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Papers by Jayden Theodore

CHEST Journal, 1987

Studies were performed measuring parameters of respiratory and circulatory function at rest and d... more Studies were performed measuring parameters of respiratory and circulatory function at rest and during maximum tolerable constant work rate treadmill exercise in 16 clinically well patients who had undergone heart-lung transplantation for end stage pulmonary hypertension. Ten patients were studied before and within eight weeks following transplantation. Long-term function with exercise was further evaluated with follow up studies at one year (n 10) and two years (n 6), posttransplantation. Posttransplant gas exchange and ventilation during exercise are essentially normal with neither being limiting to maximal exercise. Exercise capacity is significantly improved posttransplant, primarily as a result of improvement in the circulation over T he ability of the transplanted lung to maintain function during rest and exercise with the passage oftime has a direct bearing on the clinical usefulness of heart-lung transplantation. Standard measurements ofpulmonary function mdicate that the long-term function of the transplanted lung is well maintained for periods oftime measurable in years, providing no complications arise."2 Gas exchange at rest remains essentially normal despite the persistence of a mild restrictive abnormality. Pretransplant and posttransplant studies performed during exercise provide a more rigorous assessment of function in heart-lung transplant patients than is possible from standard pulmonary function measurements alone. We report studies evaluating exercise capacity and

CHEST Journal, 1990

We evaluated bronchial responsiveness to inhaled albuterol (salbutamol), ipratropium bromide, met... more We evaluated bronchial responsiveness to inhaled albuterol (salbutamol), ipratropium bromide, methacholine, and propranolol in eight heart-lung transplant (JILT) recipients 2.3 ± 1.5 months (mean ± SD) (range, 1 to 4.5 months) after HLT. All patients had a restrictive ventilatory defect but none had airflow limitation (FEV1/FVC 0.93 ± 0.05) (range, 0.86 to 0.97). Specific airway conductance (sGaw) improved significantly with both albuterol (p<O.Ol) and ipratropium bromide (p<O.Ol) but FEV1 did not. Only one HLT patient had bronchoconstriction with propranolol, whereas all but one were hyperresponsive to methacholine. Prior inhalation of ipratropium bromide blocked the response to methacholine (p<O.005). Serial methacholine provocation tests performed in seven long-term survivors of HLT 24.6 ± 16.0 months (range, 12 to 51 months) after HLT revealed no time-dependent evolution of bronchial hyperresponsiveness to methacholine. Limited maximal airway narrowing to methacholine was seen in five HLT recipients who showed a 29±4 percent (range, 23 to 35 percent) fall in FEV, compared with two patients who did not achieve a plateau with a 47 percent and 63 percent fall in FEV1, respectively. These results further our understanding of bronchial responsiveness in the denervated transplanted lung.

CHEST Journal, 1986

The ventilatory response to submaximal exercise, defined as the slope of minute ventilation over ... more The ventilatory response to submaximal exercise, defined as the slope of minute ventilation over carbon dioxide production (VEIVc09), was determined in 12 normal subjects, ten patients with pulmonary hypertension before and after heart-lung transplantation, and eight patients following heart transplantation. Patients with pulmonary hypertension show an augmented ventilatory response compared to normal subjects (pulmonary hypertension [mean, 57.7 ± 6.8 (SE) mI/mI Tco,; normal subjects, 22.3±1.4 mI/mI Vco,; p<O.OOl]). Following heart-lung transplantation, VEIVC0, slope fell to 24.7±L6 mi/mi Vco2, a value which is not significantly different than the value in normal subjects. Patients after heart transplantation show a mean slope value of 25.3 ± 1.3 mi/mI Vco9, which is not significantly different than the normal value or the value found after heart-lung transplantation. The augmented ventilatory response to Pat ients with pulmonary hypertension usually manifest both resting hyperventilation' and also excessive ventilation for any given exercise load."3 The mechanisms for both phenomena are obscure.

Science, 1972

Alveolar macrophages acquired the capacity to oxidize uric acid after exposure to uricase. Presum... more Alveolar macrophages acquired the capacity to oxidize uric acid after exposure to uricase. Presumably this resulted from intracellular incorporation of the enzyme by endocytosis. This approach may provide a general method for (i) testing regulatory biochemical mechanisms, (ii) therapeutic replacement of deficient regulatory macromolecules, and (iii) studying environmental factors that produce genetic alterations.

The American journal of …, 1984

Chest, 1997

Study objective: To assess the potential utility of specific airway conductance (sGaw) in detecti... more Study objective: To assess the potential utility of specific airway conductance (sGaw) in detecting small airways dysfunction, the postlung-transplant bronchiolitis obliterans syndrome (BOS) was used as a model of small airways dysfunction. BOS is defined as an otherwise unexplained 20% reduction in FEVX. We hypothesized that if sGaw is sensitive to small airways dysfunction, it should decrease before the decline in FEVX. Design/methods: The pulmonary function test and sGaw measurements of patients who under¬ went heart-lung or bilateral lung transplantation between May 1981 and January 1993 were reviewed. Patients with and without BOS were identified. A significant decrease in sGaw was defined as a 20% fall from baseline. Results: Twenty-six BOS and 15 non-BOS patients had at least three sGaw measurements such that trends could be examined. Eleven of the 26 BOS patients (42%) had a significant decrease in sGaw before a 20% decrease in FEVl9 as compared to 2 of the 15 non-BOS patients (13%) (p=0.08). In comparison, 12 of the 26 BOS patients (46%) and 4 of the 15 non-BOS patients (27%) had a significant decrease in forced expiratory flow at 25 to 75% of the forced lung volume (FEF25.75) (p=0.32), an accepted test of small airways dysfunction. Conclusion: sGaw tended to decrease before FEVr in BOS. The trend in sGaw was similar to the trend in FEF25.75. We conclude that (1) small airways may contribute more to airway conductance than previously thought, and (2) further prospective studies are warranted to better define the relative contribution of small and large airways to sGaw.

Archives of Internal Medicine, 1993

Infection remains an important cause of morbidity and mortality in heart-lung transplant recipien... more Infection remains an important cause of morbidity and mortality in heart-lung transplant recipients. This study was designed to assess the frequency, type, and timing of infection in heart-lung transplant recipients. A retrospective analysis of 200 episodes of serious infections occurring in 73 heart-lung recipients at Stanford (Calif) University Medical Center between 1981 and 1990. Bacterial infections accounted for half of all infections, with the highest incidence in the first month after transplantation. Fungal infections (14%) were also common in the first month. Cytomegalovirus was the most common viral agent (15%), occurring primarily in the second month after transplantation. Other viruses (herpes simplex, adenovirus, and respiratory syncytial virus) accounted for a further 15% of total infections. Pneumocystis carinii infections were common 4 to 6 months after transplantation, and Nocardia typically infected recipients later than 1 year after transplantation. There was no significant difference in incidence of infections between patients receiving triple (cyclosporine, prednisone, immuran) or double (cyclosporine and prednisone) immunosuppression therapy. Mortality due to infection accounted for 40% of all deaths. Knowledge of the incidence and timing of infection should help in the prevention, early detection, and initiation of therapy in these patients.

The Annals of Thoracic Surgery, 1984

The Annals of Thoracic Surgery, 1998

We present a patient with a history of tricuspid and pulmonary atresia who underwent a classic Gl... more We present a patient with a history of tricuspid and pulmonary atresia who underwent a classic Glenn shunt and a Potts shunt during childhood, resulting in different right and left pulmonary physiology. Because of progression of cardiopulmonary disease and the fact that the right lung was "protected," the patient underwent combined heart-left single-lung transplantation. The postoperative course was uneventful. Potential early and late advantages of this approach include simplifying of the operative procedure and mitigating the potential effects of obliterative bronchiolitis.

Virginia Law Review, 1976

2 I like to think that my intervening years in the academic world have expunged any taint of clie... more 2 I like to think that my intervening years in the academic world have expunged any taint of client interest. But for the record I should note that two of the cases on which Mr. Dunau and I worked were the companion antitrust decisions in UMW v. Pennington, 381 U.S. 657 (1965), and Meat Cutters Local 189 v. Jewel Tea Co., 381 U.S. 676 (1965). He briefed and argued the latter for the union, and I briefed and argued the former for the AFL-CIO as amicus curiae.

Annals of Internal Medicine, 1973

Excerpt To the editor: There are several serious questions that should be raised concerning the l... more Excerpt To the editor: There are several serious questions that should be raised concerning the lead article in the November 1972 issue (pp. 669-676), "Effect of Freeway Travel on Angina Pectoris" ...

American Journal of Roentgenology, 1997

The purpose of this study was to compare the high-resolution CT findings in patients with patholo... more The purpose of this study was to compare the high-resolution CT findings in patients with pathologically proven bronchiolitis obliterans after lung transplantation with high-resolution CT findings in control subjects. MATERIALS AND METHODS. High-resolution CT examinations of 15 patients with pathologically proven bronchiolitis obliterans after lung transplantation and I 8 control subjects were retrospectively evaluated by two independent observers who were unaware of the diagnosis in each case. All 33 subjects underwent inspiratory high-resolution CT. Five patients with bronchiolitis obliterans and 16 control subjects underwent expiratory CT. RESULTS. Findings in patients with bronchiolitis obliterans included bronchial dilatation in 80%, mosaic perfusion in 40%, bronchial wall thickening in 27%, and air trapping in 80%, compared with the control subjects with bronchial dilatation in 22%, mosaic perfusion in 22%, and air trapping in 6%. The combination of bronchial dilatation on the inspiratory CT scan and air trapping on the expiratory CT scan was seen only in patients with bronchiolitis obliterans. We calculated good agreement between the two observers (K .63). CONCLUSION. Air trapping and bronchial dilatation were the two most sensitive and specific findings on high-resolution CT scans of patients with bronchiolitis obliterans. The combination of these two findings was seen exclusively in patients with bronchiolitis obliterans.

American Journal of Kidney Diseases, 1995

American Journal of Roentgenology, 1992

The purpose of this study was to evaluate the significance of bronchial dilatation identified on ... more The purpose of this study was to evaluate the significance of bronchial dilatation identified on high-resolution CT scans obtained after heart-lung transplantation. Bronchial dilatation has been identified on pathologic specimens and on high-resolution CT scans of patients with severe bronchiolitis obliterans after lung transplantation, but this finding has not previously been systematically studied as a manifestation of this complication. We studied the high-resolution CT scans of 16 patients who had had heart and lung transplantation at least 1 year before, and compared the percentage of dilated bronchi with evidence of small airways disease shown on pulmonary function tests. We found a close correlation between the percentage of bronchi in the lower lobes that were dilated and the percent predicted forced expiratory volume in 1 sec, forced vital capacity, and forced expiratory flow between 25% and 75% of vital capacity. No other feature identified on high-resolution CT scans correlated with pulmonary function abnormalities. We conclude that dilatation of the lower lobe bronchi is a good indicator of bronchiolitis obliterans in this population, and that the percentage of dilated bronchi generally increases with increasing pulmonary dysfunction.