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Biomedical subjects

D Thomson

Publications and source records attributed to D Thomson.

At least 109 records · Page 6Linked to original sources
PubMed1985

Proliferative glomerulonephritis and exposure to organic solvents.

Exposure to organic solvents was compared by interview and questionnaire in 50 patients with biopsy-proven proliferative glomerulonephritis in whom there was no evidence of systemic disease or preceding infection with that of 100 control subjects matched for age, sex and social class. The interview was conducted by a lay person who did not know whether the interviewee was a patient with glomerulonephritis or a control subject. The exposure scores derived from the results of the questionnaires were significantly greater in the patients with glomerulonephritis than the control subjects (13,186 +/- 3,716 vs. 3,030 +/- 1,152, p less than 0.01). The degree of exposure was higher in those patients with the more severe diffuse endocapillary proliferative glomerulonephritis than in those with mesangial proliferative glomerulonephritis. In the glomerulonephritis patients solvent exposure was mainly occupational in origin and involved fuels, paints and degreasing agents in most cases. This occupational exposure was significantly greater than in the control subjects (13,061 +/- 3,858 vs. 2,878 +/- 1,146, p less than 0.01). It is suggested that exposure to organic solvents may participate in the pathogenesis of non-systemic proliferative glomerulonephritis.

Biopsy↗
PubMed1985

Membranous nephropathy in a patient with nail-patella syndrome nephropathy.

Membranous nephropathy is described in a patient with nail-patella syndrome who also had the characteristic changes of nail-patella syndrome nephropathy on electron microscopy. This combination has not previously been reported. Nail-patella syndrome nephropathy is reviewed in relation to other glomerular lesions which have been reported.

Adult↗
PubMed1984

Reversible renal failure due to isolated renal sarcoidosis.

Renal impairment in sarcoidosis is usually due to hypercalcaemia and nephrocalcinosis but can also be caused by granulomatous nephritis or interstitial nephritis without sarcoid granulomata. A variety of types of glomerulonephritis have also been described in sarcoidosis but these rarely cause impaired renal function. Renal failure as an isolated manifestation of sarcoidosis is uncommon. A 66-year-old woman presented with a 1-year history of lethargy, polyuria and nocturia. Clinical examination was unremarkable and she had impaired renal function (urea 18 mmol/l (108 mg%) and creatinine 380 mumol/l (4.3 mg%)). As her kidneys were normal in size, she underwent renal biopsy, which revealed granulomatous interstitial nephritis. Reevaluation showed no other evidence of sarcoidosis and she had impaired urinary acidification and concentrating capacities. Therapy with corticosteroids produced a marked improvement in symptoms and renal function. This case confirms the view that granulomatous sarcoid nephritis is steroid sensitive and that full recovery can be expected provided interstitial fibrosis and scarring do not occur.

Acute Kidney Injury↗
PubMed1983

Mesangiocapillary glomerulonephritis: a long-term study of 40 cases.

Forty cases of mesangiocapillary glomerulonephritis are reviewed for whom both light and electron microscopy and full clinical data were available. Immunofluorescence microscopy (IF) was performed on 23 cases and complement screening (CH50, C4 and C3) on 25 cases, with follow-up period of 5-22 y. The results of EM revealed 17 cases (42 per cent.) of Type I and 23 cases (58 per cent.) of Type II MCGN but only 52 per cent. of Type II cases were correctly identified by light microscopy. Epimembranous deposits were seen as frequently in Type II as in Type I (26 per cent. and 30 per cent.) and fragmentation of glomerular capillary basement membranes (GBM) was seen in 27 per cent. of Type I cases. Overall patient survival was 49 per cent. at 10 y and that of patients who presented with nephrotic syndrome was poor (39 per cent. at 10 y). Persistent hypocomplementaemia with C3 Nephritic Factor was present in 40 per cent.; the survival of these patients was less than those with normal complement levels (70 per cent. vs 100 per cent. at 5 y) and they were also more likely to develop renal failure. Renal failure was more likely to develop in those with a creatinine clearance of less than 100 ml/min at presentation and where the biopsy showed substantial crescents in greater than 20 per cent. of glomeruli. Mean CH50, C3 and C4 was lower in the hypocomplementaemic as compared to normocomplementaemic patients, and there were no differences between Type I and Type II. IF showed immunoglobulins and fibrin as well as C3 in both Type I and Type II cases. Our results support the concept of an immune-complex mediated phase in both types of MCGN, and we further suggest that (a) epimembranous deposits are common in both Type I and Type II and (b) cases with fragmentation of the GBM should be designated Type Ia.

Adolescent↗
PubMed1983

Circulation, respiration and serotonin levels in carcinoid patients during neurolept anaesthesia.

Release of hormones peri-operatively in patients with metastatic carcinoids may lead to severe circulatory and respiratory disturbances. Fourteen patients with liver metastases were studied during 16 operations with a modified neurolept anaesthesia in order to evaluate the central haemodynamic and respiratory functions as well as plasma serotonin levels. The premedication in five patients was supplemented with levopromazine. During the 11 operations performed on patients not pretreated with levopromazine, no major significant fluctuations in circulatory or respiratory functions were recorded although big variations in serotonin plasma levels were measured. In the patients treated with levopromazine, however, significant changes were observed in heart rate, mean pulmonary artery pressure, cardiac index, and left and right ventricular stroke work especially during flushing episodes. However, these changes did not correlate with the changes in plasma serotonin levels. Modified neurolept anaesthesia without levopromazine pretreatment combined with careful monitoring seems to be a safe procedure for carcinoid patients. Using this type of anaesthetic procedure only one major complication occurred in connexion with 16 major operations and then in the postoperative period.

Adult↗
PubMed1983

Temporary incomplete ischemia of the legs induced by aortic clamping in man. Metabolic and hemodynamic effects of temporary extracorporeal by-pass.

The effects on central hemodynamics and skeletal muscle metabolism during surgery for abdominal aortic aneurysm were compared in 6 patients given a preoperative adrenergic block (group B) and in 6 patients who additionally had a temporary brachio-femoro-femoral by-pass during the aortic clamping (group B + S). The cardiac output, heart rate, arterial and pulmonary artery pressures and the cardiac filling pressure were studied. Biopsy specimens from the lateral vastus muscle and blood samples from the radial artery and the iliac vein were taken before aortic clamping and also before and 30 minutes, 4 and 16 hours after the aortic declamping. Intramuscular temperature and pH were measured. The glycogen, glucose, lactate, pyruvate, ATP, ADP, AMP, phosphocreatine (PCr) and creatine (Cr) contents of the muscle and the lactate and pyruvate concentration in iliac venous and radial arterial blood were determined, using enzymatic fluorometric techniques. In group B, aortic clamping induced severe temporary incomplete ischemia with a 300% increase in lactate/pyruvate (L/P) ratio and a fall in intramuscular pH (pHm). The adenylate energy charge (EC) decreased, but the creatine (PCr + CR) and the adenylate (ATP + ADP + AMP) pool remained unchanged. After aortic declamping, the L/P ratio, EC and pHm regained their preclamping values, but the pools of energy phosphate compounds were reduced, indicating dysfunction or damage of the muscle cells. In group B + S there were no major muscle metabolic changes during clamping or after declamping of the aorta. In group B the systemic vascular resistance (SVR), mean arterial blood pressure (MAP) and left ventricular stroke work (LVSW) increased during the occlusion. On release of the clamp, cardiac output rose, possibly due to the sudden reduction of SVR. A temporary marked fall of MAP occurred. In group B + S, no increase of SVR, MAP or LVSW was observed during aortic clamping. After the declamping, only a minor MAP drop was observed. In both groups, a brief rise in pulmonary vascular resistance after the aortic declamping suggested transient pulmonary microembolism. If a high-risk patient is to undergo reconstructive surgery of the abdominal aorta and/or technical difficulties can be expected to necessitate prolonged cross-clamping during the operation, a temporary extracorporeal by-pass may be a favorable adjuvant, improving cardiac performance and preventing derangement of muscle metabolism.

Adrenergic beta-Antagonists↗
PubMed1982

Plasma exchange in the successful treatment of drug-induced renal disease.

A 20-year-old girl with rheumatoid arthritis who has been treated with D-penicillamine for 7 months presented with fulminating Goodpasture's syndrome and a focal necrotising glomerulonephritis. A 35-year-old man who had been taking a low dose of phenytoin for epilepsy presented with nephrotic syndrome and a mesangiocapillary glomerulonephritis. CH50, C3 and C4 were low and a high level of immune complexes was detected. Both patients had severe lesions which were unlikely to recover on immunosuppression alone so were treated with intensive plasma exchange. 2 patients are described with serious drug-induced renal disease who recovered with intensive plasma exchange and immunosuppression.

Adult↗
PubMed1982

Mesangial disposal of glomerular immune deposits in acute malarial glomerulonephritis of rats.

The disposal of immune complexes by the glomerulus and the participation of infiltrating monocytes were studied in acute malaria-associated glomerulonephritis. Young Sprague-Dawley rats were infected with Plasmodium berghei. Parasitemia reached a maximum after 8 to 12 days, ending by day 20. In all infected rats, renal immunofluorescence microscopy showed in all glomeruli granular deposition of rat IgG, IgM, and C3 in a mesangial distribution. The staining was strongest from days 8 to 12, then diminished and disappeared after day 32. By contrast, electron-dense deposits were rarely seen before day 16 when they became detectable in the mesangial matrix, particularly along the inner aspect of the glomerular basement membrane. They were most conspicuous on days 20 and 34 and disappeared by day 100. Few monocytes were detected in the glomeruli by electron microscopy and by histochemistry for nonspecific esterase. Highest counts of esterase-positive monocytes were found on day 10 (means 2.9 per glomerulus, range 0 to 5; normal control range 0 to 1). Total glomerular cell counts were transiently elevated on days 10 and 20. Renal functional damage of malarial rats was mild as reflected by a transient increase of urinary protein excretion, whereas serum urea values remained in the normal range. The results suggest that elimination of glomerular immune deposits in acute malarial glomerulonephritis of rats involves their gradual condensation and degradation in the mesangium which reduces detection by immunofluorescence while leading to formation of transient electron-dense deposits. In this model, the efficient disposal of glomerular immune deposits by the mesangium appears to minimize the infiltration of monocytes and to prevent aggravation of the glomerular injury.

Animals↗
PubMed1981

Two's company.

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Partnership Practice↗
PubMed1981

Doctor in a cave.

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Emergency Medical Services↗