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Biomedical subjects

C C Doherty

Publications and source records attributed to C C Doherty.

54 records · Page 3Linked to original sources
PubMed1984

Pathology of the heart and the cardiac conduction system in Wegener's granulomatosis.

Two cases of Wegener's granulomatosis occurred in two women aged 53 and 67 years. The clinical course in both was of rapid deterioration resulting from renal failure and leading to death. At necropsy both cases showed severe and disseminated necrotising granulomatosis in the lungs, kidneys, and spleen but with variable degrees of cardiac and systemic vasculitis. One patient, with appreciable cardiac damage, developed a P wave abnormality due to atrial disease. In patients with Wegener's granulomatosis damage to the heart should be suspected and signs of conduction system abnormalities looked for on the electrocardiogram.

Aged↗
PubMed1983

Plasma prednisolone concentrations and kinetics in renal transplant patients.

Plasma prednisolone concentrations were measured in 26 renal transplant (RT) patients and five control subjects. A linear relationship was found between prednisolone dosage in mg/kg and area under the plasma concentration time curve in seven stable RT patients (r = 0.98) and in all subjects (n = 19) with estimated prednisolone clearance rates (CLp) between 0.075 and 0.11 L/kg/hr (r = 0.96). The greatest deviation from this occurred in five patients having reduced CLp with prolonged prednisolone half life (t1/2p) and in one having increased CLp while taking phenytoin. Three of the five with reduced clearance had steroid induced diabetes and one a Cushingoid appearance. There was some correlation between peak plasma prednisolone and dosage (r = 0.77) in all subjects, but none between creatinine clearance and t1/2p or CLp.

Dose-Response Relationship, Drug↗
PubMed1983

Hereditary glomerulonephritis of non-Alport type.

In three unrelated kindreds, 21 subjects with hereditary renal disease were identified. The mode of inheritance was autosomal dominant and the main clinical features were asymptomatic proteinuria and/or haematuria. Three of the 16 females but none of the five males developed progressive renal failure. Renal biopsy carried out in six of the 21 patients showed varying degrees of mesangial change with glomerular deposition of IgM and C3 in some cases. Nerve deafness and renal ultrastructural changes typical of Alport's Syndrome were absent. The renal disease in these subjects does not conform with previously recognised types of familial nephropathy.

Adolescent↗
PubMed1980

Advantages of low dose steroid from the day after renal transplantation.

We have used a low dose of steroid (20 mg of prednisolone), commencing the day after transplantation, for 151 consecutive renal transplants in 141 patients. Five patients received grafts from living related donors, 146 received cadaver grafts. All patients received azathioprine for routine immunosuppression and the first 47 received a single dose of actinomycin C i.v. for treatment of rejection. No other immunosuppressive drugs were used. This treatment provided satisfactory immunosuppression as 109 of 151 grafts continue to function for periods of 3 months to 10 years and, of 42 grafts lost, only 17 failed from rejection. The cumulative survival of first cadaver grafts at 1 and 2 years in recipients of all ages (7 to 55 years) was 77.9 and 76.0%, respectively; in recipients 15 to 34 years old, 90.9 and 86.1%, respectively. Twenty-three patients died, no patient died from infection during the admission for transplantation, and infection played a part in the deaths of only four patients. The incidence of other complications was low; seven patients developed gastrointestinal complications, one died, four patients developed diabetes, all survived; only one patient developed avascular necrosis of bone.

Administration, Oral↗
PubMed1978

Isotope renography and long term follow-up of renal transplant patients.

Isotope renography was carried out in 64 kidney transplant patients attending a follow-up clinic. Graft survival in these patients ranged from two months to ten years. Forty-one patients had normal renograms and 98% of these had satisfactory function (creatinine clearance greater than 50 ml/min). Eighteen patients showed a major renogram abnormality and 50% of these had impaired function. Five of these 18 have been explored and found to have graft complications (obstructive disease in four, chronic pyelonephritis in one). Exploration has not been undertaken in the remaining 13 but nine show evidence suggestive of graft pathology (proteinuria, impaired creatinine clearance, elevated urinary enzymes, calyceal distortion on IVP). A successful kidney transplant should result in a normal isotope renogram, and a major abnormality of the renogram suggests the presence of a graft complication, even when the creatinine clearance is unimpaired. We feel renography is useful for identification of renal transplant patients who require further investigation or closer follow-up.

Creatinine↗
PubMed1978

Prevention of upper gastrointestinal complications after kidney transplantation.

In 94 renal transplant patients, the incidence and mortality rate of upper gastrointestinal complications was lower than in 11 other reports comprising over three thousand patients. This difference may be due to the smaller doses of prednisolone used. Duodenal ulcer and erosive gastritis were the commonest lesions and 73% occurred in the first 6 months after operation. In 131 transplant candidates, gastric assessment including endoscopy showed 34 (26%) had peptic ulceration prior to operation. In 130 subjects (38 renal transplant, 68 chronic uraemia, 24 controls), pentagastrin tests showed acid hypersecretion in uraemic patients undergoing dialysis (P less than 0.02) and a tendency for acid output to decrease after operation (P less than 0.005). In 8 transplant patients with duodenal ulcer, preliminary experience with prophylactic cimetidine has been favorable. Upper gastrointestinal complications after renal transplantation are likely to be lessened by, a) use of less prednisolone in the early post-transplant phase; b) pre-transplant gastric assessment and c) the use of a safe and effective antisecretory drug in those with duodenal ulcer.

Cimetidine↗
PubMed1978

Elevations of gastrointestinal hormones in chronic renal failure.

Fasting levels of 5 gut hormones were studied in 30 patients with advanced uraemia (CRF), 40 undergoing regular dialysis (RD) and 555 renal transplant patients (RT). Mean values of gastrin and total glucagon were markedly elevated in CRF and RD patients compared with 20 normal subjects; there were lesser elevations in pancreatic glucagon, insulin and vasoactive intestinal peptide (VIP). Secretin levels were unchanged. In RT patients, fasting levels of VIP and pancreatic glucagon had returned to normal, while levels of gastrin, total glucagon and insulin remained slightly elevated compared with controls. Food stimulated hormone levels were measured in 18 RD patients and compared with 18 controls. After eating, RD patients failed to show the late increase in total glucagon, or the suppression of VIP and secretin seen in normal subjects; the pattern of gastrin and insulin response was similar to controls, but after the initial increase plasma levels in RD patients tended to show a slower decline. Thus involvement of the gastrointestinal tract in uraemia is associated with functional disturbance of the endocrine system of the gut.

Gastrins↗
PubMed1977

Cimetidine for duodenal ulceration in patients undergoing haemodialysis.

Peptic ulcer is a common problem in advanced renal failure, but most drugs for ulcers are hazardous in this condition. In a small open study cimetidine was given to nine patients with acid hypersecretion and endoscopically diagnosed duodenal ulceration who were undergoing haemodialysis. The patients obtained good pain relief and suffered no serious side effects. Both basal and stimulated acid output fell considerably and the plasma gastrin response to food increased during treatment. Two patients with recurrent vomiting during haemodialysis had a striking response to cimetidine, which suggested that such vomiting may be acid-mediated in some patients. These preliminary results suggest that cimetidine may prove to be an advance in the management of peptic ulcer in uraemic patients.

Adolescent↗
PubMed1977

Treatment of peptic ulcer in renal failure.

The occurrence and pathophysiology of peptic ulcer was studied in 117 uraemic patients. Ulcer disease was unusually frequent, and the highest incidence was found in patients on regular dialysis (48%). Factors implicated were hyperacidity, hypergastrinaemia, and the effect of dialysis itself. We found that the occurrence of gastrointestinal bleeding was lower post-transplant (7%), than pre-transplant (15%), and that bleeding in renal transplant patients was due more commonly to erosive gastritis than peptic ulcer. Cimetidene was given to 9 regular dialysis patients with peptic ulcer. Symptomatic relief and significant reduction of acid secretion was demonstrated, and no major side effects occured. There is a logical basis for conservative treatment of uncomplicated peptic ulcer in the dialysis patient, and further evaluation of cimetidene is indicated.

Cimetidine↗