Search PubMed⌕ Search

Biomedical subjects

J McCauley

Publications and source records attributed to J McCauley.

At least 109 records · Page 6Linked to original sources
PubMed1990

Kidney transplantation under FK 506.

The experimental immunosuppressive drug FK 506 was given to 36 renal transplant recipients, many of whom were highly sensitized. Ten were undergoing kidney retransplantation, 10 also underwent liver transplantation at an earlier time (6 patients) or concomitantly (4 patients), and 2 patients received a third organ (heart or pancreas) in addition to a liver and kidney. With follow-ups of 4 to 13 months, all but 2 of the 36 patients are alive, 29 (81%) are dialysis free, and most have good renal function. Twenty of the 29 dialysis-free patients are receiving no or low-dose (2.5 to 5.0 mg/d) prednisone therapy. Only one kidney was lost to cellular rejection. However, patients who had antidonor cytotoxic antibodies in current or historical serum samples had a high rate (3 of 9) of irreversible humoral rejection. A low incidence of posttransplant hypertension was noteworthy. Hirsutism and gingival hyperplasia were not observed. Serum cholesterol levels in patients who took FK 506 were unexpectedly low, and the effect on the level of uric acid was minimal. The side effects of FK 506 therapy include nephrotoxicity, neurotoxicity, and potential induction of a diabetic state. These are similar to the side effects of cyclosporine use, but probably less severe. The seeming safety, efficacy, and relative freedom from side effects of FK 506 encourage further trials in kidney transplantation.

Adult↗
PubMed1990

Acute and chronic renal failure in liver transplantation.

We have performed a retrospective review of the incidence and etiologies of acute renal failure (ARF) in 105 adult patients receiving liver transplants. The prevalence of chronic renal failure was also determined. ARF occurred in 94.2% of these patients. Acute tubular necrosis was the leading cause of ARF and was associated with the highest mortality. Factors associated with increased mortality included: (1) peak serum creatinine greater than 3 mg/dl, (2) multiple liver transplants and (3) the need for dialysis. Pretransplant renal failure did not increase mortality. Chronic renal failure developed in 83% of patients at latest follow-up (mean: 30.5 +/- 7.9 months).

Acute Kidney Injury↗
PubMed1990

Superior vena cava syndrome due to subclavian hemodialysis catheters.

The widespread use of subclavian dialysis catheters has revealed a high incidence of venous thrombosis and exposed their potential to cause major obstructive complications that may compromise permanent vascular access. We describe for the first time a patient who developed superior vena cava syndrome secondary to central vein stenosis caused by multiple uses of subclavian dialysis catheters. Central vein stenosis in our patient probably caused the failure of permanent vascular accesses in the upper extremities and rendered both arms useless for any further temporary or permanent vascular access. In view of these late vascular complications, use of subclavian dialysis catheters should be kept to a minimum by creating an early permanent vascular access.

Aged↗
PubMed1989

Exacerbation of aluminium encephalopathy after treatment with desferrioxamine.

Two haemodialysis patients with aluminium encephalopathy developed dramatic deteriorations of their neurological symptoms after initiation of desferrioxamine (DFO) therapy. Both patients were treated with relatively large doses of DFO (1 g and 2 g per treatment). In the first case, paranoid delusions, visual hallucinations, seizures and deteriorating speech followed each dialysis treatment with DFO. The second patient experienced increasing confusion, decreasing short-term memory, and deterioration in speech. In both cases the neurological symptoms regressed after decreasing or discontinuing the DFO. These patients demonstrate the potential dangers of using high doses of DFO. The pathogenesis of the exacerbation is not well understood but, may not simply be due to the result of elevated plasma aluminium levels after DFO therapy. We argue in this communication for reducing DFO in patients with aluminium encephalopathy to doses of 1 g three times per week to ensure adequate treatment of aluminium encephalopathy while minimising the risk of exacerbation from overzealous DFO administration.

Aged↗
PubMed1988

The effect of potassium ion depletion on postinfarction canine cardiac arrhythmias.

The effect of potassium ion (K+) depletion on postmyocardial infarction ventricular arrhythmias was investigated in 32 dogs: 12 control animals, 10 animals that ate a diet extremely low in K+ for 15 days, and 10 others that, in addition to dietary K+ deprivation, received 50 mg of hydrochlorothiazide four times. The experimental myocardial infarction was created by proximal left anterior descending coronary artery ligation. In a subgroup of 24 animals selected for relatively uniform size of myocardial infarction (14% to 22% of left ventricular mass), eight animals with mean cumulative K+ balance of -4.01 +/- 2.19 meq/kg developed spontaneous ventricular fibrillation within 4 to 17 min of coronary ligation, whereas 16 animals with a mean cumulative K+ balance of -0.11 +/- 1.82 meq/kg didn't. By univariate analysis cumulative K+ deficit (p = .001) and plasma K+ concentration (p = .039) correlated significantly with spontaneous ventricular fibrillation. Multivariate analysis of the entire population of 32 animals identified cumulative K+ deficit and size of myocardial infarction as the only independent predictors of ventricular fibrillation. Cumulative K+ deficit was also an independent predictor of ventricular fibrillation induced by programmed cardiac stimulation in the conscious state 1 day after myocardial infarction.

Animals↗
PubMed1987

Toluidine blue in the corroboration of rape in the adult victim.

Objective physical evidence to corroborate a claim of rape is frequently absent. Genital lacerations are considered evidence that rape has occurred. In this study, toluidine blue dye, a nuclear stain, was used to detect vaginal lacerations. The detection of vaginal lacerations in reported rape victims increased from one in 24 to 14 in 24 with toluidine application. Toluidine blue increases the detection of perineal lacerations in adult rape victims and the presence of lacerations is supportive of the documentation of rape.

Adult↗
PubMed1986

Toluidine blue in the detection of perineal lacerations in pediatric and adolescent sexual abuse victims.

Posterior fourchette lacerations are suggestive of sexual assault, and toluidine blue dye has increased the detection of these lacerations in adult rape victims. This study investigated the use of toluidine blue dye in the pediatric (0 to 10 years) and adolescent (11 to 18 years) patients to detect posterior fourchette lacerations in sexually abused and control populations. Application of toluidine blue dye increased the detection rate of posterior fourchette lacerations from 4% (1/25) to 28% (7/25) (P less than .05, Fisher exact test) in adolescent sexually abused patients and from 16.5% (4/24) to 33% (8/24) (P = .318, Fisher exact test) in pediatric sexually abused patients. Posterior fourchette lacerations occurred with the same frequency in sexually abused adolescents and sexually active controls adolescents. In the pediatric aged population, 33% of the sexually abused group had lacerations detected, whereas none of the control patients had lacerations. The presence of posterior fourchette lacerations in the pediatric aged patient is strongly suggestive of sexual abuse. Toluidine blue increases the detection of posterior fourchette lacerations in children and adolescents (P less than .001, Fisher exact test). The application of toluidine blue dye to highlight posterior fourchette lacerations is an important addition to tools already used in the evaluation of the sexually abused patient.

Adolescent↗
PubMed1985

Assessment of cervical carotid artery disease. A comparison between the Doppler "Echoflow" and conventional angiography.

Carotid artery disease is an important factor in the aetiology of stroke and cerebrovascular insufficiency. Angiography remains the definitive technique for the investigation of the carotid arteries, but the risk and expense involved has stimulated research into suitable non-invasive techniques. A comparison between a velocity-sensitive, colour-coded Doppler principle ultrasound flowmeter (Echoflow) and conventional angiography was conducted on 52 patients (101 arteries) investigated at Royal Perth Hospital over a 16-month period. An acceptable correlation was found in 78% of cases. Echoflow scanning proved to be particularly accurate in assessing normal arteries. Our results support the use of Echoflow as a first line of investigation, and in aiding the selection of cases requiring further study, although we caution against routine angiography in all patients with positive Echoflow scan results.

Adult↗
PubMed1985

Family awareness demonstrated by family practice residents: physician behavior and patient opinions.

Audiotapes of the visits of 50 new patients with 20 family practice residents were analyzed to determine how aware the residents were of their patients' families. The same patients' opinions about family awareness were elicited by interviews. Residents exhibited only limited family awareness. Despite this, patients thought that the residents showed more interest in family matters than they usually expected from a family physician. Patients thought the physicians were most interested in their family situations when they asked more questions about family matters. Physicians were seen as least interested when they asked few family questions and when they were absent from the examination room for a relatively high proportion of the visit. Physicians were much less likely to discuss family matters with a patient during a short visit for an acute problem than during a longer visit for a chronic problem or for health maintenance. Most patients identified physician attitudes and behaviors as more important obstacles to the discussion of family matters than patient attitudes. Patients generally wanted substantially more help from their family physician for family problems than they expected to receive.

Adult↗
PubMed1985

Social supports and stress as predictors of illness.

The incidence and pattern of self-reported illness were studied over a six-month period in panels of 292 women and 188 men categorized by their experience of stressful life changes and their perceived supportive relationships. Men and women with more than average stressful changes had a risk of illness 1.6 and 1.8 times that reported by those with below-average changes. Analysis of the interaction of stressful changes with social supports showed that women with a combination of high changes and low supports experienced 2.5 times the rate of illness as those with low changes and high supports. This interaction was not found for men. A monthly rating of perceived life stress was correlated with subsequently recalled life changes for both men and women. The findings for women are consistent with the hypothesis that the interaction of stress with degree of social support is an important predictor of illness experience.

Adult↗