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Affiliation(s)
- N A Yonan
- Department Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, United Kingdom
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Aziz T, el-Gamel A, Krysiak P, Rahman A, Campbell C, Yonan N, Deiraniya A. Ten year experience in orthotopic heart transplantation: single center result. Transplant Proc 1998; 30:1915-6. [PMID: 9723331 DOI: 10.1016/s0041-1345(98)00480-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- T Aziz
- Cardiac Transplantation Unit, Wythenshawe Hospital, Manchester, United Kingdom
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Aziz TM, Sheldon S, el-Gamel A, Krysiak P, Campbell C, Rahman A, Dyer P, Yonan N, Deiraniya A. Implication of HLA mismatch in the clinical outcome of orthotopic heart transplantation. Transplant Proc 1998; 30:1917-9. [PMID: 9723332 DOI: 10.1016/s0041-1345(98)00481-3] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- T M Aziz
- Department of Transplantation Surgery, Wyhenshawe Hospital, Manchester, United Kingdom
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Aziz TM, Krysiak P, el-Gamel A, Campbell C, Rahman A, Deiraniya A, Isalska B, Yonan N. Bacteremia and endocarditis following endomyocardial biopsy. Transplant Proc 1998; 30:2112-3. [PMID: 9723409 DOI: 10.1016/s0041-1345(98)00556-9] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- T M Aziz
- Cardiac Transplant Unit, Wythenshawe Hospital, Manchester, United Kingdom
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Aziz T, el-Gamel A, Krysiak P, Rahman A, Campbell C, Yonan N, Deiraniya A. Risk factors for early mortality, acute rejection, and factors affecting first-year survival after heart transplantation. Transplant Proc 1998; 30:1912-4. [PMID: 9723330 DOI: 10.1016/s0041-1345(98)00479-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T Aziz
- Cardiac Transplantation Unit, Wythenshawe Hospital, Manchester, United Kingdom
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Yonan NA, Bishop P, el-Gamel A, Hutchinson IV. Tracheal allograft transplantation in rats: the role of immunosuppressive agents in development of obliterative airway disease. Transplant Proc 1998; 30:2207-9. [PMID: 9723443 DOI: 10.1016/s0041-1345(98)00702-7] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- N A Yonan
- Department of Cardio-thoracic Surgery and Transplantation, Wythenshawe Hospital, Manchester, UK
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Aziz T, el-Gamel A, Keevil B, Krysiak P, Campbell C, Rahman A, Deiraniya A, Yonan N. Clinical impact of Neoral in thoracic organ transplantation. Transplant Proc 1998; 30:1900-3. [PMID: 9723326 DOI: 10.1016/s0041-1345(98)00475-8] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- T Aziz
- Department of Transplantation Surgery, Wythenshawe Hospital, Manchester, United Kingdom
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Affiliation(s)
- T Aziz
- Department of Transplantation, Surgery, Wythenshawe Hospital, Manchester, UK
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el-Gamel A, Awad M, Yonan N, Keevil B, Egan J, Campbell C, Rahman AN, Haselton P, Deiraniya AK, Hutchinson IV. Does cyclosporin promote the secretion of transforming growth factor-beta 1 following pulmonary transplantation? Transplant Proc 1998; 30:1525-7. [PMID: 9636621 DOI: 10.1016/s0041-1345(98)00344-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A el-Gamel
- Transplant Unit, Wythenshawe Hospital, Manchester, United Kingdom
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el-Gamel A, Evans C, Keevil B, Aziz T, Rahman A, Campbell C, Deiraniya A, Yonan N. Effect of allopurinol on the metabolism of azathioprine in heart transplant patients. Transplant Proc 1998; 30:1127-9. [PMID: 9636457 DOI: 10.1016/s0041-1345(98)00179-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A el-Gamel
- Cardiothoracic Transplant Unit, Wythenshawe Hospital, Manchester, UK
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el-Gamel A, Doran H, Aziz T, Rahman A, Deiraniya A, Campbell C, Yonan N. Natural history and the clinical importance of early and late grade 2 cellular rejection following cardiac transplantation. Transplant Proc 1998; 30:1143-6. [PMID: 9636463 DOI: 10.1016/s0041-1345(98)00185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A el-Gamel
- Transplant Unit, Wythenshawe Hospital, Manchester, UK
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Yonan NA, el-Gamel A, Egan J, Kakadellis J, Rahman A, Deiraniya AK. Single lung transplantation for emphysema: predictors for native lung hyperinflation. J Heart Lung Transplant 1998; 17:192-201. [PMID: 9513858] [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: 02/06/2023] Open
Abstract
BACKGROUND Single lung transplantation is an established procedure for the treatment of respiratory failure resulting from emphysema. Initial concerns suggested that ventilation/perfusion mismatch may result in an unsatisfactory outcome, but good clinical results proved those concerns to be unfounded. However, a proportion of patients have had development of native lung hyperinflation (NLH), with increased morbidity and mortality rates. This study was undertaken to evaluate the factors that might predict those patients with emphysema who are at greatest risk for development of NLH. METHODS We retrospectively analyzed data from 27 patients who underwent 31 single lung transplantations for emphysema. The patients were divided into two groups: group A, 12 patients with development of acute or chronic NLH, and group B, 15 patients without development of hyperinflation. NLH was defined as radiologic mediastinal shift with flattening of the ipsilateral diaphragm associated with respiratory dysfunction or hemodynamic instability. All preoperative and postoperative data from recipients and data from donors were analyzed. RESULTS There were no differences between the two groups regarding age, preoperative partial pressure of oxygen, partial pressure of carbon dioxide, acid-base status, donor lung size and physiological structure, side of transplantation, primary pathologic condition, rejection score, infection episodes and obliterative bronchiolitis in the transplanted lung after operation. Patients with NLH had a significantly higher preoperative mean pulmonary artery pressure of 31.6 mm Hg (confidence interval [CI] 26.7 to 35.7), transpulmonary gradient of 20.5 mm Hg (CI 17.4 to 23.5), a lower mean forced expiratory volume in 1 second of 427 ml (CI 352 to 502), and higher mean residual volume of 4450 ml (CI 3769 to 5132). The duration of ventilation, 168 hours (CI 45 to 290), and the postoperative mean pulmonary artery pressure of 26 mm Hg (CI 23 to 28.7) are significantly higher in the hyperinflation group. Early death in group A (n = 5) was higher than in group B (no deaths) (p = 0.02). Six patients in group A required surgical treatment (two early native lung volume reductions, two early ipsilateral retransplantations, and two late contralateral transplantations). Group A patients tended to have poorer long-term lung function after transplantation, with reduced forced expiratory volume in 1 second, forced vital capacity, and higher residual volume (p = NS). CONCLUSION Patients with end-stage emphysema and relative pulmonary hypertension, severe airway obstruction, and air trapping are at greatest risk for development of early and late NLH. In this subgroup of patients, an alternative treatment strategy may be considered.
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Affiliation(s)
- N A Yonan
- Department of Cardiothoracic Surgery, North West Lung Centre, Wythenshawe Hospital, Manchester, United Kingdom
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Abstract
STUDY DESIGN This case report illustrates a rare presentation of spinal osteomyelitis that initially manifested as a life-threatening pleural empyema leading to misdiagnosis. OBJECTIVES A high index of suspicion is required to make the correct diagnosis of spinal osteomyelitis, especially with unusual presentations. Appropriate antibiotic management should be commenced immediately the diagnosis is made. SUMMARY OF BACKGROUND DATA A review of the literature reveals five previous cases of vertebral osteomyelitis associated with pleural effusions. In three of these, the effusions were reactive and sterile. There is only one previous case of a pleural empyema related to primary spinal osteomyelitis. There also is one case report of vertebral osteomyelitis presenting as a mediastinal abscess. METHODS A case is presented of a man thought to have bronchogenic carcinoma with a destructive vertebral metastasis who was sent for palliative radiation therapy. A life-threatening pleural effusion subsequently developed, and after additional investigation, he was found to have spinal osteomyelitis with a pleural empyema. RESULTS The empyema was drained through an indwelling chest tube, and the patient was administered appropriate antibiotics. He made a complete and uneventful recovery. CONCLUSIONS The case illustrates a rare presentation of spinal osteomyelitis. It exemplifies the dictum that if a malignant disease is suspected, every effort has to be made to establish a histologic diagnosis to prevent inappropriate management and the potentially devastating consequences of an incorrect diagnosis. It also high-lights the difficulties in diagnosis of vertebral osteomyelitis with empyema. With correct management, the prognosis is excellent.
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Affiliation(s)
- S Jari
- Department of Orthopaedic, Wythenshawe Hospital, South Manchester, United Kingdom
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el-Gamel A, Deiraniya AK, Rahman AN, Campbell CS, Yonan NA. Orthotopic heart transplantation hemodynamics: does atrial preservation improve cardiac output after transplantation? J Heart Lung Transplant 1996; 15:564-71. [PMID: 8803753] [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: 02/02/2023] Open
Abstract
BACKGROUND We have described an alternative technique for orthotopic heart transplantation (bicaval Wythenshawe technique) which maintains the right and left atrial anatomy and contractility. METHODS Fifty patients were randomized into two groups: group A (n = 25) who had orthotopic heart transplantation using the bicaval Wythenshawe technique and group B (n = 25) who had conventional (Lower and Shumway) technique of orthotopic heart transplantation. We compared the cardiac output (measured by thermodilution technique) with atrial activation (AAI pacing) to cardiac output without atrial activity (VVI pacing) in both groups to identify any beneficial hemodynamic effects. All patients were studied the first and second weeks after transplantation. The inaccuracies of comparing cardiac output measurements caused by different loading conditions, inotropic state, and systemic vascular resistance were eliminated by using the patient as his or her own control. RESULTS The difference between the measured cardiac output with atrial pacing and ventricular pacing was 1.42 +/- 0.44 L/min in group A in comparison with 0.32 +/- 0.4 L/min in group B (p = 0.001 Wilcoxon signed rank). The percentage of atrial contribution to the cardiac output in group A was 30% +/- 12% (standard deviation), 95% confidence interval in comparison with 7% +/- 9%, 95% confidence interval in group B. The mean stroke volume in group A was higher in sinus rhythm (65 +/- 19.2 ml) and atrial pacing (62 +/- 17.7 ml) compared with ventricular pacing (49.17 +/- 16.43 ml) p = 0.001. In group B no statistical difference was found between stroke volume measured with atrial (47.71 +/- 6.23 ml) or ventricular pacing (46.9 +/- 6.35 ml). CONCLUSIONS We conclude that the bicaval technique of orthotopic heart transplantation preserve the atrial kick and its contribution to cardiac output early after transplantation.
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Affiliation(s)
- A el-Gamel
- Wythenshawe Hospital Transplant Unit, Manchester, United Kingdom
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el-Gamel A, Doran H, Rahman A, Deiraniya A, Campbell C, Yonan N. Clinical importance of grade 2 cellular heart rejection. J Heart Lung Transplant 1996; 15:319-21. [PMID: 8777219] [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: 02/02/2023] Open
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el-Gamel A, Bridgewater B, Doran H, Yonan NA, Campbell CS, Hooper TL. Severe mitral valve dysfunction due to unsuspected granulomatous myocarditis: successful cardiac transplantation following attempted mitral valve repair. Eur J Cardiothorac Surg 1996; 10:702-4. [PMID: 8875182 DOI: 10.1016/s1010-7940(96)80390-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Granulomatous involvement of the myocardium is a rapidly fatal disease of uncertain aetiology rarely diagnosed premorbidly. We report a patient who presented with mitral valve incompetence and congestive cardiac failure who underwent a successful mitral valve repair but could not be weaned from cardiopulmonary bypass. Urgent heart transplantation was successfully performed and histological studies of the explanted heart revealed granulomatous myocarditis involving the mitral subvalvular apparatus. Endomyocardial biopsy may be necessary in young patients presenting with mitral valve disease of unknown aetiology.
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Affiliation(s)
- A el-Gamel
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
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al-Abdulla NA, Cole G, Braxton JH, Letsou GV, Liu W, Eisen RN, el-Gamel A, Baldwin JC. The effects of supercooling chemicals on myocardial ultrastructure: a transmission electron microscopy case study. Conn Med 1995; 59:387-99. [PMID: 7671597] [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: 01/26/2023]
Abstract
Extended ischemia results in organ infarction which limits the availability of donor hearts. Hypothermic storage extends heart preservation by effectively stopping cellular metabolism, thereby preventing toxic accumulations of metabolic wastes and depletion of energy stores. However, cell swelling as a result of ion concentration changes and cell laceration due to ice crystal growth are consequences of hypothermic ischemia. Supercooling successfully preserves hearts for an extended time without associated myocardial necrosis. The efficacies of four supercooling preservative solutions, containing hypertonic glucose, polyethylene glycol, and or winter flounder antifreeze protein, are assessed using the Langendorff isolated organ perfusion apparatus and transmission electron microscopy. Polyethylene glycol seems the most effective in preventing myocardial necrosis possibly by dehydrating, minimizing cellular ice formation, protecting against cell swelling, and functioning as an antioxidant. Hypertonic glucose seems the most effective in reducing cell swelling; it may also depress solution freezing points, bind water, adjust both intra- and extracellular osmolarities, stabilize proteins, and assist in adenosine triphosphate (ATP) production. Antifreeze protein seems to bind effectively to ice and inhibit its growth; it may also reduce membrane permeabilities to Ca2+ and K+ ions.
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Affiliation(s)
- N A al-Abdulla
- Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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el-Gamel A, Yonan N, Egan J, Smith KJ, Campbell CS, Rahman A, Deiraniya AK. The histological grade of rejection does not relate to intracardiac pressures. Transplant Proc 1995; 27:1947-9. [PMID: 7792846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A el-Gamel
- Transplant Unit, Wythenshawe Hospital, Manchester, United Kingdom
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el-Gamel A, Yonan N, Keevil B, Nicholls S, Smith KJ, Campbell C, Rahman A, Deiraniya AK. Measurement of microalbumin and retinol binding protein in cardiac and lung transplant recipients. Transplant Proc 1995; 27:1969-72. [PMID: 7792854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A el-Gamel
- Transplant Unit, Wythenshawe Hospital, Manchester, United Kingdom
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el-Gamel A, Yonan NA, Rahman AN, Deiraniya AK, Campbell CJ. Donor lung procurement. Ann Thorac Surg 1994; 58:276-7. [PMID: 8037551 DOI: 10.1016/0003-4975(94)91133-9] [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] [Indexed: 01/28/2023]
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el-Gamel A, Watson DC. Transbronchial intubation of the right pleural space: a rare complication of nasogastric intubation with a polyvinylchloride tube--a case study. Heart Lung 1993; 22:224-5. [PMID: 8491658] [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: 01/31/2023]
Abstract
Inappropriate intubation of the tracheobronchial tree by a fine-bore nasogastric tube with a metal stylet is a well-known hazard. We report a pulmonary perforation and hydropneumothorax caused by a polyvinylchloride nasogastric tube without a stylet in a child of 13 months. The position of the tube was checked by auscultation before feeding. It would appear that the auscultatory method is inadequate in checking the correct placement of a nasogastric tube in young children. An ordinary nasogastric tube can cause pulmonary perforation.
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Affiliation(s)
- A el-Gamel
- Children's Hospital, Ladywood, Birmingham, U.K
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el-Gamel A. Plea for selective operative cholangiography. J R Coll Surg Edinb 1991; 36:423-4. [PMID: 1774720] [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: 12/28/2022]
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