ABSTRACT
BACKGROUND: A state of tolerance may be more easily achieved if fully vascularized and functional donor thymus is transferred to the recipient at the time of whole organ transplantation. METHODS: A composite "thymoheart" allograft was created by implanting autologous thymus into a donor heart 60-90 days before organ procurement. Successful intracardiac engraftment of autologous thymus was documented by histology and by flow cytometric analysis. RESULTS: Histology of the thymic autografts at explantation revealed viable thymus with preservation of normal thymic architecture. Cells retrieved from thymic autografts 60 days after implantation exhibited the same MHC class I and class II staining profiles by flow cytometry as cells taken from the residual native thymus. CONCLUSION: We have created a novel composite organ that confers vascularized and functional donor thymus to heart allograft recipients at the time of transplantation without affecting cardiac function.
Subject(s)
Heart Transplantation/methods , Thymus Gland/transplantation , Animals , Heart Transplantation/immunology , Histocompatibility Antigens Class I/immunology , Histocompatibility Antigens Class I/metabolism , Histocompatibility Antigens Class II/immunology , Histocompatibility Antigens Class II/metabolism , Swine , Swine, Miniature , Thymus Gland/cytology , Thymus Gland/immunology , Transplantation, Homologous/methodsABSTRACT
The diuretic response of patients with congestive heart failure to establish doses of diapamide (750 mg) and furosemide (80 mg) was compared in an open, crossover study. Peak urine output occurred in the first 6 hours after administration of furosemide but somewhat later (12 to 18 hours) with diapamide. Both agents produced active diuresis and natriuresis in most patients. Comparisons of drug effect during the first days of each treatment period and analysis of the entire first treatment period indicated that urine output with furosemide was significantly greater than with diapamide. Urinary sodium excretion on the first day of treatment was not significantly greater with furosemide than with diapamide, nor were the differences significant on subsequent days. The observed differences between drugs on urinary potassium and chloride excretion were not statistically significant. The most frequently occurring adverse reaction was mild to moderate nausea, which was reported by five patients receiving diapamide and two patients receiving furosemide. Diarrhea and vomiting were also more frequent with diapamide. Diapamide would appear to serve a role between the milder thiazide diuretics and the more effective furosemide.
Subject(s)
Diuretics/therapeutic use , Heart Failure/drug therapy , Adult , Aged , Clinical Trials as Topic , Diuretics/adverse effects , Female , Furosemide/adverse effects , Furosemide/therapeutic use , Humans , Kidney Function Tests , Male , Middle Aged , Sodium/urine , Sulfonamides , Time FactorsABSTRACT
High-quality echocardiograms were performed on 146 normal individuals whose ages ranged from 3 to 73 years (mean 27 years). Normal values for mitral diastolic excursion and E-F slope, the chamber dimensions of the right ventricle, left atrium, and left ventricle, the aortic root dimension, and thickness of the interventricular septum and left ventricular posterior wall were determined. Each tracing was then read independently by two experienced echocardiographers. The extent of interobserver variability was calculated and expressed as a percent of the mean. The 95 per cent confidence limits for these estimates were calculated. Small but significant interobserver variability was found for all nine of these commonly measured echocardiographic parameters. Observer variability is a small but potentially important consideration in investigative echocardiography.
Subject(s)
Echocardiography , Heart Diseases/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Clinical Competence , Echocardiography/standards , Humans , Middle AgedABSTRACT
The prevalence of mitral valve prolapse has been established in selected groups of patients but not in the general population. The present study was designed to define the echocardiographic spectrum of mitral valve motion in a population of young individuals without clinical evidence of significant cardiac disease or hypertension. Echocardiograms were performed on 136 normal volunteers. Six subjects (4.4 per cent) had mitral valve prolapse. Eighteen subjects (13.2 per cent) had a lesser degree of posterior systolic motion of the mitral valve leaflets which was suggestive but not diagnostic of prolapse. Minor degrees of posterior systolic mitral valve motion may represent a variant of normal. Caution should be exercised in making the echocardiographic diagnosis of mitral prolapse until this question is settled.
Subject(s)
Echocardiography , Mitral Valve Insufficiency/epidemiology , Adolescent , Adult , Child , Child, Preschool , Female , Heart Diseases/diagnosis , Humans , Hypertension/diagnosis , Male , Massachusetts , Middle AgedABSTRACT
Gated radionuclide cardiac blood pool scans (GCS) of end-systole and end-diastole or eight images subtending the entire cardiac cycle were performed on seven patients with left atrial myxomas documented by pulmonary cineangiography with left atrial follow-through. The ethocardiogram was either suggestive or diagnostic in all patients. In addition to demonstration of the tumor (6 patients), the GCS detected three patterns of tumor motion: 1) a defect which moved from the left atrium in end systole to the left ventricle in end diastole (2 patients); 2) a defect which remained within the region of the left atrium but decreased in size between end diastole and end systole (3); and 3) a defect which was observed within the region of the left ventricle in end diastole but disappeared in end systole (1). Thus, the GCS is a noninvasive method for detection and evaluation of motion of left atrial myxomas.
