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Biomedical subjects

N McKenzie

Publications and source records attributed to N McKenzie.

32 records · Page 2Linked to original sources
PubMed1986

Experience of a Canadian multi-organ transplant service.

Organ transplantation has become the treatment of choice for selected patients with end-stage failure of the heart, liver or kidneys. The expanding role for organ transplantation, however, has led to a corresponding increase in the complexity of patient management. In response to these changes, University Hospital, London, Ont., has established an interdisciplinary multi-organ transplant service (MOTS). MOTS coordinates donor organ procurement and patient management. Donor organs have been retrieved from as far south as Dalton, Georgia, as far west as Calgary and as far east as Halifax. As of Dec. 31, 1985, 485 transplants had been performed, including 387 kidney transplants, 51 heart transplants, 3 heart/lung transplants, 43 liver transplants (in adults and children) and 1 pancreas transplant. With current immunosuppressive protocols MOTS projects 1-year patient survival rates of 95% after kidney transplantation, 88% after heart transplantation and 81% after liver transplantation. Patient rehabilitation has been excellent.

Adult↗
PubMed1984

Cyclosporine in cardiac transplantation.

Since 1981 the authors have performed 14 orthotopic heart transplantations and one heart-lung transplantation, using cyclosporine and prednisone as immunosuppressants. Eight of the recipients had terminal congestive cardiomyopathy and six had ischemic cardiac dysfunction. The combined heart-lung transplantation was performed on a patient with a congenital ventricular septal defect with Eisenmenger's syndrome. Twelve of the patients were alive and well at follow-up 9 to 34 months (mean 17.4 months) after transplantation. One patient died of acute rejection and one of acute pancreatitis and secondary peritonitis. The third death, due to acute right ventricular failure, occurred immediately after transplantation. Rejection was diagnosed histologically on seven other occasions in four patients and was treated successfully. Infection was not a major problem. Cyclosporine -induced reversible nephrotoxicity was evident in 12 patients, 2 of whom required dialysis. Other side effects of cyclosporine seen in these patients included hypertension, gastrointestinal upset, headaches and hirsutism. This experience suggests that cyclosporine is a potent immunosuppressive agent that has greatly reduced the hazards of rejection and infection. However, the frequency of nephrotoxicity is high; careful monitoring of cyclosporine blood levels and renal function is essential.

Adolescent↗
PubMed1982

Cyclosporin A: a powerful immunosuppressant.

Cyclosporin A (CyA) is a powerful immunosuppressive agent whose lack of myelotoxicity makes it unique among nonsteroidal drugs currently given for immunosuppression. It has been used with initial success in recipients of kidney, liver, bone marrow and pancreas transplants, and it may also have clinical application in the treatment of autoimmune disorders. In regard to its use in transplant recipients, there are many remaining questions about its mechanism of action, the optimum dose, whether it should be used alone or with other immunosuppressants, whether it can suppress chronic rejection and what its long-term side effects may be. These questions can only be answered by further careful laboratory investigation and controlled clinical trials. Until then, CyA should only be administered in centres experienced in its use.

Chemical Phenomena↗
PubMedDate not supplied

Family and past history of mental illness as predisposing factors in post-traumatic stress disorder.

BACKGROUND: Family studies of post-traumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. METHOD: Retrospective case note study of 87 PTSD patients who participated in an RCT, and 51 PTSD patients and 87 agoraphobics treated routinely in outpatients. RESULTS: Compared to agoraphobics, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. CONCLUSIONS: Trauma precipitated PTSD in subjects who had significantly fewer premorbid predisposing factors than did agoraphobics. Such factors may predispose agoraphobics to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.

Adult↗
PubMedDate not supplied

Effects of cyclosporine on renal function following orthotopic heart transplantation.

The early and late nephrotoxicity of cyclosporine was examined in 23 orthotopic heart transplant recipients and two heart-lung transplant recipients up to four years after the operation. Cyclosporine was given orally pre-operatively and intravenously for the first two to five days after the operation. Subsequent daily oral therapy, in two divided doses, was adjusted to maintain serum trough levels in the range of 150 vg/ml to 200 vg/ml. By six months after the transplantation, the trough level was reduced to approximately 100 vg/ml. The mean pre-operative creatinine was 119 +/- 27 microM/L. After the operation there was transient oliguria in all patients, the mean peak creatinine (251 +/- 104 microM/L) occurring on days two to five. By day eight, creatinine (138 +/- 68 microM/L) was not significantly different from the pre-operative value. The maximal cyclosporine trough level (479 +/- 216 vg/ml) was also seen on days two to five and declined (195 +/- 53 vg/ml) on day ten. Despite the temporal association, linear regression analysis demonstrated no correlation between the early increase in creatinine and the cyclosporine level. There was, however, a correlation between the pre-operative creatinine and the peak post-operative creatinine. Two patients required dialysis but no death could be attributed to renal failure. By six months after the operation, serum creatinine had increased to 145 +/- 53 microM/ml and thereafter, with gradual reduction in cyclosporine dosage serum creatinine levels stabilized at 197 +/- 97 mu/mL at two years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗