Biomedical subjects
Publications and source records attributed to A Miralles.
Heart transplantation is now an accepted therapeutic modality for end-stage heart disease. However, better immunosuppressive treatments and new methods to monitor rejection or detect early atherosclerosis must be developed to improve the long-term results after heart transplantation.
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1. A total particulate fraction of chick cerebellar membranes, obtained by a simple method, has been found to specifically bind [3H]kainic acid. Non-neuronal tissue, like chick liver, does not show any appreciable specific binding under the same experimental conditions. 2. Specific [3H]kainic acid binding to chick cerebellar membranes increases linearly with tissue concentration, reaches the binding equilibrium almost instantaneously and is pH and temperature dependent. 3. Specifically bound [3H]kainic acid is displaced by suitable concentrations of unlabelled kainic acid, L-glutamic acid and other excitatory amino acid analogues, both agonist and antagonist. This pharmacological pattern agrees with the general pharmacological properties of kainic acid receptors. 4. Saturation kinetic studies of kainic acid binding sites show one single binding mode with an apparent dissociation constant KD = 278 nM and a maximum number of binding sites of 187 pmoles/mg of protein. 5. In view of the mentioned data and the high amount of receptor sites found in chick cerebellar membranes, as compared with related values in rat cerebellum, we suggest that these receptors play a different physiological role or that they have a different cellular localization in chick and rat cerebellum.
Since our initial orthotopic heart transplant (OHT) in 1968, the first in Europe, 1130 patients with ages ranging from 1 month to 66 years have been referred to us. The cause of irreversible myocardial damage was idiopathic cardiomyopathy in 74%, ischemic heart disease in 19% and left ventricular failure after valvular replacement in 7%. A total of 540 transplantations, 463 orthotopic, 40 heterotopic and 37 heart-lungs were carried out. Features of the early post-operative course include temporary (first week) cardiac instability treated by isoproterenol. Later complications included rejection (95%) and side-effects of immunosuppressive therapy; infection (83%), osteoporosis, malignancy, graft atherosclerosis (2%). Cyclosporine (Cy) was responsible for diastolic hypertension, renal dysfunction, hirsutism, hyperplasia of the gingiva, hepatic dysfunction, and seizures. The survival rate of the Cy-treated patients was 68% at 7 years. All survivors have virtually normal social and professional lives, included the longest survivor 14 years after the operation. Recently in 34 patients in acute irreversible cardiac failure and who cannot have a transplant in time, we implant a total artificial heart (TAH) type JARVIK 7 during a period from 1-150 days. There has been no mechanical failure, hemolysis or thrombo-embolism and only one right ventricular device malposition; 20 patients died before transplantation, 13 were successfully transplanted, 1 is still on the artificial heart. Heart transplantation, and TAH used as a bridge to transplantation are now an accepted therapeutic means for irreversibly cardiac failure in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
1. The rates of gastrointestinal (GI) emptying of 8- and 15-d-old chickens treated with 17-hydroxycorticosterone was measured using 14C-polyethylene glycol-4000. 2. The rate of progression of intraluminal contents along the GI tract was decreased by 17-hydroxycorticosterone in both 8- and 15-d-old chickens. Glucocorticoid treatment only delayed the rate of progression of intraluminal contents along the large intestine of the older birds. 3. Delayed transit of intraluminal contents could be explained by a precocious maturation of chick GI tract, induced by glucocorticoids. Loss of responsiveness to glucocorticoids occurs during the second week after hatching, except in the large intestine.
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We reviewed all the patients who underwent surgical excision of cardiac myxomas at La Pitié during the last fifteen years. Fifty-one cases were found (32 female and 19 male) aging from 16 to 75 years (mean 51). Congestive heart failure was the primary symptom present in 28 patients. Thirteen patients presented peripheral embolization, four with syncope and 11 with tachyarrhythmias. The diagnosis was made either by echocardiography or angiography. All of them had correct preoperative diagnoses, and no tumors were found incidentally at operation. Forty-six myxomas were localized in the left atrium, four in the right atrium and one in the right ventricle. All the patients underwent open-heart operation and myxomas were successfully removed with excision of a portion of normal atrial septum or wall. Path reconstruction of the atrial septum was required thirty-six times. Mortality after surgical excision is very low. Only one death (1.96%) occurred as a result of a postoperative low output syndrome. Late recurrences have been reported in other series, but no recurrences were diagnosed in our patients up to the present. Although the recurrence rate is low, long-term clinical and echocardiographic follow-up is recommended.
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We report two cases of constrictive pericarditis after heart transplantation. It is noteworthy that constriction developed after a healed intrathoracic infection in the two patients. Unlike previous reported experiences, pericardiectomy was uneventful and successfully performed, although incomplete improvement was achieved in one case.