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Biomedical subjects

A D Barnes

Publications and source records attributed to A D Barnes.

At least 55 records · Page 3Linked to original sources
PubMed1980

Surgical treatment of primary hyperparathyroidism in the elderly.

Twelve patients aged over 70 with primary hyperparathyroidism (persistent hypercalcaemia and raised serum parathyroid hormone concentrations) underwent parathyroidectomy, which was well tolerated by all. After operation serum calcium concentrations returned to normal and the commonest symptoms before operation (muscle weakness, malaise, and mild to severe dementia), although not related in severity to the degree of hypercalcaemia, improved. Mental function was greatly improved. The findings suggest that primary hyperparathyroidism should be sought in any elderly patient with hypercalcaemia and that more such patients with the diagnosis should be considered for parathyroidectomy irrespective of age.

Adenoma↗
PubMed1979

Value of 1-alpha-hydroxy vitamin D3 in treatment of primary hyperparathyroidism before parathyroidectomy.

The postoperative course of six patients with primary hyperparathyroidism and obvious radiological evidence of bone disease pretreated with 1-alpha-hydroxy vitamin D3 (1 alpha HCC) was indistinguishable from that of six patients with a similar clinical and radiological picture who were not pretreated. 1alphaHCC may increase the hypercalcaemia in some cases and cannot be recommended for the routine preparation of such patients for surgery.

Adolescent↗
PubMed1978

One thousand prospective cadaveric renal transplant donors.

In a community where cadaveric renal transplantation is the mainstay for the treatment of chronic renal failure a review of 1,000 prospective cadaveric renal donors shows that failure by the medical and surgical teams in the intensive care units to notify the transplant team every time of a potential donor is the major cause for the lack of donor organs. Lack of consent by the donor's relatives is also a significant factor but is less common when the donor is brain dead on a ventilator than when they still have spontaneous respiration. Gradually the transplant team is persuading their colleagues in medicine and trauma to help but at the present rate of progress it will be another decade before enough kidneys are available.

Cadaver↗
PubMed1978

The significance of vascular anomalies in human renal transplantation.

In a review of 250 consecutive human cadaveric kidney transplants the primary failure rate of donor kidneys with an anatomically abnormal blood supply was 36.7% as compared with 16.2% for kidneys with a single artery and vein (P less than 0.001). The incidence of primary failure due to renal vascular thrombosis in the abnormal group was 24.2%, compared with 4.1% in the normal group (P greater than 0.001). A significantly greater incidence of anastomotic haemorrhage and urinary leak was also associated with an abnormal blood supply in the donor kidney.

Cadaver↗
PubMed1976

Transplantation of tumour with a kidney graft.

A cerebral glioma discovered by angiography and brain biopsy in a kidney donor was subsequently suspected of being a secondary tumour. By this time a biopsy of one of the transplanted kidneys had shown a clump of malignant cells in a glomerulus. Because of the psychological state of this recipient the transplant was not removed, but the recipient of the second kidney was immediately told of the danger of tumour cell transfer, and underwent nephrectomy. The patient remained well on haemodialysis; multiple sectioning of the kidney showed no signs of tumour. The transplant in the first recipient functioned well until his death, six months after operation. At necropsy undifferentiated tumour was found in the pleura, liver, pelvic peritoneum, and transplanted kidney. All cadaver donors should undergo full laparotomy after removal of the kidneys, particularly those with a high risk of cancer, and a full necropsy should also be performed shortly afterwards to exclude tumour and other unsuspected diseases. Then it is not too late to remove a transplanted kidney should a tumour be found.

Adult↗
PubMed1976

Results of 250 consecutive cadaver kidney transplants.

The results of 250 cadaver kidney transplants performed at this hospital between May 1968 and December 1974 were analysed. A functioning transplant was defined strictly as one that maintained the recipient in good health with a serum creatinine below 442 mumol/1 (5 mg/100 ml) without any need for dialysis. The proportions of kidneys functioning after one, two, and three years were 40-4%, 33-9%, and 31-1% respectively, the corresponding survival rates of patients being 62-6%, 57-4%, and 43-8%. The primary failure rate overall was 21-6%, while the failure rates for first, second, and third transplants were 18-1%, 39-9%, and 66-7% respectively. Half of the primary failures were attributed to the use of cadaver kidneys with abnormal vasculature or long ischaemic times or originating from non-ventilated donors. Of the initially successful transplants 49% were subsequently lost due to rejection (53%) or death of the patient with a functioning transplant (46%), and of the secondary losses 58% occurred within three months of transplantation. HLA matching of donor and recipient for two or more antigens was associated with a significant increase in transplant survival--46% at three years as opposed to 9-5% at three years for kidneys with poorer matches.

Adolescent↗
PubMed1976

The use of antithymocyte globulin in myasthenia gravis.

Antithymocyte globulin (ATG) has been used to treat three female patients with myastenia gravis. No other immunosuppressive agent was used. All three cases responded favourably to ATG therapy. This suggest that further work should be undertaken in this field though the condition itself is extremely variable and this study was not controlled.

Adult↗
PubMed1976

A randomized prospective clinical trial of antilymphocyte globulin in 100 cadaveric renal transplants.

In controlled randomized study of antilymphocyte globulin (ALG) in 100 cadaveric renal transplants, 15 patients receiving a second transplant were excluded. Ofthe first transplants, 42 were in the control and 43 in the ALG group. The two groups were similar. The ALG used was either prodduced in our laboratories or obtained from a commerical source. It was observed that ALG produced a significant lymphopenia, that the oliguric phase of the ALG group was half that of the controls, and that the ALG group although less likely to suffer rejection episodes responded significantly better when treated than did those in the control group.

Adult↗
PubMed1975

Agonal phase, ischaemic times, and renal vascular abnormalities and outcome of cadaver kidney transplants.

A retrospective study of 250 cadaver kidney transplants was carried out to determine the effects of the agonal period, the warm and cold ischaemic times, and the use of kidneys with vascular anomalies on the primary success and failure and the subsequent level of function of the transplants. Kidneys with vascular anomalies or from non-ventilated donors had a primary failure rate of over 30%, whereas those with normal vasculature or from ventilated donors had a rate of 17%. An initial warm ischaemic time of more than 60 minutes was associated with a primary failure rate of 57% and a cold ischaemic time of over 550 minutes with a primary failure rate of 47%. The interrelationship between the warm and cold ischaemic times in the primary success or failure of the transplants was examined and criteria defined for selecting potentially viable cadaver kidneys for transplantation, as follows: (1) The donor should be (a) ventilated, (b) aged 6-50 years, and (c) have normal ante-mortem renal function and have secreted more than 1-5 1 of urine in the 24 hours before death (or an equivalent volume if the urinary output was recorded for less than 24 hours before death); (2) the kidney should have normal renal vasculature enabling single arterial and venous anastomoses to be performed; (3) kidneys with I.W.I.T.s of longer than 60 minutes should not be used; (4) for kidneys with I.W.I.T.s of less than 20 minutes the C.I.T. is not critical but should not exceed 12 hours; (5) for kidneys with I.W.I.T.s of 20-60 minutes the C.I.T. should not exceed 450 minutes.

Adolescent↗