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Biomedical subjects

J P Isbister

Publications and source records attributed to J P Isbister.

At least 55 records · Page 3Linked to original sources
PubMed1983

Multiple myeloma with renal failure. A case for intensive treatment.

A series of nine consecutive patients with multiple myeloma and renal failure is presented. All patients were treated with urinary alkalinisation with sodium bicarbonate and/or acetazolamide, diuresis with saline, mannitol and/or furosemide, pulse melphalan and prednisone and, where indicated, allopurinol and aluminium hydroxide. A substantial and sustained improvement in renal function has been achieved in all nine patients. Of five patients with a urea more than 25 mmol/L at presentation, the median survival to date is 64 weeks. Of these patients only one has died --not from renal failure but pneumonia, eighteen months after presentation. The others are alive and well. The results confirm the effectiveness of these measures in both improving renal function and prolonging survival, and suggest a more optimistic prognosis for patients with multiple myeloma and renal failure.

Adult↗
PubMed1983

A rational approach to crossmatching blood for elective surgery.

A group-and-screen system was introduced for selected surgical procedures to improve the cost-effectiveness of the hospital blood transfusion service. The mean crossmatch-transfusion ratio for eleven procedures was 11.1 but fell to 3.3 after the change. The overall crossmatch-transfusion ratio in the hospital improved from 2.7 to 2.2 (p less than 0.001) and blood wastage by expiry fell from 12% to 5% (p less than 0.02). The mean age of blood being transfused also improved slightly from 12.3 days to 10.4 days (p less than 0.001). No problems have arisen from the group-and-screen system to date. It has led to improvement in the efficiency and cost-effectiveness of the hospital blood bank and resulted in fresher blood being transfused.

ABO Blood-Group System↗
PubMed1982

Incidence and causes of hyperbilirubinaemia in a hospital population: with particular reference to blood transfusion.

We surveyed a large hospital population of patients to establish the incidence and causes of hyperbilirubinaemia. In a review of 6890 patients, we found an overall incidence of hyperbilirubinaemia of 9%. We reviewed the case histories of 175 patients with hyperbilirubinaemia to analyse the causes and contributory factors. In 22% of patients with hyperbilirubinaemia, hepatobiliary disease was the sole cause and was a contributory cause in another 7%. Disorders of oxygen transport were the single most common cause of hyperbilirubinaemia, being the sole cause in 38% of patients and a contributing cause in a further 9%. Blood transfusion was the sole cause of elevation in bilirubin level in only three patients (1.7%), but was a very significant contributing factor in a further 18%. It is likely that Gilbert's syndrome was a contributing factor in some cases but, as there is no definitive test for diagnosis, clear identification was not possible.

Australia↗
PubMed1981

Respiratory failure due to leukostasis in leukaemia.

A case is presented in which leukostasis, which followed splenectomy for chronic granulocytic leukaemia in metamorphosis, was associated with respiratory failure. The pathophysiology and predisposing factors are discussed.

Aged↗
PubMed1981

Fulminant lupus pneumonitis with acute renal failure and RBC aplasia. Successful management with plasmapheresis and immunosuppression.

Acute interstitial pneumonitis is a well-recognized, although rare, complication of systemic lupus erythematosus (SLE) that has been associated with a poor prognosis. Fulminant lupus pneumonitis, acute renal failure, and RBC hypoplasia occurred in a 14-year-old girl. The patient's condition was managed with large-volume plasmapharesis, dialysis, and immunosuppressive therapy. Her respiratory, renal, and hematologic changes all resolved, and response was maintained with cyclophosphamide and prednisolone therapy. Although serologic evidence of SLE persisted, clinically, the patient was well four years after the initial appearance of SLE. There are several acute pulmonary manifestations of SLE, and plasmapheresis may be useful in the management of some of these conditions.

Acute Kidney Injury↗
PubMed1980

Post-transfusion purpura.

Two cases of post-transfusion purpura in multiparous women are described. Anti-PIA1 antibody was detected in both patients who subsequently recovered. This alloantibody causes the destruction of autologous platelets. The role of steroids and plasma exchange in therapy of this condition remains controversial, but they should probably be used in combination.

Adrenal Cortex Hormones↗
PubMed1980

Cytotoxic-induced fulminant hyperpyrexia.

Two cases of fulminant hyperpyrexia induced by cytotoxic agents (bleomycin in a patient with lymphoma, and daunorubicin in a patient with acute myeloblastic leukemia) are presented. Each patient had a fever greater than 42 degrees C, with a shock-like reaction and coma. Evidence of disseminated intravascular coagulopathy developed in the patient with bleomycin-induced hyperpyrexia and she died 24 hours afterwards. The pathogenesis and management of hyperpyrexial reactions to cytotoxic drugs are discussed.

Adult↗
PubMed1980

A fatal case of cold autoimmune hemolytic anemia.

A fatal case of acute low-titer wide-thermal-range cold agglutinin disease is reported. High-dose corticosteroids, cyclophosphamide, and plasmapheresis failed to control hemolysis. This uncommon syndrome is discussed, and current approaches to treatment are reviewed.

Anemia, Hemolytic, Autoimmune↗