Health-related quality of life and symptom frequency before and after lung transplantation.

Health-related quality of life (HRQOL) and symptom frequency and severity were assessed in 17 lung transplant recipients both prior to and following the procedure. Using standardized assessment techniques we found that the following components of QOL significantly improved post-transplantation: physical functioning, general health, vitality and social functioning. Both prior to and following transplantation, lung transplant recipients had significantly lower scores on all health-related quality of life indices when compared with a normative sample. Perhaps as a consequence of immunosuppression medication, recipients reported increased frequency of symptomatology following the procedure; however, considered together the symptoms were not reported as significantly more problematic following transplantation. These findings document improved HRQOL for lung transplant recipients and provide useful information for patients considering this potentially life-saving treatment option.

Prevention of postoperative pericardial adhesions using tissue-protective solutions.

Repeat cardiac surgical procedures are associated with increased technical difficulty and risk because of the previous formation of dense adhesions between the heart and the surrounding tissues. Dilute solutions of sodium hyaluronic acid (NaHA) and carboxymethyl cellulose (CMC) have been shown to prevent postoperative abdominal and pelvic adhesions and could therefore potentially inhibit adhesion formation following cardiac surgery. Adhesion prevention using 0.1% NaHA, 0.4% NaHA, or 0.1% CMC solutions was examined in a canine abrasion/desiccation pericardial adhesion model (5 animals/group) and compared to 10 animals treated with Ringer's lactate (RL) solution alone. The pericardium and heart were coated with 25 ml of test or control solution prior to and after pericardiotomy, after controlled gauze abrasion, after 30 min of desiccation, and prior to closure. At 6 weeks, animals were reexplored and adhesions were scored in a blinded manner by three to four surgeons using a 0-4 scale. Scores of 2 or greater were considered clinically significant. Mean adhesion scores from the left epicardium were 0.0 in animals treated with 0.1% NaHA, 0.6 in animals treated with 0.4% NaHA or 1% CMC, and 2.3 in animals treated with RL (P < 0.05 Duncan's ANOVA). In addition, none of the animals treated with 0.1% NaHA, 20% of the animals treated with 0.4% NaHA, and 20% of the animals treated with 1% CMC had clinically significant adhesions, whereas 80% of animals treated with RL had such adhesions. Sodium hyaluronic acid and CMC solutions, used as tissue coatings during cardiac surgery, inhibit the formation of undesired postoperative adhesions. Application of these biocompatible polymer solutions during surgery could reduce the technical difficulty and risk of repeat cardiac surgical procedures.

Haemostatic factors in human aortic intima.

Accumulation of lipid in developing fibrous atherosclerotic plaques is associated with high concentrations of fibrin and accumulation of a tightly bound lipoprotein fraction that can be released by incubation with fibrinolytic enzymes, suggesting that fibrin may play a key role in lesion development. It is not known whether this fibrin represents incorporated mural thrombus or is produced in situ by clotting of the fibrinogen that is present in intima in high concentration. Immunoelectrophoresis was used to measure the concentrations of fibrinogen and components of the clotting system in human aortic intima and lesions, and in mural thrombi. In the lipid and fibrin rich plaque centres prothrombin concentration was almost twice that in normal intima, but concentrations of the thrombin inhibitors antithrombin III and alpha 2-macroglobulin fell, so that the molar ratios of inhibitor/prothrombin fell from 3:1 in normal intima to 1:1 in the plaque centre. In mural thrombi there was preferential sequestration of fibrinogen-like antigen and prothrombin. Distribution of factor-VIII-related antigen was highly unpredictable; in both normal intima and all types of intimal lesion substantial amounts were recovered from some samples, whereas none was recovered from others. The highest concentrations were found in samples free of endothelium from the deep layers of lesions. The results are compatible with the idea that fibrinogen may be converted to fibrin within lesions; once some fibrin has accumulated within the intima it seems to bind low-density lipoprotein and sequester fibrinogen and clotting factors, thereby producing a self-amplifying system.

Distribution of plasma proteins across the human aortic wall--barrier functions of endothelium and internal elastic lamina.

The concentrations of plasma proteins of different molecular weights were measured in layers across the human aortic wall. On a volumetric basis the concentration of low density lipoprotein (LDL) in inner intima, adjacent to the endothelium, was almost twice the concentration in the patient's plasma. With the exception of transferrin, which behaved anomalously, the concentration of each protein was a linear function of is plasma concentration and molecular weight, so that the relative retention of albumin was only 15% of LDL retention and its concentration in inner intima less than one-quarter of the plasma concentration. Between the inner (luminal) and outer layers of intima the concentration of all proteins decreased by about 40%. In aortas in which the internal elastic lamina (IEL) appeared to be intact it provided an almost total barrier to LDL, but for smaller proteins the concentrations in the layer immediately outside it were inversely related to molecular weight; the concentration of LDL was only 0.3% of the intimal concentration whereas albumin was 26% of the intimal concentration. However, in aortas in which the IEL appeared morphologically frayed, fragmented or discontinuous there was an 80% increase in albumin, and a 25-fold increase in LDL in this layer. The differential barrier functions of endothelium and IEL produce bizarrely different macromolecular environments for smooth muscle cells in intima and media.

Role of endothelium in sequestration of lipoprotein and firbrinogen in aortic lesions, thrombi, and graft pseudo-intimas.

In the soft, gelatinous thickenings that appear to be the precursors of fibrous plaques, concentrations of plasma low-density lipoproteins (LP) and fibrinogen were three to four times higher than that in normal intima, but their concentrations of fibrin was not significantly higher. By contrast, in 60% of cholesterol-rich areas from more advanced plaques, fibrin (mean concentration 22.7 mg/100 mg lipid-extracted dry weight) was ten times higher than normal, and this was associated with a twelve-fold increase in a bound LP fraction that was released by incubation with fibrinolytic enzymes. The origin of this fibrin is uncertain, and to test similarity of fibrin in the lesion with that of mural thrombus free and bound LP, fibrinogen, and cholesterol were measured in thrombi and pseudo-intimas from prosthesis grafts. In the pseudo-intimas and the thrombi that were not covered with endothelium the concentrations of all these substances were very low, but in thrombi covered with endothelium the concentrations of free and bound LP were similar to those in intimal lesions. Thus, endothelialisation appears to promote accumulation of LP in mural thrombi.