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Madden BP, Kumar P, Sayer R, Murday A. Successful resection of obstructing airway granulation tissue following lung transplantation using endobronchial laser (Nd:YAG) therapy. Eur J Cardiothorac Surg 1997; 12:480-5. [PMID: 9332930 DOI: 10.1016/s1010-7940(97)00207-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Airway obstruction due to an excessive growth of granulation tissue at the level of the anastomosis is an important complication following lung transplantation which requires early diagnosis and treatment. We report encouraging experience in the management of this condition using endobronchial Nd:YAG laser therapy. METHODS Four adult lung transplant recipients developed airway anastomotic obstruction secondary to granulation tissue formation at 9, 10, 32 and 32 days following bilateral sequential lung transplantation (2 patients), en bloc double lung transplantation (1 patient) and single lung transplantation (1 patient). The diameter of the airways at the level of the anastomoses was reduced by 75, 30, 60, 60, 50 and 90%, respectively. Endobronchial Nd:YAG laser was applied via a fiberoptic bronchoscope introduced through a rigid bronchoscope. The granulation tissue was visualised and resected with photocoagulation with the laser using between 1000-2000 J depending on the amount of tissue present. Necrotic tissue was removed with large forceps. If the obstruction extended to the orifice of a lobar bronchus resection was undertaken in a staged fashion. RESULTS Airway patency was fully restored at two anastomotic sites, and restored to 90% patency at two and 80 and 75% at one each, respectively. This was associated with a significant improvement in pulmonary function in 3 patients. One patient had a subsequent bougie dilatation of a stenotic area and 2 patients received an endobronchial stent for tracheo or broncho-malacia. One patient died from a gastrointestinal haemorrhage. Three patients are well at 10, 17 and 18 months following transplantation and have no further granulation tissue recurrence. There were no complications directly attributable to laser therapy. CONCLUSION Our encouraging early experience leads us to suggest that Endobronchial Nd-YAG laser therapy should be considered in the management of airway anastomotic obstruction due to excessive granulation tissue formation after lung transplantation.
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Madden BP, Shenoy V, Dalrymple-Hay M, Griffiths T, Millard J, Backhouse L, Clarke J, Murday A. Absence of bradycardic response to apnea and hypoxia in heart transplant recipients with obstructive sleep apnea. J Heart Lung Transplant 1997; 16:394-7. [PMID: 9154949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In patients with obstructive sleep apnea, the vagal stimulation caused by inspiration against the upper airway obstruction results in sinus bradycardia during the apnea followed by a reflex tachycardia at apnea termination. We report on five heart transplant recipients with obstructive sleep apnea who demonstrated no change in baseline heart rate in spite of marked hemoglobin oxygen desaturation, presumably on account of parasympathetic denervation of the allograft. Heart transplant recipients with obstructive sleep apnea may be at an increased risk of development of potentially fatal ventricular arrhythmias if the allograft is unable to respond appropriately to hypoxia. Should cardiac parasympathetic reinnervation occur, prospective polysomnography may be a marker for this process in these patients.
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Robinson DS, Geddes DM, Hansell DM, Shee CD, Corbishley C, Murday A, Madden BP. Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation. Thorax 1996; 51:1158-9; discussion 1164-9. [PMID: 8958902 PMCID: PMC1090530 DOI: 10.1136/thx.51.11.1158] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The case of a 49 year old man presenting with rapidly progressive interstitial lung disease is described. Radiological findings and the lung biopsy specimen were compatible with an acute interstitial pneumonia, as was the relentless clinical course culminating in hypoxic respiratory failure. After right single lung transplantation there was considerable improvement in lung function and radiographic clearing of disease in the native left lung.
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Boriskin YS, Booth JC, Corbishley CM, Madden BP, McKenna WJ, Murday AJ, Steel HM. Human cytomegalovirus and acute rejection after heart transplantation are not directly associated. J Med Virol 1996; 50:59-70. [PMID: 8890042 DOI: 10.1002/(sici)1096-9071(199609)50:1<59::aid-jmv11>3.0.co;2-t] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Retrospective and prospective analyses of heart transplant recipients showed no significant association between acute rejection and the detection of cytomegalovirus (CMV) infection by culture or the polymerase chain reaction (PCR) for viral DNA, neither on grounds of the incidence of both conditions nor in relation to which was diagnosed first in the patient. Semiquantitative PCR of serial blood and endomyocardial biopsy specimens from individual patients revealed different patterns in the development of the viral DNA in the blood and the heart, also clear episodes of CMV infection in CMV antibody-negative recipients of hearts from CMV antibody-negative donors, none of whom went on to develop a CMV-specific antibody response. None of these findings was associated with the development of rejection in the patient. On the other hand, in those patients who did experience rejection, peak levels of CMV DNA in the blood and the heart were usually not reached until 6 weeks or more after transplantation, whereas in those in whom rejection was not detected at all during the period of observation, peak levels of CMV DNA were detected earlier, mainly within the first 6 weeks after transplantation. In several cases, the delayed increase in CMV DNA in those with rejection, albeit not the delay itself, was linked to treatment with steroids. These findings support the view that CMV infection and rejection are independent events, but that the timing of the infection, and whether or not rejection is detected, are indicative of the general status of the immune response in individual patients.
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Madden BP, Backhouse L, McClosky D, Reynolds L, Tait D, Murday A. Total lymphoid irradiation as rescue therapy after heart transplantation. J Heart Lung Transplant 1996; 15:234-8. [PMID: 8777204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Allograft dysfunction develops in a proportion of heart transplant recipients without significant cellular infiltrate in endomyocardial biopsies and with normal coronary arteries at angiography. The mechanisms responsible for this presentation are unclear, and the prognosis is poor. We report encouraging experience with total lymphoid irradiation given in addition to cyclosporine A, cyclophosphamide, and prednisolone therapy in three heart transplant recipients with poor graft function with normal endomyocardial biopsies and coronary angiography. METHODS Three patients who had severe allograft dysfunction after orthotopic heart transplantation, with normal endomyocardial biopsies and coronary angiography, were successfully treated with total lymphoid irradiation. Biventricular failure developed in each patient despite immunosuppression with cyclosporine A, azathiaprine, oral prednisolone, cyclophosphamide, and intravenous methylprednisolone therapy. Total lymphoid irradiation was given with standard mantle and inverted y fields over 10 treatments to achieve a cumulative dose of 8 Gy. RESULTS Each patient had a significant improvement in clinical response and in ventricular performance after total lymphoid irradiation, which was well tolerated in each case. The patients remain well at 8, 9, and 12 months after completion of treatment. CONCLUSIONS Total lymphoid irradiation should be considered as adjunct therapy to conventional immunosuppression for heart transplant recipients with poor graft function in the absence of cellular rejection or coronary artery disease.
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Thomas SH, Butt AY, Corris PA, Egan JJ, Higenbottam TW, Madden BP, Waller PC. Appetite suppressants and primary pulmonary hypertension in the United Kingdom. Heart 1995; 74:660-3. [PMID: 8541174 PMCID: PMC484125 DOI: 10.1136/hrt.74.6.660] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Amphetamine-like appetite suppressants, particularly fenfluramines, have been implicated in the aetiology of primary pulmonary hypertension. At one specialist centre in France 20% of patients with primary pulmonary hypertension had been exposed to fenfluramine. The prevalence of primary pulmonary hypertension associated with fenfluramines and other appetite suppressants in the United Kingdom is unknown. This study was performed to measure prior exposure to appetite suppressants in patients with primary pulmonary hypertension. SETTING Heart lung transplantation centres in England. PATIENTS United Kingdom residents with proven primary pulmonary hypertension referred for consideration of heart lung transplantation. METHODS Case surveillance study, obtaining data from the hospital and general practitioner's notes and directly from the patients or their relatives. RESULTS 55 patients were identified. Drug histories were available from hospital records in all patients, from the general practitioner's notes in 51, and from the patients or relatives in 44. Of these, 3 female patients had been exposed to appetite suppressants (2 fenfluramine, 1 diethylpropion): 2 have since died. In each case exposure was brief and apparently predated the development of symptoms by several years. CONCLUSIONS Exposure of patients with severe primary pulmonary hypertension to fenfluramine and other appetite suppressants is uncommon in the United Kingdom unlike in France, where most of the cases associating primary pulmonary hypertension with fenfluramine use have originated. This may reflect more conservative prescribing of these agents in the United Kingdom.
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Mann JM, Anderson JR, Madden BP, Parker DJ, Treasure T, Murday A. Myocyte nuclear area as a measure of left ventricular hypertrophy in transplant patients. Cardiovasc Pathol 1995; 4:185-8. [PMID: 25851006 DOI: 10.1016/1054-8807(95)00024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/1994] [Accepted: 03/10/1995] [Indexed: 10/27/2022] Open
Abstract
Transplanted hearts have been reported to increase in size/weight in the first few months after transplant and to remain stable thereafter. An indirect way of assessing the changes in heart weight is through the changes in the area of the myocyte nucleus (MNA). We studied 20 patients who had undergone orthotopic heart transplantation more than 12 months previously; 10 had become hypertensive, and the remaining 10 were normotensive. Myocardial biopsies taken the first week after transplant and 6, 12, 24, and 52 weeks after transplant were assessed. Myocyte nuclear area was measured in 200 myocytes/biopsy with an image analyzer. Individual measurements showed a wide variation in MNA, with significant overlaps among the different biopsies. Assessment of MNA at one year showed increased MNA in 4 10 patients in the hypertensive group and 5 10 in the normotensive group. The remaining patients showed either no statistically significant changes in MNA or a significant (p < 0.0001) decrease in MNA. The presence of systemic hypertension was not a predictive factor for significant hypertrophy and, in some cases, not even for hypertrophy itself. We conclude that although there is often an increase in MNA of the transplanted heart at one year posttransplant, this increase is not systematic, and isolated morphometric results should be viewed cautiously.
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Madden BP, Gosney J, Coghlan JG, Kamalvand K, Caslin AW, Smith P, Yacoub M, Heath D. Pretransplant clinicopathological correlation in end-stage primary pulmonary hypertension. Eur Respir J 1994; 7:672-8. [PMID: 8005247 DOI: 10.1183/09031936.94.07040672] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of the study was to see if there was any correlation between the histopathology, ultrastructure, pulmonary endocrinology and clinical manifestations of end-stage primary pulmonary hypertension. Twenty patients undergoing heart-lung transplantation for the disease were studied. The nature and duration of symptoms and signs, results of haematological, electrocardiographic, radiographic, echocardiographic and haemodynamic studies, and the response of patients to vasodilators were compared with data from histopathological and ultrastructural study of lungs removed at transplantation. Length of clinical history and clinical evidence of severe disease were not necessarily associated with advanced histopathology, nor did the presence of small, contracted muscular pulmonary arteries imply responsiveness to vasodilators. Numbers of gastrin-releasing peptide-containing pulmonary endocrine cells were greater in lungs in which there was activity of myofibroblasts in pulmonary arterial vessels, and correlated negatively with mean pulmonary artery pressure and pulmonary artery systolic pressure. Whereas the prognosis of primary pulmonary hypertension cannot as yet be defined by other than its clinical manifestations, intimal proliferation as well as vasoconstriction may be important in its pathogenesis. The release of gastrin-releasing peptide from pulmonary endocrine cells may possibly be involved in this process.
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Madden BP. VIDEO REVIEW. BRITISH HEART JOURNAL 1994. [DOI: 10.1136/hrt.71.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Madden BP, Geddes DM. Which patients should receive lung transplants? Monaldi Arch Chest Dis 1993; 48:346-52. [PMID: 8257977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Lung transplantation is a therapeutic option for selected patients with end-stage respiratory failure from a variety of pulmonary vascular and parenchymal lung diseases. Early problems due to ischaemic dehiscence of the bronchial anastomosis were avoided with heart-lung transplantation where the coronary bronchial collateral circulation remains intact. With the increase in number of cardiac transplantation, the number of heart-lung blocks available for heart-lung transplantation are declining significantly. Improved techniques now make double lung, bilateral single lung and single lung transplantations suitable alternatives to heart-lung transplantations for many patients, with good anastomotic healing and encouraging results. Patients should only be accepted onto the transplant waiting list if they have deteriorating chronic respiratory failure with a severely impaired quality of life. All patients require a detailed pre-transplant medical and psychosocial assessment. While the absolute contraindications to transplantation include pre-existing malignant disease, active aspergillus or mycobacterial infection, infection with HIV or hepatitis B and noncompliance with treatment, new haemostatic techniques have made it possible to treat many patients who have had previous thoracic surgery. Advances in immunosuppressive agents and post-operative medical care have led to improved survival and quality of life. However, obliterative bronchiolitis remains a serious problem. Demand will always be in excess of available human organs. It is hoped that the development of successful xenografting will enable more patients to benefit from lung transplantation.
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Madden BP, Kamalvand K, Chan CM, Khaghani A, Hodson ME, Yacoub M. The medical management of patients with cystic fibrosis following heart-lung transplantation. Eur Respir J 1993; 6:965-70. [PMID: 8370445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Transplantation for end-stage respiratory failure in cystic fibrosis (CF), with encouraging medium-term results, is now possible. This paper details the postoperative medical treatment required by these patients. The management of 79 patients who underwent heart-lung transplantation is described. Details of intensive care, postoperative care, long-term follow-up, and the problems specific for cystic fibrosis patients are reported. The duration of care in the Intensive Care Unit (ICU) was 1-93 days (median 5 days). Intubation was required for 7 h to 93 days (median 48 h), and 11 patients required haemodiafiltration. High doses of cyclosporin A (mean 22 mg.kg-1 q.d.) were required. Acute rejection was common. There were 133 episodes of infection: bacterial 115, viral 11, and other organisms 7. Grand mal seizures occurred in 10 patients, lymphoproliferative disorders in 4, and obliterative bronchiolitis in 17. The median duration of hospital stay was 32 days. Despite having a multi-system disease, patients with CF can be successfully transplanted, if detailed attention is paid to their complex medical management.
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Madden BP, Kamalvand K, Chan CM, Khaghani A, Hodson ME, Yacoub M. The medical management of patients with cystic fibrosis following heart-lung transplantation. Eur Respir J 1993. [DOI: 10.1183/09031936.93.06070965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transplantation for end-stage respiratory failure in cystic fibrosis (CF), with encouraging medium-term results, is now possible. This paper details the postoperative medical treatment required by these patients. The management of 79 patients who underwent heart-lung transplantation is described. Details of intensive care, postoperative care, long-term follow-up, and the problems specific for cystic fibrosis patients are reported. The duration of care in the Intensive Care Unit (ICU) was 1-93 days (median 5 days). Intubation was required for 7 h to 93 days (median 48 h), and 11 patients required haemodiafiltration. High doses of cyclosporin A (mean 22 mg.kg-1 q.d.) were required. Acute rejection was common. There were 133 episodes of infection: bacterial 115, viral 11, and other organisms 7. Grand mal seizures occurred in 10 patients, lymphoproliferative disorders in 4, and obliterative bronchiolitis in 17. The median duration of hospital stay was 32 days. Despite having a multi-system disease, patients with CF can be successfully transplanted, if detailed attention is paid to their complex medical management.
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Madden BP, Hodson ME, Tsang V, Radley-Smith R, Khaghani A, Yacoub MY. Intermediate-term results of heart-lung transplantation for cystic fibrosis. Lancet 1992; 339:1583-7. [PMID: 1351559 DOI: 10.1016/0140-6736(92)91842-v] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Between September, 1984, and March, 1991, 79 patients underwent heart-lung transplantation for end-stage cystic fibrosis at the Harefield Hospital. Short-term outcome has already been reported, and we now present intermediate-term results. The overall actuarial patient survival was 69% at 1 year, 52% at 2 years, and 49% at 3 years. 17 patients had diabetes mellitus with a survival of 62% to 1 year and 51% to 2 years. 23 patients had one or more other possible high-risk factors, and survival of these patients was 64% at 1 year and 57% at 2 years, compared with 71% and 49%, respectively, in the low-risk group (n = 56). Pseudomonas aeruginosa infection was the most common respiratory infection encountered postoperatively. 92% of patients had at least one episode of acute rejection during the first 3 postoperative months. Lung function was greatly improved after transplantation, the mean forced expiratory volume in 1 s and forced vital capacity increasing from 22% and 35% predicted, respectively, preoperatively to 68% and 70% predicted, respectively, by the sixth postoperative month. This improvement was maintained at 1, 2, and 3 years after transplantation. Lymphoproliferative disorders (4 patients) were successfully treated. Obliterative bronchiolitis developed in 17 patients and the cumulative probability of getting this complication at 1, 2, and 3 years postoperatively was 17%, 23%, and 48%, respectively. Overall, 7 patients were retransplanted. There was no coronary artery disease in the 37 patients who underwent coronary angiography at 1 year, 14 at 2 years, and 9 at 3 years after surgery. 58 patients donated their hearts for subsequent "domino" heart transplantation. Our 5 1/2-year experience with heart-lung transplantation is encouraging but the shortage of donor organs and the complication of obliterative bronchiolitis are the two main obstacles to be overcome.
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Madden BP, Hodson ME, Yacoub MH, Alton EW, Barnes PJ, Denison DM, Kay AB, Newman-Taylor A, Geddes DM. Heart-lung transplantation for cystic fibrosis. BMJ (CLINICAL RESEARCH ED.) 1992; 304:835-6. [PMID: 1327362 PMCID: PMC1881685 DOI: 10.1136/bmj.304.6830.835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Madden BP, Khaghani A, Yacoub M. Successful Retransplantation of the Heart and Lungs in an Adult with Cystic Fibrosis. Med Chir Trans 1991; 84:561. [PMID: 1941862 PMCID: PMC1293424 DOI: 10.1177/014107689108400921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hodson ME, Madden BP, Steven MH, Tsang VT, Yacoub MH. Non-invasive mechanical ventilation for cystic fibrosis patients--a potential bridge to transplantation. Eur Respir J 1991; 4:524-7. [PMID: 1936222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The case histories of six cystic fibrosis patients awaiting heart-lung transplantation are reviewed. They all deteriorated with severe hypoxia and hypercapnia before donor organs became available. Nasal intermittent positive pressure ventilation was used in preference to conventional ventilation with excellent results in four patients. There were no episodes of hypotension or toxaemia and the patients were in a stable condition at the time of surgery and made an excellent post-operative recovery. The patients who were transplanted and the patient who died, for whom suitable donor organs did not become available, probably had a more comfortable time than they would have done if treated with conventional ventilation. This method of ventilation appears to be a useful bridge to transplantation when a patient suddenly deteriorates. It gives them a chance of survival for a few more days or even weeks during which time an urgent search for donor organs can be made. This is also a very cost effective method of ventilation and does not encroach on conventional Intensive Care Unit (ICU) facilities.
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Hodson ME, Madden BP, Steven MH, Tsang VT, Yacoub MH. Non-invasive mechanical ventilation for cystic fibrosis patients--a potential bridge to transplantation. Eur Respir J 1991. [DOI: 10.1183/09031936.93.04050524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The case histories of six cystic fibrosis patients awaiting heart-lung transplantation are reviewed. They all deteriorated with severe hypoxia and hypercapnia before donor organs became available. Nasal intermittent positive pressure ventilation was used in preference to conventional ventilation with excellent results in four patients. There were no episodes of hypotension or toxaemia and the patients were in a stable condition at the time of surgery and made an excellent post-operative recovery. The patients who were transplanted and the patient who died, for whom suitable donor organs did not become available, probably had a more comfortable time than they would have done if treated with conventional ventilation. This method of ventilation appears to be a useful bridge to transplantation when a patient suddenly deteriorates. It gives them a chance of survival for a few more days or even weeks during which time an urgent search for donor organs can be made. This is also a very cost effective method of ventilation and does not encroach on conventional Intensive Care Unit (ICU) facilities.
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Madden BP. The hybrid model for concept development: its value for the study of therapeutic alliance. ANS Adv Nurs Sci 1990; 12:75-87. [PMID: 2107793 DOI: 10.1097/00012272-199004000-00008] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Schwartz-Barcott and Kim's hybrid model is used as a research methodology for the development and analysis of the concept of therapeutic alliance. Empirical data gathered in a community health setting by field research techniques are used to compare, to contrast, and to rework existing definitions and related concepts from literature review. The resulting definitional refinement provides clear distinctions between the concepts of compliance and therapeutic alliance and assists in selection of appropriate nursing interventions supportive of clients' health goals.
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Madden BP, Walker F, Gaffney E, Keogh JA. A case of IgA nephropathy associated with vitiligo, primary hypothyroidism and primary adrenocortical insufficiency. Ir J Med Sci 1989; 158:153-4. [PMID: 2767933 DOI: 10.1007/bf02943058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 14 year old boy presented with recurrent attacks of macroscopic haematuria preceded by tonsillitis. Clinical examination revealed generalised vitiligo. Renal function was normal with microscopic haematuria. Percutaneous renal biopsy showed mesangial proliferation on light microscopy with deposition of IgA and IgM in a granular pattern in the mesangium and glomerular basement membrane compatible with a diagnosis of IgA nephropathy. Biochemical investigations revealed primary hypothyroidism and primary adrenocortical insufficiency with negative organ specific autoimmune screen. Renal function has not deteriorated after three years follow-up. This particular association has not been previously described to our knowledge.
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Madden BP. Raising the consciousness of nursing students. Nurs Outlook 1975; 23:292-6. [PMID: 1040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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