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Biomedical subjects

K McLaughlin

Publications and source records attributed to K McLaughlin.

At least 37 records · Page 2Linked to original sources
PubMed1999

Idiopathic thrombocytopenia after cytomegalovirus infection in a renal transplant recipient.

Infection with cytomegalovirus (CMV) is a frequent complication of organ transplantation and presents a spectrum of disease ranging from asymptomatic viremia to life-threatening tissue-invasive disease. CMV is also lymphotrophic, with the potential to induce autoimmune disease, although immunosuppressive therapy may prevent or attenuate the clinical course in transplant patients. We report a case of idiopathic thrombocytopenic purpura occurring in a renal transplant recipient after primary CMV infection and discuss the possible mechanisms involved.

Cytomegalovirus Infections↗
PubMed1999

Clinical management of diabetic nephropathy.

From the viewpoint of nephrologists dealing with diabetic patients with ESRD and the associated complications and devastating prognosis, the need to reduce the incidence, and delay the rate of progression of diabetic nephropathy is obvious. Studies published within the last year have provided support for views that seem intuitively obvious; that improved glycaemic control and reduced blood pressure are associated with delayed onset and delayed progression of diabetic nephropathy. These reports have also demonstrated the difficulty of achieving ideal blood pressure targets and glycaemic control in diabetic patients. Thus, even with available therapy it is likely that improved compliance and achieving targets will have a major impact on disease outcome. There is evidence in several subgroups that ACEi are beneficial over other agents and the favourable side-effect and efficacy profile of these agents makes it reasonable to suggest that they should be used 'first line' in all patients with diabetes unless specifically contra-indicated. However, the failure to readily achieve blood pressure targets and the need for polypharmacy suggest that novel agents are required. We believe that statin therapy will have a major impact on CVD in diabetic patients and is also likely to delay progression; studies assessing the combined affect of anti-hypertensive and statin therapy specifically on the development and progression of diabetic nephropathy will be necessary before evidence-based recommendations can be made. The role for newer agents and targeting high risk groups using genetic markers remains uncertain but we await there development with interest. The future can only get better for patients with DN.

Antihypertensive Agents↗
PubMed1999

Angiotensin converting enzyme inhibitors and angiotensin receptor (AT1) antagonists: either or both for primary renal disease?

At the present time we cannot assume that the proven benefits of ACEI on renal disease will be reproduced by using AT1-ra. With potentially differing modes of activity of these drugs, they cannot be seen as interchangeable and ACEI should remain the drug of choice in patients with progressive renal disease unless they are not tolerated. It is possible that AT1-ra may offer additional advantages in some patients or that synergy exists between the two agents, but this view will remain entirely speculative unless proper trials are conducted. Despite the results of the ELITE study [22], the uncertainty regarding the use AT1-ra in cardiovascular disease mirrors that of renal disease. This issue is obviously of relevance to the nephrologist in view of the spectrum of cardiac disease that accompanies chronic renal failure, such as left ventricular hypertrophy and cardiac failure, which provide multiple indications for manipulation of RAS. Despite their renoprotective effect, previous studies on ACEI [3,4] have not shown an overall reduction in mortality and this issue needs to be addressed in addition to renoprotection in studies comparing AT1-ra and ACEI.

Angiotensin Receptor Antagonists↗
PubMed1999

Ethical dilemmas in critical care: nurse case managers' perspective.

Nurse case managers often face ethical dilemmas as they advocate for their critically ill and critically injured patients. They experience the tension that exists between advocating for the critically ill, the patient's right to self-determination, and the payer source constraints. When there are no good alternatives for the patient or the list of options include none that are desirable, the nurse case manager may experience an ethical dilemma. Working with the critically ill and injured inherently presents a spectrum of biopsychosocial complexities, which present potential ethical dilemmas for the nurse case manager. The three case studies presented posed particular challenges to the nurse case managers and deal with the ethical principles of beneficence, autonomy, veracity, and justice.

Adult↗
PubMed1998

On-column sample preconcentration using sample matrix switching and field amplification for increased sensitivity of capillary electrophoretic analysis of physiological samples.

An on-line sample concentration method using sample matrix switching and field amplification peak stacking has been developed. A microbore LC guard column is used to slightly retain the analytes in order to switch from a high ionic strength sample matrix (the physiological fluid) to a low ionic strength matrix (the LC mobile phase). The eluted LC peak is then trapped in a CE system and preconcentrated by field amplification peak stacking. The concentrated sample peak is then analyzed by CE. Compared to normal hydrodynamic injection, the sensitivity was increased by more than 500-fold without loss in resolution. A limit of detection of less than 10 nM for a physiological sample was achieved using UV adsorption detection. This method can be used for negatively or positively charged analytes.

Bupivacaine↗
PubMed1998

Has the prognosis for patients with pauci-immune necrotizing glomerulonephritis improved?

BACKGROUND: Over the past 14 years, important advances have been made in diagnosis and treatment of patients with pauci-immune necrotizing glomerulonephritis (PINGN). The present study set out to evaluate the impact of these advances on prognosis by comparing patient survival during the period 1985-1995 with previously reported results for such patients between 1975 and 1982. METHOD: A retrospective analysis was carried out at two affiliated inner-city renal units on all patients considered to have PINGN during the period 1985 1995. Details of renal and extra-renal disease at presentation and during follow-up, along with treatment regimes, were noted. Figures for renal and patient survival were compared with those previously reported from one of these units. RESULTS: A total of 47 patients were diagnosed over the period 1985 1995, with a median age of 57 years. The overall patient survival (+/- standard error) at 1 and 5 years was 72.3 (+/- 0.06) and 51.2% (+/- 0.12) respectively, with corresponding renal survival (alive and independent of renal replacement therapy) at these times of 61.7 (+/- 0.07) and 49.9% (+/- 0.09) respectively. We identified increased age at presentation and advanced renal failure (requiring dialysis or serum creatinine > 300 micromol/l) as predictors of reduced patient and renal survival. When comparing our results with those previously reported (1975-1982), we found no improvement in prognosis for patients with PINGN during the latter period. CONCLUSIONS: These results suggest that the prognosis for patients with PINGN has not improved despite diagnostic and therapeutic advances. Delay in diagnosis and treatment may compromise the therapeutic potential in PINGN.

Age Factors↗
PubMed1997

Tumor angiogenesis as a prognostic factor in laryngeal cancer.

BACKGROUND: Lymph node metastasis is the single greatest predictor of recurrence in laryngeal cancer. Prognostic factors are needed to target patients who may benefit from adjuvant therapy. Tumor angiogenesis correlates with metastasis in breast, bladder, and oral cavity cancer and may have prognostic value in other tumors. METHODS: In order to examine the relationship of tumor angiogenesis to recurrence, 51 patients with squamous cell carcinoma of the larynx were reviewed. In a blinded design, previously sectioned slides were chosen for advanced tumor and highest vessel concentration. Samples were cut and immunocytochemically stained for CD-31 (an endothelial marker). A computer image analyzer quantitated the percent area of staining. Variables were statistically examined against recurrence. RESULTS: Patients were stratified by percent tumor staining. Nodal involvement was seen in 9 (36%) patients with tumor staining < or = 20% and in 20 (77%) with tumor staining > 20% (P = 0.003). Patients with < or = 20% staining and without metastasis had a 13% rate of recurrence whereas patients with > 20% staining and without metastasis had a 67% rate of recurrence (P = 0.025). CONCLUSIONS: Though nodal status was suggestive of predictability, only angiogenesis is a statistically significant predictor of recurrence in node negative patients (P = 0.025). Angiogenesis shows strong correlation with regional recurrence and may be used as an independent prognostic indicator to determine clinically node negative patients who may be at higher risk for metastasis and require adjuvant therapy.

Carcinoma, Squamous Cell↗
PubMed1997

Long-term vascular access for hemodialysis using silicon dual-lumen catheters with guidewire replacement of catheters for technique salvage.

Difficulties in creating vascular access in patients on hemodialysis are encountered in most dialysis centers. This is usually due to a lack of suitable peripheral vessels due to previous access surgery in patients on long-term hemodialysis, but also may be seen in some patients de novo, particularly diabetics and patients with peripheral vascular disease. Surgical techniques used to overcome this problem vary depending on patient characteristics and, to a certain extent, on local expertise/preference. We report our experience of using silicon dual-lumen hemodialysis catheters over a 3-year period; during this time, 54 catheters were inserted into 32 hemodialysis patients. The indication for this procedure in 52 catheters (31 patients) was either exhausted vascular access or obvious difficulty identifying a suitable peripheral blood vessel. Of the catheters inserted, 20 were placed into subclavian veins by primary insertion (ie, patients did not have existing subclavian catheter); 34 were replaced over a guidewire (a procedure used to allow technique salvage). The catheter survival rate was 72.7% at 90 days and 48.7% at 1 year. Corresponding rates at 90 days and 1 year for technique survival were 93.3% and 81.8%, respectively. The mean catheter and technique survival was 387 (95% confidence intervals [CIs], 273, 502) and 844 (95% CIs, 684, 1,005) days, respectively. Poor flow accounted for 70.4% of catheter failures and, despite 18 episodes of catheter-related sepsis, no catheters were lost due to infection. Factors identified as leading to reduced catheter survival were left-sided placement and catheter tip placement in the superior vena cava (as opposed to right atrial placement). We did not observe poorer survival or increased sepsis in catheters replaced over a guidewire, and would advocate this technique as a means of salvage in this group of patients.

Adult↗
PubMed1996

Latex allergy in patients with myelomeningocele presenting for imaging studies of the urinary tract.

OBJECTIVE: We prospectively surveyed patients with myelomeningocele who presented in our department over a 3-month period to determine the frequency of latex allergy in this population. MATERIALS AND METHODS: A questionnaire assessed history of allergy to latex and attitudes toward and use or avoidance of latex-containing products in both medical and nonmedical environments. RESULTS: Surveys were completed by 118 patients (56 boys, 62 girls; mean age 10.4 years, range 0.6-30.9 years). Seventy-two (61%) had heard of latex allergy and 25 (21%) reported being allergic to latex. Most allergic patients were performing intermittent self-catheterization (92%) and tended to be slightly older (mean age 12.7 years) than those not reporting allergy (mean age 9.8 years). Although most reactions were limited to rashes and mucosal irritation, two patients experienced anaphylaxis with severe respiratory symptoms or hypotension or both. No reactions had occurred in the Department of Radiology. While 84% of patients with previous allergic reactions reported trying to avoid further exposure to latex in the hospital, at home, or in school, only 14% of non-allergic patients took any special precautions. CONCLUSION: Allergy to latex is common in patients with myelomeningocele who are examined in our department. We have developed a policy designed to prevent exposure of such patients to latex during imaging studies.

Child↗
PubMed1996

Sclerosing peritonitis occurring in a hemodialysis patient.

The pathogenesis of sclerosing peritonitis is poorly understood. In patients with end-stage renal failure, it has been described in association with continuous ambulatory peritoneal dialysis (CAPD), although it has not been described in patients treated exclusively by hemodialysis. We present a case of sclerosing peritonitis occurring in a 47-year-old man who was treated solely by hemodialysis. Additionally, the patient was diagnosed as having "nephrogenic ascites" 5 years before developing sclerosing peritonitis, and we discuss a possible link between these two conditions.

Ascites↗