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Biomedical subjects

S K Koerner

Publications and source records attributed to S K Koerner.

At least 55 records · Page 3Linked to original sources
PubMed1978

Transplantation of the left lung into the right hemithorax to facilitate immediate reconstitution of bronchial artery flow.

Immediate bronchial artery reconstitution may be important in the prevention of bronchial anastomotic problems in lung transplantation. To facilitate this reconstitution in circumstances requiring allograft replacement of the right lung, we developed a method for transplanting the left lung together with its bronchial arterial supply into the right hemithorax. With this method, left lungs were allotransplanted into the right hemithorax of nine immunosuppressed dogs. Six recipients survived 1 to 4 weeks. Death resulted from pneumonia or rejection, and there were no bronchial anastomotic problems. Roentgenograms showed that the bronchial artery was patent and that the inverted transplanted left lungs could conform exactly to the thorax without space problems or radiographic abnormalities. Except for the unusual position of the large pulmonary arteries, angiographic patterns, function, and perfusion of the transplanted lungs were often normal and equivalent to those of the recipient's normal left lung. Thus it is possible to transplant a left lung into either hemithorax and immediately reconstitute its bronchial arterial circulation. Bronchial anastomotic problems may thereby be decreased.

Animals↗
PubMed1977

Restoration of bronchial artery circulation after canine lung allotransplantation.

To evaluate the re-establishment of the bronchial circulation in lung transplantation, we studied 10 immunosuppressed dogs up to 14 weeks after left lung allografting. Selective in vivo bronchial arteriograms were performed repetitively via the transfemoral route. In the early postoperative period, no fillinf og vessels distal of the bronchial anastomosis could be shown. After 12 days, however, continuity of the bronchial arteries across the anastomosis was present, and dye-filled ramifications of these vessels were visualized on the secondary and tertiary bronchi. Reconstitution of the bronchial circulation was also confirmed by postmortem studies after injecting the isolated descending thorasis aorta with colored radiopaque material (microfil). The bronchial mucosa at autopsy was examined microscopically. There was no correlation between its viability and bronchial artery regeneration. Although early ischemia of the transplant bronchus may be after a factor in the bronchial complcations that follow lung transplantation, the present study indicates that this ischemia is not due to failure of bronchial artery regeneration.

Animals↗
PubMed1976

Transbronchial biopsy for the diagnosis of lung transplant rejection. Comparison with needle and open-lung biopsy techniques in canine lung allografts.

The accurate diagnosis of lung transplant rejection requires histologic examination of the grafted lung. Because transbronchial lung biopsy has been advocated as an effective diagnostic procedure for a variety of lung diseases, it was elected to assess this technique in rejecting transplanted lungs. Twenty-two dogs received allografts and underwent simultaneous lung biopsy by 3 techniques when signs of rejection occurred. Open lung biopsy was diagnostic of rejection in all instances. Transthoracic needle biopsy correlated with the open biopsy in 59 per cent of the cases. No specimen obtained by transbronchial lung biopsy provided sufficient material to permit fulfillment of the strict histologic criteria needed to diagnose allograft rejection. Although transbronchial lung biopsy is successful in many pulmonary infiltrative processes, it appears to be inadequate for the diagnosis of lung allograft rejection.

Animals↗
PubMed1976

Chemotherapy of tuberculosis.

Drug treatment of tuberculosis is reviewed. Factors influencing the choice of antituberculosis agents and antituberculosis regimens are discussed. The advantages of two regimens are emphasized--isoniazid and ethambutol, and isoniazid and rifampin. Short-term and intermittent therapy, and retreatment of previous infections, are discussed. The toxicity of isoniazid, ethambutol, rifampin and streptomycin is summarized. Other topics are the use of second-line drugs (aminosalicylic acid, pyrazinamide, cycloserine and ethionamide), hospitalization of tuberculosis patients, chemoprophylaxis, follow-up of patients with isoniazid prophylaxis, and the use of corticosteroids.

Adrenal Cortex Hormones↗
PubMed1976

Effective preservation and transportation of lung transplants.

To evaluate a system for preserving and transporting lungs before transplantation, we removed the left lungs of 37 dogs, flushed them with a hypertonic solution having an electrolyte composition resembling intracellular fluid, and immersed them at 4 degrees C. for 7 to 24 hours. Some lungs were maintained at exactly 4 degrees C. during transport by means of a mixture of solid and liquid l-hexadecene. The lungs were allografted into immunosuppressed dogs whose right pulmonary artery was immediately ligated. Twelve recipients (32 per cent) survived 5 days or more solely on the function of the preserved lung. Four survived 10, 19, 40, and 40 days with lungs that had been preserved for 7 to 21 hours. Survival of recipients of preserved lungs (5 +/- 2 days) was equivalent to that of 75 comparably immunosuppressed recipients of nonpreserved allografts (6 +/- 1 days). One group of 10 dogs receiving lungs flushed against outflow resistance survived 12 +/- 5 days. In recipients of preserved allografts, arterial oxygen tensions remained in the normal range up to 5 weeks after transplantation, and radiographic infiltrates in the transplant were no greater than those present in recipients of nonpreserved transplants. Thus lungs transported and preserved up to 21 hours can provide total pulmonary function after transplantation and can function at least as well as nonpreserved transplants. The effectiveness and simplicity of this method are such that it might be considered for use in man.

Animals↗
PubMed1976

131I-fibrinogen in the detection of pulmonary allograft rejection.

The uptake of 131I-fibrinogen in canine pulmonary allografts was compared to that in lung autografts or lungs with papain-induced unilateral hemorrhagic pneumonia. In addition to serial lung scans and the postmortem measurement of tissue radioactivity, all dogs had serial chest roentgenograms and histologic study of their lungs. All four animals in the allografted group had increased radioactive uptake on the side of the allograft lung at the same time as or slightly before radiographic abnormalities were evident. However, increases in lung radioactivity also occurred in animals with pneumonia or autografts at the time infiltrates were present. Thus the presence of increased lung scan activity, which occurs in rejecting lung allografts after the injection of 131I-fibrinogen, is not a specific index of pulmonary rejection.

Animals↗
PubMed1975

Transbronchial lung biopsy for the diagnosis of sarcoidosis.

To evaluate the efficacy of transbronchial lung biopsy in the diagnosis of sarcoidosis, 26 consecutive patients with clinical features of sarcoidosis underwent this procedure during fiberoptic bronchoscopy. In 21, the biopsy revealed noncaseating granuloma and, in the remaining five, normal lung parenchyma. Subsequently, two of these five patients were found to have tuberculosis, one was confirmed as having sarcoidosis, and the fifth has not had further evaluation. Transbronchial lung biopsy was therefore successful in the histologic confirmation of sarcoidosis in 21 of 23 patients. The only complication was one 20 per cent pneumothorax, which resolved spontaneously. Because of its low morbidity rate, high diagnostic yield and specificity transbronchial lung biopsy is recommended as one of the initial procedures for obtaining histologic confirmation in patients with suspected sarcoidosis.

Adolescent↗
PubMed1975

Corticosteroids in clinical and experimental lung transplantation.

Lung allograft rejection can usually be diagnosed by the appearance of infiltrates on plain chest roentgenograms when these are interpreted in the light of other clinical and bacteriologic information. Large pulsed intravenous doses of methylprednisolone were usually effective in reversing lung allograft rejection that occurred in immunosuppressed dogs. In 10 of 15 animals the presence of moderate to severe rejection and its effective reversal with treatment were documented with roentgenograms and histologic sections. This ability to reverse the manifestations of lung allograft rejection, when they occur, has helped in the management of human lung allograft recipients.

Animals↗
PubMed1975

Alveolar lavage cytology in transplanted lungs. I. Staining methods and findings in dogs with autografts and allografts without immunosuppression.

Alveolar lavages were performed repetitively on the normal and transplanted lungs of dogs that had recieved autografts or allografts without immunosuppression. One half of the lavage returns was fixed as a cytologic smear; the other half was subjected to semi-thin section or electron microscopic examination. Of the staining methods was used, the periodic acid-Schiff (PAS) and Giemsa techniques were best for differentiating and counting cells. The Ladewig technique was best for evaluating the presence and location of fibrin. After autotransplantation, the proportion of so-called alveolar marcophages increased, reached a peak in 4 to 7 days, and then returned to normal. Phagocytized fibrin increased for the first postoperative week, but not extracellular fibrin was ever observed. After allotransplantation, a progressive decrease in the proportion, size, and vacuolization of so-called alveolar macrophages was noted along with an increase in extracellular fibrin. Intracellular fibrin could be detected only up to the third day. These findings define adequate methods for preparing and staining material obtained from diagnostic alveolar lavages, and they suggest that the procedure may serve as an index of lung allograft rejection.

Animals↗