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Biomedical subjects

J R Salaman

Publications and source records attributed to J R Salaman.

At least 19 recordsLinked to original sources
PubMed1995

Ogilvie's syndrome: a new approach to an old problem.

PURPOSE: This study was designed to determine the value of intravenous neostigmine in achieving adequate colonic decompression in patients with Ogilvie's syndrome. METHODS: A prospective study was undertaken in 12 consecutive patients (median age, 60 (range, 38-98) years) with contrast enema-proven Ogilvie's syndrome (median duration, four (range, two-nine) days) RESULTS: Satisfactory clinical decompression of large bowel distention was attained in 11 patients, although one required colectomy for subsequent recurrence and ischemia. CONCLUSION: These results support the theory that many cases of Ogilvie's syndrome are the result of excessive large bowel parasympathetic suppression rather than sympathetic overactivity.

Adult↗
PubMed1995

An audit of stab wounds in Cardiff.

The incidence of stabbings in the United Kingdom has not been determined. We audited all cases of stabbings presenting to the Accident and Emergency Department of the Cardiff Royal Infirmary over an 18-month period from 1 January 1991. Over 122 000 new cases presented, 92 (0.075) with stab wounds, 48% of which required hospital admission. Stabbings accounted for 62 060 pounds of the surgical budget. There was a high incidence of self-inflicted stab wounds accounting for a significant proportion of the expenditure. This has not been reported previously.

Adolescent↗
PubMed1994

Pancreatic transplantation as a small programme.

Seventeen pancreatic transplantations were performed in 17 patients with diabetic renal failure over a 6-year period. Ten patients received a simultaneous kidney transplant, the other seven having undergone previous successful renal transplantation. The actuarial pancreatic survival rate at 12 months was 63 per cent and the patient survival rate 92 per cent. The kidney transplant 12-month survival rate (86 per cent) did not differ significantly from that in a group of 22 diabetic patients receiving kidney transplants alone during the same period. Patients with a successful pancreatic transplantation had an increase in quality of life but most developed one or more complications; sometimes these required prolonged hospitalization. Pancreatic transplantation should be restricted to patients with diabetic renal failure who are particularly unstable or exhibit progressive diabetic complications. A small programme can be successful in directing what is an expensive procedure towards patients who are most likely to benefit.

Adult↗
PubMed1994

Transplanting patients with abnormal lower urinary tracts.

Since 1977, 23 patients with bladder or bladder outlet dysfunction leading to renal failure have received 28 kidney transplants in our institution. Three patients were provided with an ileal conduit, but the remainder were transplanted using their own bladder following urodynamic assessment and bladder reconstruction. Graft and patient survival were good when compared to a group of patients with normal lower urinary tracts, actuarial graft survival at 5 years being 70% for both groups and patient survival being 82% and 90%, respectively. Patients who develop renal failure from detrusor/sphincter dysfunction can be transplanted successfully once the cause of the renal failure has been identified and corrected.

Adolescent↗
PubMed1994

Into interferon.

Explore the source record for details and available documents.

Humans↗
PubMed1993

Is there an optimal time for the first cyclosporin dose in renal transplantation?

It is customary for patients undergoing kidney transplantation to receive their first dose of cyclosporin either just before or during the transplant operation. This ensures the early establishment of good levels of immunosuppression but might depress early graft function and contribute towards the development of acute tubular necrosis. In a controlled clinical trial, we have studied the effects of withholding cyclosporin for 12 h in patients undergoing cadaveric renal transplantation. Consecutive adult recipients of a cadaveric renal transplant were randomised to receive their first dose of cyclosporin (10 mg/kg p.o.) 6 h prior to transplant surgery or 12 h afterwards. All patients received azathioprine (1.5 mg/kg i.v.) and methylprednisolone (0.5 g i.v.) in addition during surgery. From the 2nd day onwards both groups were treated with an identical triple immunosuppressive regimen. The 27 patients who received their first dose of cyclosporin post-operatively had significantly better immediate and subsequent function than did the 26 patients who received their cyclosporin at the time of surgery. The delayed dosing was associated with improved graft survival and no increase in the frequency of rejection episodes. This regimen is recommended for all patients receiving triple therapy.

Adult↗
PubMed1993

Low-dose cyclosporin nephrotoxicity in the rat.

The nephrotoxicity of cyclosporin (CsA) continues to be a clinical problem that detracts from its obvious benefits as an immunosuppressive agent. Animal models designed to study the problem have generally relied either on chronic administration of high doses of the drug or acute administration of single i.v. doses. The present study establishes a model of CsA nephrotoxicity using doses of the drug comparable to those used in man administered over a time period sufficient for haemodynamic and structural changes to become evident. The technique used measures glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) by the plasma clearance of chromium EDTA and iodohippuran respectively. This has the advantage of allowing sequential measurements in individual animals. Significant impairment of GFR was seen in animals treated intraperitoneally with doses of CsA as low as 5 mg/kg/day. CsA 7.5 mg/kg/day caused a significant reduction in ERPF, and at 10 mg/kg/day and greater filtration fraction also declined significantly. Detailed histological examination of the kidneys from these animals also revealed significant tubular dilatation at 10 mg/kg/day and above. This model of CsA toxicity circumvents many of the problems associated with other models. The animals can be studied longitudinally and the period of administration has relevance to clinic practice. This work provides the basis for further studies which can closely mimic the clinical situation using doses similar to those used for human maintenance immunosuppression.

Animals↗
PubMed1991

Renal transplantation without steroids.

Cyclosporin has been in use in our unit since 1982 to treat renal transplant recipients. In two controlled clinical trials cyclosporin monotherapy was compared with cyclosporin with steroids, and with cyclosporin with azathioprine. The addition of steroids did not improve graft survival but did increase the incidence of infection. The addition of azathioprine also had no effect upon graft outcome. We conclude that cyclosporin monotherapy provides very adequate immunosuppression in the majority of cases giving an 80% survival rate for cadaveric kidney transplants at 1 year. Triple therapy has been used successfully by other centres although graft survival rates are no different from our own. Such treatment does, however, provide more powerful immunosuppression and is appropriate for previously sensitised patients and for children. Under this regimen steroids can be withdrawn at a later date. Sequential therapy with four agents is highly immunosuppressive. The long-term results are uncertain at the present time, and this expensive treatment needs careful evaluation. In our experience it is perfectly possible to undertake cadaveric renal transplantation without having to prescribe regular steroid therapy for the majority of patients. We have been impressed by the lack of serious side effects with this treatment and would still regard cyclosporin monotherapy as the treatment of choice for unsensitised renal transplant patients.

Adrenal Cortex Hormones↗
PubMed1991

Monitoring of rejection in renal transplantation.

With better immunosuppression, the results of kidney transplantation have improved greatly during the last 10 years. It has never been possible to completely suppress rejection, and transplant physicians and surgeons still need to maintain a constant vigilance in order that rejection does not go unrecognised in their patients. 1.1. CLINICAL FEATURES. These are often absent, although the patient may have noted a decreased urine volume and gain in weight. The kidney is sometimes tender and enlarged. 1.2. BIOCHEMICAL FEATURES. There is a rise in the plasma urea and creatinine and a reduced creatinine clearance. Unfortunately, other conditions such as cyclosporin nephrotoxicity can produce similar changes. 1.3. RADIOLOGICAL FEATURES. Isotope renography may demonstrate reduced renal perfusion and excretion but this is also seen in ATN. Ultrasound may demonstrate an increase in renal size. On Duplex renal ultrasonography changes in renal perfusion patterns can often be demonstrated. MRI has shown a loss of cortico-medullary differentiation during rejection, but this is not very specific. 1.4. CYTOLOGICAL FEATURES. The presence of lymphocytes in the urine is often indicative of rejection, as is the finding of inflammatory cells in fine needle aspirates from the transplanted kidney. 1.5. HISTOLOGICAL FEATURES. Renal biopsies are best obtained using a Biopty Gun under ultrasound control. Cellular rejection is characterised by a heavy infiltrate of lymphocytes which invade the renal tubules (tubulitis). Vascular rejection is characterised by endothelial proliferation and fibrinoid necrosis of the vessel wall. 1.6. CONCLUSION. Several of the above tests are often required to establish the presence or absence of rejection.

Graft Rejection↗
PubMed1990

Calcium-channel blockers and other factors influencing delayed function in renal allografts.

A retrospective analysis was undertaken to examine the influence of calcium-channel blocking drugs on early renal allograft function. Delayed function was defined as the need for dialysis or a reduction in serum creatinine of less than 15% within 4 days of transplantation. The drug histories of 172 patients were examined. After exclusions, the data from 138 patients were analysed. No patient was taking any calcium-channel blocking drug other than nifedipine. Thirty-one patients were taking nifedipine at the time of transplantation and these had a delayed function rate of 16% compared with 40% for 107 patients not taking nifedipine (chi 2, P less than 0.05). Delayed function occurred in 61% of cases when the donor age was over 50 years compared with 29% with younger donors (chi 2, P less than 0.05). A total ischaemic time of longer than 24 h and administration of inotropic support to the donor were associated with delayed function (chi 2, P less than 0.05). Administration to the donor of mannitol, steroids, phenoxybenzamine and heparin had no effect on the rate of delayed function. Recipients treated with low-dose dopamine in the perioperative period had no advantage. Elevated trough whole blood concentrations of cyclosporin in the first week after transplant were associated with delayed function (Mann-Whitney U, P less than 0.05).

Adult↗