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Biomedical subjects

J Colonna

Publications and source records attributed to J Colonna.

At least 19 recordsLinked to original sources
PubMed2000

A high panel-reactive antibody rescue protocol for cross-match-positive live donor kidney transplants.

BACKGROUND: Alloimmunization can present a virtually insurmountable barrier to kidney transplantation. Past protocols to desensitize patients using plasmapheresis and cyclophosphamide have not been broadly applied because of the fear of complications, including high rates of immunologic failure. METHODS: Fifteen patients with a positive donor-recipient cross-match were desensitized with plasmapheresis to permit live donor (LD) transplantation under newer maintenance immunosuppressants. Pretransplant the patients received plasmapheresis three times weekly for a planned maximum of six treatments, plus intravenous hyperimmune globulin, tacrolimus, mycophenolate mofetil, and prednisone. Patients who were successfully desensitized and received transplants were given 10 days of OKT3 postoperatively. RESULTS: Eleven of the 15 patients became anti-human globulin cross-match-negative after one to five plasmapheresis treatments and underwent LD transplantation. Relatively low initial titers of donor-specific antibody were predictive of successful attainment of a negative cross-match. Few side effects and rejection episodes were observed. All transplant patients remain dialysis-free after 3-26 months of follow-up. CONCLUSION: A positive cross-match is not necessarily a contraindication to LD transplantation, especially for patients with low donor-specific alloantibody titers.

Adult↗
PubMed2000

Use of radiation therapy in posttransplant lymphoproliferative disorder (PTLD) after liver transplantation.

Posttransplant lymphoproliferative disorder (PTLD) is a common and life-threatening complication of immunosuppression used to prevent rejection of solid organ and bone marrow transplants. There is no standardized treatment algorithm, but numerous management strategies are available. We describe a patient who developed a solitary lymphoproliferative lesion in the porta hepatis 9 months after orthotopic liver transplant. Following reduction in immunosuppression with no response, she was treated with involved field radiotherapy utilizing CT-based treatment planning. A partial radiographic response was obtained, and she has not developed disease in the engrafted liver or systemically. Based on the present case report, involved field radiotherapy seems to be a reasonable treatment option for patients with localized PTLD. Int. J. Cancer (Radiat. Oncol. Invest.) 90:104-109, 2000.

Algorithms↗
PubMed2000

Increased rates of donation with laparoscopic donor nephrectomy.

OBJECTIVE: To examine the impact of laparoscopic nephrectomy and recipient education on the proportion of kidney recipients who could identify a potential live donor, and on the live donor (LD) transplantation rate. SUMMARY BACKGROUND DATA: Laparoscopic donor nephrectomy (LDN) results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery than the standard open donor nephrectomy (ODN). The authors hypothesized that the availability of this less invasive surgical technique would enhance the willingness of family and friends to donate. METHODS: The study population consisted of 3,298 end-stage renal disease patients referred for kidney transplant evaluation between November 1991 and February 2000, divided into three groups. The first group received no formal LD education and had only ODN available. The second group received formal education about the LD process and had only ODN available. The third group had both formal LD education and LDN available. Records were examined to determine what proportion of each group had any potential donors tissue-typed, and the rate at which they received an LD transplant. RESULTS: Before LDN availability and formal LD education, only 35.1% of referrals found a potential donor, and only 12.2% received an LD transplant within 3 years. Institution of a formal education program increased the volunteer rate to 39.0%, and 16.5% received an LD transplant. When LDN became available, 50% of patients were able to find at least one potential donor, and within 3 years 24.7% received an LD transplant. Regression analysis indicated that availability of LDN was independently associated with a 1.9 relative risk of receiving an LD transplant. Kaplan-Meier death-censored 1- and 3-year graft survival rates for ODN transplants were 95.8% and 90.6%, versus 97.5% and 94. 8% for LDN. CONCLUSIONS: The availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.

Adolescent↗
PubMed2000

Simultaneous cadaver pancreas living-donor kidney transplantation: a new approach for the type 1 diabetic uremic patient.

OBJECTIVE: To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). SUMMARY BACKGROUND DATA: Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function. METHODS: Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants. RESULTS: One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95% for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immediate renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. CONCLUSIONS: Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.

Adult↗
PubMed2000

The circulating hormonal milieu of the endocrine pancreas in healthy individuals, organ donors, and the isolated perfused human pancreas.

Although basal circulating levels of individual islet cell hormones have been measured, few studies compared the molar ratios of the major hormones secreted by the endocrine pancreas. This study examined the basal levels of four major islet hormones: insulin, C-peptide (C-P), glucagon (G), and pancreatic polypeptide (PP) in normal subjects, in organ donors with brain death, and in the isolated perfused human pancreas. Basal blood samples were taken from normal, fasted control subjects (NCs). Pancreata were obtained from 17 organ donors (ODs) with donor portal vein (DPV) and radial arterial (DRA) blood samples taken before organ procurement. Single-pass perfusion was performed on the procured pancreata, and after rewarming and equilibration, basal samples were collected from the splenic vein (SV) for 30 min. Radioimmunoassays of insulin, C-P, G, and PP were performed on all samples, and basal levels of all hormones were expressed as a common unit, femtomoles per milliliter. The data suggest that in the basal state, these four major islet hormones circulate in a relatively constant molar ratio. The ratio of the hormones is altered in brain death and with in vitro perfusion of the pancreas. The isolated perfused human pancreas secretes a relatively constant molar ratio of these hormones; however, this ratio is markedly different from the circulating ratio seen in either the NC group or the OD group. We conclude that a relatively constant hormonal milieu is secreted from the normal endocrine pancreas, and this hormonal milieu is altered after brain death and with isolation and perfusion of the human pancreas.

Adult↗
PubMed2000

[Effectiveness of the treatment of arterial hypertension in a specialized service. An audit using the automatic measurement of arterial blood pressure].

UNLABELLED: The ineluctable fade out of mercury sphingomanometer pressure device involve the necessity in using automatic blood pressure systems. In parallel the recent PHARE II study witness of a lack in the control of hypertension in general practice. In the basis of an automatic blood pressure device measure, we had try to know the efficiency of blood pressure contrôl (BPC) in a specialised consultation. METHOD: 100 patients with essential systolo-diastolic hypertension (HTA) were screened. An independent physician measured the blood pressure level with an OMRON 705 CP device 3 times. The acceptable BPC was considered less than 160/95 mmHg and the optimal BPC less than 140/90 mmHg. There was 70 man, 30 female (mean age = 67 year old). The initial mean blood pressure was 169/104 mmHg. RESULTS: The final blood pressure measured was 137/80 mmHg. The percentage of patients who have an acceptable contrôl (< 160/95) was 91% and an optimal contrôl (< 140/90) 66%. 12% of these 66 maintain a height cardio-vascular risk. The mean number of medication used was 2 and it's paradoxally not differ between the optimal blood pressure control group and the other patients who need probably an intensive medication. In conclusion these study shows us the importance in understanding our patients particularity in order to increase the treatment efficiency.

Age Factors↗
PubMed1997

The hospital as business. How saving money can help save lives.

As hospitals and clinics merge into integrated delivery networks dependent for patients on health maintenance organizations, it is sometimes hard to remember who's on first. Instead of doctors, nurses, patients and hospitals, the world of health care now contains an alphabet soup of IDNs, HMOs, providers, consumers and payers. The changes extend deeply into the materials management department, where simply bargaining for the best price has been complicated by standardization, capitation, and a host of expense management strategies. Perhaps as a result of this ever-changing identity, most hospitals have yet to fully adopt the style and culture of the businesses they really are. Even purchasing managers, who are closer to the business end of the operation, are caught up in the traditional image. In the following comments, two experts in materials management explore the impact that this ambivalence has on a hospital's relationship with the outside world--including suppliers. Joseph Colonna is corporate vice president of the purchasing program at Shared Services Healthcare, Atlanta. Michael Garvin is an adjunct professor at the University of Iowa, and a researcher in medical supply purchasing practices.

Budgets↗
PubMed1993

Arterial ketone body ratio in pediatric liver transplantation.

Arterial ketone body ratio (AKBR) was measured serially in 49 pediatric orthotopic liver transplantations. The AKBR pattern correlated with hepatic synthetic function, as well as with short-term graft and patient survival. A rapid recovery pattern of AKBR to above 1.0 within 40 hr after reperfusion was associated with 94% graft and patient survival. Pediatric liver grafts were found to have better tolerance to low energy levels when compared with previously published data for adult OLT. The salvage rate of pediatric grafts exhibiting a slow recovery pattern (AKBR 0.7-1.0) was 71%. No recovery pattern (AKBR < 0.7) was seen in all 6 cases of primary nonfunction, and in 3 of 4 cases of early hepatic artery thrombosis (HAT). All these grafts were lost; however, 56% of the children in this group survived retransplantation. Unlike the PNF grafts, the no recovery pattern after HAT was characterized by gradual improvement of the synthetic function, despite the low energy state.

Arterial Occlusive Diseases↗
PubMed1988

The role of liver biopsy in evaluating acute allograft dysfunction following liver transplantation: a clinical histologic correlation of 34 liver transplants.

One hundred six liver biopsy specimens from 34 orthotopic liver transplant (OLT) patients were examined and the histologic findings correlated with the clinical course of the patients to determine if specific morphologic patterns were associated with specific causes of acute allograft dysfunction. The principle causes of allograft injury in these patients appeared to be acute rejection and ischemic injury, with rarer cases of viral infection and biliary obstruction. Graft rejection causing transient liver dysfunction was associated with a mixed inflammatory infiltrate in the portal tracts and involving the interlobular bile ducts. Rejection resulting in severe, persistent dysfunction was associated with destruction and loss of the interlobular bile ducts or portal inflammation, followed by acute centrilobular hepatocyte necrosis. Ischemic liver injury was characterized by hepatocyte ballooning and/or hepatocyte necrosis. Ischemic injury causing transient graft dysfunction demonstrated focal, limited areas of hepatocyte necrosis or transient centrilobular hepatocyte ballooning. Severe ischemic injury resulting in persistent dysfunction caused diffuse hepatocyte necrosis or centrilobular ballooning followed by centrilobular hepatocyte loss and severe cholestasis with evidence of bile duct epithelial injury. The histologic patterns observed were not pathognomonic; radiologic studies, bile cultures, and other laboratory tests were necessary to rule out biliary or vascular obstruction and bacterial cholangitis. However, liver biopsies, especially serial biopsies, were helpful in suggesting the probable cause of liver dysfunction and in predicting subsequent allograft recovery or failure.

Adolescent↗
PubMed1988

[Cardiac Doppler in the selection of patients for aortic valvuloplasty. Comparison with data of phonomecanograms].

Between December 1986 and August 1987, 34 patients referred for aortic valvuloplasty, undergo before catheterization an ultrasonocardiography with continuous and pulsed Doppler study and a phonocardiography for 22 of them. They all present functional and physical signs of aortic stenosis. The cardiac Doppler enables a positive diagnosis in all patients, while the phonocardiography recordings fail to recognize a tight aortic stenosis. On the other hand, the Doppler enables a diagnosis of severity well correlated with the catheterization (r = 0.88 for maximum instantaneous gradients) in 30 patients: in four patients, the correlation could not be calculated because of technical problems related to the catheterization (2 patients) or the ultrasonic examination (2 patients). From this study, it results that the cardiac Doppler may perfectly select patients who are to undergo an aortic valvuloplasty, unlike phonocardiography.

Adult↗
PubMed1980

[Contribution to the study of the phagocytosing ability of broncho-alveolar macrophages in smokers and non-smokers (author's transl)].

Broncho-alveolar macrophages were obtained by bronchial washing from 20 pairs of matched smokers and non-smokers. The following parameters were studied: phagocytosing ability of macrophages on silica in cell culture in the presence or absence of cotinin, a biocompound of nicotin; migration inhibitory factor (MIF), and power and level of alpha 1-antitrypsin in sera of patients. The results are reported as a function of absolute number of macrophages obtained, their viability, the amount of cigarettes smoked, and the action of cotinin. MIF was stronger in the smokers. There was no difference between the groups as far as power and level of alpha 1-antitrypsin are concerned. Cotinin provokes important lesions in the macrophages. The phagocytic power was not significantly different in smokers and non smokers, but the results were better in non-smokers.

Aged↗
PubMed1980

[Dermatoglyphics of subjects with bronchial cancers].

Every high smokers are not able to make a lung carcinoma, on the over hand nonsmokers can be able to develop a bronchial carcinoma. It is possible that genetic factors can be involved in the occurrence of this carcinoma. Dermatoglyphic studies are one of the technics to appreciate this problem. The study was done upon 37 bronchial carcinoma and 51 lung diseases (European origin, only man, same age). There are some big differences upon: --The Cummins index: the right index as well as the left are higher in bronchial carcinoma than in controls, but it is significative only for the right one (p less than 0,05) (28,89 +/- 3,7 to 26,88 +/- 4,55). --The frequency of the ten fingerprints: the differences between lung carcinoma and controls are highly significative (p less than 0,01) for the whorls (22,7 to 34,9) and slightly significative (p less than 0,05) for the ulna loops (65,4 to 57,4), the other fingerprints (arch, radial loops) are quite the same in the two groups. The studies upon the other figures (TFRC and the position of the axial tri-radius) do not show any differences. It seems to us that the dermatoglyphic studies of men with bronchial carcinoma differ from controls (hospitalized for lung diseases). These population have the same dermatoglyphic structure than a control population from blood donors of Marseilles. The dermatoglyphic studies can be an aid to identify high risk people.

Aged↗
PubMed1980

[Respiratory function profile in scleroderma. 20 cases (author's transl)].

This study involved 20 patients, 13 female and 7 male, with a mean age of 49 years, suffering from localized (6 cases) scleroderma or generalized without Raynaud's syndrome (6 cas), with Raynaud's syndrome (6 cas) or acrosclerosis (2 cases). Respiratory function tests included study of volumes, flow rates, CO transfer (TLCO) and blood gases. There were 38% normal chest X-rays, 58% ventilatory disturbances (predominance of restrictive syndrome and decrease in (TLCO) was found in only 25% of cases. The authors emphasize the extent of pulmonary vascular lesions in these patients.

Adult↗
PubMed1979

[Is long term medical follow up of tuberculous patients possible? (author's transl)].

Tuberculosis still remains a current disease, of difficult eradication as shown by numerous studies and epidemiological surveys. The authors studied 180 newly affected tuberculous patients admitted to Pr. Laval's department at Marseille and tried to discover why only 91 (50.6%) were still followed or could be traced 3 years after their first hospitalization. Five parameters were studied: origin, sex and age, living area, socio-economical data (change of address, lack of accomodation, profession), tobacco and alcohol addiction. No significant part was played by nationality, living area, or profession. On the other hand, changing of address, chronic tobacco and alcohol addiction were the factors responsible for loosing sight of the patients. An attempt to define this tuberculous patient, which would not be followed up for long, gave the picture of a 40 to 45 years old man, living in a hotel or with no fixed accomodation, smoking more than 20 cigarettes a day and drinking. Such a profile of a tuberculous patient should increase the watchfulness over likely ones.

Age Factors↗