Intensive care medicine
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Several immunological factors affect the outcome of human kidney transplants. HLA-A, -B and -DR matching improves kidney graft survival rate, especially matching for HLA-DR antigens. The beneficial effect of pretransplant blood transfusion has been confirmed although the mechanisms of the beneficial effect are not clear. ⋯ Major improvements in the results of organ transplantation have been achieved during the past few years with the use of new immunosuppressive agents, namely cyclosporin and monoclonal antibodies reacting with T lymphocytes. Both agents act selectively on T lymphocytes. However, nephrotoxicity of cyclosporin may limit its use.
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Cardiac transplantation is now an accepted therapeutic option for patients with end-stage myocardial failure. Provided donor and recipient are appropriately selected and adequately matched, expected survival rates at one and five years are 85% and 65%, respectively. Two major challenges are encountered in clinical heart transplantation. ⋯ The second challenge is accelerated coronary disease, which has emerged as the major factor limiting long-term survival. It is usually clinically silent and often presents with sudden death, acute myocardial infarction, or progressive unexplained graft failure. Coronary arteriography is currently the only method for premorbid diagnosis, and retransplantation the only effective therapy.
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A minitracheotomy tube was inadvertently placed in the oesophagus of a 22-year-old woman with cystic fibrosis. The authors discuss how this may have occurred and ways of avoiding this complication.
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Intensive care medicine · Jan 1989
Comparative StudyHigh-frequency jet ventilation during oleic-acid induced pulmonary oedema.
In oleic acid-induced pulmonary oedema (OAPO) sequential intrapulmonary fluid accumulation occurs leading to different expiratory flow pattern in dependent lung regions. The potential effects on efficacy of high-frequency jet ventilation (HFJV, f = 3 Hz, I: E = 0.43, FiO2 = 0.4) were studied and compared with continuous positive pressure ventilation (CPPV, f = 12-18/min, I:E = 0.5, TV = 12 ml/kg, PEEP = 0.5 kPa, FiO2 = 0.4) in a dog model of OAPO. In the control state (lung-healthy dogs), 15 min after oleic acid lung injury (interstitial oedema, period I) and 60 min after onset of OAPO (alveolar oedema, period II), gas exchange, lung volumes, compliance, resistance and haemodynamics were measured. ⋯ Onset of phase IV of the alveolar plateau (closing volume CV) occurred significantly earlier (p less than 0.05) in all animals. Impaired ventilation of dependent lung regions, increased maldistribution of intrapulmonary gas and VA/Q-mismatching may be the underlying mechanisms for lower efficacy of HFJV during interstitial lung oedema. In period II, pulmonary and cardiocirculatory parameters had changed significantly in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1989
Letter Case ReportsPericardial aspergillosis in a bone marrow transplant recipient.