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Biomedical subjects

D N Hamilton

Publications and source records attributed to D N Hamilton.

At least 37 records · Page 2Linked to original sources
PubMed1983

Medical research council trial of antilymphocyte globulin in renal transplantation. A multicenter randomized double-blind placebo controlled clinical investigation.

A total of 173 patients who received live donor or cadaveric primary or secondary renal transplants at five British hospitals were entered into a randomized double-blind controlled clinical trial of equine antilymphocyte globulin (ALG) administered prophylactically to prevent rejection. The ALG was prepared in the early 1970s and used cultured human lymphoblasts as antigen. Following transplantation all patients were treated with a standard immunosuppressant regimen of steroids and azathioprine and, in addition, were given either 30 mg/kg ALG or placebo daily for 10 days by intravenous infusion. In comparison with more recently produced materials, the ALG employed in this study was of moderate potency in prolonging skin graft survival in monkeys. Primary graft failure occurred in 27 patients (15/86 ALG and 12/87 placebo). At three to five years after transplantation 50 of the remaining patients had died, almost all from diseases relating to their renal condition, and 25 more had suffered complete graft failure. No significant differences were found between patients treated with ALG and placebo in the numbers with functioning grafts during the 3 years following transplantation, in the time between transplantation and the first rejection episode, or in the number of episodes during the first six months after transplantation. This applied whether live or cadaveric grafts were employed. Within the first 6 months of operation, infection was given as a major contributory cause of death in 12 patients treated with ALG and in 5 who received placebo (P greater than 0.1). Infections were also slightly more common during the two weeks following transplantation in those receiving ALG (13/86 ALG, 10/87 placebo). As expected, graft survival was significantly better in patients who received live donor grafts (P = 0.001) and in patients with the least donor-recipient histocompatibility mismatches (P = 0.008). The results of this multicenter trial show no therapeutic benefit to renal graft recipients from the administration of ALG, and suggest that the risks of fatal infection may have been aggravated. Use of such equine ALG in similar dose regimens is therefore, not, justified in renal transplantation, especially if some part of the apparent effects on fatal infections is real. It is stressed that these findings are relevant only to the equine ALG used in this study, which was raised with cultured human lymphoblasts as the antigen, and to ALG prepared in a similar way and of similar potency. It should not be inferred that these results are applicable to ALG prepared in other ways.

Adolescent↗
PubMed1983

Early detection of obstructed ureter by ultrasound following renal transplantation.

Serial ultrasound examinations were carried out following 144 renal transplants. Eleven patients (8%) required surgery for ureteric obstruction and in all cases the ultrasound correctly identified the obstruction at an early stage. One false positive result was obtained with the ultrasound and this compared favourably with both the intravenous urogram (IVU) and isotope renogram. There were false positive and false negative results with both the IVU and renogram in addition to which neither of these techniques, particularly the IVU, is as simple or atraumatic for the patient as the ultrasound. Serial ultrasound examinations have a useful role in the detection of ureteric obstruction as well as being of value in the detection of perinephric fluid collections and acute rejection.

Diagnostic Errors↗
PubMed1982

Principal neuropathological and general necropsy findings in 24 renal transplant patients.

The principal neuropathological and general pathological findings in a group of 24 patients with renal transplants who died in a nine-year period at the Western Infirmary, Glasgow, are described. Opportunistic infections--bacterial, protozoal, and fungal--were the commonest causes of death. Other causes included cardiac and vascular lesions, upper gastrointestinal bleeding and neoplasia.

Adolescent↗
PubMed1982

Candida colonization of the oral cavity.

A quantitative study of candida colonization of the oral cavity was made in 20 normal persons, 20 patients receiving regular dialysis treatment, 21 patients who underwent operation and were in a general surgical ward and in 20 critically ill patients who had undergone operation and were in an intensive therapy unit. Candida colonization was common in the patients who had operations, and levels were highest in those receiving antibiotics. However, the administration of antibiotics was not the only factor accounting for high candida colonization, since many of the patients studied, receiving regular dialysis treatment and antibiotic therapy, had only low levels of colonization. Candida levels in the oral cavity were highest in the critically ill patients, two of whom had candida infection of the oral cavity and one patient who had systemic candidiasis. Within this group, candida colonization was not significantly different, according to the clinical outcome or the response to recall antigens. This increased candida colonization of the oral cavity may be important in the development of candida infection in these patients.

Adolescent↗
PubMed1981

Assessment of host resistance in critically ill surgical patients by the response to recall skin antigens.

The cell-mediated immunity (CMI) of 47 critically ill surgical patients admitted to an Intensive Therapy Unit was assessed by their response to recall skin antigens and found to be markedly reduced. Thirty-seven patients showed no reaction to initial skin testing (NR), and there were 21 deaths in this group. Ten patients reacted (R) to initial skin testing and only one of these patients died (p less than 0.025). Repeat skin testing was performed on 22 NR patients. Eight became R on repeat testing and there was one death in this group, whilst 14 remained NR and there were 11 deaths in this group (p less than 0.025). The major clinical difference between R and NR patients was a greater incidence of severe sepsis in the NR patients. These findings suggest that the use of recall skin antigens to assess CMI may be a valuable investigation in critically ill surgical patients and that initial and persisting failure to react to skin tests is associated with a poor outcome.

Adolescent↗
PubMed1981

Cell-mediated immunity during RDT and the outcome of transplantation.

Previous studies have demonstrated depression of cell-mediated immunity (CMI) in uraemia. We have measured CMI in a group of 248 patients on regular dialysis using a quantitative dinitrochlorobenzene (DNCB) skin test which gives a score of 0 to 15. Ninety-eight of these patients subsequently had first cadaver transplants and the relationship between the DNCB score and graft survival has been examined. Graft survival was found to decline progressively with higher DNCB scores. Blood transfusion also had a major influence on graft survival and the relation between the DNCB score and outcome was observed in all the blood transfusion groups.

Adolescent↗
PubMed1980

The radiology of local complications of haemodialysis access devices.

Of the three types of haemodialysis access devices, radiology is of value in demonstrating local vascular complications only in the arteriovenous graft. The local complications are classified as inflow obstruction, false aneurysm and outflow obstruction. A rational angiographic technique is described and the local complications likely to be encountered are illustrated.

Angiography↗
PubMed1978

Morbidity and mortality in renal transplant patients after incidental surgery.

Sixty-five further surgical procedures were carried out in 39 renal transplant patients without mortality and with low morbidity. There was a 9 per cent incidence of clean wound infection, and minor chest infection occurred in another 9 per cent. Stay in hospital for these procedures was not prolonged. The function of the transplanted kidney showed no deterioration after these further surgical procedures. The successfully transplanted patients is thus a good candidate for further surgery despite the previous renal failure and the continuing immunosuppressive therapy.

Creatinine↗
PubMed1978

Influence of HLA matching and blood transfusion on renal allograft survival.

One hundred and seven consecutive cadaver kidney transplants have been followed for up to 6 years. The beneficial effect of HLA matching, shown in previous studies, has been confirmed. The 2-year failure rate from rejection was 29% for grafts with less than two incompatibilities, in comparison with a figure of 52% where there were two or more incompatibilities. In contrast to some reports, the presence of HLA antibodies did not have an adverse effect on the survival of first grafts. Patients not transfused prior to transplantation had a much higher 1-year graft failure rate (72%) than those given either frozen-thawed red cells (29%) or whole blood (23%). This apparently beneficial effect of blood transfusion was no greater in patients transfused with more than five units compared with those given less than five units. We believe that blood transfusion has an important influence on the outcome of renal transplantation.

Adolescent↗