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Biomedical subjects

D Chamberlain

Publications and source records attributed to D Chamberlain.

113 records · Page 7Linked to original sources
PubMedDate not supplied

Treatment for amblyopia: results using occlusive contact lens.

PURPOSE: Amblyopia treatment occasionally is complicated by patch intolerance, resulting in a poor outcome. Therefore, a prospective study was designed to examine the efficacy and safety of using occlusive contact lenses in the treatment of amblyopia. METHODS: Twenty-five patients, aged 2.5 to 9.5 years, who were using an opaque hydrogel contact lens for the treatment of amblyopia, were followed prospectively. RESULTS: Overall, 92% of patients improved at least one line of visual acuity. Eight patients improved > or = 2 octaves and 12 other patients improved > or = 1 octave. In three patients, the change in visual acuity was < 1 octave. Complications were seen in nine patients: contact lens irritation in five; poor contact fit in three; and peeking around the lens in one. The recurrence rate was high. In 11 of 25 patients, amblyopia rapidly returned to a reduced level when the contact lens was discontinued. CONCLUSIONS: Occlusive contact lenses can be used in treating amblyopia in children. This treatment is ideal in patients who were patch-intolerant and failed with conventional treatment. Patients should have close follow up, however, to monitor any anterior segment complications from contact lens use and to identify the patients in whom amblyopia recurs.

Amblyopia↗
PubMedDate not supplied

Acute lung injury in lung allografts.

BACKGROUND: Acute alveolar injury is a pathologic description of a nonspecific response of the lung to an acute injury. It has been our experience that acute alveolar injury may be seen in transbronchial biopsy and open lung biopsy specimens from patients who have successfully undergone lung transplantation. Because no studies of the clinical significance of acute alveolar injury in lung transplant recipients are available in the literature, we reviewed the impact of this pathologic finding in patients who underwent transplantation in the Toronto Lung Transplant Program. METHODS: From November 1983 through December 1992, we retrospectively reviewed all transbronchial biopsies and open lung biopsies performed in lung transplant recipients. RESULTS: Of the 137 transplantations performed (53 single and 84 double) acute alveolar injury was observed in 21 single (34 of 173 transbronchial biopsy and 3 of 11 open lung biopsy) lung biopsy) and 22 double (38 of 415 transbronchial biopsy and 3 of 11 open lung biopsy) lung transplantations. We sought to explain this finding on the basis of the concurrent clinical scenario. Acute alveolar injury occurred most commonly in association with infection (52%) followed by postoperative period (19%) and acute (16%) rejection. Acute alveolar injury occurred as an isolated finding in 7% of patients. It occurred within the first 4 months after transplantation in 80% of cases. In 10 of 21 single lung transplantations and 12 of 22 double lung transplantations, acute alveolar injury was seen at least twice. However, no difference was found in mortality between such patients (6 of 10 single and 6 of 12 double lung transplantations) and patients with only one episode of acute alveolar injury. CONCLUSION: Acute alveolar injury is a relatively common finding in histologic specimens from patients with lung transplantation and is most commonly associated with infection.

Biopsy↗
PubMedDate not supplied

Causes of death in lung transplant recipients.

Between November 1983 and September 1992, The Toronto Lung Transplant Program performed 131 lung transplantations in 122 recipients; 53 single lung transplantations and 78 double lung transplantations. Forty-five patients died, 25 (47%) in the single lung transplantation and 20 (25%) in the double lung transplantation groups. We retrospectively reviewed the hospital charts of all deceased recipients and the postmortem reports of the 35 patients (20 single lung transplantations and 15 double lung transplantations) who had autopsies. Preoperative single lung transplantation diagnoses included pulmonary fibrosis, (n = 17) obstructive disease (n = 6) and vascular disease (n = 2). Preoperative diagnosis of double lung transplantation included pulmonary fibrosis (n = 2), obstructive disease (n = 6), septic lung disease (n = 9), and vascular disease (n = 3). The most common cause of death in single lung transplantation was infection. Five patients died of bronchiolitis obliterans, and five more had bronchiolitis obliterans lesions present at autopsy that were not a direct cause of death. Diagnosis of primary disease was made in 23 of 25 single lung transplantations antemortem and 2 of 25 at autopsy. Autopsy diagnoses were disseminated Aspergillus and cytomegalovirus infection. In double lung transplantations, infection was also the primary cause of death; in three other patients, airway dehiscence preceded infection. Bronchiolitis obliterans was the second most common cause of death and was also present in four patients dying of infection. All double lung transplantation diagnoses were made antemortem. We concluded that infection and then bronchiolitis obliterans are the primary causes of death after lung transplantation. Although infection is a major cause both early and late after transplantation, bronchiolitis obliterans is an important factor in transplantation only late after the operation.

Adolescent↗
PubMedDate not supplied

Evaluation of transbronchial lung biopsy specimens in the diagnosis of bronchiolitis obliterans after lung transplantation.

We investigated the utility of transbronchial lung biopsy in allograft evaluation, particularly with reference to rejection-mediated bronchiolitis obliterans in 105 transplant recipients surviving 3 months or more (29 single lung, 76 double lung). A sensitivity and specificity of one transbronchial biopsy procedure with an average procurement of 7.6 tissue fragments was 17.1% and 94.5%, respectively, according to results obtained from biopsies carried out after 2 months transplantation in 29 patients with confirmed rejection-mediated bronchiolitis obliterans and 61 patients known not to have the disease. The predictive value of a positive procedure for the presence of disease was 65.5% and that of a negative procedure for the absence of disease was 65.2%. Similarly, the sensitivity and specificity for the finding of bronchiolar mural fibrosis were 18.5% and 85.3%, respectively; and, for lymphocytic bronchiolitis, the values were 1.9% and 100%, respectively. We conclude that, although the sensitivity of transbronchial biopsy and the predictive value of a procedure which shows microscopic bronchiolitis obliterans are low, attempts should be made to support a clinical diagnosis of bronchiolitis obliterans through biopsy, given the problems inherent in achieving an early and certain diagnosis according to clinical criteria alone.

Biopsy↗