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Biomedical subjects

J E Codd

Publications and source records attributed to J E Codd.

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

Selective posttransplantation bilateral native nephrectomy. Indications and results.

Twenty-five patients underwent bilateral native nephrectomy one to 68 months (mean, 15.6 months) following renal transplantation. The indications were erythrocytosis in two patients, recurrent urinary tract infection in three, medically uncontrolled hypertension in 18, and hypertension and urinary tract infection in two. One patient died two months after the nephrectomy, and one allograft was lost because of acute tubular necrosis. Both patients with erythrocytosis had prompt return of the hematocrit level and RBC mass to normal. Native nephrectomy eradicated the infection in each of the five patients with recurrent urinary tract infections. Results of nephrectomy for hypertension were classified as excellent in six patients, good in nine, and poor in four. Native renal-vein renin ratios of patients with excellent or good responses were not statistically different when compared with those of poor responders.

Adult↗
PubMed1983

Recipient race as a risk factor in renal transplantation.

We analyzed 118 renal transplants performed from November 1977 through October 1981 to determine the effect of recipient race on graft and patient survival. Fifty-one cadaver and three living related transplants were performed in the black recipients and 41 cadaver and 23 living related transplants in the white recipients. No significant differences existed between the groups in regard to age, incidence of pretransplant nephrectomy or splenectomy, warm ischemia time, perfusion time, panel-reactive alloantibody (PRA) status, or number of pretransplant blood transfusions. The mean HLA-A and -B locus match was significantly less in black cadaver recipients and the incidence of malignant hypertension was significantly greater in black recipients. The one-year graft survival rate was 54.9% for black cadaver recipients and 48.7% for white cadaver recipients with a corresponding patient survival rate of 86.2% and 85.3%. The one-year graft survival rate for living-related recipients was 100% for blacks and 73.9% for whites with a corresponding patient survival rate of 100% and 86.9%. These results were not significantly different. When the recipients were matched for age, pretransplant transfusions, HLA-A and -B locus matching, and PRA status, no difference in transplant outcome was identified. We concluded that recipient race is not of prognostic significance in determining the outcome of either cadaver or living related donor transplantation.

ABO Blood-Group System↗
PubMed1983

The effects of ATP-MgCl2 and dipyridamole in cold-storage preservation.

The effects of ATP-MgCl2 and dipyridamole were evaluated in a canine model. Twenty-five adult mongrel dogs were divided into five equal groups. All dogs underwent left nephrectomy and 30 min of warm ischemia followed by Collins' C-4 flush and 24 hr of cold-storage preservation. Heterotopic autotransplantation and immediate contralateral nephrectomy were then performed. Group A served as controls; Group B was pretreated with intravenous ATP-MgCl2 (2.5 mM); Group C with intravenous dipyridamole (10 mg), and Group D with both ATP-MgCl2 (2.5 mM) and dipyridamole (10 mg). Group E was treated with ATP-MgCl2 (2.5 mM) at the time of transplantation. All kidneys underwent cortical biopsies at the end of preservation and 1 hr after restoration of blood flow for determinations of AMP, ADP, and ATP. In Groups A and E there were no survivors, whereas Groups B, C, and D had 40, 60, and 40% graft survival. In Groups B and D, ATP and energy charge (EC) were greater than that of controls after 24 hr of preservation, with Group D values being significantly greater (P less than 0.01). AMP and ADP levels were significantly greater (P less than 0.02) in Group C when compared to Group A. One hour posttransplantation biopsies demonstrated greater ability to regenerate cortical nucleotides in the surviving animals, but no absolute value could be identified as a predictor of viability. In conclusion, pretreatment with ATP-MgCl2 or dipyridamole maintains intracellular nucleotide levels and has a beneficial effect on graft survival in ischemically injured kidneys undergoing cold-storage preservation.

Adenine Nucleotides↗
PubMed1983

Renal allograft accumulation of Tc-99m sulfur colloid: temporal quantitation and scintigraphic assessment.

Renal allograft accumulation of Tc-99m sulfur colloid (TSC) was studied using visual assessment of scintigraphic displays and a quantitative temporal model in 210 examinations of 56 transplant recipients. The quantitative temporal model related the immediate pool of the radioagent in the transplant to the fixed allograft accumulation of TSC at 20 minutes after administration. Examinations performed less than 3 days after grafting or steroid pulse therapy were excluded. Rejection was established by clinical and biochemical evaluation in all 84 examinations that showed acute or chronic allograft rejection. Rejection was accurately diagnosed by visual scintigraphic assessment in 82% of the established cases; this improved to 99% with relative temporal quantitation analysis. Sensitivity improved from 78% by visual examination to 95% with temporal quantitation and specificity improved from 83% to 100%.

Graft Rejection↗
PubMed1982

Etiology and management of bovine graft aneurysms.

From April 1975 to September 1980, 16 symptomatic bovine graft aneurysms were identified in 200 grafts used for long-term hemodialysis. Aneurysms occurred in five (3.6%) straight forearm grafts, two (33%) reversed forearm grafts, two (33%) straight thigh grafts, and seven (18.9%) upper arm grafts. Mean blood pressures were similar in the aneurysm and non-aneurysm groups (142/81 vs 153/83 mm Hg). At operation, the aneurysms were determined to be true in three patients and false in 13. Five patients were treated by graft ligation and aneurysm excision and 11 by aneurysm excision and graft revision, with additional graft survivals of one to 25 months. In conclusion, bovine graft aneurysms are usually false and are more frequent in proximal grafts. In the absence of infection, resection is indicated and will result in considerable prolongation of graft survival.

Animals↗
PubMed1982

Peptic ulcer disease following transplantation: the role of cimetidine.

Of 253 consecutive renal transplants performed in 209 patients between January 1971 and December 1980, symptomatic gastroduodenal ulcerations developed in 22 (8.7 percent). Time of presentation ranged from 5 days to 9 years (mean 225 days) following transplantation with 16 of these patients presenting within the first 3 months. Nine (Group I) patients were diagnosed before the administration of H2 antagonist cimetidine. Mode of presentation in this group was upper gastrointestinal bleeding in each instance. Thirteen patients (Group II) were diagnosed after the clinical use of cimetidine was established. The mode of presentation in this group was bleeding in 11 patients and abdominal pain in 2 patients. In Group I, one patient died from liver failure and an ulcer was not contributory. The remaining eight patients were treated with antacids and blood transfusions (mean 12.7 units). Five patients in this group demonstrated ulcer healing, whereas three patients (37.5 percent) required emergency operations with two postoperative deaths. In Group II, one patient died from hemorrhagic shock before therapy could be instituted. In the other 12 patients treatment consisted of antacids, cimetidine, and blood transfusions (mean 6.8 units). Ten patients had relief of symptoms, whereas two patients (16.7 percent) required emergency operations with no deaths. During cimetidine therapy, two patients had rejection episodes that were reversible, and the remaining patients had no significant alterations in renal function. To conclude, cimetidine is a safe and effective adjunct in the treatment of peptic ulceration in renal transplant recipients.

Cimetidine↗
PubMed1982

Coronary artery stenosis following aortic valve replacement and intermittent intracoronary cardioplegia.

From July, 1977, to July, 1980, intermittent cold blood potassium cardioplegia was used in 208 patients undergoing aortic valve replacement. Aortic root injection of the cardioplegic solution at 10 degrees C was followed every 20 to 30 minutes by infusions of the solution through Silastic cannulas sutured in the coronary orifices or reinserted with each injection. Symptoms of myocardial ischemia developed in 6 patients 3 to 30 months postoperatively. Coronary angiography confirmed new stenoses of the left orifice (3 patients), left main trunk (1 patient), left anterior descending coronary artery (2 patients), circumflex coronary artery (1 patients), and right orifice (3 patients). Four patients underwent saphenous vein grafting procedures, with 2 deaths; 2 patients refused reoperation. A seventh patient with 80% stenosis of the circumflex coronary artery and a posterolateral myocardial infarction died 2 months after double-valve replacement. Intermittent cold blood potassium cardioplegia instead of continuous perfusion did not prevent coronary arterial injury. Injuries occurred in the distal coronary arteries as well as the orifices and were not prevented by withdrawal of the cannulas between injections. Tight-fitting cannulas and high-pressure injection should be avoided. A careful search for coronary arterial injury should be made in all symptomatic patients following aortic valve replacement.

Adult↗
PubMed1981

Renal cortical levels of adenosine triphosphate: restoration after prolonged ischemia by in situ perfusion of ATP-MgCl2.

The metabolic consequences of low-temperature kidney preservation by pulsatile perfusion and cold storage were evaluated in canine kidneys by serial adenosine triphosphate (ATP) determinations. Serial cortical ATP levels were determined (1) after optimal harvest, (2) after 60 minutes of warm ischemia, and (3) after 60 minutes of warm ischemia followed by an intra-aortic infusion of ATP-MgCl2. After 24 hours of preservation, cortical ATP levels were significantly greater when pulsatile perfusion was used-both after optimal harvest and after 60 minutes of warm ischemia. Cortical ATP levels were significantly greater at 24 hours in both perfused and cold-storage kidneys when an intra-aortic infusion of ATP-MgCl2 was used following ischemia. These results may explain the 24-hour limitation of cold storage as well as its inferior results following ischemia injury. Furthermore, since ATP is critical in cellular metabolism, the technique of intra-aortic ATP-MgCl2 infusion warrants further investigation in the field of organ preservation.

Adenosine Triphosphate↗
PubMed1981

Continuous hydralazine infusion for afterload reduction.

Impedance reduction with a continuous infusion of hydralazine was evaluated in 20 patients following cardiopulmonary bypass. Patients were selected for therapy when the cardiac index (CI) was less than 2.2 L/m2/min, when the systemic vascular resistance index (SVRI) was greater than 2,500 dyne sec cm-5, or when both conditions were present. No other vasoactive or cardiotonic drugs were used intraoperatively or postoperatively. Responses were measured at 15, 30, 60, 120, 180, and 240 minutes and compared with control measurements. Significant responses appeared by 15 minutes in the mean arterial pressure, CI, and SVRI, which were maximal by 2 hours. At 4 hours, the SVRI was 1,520 +/- 276 dyne sec cm-5 (control, 3,235 +/- 222) and pulmonary vascular resistance index, 365 +/- 102 dyne sec cm-5 (control, 592 +/- 71). The CI was 3.20 +/- 0.29 L/m2/min (control, 1.96 +/- 0.16) and mean arterial pressure, 75 +/- 2.3 mm Hg (control, 92 +/- 2.4). Left atrial, pulmonary artery diastolic, and right atrial pressures increased from control but not significantly: 11.4 +/- 0.8 to 13.3 +/- 1.2 mm Hg, 13.6 +/- 1.6 to 17.2 +/- 1.5 mm Hg, and 6 +/- 1.6 to 9.4 +/- 1.7 mm Hg, respectively. In 16 patients, hydralazine was continued for 24 hours and in 11, the transition to oral therapy was made. Hydralazine by infusion effectively reduces after load, avoids the fluctuations of bolus therapy, and allows the transition to oral therapy if needed.

Blood Pressure↗
PubMed1981

Left main equivalent: results of medical and surgical therapy.

Stenosis of at least 50% of both the left anterior descending and circumflex coronary arteries proximal to their major branches has sometimes been called left main equivalent (LME) disease. During a 4-year interval, 189 LME patients were identified as surgical candidates by angiographic criteria. Coronary artery bypass grafting (CABG) was performed in 119 patients; 70 patients were managed nonoperatively. Treatment assignment was nonrandom. During the same interval, 203 patients with significant left main coronary artery (LMCA) stenosis and 742 patients with three-vessel disease without LMCA or LME stenosis underwent CABG. Follow-up is 99.2% complete at an average of 48 months (range 24--73 months). Operative mortality was significantly higher among LMCA patients (4.0%) than among LME surgical patients (0.8%) (p less than 0.05). Cumulative 5-year survival was better among LME surgical patients (98.2 +/- 1.3%) than among LME medical patients (75.9 +/- 5.7%) (p less than 0.0001) or LMCA surgical patients (92.8 +/- 2.1%) (p less than 0.03). All operative patient groups had a significantly lower incidence of myocardial infarction (10.3--13.4%) than the LME medical patients (25.7%) (p less than 0.05). Relief of angina was also significantly better in the operative groups (61--67.6%) than in LME medical patients (36%) (p less than 0.005). Major differences exist between LME and LMCA patients; LME is more properly considered a variant of multivessel coronary artery disease. Results of medical and surgical therapy suggest that patients with LME disease should be strongly considered for early operative therapy.

Aged↗
PubMed1980

In situ cold perfusion of kidneys for transplantation. An experimental and clinical evaluation.

Cadaver kidneys from donors who have sustained cardiac standstill are often unsuitable for transplantation due to prolonged warm ischemic time. In an attempt to increase the salvage rate of these kidneys, the efficacy of in situ intra-aortic cold perfusion in producing immediate function of allografted kidneys was assessed in the nonheart beating canine model. In the first experiment, kidneys harvested after cardiac standstill and immediate intra-aortic cold perfusion were demonstrated to function equally as well as kidneys harvested "optimally." In the second experiment, evaluation of intra-aortic cold perfusion on renal core temperature demonstrated rapid cooling of these kidneys to a protective range. Early clinical results in donors whose kidneys were removed after cardiac arrest demonstrate that most of the kidneys allotransplanted after in situ intra-aortic cold perfusion functioned immediately. These preliminary experimental and clinical results demonstrate the effectiveness of in situ intra-aortic cold perfusion. Wider application of this technique to donors with cardiac standstill should increase the available organs for transplantation.

Animals↗
PubMed1980

Clinical experience with cold blood as the vehicle for hypothermic potassium cardioplegia.

Intermittent cold ischemic arrest was compared with hypothermic potassium cardioplegia using cold blood as the vehicle in two consecutive series of patients having isolated coronary bypass grafting. Between January 1, 1977, and June 30, 1977, 196 patients were operated on using cold ischemic arrest. The incidence of perioperative infarction was 14.3%, and mean total myocardial ischemia time was 42 +/- 1.2 minutes. From July 1, 1977, to June 30, 1978, there were 428 operations done using cold blood with potassium. The incidence of perioperative infarction was 5.6% (p less than 0.005), and the mean total myocardial ischemic time was 80 +/- 2.1 minutes. In the five years prior to this study, the incidence of perioperative infarction was constant at 13% while operative mortality was declining from 5 to 1% and the need for postoperative myocardial support was declining also. Use of cold blood potassium cardioplegia compared with cold ischemic arrest for myocardial protection during coronary artery operations has significantly reduced the incidence of perioperative infarction while doubling cross-clamp time.

Aspartate Aminotransferases↗
PubMed1980

The rationale for operative therapy of symptomatic single-vessel coronary artery disease.

During an 8 year interval, 184 patients with symptomatic single-vessel disease underwent coronary artery bypass grafting (CABG). There were no operative deaths and only one late cardiac death (5 year cumulative survival 97.9%). At 48 months mean follow-up, 91% are angina free or improved. The low incidence of perioperative and late myocardial infarction (MI) and the preservation of ventricular function seen on follow-up catheterization suggest that coronary bypass operations yield significant benefits in severely symptomatic patients with single-vessel disease. Evidence is presented which supports the idea that single-vessel coronary artery disease may be a unique manifestation of coronary atherosclerosis and not one stage in a continuum.

Angiocardiography↗