Building a cardiology practice.

This study was designed to quantify the clinical and marketing effectiveness of the Pocket EKG Clinical Based Marketing Program by measuring its impact on new patient visits, patient satisfaction, payor negotiations, and patient management at Pikes Peak Cardiology (PPC), Colorado Springs, Colorado. New patient visits were found to increase by 22% for 6.5 consecutive years.

Prevention of Pneumocystis carinii pneumonia in cardiac transplant recipients by trimethoprim sulfamethoxazole.

Pneumocystis carinii pneumonia (PCP) continues to cause significant morbidity in recipients of solid-organ transplants. While some programs administer trimethoprim-sulfamethoxazole (TMP-SMX) prophylactically following transplantation, a prospective determination of the safety and efficacy of TMP-SMX in cardiac transplant recipients has not previously been reported. We therefore prospectively randomized 58 cardiac transplant recipients to receive TMP (160 mg)-SMX (800 mg) twice daily either three days per week (group B), or seven days per week (group C), or to receive no treatment (group A).

Clinical significance of mild rejection of the cardiac allograft.

Background: The clinical status of heart transplant patients during mild rejection (lymphocytic infiltrate without myocyte necrosis) has not been previously reported. This study examined the frequency and outcome of mild rejection associated with allograft dysfunction sufficient in magnitude to be evident on clinical exam (two or more abnormal findings) and/or two-dimensional echocardiography.

Methods And Results: The study population consisted of 59 patients, 50 men and nine women 14-61 years old (mean, 1.

Quality of life and coping in patients awaiting heart transplantation.

The psychosocial adaptation of patients awaiting heart transplantation has not been defined. Forty-one patients (36 men, 5 women; mean age, 48 years) completed standardized questionnaires before transplantation to assess quality of life, physical symptoms, marital/social adjustment, psychiatric morbidity, coping, and compliance to medical regimens. Also, data were obtained from spouses/partners and the transplantation nurse coordinator.

Heart transplantation in children.

Orthotopic cardiac transplantation has been performed in 15 consecutive neonates and children since 1987. Diagnoses include hypoplastic left heart syndrome (5 patients), critical aortic stenosis with small left ventricle (1 patient), complex cyanotic heart disease (6 patients), and cardiomyopathy (3 patients). Twelve patients survived operation and have been followed from 1 to 45 months.

Therapy of refractory, recurrent heart rejection with multiple courses of OKT3.

The treatment for recurrent cardiac allograft rejection refractory to conventional immunotherapy is retransplantation. When retransplantation is not possible, alternative approaches must be undertaken. This report reviews the successful management of persistently recurring rejection using five serial 14-day courses of OKT3 in a 35-year-old man after two heart transplantations.

Unique antithymocyte serum versus OKT3 for induction immunotherapy after heart transplantation.

To determine the efficacy of a unique polyclonal rabbit antithymocyte serum (ATS), we compared 17 consecutive nonrandomized heart transplant recipients (mean age, 38 +/- 15 years) given a 7-day prophylactic postoperative course of locally produced ATS (whole serum, no Freund's adjuvant, IV) with 19 patients (mean age, 42 +/- 17 years) given 14 days of monoclonal antibody OKT3. Cyclosporine, steroid, and azathioprine dosages were similar. At 30 days the event-free incidence of rejection was 66% +/- 11% for OKT3 (2.

Total lymphoid irradiation in heart transplantation: adjunctive treatment for recurrent rejection.

In the face of recurrent heart transplant graft rejection refractory to all conventional immunotherapy, retransplantation is customary treatment. The case of a heart transplant recipient unsuitable for retransplantation whose recurrent rejection was successfully treated with postoperative total lymphoid irradiation is described.