Search PubMed⌕ Search

Biomedical subjects

J M Barry

Publications and source records attributed to J M Barry.

At least 73 records · Page 4Linked to original sources
PubMed1990

Monoclonal antibody OKT3 therapy in pediatric kidney transplant recipients.

Thirty-one pediatric patients with acute renal allograft rejection were treated with the monoclonal antibody OKT3. In 24 cases, increased doses of steroids followed by a polyclonal antithymocyte globulin were ineffective in reversing the rejection episode. Twenty-eight patients completed the prescribed minimum 10-day treatment course, with effective rejection reversal in 22. Three patients failed to complete the course of therapy: one because of leukopenia that developed after the first dose, one because of a clotted graft, and another because of symptomatic cytomegalovirus infection. The overall success rate of OKT3 for rejection reversal was 74%; however, 55% of recipients had rebound rejection, and 85% of patients had detectable anti-OKT3 antibodies after completion of the course of therapy. Ten patients were treated with a second course of OKT3, and in eight of these patients, rejection was at least temporarily reversed. The starting dose of OKT3 for second-course therapy was the same as that used during first-course therapy, but in five cases the dose was increased during the course because of inadequate therapeutic response. Seven of these patients lost their grafts a mean of 6.5 months after completion of second-course therapy. We looked for anti-OKT3 antibody in nine recipients after completion of a second treatment course and found it in all nine. Our observations regarding a second treatment course with this monoclonal antibody preparation suggest that although rejection reversal may be observed, ultimate graft survival is poor and anti-OKT3 antibody formation is enhanced.

Acetaminophen↗
PubMed1990

A comparison of 2 protocols for living-related renal transplantation in children: donor-specific transfusions versus cyclosporine.

We analyzed the results obtained with protocols for immunosuppression of pediatric recipients of haploidentical living-related renal transplants. In the donor-specific transfusion group transfusion of blood products obtained from the prospective organ donor was performed before transplantation, and at transplantation maintenance immunosuppression of azathioprine and prednisone was begun. In the cyclosporine group donor-specific transfusion was not used, and maintenance immuno-suppression of cyclosporine and azathioprine was begun 1 week before transplantation, with the addition of prednisone at transplantation. Of 24 donor-specific transfusion recipients 3 had circulating cytotoxic antibodies to the prospective donor for an incidence of 12%. There was no significant difference between groups with respect to 1-year actual patient and graft survival (100 and 89 versus 100 and 86%, respectively), 1-year mean serum creatinine level (1.1 versus 1.2 mg./dl.), rejection treatments per patient (2.5 versus 2.6) and total days hospitalized during year 1 after transplantation (27 versus 18), with donor-specific transfusion data presented first. Initial hospitalization was significantly shorter (10 versus 16 days, p less than 0.05) and the incidence of rejection crises within 3 months was significantly less (68 versus 94%, p less than 0.05) in the cyclosporine group. We believe that cyclosporine and azathioprine pre-treatment of pediatric recipients of haploidentical living-related renal transplants with the addition of prednisone at transplantation is preferable to a donor-specific transfusion protocol because there is no risk of recipient sensitization to the prospective donor, and patient and graft survival is not adversely affected.

Azathioprine↗
PubMed1990

De novo carcinoma of the lower urinary tract in renal allograft recipients.

Immunocompetence has been postulated as an important defense against the progression of urothelial carcinoma. Three cases of de novo lower urinary tract carcinoma in renal transplant recipients demonstrated the potential for unusually rapid urothelial extension and invasion in chronically immunosuppressed patients. Two patients had a history of perineal condyloma acuminata; tumors from 1 of these harbored the genetic sequences of human papillomavirus type 6. One patient had multiple manifestations of cyclophosphamide-related urothelial injury, including bladder carcinoma. Treatment of 2 patients culminated in a radical operation during which the remaining native urinary system was resected completely, with sacrifice of the allograft kidney in 1 and diversion into an ileal conduit in 1. The remaining patient underwent urethrectomy and partial cystectomy with a sigmoid conduit.

Adult↗
PubMed1990

Acute lumbosacral plexopathy in diabetic women after renal transplantation.

Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Within 24 hours of surgery they complained of ipsilateral buttock pain, numbness in the leg and weakness below the knee. This complication has not been observed in nondiabetic patients at our institution, nor in diabetic patients when the internal iliac artery was not used. However, lumbosacral plexopathy occurred in 4 of 27 (14.8%) female patients with insulin-dependent diabetes mellitus when the internal iliac artery was used (p less than 0.001). Age, duration of insulin-dependent diabetes mellitus, hypertension, cigarette smoking history and kidney donor were not significant predictors of this complication. This unusual and newly recognized complication appears to result from ischemia of the lumbosacral plexus following ligation of the internal iliac artery in patients with severe small vessel disease.

Acute Disease↗
PubMed1990

Ten years of training community urologists and general surgeons to do cadaver kidney retrievals.

We trained 82 community hospital cadaver kidney retrieval teams during a 10-year period ending June 30, 1987. During the last 5 years of that period the concept of multiple organ retrieval was introduced into the training sessions and 429 cadaver kidney grafts were retrieved. Of those kidneys 292 were transplanted at our hospital, and the function of 220 cadaver kidney grafts retrieved by the community hospital teams was compared to that of 72 retrieved by the transplant center retrieval team. Of the cadaver kidney transplants 114 were from multiple organ donors. There was no significant difference in 1-month serum creatinine nadir of surviving grafts (2.1 +/- 1.8 versus 1.9 +/- 1.7 mg. per dl.), 6-month serum creatinine level (1.7 +/- 0.8 versus 1.6 +/- 0.6 mg. per dl.), 12-month serum creatinine level (1.8 +/- 0.9 versus 1.6 +/- 0.6 mg. per dl.) and 5-year actuarial graft survival (44.8 +/- 4.1 versus 52.4 +/- 7.5%), with the community hospital data presented first. The delayed graft function rate was significantly higher in the recipients of cadaver kidney grafts retrieved by community hospital teams (54 versus 35%), which was reduced by the in situ flush technique. There was no significant difference in delayed graft function rate (48 versus 40%) for the 114 cadaver kidney transplants retrieved from multiple organ donors by either community hospital or transplant center teams. With continuing education and quality control, community hospital retrieval teams can provide kidneys satisfactory for transplantation, even when working with multiple organ retrieval teams.

Actuarial Analysis↗
PubMed1990

The predictive accuracy of staging transurethral resection of the prostate in the management of stage A cancer of the prostate: a comparative evaluation.

The role of staging transurethral resection of the prostate in the management of stage A prostate cancer is controversial. The accuracy of staging transurethral resection, A1/A2 substaging and probability of progression tables for predicting cancer progression was evaluated in untreated patients with stage A adenocarcinoma of the prostate who were followed for at least 5 years. Survival free of disease was predicted correctly in 93% of 52 patients who underwent staging transurethral resection of the prostate, 92% of 96 with the probability tables and in 85% of 96 using a common criteria for A1 and A2 substaging. Staging transurethral resection of the prostate upgraded patient risk in 7% of the low risk patients predicted by the probability tables and 14% of the stage A1 cancer patients. Staging transurethral prostatectomy and the probability of progression tables were more accurate in predicting survival free of disease than the A1/A2 substaging system. Comparison of the predictive accuracy of staging transurethral prostatectomy to that of the probability of progression tables showed no significant difference. There was no additional benefit from combining the 2 methods. When the probability of progression tables are used to predict cancer progression it may be unnecessary to use staging transurethral resection of the prostate in the patient with stage A prostate cancer.

Adenocarcinoma↗
PubMed1989

Transplant techniques applied to general urology.

Described herein are renal transplant techniques which have been successfully applied to general urology patients. These include surface and core cooling of the kidney, autotransplantation, renal vein translocation, the use of a transcutaneous stent for upper urinary tract repairs, and an unstented, parallel incision, extravesical ureteroneocystostomy.

Adult↗
PubMed1989

Visual urethrotomy in the management of the obliterated membranous urethra.

Delayed direct-vision internal urethrotomy is a reasonable first treatment of the traumatically obliterated posterior urethra. Postoperative continence is achieved if the bladder neck is competent on preoperative cystogram. Simultaneous suprapubic and transurethral instrumentation most accurately define the length of obliterated urethra, and rectal examination determines any prostatic displacement. Half the patients will require repeat endoscopic surgery for significant stricture, and all require long-term follow-up to assure urethral patency. Potency is not affected by the procedure. Urethrotomy failure should not preclude a subsequent open procedure.

Adult↗
PubMed1988

Time-related recurrence rates in patients with upper tract transitional cell carcinoma.

Disagreement exists about the necessity and frequency of contrast medium imaging of the upper urinary tract in patients with transitional cell carcinoma. During a 10-year period 39 patients were treated for upper urinary tract transitional cell carcinoma. There were 3 contralateral recurrences in 33 patients treated by nephroureterectomy for the initial lesion. Of 4 patients treated initially by segmental ureterectomy or partial renal pelvectomy 1 had an ipsilateral recurrence 3 years later. Two patients with bilateral upper tract transitional cell carcinoma were treated by simple nephrectomy combined with simultaneous contralateral segmental ureterectomy or renal pelvectomy. Both patients had no evidence of recurrent tumor after 4 years of followup. Of the 39 patients with upper tract transitional cell carcinoma 6 had multiple bladder tumors or carcinoma in situ documented on biopsy before the development of an upper tract tumor. The interval between the treatment for the last bladder tumor or carcinoma in situ was 1 year in 4 patients, 2 1/2 years in 1 and 5 years in 1. Of these 6 patients 2 had bilateral upper tract tumor occurring at different times. Both patients had multiple bladder tumors diagnosed between the development of each upper tract lesion. Annual contrast medium imaging of the upper urinary tract is recommended in patients who have had multiple bladder tumors and in those who have undergone treatment for upper urinary tract transitional cell carcinoma.

Carcinoma, Transitional Cell↗
PubMed1988

Renal function 27 years after unilateral nephrectomy for related donor kidney transplantation.

Renal function in a living related kidney donor was evaluated 27 years after unilateral nephrectomy. The patient was normotensive and had no significant proteinuria. Creatinine was 0.8 mg. per dl. and creatinine clearance was 88 ml. per minute per 1.73 m.2 or 152 per cent of the single kidney pre-nephrectomy value. Tubular function assessed by the ability to lower urinary pH in response to an acid load was normal. Biopsy of the transplanted kidney 18 years after donation was histologically normal. This case represents one of the longest followup evaluations of a living related donor reported to date and it argues against any adverse effects of organ donation on the function of the remaining kidney.

Adult↗
PubMed1988

Ultrasonically determined kidney transplant hypertrophy.

Increased renal transplant size is a criterion of acute rejection. Statistically significant increases in ultrasonically measured kidney graft dimensions were demonstrated in 8 recipients of living related donor kidneys who never had rejection crises. After an average followup of 4.9 +/- 3.8 months (range 2 to 12 months), anteroposterior, cross-sectional and pole-to-pole measurements were increased by 0.75, 1.9 and 0.58 cm., respectively. Some increase in kidney graft size is normal and should not be confused with acute rejection.

Adult↗
PubMed1988

The use of OKT3 in cadaveric renal transplantation for rejection that is unresponsive to conventional anti-rejection therapy.

Thirty-one recipients of cadaver kidney transplants were given OKT3 monoclonal anti-T cell antibody for rejection treatment after conventional therapy had failed. Seventy-four percent of steroid or steroid and antithymocyte globulin (ATG) resistant rejections reversed with a standard course of OKT3. Rejections reversed in 85% of 26 patients treated within 90 days of transplantation. Late rejections treated more than 90 days after transplantation were poorly responsive to OKT3 and graft survival for this group of five patients was poor (20%). However, for those patients treated with OKT3 for early resistant rejection, actuarial 4-year graft survival was 66%. Actuarial 4-year patient survival was 97%, and the incidence of serious infection was low. Acute rejections in cadaver transplantation are common and a small percentage of rejections are resistant to steroids and ATG. OKT3 has proven to be useful for reversing these resistant rejections without causing significant morbidity from infection or death.

Adolescent↗
PubMed1988

Significance of delayed graft function in cyclosporine-treated recipients of cadaver kidney transplants.

Many transplant teams are reluctant to initiate cyclosporine immunosuppression in recipients of cadaver kidney grafts with delayed graft function (DGF). The renal function of cadaver kidney grafts in cyclosporine-treated recipients was compared in 47 recipients with DGF and 57 without DGF. Regardless of initial renal function, all recipients received prednisone, azathioprine, and oral cyclosporine 5 mg/kg/day or its intravenous equivalent. All kidneys were flushed with ice-cold intracellular electrolyte solution and cold-stored for 15-54 hr (mean of 31 hr) prior to transplantation at our hospital between April 10, 1985 and November 30, 1986. Rejection crises were treated with high-dose steroids or OKT3. Cyclosporine was discontinued during courses of OKT3. Recipients with DGF had significantly higher one-month serum creatinine nadirs (2.6 +/- 1.8 mg/dl vs. 1.5 +/- 0.5 mg/dl). Actuarial graft survivals were not significantly different at one year (82.2 +/- 5.5% vs. 82.6 +/- 6.4%, all graft losses included). Mean serum creatinine levels at six months and twelve months after grafting were not significantly different (1.7 +/- 0.4 mg/dl vs. 1.8 +/- 1.2 mg/dl and 2.0 +/- 0.5 vs. 1.7 +/- 0.7 mg/dl, respectively). Delayed graft function following cadaver kidney transplantation does not adversely affect intermediate term function of kidney grafts flushed with intracellular electrolyte solution and cold-stored until transplantation when a low-dose cyclosporine induction protocol is used and cyclosporine is discontinued during OKT3 administration.

Cadaver↗