.

Methods: Twenty-seven patients without angiographic evidence of coronary artery disease underwent measurement of fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR) within 8 weeks and then 1 year after transplantation using a pressure sensor/thermistor-tipped guidewire. Measurements were compared between consecutive patients who were on rapamycin for at least 3 months during the first year after transplantation (rapamycin group, n = 9) and a comparable group on mycophenolate mofetil (MMF) instead (MMF group, n = 18).

Reninoma: case report and literature review.

Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia via hypersecretion of renin. We describe a case of reninoma and provide a review of the literature, with a discussion emphasizing the diagnostic evaluation for such patients. The subject had persistent elevation of both plasma renin activity (PRA) and aldosterone.

Outcome in cardiac recipients of donor hearts with increased left ventricular wall thickness.

The ongoing shortage of donors for cardiac transplantation has led to a trend toward acceptance of donor hearts with some structural abnormalities including left ventricular hypertrophy. To evaluate the outcome in recipients of donor hearts with increased left ventricular wall thickness (LVWT), we retrospectively analyzed data for 157 cardiac donors and respective recipients from January 2001 to December 2004. There were 47 recipients of donor heart with increased LVWT >or=1.

Pulmonary nocardiosis in a heart transplant patient: case report and review of the literature.

Pulmonary infection with Nocardia is an uncommon but serious infection found in immunocompromised patients. We describe a rapidly progressive pulmonary nocardiosis in a heart transplant patient. We then review the common clinical features of Nocardia infection in transplant recipients, outlining the challenges in its diagnosis and management.

Use of the implantable cardioverter-defibrillator in long-term survivors of orthotopic heart transplantation.

Background: Orthotopic heart transplantation is considered an effective treatment for patients with refractory heart failure. The long-term survival of orthotopic heart transplantation recipients has increased over the last several decades, but many long-term survivors of orthotopic heart transplantation develop graft atherosclerosis and associated left ventricular dysfunction. The risk of sudden cardiac death in long-term survivors of orthotopic heart transplantation with these complications is believed to be high.

Pseudoallescheria boydii pneumonia and empyema: a rare complication of heart transplantation cured with voriconazole.

Pseudoallescheria boydii pneumonia is a rare occurrence, usually resistant to amphotericin B and other anti-fungal agents. We report a complete response to voriconazole in an immunosuppressed host.

Post-transplantation lymphoproliferative disease in heart and heart-lung transplant recipients: 30-year experience at Stanford University.

Background: Post-transplantation lymphoproliferative disease (PTLD) is an important source of morbidity and mortality in transplant recipients, with a reported incidence of 0.8% to 20%. Risk factors are thought to include immunosuppressive agents and viral infection.

Coronary artery: quantitative evaluation of normal diameter determined with electron-beam CT compared with cine coronary angiography initial experience.

Eight male heart transplant recipients underwent contrast material-enhanced electron-beam computed tomographic angiography. Coronary artery diameters measured with fixed thresholds and adaptive line density profile (LDP) methods were calculated relative to findings at quantitative coronary angiography. Variation with fixed-threshold methods was significantly greater than that with LDP methods because of variations in vessel enhancement.

Atrial arrhythmias in adults after repair of tetralogy of Fallot. Correlations with clinical, exercise, and echocardiographic findings.

Background: The long-term success of intracardiac repair of tetralogy of Fallot is hampered by the occurrence of arrhythmias. Numerous studies have stressed the potential role of ventricular arrhythmias. However, the importance of other arrhythmias in the morbidity of these patients appears to be underestimated.

[Cyclosporin in heart transplantations. The authors' personal experience].

The discovery of cyclosporine A (CsA) was a major development in the evolution of organ transplantation. In renal transplantation use of CsA improved graft survival such that HLA-matching is no longer as important and determinant as before. Liver transplantation prior to the arrival of CsA was almost abandoned by Starzl because of uncontrollable rejection.

Cardiac transplantation: a review for the intensivists.

Cardiac transplantation has now become accepted therapy for the treatment of end-stage heart disease in both children and adults, and literally thousands of patients are bearers of cardiac grafts. Because of these patients' susceptibility to infections, rejection, coronary disease, and malignancy, as well as to serious illnesses unrelated to their transplantation, they will often be encountered at hospital centers both close to their homes and distant from the site of their surgery. The intensive care unit physician's role will be a demanding one when caring for these patients because of the broad differential diagnosis of infections, frequency of drug interactions and altered immunosuppression, and continuous uncertainty regarding the possibility of rejection, particularly during the first year after transplantation.

Chronic injury of human renal microvessels with low-dose cyclosporine therapy.

Physiologic and morphologic techniques were used to study kidneys of cardiac transplant recipients treated with either low-dose (low-CsA) or high-dose (high-CsA) cyclosporine. After 12 months both low-CsA (4.6 +/- 0.

Limitations of creatinine in quantifying the severity of cyclosporine-induced chronic nephropathy.

The glomerular filtration rate (GFR), as measured by the clearance of inulin, was depressed severely in 34 heart transplant recipients receiving cyclosporine (CsA) for 12 months or longer. The clearance of 99mTc-DTPA, a filtration marker similar in size to creatinine, was identical to that of the larger inulin molecule. In contrast, the clearance of creatinine was enhanced (P less than .

Chronic tricuspid regurgitation and bifascicular block due to blunt chest trauma.

Closed-chest trauma in a young man was followed by rupture of a right ventricular papillary muscle and bifascicular block. This produced signs and symptoms of tricuspid regurgitation and recurrent syncope. Treatment by valve replacement and pacemaker implantation was successful.