Transplantation using hearts from primary pulmonary hypertensive donors for recipients with a high pulmonary vascular resistance

BACKGROUND: Transplantation for patients with a high pulmonary vascular resistance (PVR) carries an increased risk of mortality and right heart failure following heart transplantation and continues to be a major problem. We evaluated the use of hearts from patients who underwent heart and lung transplantation for primary pulmonary hypertension (PPH) as part of a domino procedure because these hearts have hypertrophied right ventricles used to increased pulmonary pressures, but could have a compromised left ventricle or irreversible damage of the right ventricle. METHODS: We reviewed 12 patients with PVR >4 Wood units who underwent orthotopic heart transplantation between 1989 and 1998 using hearts from donors with PPH as part of a domino procedure. RESULTS: We studied 10 men and 2 women, mean age 42.9 years. Mean PVR was 5.3 (range, 4-9) Wood units. Mean ischemia time was 85.3 minutes, and mean donor age was 32 years. Actuarial survival was 75% at 1 year and 75% at 5 years. In the early post-operative period, 3 patients had temporary arrhythmias, 2 required permanent pacemaker implantation, 1 had atrial fibrillation, and 1 had ventricular tachycardia that required defibrillator implantation. At a mean follow-up of 7.8 years, 2 patients had developed asymptomatic transplant coronary disease (both at 8.5 years after transplantation), 1 moderate and 1 very mild; the rest had none. Mean left ventricular ejection fraction at latest follow-up was 70.1% (range, 63%-78%). Right ventricular function assessed clinically and by echocardiography was adequate in the short and long term. CONCLUSIONS: Our results suggest that heart and lung recipients with PPH can provide useful donor hearts to patients with increased PVR and that these hearts function well in the intermediate and long term.     

Dislocation of an upper third molar into the maxillary sinus after a severe trauma: a case report

Abstract – Dental injuries are common following facial trauma. This article presents a rare injury: the dislocation of a third molar into the maxillary sinus after complex mandibular and maxillary tuberosity fractures. The possible mechanism and clinical treatment are discussed.     

Color vision screening and viewing conditions: the problem of misdiagnosis

The most popular techniques for assessing color vision, the pseudoisochromatic tests, have been found to differ widely in their sensitivity to changes in viewing conditions. A significant number of color-normal subjects will be misdiagnosed as color defective by some of the standard tests with even relatively minor variations from standardized viewing conditions. These results appear to have strong implications for the use of the tests in many applied settings which precise control over viewing conditions is difficult. In particular, as the consequences of a misdiagnosis become very serious, the tests must be used with special caution. If we were to recommend one test for use, our findings point to the Ishihara, which appears impervious to variation in viewing conditions.     

Monte Carlo study of electron spectra produced in semi-infinite and finite water phantoms irradiated by photons of energies up to 2 MeV

A Monte Carlo calculation for the initial electron energy spectra produced in semi-infinite and finite water phantoms irradiated by photons of energies up to 2 MeV and photons from 60Co are presented incorporating successive Compton scattering, photoelectric absorption and Auger effect. The backscattering of photons through the top of the phantom and transmission of photons out of the finite phantom through the sides also are considered. The results are compared with the earlier calculation for infinite water phantom of Turner et al. who assumed that all the photons remained in the water until they were absorbed. It is found that inclusion of backscattering in a semi-infinite phantom yields significantly different results from those of Turner et al. for the infinite phantom. It is also found that backscattering and transmission of the photons through the sides of the finite phantom further alter the initial energy spectra of electrons, as well as the average number of electrons per photon at different photon incident energies.     

Effects of the phosphodiesterase inhibitor rolipram on the acoustic startle response in rats

Systemic administration of the phosphodiesterase inhibitor rolipram (0.05–10.0 mg/kg, IP) produced a rapid and dose-related increase in the amplitude of the acoustic startle response in rats. The (−) isomer was more potent than the (+) isomer in enhancing startle amplitude. Rolipram increased startle responses that were elicited by brief electrical stimulation of the ventral cochlear nucleus or nucleus reticularis pontis caudalis, two brainstem relay nuclei of the startle neural circuit. A low (5 μg) dose of rolipram produced an excitatory effect on startle following spinal (lumbar intrathecal) infusion but not following supraspinal (lateral ventricle) infusion. Rolipram (0.5 mg/kg, IP) excitation of startle was not blocked by drugs which differentially disrupt the release of monoamines (DSP4, reserpine + alpha-methylpara-tyrosine, reserpine + para-chloro-phenylalanine) or by drugs which differentially block monoamine receptors (haloperidol, prazosin, idazoxan, cinanserin, or cyproheptadine). The marked increase in startle seen following systemic rolipram injection is attributable, at least in part, on an action in the lumbar spinal cord that directly or indirectly facilitates neural transmission along the reticulospinal component of the startle reflex neural pathway. The startle reflex should be a useful behavioral test system for studying the mechanism of action of rolipram and related compounds purported to selectively inhibit calmodulin-independent forms of phosphodiesterase.     

Immature Megakaryocytes in the Mouse: Morphology and quantitation by acetylcholinesterase staining

Three types of immature megakaryocytes, detected by their morphological properties, have been characterized in bone marrow of normal C57BL/6 mice. Morphological classification of these cells was carried out by determining (1) presence and relative amount of acetylcholinesterase, (2) cell size, (3) nuclear/cytoplasm ratio, and (4) nuclear shape. The immature megakaryocytes were classified as: (A) cells distinguished by a round nucleus (10.6 +/- 1.1 mu diameter; mean +/- SEM), which had the highest nucleus / cytoplasm ratio and lowest content of acetylcholinesterase; (B) cells with an indented nucleus (13.0 +/- 1.9 mu diameter), which had increased acetylcholinesterase content and reduced nucleus/cytoplasm ratio compared to the round-nucleus cell type; and (C) lobed-nucleus cells (14.5 +/- 2.9 mu diameter), which showed further increase in acetylcholinesterase content and reduction in nucleus/cytoplasm ratio. Increased numbers of immature megakaryocytes were detected, indicating that a proportion of these cells are undetected using conventional staining techniques. Based on the observed alterations in size, acetylcholinesterase content, and nuclear complexity, it was concluded that these cells constitute part of a progressive maturation sequence intermediate between the progenitor cell (CFU-Mk) and mature easily recognizable megakaryocytes.     

两种剂量氟碳部分液体通气治疗犬吸入伤的比较研究

目的：对比研究两种剂量氟碳（PFC）部分液体通气（PLV）对蒸气吸入性损伤犬的血气和血流动力学的影响，方法：将健康犬15条随机分面两组，即PFC6ml/kg组（PFC－6）和PFC 12ml/kg(PFC-12)组，采用蒸气吸入造成吸入性损伤模型后经气管内注入PFC实施部分液体通气（PLV）治疗，观察治疗后30min,60min,90min血气，血流动力学参数的变化，结果：PFC－6组PaO2在PLV治疗30min后明显升高（P＜0．05），在治疗60min,90min生的PaO2与致伤值比较无统计学意义，而PFC－12组的PaO2在PLV治疗后30min,60min,90min均明显升高（P＜0．05），与PFC－6组相比，PFC－12组的PaO2,PvO2均呈上升趋势，但未达显著水平（P＞0．05），在PLV治疗后各时间点的PaCO2HR,MAP,CVP 致伤值相比均无明显变化（P＞0．05），两组之间比较，各对应时间点的PaCO2,HR,MAP,CVP也均无明显变化（P＞0．05），结论：氟碳部分液体通气是一种新的通气技术，它能明显改善蒸气入伤犬的氧合作用，对血液动力学参数无不良影响，两种剂量氟碳部分液体通气治疗蒸气吸入性损伤未呈现明显剂量一效应关系。