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Santarsieri A, Sturgess K, Brice P, Menne TF, Osborne W, Creasey T, Ardeshna KM, Behan S, Bhuller K, Booth S, Collins GP, Cwynarski K, Furtado M, Iyenga S, Jones SG, O'Mahony D, Martinez‐Calle N, McKay P, Nagumantry SK, Rudge JF, Shah N, Stafford G, Sternberg A, Uttenthal BJ, McMillan AK, Follows GA. MODIFICATION OF ESCALATED BEACOPP WITH DACARBAZINE SUBSTITUTION REDUCES TOXICITY WHILE MAINTAINING EFFICACY FOR THE TREATMENT OF ADVANCED STAGE HODGKIN LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.109_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A. Santarsieri
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - K. Sturgess
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - P. Brice
- Hôpital Saint‐Louis Hématologie‐Oncologie Paris France
| | - T. F. Menne
- Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust Haematology Newcastle UK
| | - W. Osborne
- Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust Haematology Newcastle UK
| | - T. Creasey
- Newcastle University Hospitals NHSFT Haematology Newcastle UK
| | - K. M. Ardeshna
- University College London Hospitals NHS Foundation Trust Haematology London UK
| | - S. Behan
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - K. Bhuller
- University Hospitals of Leicester NHS Trust Haematology Leicester UK
| | - S. Booth
- Oxford University Hospitals NHS Foundation Trust Haematology Oxford UK
| | - G. P. Collins
- Oxford University Hospitals NHS Foundation Trust Haematology Oxford UK
| | - K. Cwynarski
- University College London Hospitals NHS Foundation Trust Haematology London UK
| | - M. Furtado
- Royal Cornwall Hospitals NHS Trust Haematology Cornwall UK
| | - S. Iyenga
- The Royal Marsden NHS Foundation Trust Haematology London UK
| | - S. G. Jones
- Sherwood Forest Hospitals NHS Foundation Trust Haematology Nottinghamshire UK
| | - D. O'Mahony
- Cork University Hospital Oncology Cork Ireland
| | | | - P. McKay
- Beatson West of Scotland Cancer Centre Haematology Glasgow UK
| | - S. K. Nagumantry
- Peterborough City Hospital North West Anglia NHS Foundation Trust Haematology Peterborough UK
| | - J. F. Rudge
- Bullard Laboratories University of Cambridge Cambridge UK
| | - N. Shah
- Norfolk and Norwich University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - G. Stafford
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - A. Sternberg
- Great Western Hospitals NHS Foundation Trust Haematology Swindon UK
| | - B. J. Uttenthal
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
| | - A. K. McMillan
- Nottingham University Hospitals NHS Trust Haematology Nottingham UK
| | - G. A. Follows
- Cambridge University Hospitals NHS Foundation Trust Haematology Cambridge UK
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Follows G, Santarsieri A, Sturgess K, Menne T, Osborne W, Creasey T, Ardeshna K, Behan S, Booth S, Collins G, Cwynarski K, Iyengar S, Jones S, Martinez-Calle N, McKay P, Nagumantry S, O'Mahony D, Rudge J, Shah N, Stafford G, Sternberg A, Uttenthal B, McMillan A. MODIFICATION OF ESCALATED BEACOPP WITH DACARBAZINE / PROCARBAZINE SUBSTITUTION REDUCES RED CELL TRANSFUSION REQUIREMENTS AND MAY SHORTEN TIME TO MENSTRUAL PERIOD RECOVERY. Hematol Oncol 2019. [DOI: 10.1002/hon.168_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G. Follows
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Santarsieri
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - K. Sturgess
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - T. Menne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - W. Osborne
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - T. Creasey
- Haematology; Freeman Hospital; Newcastle upon Tyne United Kingdom
| | - K.M. Ardeshna
- Haematology; University College London Hospital; London United Kingdom
| | - S. Behan
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - S. Booth
- Haematology; Royal Berkshire NHS Foundation Trust; Reading United Kingdom
| | - G. Collins
- Haematology; Oxford University Hospitals NHSFT; Oxford United Kingdom
| | - K. Cwynarski
- Haematology; University College London Hospital; London United Kingdom
| | - S. Iyengar
- Haematology; The Royal Marsden; London United Kingdom
| | - S. Jones
- Haematology; Sherwood Forest Hospitals; Sutton in Ashfield United Kingdom
| | - N. Martinez-Calle
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
| | - P. McKay
- Haematology; Beatson West of Scotland Cancer Centre; Glasgow United Kingdom
| | - S.K. Nagumantry
- Haematology; Peterborough City Hospital; Peterborough United Kingdom
| | - D. O'Mahony
- Haematology; Cork University Hospital; Wilton Republic of Ireland
| | - J.F. Rudge
- Department of Earth Sciences; University of Cambridge.; Cambridge United Kingdom
| | - N. Shah
- Haematology; Norfolk and Norwich University Hospitals; Norwich United Kingdom
| | - G. Stafford
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. Sternberg
- Haematology; Great Western Hospital NHS Foundation Trust; Swindon United Kingdom
| | - B. Uttenthal
- Haematology; Cambridge University Hospitals NHSFT; Cambridge United Kingdom
| | - A. McMillan
- Haematology; Nottingham University Hospital NHS Trust; Nottingham United Kingdom
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Skinner D, Tadros BJ, Bray E, Elsherbiny M, Stafford G. Clinical outcome following primary total hip or knee replacement in nonagenarians. Ann R Coll Surg Engl 2016; 98:258-64. [PMID: 26924477 DOI: 10.1308/rcsann.2016.0095] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population. Methods Our dataset was reviewed retrospectively for a cohort of nonagenarians undergoing either a primary total hip replacement (THR) or total knee replacement (TKR) between April 2008 and October 2011. Postoperative complications, mortality rates and functional outcomes were compared with those of a time matched 70-79-year-old cohort. Results Nonagenarians requiring a THR presented with a lower preoperative OHS (p=0.020) but made a greater improvement in the first postoperative year than the younger cohort (p=0.040). The preoperative OKS was lower for nonagenarians than for the control group (p=0.022). At one and two years after TKR, however, there was no significant difference between the age groups. The nonagenarians had a greater risk of requiring a blood transfusion following both THR (p=0.027; 95% confidence interval [CI]: 1.11-5.75) and TKR (p=0.037; 95% CI: 1.08-16.65) while the latter cohort also required a longer stay than their younger counterparts (p=0.001). Mortality rates were higher in the nonagenarian group but these were in keeping with the life expectancy projections identified by the Office for National Statistics. Conclusions Over a two-year period, the functional outcome and satisfaction rates achieved by nonagenarians following a THR or TKR are comparable with 70-79-year-olds.
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Affiliation(s)
- D Skinner
- Elective Orthopaedic Centre , Epsom , UK
| | - B J Tadros
- Elective Orthopaedic Centre , Epsom , UK
| | - E Bray
- Elective Orthopaedic Centre , Epsom , UK
| | | | - G Stafford
- Elective Orthopaedic Centre , Epsom , UK
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Abstract
Periodontal pathogens, like any other human commensal or pathogenic bacterium, must possess both the ability to acquire the necessary growth factors and the means to adhere to surfaces or reside and survive in their environmental niche. Recent evidence has suggested that sialic acid containing host molecules may provide both of these requirements in vivo for several periodontal pathogens but most notably for the red complex organism Tannerella forsythia. Several other periodontal pathogens also possess sialic acid scavenging enzymes - sialidases, which can also expose adhesive epitopes, but might also act as adhesins in their own right. In addition, recent experimental work coupled with the release of several genome sequences has revealed that periodontal bacteria have a range of sialic acid uptake and utilization systems while others may also use sialic acid as a cloaking device on their surface to mimic host and avoid immune recognition. This review will focus on these systems in a range of periodontal bacteria with a focus on Ta. forsythia.
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Affiliation(s)
- G Stafford
- Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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Funk JL, Chen J, Downey KJ, Davee SM, Stafford G. Blockade of parathyroid hormone-related protein prevents joint destruction and granuloma formation in streptococcal cell wall-induced arthritis. Arthritis Rheum 2003; 48:1721-31. [PMID: 12794841 DOI: 10.1002/art.10985] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether parathyroid hormone-related protein (PTHrP), an interleukin-1beta-inducible, bone-resorbing peptide that is produced in increasing amounts by the synovium in rheumatoid arthritis (RA), may play a role in the pathophysiology of joint destruction in RA. METHODS PTHrP expression and the effect of PTHrP 1-34 neutralizing antibody on disease progression were tested in streptococcal cell wall (SCW)-induced arthritis, an animal model of RA. RESULTS As has been reported in RA, while serum levels of PTHrP did not change during SCW-induced arthritis, PTHrP expression dramatically increased in the arthritic synovium. Treatment with PTHrP neutralizing antibody (versus control antibody) did not affect joint swelling in SCW-treated animals. However, PTHrP antibody significantly inhibited SCW-induced joint destruction, as measured by its ability to block increases in serum pyridinoline (a marker of cartilage and bone destruction), erosion of articular cartilage, decreases in femoral bone mineral density, and increases in the numbers of osteoclasts in eroded bone. Unexpectedly, granuloma formation at sites of SCW deposition in the liver and spleen was also inhibited by PTHrP antibody, an effect associated with significant decreases in the tissue influx of PTH/PTHrP receptor-positive neutrophils and in SCW-induced neutrophilia. In vitro, neutrophil chemotaxis was stimulated by PTHrP 1-34. CONCLUSION These findings suggest that PTHrP, consistent with its previously described osteolytic effects in metastatic bone disease, can also be an important mediator of joint destruction in inflammatory bone disorders, such as RA. Moreover, this study reveals heretofore unknown effects of PTHrP peptides on neutrophil function that could have important implications in the pathogenesis of inflammatory granulomatous disorders.
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MESH Headings
- Amino Acids/blood
- Animals
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Experimental/immunology
- Arthritis, Experimental/pathology
- Arthritis, Experimental/prevention & control
- Arthritis, Reactive/immunology
- Arthritis, Reactive/pathology
- Arthritis, Reactive/prevention & control
- Bone Density/drug effects
- Cartilage, Articular/drug effects
- Cartilage, Articular/pathology
- Cell Wall/immunology
- Disease Models, Animal
- Female
- Femur/diagnostic imaging
- Femur/drug effects
- Femur/metabolism
- Granuloma/immunology
- Granuloma/pathology
- Granuloma/prevention & control
- Growth Plate/drug effects
- Growth Plate/pathology
- Hindlimb/pathology
- Immunohistochemistry
- Joints/metabolism
- Joints/pathology
- Parathyroid Hormone-Related Protein
- Peptide Hormones/analysis
- Peptide Hormones/biosynthesis
- Peptide Hormones/immunology
- Radiography
- Rats
- Rats, Inbred Lew
- Streptococcus/immunology
- Synovial Membrane/chemistry
- Synovial Membrane/metabolism
- Synovial Membrane/pathology
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Affiliation(s)
- J L Funk
- University of Arizona Health Science Center, University of Arizona, Tucson, Arizona 85724, USA.
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Funk JL, Trout CR, Wei H, Stafford G, Reichlin S. Parathyroid hormone-related protein (PTHrP) induction in reactive astrocytes following brain injury: a possible mediator of CNS inflammation. Brain Res 2001; 915:195-209. [PMID: 11595209 DOI: 10.1016/s0006-8993(01)02850-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PTHrP, a peptide induced in parenchymal organs during endotoxemia and in the synovium in rheumatoid arthritis, has recently been shown to be expressed in immature or transformed human astrocytes, but not in normal cells. This finding has led us to postulate that PTHrP might also be induced in reactive astrocytes in inflamed brain and, thus, act as a mediator of CNS inflammation. To test this hypothesis, PTHrP expression was examined following cortical stab wound injury in rats, a classical model of reactive gliosis. To determine whether PTHrP was induced in glia by TNF-alpha, a known mediator of inflammation in brain and of PTHrP induction in peripheral tissues, and to determine whether PTHrP, in turn, mediated inflammatory changes in glia, in vitro studies with rat astrocytes and glial-enriched mixed brain cells were also undertaken. Consistent with previous reports of PTHrP expression in normal brain, neurons were the primary site of immunoreactive PTHrP expression in the injured cortex 1 day after stab wound injury. Over the subsequent 3 days, specific immunostaining for PTHrP and for GFAP, a marker of reactive astrocytes, appeared in reactive astrocytes at the wound edge and in perivascular astrocytes, reaching a maximum level of expression at the last time point examined (day 4). TNF-alpha induced PTHrP expression in astrocyte and glial-enriched brain cells in vitro, suggesting that this pro-inflammatory peptide was a possible mediator of PTHrP expression in CNS inflammation. PTHrP(1-34) acted in an additive fashion with TNF-alpha to induced astrocyte expression of IL-6, a cytokine with demonstrated neuroprotective effects. Astrocyte proliferation was inhibited by PTHrP(1-34) and PTHrP(1-141), acting via a PTH/PTHrP receptor cAMP signaling pathway. These studies suggest that PTHrP, analogous to its regulatory functions in other non-CNS models of inflammation, may be an important mediator of the inflammatory response in brain.
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Affiliation(s)
- J L Funk
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA.
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O'Brien MF, Harrocks S, Stafford G, Gardner M, Sparks L, Barnett A. Allograft aortic root replacement in 418 patients over a span of 15 years: 1985 to 2000. Semin Thorac Cardiovasc Surg 2001; 13:180-5. [PMID: 11805969] [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: 02/23/2023]
Abstract
Allograft aortic root replacement for primary aortic valve or ascending aortic root pathology is the favored method of technical implantation. Results in 418 patients over 15 years demonstrate exceedingly low early mortality (<1%), complete eradication of preoperative endocarditis but poor long-term durability in the young age group of 20 years or less.
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Affiliation(s)
- M F O'Brien
- Cardiac Surgical Research Unit, The Prince Charles Hospital, Chermside, Brisbane, Australia
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Hamby CV, Mendola CE, Potla L, Stafford G, Backer JM. Differential expression and mutation of NME genes in autologous cultured human melanoma cells with different metastatic potentials. Biochem Biophys Res Commun 1995; 211:579-85. [PMID: 7794272 DOI: 10.1006/bbrc.1995.1852] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The putative metastasis suppressor genes, NME1(nm23-1) and NME2(nm23-2), were examined in a model system we developed to approximate the dissemination of melanoma from a primary skin tumor. We utilized two autologous human melanoma cell lines, IV Cl 1 and IV Cl 3, which displayed qualitatively different metastatic phenotypes following subdermal inoculation into nude mice. Highly metastatic IV Cl 1 cells expressed approximately 5 fold lower levels of protein encoded by NME genes than non-metastatic IV Cl 3 cells. Similar differences in NME protein levels were observed in tumors induced by the two cell lines in nude mice. There were no differences in NME mRNA levels between these two cell lines, suggesting that expression of these proteins is regulated at a post-transcriptional level. We found a ser122-pro mutation in the NME2 gene of metastatic IV Cl 1 cells. A similar ser120-gly mutation in NME1 has been found in human neuroblastoma, suggesting that mutation in this region may be a general phenomenon related to tumor progression. These mutations may have functional consequences since they eliminate potential phosphorylation sites and may affect the tertiary structure of mature protein complexes.
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Affiliation(s)
- C V Hamby
- Department of Microbiology & Immunology, New York Medical College, Valhalla 10595, USA
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Lyos AT, Stal S, Stafford G. Topical anesthesia in soft-tissue expansion. Plast Reconstr Surg 1995; 95:940. [PMID: 7708891] [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: 01/26/2023]
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O'Brien MF, Johnston N, Stafford G, Gardner M, Pohlner P, McGiffin D, Brosnan A, Duffy P. A study of the cells in the explanted viable cryopreserved allograft valve. J Card Surg 1988; 3:279-87. [PMID: 2980028 DOI: 10.1111/jocs.1988.3.3s.279] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
From June 1975 to December 1987, 231 patients underwent aortic valve replacement with a viable cryopreserved allograft aortic valve. Throughout this era, a uniform procurement and preservation was used to maintain leaflet fibroblast viability. The allograft valve was obtained from coroner's autopsies within 24 hours of death, and more recently from organ donors, incubated for 24 hours in low dose antibiotic solution followed immediately by cryopreservation (mean time interval 39 hours after donor death). Viability was ensured by monitoring glucose utilization of the aortic and pulmonary valves and by demonstrating fibroblast growth in tissue cultured from the pulmonary valve. A uniform protocol for valve preparation was used during the entire experience. Nine allograft aortic valves have been obtained by eight reoperations (two were for leaflet degeneration) and one autopsy. The time intervals from implantation to explantation were 2 months, 10 months, 20 months, 22 months, 2.2 years, 5 years, 8.3 years, 9.2 years, and 10.8 years. Histologic examination of the leaflet tissue disclosed a variable degree of cellularity, ranging from a highly cellular matrix (9.2 years) to minimal cellularity (20 months). Within the same valve (10 months), one leaflet was completely acellular with a moderate degree of cellularity in the other two leaflets. The competent valve recovered at autopsy (8.2 years) was essentially acellular. Fibroblasts could consistently be cultured from leaflets in which viable cells were seen histologically. Chromosomal analysis of cultured cells from a valve leaflet (9.2 years) that was implanted with a donor and recipient sex mismatch demonstrated persistence of donor cells.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M F O'Brien
- Department of Cardiac Surgery & Pathology, Prince Charles Hospital, Brisbane, Australia
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Bier M, Amy J, Cooks R, Syka J, Ceja P, Stafford G. A tandem quadrupole mass spectrometer for the study of surface-induced dissociation. ACTA ACUST UNITED AC 1987. [DOI: 10.1016/0168-1176(87)83022-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.0] [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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12
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Abstract
One hundred and twenty-four patients underwent aortic valve replacement with a nonviable 4 degrees C refrigerated aortic allograft valve. One hundred and eighty-four patients underwent aortic valve replacement with a viable cryopreserved aortic allograft valve in a later era. The longest follow-up was 16 years for the group with the nonviable valve and 11 years for the group with the viable valves. Within this time frame, reoperation was required in 23 patients with nonviable valves for leaflet perforation or rupture whereas no patients in the group with viable valves developed this complication (p less than 0.0001). The prevalence of endocarditis and thromboembolism was very low in both groups. Viability of leaflet tissue is associated with an important improvement in durability over nonviable allograft valves. Consequently, long-term follow-up results of allograft valves might be best expressed in terms of viability. The current evidence suggests that the viable cells are donor in origin. The viable cryopreserved aortic allograft valve offers significant advantages over current nonviable allograft valves, mechanical valves, and bioprostheses.
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Affiliation(s)
- M F O'Brien
- Prince Charles Hospital, Brisbane, Australia
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13
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Stafford G. Coronary artery surgery in private hospitals. Med J Aust 1986; 145:183-4. [PMID: 3747890 DOI: 10.5694/j.1326-5377.1986.tb113805.x] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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14
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Belic L, Stafford G, Allen JW, Venkataraman K. Cardiac tamponade during anticoagulation. Management with a pericardial drain and continued anticoagulation. JAMA 1978; 240:672. [PMID: 671691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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15
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Abstract
Eleven patients with aortic rupture secondary to non-penetrating thoracic trauma, recent in four patients and of longer standing in seven, have been operated upon. Every patient with an acute injury had a widened mediastinum in the chest skiagram. The diagnosis of traumatic rupture was made by aortography in each case. The operative procedure involved cardiopulmonary bypass, left heart bypass or aorta to aorta bypass shunt. There was one postoperative death. It is recommended that in the acute stage a rupture of the aorta secondary to trauma should be repaired as soon as possible, while ruptures of long standing should be electively repaired.
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Abstract
Thirteen patients with proven Q fever endocarditis and three additional patients with probable endocarditis are reviewed. The most helpful diagnostic test is the demonstration of a high complement fixing antibody titre to Phase 1 antigen of Coxiella burneti. The macroscopic pathology of the aortic valve is described and includes aneurysmal pockets in the aortic wall and valve annulus which are demonstrable angiographically. Evidence is presented that the infection may be controlled by prolonged tetracycline therapy and that this is accompanied by a falling antibody titre to Phase 1 antigen. Valve replacement is undertaken only for symptomatic and hemodynamic indications. The combined tetracycline therapy and valve replacement have produced a fall in titres with eradication of infection and palliation of the cardiac disability in all patients followed for long periods.
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18
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