Frequency of angiographic detection and quantitative assessment of coronary arterial disease one and three years after cardiac transplantation.

The reported high incidence of coronary atherosclerosis in many transplant series led us to critically review our experience in 83 patients who have had selective coronary angiography at greater than or equal to 1 years after transplantation. Angiograms were reviewed for evidence of coronary vascular disease, and quantitative analysis of multiple coronary artery segments was performed in serial films. Qualitative analysis revealed only 3 of 83 patients with any angiographic abnormality at follow-up, 1 with minimal luminal irregularities in the right coronary artery at 1 year, a second with a 50% diameter stenosis of the proximal left anterior descending artery and minimal irregularity of the proximal circumflex artery at 1 year and a third patient who developed a new 30% diameter eccentric proximal right coronary artery stenosis at 3-year follow-up. The cumulative incidence of graft vascular disease assessed angiographically was therefore 2% at 1 year and 4% at 3 years. Quantitative analysis, however, showed a significant decrease in coronary artery luminal diameter over time. The mean left main coronary artery diameter decreased from 5.4 +/- 0.9 mm at 1 year to 4.7 +/- 0.8 mm at 3 years (p = 0.0007).(ABSTRACT TRUNCATED AT 250 WORDS)

Extending cardiac allograft ischemic time and donor age: effect on survival and long-term cardiac function.

Of 219 heart transplant patients with follow up for at least 3 months after transplantation, cardiac allograft ischemic time was more than 4 hours in 28% and more than 5 hours in 10%. In 1988 and 1989 grafts with ischemic times longer than 4 hours were used in 44% and 45% of cases, respectively. Overall, donor age has been 35 or more years in 22% and 45 or more in 9%. In 1989 donor age was 35 or more years in 39% of cases and 45 or more in 18%. Fifteen of 20 grafts from donors 45 years or older were used for patients aged 50 or older. There was no relationship between donor age or ischemic time and 90-day graft loss. At 3 and 12 months, cardiac function, assessed by treadmill exercise duration, radionuclide angiography, and rest and peak supine exercise hemodynamics, was also unrelated to donor age or ischemic time. Therefore by careful selection of appropriate donors, extending both graft ischemic time and donor age has increased the potential donor pool and has not to date been associated with increased graft loss or adverse effects on cardiac function 3 months and 1 year after heart transplantation.

Role of chemoradiation in advanced cervical cancer.

A prospective randomized study was conducted in our department of Radiotherapy, Regional Institute of Medical Sciences, Imphal to evaluating the role of chemoradiation in the management of advanced inoperable cervical cancer (stage IIB-IIIB) taking only radiation treatment as control spanning the period 1996-1999. Of the fifty patients accumulated in the study group, three patients did not complete treatment, one expired due to other causes and three were lost to follow up. Likewise, of the forty-six patients in the control group, one patient did not complete treatment and 4 were lost to follow up. Thus only 43 and 41 patients were available for the result analysis for the study and control groups respectively. The early treatment response as assessed after two months of treatment conclusion were 79.1%, 13.9%, 93.0% and 58.5%, 31.7%, 90.2% as complete response (CR), partial response (PR), and total response (TR) respectively for the study and control groups. Our patients included in this study had a median follow up of 35 months and 33 months for study and control groups respectively. For this follow up, the disease-free survival, survival with disease and overall survival were 67.4%, 7.0%, 74.4% and 43.9%, 12.2%, 56.1% for study and control groups respectively. There was an increase in early side-effects in the chemoradiation group but the difference was not significant. Because of the early side effects, treatment delays ensued in 7 patients (16.3%) and in 3 patients (7.3%) in the study and control groups respectively. There was no significant increase in the late treatment toxicities in both the groups.

Groundwater quality in Imphal West district, Manipur, India, with multivariate statistical analysis of data.

The aim of this paper was to analyze the groundwater quality of Imphal West district, Manipur, India, and assess its suitability for drinking, domestic, and agricultural use. Eighteen physico-chemical variables were analyzed in groundwater from 30 different hand-operated tube wells in urban, suburban, and rural areas in two seasons. The data were subjected to uni-, bi-, and multivariate statistical analysis, the latter comprising cluster analysis (CA), principal component analysis (PCA), and factor analysis (FA). Arsenic concentrations exceed the Indian standard in 23.3% and the WHO limit in 73.3% of the groundwater sources with only 26.7% in the acceptable range. Several variables like iron, chloride, sodium, sulfate, total dissolved solids, and turbidity are also beyond their desirable limits for drinking water in a number of sites. Sodium concentrations and sodium absorption ratio (SAR) are both high to render the water from the majority of the sources unsuitable for agricultural use. Multivariate statistical techniques, especially varimax rotation of PCA data helped to bring to focus the hidden yet important variables and understand their roles in influencing groundwater quality. Widespread arsenic contamination and high sodium concentration of groundwater pose formidable constraints towards its exploitation for drinking and other domestic and agricultural use in the study area, although urban anthropogenic impacts are not yet pronounced.

Cardiac allograft ischemic time. Relation to graft survival and cardiac function.

Organ donor scarcity has resulted in an increasing number of long-distance cardiac allograft procurements. The effect on short-term (90-day) survival and cardiac function was assessed in a consecutive series of 167 heart transplants performed between April 1981 and July 1988. During that time, total allograft ischemic time was more than 4 hours in 22% of cases and more than 5 hours in 7%. In 1988, total ischemic times have been more than 4 hours in 38% of cases. Ninety-day graft loss (any cause) was 11% for ischemic times 0-120 minutes, 27% for ischemic times 121-240 minutes, 17% for ischemic times 241-300 minutes, and 0% for ischemic times greater than 300 minutes. In 107 patients who survived 3 months, cardiac function was assessed at 1 week by resting hemodynamics and at 3 months by treadmill testing (Bruce protocol), supine rest and exercise radionuclide angiography, and supine rest and exercise right-heart hemodynamics. Treadmill exercise duration was similar in the four groups of patients. Resting ejection fraction was also not different among the groups. Exercise ejection fraction did not rise in the group with ischemic times greater than 3 hours, but the difference did not achieve statistical significance. Resting right atrial pressure was not different among groups at 1 week and decreased significantly in all groups at 3 months. During supine exercise, right atrial pressure rose markedly in each group but was not different among groups.(ABSTRACT TRUNCATED AT 250 WORDS)