Sequence of the Phytophthora infestans glyceraldehyde-3-phosphate dehydrogenase-encoding gene (gpdA).
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Amino Acid Sequence↗
Biomedical subjects
J M Duncan
Publications and source records attributed to J M Duncan.
Zinc fingerprinting for Phytophthora species: ZIF markers.
We have assessed the potential of using zinc finger markers for identification of fungal species using Phytophthora as a model organism, since it is particularly difficult to classify. The results show that such markers are suitable for species identification of Phytophthora but do not appear to aid strain identification within species.
Base Sequence↗
Preoperative and postoperative Hemopump support for patients undergoing orthotopic heart transplantation.
The Hemopump (Johnson & Johnson Interventional Systems, Rancho Cordova, CA) can be used successfully as a bridge to cardiac transplantation in patients with advanced cardiogenic shock that proves to be irreversible. Some patients, however, may also benefit from maintaining Hemopump support for a period of time after transplantation. A technique has been developed for continuing Hemopump support after transplantation that does not require repositioning of the device.
Adult↗
Intracavitary repair of ventricular aneurysm and regional dyskinesia.
Myocardial damage after infarction is a common sequela in patients with coronary occlusive disease. The extent of injury varies and may be localized or diffuse. Since March 1989, the authors have used a new surgical repair technique that employs an intracavitary patch of Dacron fabric or glutaraldehyde-treated pericardium to exclude the hypokinetic or fibrotic myocardial segment. An elliptical configuration preserves the contour and volume of the ventricular cavity. After securing the patch, the ventriculotomy is closed with a simple continuous suture. Through July 31, 1991, 136 patients underwent repair using this technique. Of these patients, 100 (group I) had neither sustained an acute myocardial infarction (within 30 days before surgery) nor had undergone previous cardiac surgery, whereas 36 (group II) had sustained an acute myocardial infarction or had undergone previous cardiac surgery. In group I, four (4%) died within 30 days of surgery, and seven died later, resulting in a 6-month survival of 90.5% and a 1-year survival of 85.3%. In group II, 11 (30.6%) died within 30 days of surgery, and three died later. Functional class improved after repair in 95.7% of patients in group I and all patients in group II. In both groups, ejection fraction improved significantly (p less than 0.0001, group I; p less than 0.0001, group II). By eliminating the need for epicardial buttresses to repair the ventriculotomy, myocardial revascularization has been possible in most patients. This method of intraventricular repair is also appropriate for patients with calcified aneurysms, acquired ventricular septal defects, and acute ventricular rupture.
Bioprosthesis↗
Implantation technique for the HeartMate left ventricular assist device.
The technique for implanting the HeartMate, an intraabdominally placed, pulsatile left ventricular assist device, is described. This device, which has been developed for potential use in patients requiring permanent left ventricular assistance, is currently undergoing clinical investigation in patients requiring temporary support as they await cardiac transplantation. This clinical experience has demonstrated device safety and efficacy, even for patients requiring extended periods of support.
Abdomen↗
Recovery of pulmonary function in patients undergoing extended left ventricular assistance.
Heart transplantation should follow the implantation of a left ventricular assist device (LVAD) only after optimal postoperative recovery of pulmonary function. We reviewed hospital records of 12 patients who underwent extended (greater than 30 days) left ventricular support before transplantation to determine the rate of return of pulmonary function. The mean cardiac index and pulmonary capillary wedge pressure returned to normal in all patients within three days after LVAD implantation. The mean pulmonary artery pressure and pulmonary vascular resistance decreased but did not return to normal. The mean central venous pressure remained elevated throughout the first month but decreased by the time of transplantation. Supplemental oxygen requirements and peak airway pressures improved, and ten of the 12 patients were extubated by the fifth postoperative day. Preoperative roentgenographic evidence of pulmonary edema was present in eight patients, and pulmonary hilar prominence was present in the remaining four patients. Roentgenographic resolution of the pulmonary edema occurred slowly, persisting for one week after surgery in seven of eight patients. Ten patients were able to exercise strenuously 30 days after surgery, and 11 were returned to excellent condition before undergoing heart transplantation. Although the hemodynamic status in these patients significantly improved shortly after LVAD implantation, optimal recovery of pulmonary function required several weeks. Therefore, we advocate delaying transplantation after LVAD implantation to allow optimal pulmonary recovery.
Adult↗
Clinical evaluation of right ventricular function in patients with left ventricular assist device (LVAD).
Right ventricular function (RVF) during LVAD support can be a threat for patient survival. Despite extensive research, RVF and its interference with left heart function is unclear. This study examines RVF in a retrospective analysis of 14 patients. Hemodynamic data were collected, including heart rate (HR), central venous pressure (CVP), mean pulmonary artery pressure (mPAP), total cardiac output (CO), calculated stroke volume index (SVI) and right ventricular stroke work index (RVSWI). In all patients, CO increased gradually throughout the study period; CVP showed no significant decrease; mPAP and PCWP decreased significantly over the time period; SVI improved and RVSWI increased from the starting level prior to implantation of the LVAD. We conclude that the CO improved with a lowering of the right ventricular afterload combined with a decrease in total circulating volume. The improvement of RVF with LV assist makes this device an option as a bridge to transplant.
Blood Pressure↗
Subclavian vein-to-right atrial bypass for symptomatic venous hypertension.
A new surgical technique for bypassing subclavian vein thromboses in patients undergoing hemodialysis is presented. Subclavian vein stenosis or occlusion can occur after the use of temporary access catheters in subclavian vein dialysis. If this occurs in a patient with an arteriovenous access fistula of an ipsilateral upper extremity, venous hypertension, massive edema of the arm, and dysfunction of the access graft may result. In 2 patients with this condition, we successfully performed axillary vein-to-right atrial bypass, which resolved swelling and restored function of the access graft. This may be an appropriate surgical option for symptomatic venous hypertension in such patients.
Anastomosis, Surgical↗
Myocardium-sparing cannulation technique for left ventricular assist device support.
The left atrium and the left ventricular apex are the most commonly used sites of inflow cannulation for postcardiotomy left ventricular support. A new cannulation technique that requires only an ascending aortotomy is introduced. This procedure can be undertaken with equipment present in any cardiac operating room and may prove to cause fewer complications than conventional cannulation techniques.
Aorta↗
Patent foramen ovale: a cause of hypoxemia in patients on left ventricular support.
We describe 2 patients who experienced right-to-left shunting during support with a left ventricular assist device as a result of patent foramen ovale. In the first patient, the patent foramen ovale was not found until autopsy. In the second patient, fluctuations in continuous mixed venous oxygen saturations caused us to suspect a patent foramen ovale, which was confirmed with transesophageal contrast echocardiography. We promptly repaired the defect and this patient survived. When patients on assist devices experience unexplained arterial hypoxemia, a patent foramen ovale should be considered. If a patent foramen ovale is found, surgical correction should be done early.
Adult↗
Actin in the oomycetous fungus Phytophthora infestans is the product of several genes.
Actin (ACT) in Phytophthora infestans is encoded by at least two genes, in contrast to unicellular and other filamentous fungi where there is a single gene. These genes (designated actA and actB) have been isolated from a genomic library of P. infestans. The complete nucleotide sequence of both genes has been determined. Unlike the actin-encoding genes (act) of other filamentous fungi, no introns are obvious in the coding region, a feature shared with the act genes of certain protists. Northern blotting and primer extension studies of the mRNA show that actA and actB are actively transcribed in mycelium, sporangia and germinating cysts but only at a low level in the case of actB. Both genes display bias in their codon usage. This is more extreme in actA. The deduced ACTB protein is strikingly similar to that of the Phytophthora megasperma actin and is more diverged from other actins than ACTA.
Actins↗
Innominate artery occlusive disease: surgical approach and long-term results.
We reviewed our experience with 54 patients who underwent innominate artery revascularization during a 10-year period. Their age range was from 16 to 75 years (mean, 49.8 years). The innominate artery alone was involved in 21 patients (39%); the remaining patients had additional arch vessel obstructions. Before operation, neurologic symptoms occurred in 25 patients (46%), arm ischemia related to claudication and microembolization occurred in 8 patients (14%), a combination of symptoms occurred in 17 patients (32%), and no symptoms were noted in 4 patients (8%). The extrathoracic approach to surgery was used in 16 patients (30%). Eleven of the 38 patients in whom the intrathoracic approach was used had endarterectomy of the innominate artery; in three of those, the procedure was combined with left common carotid endarterectomy. Bypass grafts were used in the other 27 patients undergoing procedures with an intrathoracic approach; in six of those, bypass was combined with carotid endarterectomy. No operative deaths occurred. Perioperative revascularization failure occurred in four cases; all of those patients underwent a second revascularization procedure, with a secondary patency rate of 100%. In four patients, late occlusion was noted at 6 months and at 1, 1.5, and 10 years. One patient had a permanent perioperative neurologic deficit in the distribution of the left carotid artery after a combined common carotid endarterectomy/innominate endarterectomy procedure. No neurologic deficits were directly related to the innominate artery territory. Long-term actuarial survival was 83% at 10 years. Early and late graft failures were related to inadequate inflow in bypass grafts, progression of distal disease in arteritis, and primary closure in endarterectomy.
Adolescent↗
A community study of vitamin B12 and folate levels in the elderly.
OBJECTIVE: To measure the prevalence of low serum vitamin B12, folate, and red cell folate levels and their relationship with other nutritional indices. DESIGN: Prospective survey of elderly subjects using radioisotope dilution assays. SETTING: Primary care medical center, Christchurch, New Zealand. PATIENTS: 257 elderly subjects (age 65 years and over), residing in their own homes or in residential homes, were randomly selected. Of these, 204 (79%) participated. The study population was comparable to the elderly population of New Zealand. MAIN OUTCOME MEASURES: Vitamin B12, serum, and red cell folate levels. RESULTS: The prevalence rates for low levels of serum vitamin B12, folate, and red cell folate were 7.3%, 1%, and 3.3%, respectively. The elderly cohort had lower vitamin B12 (P less than 0.001) but higher serum and red cell folate levels (P less than 0.001) than our normal reference range (age 18-65 years). Red blood cell folate levels showed positive correlations with nutritional indices and mental test scores. No correlations were found between vitamin B12 levels and diet or other nutritional indices. CONCLUSIONS: Low folate levels in older people living at home are infrequent findings. In contrast low vitamin B12 levels are more common. Poor diet and undernutrition may contribute to low folate levels, but these factors are less important for the low B12 levels found.
Aged↗
Heart transplantation in Jehovah's Witnesses. An initial experience and follow-up.
More than 25 years of experience performing heart surgery on Jehovah's Witnesses has culminated in successful cardiac transplantation without administering blood products in five patients (mean age, 44.4 +/- 8.3 years) of this faith. The use of blood-conserving methods, iron supplementation, bone marrow-sparing maintenance immunotherapy, and brisk postoperative diuresis has added to the efficacy of cardiac transplantation in these patients. No perioperative deaths occurred, and early follow-up studies have shown that these patients have not been more susceptible to higher graft rejection rates due to the lack of pretransplant blood transfusions. As more Jehovah's Witnesses undergo heart transplantation in the future, comparison with other recipients who allow pretransplant blood transfusions may lead to a better understanding of rejection immunobiology. We conclude that cardiac transplants may be safely offered to Jehovah's Witnesses without fear of a uniformly poor outcome.
Adult↗
Extension of donor criteria in cardiac transplantation: surgical risk versus supply-side economics.
To combat the continuing shortage of ideal donor hearts, we have used cardiac allografts from high-risk donors for critically ill recipients. We defined high-risk donor variables as age greater than 40 years, systemic (noncardiac) infection, cardiopulmonary resuscitation greater than 3 minutes, ischemic time longer than 5 hours, weight more than 20% less than that of the recipient, and requirements for high doses of inotropes. Of the 305 donors we have used, 73 (23.9%) have been high-risk, with 59/73 (80.8%) exhibiting one variable, 12/73 (16.4%) exhibiting two variables, and 2/73 (2.7%) exhibiting three variables. No correlation was found between the number of donor variables and a poor postoperative result. No infectious complications occurred in 17 patients receiving hearts from potentially infected donors. Hospital mortality rates (30 day) for recipients of high-risk donor versus non-high-risk donor hearts were 8.2% and 6.9%, respectively (not significant). The 1-, 6-, and 12-month actuarial survival rates were 91.7%, 81.2%, and 75.9% for the high-risk donor group and 93.5%, 80.3%, and 77.8% for the non-high-risk donor group (not significant). Among survivors with high-risk donor hearts, mean left ventricular ejection fractions were 0.54 +/- 0.08 at 3 months, 0.55 +/- 0.08 at 1 year, and 0.54 +/- 0.09 at 2 years after transplantation. These results suggest that accepting less than ideal donor hearts can be safe and might be considered when better options are not available.
Adult↗
First human use of the Hemopump, a catheter-mounted ventricular assist device.
The Hemopump, a catheter-mounted, temporary ventricular assist device, consists of an external electromechanical drive console and a disposable, intraarterial axial-flow pump (21F). Power is transmitted percutaneously to the pump by a flexible drive shaft within the catheter. The device is positioned in the left ventricle by way of the femoral artery approach or through the ascending aorta. Blood is drawn from the left ventricle through the transvalvular inlet cannula and pumped into the aorta. As of December 1988, the Hemopump had successfully supported the circulation of 7 patients (5 men, 2 women) ranging in age from 44 to 72 years (mean age, 59 years) and suffering from cardiogenic shock (cardiac index less than 2.0 L/min/m2). Indications for use included failure to be weaned from cardiopulmonary bypass in 4 patients, acute myocardial infarction in 1, severe cardiac allograft rejection in 1, and donor heart failure in 1. Duration of support ranged from 26 to 113 hours (mean, 66 hours). Although 5 patients demonstrated transient hemolysis, none experienced infection, thrombosis, or vascular injury. Hemodynamic variables improved in all patients during support by the device. As of December 1988, 5 of the 7 patients were alive more than 30 days after support had been discontinued, and 3 of these patients were discharged from the hospital. On the basis of our initial clinical results, the Hemopump, which does not require a major surgical procedure for insertion, provides effective, temporary circulatory support in patients with potentially reversible cardiac failure.
Adult↗
Rapid placement of the Hemopump and hemofiltration cannula.
Hypervolemia, a potential complication in patients on ventricular assist device support, can be managed by use of continuous arteriovenous hemofiltration. The Hemopump, a new catheter-mounted, transaortic axial-flow ventricular assist device, and the vascular access catheter for the Diafilter-30 Hemofilter system, used in continuous arteriovenous hemofiltration, are both usually inserted by way of the femoral artery. Because placing two large catheters in the femoral artery of a patient with peripheral vascular disease can compromise circulation, a technique for placing them in the abdominal aorta was developed. Two patients have undergone combined Hemopump and hemofiltration treatment, and neither experienced complications. Such techniques may benefit more patients in the future, as the usefulness of the Hemopump is proved.
Aorta, Abdominal↗
Use of potentially infected donor hearts for cardiac transplantation.
Despite the nationwide shortage of heart donors, more patients, some of whom are critically ill, are being accepted as candidates for transplantation. Thus, on occasion, we have liberalized our donor criteria to meet the demand. We have recently transplanted 16 potentially infected donor hearts into critically ill recipients. Of these 16 donors, 7 had multiple positive blood cultures as follows: Streptococcus pneumoniae (3), Staphylococcus aureus (2), Klebsiella pneumoniae (1), and Enterobacter sp (1). Seven other donors were accepted despite high fevers (rectal temperature greater than 38.9 degrees C), leukocytosis (greater than 18 x 10(9)/L [greater than 18,000 cells/microL]), and pulmonary infiltrates with positive sputa (Enterobacter [3], Klebsiella pneumoniae [2], and Staphylococcus [2]). Two other donors with hepatitis B surface antigen positivity were deemed at high risk but were used because the recipients were in immediate need. Early mortality (less than or equal to 30 days) among the recipients was 3/16 (18.7%) with 1 patient dying of uncontrolled allograft rejection, 1 of hepatic failure, and 1 of Pseudomonas septicemia. Late mortality (greater than 30 days after operation) occurred in 6 patients: 2 patients died of hepatic failure, 3 died of graft atherosclerosis, and 1 died of iatrogenic hemorrhage after a liver biopsy. Only 1 patient died of infection unrelated to that of the donor, and the other patients had no infectious complications resulting from the organisms identified in their respective donors. Use of potentially infected donor hearts resulted in surprisingly few infectious complications in this group of recipients. This practice can be safe and should be considered when other options are unavailable.
Adult↗