Biomedical subjects

M De Kock

Publications and source records attributed to M De Kock.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Aortic valve replacement thirty-one months after orthotopic heart transplantation.

Aortic valve replacement with a St. Jude prosthesis was performed 31 months after orthotopic heart transplantation in a 28-year-old male patient with Steinert's disease and idiopathic cardiomyopathy. The donor heart was reported as being normal by the cardiologist of the referring hospital. During implantation, a bicuspid aortic valve was noted, and early after the operation mild aortic regurgitation became apparent. Aortic incompetence advanced to a severe degree within 2 years after transplantation. Valve replacement, instead of retransplantation, was undertaken after careful consideration of the advantages and disadvantages of the therapeutic choice. This case report demonstrates the feasibility of valve replacement after heart transplantation and emphasizes the need for careful evaluation of potential donor hearts before harvesting.

Adult↗

PubMedDate not supplied

Digoxin enhances bupivacaine toxicity in rats.

The influence of digoxin on the systemic toxic effects of bupivacaine was studied in a rodent animal model. The experiment was undertaken with consideration to clinical situations such as pregnancy that are associated with the secretion of an endogenous digoxin-like factor. Twenty Wistar male rats, under barbiturate anesthesia and controlled ventilation, received either 5 micrograms/kg intravenous digoxin (n = 10) or saline (n = 10), blinded to the observer. Digoxin serum concentration was 1.8 +/- 0.24 ng/ml in the study group. Thirty minutes after digoxin or saline was administered, bupivacaine was infused at a constant rate of 2mg/kg/minute. The threshold doses of bupivacaine toxic effects (first ventricular arrhythmia, 25% fall of baseline heart rate, 25% fall of baseline mean arterial blood pressure, first seizure activity, isoelectric electroencephalogram, and asystole) were significantly lower in the digoxin group, as were the lethal bupivacaine serum concentrations. Digoxin, in hyperoxic nonacidotic rats, increases the cardiac and central nervous system toxicity of bupivacaine. Based on the known electrophysiologic actions of these two drugs, a synergistic toxic interaction is demonstrated.

Animals↗

PubMedDate not supplied

[Hepatic transplantation in cirrhosis].

The authors review the indications and outcome of liver transplantation for hepatic cirrhosis of various aetiologies in adults, on the basis of their experience and that of the literature. Up to 1989, they performed 107 liver transplantations in 93 adults, including 70 patients with cirrhosis: primary biliary cirrhosis (PBC) in 20, primary sclerosing cholangitis (PSC) in 2, secondary biliary cirrhosis in 1, post-necrotic cirrhosis in 35, alcoholic cirrhosis in 5, metabolic cirrhosis in 7. The best indications are PBC with rising bilirubinemia (greater than 5 mg/dl) or portal hypertension and PSC with severe and diffuse lesions. The outcome of transplantation was satisfactory in patients with PBC: 16 survived with a mean follow-up of 23 months. In patients transplanted for postnecrotic cirrhosis the outcome might be better if HBS is associated preoperatively with delta antigen: 6 patients of this group survived with a mean follow-up of 12.6 months while in the group of 8 patients with HBS not associated preoperatively with delta antigen, 6 patients survived with a mean follow-up of 12.8 months. There was a trend toward a higher hospital mortality after transplantation in cirrhotic patients with pulmonary arterio-venous shunts in comparison with cirrhotic patients without significant pulmonary arterio-venous shunts preoperatively.

Cholangitis, Sclerosing↗