63 research outputs found

    Right ventricular performance after valve repair for chronic degenerative mitral regurgitation.

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    Our aim was to assess right ventricular (RV) performance after mitral valve repair by use of RV focused echocardiography and to evaluate the influence of elevated pulmonary artery systolic pressure (PASP) on RV recovery

    How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

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    A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart

    How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

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    A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart

    Direct and indirect transmission of four Salmonella enterica serotypes in pigs

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    <p>Abstract</p> <p>Background</p> <p>Feed-borne spread of <it>Salmonella </it>spp. to pigs has been documented several times in recent years in Sweden. Experiences from the field suggest that feed-associated serotypes might be less transmittable and subsequently easier to eradicate from pig herds than other serotypes more commonly associated to pigs. Four <it>Salmonella </it>serotypes were selected for experimental studies in pigs in order to study transmissibility and compare possible differences between feed-assoociated (<it>S </it>Cubana and <it>S </it>Yoruba) and pig-associated serotypes (<it>S </it>Derby and <it>S </it>Typhimurium).</p> <p>Methods</p> <p>Direct contact transmission was studied in four groups of pigs formed by six 10-week-old salmonella negative pigs commingled with two fatteners excreting one of the four salmonella serotypes. Indirect transmission was studied by putting six 10-week-old salmonella negative pigs in each of four salmonella contaminated rooms. Each room had previously housed a group of pigs, excreting one of the four selected serotypes.</p> <p>All pigs were monitored for two weeks with respect to the faecal excretion of salmonella and the presence of serum antibodies. At the end of the trial, eight samples from inner tissues and organs were collected from each pig at necropsy.</p> <p>Results</p> <p>In the four direct transmission groups, one pig shed <it>Salmonella </it>(Cubana) at one occasion. At necropsy, <it>S </it>Typhimurium was isolated from one pig.</p> <p>In the indirect transmission groups, two pigs in the Yoruba room and one pig in each of the other rooms were excreting detectable levels of <it>Salmonella </it>once during the study period of two weeks. At necropsy, <it>S </it>Derby was isolated from one of six pigs in the Derby room and <it>S </it>Typhimurium was isolated from four of the six pigs in the Typhimurium room.</p> <p>No significant serological response could be detected in any of the 48 pigs.</p> <p>Conclusions</p> <p>These results show that all four selected serotypes were able to be transmitted in at least one of these field-like trials, but the transmission rate was low in all groups and no obvious differences between feed-associated and pig-associated serotypes in the transmission to naïve pigs and their subsequent faecal shedding were revealed. However, the post mortem results indicated a higher detection of <it>S </it>Typhimurium in the ileocecal lymph nodes of pigs introduced into a contaminated environment in comparison with the other three serotypes.</p

    NHBD Lung Transplantation

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    The waiting list for lung transplantations world-wide is steadily growing. So, the use of lungs from non-heart-beating donors (NHBD) needs to be addressed. Hence, the aim of this thesis was to evaluate, in realistic animal models, the new donor organ concept: NHBD transplantation. Left rat lungs were topically cooled for 2 hours in situ after failed resuscitation, with subsequent transplantation. Five weeks after transplantation, right pneumonectomy was done and blood gases and histology evaluated. Comparison was made with a control transplant group and a group with normal rats after right pneumonectomy. Also, pigs were studied after failed resuscitation with intrapleural topical cooling initiated after 65 minutes. The lungs were cooled for 6 hours in situ after which their function was assessed ex vivo, followed by left lung transplantation and right pneumonectomy, thus making the recipient animals 100% dependent for their survival on the function of the donor lungs assessed ex vivo. Cold flush perfusion was studied in ventilated, isolated rat lungs perfused with either Euro-Collins solution or Perfadex at a pressure of 10, 15, or 20 mmHg. Weight gain was recorded and comparisons were made between values obtained at different perfusion pressures and with the two solutions. All the transplanted rats survived in good condition and at five weeks there were no significant differences in blood gases. The bronchial anastomoses showed normal healing in all cases and the histologic changes in the lung parenchyma were generally mild and focal, interstitial and perivascular mononuclear inflammation. Surprisingly, the transplanted controls demonstrated the most pronounced changes. The gas-exchange function during the ex-vivo evaluation in pigs did not differ from the basal values obtained before CPR. After the subsequent transplantation, all recipient animals survived in good condition at the end of the 24-hour observation period. The blood gas function did not differ significantly from that in the donor animals and the pulmonary vascular resistance was within normal range. In the isolated rat lungs, already at a perfusion pressure of 10 mmHg, there was a macro- and microscopically apparent edema, irrespective of the type of preservation solution. Perfusion pressures of 10 and 20 mmHg gave weight gains of 100% and 350%, respectively, after 3 min of perfusion. There were no statistically significant differences in weight gain or amount of perfused fluid between the different solutions at equal perfusion pressure. The concept of lung transplantation from non-heart-beating donors is feasible, if the lungs are cooled in situ within one hour after failed resuscitation. During cold flush perfusion, the edema formation is related to the perfusion pressure

    An assessment of soybeans and other vegetable proteins as source of salmonella contamination in pig production

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    Abstract Background The impact of salmonella contaminated feed ingredients on the risk for spreading salmonella to pigs was assessed in response to two incidences when salmonella was spread by feed from two feed mills to 78 swine producing herds. Methods The assessment was based on results from the salmonella surveillance of feed ingredients before introduction to feed mills and from HACCP - based surveillance of the feed mills. Results from the mills of the Company (A) that produced the salmonella contaminated feed, were by the Chi. Square test compared to the results from all the other (B - E) feed producers registered in Sweden. Isolated serovars were compared to serovars from human cases of salmonellosis. Results Salmonella (28 serovars) was frequently isolated from imported consignments of soybean meal (14.6%) and rape seed meal (10.0%). Company A largely imported soybean meal from crushing plants with a history of unknown or frequent salmonella contamination. The risk for consignments of vegetable proteins to be salmonella contaminated was 2.4 times (P Conclusions Salmonella contaminated feed ingredients are an important source for introducing salmonella into the feed and food chain. Effective HACCP-based control and associated corrective actions are required to prevent salmonella contamination of feed. Efforts should be taken to prevent salmonella contamination already at the crushing plants. This is challenge for the EU - feed industry due to the fact that 98% of the use of soybean/meal, an essential feed ingredient, is imported from crushing plants of third countries usually with an unknown salmonella status.</p

    Gas exchange function one month after transplantation of lungs topically cooled for 2 hours in the non-heart-beating cadaver after failed resuscitation

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    BACKGROUND: If lungs from subjects dying of heart attacks could be used for transplantation, the lung donor shortage could be radically reduced. The aim of this study was to investigate, in an experimental survival model, the results of lung transplantation using lungs from non-heart-beating donors. METHODS: The left lung, topically cooled to 25 degrees C for 2 hours in situ after 5 minutes of circulatory arrest and 26 minutes of unsuccessful cardiopulmonary resuscitation, was transplanted into a syngeneic rat. Five weeks after the transplantation, right pneumonectomy was performed and blood gases measured every 10 minutes for 1 hour. Comparison were made with two control groups, one where fresh donor lungs were transplanted and another where only right pneumonectomy was done. RESULTS: All animals survived and were in good condition at the end of the observation period. There was no statistically significant difference in arterial oxygen or carbon dioxide tension between the groups. The bronchial anastomoses showed normal healing in all cases. CONCLUSION: Lungs from non-heart-beating donors topically cooled in situ to 25 degrees C for 2 hours before being harvested showed excellent gas exchange and bronchial healing 5 weeks after transplantation

    Transplantation av lungor från hjärtdöda donatorer

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    Transfusion of sex-mismatched and non-leukocyte-depleted red blood cells in cardiac surgery increases mortality.

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    OBJECTIVE: To examine the mortality risk of blood transfusions when donor information, postdonation treatment, and a wide selection of risk factors are taken into account. METHODS: A retrospective study was performed on 9907 patients who underwent coronary artery bypass grafting and/or aortic valve replacement. Several transfusion-related risk factors, including age of blood products, sex of donor, ABO group, Rh group, posttransfusion treatment, and sex matching, were included in the analysis. A wide selection of preoperative comorbidities were included as well. A Cox proportional hazards analysis was performed to determine significant risk factors. Patients were followed for a period of up to 12 years posttransfusion. RESULTS: We found an excess mortality for transfusions of sex-mismatched red blood cells (RBCs) per unit transfused (hazard ratio [HR], 1.083; 95% confidence interval [CI] 1.028-1.140; P = .003). In addition, we found a significant risk during the first year for transfusing 1 to 2 units of non-leukocyte-depleted RBCs (HR, 1.426; 95% CI, 1.004-2.024; P = .047). Transfusion of 1 to 2 units of leukocyte-depleted RBCs was not associated with increased risk (HR, 0.981; 95% CI, 0.866-1.110; P = not significant). The age of blood products was not associated with increased mortality. CONCLUSIONS: In this large retrospective study, transfusion of non-sex-matched RBCs was associated with increased mortality. In addition, in patients receiving small amounts of blood, leukocyte depletion of RBCs had a beneficial effect on patient survival
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