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Basu S, Irving C, Roberts P, Orr Y, Reilly C, Casey C, Griffiths A, Oake D, McElduff M, Macdonald P, Nair P, Jansz P, Festa M. Quality care close to home: Objectives and early outcomes of a second paediatric heart transplant service in Australia. J Paediatr Child Health 2023. [PMID: 37144911 DOI: 10.1111/jpc.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/02/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
AIM We describe the experience of a new paediatric heart transplant (HT) centre in Australia. New South Wales offers quaternary paediatric cardiac services including comprehensive care pre- and post-HT; however, perioperative HT care has previously occurred at the national paediatric centre or in adult centres. Internationally, perioperative HT care is highly protocol-driven and a majority of HT occurs in low volume centres. Establishing a low volume paediatric HT centre in New South Wales offers potential for quality HT care close to home. METHODS Retrospective review of programme data for the first 12 months was undertaken. Patient selection was audited against the programme's intended initiation criteria. Longitudinal patient data on outcomes and complications were obtained from patient medical records. RESULTS The programme's initial phase offered HT to children with non-congenital heart disease and no requirement for durable mechanical circulatory support. Eight patients met criteria for HT referral. Three underwent interstate transfer to the national paediatric centre. Five children (13-15 years, weight 36-85 kg) underwent HT in the new programme. Individual predicted 90-day mortality was 1.3-11.6%, with increased risk for recipients transplanted from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and with restrictive/hypertrophic cardiomyopathies. Survival at 90 days and for duration of follow-up is 100%. Observed programme benefits include mitigation of family dislocation and improved continuity of care within a family-centred programme. CONCLUSION Audit of the first 12 months' activity of a second paediatric HT centre in Australia demonstrates adherence to proposed patient selection criteria and excellent 90-day patient outcomes. The programme demonstrates feasibility of care close to home, providing continuity for all patients including those requiring increased rehabilitation and psychosocial support post-transplantation.
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Affiliation(s)
- Shreerupa Basu
- Paediatric Intensive Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Claire Irving
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Philip Roberts
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Yishay Orr
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Catherine Reilly
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Charlene Casey
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Amelia Griffiths
- Paediatric Intensive Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Diane Oake
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michelle McElduff
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter Macdonald
- Advanced Heart Failure and Transplant Service, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Priya Nair
- Advanced Heart Failure and Transplant Service, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Jansz
- Advanced Heart Failure and Transplant Service, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Marino Festa
- Paediatric Intensive Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Singh J, Zaballa K, Kok H, Fitzgerald N, Uy C, Nuth D, Castro C, Irving C, Waters K, Fitzgerald DA. Cheyne-stokes respiration in children with heart failure. Paediatr Respir Rev 2022; 43:78-84. [PMID: 35459626 DOI: 10.1016/j.prrv.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Cheyne-Stokes respiration (CSA-CSR) is a form of central sleep apnea characterized by alternating periods of hyperventilation and central apneas or hypopneas. CSA-CSR develops following a cardiac insult resulting in a compensatory increase in sympathetic activity, which in susceptible patients causes hyperventilation and destabilizes respiratory control. The physiological changes that occur in CSA-CSR include hyperventilation, a reduced blood gas buffering capacity, and circulatory delay. In adults, 25% to 50% of patients with heart failure are reported to have CSA-CSR. The development of CSA-CSR in this group of patients is considered a poor prognostic sign. The prevalence, progression, and treatment outcomes of CSA-CSR in children remain unclear with only 11 children being described in the literature. The lack of data is possibly not due to the paucity of children with severe heart failure and CSA-CSR but because they may be under-recognized, compounded by the absence of routine polysomnographic assessment of children with moderate to severe heart failure. Building on much broader experience in the diagnosis and management of CSA-CSR in adult sleep medicine and our limited experience in a pediatric quaternary center, this paper will discuss the prevalence of CSA-CSR, its' treatment options, outcomes in children, and the potential future direction for research in this understudied area of pediatric sleep medicine.
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Affiliation(s)
- Jagdev Singh
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Katrina Zaballa
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Harvey Kok
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Nicholas Fitzgerald
- Department of Cardiology, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carla Uy
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Dara Nuth
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chenda Castro
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Claire Irving
- Department of Cardiology, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Karen Waters
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Sleep Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Basu S, Irving C, Roberts P, Orr Y, Casey C, Reilly C, Griffiths A, Nair P, Macdonald P, Festa M. Care Close to Home: Justification for a Second Paediatric Heart Transplant Centre in Australia. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Denfield SW, Azeka E, Das B, Garcia-Guereta L, Irving C, Kemna M, Reinhardt Z, Thul J, Dipchand AI, Kirk R, Davies RR, Miera O. Pediatric cardiac waitlist mortality-Still too high. Pediatr Transplant 2020; 24:e13671. [PMID: 32198830 DOI: 10.1111/petr.13671] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/28/2022]
Abstract
Cardiac transplantation for children with end-stage cardiac disease with no other medical or surgical options is now standard. The number of children in need of cardiac transplant continues to exceed the number of donors considered "acceptable." Therefore, there is an urgent need to understand which recipients are in greatest need of transplant before becoming "too ill" and which "marginal" donors are acceptable in order to reduce waitlist mortality. This article reviewed primarily pediatric studies reported over the last 15 years on waitlist mortality around the world for the various subgroups of children awaiting heart transplant and discusses strategies to try to reduce the cardiac waitlist mortality.
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Affiliation(s)
- Susan W Denfield
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Estela Azeka
- Division of Pediatric Cardiology, University of Sao Paolo, Sao Paolo, Brazil
| | - Bibhuti Das
- Texas Children's Hospital, Baylor College of Medicine, Austin, TX, USA
| | - Luis Garcia-Guereta
- Division of Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Claire Irving
- Division of Pediatric Cardiology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Mariska Kemna
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Zdenka Reinhardt
- Division of Pediatric Cardiology, Freeman Hospital, New Castle upon Tyne, UK
| | - Josef Thul
- Division of Pediatric Cardiology, Children's Heart Center, University of Giessen, Giessen, Germany
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
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Kirk R, Dipchand AI, Davies RR, Miera O, Chapman G, Conway J, Denfield S, Gossett JG, Johnson J, McCulloch M, Schweiger M, Zimpfer D, Ablonczy L, Adachi I, Albert D, Alexander P, Amdani S, Amodeo A, Azeka E, Ballweg J, Beasley G, Böhmer J, Butler A, Camino M, Castro J, Chen S, Chrisant M, Christen U, Danziger-Isakov L, Das B, Everitt M, Feingold B, Fenton M, Garcia-Guereta L, Godown J, Gupta D, Irving C, Joong A, Kemna M, Khulbey SK, Kindel S, Knecht K, Lal AK, Lin K, Lord K, Möller T, Nandi D, Niesse O, Peng DM, Pérez-Blanco A, Punnoose A, Reinhardt Z, Rosenthal D, Scales A, Scheel J, Shih R, Smith J, Smits J, Thul J, Weintraub R, Zangwill S, Zuckerman WA. ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation. J Heart Lung Transplant 2020; 39:331-341. [PMID: 32088108 DOI: 10.1016/j.healun.2020.01.1345] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
The number of potential pediatric heart transplant recipients continues to exceed the number of donors, and consequently the waitlist mortality remains significant. Despite this, around 40% of all donated organs are not used and are discarded. This document (62 authors from 53 institutions in 17 countries) evaluates factors responsible for discarding donor hearts and makes recommendations regarding donor heart acceptance. The aim of this statement is to ensure that no usable donor heart is discarded, waitlist mortality is reduced, and post-transplant survival is not adversely impacted.
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Affiliation(s)
- Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas.
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Jennifer Conway
- Department of Pediatrics, Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Denfield
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Gossett
- University of California Benioff Children's Hospitals, San Francisco, California
| | - Jonathan Johnson
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Michael McCulloch
- University of Virginia Children's Hospital, Charlottesville, Virginia
| | - Martin Schweiger
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Vienna and Pediatric Heart Center Vienna, Vienna, Austria
| | - László Ablonczy
- Pediatric Cardiac Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Iki Adachi
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dimpna Albert
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Estela Azeka
- Heart Institute (InCor) University of São Paulo, São Paulo, Brazil
| | - Jean Ballweg
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center University of Nebraska Medical Center, Omaha, Nebraska
| | - Gary Beasley
- Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Jens Böhmer
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alison Butler
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | | | - Javier Castro
- Fundacion Cardiovascular de Colombia, Santander, Bucaramanga City, Colombia
| | | | - Maryanne Chrisant
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | - Urs Christen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lara Danziger-Isakov
- Pediatric Infectious Diseases, Cincinnati Children's Hospital Medical Center & University of Cincinnati, Cincinnati, Ohio
| | - Bibhuti Das
- Heart Institute, Joe Dimaggio Children's Hospital, Hollywood, Florida
| | | | - Brian Feingold
- Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Fenton
- Great Ormond Street Hospital for Children Foundation Trust, London, United Kingdom
| | | | - Justin Godown
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dipankar Gupta
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Claire Irving
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Anna Joong
- Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Steven Kindel
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Kimberly Lin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Lord
- New England Organ Bank, Boston, Massachusetts
| | - Thomas Möller
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Deipanjan Nandi
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | | | - Ann Punnoose
- Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Angie Scales
- Pediatric and Neonatal Donation and Transplantation, Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | - Janet Scheel
- Washington University School of Medicine, St. Louis, Missouri
| | - Renata Shih
- Congenital Heart Center, University of Florida, Gainesville, Florida
| | | | | | - Josef Thul
- Children's Heart Center, University of Giessen, Giessen, Germany
| | | | | | - Warren A Zuckerman
- Columbia University Medical Center, Morgan Stanley Children's Hospital of New York, New York, New York
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Irving C, Crennan M, Vanniasinkam T. Can serological methods help distinguish between prophylactic and alloimmune anti-D? Transfus Med 2017; 27 Suppl 5:362-368. [DOI: 10.1111/tme.12420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/16/2017] [Accepted: 04/12/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C. Irving
- Haematology Department; Melbourne Pathology; Collingwood, Victoria Australia
| | - M. Crennan
- Haematology Department; Melbourne Pathology; Collingwood, Victoria Australia
| | - T. Vanniasinkam
- School of Biomedical Sciences; Charles Sturt University; Wagga Wagga Australia
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de Rita F, Gandolfo F, Kirk R, Irving C, Haynes S, Crossland D, Hasan A, Griselli M. 115-I * OUTCOME OF PAEDIATRIC CARDIAC RE-TRANSPLANTATION IN THE MECHANICAL SUPPORT ERA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Cain N, Irving C, Webber S, Beerman L, Arora G. Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood. Am J Cardiol 2013; 112:961-5. [PMID: 23827401 DOI: 10.1016/j.amjcard.2013.05.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 11/30/2022]
Abstract
Wolff-Parkinson-White (WPW) syndrome carries a risk for symptomatic arrhythmias and sudden death. The aim of this study was to examine the natural history of patients with Wolff-Parkinson-White syndrome diagnosed in childhood followed longitudinally at a single institution. The study population consisted of 446 patients. The median age of diagnosis was 7 years, and 61% were male. Associated heart disease was present in 40 patients (9%). Modes of presentation included supraventricular tachycardia (38%), palpitations (22%), chest pain (5%), syncope (4%), atrial fibrillation (0.4%), sudden death (0.2%), and incidental findings (26%); data were unavailable in 4%. During the study period, a total of 243 patients (54%) had supraventricular tachycardia, and 7 patients (1.6%) had atrial fibrillation. Of patients who presented at ≤3 months of age, 35% had resolution of manifest preexcitation compared with 5.8% who presented at >3 months of age (p <0.0001). There were 6 sudden deaths (1.3%), with an incidence of 2.8 per 1,000 patient-years. Two of these patients had structurally normal hearts (incidence 1.1 per 1,000 patient-years). Four of these patients had associated heart disease (incidence 27 per 1,000 patient-years) (p <0.01). In conclusion, in a large population of patients with Wolff-Parkinson-White syndrome diagnosed in childhood, 64% had symptoms at presentation, and an additional 20% developed symptoms during follow-up. There were 6 sudden deaths (1.3%), with an overall incidence of 1.1 per 1,000 patient-years in patients with structurally normal hearts and 27 per 1,000 patient-years in patients with associated heart disease.
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Affiliation(s)
- Nicole Cain
- Medical University of South Carolina, Charleston, South Carolina.
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Gill T, Barua N, Woolley M, Bienemann A, Johnson D, S.O'Sullivan, Murray G, Fennelly C, Lewis O, Irving C, Wyatt M, Moore P, Gill S. In vitro and in vivo testing of a novel recessed-step catheter for reflux-free convection-enhanced drug delivery to the brain. J Neurosci Methods 2013; 219:1-9. [DOI: 10.1016/j.jneumeth.2013.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
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Irving C, Gennery A, Kirk R. Pushing the boundaries: the current status of ABO-incompatible cardiac transplantation. J Heart Lung Transplant 2012; 31:791-6. [PMID: 22694850 DOI: 10.1016/j.healun.2012.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 01/30/2023] Open
Abstract
Since the introduction of intentional ABO-incompatible (ABOi) cardiac transplantation in infants in the late 1990's, the number of patients listed for and undergoing ABOi transplants has increased. This practice has been shown to lead to a reduction in waiting list mortality and increased utilisation of donor organs with equivalent outcomes to ABO-compatible transplants. Differences in the infant immune system provide a window of opportunity for ABOi transplantation. However it is increasingly clear that older patients and those with significant amounts of blood group antibody specific isohaemagglutinins may also benefit. Newer research is now focussing on longer term outcomes of ABOi transplants - in particular the development of graft accommodation or tolerance. This review assesses the current status of ABO-incompatible cardiac transplantation both in infants and in sensitized and older patients.
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Affiliation(s)
- Claire Irving
- Department of Paediatric Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
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Heslop K, Stenton C, Irving C. P89 Ambulatory oxygen assessments in COPD and pulmonary fibrosis. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Feingold B, Irving C, Tatum GH, Webber SA. Prognostic significance of recurrent grade 1B rejection in the first year after pediatric cardiac transplantation: a case for reinstatement of the 1B rejection grade. Pediatr Transplant 2011; 15:589-93. [PMID: 21884346 PMCID: PMC3172690 DOI: 10.1111/j.1399-3046.2011.01530.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The 2005 ISHLT rejection grading system merged grades 1A, 1B, and 2 into a single grade (1R) assuming equivalent prognostic significance. We hypothesized that recurrent 1B ACR is associated with adverse outcomes. Data on all heart transplant recipients at our center from 1990 to 2007 were reviewed. Patients were excluded if they had more than one grade ≥ 3A/2R biopsy in the first six wk or any grade ≥ 3A/2R biopsies during the first year thereafter. Patients with ≥ 2 grade 1B biopsies from six wk to one yr were classified as "recurrent 1B." Outcomes were freedom from late (greater than one yr) ACR (grade ≥ 3A/2R), CAD, retransplantation/death, and a composite end-point. Sixty-two patients (53 non-recurrent 1B, nine recurrent 1B) met inclusion criteria. In univariate analyses, recurrent 1B status was associated with decreased freedom from late ACR (p < 0.001), CAD (p = 0.004), and the composite outcome (p < 0.001). There was no difference in freedom from retransplantation/death (p = 0.48). After controlling for demographic differences between the groups, recurrent 1B status was independently associated with late ACR (HR 5.90; p = 0.002) and the composite outcome (HR 4.52; p = 0.002). These data suggest that further study of the impact of removal of the 1B classification from the ISHLT grading scheme is warranted.
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Affiliation(s)
- Brian Feingold
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
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Irving C, Parry G, Crossland D, Cassidy J, Ferguson L, Guillen M, Thiru Y, Hasan A, Griselli M, Kirk R. 262 Experience with ABO-Incompatible Cardiac Transplantation in Sensitised Patients. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bere T, Florenes TW, Krosshaug T, Koga H, Nordsletten L, Irving C, Muller E, Reid RC, Senner V, Bahr R. Mechanisms of anterior cruciate ligament injury in world cup alpine skiing: a systematic video analysis of 20 cases. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Irving C, Parry G, Kirk R, Griselli M, Hasan A. 520 Improving Results of Adult Congenital Cardiac Transplantation in the Current Era. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Irving C, Carter V, Parry G, Hasan A, Kirk R. Donor-specific HLA antibodies in paediatric cardiac transplant recipients are associated with poor graft survival. Pediatr Transplant 2011; 15:193-7. [PMID: 21199210 DOI: 10.1111/j.1399-3046.2010.01446.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is increasing evidence that DSA are associated with poor graft survival, although there are little data in children. We aimed to describe the incidence of DSA in this group and to determine correlation with graft survival. HLA antibodies were analysed in 59 paediatric cardiac transplant recipients. Mean age 10.4 (0.7-18.5) yr, mean time post-transplant 5.1 (0.3-17.3) yr. Antibody detection/identification was performed on the Luminex platform with subsequent identification using Lifescreen Identification kits/One-Lambda Single antigen kits. Forty patients (69%) had no HLA antibodies. DSA were found in four (7%). One had transient Class I antibodies and normal cardiac function. The other three had persistent Class II antibodies (two subsequently required re-transplantation, the third had cardiac failure due to CAV). Non-DSA were found in 15 (25%), all with normal graft function and without rejection. There was no difference in function or CAV prevalence between those with non-DSA and those without antibodies. HLA DSA is uncommon in paediatric cardiac allograft recipients but, if persistent, suggests poorer prognosis. In our series, antibodies to HLA class II on donor tissue were associated with increased graft loss. Routine screening and regular testing are recommended.
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Affiliation(s)
- Claire Irving
- Department of Pediatric Cardiothoracic Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
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Irving C, Parry G, Cassidy J, Hasan A, Griselli M, Kirk R. Outcomes following infant listing for cardiac transplantation: the impact of strategies introduced to counteract limited donor availability. Arch Dis Child 2010; 95:883-7. [PMID: 20656734 DOI: 10.1136/adc.2009.171348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Survival following cardiac transplantation in infancy has improved substantially. There is a growing shortage of donors, the impact of which may be offset by increase in ABO-incompatible transplants, size-mismatching and mechanical support. The authors reviewed their results and outcomes following infant listing for cardiac transplantation over 22 years. METHODS Children <12 months at time of listing for cardiac transplant in 1987-2008 were identified using the departmental cardiopulmonary transplant database. Details were obtained from databases and hospital medical records and subdivided into two eras, 1987-1997 and 1998-2008. RESULTS In 1987-2008, 49 infants were listed, and 28 (57%) underwent cardiac transplantation (12 in 1987-1997 and 16 in 1998-2008). 15 patients (31%) died on the waiting list, 6 patients were delisted (5 of these because of recovery of cardiac function). There was a decrease in suitable donor offers from a mean of 36 per year in 1996-2000 to 11 per year in 2001-2006 (p=0.008). In 1998-2008, nine listed infants were on mechanical support; there were seven ABO-incompatible transplants, and all transplants were size-mismatched with donors on average 2.7 times heavier than recipients. Waiting times decreased from median 83 to 47 days. Six (21%) of the transplanted patients died, the majority in 1987-1997 and perioperatively. CONCLUSIONS There has been a fall in suitable donors for infant cardiac transplants over time despite increased demand. However, the introduction of size-mismatching, ABO-incompatible transplants and mechanical support has enabled an increase in the number of transplants to be carried out despite this fall in donor numbers. Outcomes following transplantation have improved over time.
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Affiliation(s)
- C Irving
- Department of Paediatric Cardiothoracic transplantation, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.
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Irving C, Parry G, O'Sullivan J, Dark JH, Kirk R, Crossland DS, Chaudhari M, Griselli M, Hamilton JRL, Hasan A. Cardiac transplantation in adults with congenital heart disease. Heart 2010; 96:1217-22. [DOI: 10.1136/hrt.2009.184713] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Irving C, Richmond S, Wren C, Longster C, Embleton ND. Changes in fetal prevalence and outcome for trisomies 13 and 18: a population-based study over 23 years. J Matern Fetal Neonatal Med 2010; 24:137-41. [PMID: 20384468 DOI: 10.3109/14767051003758879] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Changes in prenatal diagnosis and maternal age are likely to have an impact on live born prevalence of trisomies 13 and 18. We investigated trends in diagnosis, prevalence, and survival in these conditions. METHODS A population-based study of one UK health region in 1985-2007 using a well-established congenital abnormality register. Individual records were reviewed and live birth and maternal age data obtained. RESULTS Pregnancies with trisomies 13 and 18 increased from 0.08 to 0.23 per 1000 registered births and 0.20 to 0.65 per 1000 registered births, respectively. Prenatal diagnosis increased and was associated with high termination rates. Live born prevalence with trisomy 13 decreased from 0.05 to 0.03 per 1000 live births and with trisomy 18 from 0.16 to 0.10 per 1000 live births. Postnatal survival remains poor: one baby (3%) with trisomy 13 and four (6%) with trisomy 18 survived the first year. The percentage of mothers over 35 years increased from 6 to 15%. CONCLUSIONS Changes in prenatal screening and maternal age have had dramatic effects on the live born prevalence of trisomies 13 and 18. Infant survival remains largely unchanged with the majority dying in the neonatal period.
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Affiliation(s)
- Claire Irving
- Department of Paediatric Cardiology, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK
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Abstract
Radial arterial access for coronary angiography is widely used in adults. We aimed to determine its safety and feasibility in pediatric practice. Twelve children and adolescents post cardiac transplantation (13 procedures) were studied. The radial artery was cannulated with a 5-Fr sheath after subcutaneous injection of 2% lidocaine. A mixture of verapamil, heparin, and isosorbide dinitrate was administered to reduce spasm. Selective coronary angiograms were obtained using Judkin or Amplatz coronary catheters. Following the procedure, hemostasis was achieved with a TR Band. Median age was 16.7 years (range, 12.1-18.8 years), and median weight 55.2 kg (range, 39-81 kg). Seventy percent of cases were under local anesthetic. Radial access was successful in 85%. Severe arterial spasm led to abandonment in one and failure to complete the study adequately in two patients. No vascular complications occurred. On direct questioning all but one patient preferred the radial approach. We conclude that the radial approach to coronary angiography is safe and feasible in children and adolescents. Radial artery spasm can be a problem and difficult to reverse once it occurs, leading to procedure abandonment. However, the technique is successful in the majority of cases and provides an alternative approach to arterial access in this age group.
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Affiliation(s)
- Claire Irving
- Department of Paediatric Cardiology and Cardiothoracic Transplantation, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7-7DN, UK
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Irving C, Wren C. Asymptomatic anomalous origin of the left coronary artery from the pulmonary artery. Pediatr Cardiol 2009; 30:385-6. [PMID: 19052799 DOI: 10.1007/s00246-008-9356-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 11/13/2008] [Accepted: 11/15/2008] [Indexed: 11/29/2022]
Abstract
Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly of the coronary arteries which usually presents with heart failure in early infancy. We describe the unusual occurrence of this in an older child with no signs of cardiac ischemia.
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Affiliation(s)
- Claire Irving
- Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.
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Irving C, Parry G, Hasan A, Kirk R. 679: Outcomes of 21 Years of Paediatric Cardiac Transplantation: The Freeman Experience. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Irving C, Kirk R, Hasan A, Parry G. 366: Outcomes of Cardiac Transplantation for Adult Congenital Heart Disease. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Irving C, Cassidy J, Kirk R, Griselli M, Hasan A, Crossland D. 605: Assessment of Recovery on Ventricular Assist Device Support. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Irving C, Hasan A, Carter V, Gennery A, Parry G, Kirk R. 479: Association between Donor-Specific HLA Antibodies and Adverse Outcome Following Paediatric Cardiac Transplantation. J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Irving C, Chaudhari M. Enlarged bronchial collateral artery complicating recovery after arterial switch for simple transposition of the great arteries. Interact Cardiovasc Thorac Surg 2008; 7:1176-7. [DOI: 10.1510/icvts.2008.188003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Oropharyngeal lipomas are rare tumours. We present the case of a young man with an asymptomatic lipoma almost completely occluding his supraglottic airway, found on magnetic resonance imaging (MRI) for a separate oral cavity lesion. Pre-operative anaesthetic assessment was undertaken because of the risk of airway obstruction at induction of general anaesthesia. We discuss the awake fibre-optic technique used for induction, as well as the treatment and follow-up of these tumours. This case highlights the need for formal anaesthetic assessment, in such cases, to avoid total airway obstruction at induction of general anaesthesia. It also emphasizes the extent of supraglottic obstruction that can be present without giving rise to any symptoms.
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Affiliation(s)
- J Rimmer
- Head and Neck Surgery Department, Royal Marsden Hospital, London, UK.
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Irving C. Intramuscular Droperidol versus Intramuscular Dimenhydrinate for the Treatment of Acute Peripheral Vertigo in the Emergency Department: A Randomized Clinical Trial. Acad Emerg Med 2002. [DOI: 10.1197/aemj.9.6.650] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
PURPOSE Earlier studies have highlighted risk factors for perioperative stroke after carotid endarterectomy, such as female sex, preoperative symptoms, and cerebral infarction. In this study, we investigated the relationship between these factors and perioperative microembolization. METHODS A total of 235 patients were entered in the study at two centers. Transcranial Doppler ultrasound scanning was possible in 190 patients (81%) and was performed for 1 hour preoperatively and continuously intraoperatively as a means of detecting microemboli and monitoring mean middle cerebral artery velocity. The findings of transcranial Doppler ultrasound scanning were related to perioperative risk factors by means of univariate analysis. RESULTS Microemboli were detected in 28 (15%), 79 (42%), and 98 (52%) patients preoperatively, during carotid artery dissection, and after closure of the artery, respectively. Having 10 or more emboli after carotid artery closure was more common in women (P = .04) and in patients with symptomatic carotid artery disease (P = .04) and was demonstrated in three of the six patients who had a perioperative stroke. These three patients also had preoperative evidence of cerebral infarction and an intraoperative middle cerebral artery velocity less than 40 cm/s. CONCLUSION In this study, perioperative microembolization was more common in women and patients with symptomatic carotid artery disease. These findings may explain the increased risk of carotid surgery in these patients.
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Affiliation(s)
- J Golledge
- Department of Vascular Surgery, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
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Mason I, Chambers D, Shamim H, Walshe J, Irving C. Regulation and function of FGF8 in patterning of midbrain and anterior hindbrain. Biochem Cell Biol 2001; 78:577-84. [PMID: 11103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
In this article, an adjunct to a platform presentation at the Winternational 2000 Symposium, we summarize the recent findings of this group concerning the regulation and functions of FGF8 expressed at the isthmus of the developing brain. We show that several different FGF8 isoforms, ectopically expressed in midbrain or posterior forebrain, are able to mimic the proliferative and patterning functions previously attributed to the isthmus in tissue grafting studies. Moreover, we also show that FGF8 protein is sufficient to induce an ectopic isthmic organiser (Fgf-8+, Gbx2+) in anterior midbrain. We also provide evidence that isthmic FGF8 patterns anterior hindbrain, repressing Hox-a2 expression and setting aside a territory of the brain that includes the cerebellar anlage. We show that these effects of FGF8 are likely to be mediated via FGFR1 and be modulated by the putative FGF antagonist, Sprouty2, identified using a differential display screen. Finally, we provide evidence that the onset of Fgf8 expression is regulated by En1 and that its expression at the isthmus is subsequently maintained by a specific and direct interaction between rhombomere 1 and midbrain.
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Affiliation(s)
- I Mason
- MRC Centre for Developmental Neurobiology, King's College London, UK.
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Abstract
Current evidence suggests that the anterior segment of the vertebrate hindbrain, rhombomere 1, gives rise to the entire cerebellum. It is situated where two distinct developmental patterning mechanisms converge: graded signalling from an organising centre (the isthmus) located at the midbrain/hindbrain boundary confronts segmentation of the hindbrain. The unique developmental fate of rhombomere 1 is reflected by it being the only hindbrain segment in which no Hox genes are expressed. In this study we show that ectopic FGF8 protein, a candidate for the isthmic organising activity, is able to induce and repress gene expression within the hindbrain in a manner appropriate to rhombomere 1. Using a heterotopic, heterospecific grafting strategy we demonstrate that rhombomere 1 is able to express Hox genes but that both isthmic tissue and FGF8 inhibit their expression. Inhibition of FGF8 function in vivo shows that it is responsible for defining the anterior limit of Hox gene expression within the developing brain and thereby specifies the extent of the rl territory. Previous studies have suggested that a retinoid morphogen gradient determines the axial limit of expression of individual Hox genes within the hindbrain. We propose a model whereby activation by retinoids is antagonised by inhibition by FGF8 in the anterior hindbrain to set aside the territory from which the cerebellum will develop.
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Affiliation(s)
- C Irving
- MRC Brain Development Programme, Centre for Developmental Neurobiology, King's College London, Guy's Hospital Campus, UK
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Abstract
The midbrain-hindbrain boundary, or isthmus, is the source of signals that are responsible for regional specification of both the midbrain and anterior hindbrain. Fibroblast growth factor 8 (Fgf8) is expressed specifically at the isthmus and there is now good evidence that it forms at least part of the patterning signal. In this study, we use Fgf8 as a marker for isthmic cells to examine how interactions between midbrain and hindbrain can regenerate isthmic tissue and, thereby, gain insight into the normal formation and/or maintenance of the isthmus. We show that Fgf8-expressing tissue with properties of the isthmic organiser is generated when midbrain and rhombomere 1 tissue are juxtaposed but not when midbrain contacts any other rhombomere. The use of chick/quail chimeras shows that the isthmic tissue is largely derived from rhombomere 1. In a few cases a small proportion of the Fgf8-positive cells were of midbrain origin but this appears to be the result of a local respecification to a hindbrain phenotype, a process mimicked by ectopic FGF8. Studies in vitro show that the induction of Fgf8 is the result of a direct planar interaction between the two tissues and involves a diffusible signal.
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Affiliation(s)
- C Irving
- MRC Brain Development Programme, Department of Developmental Neurobiology, Guy's, King's and St. Thomas' Hospital Medical School, Hodgkin Building, Guy's Campus, London SE1 9RT, UK
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Abstract
The use of intramuscular droperidol to treat acute migraine headache has not been previously reported in the emergency medicine literature. It is a promising therapy for migraine. The authors performed a pilot review of all patients receiving droperidol for migraine in our emergency department (ED) to evaluate its efficacy. We used a retrospective case series, in a suburban ED with an annual patient census of 48,000. All patients with a discharge diagnosis of migraine headache who were treated with i.m. droperidol during a consecutive 5-month period in our ED were identified. All patients received droperidol 2.5 mg intramuscular. As per ED protocol, their clinical progress was closely followed and documented at 30 minutes after drug administration (t30). Demographic and clinical variables were recorded on a standardized, closed-question, data collection instrument. The primary outcome measurement was relief of symptoms at t30 to the point that the patient felt well enough to go home without further ED intervention (symptomatic relief). Thirty-seven patients were treated (84% female), with an ED diagnosis of acute migraine with droperidol during the study period. The mean age was 36 +/- 12 years. Analgesics had been used within 24 hours before ED presentation by 62% of patients. At t30, 30 (81%) patients had symptomatic relief, 2 (5%) felt partial relief but required rescue medication, and 5 (14%) had no relief of symptoms. Drowsiness (14%) and mild akathisia (8%) were the only adverse reactions observed following drug administration. Droperidol 2.5 mg intramuscular may be a safe and effective therapy for the ED management of acute migraine headache. Randomized, controlled trials are warranted to further validate the findings of this preliminary study.
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Affiliation(s)
- P B Richman
- Department of Emergency Medicine, Morristown Memorial Hospital, NJ 07962, USA
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Irving C, Shih RD. Cecal hernia: a rare cause of intestinal obstruction. Ann Emerg Med 1998; 31:655-6. [PMID: 9581155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Burstein R, Coward AW, Askew WE, Carmel K, Irving C, Shpilberg O, Moran D, Pikarsky A, Ginot G, Sawyer M, Golan R, Epstein Y. Energy expenditure variations in soldiers performing military activities under cold and hot climate conditions. Mil Med 1996; 161:750-4. [PMID: 8990835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study assessed the energetic status of soldiers exposed to intense physical activities in cold and warm weather. Thirty subjects participated in a two-phase study group A (n = 18) in the winter phase and group B (n = 12) in the summer phase. Energy expenditure (EE) was measured by the doubly labeled water technique; after a single, oral dosing of 2H(2)18O, daily urine samples were collected for 12 successive days. Energy intake (EI) was assessed from detailed food records analyzed by computerized food charts. Energy balance was calculated as the difference between EI and EE for each subject. Mean (+/- SE) daily EE was 4,281 +/- 170 and 3,937 +/- 159 kcal/day for the winter and summer groups, respectively. Daily EI was 2,792 +/- 124 kcal/day in group A and almost identical in group B. A negative energy balance of 1,422 +/- 163 kcal/day and 924 +/- 232 kcal/day (not significant) was calculated for groups A and B, respectively. Energy expenditure is primarily determined by the level of activity rather than by climate conditions; EI is insufficient to offset the high energy requirements under these conditions.
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Affiliation(s)
- R Burstein
- Israel Defence Forces Medical Corps, Institute of Military Physiology, Israel
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Patel K, Nittenberg R, D'Souza D, Irving C, Burt D, Wilkinson DG, Tickle C. Expression and regulation of Cek-8, a cell to cell signalling receptor in developing chick limb buds. Development 1996; 122:1147-55. [PMID: 8620841 DOI: 10.1242/dev.122.4.1147] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Eph-related receptor tyrosine kinase gene, Cek-8, is expressed in mesenchyme at the tip of chick limb buds, with high levels of transcripts posteriorly and apically but fading out anteriorly. Expression of Cek-8 in distal mesenchyme is regulated by apical ridge- and FGF-polarising signals and retinoic acid, and is uniform across the anteroposterior axis in talpid3 mutants. These data indicate that Cek-8 expression responds to regulatory signals during limb patterning and suggest that this receptor tyrosine kinase may have a role in coordinating responses to signals in the progress zone of early buds. Later on in limb development, Cek-8 expression is associated with cell condensations that form tendons and their attachments to cartilage rudiments and then in developing feather buds.
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Affiliation(s)
- K Patel
- Division of Developmental Neurobiology, National Institute for Medical Research, London, UK
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Irving C, Nieto MA, DasGupta R, Charnay P, Wilkinson DG. Progressive spatial restriction of Sek-1 and Krox-20 gene expression during hindbrain segmentation. Dev Biol 1996; 173:26-38. [PMID: 8575627 DOI: 10.1006/dbio.1996.0004] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
After segmentation of the vertebrate hindbrain, expression of the zinc-finger gene Krox-20 and the receptor tyrosine kinase gene Sek-1 is precisely restricted to rhombomeres (r) 3 and 5. This precise segmental expression is likely to reflect a critical requirement for these rhombomeres to acquire a distinct and homogeneous identity and raises the question as to how this relates to the intermingling and restriction of cell movement during segmentation. We have analysed Krox-20 and Sek-1 expression in the mouse and chick hindbrain at single-cell resolution using whole-mount in situ hybridisation and immunocytochemistry. We find that, in the mouse, the presumptive r3 and r5 expression domains each arise as narrow stripes that then broaden, suggestive of a recruitment of cells to an r3/r5 identity and/or a segmental regulation of cell proliferation. In addition, we find that expression of these genes initially occurs in fuzzy domains, and that these are progressively restricted to segmental domains, although occasional "violating" cells are observed even after segmentation. We propose that the establishment and maintenance of these segmental domains may involve both a dynamic regulation of r3/r5 identity and the restriction of cell movement across rhombomere boundaries.
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Affiliation(s)
- C Irving
- Division of Developmental Neurobiology, National Institute for Medical Research, Mill Hill, London, United Kingdom
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Kopald KH, Hiatt JR, Irving C, Giuliano AE. The pathology of nonpalpable breast cancer. Am Surg 1990; 56:782-7. [PMID: 2268107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A principal goal of mammographic screening is the early detection of breast cancer. We reviewed records of 125 women who were referred because of nonpalpable, suspicious abnormalities on mammogram, which subsequently proved to be cancer, requiring mammographic localization biopsy and subsequent surgery for therapy. We found that 72 (57.6%) had invasive tumors, 15 (12%) showed evidence of microinvasion and 38 (30.4%) were noninvasive. A total of 115 patients had lymphadenectomy as part of their definitive surgery. Nine (12.7%) of the patients with infiltrating tumors had between one and 10 malignant nodes on histologic section. None of the patients with noninvasive or microinvasive tumors were found to have involved nodes. The mammographic abnormalities which led to biopsy in our series were: calcifications in 74 (59.2%) patients, mass lesions in 39 (31.2%), mass lesions with calcifications in 11 (8.8%), and asymmetry in one (0.8%). Of the nine patients with nodal metastases, seven (77.8%) had a mass with or without calcifications as the indication for biopsy. Increasing tumor size was found to correlate with invasive tumors on histopathologic examination and the incidence of lymph node metastases. Thirty-seven (54.4%) of the patients with infiltrating tumors had a tumor size greater than 1 cm. Further, seven (77.8%) of the nine lymph node positive patients had tumors between 1 and 3 cm in size. Of note, however, is that two (22.2%) patients with microscopic tumors had involved nodes. The 4-year actuarial survival in patients with infiltrating tumors was 85.2 per cent, while that for patients with noninvasive or microinvasive tumors was 100 per cent (median follow-up of 20 months).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K H Kopald
- Department of Surgery, UCLA School of Medicine 90024
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Thompson JE, Pitt HA, Doty JE, Coleman J, Irving C. Broad spectrum penicillin as an adequate therapy for acute cholangitis. Surg Gynecol Obstet 1990; 171:275-82. [PMID: 2218831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In a previous study of patients with acute cholecystitis, we demonstrated equal efficacy with a broad spectrum penicillin (piperacillin) and a penicillin plus amino-glycoside combination. Whether a single agent broad spectrum penicillin is adequate treatment for more severe infections, such as acute cholangitis, however, is still unclear. We, therefore, conducted a three center, prospective, randomized trial to determine whether or not a broad spectrum penicillin alone is adequate therapy for patients with acute cholangitis. During a 36 month period, 96 patients with sepsis and biliary obstruction were randomly assigned to receive either piperacillin (n = 49) or ampicillin plus tobramycin (n = 47). The two groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. The incidence of blood cultures with positive results (20 versus 21 per cent) and underlying malignant lesions (51 versus 62 per cent) was also similar between the two groups. The percentage of patients with a clinical cure or significant improvement was the same in the two groups (69 versus 70 per cent). However, there was a significant difference in the cure rate between patients with benign and malignant biliary obstructions (83 versus 59 per cent, p less than 0.01). No significant differences were noted between the two antibiotic groups with respect to drug toxicity, but patients with malignant conditions were more prone to antibiotic related toxicities (2 versus 19 per cent, p less than 0.05). These data suggest that outcome of treatment in patients with acute cholangitis is similar with either a broad spectrum penicillin or a penicillin plus aminoglycoside combination and is dependent upon the nature of the biliary obstruction.
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Affiliation(s)
- J E Thompson
- Department of Surgery, Johns Hopkins University, Baltimore
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Abstract
The effects of surgical glove powder on adhesion formation after surgery on the flexor tendons in the chicken was analysed biomechanically. Surgical glove powder did not increase adhesion formation in flexor tendon surgery.
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Irving C, Walker H. Rehabilitation following head injury. Nursing 1983; 2:445-6. [PMID: 6554516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Irving C. Taking to the waters of Israel: the curative springs of Tiberias. Nurs Times 1980; 76:2235-6. [PMID: 6906675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Irving C. Modern medicine, old mystique in Macedonia. Nurs Times 1978; 74:686-7. [PMID: 349505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Irving C. Franja Bolnica- a partisan hospital. Nurs Times 1977; 73:316-7. [PMID: 322101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Irving C. Education in the San Francisco Bay Area. Science 1974; 183:340-1. [PMID: 17821101 DOI: 10.1126/science.183.4122.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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