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Biomedical subjects

P Fauchald

Publications and source records attributed to P Fauchald.

At least 73 records · Page 4Linked to original sources
PubMed1993

Aortoiliac reconstruction in preparation for renal transplantation.

Aortoiliac angiography has always been an integral part of the pretransplantation work-up of renal transplant candidates in Norway. The present study was undertaken to investigate the value of this routine. Based on the angiograms of approximately 1400 patients evaluated for renal transplantation during the 7-year period 1984-1991, 26 were found to have aortic and/or iliac atherosclerosis requiring pretransplant vascular reconstruction. Fifteen of the 26 patients had aneurysm of the abdominal aorta and 11 had extensive aortoiliac occlusive disease. A prosthetic graft was inserted in 25 patients and endarterectomy of the aortic bifurcation was performed in one. The cause of death was coronary heart disease in four of six patients who died before, and in one patient who died after, transplantation. Sixteen patients received a renal transplant while four patients are still on the waiting list. Fifteen of the recipients are alive, 14 with functioning renal transplants. The low yield of patients below 40 years of age requiring vascular reconstruction calls into question the routine use of angiographic investigation of renal transplant candidates below this age. However, we recommend this routine for the higher age groups because it often provides the surgeon performing the transplantation with valuable information. Aortoiliac reconstruction as preparation for renal transplantation is advocated when atherosclerosis of a degree that may preclude transplantation is found. Because of the high risk of myocardial infarction in these patients, one must be especially aware of coronary atherosclerosis when evaluating patients for this procedure.

Adult↗
PubMed1993

A Scandinavian two-center study of BMA 031 in steroid-resistant rejection of renal grafts.

BMA 031 (Behring Monoclonal Antibody) was given to 25 renal graft recipients with biopsy-proven steroid-resistant rejections. A dose of 50 mg of BMA 031 was given i.v. on 7 consecutive days concomitantly with a standard triple-drug regimen. No premedication was administered before the first BMA 031 dose. After the first dose, 7 patients experienced moderate fever (< 39 degrees C), 5 patients had high fever (> 39 degrees C), 4 patients had nausea/vomiting, 3 diarrhea, 1 headache, and 1 hypertension. These reactions were seen only after the first dose except for 1 patient who developed urticaria on days 3-4. All the rejection episodes were reversed or partially reversed. Twenty-one patients experienced re-rejections 3-46 days after the last BMA 031 dose, and were treated with methylprednisolone and/or rabbit antihuman thymocyte globulin. Seven patients lost their grafts within 1 year (28%), including 2 patients who died of infection with a functioning graft. BMA 031 seems to be a safe drug with only few mild side effects, and it effectively reverses steroid-resistant rejections. Re-rejections were frequent, but mostly reversible.

Adolescent↗
PubMed1993

Use of tissue plasminogen activator for reopening of clotted dialysis catheters.

The use of central venous catheters as permanent vascular access in chronic hemodialysis is complicated by clotting. We have tried a nonallergenic thrombolytic agent, tissue plasminogen activator (t-PA), to dissolve catheter luminal thrombosis. Eight patients, 7 in chronic hemodialysis and 1 treated by immune adsorption had 18 treatments with locally applied t-PA (2 mg/2 cm3). Fifteen out of 16 treatments with longer bolus dwell than 60 min were successful. No side effects occurred. t-PA dissolves clot formation efficiently and safely, the drug is nonallergenic and can therefore be given repeatedly.

Blood Coagulation↗
PubMed1993

Quality of life in Norwegian kidney donors.

The Norwegian kidney transplant programme is based on more extensive use of living donors than in other countries. Re-examination of the physical health of kidney donors has in the majority of studies revealed no long-term medical risk. The quality of life after donation has only been described in very few studies, and with a small number of donors. This report concerns a cross-sectional study of 494 donors with a mean observation time from donation of 6.7 years. A standardized questionnaire containing 19 items related to quality of life was used. The donors were compared to the general adult population in a county in mid-Norway. Out of the 19 quality of life items, the donors scored significantly better in 13. Donors who had experienced that the corresponding recipient had died have been tested separately. The results in this subgroup were equal to the population, but inferior compared to the rest of the donors. We conclude that the quality of life of Norwegian kidney donors is better than the general population. We will continue our policy of an extensive use of living kidney donors.

Adult↗
PubMed1992

[Central venous dialysis catheter. Silicone rubber dialysis catheter used for permanent vascular access].

51 dual lumen jugularis dialysis catheters (Permcath, Quinton) were placed by surgical technique in 34 patients and by percutaneous technique in eight patients. Mean catheter life-time was 4.1 months. Seven catheters were removed due to complications (infection three catheters, clotting four catheters). Minor flow problems occurred in 8.8% of all procedures. Seven occluded catheters were successfully reopened by use of locally applied streptokinase. A strict aseptic technique is essential to avoid infection. Permcath is an acceptable vascular access device for patients in whom it is impossible to create an arterio-venous fistula.

Adolescent↗
PubMed1992

Fifteen years' experience with renal transplantation in systemic amyloidosis.

At our center 62 renal transplantations (31 living donor and 31 cadaveric donor grafts) have been performed in 58 patients with amyloid renal disease since 1974. The amyloidosis was secondary to rheumatic disease in 74% of the patients. Predialytic transplantation was performed in 28% of the patients. Mean follow-up time was 5.1 years (0.3-14.5 years). One-year actuarial patient survival was 79%, decreasing to 65% after 5 years. First graft survival was 74% at 1 year and 62% at 5 years. Patient death with a functioning graft caused 16 out of 25 graft losses. Infections caused 11 out of 18 deaths (61%), more than half of them within 3 months. Renal transplant amyloid was diagnosed in about 10% of the cases (6/62); however, only about 3% of the grafts (2/62) were lost. These long-term results encourage transplantation in amyloid renal end-stage disease.

Adolescent↗
PubMed1992

Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis.

Twenty-five patients with transplant artery stenosis were identified among 1141 renal graft recipients. Impaired graft function (9 patients), hypertension (4 patients) or both (12 patients) were the indications for arteriography. All were treated by percutaneous angioplasty (PTA). The immediate technical success rate was 88% and actuarial graft survival was 88% and 80% at 2 and 5 years respectively. The long-term success rate on graft function was 67% (median observation time 24 months) and on hypertension 63% (median observation time 23 months). Six patients needed rePTA (8 procedures) and in only one patient was surgical repair performed. No case of graft loss due to PTA was recorded and in only one case did occlusion of a segmental artery lead to impairment of graft function. Minor complications were recorded in four other cases and in no case was surgical intervention necessary. Based on these results we favour PTA as a first-line interventional procedure in transplant renal artery stenosis, and the need for surgical repair has been low.

Adult↗
PubMed1992

Hormonal changes in patients with severe chronic congestive heart failure treated by ultrafiltration.

Plasma atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), plasma renin activity (PRA), and circulatory haemodynamics were studied in five patients with chronic congestive heart failure undergoing ultrafiltration on two consecutive days. The patients were in the New York Heart Association class IV, and were considered candidates for heart transplantation. A mean of 3.3 +/- 0.5 litres of fluid was removed during each ultrafiltration. Plasma ANP concentration remained unchanged during ultrafiltration: 369 +/- 151 pg/ml at start and 316 +/- 116 pg/ml at the end, while plasma ADH concentration and PRA increased from 5.1 +/- 2.1 to 7.5 +/- 3.4 pg/ml (P less than 0.02), and 5.9 +/- 3.0 to 7.7 +/- 3.2 ng/ml (P less than 0.03) respectively (n = 10). After treatment, plasma ADH and PRA declined to baseline values within 1 h. Pulmonary artery, pulmonary capillary wedge, and right atrial pressures decreased significantly, while blood pressure and heart rate remained constant during ultrafiltration. A volume of 3.3 +/- 0.5 litres of fluid was removed, and caused an increase in colloid osmotic pressure from 22.0 +/- 3.0 to 33.7 +/- 3.9 mmHg (P less than 0.02). It was unexpected that plasma ANP concentration did not decline. Due to long-standing severe heart failure the atrial wall may have lost some of its elastic properties, resulting in less ability to adapt to reduced filling pressures. Accordingly, atrial wall stretch remained unchanged, explaining the constant ANP levels. Ultrafiltration treatment caused an increased responsiveness to diuretic therapy, and four patients survived long enough to receive heart transplants.

Adult↗
PubMed1992

Results of the National Kidney Transplantation Program in Norway.

1. Of 2,003 patients starting renal replacement therapy for end-stage renal disease in Norway from 1983 through 1991, 83% were candidates for transplantation. The need for transplantations increased to 58 (50 first and 8 repeat) grafts PMP per year as the number of elderly patients increased. 2. There were 1,528 transplants performed at a rate increasing to 46 grafts PMP per year. The grafts were procured from LDs in 44% and CDs in 56%. Eighty percent of all patients in need were transplanted and 65% of all patients requiring replacement therapy for end-stage renal disease were treated by transplantation. The national waiting list and dialysis population remained almost stable. 3. Graft survival rates in recipients of first LD grafts (n = 593) were 91% and 77% at 1 and 5 years, respectively. One-year graft survival was 98% in HLA-identical grafts (n = 73), 91% in haploidentical grafts (n = 411), 89% in 2 haplotype-mismatched related grafts (n = 38), and 85% in spousal donor grafts (n = 71). Higher rates were observed in younger (< 55 yrs) patients. 4. Graft survival rates in recipients of first CD grafts (n = 688) were 78% and 59% at 1 and 5 years, respectively. The rates were 84% and 66% in younger (n = 342) versus 72% and 52% in older (> 55 years) (n = 346) patients. Death with a functioning graft caused approximately 45% and 75% of all graft losses in younger and older patients, respectively. Cardiovascular disease was the major cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Pregnancy outcome in renal allograft recipients: influence of ciclosporin A.

The outcome of 35 pregnancies in 26 renal allograft recipients is reported. Twenty-four pregnancies in patients treated with prednisolone and azathioprine resulted in 22 live-born infants (one twin pregnancy) and 3 induced abortions on medical indications. Three of the deliveries were preterm, and one of the infants had a birth weight below the 2.5th percentile. Ten patients (11 pregnancies) were treated with ciclosporin A (CsA). These women delivered 5 infants (3 preterm deliveries of whom the birth weight of one infant was below the 5th percentile) and underwent 3 induced (medical indications) and 3 spontaneous abortions. Mean birth weight in the CsA treated group was 2464 g (range 1790-2930 g), and their gestational age varied from 232 to 271 days. No foetal malformations were observed in the two groups. The results may indicate a harmful effect of CsA on pregnancy outcome.

Adolescent↗
PubMed1991

The use of elderly living donors in renal transplantation.

The safety and the results of using living donors above the age of 60 years were studied. In 235 consecutive donors the complications were not different in elderly (n = 70) compared to younger donors. Graft survival and function were studied in 232 consecutive 1-HLA-haplotype mismatched grafts. Graft survival at 1 year was equivalent (87% vs. 92%), but after 2-6 years graft survival was inferior in recipients of older grafts (n = 62). The recipients of older grafts were 10 years older, and patient death with functioning graft was a more frequent cause of graft loss. Up to 4 years serum creatinine levels were significantly higher, but stable, in recipients of older grafts; at 5 years the difference was not significant. It is concluded that the use of elderly living donors is safe. Taking recipient age into consideration, graft survival is not different in the two groups. Graft function in older grafts is some what inferior, but stable.

Adult↗
PubMed1991

Long-term metabolic control in recipients of combined pancreas and kidney transplants.

Metabolic glucose control was followed in 36 patients at 12-month intervals for up to 5 years after a successful combined kidney and segmental duct-occluded pancreas transplantation. All recipients had normal blood glucose levels at each examination. HbA1 values, intravenous glucose tolerance test, C-peptide levels and C-peptide responses to glucagon stimulation were also, on average, within the normal range. Several individual patients had, however, abnormal values for these parameters. At most 46% had abnormal values for HbA1 and intravenous glucose tolerance test, up to 13% showed low C-peptide values and up to 46% of the stimulated C-peptide responses were inadequate at the different intervals. These parameters did not deteriorate with time. This was true both for the whole group of patients as well as for the 6 patients with a 5-year observation time evaluated separately. Despite these abnormalities in glucose metabolism, all patients remained normoglycaemic without need for exogenous insulin up to 5 years after transplantation. The long-term ability of duct-occluded segmental pancreatic grafts to preserve euglycaemia therefore seems to remain intact at least for 5 years.

Adult↗
PubMed1991

Rehabilitation and quality of life in diabetic patients after successful pancreas-kidney transplantation.

Twenty-seven Type I diabetic patients in end-stage renal failure were followed after combined pancreas-kidney transplantation. All patients received duct-occluded segmental pancreas grafts. Clinical progression of extrarenal diabetic complications was studied in 11 patients with long-term functioning pancreatic and renal transplants (Group 1), and in 16 patients who had lost pancreatic graft function, but retained renal graft function (Group 2). Pretransplant, extrarenal diabetic complications were equally distributed in the two groups. In the follow-up period, however, the progress of these complications was less severe in patients with functioning pancreatic transplants. No differences were found between the groups concerning rehabilitation, working capacity, need of help or hospital admittance. It is suggested that pancreas transplantation performed in an earlier stage of diabetes before serious complications have developed, would probably improve rehabilitation and quality of life in these patients.

Adult↗
PubMed1991

Preliminary results of the Norwegian doxazosin postmarketing surveillance study: a twelve-week experience.

The study was designed to investigate the safety and efficacy of doxazosin in the control of blood pressure in general medical practice; the results presented concern the first 748 patients evaluated over a 12-week period. Blood pressure was significantly reduced after treatment with doxazosin (-13/-9 mm Hg), and heart rate was not significantly altered. In addition, doxazosin significantly reduced total cholesterol levels (-6.7%), reduced triglyceride levels (-19.8%), increased high-density lipoprotein cholesterol levels (+2.5%), and the high-density lipoprotein:total cholesterol ratio (+9.7%). The calculated risk of coronary heart disease was reduced by 20.5% over a 12-week period. Thirty-five percent of patients reported at least one side effect, and the number of patients experiencing severe adverse reactions was small. Twenty patients (2.7%) discontinued treatment because of adverse events, and 2.7% had the dose of doxazosin reduced.

Antihypertensive Agents↗
PubMed1991

Effects of isradipine on renal function in cyclosporin-treated renal transplanted patients.

The renal effects of the calcium-channel antagonist isradipine were evaluated in cyclosporin A (CsA)-treated renal allografted patients more than 5 months after transplantation. Twelve patients with stable renal function were given placebo for 2 weeks and then isradipine 1.25 mg x 2 for 1 week and 2.5 mg x 2 for the next 3 weeks in an open trial. The CsA dose was unchanged during the study. Isradipine did not interfere with the pharmacokinetics of CsA as both whole blood trough and peak levels were unchanged. Isradipine reduced mean arterial blood pressure (MAP) from 117.0 +/- 1.8 to 106.3 +/- 1.9 mmHg (P less than 0.01). The renal effects were studied during water diuresis 1-3 h after drug intake. Para-aminohippurate clearance (CPAH) increased from 256.4 +/- 21.5 to 291.5 +/- 26.3 ml/min (P less than 0.05), renal vascular resistance was reduced by 21.5% (P less than 0.01) and inulin clearance (CIn) was unchanged. Fractional proximal reabsorption, calculated from lithium clearance (CLi), was reduced by 11.9% (P less than 0.01) by isradipine. Isradipine also reduced proximal reabsorption of sodium (APRNa) and increased distal sodium delivery (DDNa). Distal sodium reabsorption (ADRNa) and free-water clearance (CH2O) were significantly increased. Urinary excretion of enzymes and proteins was unchanged by isradipine.

Adult↗
PubMed1991

Contrasting effects of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy.

An open, randomized, cross-over study was undertaken to assess the effects of lisinopril and nifedipine on albumin excretion, renal haemodynamics and segmental tubular reabsorption in overt diabetic nephropathy. The study consisted of a 4-week run-in period, a 3-week active treatment period, a 4-week wash-out period and a second 3-week active treatment period. Twelve patients with type 1 diabetes with albuminuria, mild to moderate hypertension and a serum creatinine level of less than 200 mumol l-1 were included. Lisinopril reduced albumin excretion from 1343 +/- 337 micrograms min-1 to 879 +/- 299 micrograms min-1 (P less than 0.01), whereas nifedipine was without effect, 1436 +/- 336 micrograms min-1 vs. 1319 +/- 342 micrograms min-1. Glomerular filtration rate (GFR) was unchanged by either drug. Both drugs increased effective renal plasma flow (ERPF) by about 20%. No differences between the drugs were observed with regard to their effect on renal haemodynamic parameters. By contrast, nifedipine exerted an inhibitory effect on several proximal tubular transport markers, whereas lisinopril was without effect. The different actions on tubular transport mechanisms exerted by lisinopril and nifedipine may contribute to the observed effect on albumin excretion.

Adult↗