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Biomedical subjects

T Higenbottam

Publications and source records attributed to T Higenbottam.

At least 73 records · Page 4Linked to original sources
PubMed1991

Transplantation for end-stage lung disease.

The last decade has seen lung and heart-lung transplantation move from experimental procedures to clinical treatments. Innovative surgical techniques combined with the use of ciclosporin as an immunosuppressive agent have enabled successful transplantation in a wide range of end-stage lung diseases. Exclusion criteria for selecting recipients have relaxed, and improved preservation techniques have facilitated distant donor organ procurement and decreased peri-operative mortality. A range of techniques for the physiological monitoring of the graft as well as diagnosis of major complications such as rejection and opportunistic infection have been introduced. Obliterative bronchiolitis remains a major challenge to the immunologist and to the chest physician in terms of etiology, pathogenesis and treatment. As survival rates improve with improved management, lung and heart-lung transplantations are contributing towards effective treatment of end-stage pulmonary disease as well as providing new insight into pulmonary physiology and into mechanisms of lung disease.

Bronchiolitis Obliterans↗
PubMed1991

The importance of inflammatory cells in asthma.

The development of research into the mechanisms and so of treatment of asthma has reached a crossroads. Research into the physiology of 'mature' inflammatory cells and their mediators have not provided treatments as effective as steroids. Whilst it is tempting to pursue this systematic approach, new ideas are emerging which beckon the scientist along a separate path. From molecular biology and modern genetics emerges the idea that a regulatory dysfunction of a lymphocyte is the fundamental abnormality of asthma. Bone marrow transplantation and transfer of 'asthma' from one individual to another supports this view. From lung transplantation has emerged the idea that the distribution of the infiltrate of inflammatory cells may be important in airway hyperresponsiveness. Transplantation also points to the possibility of correlating pathology with physiology by use of small lung biopsies. Perhaps completely new treatments may result from such a novel and 'human' based approach.

Adrenal Cortex Hormones↗
PubMed1991

Heart and lung transplantation for terminal cystic fibrosis. A 4 1/2-year experience.

From among 112 patients with cystic fibrosis who were assessed for heart-lung transplantation, 83 were accepted. Twenty-six died while awaiting heart-lung transplantation and 32 had the operation. The management and the outcome of these 32 patients is reported. Survival, infection, and rejection rates among these patients were compared with those of 61 patients without cystic fibrosis who underwent heart-lung transplantation between 1984 and 1990. The cumulative survival rate was 72.29% +/- 94.91% at 1 year and 55.59% +/- 7.50% at 3 years. The mortality rate was slightly higher in the group with cystic fibrosis during the first year after the operation but it was lower at 3 years. The difference, however, could have been due to chance alone (p = 0.308). The same was true for the prevalence of rejection (up to 6 months: chi 2 = 1.8141, p = 0.17), and infection (up to 6 months: chi 2 = 2.20, p = 0.14), between the two groups. It is concluded that cystic fibrosis does not constitute an additional risk in terms of survival and morbidity after heart-lung transplantation.

Adolescent↗
PubMed1990

Lung function associated with histologically diagnosed acute lung rejection and pulmonary infection in heart-lung transplant patients.

A group of 34 heart-lung transplant patients were studied with serial pulmonary function measurements, chest radiographs, and transbronchial biopsies from the time of surgery. These investigations were carried out routinely at 3 and 6 months and then annually after transplantation as well as on clinical suspicion of acute lung rejection or infection. A total of 61 transbronchial biopsies and concurrent lung function and chest radiographs were obtained. Of the biopsies, 30 (49.2%) showed histologic evidence of lung rejection, 12 (19.7%) demonstrated various opportunistic infections, and 19 (31.1%) were normal. Compared to during episodes of normal biopsies, FEV1 decreased significantly with lung rejection (p less than 0.001) and with infection (p less than 0.01). Vital capacity (VC) and DLCO also fell with these acute lung complications. Using histologic diagnosis as a standard, lung function testing had a sensitivity of 86% in detecting lung rejection in the first 3 months postoperation and 75% in the subsequent period. Its sensitivity for detecting lung infection was 75%. Although not distinguishing between these two complications, lung function had a specificity of 84% for detecting occurrence of an acute lung complication. Chest radiographs, although of similar sensitivity in the first 3 months postsurgery, had a sensitivity of only 19% for rejection in subsequent months and 58% for infection. Its specificity was 100%. Lung function testing changes in a predictable fashion with lung rejection and infection, offers an improvement over chest radiographs, and provides a quantitative measurement to aid the decision of when to undertake transbronchial lung biopsy.

Biopsy↗
PubMed1990

The use of home spirometry in detecting acute lung rejection and infection following heart-lung transplantation.

The value of home spirometry in detecting acute lung rejection and opportunistic infections was studied in 15 heart-lung transplant recipients over a six-month period. The patients measured their FEV1 and FVC twice daily at home using a portable turbine spirometer. The records were then reviewed in relation to the results of transbronchial lung biopsy carried out during occurrences of respiratory symptoms and during routine posttransplant assessment. FEV1 and FVC fell by a mean (+/- SD) of 10.4 +/- 6.9 percent and 9.3 +/- 7.9 percent, respectively, during 20 episodes of lung rejection. The corresponding figures during opportunistic infections were 12.8 +/- 10.1 percent and 12.5 +/- 14.3 percent. No such change was observed during routine normal biopsies. Regular home spirometry offered early detection of these complications allowing early transbronchial lung biopsy as well as assessing efficacy of their therapy. Above all, measurements can be made daily, which is unique in the assessment of solid organ transplants.

Acute Disease↗
PubMed1990

The acute effect of the synthetic prostacyclin analogue iloprost in primary pulmonary hypertension.

Twelve patients with severe primary pulmonary hypertension and pronounced disability unresponsive to oral vasolidators were assessed as to their suitability for heart-lung transplantation. During routine right heart catheterisation, intravenous infusions of both prostacyclin (PG1(2] and its synthetic analogue, iloprost (IL), were given in random order. The dose of each drug was increased whilst the improvements in cardiac output (Q) and pulmonary vascular resistance (PVR) were recorded. The maximum rate of each infusion was determined by the onset of side effects or a fall in mean systemic blood pressure of more than 20 per cent. The mean maximum dose of PG1(2) was 6 +/- 2 ng/kg/min and that of IL 3.4 +/- 1.8 ng/kg/min, and both infusions achieved similar haemodynamic effects. In this open, randomised study, intravenous IL was as effective as prostacyclin in lowering PVR, but with a lower infused dose. Iloprost may have an important role in the acute assessment of patients with primary pulmonary hypertension, and when available for prescription should be assessed as an alterative long-term intravenous vasodilator to prostacyclin.

Adult↗
PubMed1990

Transplantation of the lung.

The introduction of cyclosporine as a highly effective immunosuppressive agent and the development of new techniques for heart-lung and lung transplantation have led to a new treatment for a wide range of fatal cardiopulmonary diseases. Indications for surgery are now becoming clear, together with major contra-indications. Suppurative lung disease, such as cystic fibrosis, can be effectively treated by heart-lung transplant (HLT). A whole new field of pulmonary medicine is emerging to provide the physiological monitoring and diagnostic techniques for major complications such as opportunistic lung infection and pulmonary rejection. Obliterative bronchiolitis, a consequence of frequent and severe rejection, still provides a major challenge to the immunological scientist and respiratory physician. Lung transplantation, by disrupting the vascular supply and innervation of the lung, is raising major questions about the generally accepted beliefs of regulation of breathing and pulmonary mechanics. Finally, as the survival rate improves beyond the current 50% at 3 yrs, lung transplantation will perhaps present further challenges to our understanding of the pathogenesis of various diseases such as asthma and cystic fibrosis.

Graft Rejection↗
PubMed1989

Early graft function following heart and lung transplantation.

Fifty-one patients underwent heart-lung transplantation between April 1984 and October 1988. The first five donor organs were removed in an adjacent operating theatre. Organs were subsequently removed from distant centres. The method of preservation consisted of cold cardioplegic arrest of the heart using St. Thomas' solution, followed by a simple, cold pulmonary artery flush of a lung perfusate developed at Papworth Hospital. Administration of the solution was preceded by an infusion of prostacyclin into the pulmonary artery during preliminary dissection of the donor organs. The total ischaemic time ranged from 48 to 51 min (mean 49.6 min) for the near procurement group and from 70 to 249 min (mean 154.2 min) for the distant procurement group. There were no primary organ failures. Function of the lungs was assessed by gas exchange, pulmonary function tests, time to extubation, and survival data. Serial radiological studies were used to monitor graft performance in the postoperative period. We report here on our clinical experience of early graft function following heart and lung transplantation.

Adolescent↗