Biomedical subjects

G K Sethi

Publications and source records attributed to G K Sethi.

111 records · Page 7Linked to original sources

PubMedDate not supplied

Coccidioidomycosis and heart transplantation.

Eleven episodes of Coccidioides immits infection (cocci) were documented in nine of 199 heart transplant recipients. Cocci was confirmed by fungal cultures and treated with 1 gram of intravenous amphotericin B, after which all patients were put on ketoconazole 200 mg orally twice a day. Two recurrent cocci episodes were noted, both occurring when ketoconazole maintenance therapy was discontinued. When compared with the group of patients without cocci, actuarial survival at 1 and 5 years was identical. We conclude that cocci does not seem to affect the early and late clinical outcome and that prophylactic use of ketoconazole (or other oral antifungal agents) after successful treatment of the initial infection is recommended.

Adolescent↗

PubMedDate not supplied

Complications of external cardiac massage: report of a case of laceration of the right ventricular outflow tract.

Closed chest cardiac massage is simple and usually a safe procedure for cardiac resuscitation. However, it is not innocuous and is occasionally associated with serious and even fatal complications. A case is reported in which fracture of the upper part of the left half of the sternum occurred following midline sternotomy. The sternum was re-approximated in the usual manner by interrupted wire sutures, but the fracture was not specifically repaired, because it was thought to be adequatley stabilized by this closure. Postoperatively, the patient required closed chest cardiac massage which caused a fatal laceration of the outflow tract of the right ventricle due to penetration of the sharp edges of fractured fragments. We believe fracture of the sternum which occurs while retracting it with sternotomy retractor during open heart surgery should be deliberately repaired to avoid this serious complication.

Heart Injuries↗

PubMedDate not supplied

Is it necessary to perform surveillance endomyocardial biopsies in heart transplant recipients?

BACKGROUND: Routine surveillance endomyocardial biopsies to diagnose unsuspected rejection are performed at 3- to 12-month intervals after heart transplantation. From 1979 to 1989, surveillance biopsies were routinely performed as a part of the yearly evaluation. METHODS: A retrospective analysis of the follow-up data showed that "routine surveillance biopsies" had an extremely low yield, and, on the basis of the results of this study, we discontinued to perform surveillance biopsies beyond 6 months after transplantation. To validate these results, we compared the outcome of two groups of patients who had similar demographics and identical immunosuppression, except that in one group the surveillance biopsies were not performed. RESULTS: No difference was found in either actuarial survival rate or freedom from late rejection between the two groups. CONCLUSIONS: These findings confirm that routine surveillance heart biopsies beyond 6 months after transplantation are not necessary and they should be performed only if there is clinical suspicion of rejection or as part of a research protocol.

Actuarial Analysis↗