Search PubMed⌕ Search

Biomedical subjects

D E Sutherland

Publications and source records attributed to D E Sutherland.

At least 289 records · Page 16Linked to original sources
PubMed1992

Chemical hepatitis associated with occupational exposure to halothane in a research laboratory.

We report a case of clinical hepatitis associated with occupational exposure to halothane in a research laboratory. A biochemist who for 3 y repeatedly used halothane for sedation and euthanization of rats suffered recurrent episodes of epigastric discomfort, culminating in an episode of malaise, anorexia, jaundice and elevated liver associated enzymes that promptly resolved after removal from exposure to halothane. Serologic testing for viral sources and risk factors for non-infectious hepatitis were negative. Halothane-induced hepatitis has been documented as an idiosyncratic reaction among anesthetized patients and has been reported once in operating room personnel. The mechanism for halothane-induced hepatitis is proposed to be a hypersensitivity reaction to liver neo-antigens produced by the halothane metabolite 2-chloro-1, 1, 1-trifluoroethane.

Adult↗
PubMed1992

Pancreas rejection. Significance of histopathologic findings with implications for classification of rejection.

To determine the significance of various histopathologic features of pancreatic rejection, we reviewed the pathology of 53 biopsies taken to rule out rejection [32 bladder drained, (BD); 18 non-BD]. Twenty-six biopsies from 23 patients with allografts which ultimately failed (FLD) (7 BD, 16 non-BD) were compared with 27 biopsies from 27 patients with allografts which continue to function (FXN) (25 BD, 2 non-BD). The groups are similar in regard to age, sex, and time after transplant to biopsy. The mean follow-up is 13 months for FLD grafts versus 35 months for FXN grafts (p < 0.0001). In BD grafts, decreases in urine amylase usually led to biopsy, while in non-BD grafts, hyperglycemia usually prompted biopsy. More patients with ultimately FLD organs (17 of 26) presented with elevated blood glucose (BG) than patients with FXN grafts (2 of 27) (p < 0.0001). Multiple histologic features were examined related to the acinar tissue, pancreatic ducts, islets, vessels, and nerves. Features which strongly correlated with a negative outcome included moderate to severe inflammation of acinar tissue (p < 0.0001), acinar tissue loss and fibrosis (p < 0.0087) and vascular luminal narrowing due to chronic rejection (p < 0.003). Twenty-one pancreases showed chronic rejection and were treated with OKT3 or anti-lymphocytic globulin (ALG), six of these continue to function 1.6-9 years after biopsy, including two who presented with elevated BG levels. A normal biopsy was found in nine pancreases, all of which continue to function. Vasculitis was only seen in biopsies with moderate to severe inflammation, whereas endothelialitis was also seen in association with mild inflammation, suggesting that vasculitis is a more aggressive lesion. A rejection classification is proposed with endothelialitis partly defining mild rejection and vasculitis defining severe rejection. We conclude that several biopsy features and elevation of BG are strongly correlated with a high probability of failure; however, antirejection therapy is justified because recovery of function occurs in some cases. A normal biopsy obviates the need for therapy and predicts a good outcome, as do mild histological findings of rejection.

Adolescent↗
PubMed1992

Factors leading to improved outcome following pancreas transplantation--the influence of immunosuppression and HLA matching.

The results of pancreas transplantation continue to improve and do not appear to have plateaued worldwide. In the United States, pancreas graft survival rates are now similar or better than those for other organ transplants, particularly when the pancreas is transplanted simultaneously with a kidney. Since 1987, more than three fourths of uremic recipients of simultaneous pancreas and kidney grafts are insulin independent and dialysis-free more than 1 year after transplantation. Although there is room for improvement in the results of solitary pancreas transplants, more than half of these patients are insulin independent at 1 year. A successful pancreas transplant results in near normalization of glucose metabolism and lowers glycosylated hemoglobin to normal levels. While a successful pancreas transplant may not elevate all diabetic patients to the level of health and function of the general population, pancreas transplant recipients report a significantly better quality of life than do those patients who remain diabetic. As the success rate of pancreas transplantation continues to improve, this treatment should be considered as a means for restoring a normal glucose level in type I diabetic patients before the development of advanced, disabling complications of the disease. Our recommendation for an approach to minimizing the antirejection response and maximizing graft survival rates in pancreas transplant recipients is to use quadruple immunosuppressive therapy with the induction doses higher than those employed for other organ transplant recipients. For SPK recipients, the allocation of organs should follow the scheme used for that of a kidney alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Graft Rejection↗
PubMed1992

Estimation of reference ranges: how many subjects are needed?

We measured Na, K, Cl, glucose, hemoglobin, erythrocytes, and hematocrit in the serum or blood from approximately 800 male and 200 female second-year medical students in an effort to define the size of an acceptable reference population. Using the data from the men and Monte Carlo simulations of 10-400 samples, each carried out 5000 times, we found that for most of the above tests, approximately 200 people are required for stable lower (2.5%) and upper (97.5%) reference limits to be obtained. This agrees with the 198 subjects required by strictly statistical criteria to define the same limits with a 99% confidence level.

Adult↗