John D. Milam

Orthotopic cardiac prosthesis for two-staged cardiac replacement

Abstract Clinical experience with cardiac transplantation has evidenced the feasibility of cardiac replacement in man but has made apparent the need for a mechanical device that will provide circulation and sustain life in emergency conditions while a suitable allograft is obtained. The cardiac prosthesis used in a 47 year old man consisted of two reciprocating pumps constructed entirely of synthetic materials and activated pneumatically in the orthotopic position by a control console connected by tubes passed through the patients chest wall. The device supported the patients circulation for 64 hours while a donor for cardiac transplantation was obtained. Death of the recipient from Pseudomonas pneumonia occurred 32 hours after the allografting. The first successful prolonged use of a total mechanical substitute for the human heart is recorded.

Posttransfusion cytomegalovirus infection in neonates: Role of saline-washed red blood cells

1. Roy RN, Chance GW, Raddle IC, et al. Late hyponatremia in very low birth weight infants (< 1.3 kilograms). Pediatr Res 1976;10:526. 2. Seccombe DW, Pudek MR, Whitfield MF, et aL Perinatal changes in a digoxin-like immunoreactive substance. Pediatr Res 1984;18:1097. 3. Valdes R, Grawers SW, Brown BA, Landt M. Endogenous substance in newborn infants causing false positive digoxin measurements. J PEDIATR 1983;102:947. 4. Ebara H, Suzuki S, Nagashima K, et al. Digoxinand digitoxin-!ike immunoreactive substances in amniotic fluid, cord blood and serum of neonates. Pediatr Res 1986; 20:28. 5. Gruber KA, whitaker JM, Buckales VM. Endogenous digitalis-like substance in plasma of Volume-expanded dogs. Nature (Lond) 1980;743:287. 6. Espinel CH. The FENa test: use in the differential diagnosis of acute renal failure. JAMA 1976;236:579. 7. Graves SW, Valdes R Jr, Brown BA, et al. Endogenous digoxin-immunoreactive substance in human pregnancies. J Cliri Endocrinol Metab 1984;58:748. 8. Sulyok E. The relationship between electrolyte and acid-base balance in the premature infant during early postnatal life. Biol Neonate 1971;17:227. 9. AI-Dahhan J, Haycock GB, Chartler C, Stimmler L. Sodium homeostasis in term and preterm neonates. I. Renal aspects. Arch Dis Child 1983;58:335. 10. Beyers AD, Spruyt LL, Seifart HI, et al. Endogenous digoxin-like material. S Afr Med J 1983;64:42.

Rejection of the transplanted human heart.

Abstract The human heart is highly vulnerable to rejection. In 16 patients with 17 allografts rejection progressed relentlessly in histocompatibility matches of C and D grades. Only three patients ...

Rejection of the Transplanted Human Heart

Abstract The human heart is highly vulnerable to rejection. In 16 patients with 17 allografts rejection progressed relentlessly in histocompatibility matches of C and D grades. Only three patients ...

Plasma exchange in selected patients with juvenile rheumatoid arthritis

Plasma exchange with either fresh-frozen plasma or 5% albumin solution as replacement fluid was performed in four selected patients with juvenile rheumatoid arthritis unresponsive to standard therapy. One 13-year-old boy with life-threatening systemic disease experienced a partial remission of disease and tolerated a decrease in prednisone dose from 15 to 4 mg daily following 14 exchanges with FFP. A 14-year-old girl, dwarfed by systemic disease and long-term corticosteroid therapy, was able to discontinue prednisone and grew 6.3 cm in 11 months following 18 plasma exchanges with FFP. An 8-year-old girl with pauciarticular disease, antinuclear antibody, and uncontrollable iridocyclitis underwent 16 plasma exchanges with 5% albumin solution as replacement; despite removal of antinuclear antibody, her eye disease and arthritis were not helped. A 16-year-old girl with erosive, polyarticular JRA showed no detectable change in her articular disease following nine exchanges. Transient decreases in hematocrit, complement components, and immunoglobulin concentrations occurred. In three patients Westergren sedimentation rate decreased for up to five months after exchanges. One patient died suddenly during an exchange with FFP; the cause of death appeared related to microemboli of unknown nature found in the lungs at autopsy. Plasma exchange should be done only in an intensive care setting and as a research procedure for children with JRA.

Human Cardiac Transplantation

Transplantation of the human heart may provide palliation for patients with end-stage cardiac disease for whom no other treatment is available. Cardiac transplantation was performed in 17 patients undergoing 18 heart transplants. Five early deaths occurred: three from acute cardiac rejection after one week and one each from pre-existing diseases and complications of immunosuppressive therapy. The transplanted heart provided effective cardiac function for each surviving patient. Two late deaths occurred from sepsis. Three patients died between five and nearly seven months after operation from chronic cardiac rejection. Clinical investigations of the role of histocompatibility testing, methods of immunosuppressive therapy, recognition and management of rejection, search for preformed anti-heart antibodies, physiological evaluation of the denervated transplanted heart, and causes of histological changes in the transplanted hearts are continuing. Further clinical trial is needed to determine the role of cardiac transplantation in palliating advanced myocardial insufficiency.