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Biomedical subjects

S M Augustine

Publications and source records attributed to S M Augustine.

At least 19 recordsLinked to original sources
PubMed1998

Perceived stressors and coping strategies among heart transplant candidates.

This study examined heart transplant candidates' perceived stressors and coping strategies at the time of placement on the waiting list and at 3, 6, 9, and 12 months following. Mean stress scores were relatively low at each assessment time. The 4 greatest stressors were (1) having a terminal disease, (2) needing a heart transplant, (3) worrying family members, and (4) undergoing prolonged hospitalization. Total stress scores indicated that candidates were effectively using a moderate number of coping strategies, the 5 most frequently used ones being thinking positively, trying to keep life normal, keeping a sense of humor, praying or trusting in God, and trying to distract oneself. The 5 most effective coping mechanisms were thinking positively, keeping a sense of humor, thinking of good things, praying or trusting in God, and trying to keep life normal. No significant differences were seen in coping use or effectiveness over time.

Adaptation, Psychological↗
PubMed1998

Obesity and hypercholesterolemia following heart transplantation.

Successful strategies for avoiding obesity and hypercholesterolemia are difficult to validate because of imprecise problem identification. The purpose of this study was to describe the incidence, severity, and onset of obesity and hypercholesterolemia among heart transplant recipients and identify relationships between demographic variables and weight or cholesterol levels during the first year following transplantation. Data were collected from retrospective chart review. Forty-two patients were randomly selected from 224 patients who were undergoing heart transplantation at the Johns Hopkins Hospital between July 1983 and December 1995. Significant differences were found in weight and cholesterol level during the first 12 months. Patients with ideal body weight less than 110%, compared with greater than 110%, survived longer. Relationships were identified between prednisone dose and weight, cumulative prednisone dose and weight, and weight change and change in total cholesterol level 1 year following transplantation. Multivariate analysis showed cumulative prednisone as an independent predictor of weight. Obesity and hypercholesterolemia were significant problems within 3 months of transplantation. Although prednisone dosage should be adjusted to the lowest possible dose, dietary and lifestyle changes remain the foundation of effective management of these posttransplant complications.

Adult↗
PubMed1990

Accelerated arteriosclerosis in heart transplant recipients is associated with a T-lymphocyte-mediated endothelialitis.

Accelerated arteriosclerosis has emerged as a major life-threatening complication in long-term survivors of heart transplantation. It has been proposed that accelerated arteriosclerosis is an immune-mediated complication of rejection. We observed a striking endothelialitis in the coronary arteries of two explanted hearts obtained from patients with severe transplant-related accelerated arteriosclerosis. This finding prompted us to review the pathologic changes in the coronary arteries of 23 autopsied patients who had received heart transplants. The infiltrate in these vessels was characterized using immunohistochemical stains for lymphocytes (CD45), macrophages (MAC-387), T lymphocytes (CD45RO), B lymphocytes (L-26), and smooth muscle cells (actin). In addition, a full panel of monoclonal antibodies was used on the fresh-frozen tissue available from one of the two explanted hearts. Ten of the eleven recipients with accelerated arteriosclerosis had a moderate to marked lymphocytic endothelialitis compared to 3 of 14 without transplant-related arteriosclerosis (P less than 0.005). Immunohistochemical staining of the paraffin-embedded material demonstrated that most of the lymphocytes in the subendothelial space of these vessels were T lymphocytes and that this infiltrate was associated with an accumulation of macrophages and a proliferation of smooth muscle cells in the intima. In the explanted heart from which fresh-frozen tissue was available for more detailed cell typing, the T cells marked predominantly as cytotoxic T lymphocytes (CD8+, CD2+). These results suggest that accelerated arteriosclerosis may be mediated, in part, by a cytotoxic T-lymphocyte-directed endothelialitis.

Adult↗
PubMed1975

Tylosis following post-corrosive stricture of the oesophagus.

A case of tylosis following corrosive stricture of the oesophagus in a male of 26 years is recorded. It is suggested that there is probably a connection between the state of the oesophagus and the state of palms and soles and that an oesophageal abnormality may precede tylosis of the late onset type.

Adult↗
PubMed1975

Restoration of bones in mycetoma.

In a case of actinomycotic mycetoma caused by Streptomyces madurae with extensive destruction of the bone, the foot was saved from amputation by appropriate antibiotic therapy given for a period of 2 1/2 years. Periodic x-ray examinations gave a valuable guide to the progress of the patient. Chemotherapy and antibiotics play an important role in the present day management of mycetoma. Cutaneous amelioration is not the criteria for cure. The bone restoration that occurs much later should be the guide for the duration of therapy.

Adolescent↗
PubMedDate not supplied

Editing a nursing practice book.

Publishing a nursing practice book can be an exciting challenge for the critical care nurse who identifies a gap in the literature. This article provides information on how to produce an edited book from the starting point to successful publication. Identifying a book idea, selecting chapter authors, finding a publisher, writing a prospectus, the editing process, production, and marketing the book are discussed. Examples drawn from the authors' experiences in editing a transplantation nursing book are provided, as well as comments from other book editors.

Books↗
PubMedDate not supplied

Gastrointestinal complications in heart and in heart-lung transplant patients.

Gastrointestinal complications after heart and heart-lung transplantation are being recognized and reported more frequently in the literature as a cause of significant morbidity. Between July 1983 and December 1989, 131 consecutive patients underwent 133 heart or heart-lung transplant procedures at The Johns Hopkins Hospital. Immunosuppression consisted of either cyclosporine and prednisone or cyclosporine, prednisone, and azathioprine. Twenty-eight patients (21%) had 38 gastrointestinal complications, including visceral perforations (n = 6), gastrocutaneous fistula (n = 1), retroperitoneal abscess (n = 1), cholecystitis (n = 5), gastric atony (n = 1), perianal abscess (n = 1), gastrointestinal bleeding (n = 4), esophagitis (n = 2), pancreatitis (n = 2), pancreatic abscess (n = 2), hepatitis (n = 2), cytomegalovirus infection (n = 3), and diarrhea (n = 8). Among this group of 28 patients, 17 operative procedures were needed by 13 patients (46%), for an incidence of major abdominal procedures in the entire transplant cohort of 10% (13/131). Operations included cholecystectomy (n = 5), colon resection with colostomy (n = 3), closure of perforated gastroduodenal ulcer (n = 3) and repair of gastrocutaneous fistula (n = 1), drainage of pancreatic abscess (n = 2), pyloroplasty (n = 1) and incision and drainage of perianal abscess (n = 1). The operative mortality rate was 8% (1/13). Overall survival in patients with gastrointestinal complications was no different than that in the entire transplant population. Age, gender, race, and number of rejection episodes did not correlate with the presence of gastrointestinal complications. Patients with gastrointestinal pathologic conditions necessitating surgery often had atypical presentations, with subtle clinical findings but with common general surgical problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Results of heart transplantation for active lymphocytic myocarditis.

To determine whether the heart-specific immunoreactivity associated with active myocarditis affects outcome after heart transplantation, we retrospectively analyzed the outcome of 12 patients with active lymphocytic myocarditis in their explanted native hearts identified by the Registry of the International Society for Heart Transplantation. The patients were 38 +/- 10 years of age and predominantly female (75%). In nine patients (75%), endomyocardial biopsy showed active myocarditis before transplant; eight of these patients also received immunosuppression before transplant. Recipient hemodynamic study before transplantation demonstrated an ejection fraction of 0.18 +/- 0.06, cardiac index of 1.7 +/- 0.4 L/min/m2, pulmonary artery pressure of 41 +/- 6/23 +/- 6 mm Hg, and mean pulmonary capillary wedge pressure of 30 +/- 5 mm Hg. Left ventricular end-diastolic dimension by echocardiography was 6.0 +/- 1.4 cm. Four of the patients were dependent on intravenous inotropes, and six required mechanical assistance. Over a 36-month follow-up period, 2.9 +/- 2.4 episodes of rejection occurred per patient. Sixty percent of the first episodes occurred within 2 weeks of transplantation. These patients experienced a 2.2 +/- 1.1-fold increase in rejection compared with institutional average rejection rates. Survival was significantly shorter than that of age-matched or female control subjects. This study is limited by its retrospective nature and the unusual pretransplant characteristics of the subjects. It indicates that active myocarditis may predispose patients to early severe rejection and a high mortality rate after heart transplantation.

Adult↗