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Mozola MA, Peng X, Wendorf M, Alles S, Artiga L, Buchholz T, Camacho A, Charveron N, Clayborn J, Decker C, Deibel C, Donohue T, Draughon A, Ewings J, Feldworth M, Gane P, Goodwin J, Gunter T, Gutierrez M, Hovland R, Jechorek R, Jones W, Keskinen L, Lamproe B, Larson E, Manwarren H, Merkling A, Osing C, Pangloli P, Remes A, Richter E, Rogers A, Rose B, Ryser E, Secraw S, Slupik M, Wessinger A, Westmoreland R, Yan Z, Zahoor T, Zhang L. Evaluation of the GeneQuence® DNA Hybridization Method in Conjunction with 24-Hour Enrichment Protocols for Detection of Salmonella spp. in Select Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/90.3.738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A multilaboratory study was conducted to compare performance of the GeneQuence® DNA hybridization (DNAH) method incorporating new 24 h enrichment protocols and reference culture procedures for detection of Salmonella spp. in select foods. Six food types (raw ground turkey, raw ground beef, dried whole egg, milk chocolate, walnuts, and dry pet food) were tested by the DNAH method and by the culture methods of either the U.S. Department of Agriculture-Food Safety and Inspection Service (USDA-FSIS) or the U.S. Food and Drug Administration's Bacteriological Analytical Manual (FDA/BAM). Fifteen laboratories participated in the study. Four of the foods tested (raw ground turkey, dried whole egg, milk chocolate, and dry pet food), showed no statistically significant differences in performance between the DNAH method and the reference procedure as determined by Chi square analysis. Sensitivity rates for the DNAH method ranged from 92 to 100. The DNAH method, with the specific enrichment protocol evaluated, was found to be ineffective for detection of Salmonella spp. in walnuts. For raw ground beef, results from one trial showed a statistically significant difference in performance, with more positives obtained by the reference method. However, evidence suggests that the difference in the number of positives was likely due to lack of homogeneity of the test samples rather than to DNAH method performance.
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Affiliation(s)
| | - Xuan Peng
- Neogen Corp., 620 Lesher Pl, Lansing, MI 48912
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Toise S, Sears S, Schoenfeld M, Blitzer M, Marieb M, Drury J, Slade M, Donohue T. P02.35. Methodology in integrative medicine research: challenges and solutions from a randomized clinical control trial using adapted yoga. BMC Complement Altern Med 2012. [PMCID: PMC3373786 DOI: 10.1186/1472-6882-12-s1-p91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ramanathan M, Srinivasan R, Geller N, Donohue T, Goodwin R, Cook L, Ramos C, Barrett J, Childs R. Combined tumor necrosis factor-α (TNF–α) and interleukin-2 (IL-2) blockade in acute steroid refractory graft-versus-host disease (SR-GVHD) following allogeneic hematopoietic stem cell transplantation (HCT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7023 Background: SR-GVHD is a frequent and often fatal complication of HCT. A variety of inflammatory cytokines have been implicated in the pathogenesis of GVHD; single agent therapy against targets such as the IL-2 receptor α chain (daclizumab) or TNF-α (infliximab) has modest activity in SR-GVHD. We hypothesized that concomitant blockade of both TNF-α and IL-2 pathways would be more effective in controlling SR-GVHD than inhibition of either cytokine alone. Methods: The incidence of and outcome following SR-GVHD in 141 pts undergoing nonmyeloablative HCT from an HLA-matched family donor at our institution between February 2001 and November 2008 were analyzed. All SR-GVHD pts were treated with a combination of daclizumab (1 mg/kg, days1, 4, 8, 15, 22) and infliximab (10 mg/kg, days1, 8, 15, 22); in addition, aspergillus prophylaxis, empiric broad-spectrum antibiotics, and a rapid reduction in the dose of corticosteroids was initiated in order to minimize the risk of opportunistic infections associated with immunosuppression. Results: Twenty-three pts (23/141, 16%) developed SR-GVHD (median age 35 y, range 17–65 y); involved organs included the GI tract (n = 23), liver (n = 3), and skin (n = 8). We observed a remarkably high response rate following therapy, with 20/23 (87%) pts experiencing complete resolution of GVHD. Responses were usually delayed (median onset 2 weeks) but durable. The most notable complication associated with therapy was the development of opportunistic infections (invasive fungal infections in 3 pts); in 2/3 of these cases, prophylactic antifungal therapy had been discontinued prematurely due to drug toxicity. The median survival for the SR-GVHD cohort was 255 days (range 67–2,148 days), with 10/23 pts surviving at the time of this analysis. Causes of death included underlying cancer (5 pts), CMV disease (2 pts), and infectious complications (5 pts). Conclusions: These data suggest combined TNF-α /IL-2 blockade is a highly effective therapeutic option for pts with SR-GVHD and highlight the need for aggressive antimicrobial prophylaxis in the management of this condition. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - N. Geller
- National Institutes of Health, Bethesda, MD
| | - T. Donohue
- National Institutes of Health, Bethesda, MD
| | - R. Goodwin
- National Institutes of Health, Bethesda, MD
| | - L. Cook
- National Institutes of Health, Bethesda, MD
| | - C. Ramos
- National Institutes of Health, Bethesda, MD
| | - J. Barrett
- National Institutes of Health, Bethesda, MD
| | - R. Childs
- National Institutes of Health, Bethesda, MD
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Savani B, Shenoy A, Stratton P, Filie A, Kozanas E, Chauvet D, Donohue T, Le Q, Childs R, Goodman S, Barrett A. 50: Increased Risk of Cervical Dysplasia in Long Term Survivors of Allogeneic Stem Cell Transplantation – Implications for Screening and HPV Vaccination. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.058] [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: 10/22/2022]
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Srinivasan R, Arrington J, Karpovich J, Donohue T, Goodwin R, Ramos C, Cook L, Barrett J, Childs R. 339: Infliximab Combined with Daclizumab Results in a High Complete Response Rate When used to Treat Acute Steroid Refractory Graft-Versus-Host Disease (SR-GVHD). Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.349] [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: 10/22/2022]
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Sakr A, Caracciolo E, Donohue T. A 45-year-old woman with fibromuscular dysplasia and celiac disease. Int J Cardiol 2007; 118:e27-30. [PMID: 17289182 DOI: 10.1016/j.ijcard.2006.11.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 11/02/2006] [Indexed: 11/23/2022]
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7
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Srinivasan R, Chakrabarti S, Walsh T, Igarashi T, Takahashi Y, Kleiner D, Donohue T, Shalabi R, Carvallo C, Barrett AJ, Geller N, Childs R. Improved survival in steroid-refractory acute graft versus host disease after non-myeloablative allogeneic transplantation using a daclizumab-based strategy with comprehensive infection prophylaxis. Br J Haematol 2004; 124:777-86. [PMID: 15009066 DOI: 10.1111/j.1365-2141.2004.04856.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Approximately 15% of patients undergoing non-myeloablative allogeneic haematopoietical cell transplantation (NMHCT) develop steroid-refractory acute-graft versus host disease (aGVHD), a usually fatal complication. We encountered 18 cases of steroid-refractory aGVHD in 146 patients, undergoing NMHCT from a related human leucocyte antigen-compatible donor following cyclophosphamide/fludarabine-based conditioning. Our initial cohort of steroid-refractory aGVHD patients treated with antithymocyte globulin (ATG) and mycophenolate mofetil (regimen-1: n = 6) had high GVHD-related mortality. Therefore, we investigated an alternative strategy for subsequent patients developing this complication (regimen-2: n = 12), consisting of daclizumab (alone or combined with infliximab/ATG) and targeted broad spectrum antibacterial and aspergillus prophylaxis in conjunction with rapid tapering of steroids to minimize opportunistic infections. In a retrospective analysis, patients receiving regimen-2 were significantly more likely to have complete resolution of GVHD compared with those receiving regimen-1 [12/12 (100%) vs. 1/6 (17%); P < 0.001]. When compared with those receiving regimen-1, regimen-2 patients also had a higher probability of survival at day 100 (100% vs. 50%) and day 200 (73% vs. 17%) post-transplant, and improved overall survival (median 453 d vs. 42 d from aGVHD onset; P < 0.0001). GVHD-related mortality was 89% for regimen-1 patients vs. 17% for regimen-2 patients (P < 0.0001). These data suggest that a co-ordinated approach using immunoregulatory monoclonal antibodies, pre-emptive antimicrobial therapy and judicious steroid withdrawal can dramatically improve outcome in steroid-refractory aGVHD.
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Affiliation(s)
- R Srinivasan
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1652, USA
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8
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Giuliani JF, Donohue T. Complex formation in dilute aqueous solutions of europium perchlorate detected through fluorescence lifetime measurements. Inorg Chem 2002. [DOI: 10.1021/ic50182a060] [Citation(s) in RCA: 8] [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: 11/29/2022]
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10
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Rubin R, Kemmerly S, Conti D, Doran M, Murray B, Neylan J, Pappas C, Pitts D, Avery R, Pavlakis M, Del Busto R, DeNofrio D, Blumberg E, Schoenfeld D, Donohue T, Fisher S, Fishman J. Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis. Transpl Infect Dis 2000. [DOI: 10.1111/j.1399-3062.2000.020303.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rubin RH, Kemmerly SA, Conti D, Doran M, Murray BM, Neylan JF, Pappas C, Pitts D, Avery R, Pavlakis M, Del Busto R, DeNofrio D, Blumberg EA, Schoenfeld DA, Donohue T, Fisher SA, Fishman JA. Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis. Transpl Infect Dis 2000; 2:112-7. [PMID: 11429021] [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: 02/20/2023]
Abstract
BACKGROUND Optimal prophylaxis against cytomegalovirus (CMV) disease for organ transplant patients at risk for primary infection (donor seropositive, recipient seronegative, D+R-) remains to be determined. We hypothesized that prolonged oral ganciclovir therapy following intravenous therapy would provide increased protection. METHODS A total of 155 evaluable D+R- organ transplant recipients from 13 transplant centers were entered into the study: all received intravenous ganciclovir (5 mg/kg/day) for 5-10 days and then either oral acyclovir (400 mg tid) or oral ganciclovir (1 g tid) for an additional 12 weeks. Patients were assigned to their treatment groups at a central randomization site, with a separate randomization scheme for each of the organs transplanted (kidney, heart, or liver). In the case of kidney transplants, the patients were stratified according to source of the kidney (living related vs. cadaveric donor). The primary endpoint was the incidence of CMV disease in the first six months post-transplant. RESULTS Treatment with oral ganciclovir was associated with a significant decrease in the incidence of symptomatic disease or viremia when compared with the oral acyclovir group (32% vs. 50%, P<0.05). This difference was most marked in terms of tissue invasive disease: only 3 of 15 symptomatic patients in the ganciclovir group vs. 10 of 21 in the acyclovir group developed tissue-invasive infection (P<0.05). There was a significant difference in the time to CMV disease or viremia in the two groups: mean time 212+/-17 days post-transplant for the acyclovir group vs. 291+/-13 days for the ganciclovir group (P<0.001). The incidence of allograft rejection was 34% in the ganciclovir group and 46% in the acyclovir group (P=NS). Leukopenia was more common in the ganciclovir group (P<0.05), but in no case did it require drug discontinuation. Ganciclovir resistance did not develop in this study. CONCLUSION Prophylaxis with oral ganciclovir following a brief course of intravenous ganciclovir provides useful protection against primary CMV disease.
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Affiliation(s)
- R H Rubin
- Infectious Disease Unit, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA
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Cohen JD, Drury JH, Ostdiek J, Finn J, Babu BR, Flaker G, Belew K, Donohue T, Labovitz A. Benefits of lipid lowering on vascular reactivity in patients with coronary artery disease and average cholesterol levels: a mechanism for reducing clinical events? Am Heart J 2000; 139:734-8. [PMID: 10740160 DOI: 10.1016/s0002-8703(00)90057-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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] [Indexed: 01/09/2023]
Abstract
BACKGROUND The favorable effects of lowering low-density lipoprotein (LDL)-cholesterol on reducing clinical events in patients with coronary disease have been well established. The mechanisms responsible for this benefit, however, have not been fully understood. This study examined the impact of lipid-lowering therapy on endothelium-dependent vasoreactivity in a subgroup of patients after myocardial infarction with average cholesterol levels who participated in the Cholesterol Recurrent Events (CARE) study to determine whether an effect on endothelial function is a viable mechanism for the observed reduction in clinical events. METHODS AND RESULTS Participants were recruited from among volunteers in the CARE trial at 2 university-based outpatient cardiology clinics. Patients were randomly assigned to pravastatin or placebo. Plasma lipids were measured at baseline and semiannually thereafter. During the final 6 months of the trial, vasoreactivity was assessed by change in ultrasound-determined brachial artery diameter in response to blood pressure cuff-induced ischemia (endothelium-dependent) and to nitroglycerin, a direct vasodilator. Differences in response were examined between the 2 randomized groups. The relation between change in LDL-cholesterol from baseline to year 5 and the magnitude of endothelium-dependent vasodilation also was examined. There was significantly greater endothelium-dependent vasodilation observed in the pravastatin group compared with the placebo group (13% vs 8%, P =.0002), with no difference between the groups in their response to the endothelium-independent vasodilator nitroglycerin. The magnitude of the endothelium-dependent vasodilation was significantly correlated with the percent change in LDL-cholesterol from baseline to final visit (r = 0.49, P =.015). CONCLUSIONS These findings indicate that the use of pravastatin in patients after myocardial infarction with average cholesterol levels is associated with greater endothelium-dependent vasodilation compared with those who received placebo. The magnitude of this vasodilatory response is correlated to the reduction in LDL-cholesterol. This improvement in endothelium-dependent vasoreactivity may be a likely mechanism, at least in part, for the reduction in recurrent clinical events observed and reported in the CARE study.
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Affiliation(s)
- J D Cohen
- Division of Cardiology, Department of Internal Medicine, Saint Louis University Health Sciences Center, MO 63104, USA.
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13
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Dolan M, Kern M, Bach R, Castello R, Donohue T, Mechern C, Vrain J, Dressler F, Labovitz A. Preservation of coronary blood flow in humans by esmolol during dobutamine. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)82243-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Intraaortic balloon pump support has been demonstrated to be of clinical benefit when used therapeutically and prophylactically in high-risk patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Afterload reduction and post-PTCA-enhanced coronary blood flow afforded by diastolic augmentation during intraaortic balloon pumping provides hemodynamic stabilization, attenuates clinical perturbations of myocardial ischemia, and may provide an important 'bridge' to emergent coronary bypass surgery following abrupt vessel closure complicating PTCA. Recent studies demonstrate a reduction in cardiac morbidity and improved coronary artery patency among patients receiving prophylactic intraaortic balloon pumping after establishing infarct artery reperfusion during acute cardiac catheterization for acute myocardial infarction. A modest increase in cardiac output (20-30%), the requirement of a stable, regular cardiac rhythm, peripheral vascular disease and aortic insufficiency limits the use of intraaortic balloon pump support in relatively few patients. These studies demonstrate that intraaortic balloon counterpulsation provides an effective and safe form of mechanical support in many high-risk patients undergoing PTCA.
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Affiliation(s)
- F V Aguirre
- Cardiac Catheterization Laboratory, St. Louis University Medical Center, Mo. 63110
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15
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Affiliation(s)
- C Bell
- Cardiology Division, St. Louis University Hospital, MO 63110-0250
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16
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Kern MJ, Donohue T, Bach R, Aguirre F, Bell C. Monitoring cyclical coronary blood flow alterations after coronary angioplasty for stent restenosis with a Doppler guide wire. Am Heart J 1993; 125:1159-61. [PMID: 8465744 DOI: 10.1016/0002-8703(93)90130-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis University Hospital, MO 63110
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17
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Bell CA, Kern MJ, Aguirre FV, Donohue T, Bach R, Wolford T, Penick D, Ofili E, Miller L, Labovitz AJ. Superior accuracy of anatomic positioning with echocardiographic- over fluoroscopic-guided endomyocardial biopsy. Cathet Cardiovasc Diagn 1993; 28:291-4. [PMID: 8462077 DOI: 10.1002/ccd.1810280405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To assess the superior anatomic positioning of echocardiographic-guided endomyocardial biopsy compared to traditional fluoroscopic-guided technique, these two modalities were compared in a blinded fashion during femoral sheath endomyocardial biopsy in 21 patients, 19 being evaluated after orthotopic cardiac transplantation. The simultaneous fluoroscopic and echocardiographic imaging indicated that traditional fluoroscopic positioning of the bioptome against the septum is inaccurate in over half of patients undergoing biopsy. This finding should be considered in cardiomyopathy patients or those at high risk for biopsy-related complications.
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Affiliation(s)
- C A Bell
- Department of Internal Medicine, J.G. Mudd Cardiac Catheterization Laboratory, St. Louis University Hospital, Missouri 63110
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Donohue T, Kern MJ, Bach R, Aguirre F, Wolford T. Examination of the effects of hemodynamic and pharmacologic interventions on coronary collateral flow in a patient during cardiac catheterization. Cathet Cardiovasc Diagn 1993; 28:155-61. [PMID: 8448801 DOI: 10.1002/ccd.1810280213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The vasomotor response of native human collateral vessels to pharmacologic or hemodynamic vasodilatory stimuli is not well known. We describe a case where retrograde collateral flow velocity was measured both at baseline and following selected hemodynamic and pharmacologic interventions. This index case represents the first in a series of potential human physiologic studies designed to address questions pertaining to control of collateral blood supply in humans.
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Affiliation(s)
- T Donohue
- Cardiology Division, St. Louis University Hospital, Missouri
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19
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Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993; 87:500-11. [PMID: 8425297 DOI: 10.1161/01.cir.87.2.500] [Citation(s) in RCA: 186] [Impact Index Per Article: 6.0] [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] [Indexed: 01/30/2023]
Abstract
BACKGROUND Controversy exists regarding the ability of intra-aortic balloon pumping to increase coronary blood flow in patients with obstructive coronary artery disease. To assess the effects of intra-aortic balloon pumping on coronary hemodynamics, we measured coronary blood flow velocity with a 0.018-in. Doppler-tipped angioplasty guide wire in 15 patients who received an intra-aortic balloon pump for typical clinical indications. METHODS AND RESULTS Intra-aortic balloon pumping augmented diastolic pressure 83 +/- 35%. In nine patients before angioplasty, peak diastolic coronary flow velocity beyond the stenosis (mean diameter narrowing, 95 +/- 7%) was 5.3 +/- 9.6 cm/sec and was unaffected by intra-aortic balloon pumping. After angioplasty, the improved coronary luminal diameter narrowing (n = 12; mean narrowing, 18 +/- 12%) was associated with increased distal diastolic flow velocity integral and peak diastolic and mean velocities (13.3 +/- 8.4 units: 36.4 +/- 18.3 and 24.0 +/- 11.4 cm/sec, respectively; all p < 0.01 versus before angioplasty), which were further augmented (36 +/- 37%, 54 +/- 49%, and 26 +/- 17%, respectively; all p < 0.01) with intra-aortic balloon pumping. Intra-aortic balloon pumping did not significantly increase the distal systolic velocity integral (10 +/- 59%) or peak systolic velocity (3 +/- 33%). Similar degrees of balloon pump augmentation of distal coronary flow velocity values were observed in five angiographically normal reference arteries in four patients. CONCLUSIONS These data demonstrate lack of significant flow improvement beyond most critical stenoses with intra-aortic balloon pumping and the unequivocal restoration and intra-aortic balloon pump-mediated augmentation of both proximal and distal coronary blood flow velocities after amelioration of severe coronary obstructions in patients after successful coronary angioplasty.
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Affiliation(s)
- M J Kern
- Department of Internal Medicine, St. Louis University, Mo
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20
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Kern MJ, Aguirre FV, Tatineni S, Penick D, Serota H, Donohue T, Walter K. Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol 1993; 21:359-68. [PMID: 8425999 DOI: 10.1016/0735-1097(93)90676-r] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.0] [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] [Indexed: 01/30/2023]
Abstract
OBJECTIVES The aim of this study was to assess coronary blood flow during intraaortic balloon counterpulsation by direct measurement. BACKGROUND In a majority of human studies, increased coronary blood flow during intraaortic balloon counterpulsation measured by indirect techniques has not been consistently demonstrated. METHODS Hemodynamic variables and coronary blood flow velocity (20-MHz Doppler-tipped catheter) data were measured in 19 patients requiring intraaortic balloon pumping for clinical indications (11 patients had acute myocardial infarction [9 with shock], 6 had unstable angina, 1 had acute mitral regurgitation and 1 was at high risk undergoing angioplasty). Hemodynamic data, mean and phasic diastolic flow velocity and velocity-time integrals (computed from digitized waveforms) were analyzed during periods of 1:1 balloon counterpulsation. RESULTS Intraaortic balloon pumping decreased systolic pressure (6 +/- 10%, p < 0.001) and increased diastolic pressure (80 +/- 30% from baseline, p < 0.001) without changing RR interval. Peak phasic, mean coronary flow velocity and diastolic flow velocity integral were significantly increased (115 +/- 115%, 67 +/- 61%, 103 +/- 81%, respectively, all p < 0.001) during intraaortic balloon pumping. In addition, although a wide splay of data was evident due to operator set variations in balloon inflation and deflation timing, the greater increases in diastolic flow velocity integral (DFVi) occurred in patients with basal systolic pressure < or = 90 mm Hg (% delta DFVi = 102 - 0.1.[unaugmented systolic pressure], SEE = 21.7 mm Hg, r = 0.30, p < 0.001). CONCLUSIONS Intraaortic balloon pumping unequivocally and significantly augments proximal coronary blood flow velocity, nearly doubling the coronary flow velocity integral in most patients. This mechanism may be a significant means of ischemia relief in hypotensive patients.
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Affiliation(s)
- M J Kern
- Cardiology Division, Saint Louis University Hospital, Missouri
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21
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Kern MJ, Aguirre F, Donohue T, Bach R. Interpretation of cardiac pathophysiology from pressure waveform analysis: multivalvular regurgitant lesions. Cathet Cardiovasc Diagn 1993; 28:167-72. [PMID: 8448803 DOI: 10.1002/ccd.1810280216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Multivalvular regurgitant lesions may have a common etiology, such as an underlying connective tissue disorder, Marfan's disease or cardiomyopathy. Careful collection of routine simultaneous left and right heart hemodynamics will document the individual valvular lesions. Combined echocardiography and angiographic data will further support the interpretation of the hemodynamic waveforms. Clinical decisions for valve repair or replacement will be based on the severity of associated lesions, myocardial function and other patient specific characteristics [9] indicating the acceptable limits of surgical risk.
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Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis University Hospital, MO 63110
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22
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Kern MJ, Donohue T, Bach R, Aguirre F. Interpretation of cardiac pathophysiology from pressure waveform analysis: simultaneous left and right ventricular pressure measurements. Cathet Cardiovasc Diagn 1993; 28:51-5. [PMID: 8416333 DOI: 10.1002/ccd.1810280111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In addition to demonstrating constrictive and restrictive cardiac physiology, simultaneous right and left ventricular pressure measurements can be helpful to identify various aspects of myocardial dysfunction. Intracardiac conduction defects will displace the right ventricular pressure under the left ventricular pressure upstroke and identify differences in the timing of ventricular contraction. Right ventricular dysfunction will also produce abnormal right ventricular pressure waveforms which may overlap left ventricular pressure and contribute to abnormalities in right atrial and ventricular pressure waveforms.
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Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis University Hospital, Missouri
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Donohue T, Kern MJ, Wolford T, Bach R, Aguirre F, Miller L. The effects of epicardial coronary spasm on intracoronary flow velocity and pressure gradient in a patient after cardiac transplantation. Am Heart J 1992; 124:1645-8. [PMID: 1462934 DOI: 10.1016/0002-8703(92)90093-b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T Donohue
- Cardiology Division, St. Louis University Hospital, MO 63110-0250
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Kern MJ, Aguirre F, Donohue T, Bach R. Interpretation of cardiac pathophysiology by waveform analysis: adult congenital anomalies. Cathet Cardiovasc Diagn 1992; 27:291-7. [PMID: 1458525 DOI: 10.1002/ccd.1810270410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Congenital anomalies are unusual in adults, but characteristic hemodynamic data facilitate precise diagnoses. A complete evaluation, including assessment for intracardiac shunts, is usually indicated in patients prior to major surgical procedures or electrophysiologic interventions.
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Affiliation(s)
- M J Kern
- Mudd Cardiac Catherization Laboratory, St. Louis University Hospital, MO 63110-0250
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Kern MJ, Donohue T, Bach R, Aguirre F. Interpretation of cardiac pathophysiology from pressure waveform analysis: cardiac arrhythmias. Cathet Cardiovasc Diagn 1992; 27:223-7. [PMID: 1384986 DOI: 10.1002/ccd.1810270314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Various arrhythmias can produce distorted pressure waveforms, which may be confused with benign physiologic events. Delay in the management of serious arrhythmias can be avoided by vigilant monitoring of systemic pressures.
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Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis University Hospital, Missouri
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Kern MJ, Aguirre F, Donohue T. Interpretation of cardiac pathophysiology from pressure waveform analysis: pressure wave artifacts. Cathet Cardiovasc Diagn 1992; 27:147-54. [PMID: 1446338 DOI: 10.1002/ccd.1810270215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis Medical Center, Missouri 63110-0250
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27
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Tatineni S, Kern MJ, Aguirre F, Donohue T, Bach R, Bell C. The usefulness of a tracking catheter in complex coronary angioplasty. Cathet Cardiovasc Diagn 1992; 27:75-81. [PMID: 1525815 DOI: 10.1002/ccd.1810270116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Complex lesion angioplasty, such as chronic total occlusions, coronary vessels with right angle take-offs, tortuous vessels, and tortuous internal mammary artery or saphenous vein grafts is a continuing challenge. The complex problems have been successfully managed with novel guiding catheter shapes and ultralow profile balloons. However, on occasion steerable guidewire placement remains extremely difficult, despite significantly improved means of intracoronary manipulations.
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Affiliation(s)
- S Tatineni
- Cardiology Division, St. Louis University Medical Center, Missouri 63110-0250
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Kern MJ, Aguirre F, Donohue T, Bach R. Interpretation of cardiac pathophysiology from pressure waveform analysis: coronary hemodynamics, Part III: Coronary hyperemia. Cathet Cardiovasc Diagn 1992; 26:204-11. [PMID: 1617712 DOI: 10.1002/ccd.1810260308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Basal patterns (systolic/diastolic components) of coronary flow velocity as previously described are generally maintained during hyperemia and can be easily recorded in the catheterization laboratory during pharmacologic stimulation. The interpretation of the clinical significance of coronary vasodilatory reserve may be complicated by both coronary and myocardial diseases. Distal coronary artery hyperemic responses measured with ultrasound Doppler-tipped guidewires will provide new information on traditional observations of coronary physiology in humans.
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Affiliation(s)
- M J Kern
- Cardiology Division, St. Louis University Hospital, Missouri 63110
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Donohue T, Aguirre F, Miller L, Kern MJ. Angiographic and intracoronary flow velocity reversal in a transplanted heart: a common etiology for an uncommon condition. Am Heart J 1992; 123:1374-7. [PMID: 1575156 DOI: 10.1016/0002-8703(92)91046-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T Donohue
- Cardiology Division, St. Louis University Hospital, MO 63110-0250
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Tatineni S, Kern MJ, Aguirre F, Donohue T, Bell C. Angiographic identification of malpositioned balloon catheters during mitral valvuloplasty. Cathet Cardiovasc Diagn 1992; 25:235-40. [PMID: 1571981 DOI: 10.1002/ccd.1810250313] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The positioning of balloon catheters for the percutaneous mitral valvuloplasty technique is critical to ensure an adequate result and minimize complications. Passage of two balloon catheters in parallel through a thickened atrial septum and maintenance of satisfactory positioning in the left ventricle can be difficult. We describe unsuspected malpositioning of the balloons in two patients documented angiographically in our laboratory. Recognizing and avoiding these positions will reduce the potential for serious complications.
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Affiliation(s)
- S Tatineni
- Cardiology Division, St. Louis University Medical Center, Missouri 63110-0250
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Affiliation(s)
- M S Flynn
- Cardiology Division, St. Louis University Medical Center, Missouri
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Donohue T, Sorkin B, Kanat IO. Postoperative fracture of os calcis and treatment. J Foot Surg 1987; 26:261-5. [PMID: 3611627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The occurrence of fracture of the calcaneus after heel spur surgery can be a devastating complication requiring prompt treatment and strict patient compliance during the postoperative course. The literature contains little information regarding this type of injury. Several factors must be considered in assessing the etiology of the fracture, including injuries incurred, surgical procedures performed, and axial forces that have been applied to the calcaneus.
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Abstract
Methods for sampling, extracting, and quantitating the metabolic pools of organic acids from bacteria have been developed. The concentration of these metabolites was determined by a new gas chromatographic method that can quantitatively determine the levels of lactate, pyruvate, fumarate, succinate, malate, alpha-ketoglutarate, and citrate. Values obtained were confirmed by fluorimetric analyses of five of the individual acids. In Escherichia coli, pools range from about 1 to 5 mumol/g of dry weight, with a variation in replicate samples of 5 to 15%. Under similar conditions, these pools in Bacillus licheniformis are in the same range, although the pyruvic acid pool is significantly larger.
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Melnick RL, Donohue T. Use of an adenosine triphosphate analog, adenylyl imidodiphosphate, to evaluate adenosine triphosphate-dependent reactions in mitochondria. Arch Biochem Biophys 1976; 173:231-6. [PMID: 176949 DOI: 10.1016/0003-9861(76)90254-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Garbus SB, Donohue T, Garbus S, Sanchez RC. Evaluation of a hypertension conference. J La State Med Soc 1975; 127:451-4. [PMID: 1214093] [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: 12/26/2022]
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