Biomedical subjects

Joseph C Cleveland

Publications and source records attributed to Joseph C Cleveland.

7 recordsLinked to original sources

PubMed2005

BOOP is common in cardiac transplant recipients switched from a calcineurin inhibitor to sirolimus.

While bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with the use of sirolimus (SIR), the incidence in a consecutive group of patients given SIR to replace a calcineurin-inhibitor (CI) is unknown. Twenty-nine consecutive cardiac transplant recipients were switched from a CI to SIR to ameliorate CI-associated nephropathy or coronary graft atherosclerosis. Seven patients (24%) developed BOOP. The clinical characteristics and biopsy results of these patients are presented. The clinical course and response to withdrawal of SIR in all and steroids in four of seven patients suggested the diagnosis of BOOP. Chest X-rays and CT scans showed typical findings of BOOP in all seven patients. Infection was excluded in all patients. Biopsy results were characteristic of BOOP in six of seven patients. Six patients recovered and one died. BOOP is a common and potentially serious adverse event in cardiac transplant patients switched from a CI to SIR, especially when SIR is started late post-transplantation.

Aged↗

PubMed2004

Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery.

BACKGROUND: Risk factors for 30-day operative (short-term) mortality following coronary artery bypass graft (CABG only) procedures are well established. However, little is known about how the risk factors for short-term mortality following valve replacement procedures (with or without a CABG procedure performed) compare with CABG only risk factors. METHODS: Department of Veterans Affairs (VA) records (65,585 records) were collected from October 1991 through March 2001 and analyzed. Risk factors for short-term mortality were compared across three subgroups of patients: CABG only surgery (n = 56,318), aortic valve replacement (AVR) with or without CABG (n = 7450), and mitral valve replacement (MVR) with or without CABG (n = 1817). Multivariable logistic regression analyses were used to compare the relative magnitude of risk for 19 candidate predictor variables across subgroups. RESULTS: Only three patient baseline characteristics differed significantly in magnitude of risk between the procedure groups. Partially or totally dependent functional status significantly increased the risk of short-term mortality for AVR patients (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.29-2.09) and MVR patients (OR 2.21, 95% CI 1.48-3.30), but not for CABG only patients (OR 1.04, 95% CI 0.93-1.16). Conversely, previous heart surgery and New York Heart Association functional class III or IV symptoms conferred greater magnitude of risk for CABG only patients compared with the valve subgroups. CONCLUSIONS: Overall, the risk factors for short-term mortality following valve replacement and CABG surgery appear to be relatively consistent. However, clinicians should be aware of the importance of preoperative functional status as a unique predictor of mortality following valve surgery.

Aged↗

PubMed2003

On-pump coronary artery bypass surgery activates human myocardial NF-kappaB and increases TNF-alpha in the heart.

PURPOSE: Myocardial tumor necrosis factor alpha (TNF) production and nuclear factor kappa B (NF-kappaB) activation has been demonstrated in chronic heart failure and experimental models of acute ischemia-reperfusion injury. Further, a cause and effect relationship has been established between these events and cardiomyocyte apoptosis following such conditions. It remains unknown, however, whether the myocardial injury associated with coronary artery bypass surgery (CAB) results in myocardial NF-kappaB activation and TNF production. We hypothesized that CAB with cardiopulmonary bypass ("on-pump") activates human myocardial NF-kappaB and increases TNF in the heart. METHODS: Patients, 18 to 65 years of age, scheduled for elective cardiac surgery but without other preexisting disease were considered eligible for the study. Biopsies of human myocardium were obtained before and after cardiopulmonary bypass and myocardial TNF levels were determined by ELISA and cytotoxicity assay, and NF-kappaB activation was determined by electrophoretic mobility shift assay (n = 6 patients). NF-kappaB activation was quantitated with gel densitometry. RESULTS: The clinical characteristics of the study patients were as follows (means +/- SEM): mean age (y) 50.0 +/- 5.7, male 6 (100%), cardiopulmonary bypass time (min) 107 +/- 37.7, cross-clamp time (min) 68 +/- 17.6, number of CAB 3.0 +/- 1.1, and length of hospital stay (d) 4.8 +/- 0.9. Before CAB, myocardial TNF-alpha levels were 251 +/- 22 pg/g and 33 +/- 9 U/g, as determined by ELISA and cytotoxicity assay, respectively. Following CAB, human myocardial TNF-alpha levels increased to 892 +/- 71 pg/g (P = 0.0008) and 141 +/- 11 U/g (P = 0.0042), as determined by ELISA and cytotoxicity assay, respectively. Before CAB, the ratio of bound to unbound NF-kappaB DNA was 0.009 +/- 0.0007 and after CAB the ratio was 0.24 +/- 0.01 (P < 0.0001). CONCLUSIONS: This study represents the initial demonstration that coronary artery bypass grafting results in an activation of NF-kappaB and an increase of TNF in the heart.

Cardiopulmonary Bypass↗

PubMed2003

Aortic emergencies.

Prompt recognition of actual or impending aortic emergencies is essential to the effective practice of emergency medicine. Understanding the pathophysiologic principles and awareness of the potential subtleties in the clinical presentations of aortic dissection, aneurysm, and occlusive disease are prerequisites to this task. Knowledge of current diagnostic modalities is also important if these entities are to be identified rapidly and managed efficiently to maximize the potential for a good patient outcome. Awareness of the potential complications of these conditions and the necessary interventional and resuscitative measures that might be called for in the appropriate clinical setting are likewise essential requirements for the EP. Appropriate surgical consultation and mobilization of operative resources form the backbone of appropriate management in the patient who has an aortic emergency.

Aortic Dissection↗

PubMed2003

Lobar torsion complicating bilateral lung transplantation.

We report a case of left lower lobe torsion in a patient who had undergone bilateral lung transplantation for alpha(1)-antitrypsin deficiency. The patient experienced acute pulmonary hypertension and hypoxemia on post-operative Day 3 and the chest X-ray showed bilateral alveolar infiltrates and a new focal consolidation of the left lower lobe. Fiberoptic bronchoscopy showed complete obstruction of the left lower lobe bronchus and abnormal rotation of the left upper lobe bronchus suggesting torsion, which was confirmed by pulmonary angiography and ultimately at thoracotomy. The possibility of acute lobar torsion should be considered in lung transplant recipients who demonstrate evidence of acute respiratory insufficiency in the early post-operative period.

Humans↗

PubMed2003

Sarcomatoid intracardiac metastasis of a testicular germ cell tumor closely resembling primary cardiac sarcoma.

This report describes a 40-year-old man with a remote history of testicular mixed nonseminomatous germ cell tumor (NSGCT) treated by surgery and chemotherapy. He presented 10 years later with shortness of breath and was found to have a mass occupying the right atrium, based high in the superior vena cava. He also had multiple pulmonary emboli. The sarcomatous and myxomatous histological appearance of the neoplasm closely resembled a primary cardiac sarcoma. However, immunohistochemical studies confirmed the diagnosis of metatstatic sarcomatoid germ cell tumor. Metastatic spindle cell tumors have been reported in patients with NSGCTs. These neoplasms are thought to arise from the spindle cell component of the yolk sac tumor that is resistant to chemotherapy.

Adult↗

PubMed2002

Quality improvement in cardiac care.

Quality improvement in cardiac care has made considerable progress over the past 30 years. During that period, there has been the development of multi-institutional databases to monitor outcomes following cardiothoracic surgery. These databases initially began using only volume and unadjusted operative (30-day) mortality as outcome criteria. There has been a progressive increase in their sophistication, with the building of risk models based on preoperative variables, which accurately predict the risk of adverse outcomes. Other outcomes have been added including risk-adjusted mortality and morbidity; efficiency outcomes such as length of stay, quality of life, functional health status, neuropsychological outcomes; and long-term outcomes.

Cardiac Surgical Procedures↗