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Biomedical subjects

C J Cardella

Publications and source records attributed to C J Cardella.

67 records · Page 4Linked to original sources
PubMed1979

Urinary lysosomal enzyme excretion after renal allotransplantation.

Three urinary lysosomal enzymes, beta-glucuronidase (beta-Gluc), beta-galactosidase (beta-Gal) and N-acetyl-beta-D-glucosaminidase (NAG), were measured in twenty-one renal allograft recipients to evaluate their role in the diagnosis and prediction of rejection episodes, and in the prediction of eventual graft outcome. A fluorometric assay using methylumbelliferone substrates was used to measure the three enzymes in morning urine samples and enzyme activity was defined in terms of urine creatinine concentration. Urinary NAG levels increased significantly in 13/16 first rejection episodes and 4/4 instances of acute tubular necrosis and graft infarction. In 5 of the 16 first rejection episodes the NAG was predictive of the rejection. NAG was not useful in diagnosing second or subsequent rejections and beta-Gluc and beta-Gal were of little value in assessing any component of renal transplant pathology. As a prognostic index of eventual graft outcome, the peak urinary NAG was particularly encouraging. It correlated strongly with deterioration in graft function as time passed such that only 2/10 patients with peak NAG greater than 1400 Units had normal serum creatinines at 6 months post transplantation. Conversely 4/4 patients with peak NAG levels less than 700 Units had normal serum creatinine at that time. In our series the measurement of urinary NAG was a useful adjunct to the diagnosis of first rejections but appears to be more valuable in predicting graft outcome.

Acetylglucosaminidase↗
PubMed1979

Role of dialysis in the treatment of severe hypercalcemia: report of two cases successfully treated with hemodialysis and review of the literature.

The role of dialysis in the treatment of patients with severe hypercalcemia is uncertain. The fourteen previously reported cases of hypercalcemia treated with either peritoneal or hemodialysis have been reviewed. Two additional patients treated with hemodialysis are described in this report. Because the use of large volumes of intravenous fluids was contraindicated, each of the patients received a low calcium bath (0-1 mEq calcium per liter) hemodialysis for three and a half hours. After dialysis, the serum calcium fell to normal in both and remained normal thereafter with treatment of the underlying disease (multiple myeloma in one and vitamin D intoxication in the other). Hemodialysis can clear up to 682 mg of calcium per hour as compared to 124 mg per hour for peritoneal dialysis and 82 mg per hour with forced saline diuresis. Low calcium bath hemodialysis is indicated when the presence of renal and/or cardiac failure prevents the administration of large volumes of intravenous fluids to hypercalcemic patients.

Aged↗
PubMed1977

Intensive plasma exchange, complement dependent microcytotoxicity and renal transplant rejection.

Intensive plasma exchange (IPE) was used to treat 13 rejection episodes in eight renal transplant recipients with biopsy evidence of humoral rejection. Prior to IPE, each patients had several rejection episodes treated with high dose steroids. The IPE-treated rejections had not responded to conventional anti-rejection therapy and all patients appeared likely to lose their grafts. IPE reversed 7 of the 13 rejections (5 of 8 patients responded). Two of the 8 grafts continue to have adequate function 6 and 8 months after IPE. IPE temporarily reverses rejection but not increase long term graft survival.

Blood Transfusion↗
PubMed1975

The relation between connective tissue cells and intercellular substances, including basement membranes.

Basement membranes are distributed widely in the body forming an extracellular matrix for epithelial and endothelial cells. The collagenous and glycoprotein constituents of basement membranes are synthesized by these two cell types. Disturbance of the interactions between basement membranes and their associated epithelial and endothelial cells can lead to the pathological changes seen in diseases involving basement membranes. These changes are illustrated here by reference to glomerulonephritis induced by the deposition of immune complexes in the glomerulus of the kidney, and chronic inflammatory changes occurring in the lung after inhalation of asbestos. In these diseases basement membrane changes can occur in several ways. Hydrolytic enzymes released from inflammatory cells degrade basement membranes while other constituents by epithelial and endothelial cells. Alternatively the physical separation of epithelial and endothelial cells from their basement membrances by space-occupying substances such as immune complexes can interfere with feedback mechanisms leading to synthesis of basement membrane constituents and cell proliferation. Studies of these pathological changes at a cellular level should shed new light on the ways in which cells interact with their pericellular environment.

Asbestos↗
PubMedDate not supplied

Recycled heart valves from transplant patients.

Forty heart transplantations were performed at the Toronto Western Hospital, University of Toronto, from October 1987 to December 1989. Each heart extracted from a recipient was examined with the view of using the aortic valve as a homograft for another patient requiring aortic valve replacement. Of the 40 explanted hearts, 26 had normal aortic valves that were potentially suitable for homografting, and 14 had aortic valves judged as unsuitable. Of the potentially suitable valves, four were preserved for ex vivo arrhythmia studies requiring aortic root perfusion and four were damaged during harvesting. The remaining 18 usable valves were sized at the time of explantation and stored in an antibiotic solution at 4 degrees C. Thirteen valves were transplanted within 10 days of harvesting, and five were discarded because no suitable recipients were available within this period. There were no operative deaths or valve-related complications in the 13 homograft valve recipients. Mean follow-up was 13 months (range, 3 to 27 months). One patient required replacement of the homograft with a mechanical prosthesis because of insufficiency and stenosis. All patients are alive, are New York Heart Association functional class status I, and have insignificant valve gradients based on Doppler echocardiography. Although hearts removed from transplant recipients are severely diseased, the aortic valves are frequently normal and should be considered for use as homografts for other patients requiring aortic valve replacement.

Adult↗
PubMedDate not supplied

Relationship between preoperative pulmonary status and outcome after heart transplantation.

To determine whether routine preoperative pulmonary function tests provide useful prognostic information in orthotopic heart transplant candidates, we evaluated the pulmonary status of 33 patients who subsequently underwent transplantation. There was one perioperative death and five other fatalities within 9 months after operation. Mean age of the six patients who died (mean +/- SD 51.8 +/- 5.0 years) was significantly different (p less than 0.05) from that of the survivors (44.6 +/- 11.1 years). Mean preoperative pulmonary vascular resistance was significantly different (p less than 0.05) between those patients who had a fatal outcome (mean, 4.4 +/- 2.0 mm Hg/L/min) and those who survived (2.7 +/- 1.0 mm Hg/L/min). By contrast, we found that measures of forced vital capacity, forced expired volume in 1 second, diffusion capacity for carbon monoxide, and arterial blood gases bore no apparent relationship to outcome. We conclude that standard noninvasive measures of pulmonary function may be useful in preoperative preparation of heart transplant candidates, but they do not appear to be helpful in predicting eventual outcome.

Adult↗
PubMedDate not supplied

Glomerulonephritis associated with polymyositis.

Five patients with primary idiopathic polymyositis developed proteinuria associated with urine sediment abnormalities. Renal biopsies disclosed a focal mesangial proliferative glomerulonephritis with deposits of immunoglobulin and complement. After treatment of the polymyositis with corticosteroids, proteinuria and urine sediment changes disappeared within 4 to 8 wk along with an improvement in the muscle disease. Although the pathogenesis remains to be determined, immune complexes may be implicated in the etiology of this renal lesion.

Adrenal Cortex Hormones↗