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Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

At least 235 records · Page 13Linked to original sources
PubMed1985

Does cyclosporine inhibit renal prostaglandin synthesis?

Urinary PGE2 excretion was measured in female renal allograft recipients being treated either with prednisolone and cyclosporine (Cys) or with prednisolone and azathioprine. The mean urinary PGE2 excretion in patients on Cys of 940 pmol/4 hr was lower than in patients on prednisolone and azathioprine (2033 pmol/4 hr) although the difference did not achieve statistical significance. These data are consistent with the hypothesis that Cys inhibits renal prostaglandin synthesis.

Cyclosporins↗
PubMed1985

Conversion from cyclosporine to prednisolone and azathioprine. Safe or unsafe?

Out of 58 consecutive cadaveric renal allograft recipients whose initial immunosuppression was cyclosporine (Cys) and prednisolone, 18 were converted to prednisolone and azathioprine. Of these all four patients converted because of rejection lost their grafts. Renal function improved in seven patients converted because of nephrotoxicity and in six out of seven patients converted for miscellaneous reasons. Out of five patients converted electively at three months, one died of infection and three developed acute rejection episodes.

Azathioprine↗
PubMed1984

Left ventricular dysfunction after acute myocardial infarction: results of a prospective multicenter study.

In a multicenter prospective study of 866 patients who survived the coronary care unit phase of an acute myocardial infarction, variables reflecting left ventricular function were examined to assess their impact on 2 year survival. Single variables that reflected left ventricular dysfunction before infarction and in the acute and recovery phases were, respectively, history of prior myocardial infarction, rales in the coronary care unit dichotomized at greater than bibasilar and predischarge radionuclide ejection fraction dichotomized at less than 0.40. When combined in a stepwise fashion, patients lacking these three risk characteristics had a 2 year 4.2% mortality rate, whereas patients possessing all three characteristics had a 45% mortality rate. Rales in the coronary care unit and predischarge ejection fraction act independently, and each contributes to mortality. Fifty-two patients with advanced rales but an ejection fraction of 0.40 or greater had a 21% mortality rate. Similarly, 208 patients with few rales but an ejection fraction of less than 0.40 had a 15% mortality rate. These data suggest that the mortality risk imposed by those factors that assess permanent left ventricular damage is independent of and additive to the mortality risk contributed by dynamic, acute phase dysfunction. These data fit the hypothesis that acute phase dysfunction is, in part, due to transient ischemia that, on reversal, can restore function toward normal. The results suggest 1) that assessment of left ventricular function during the acute and recovery phases of myocardial infarction is necessary to define prognostic characteristics of an individual patient, and 2) that of particular importance is the identification of patients whose postinfarction course is consistent with reversible ischemia.

Cardiac Output↗
PubMed1984

Nonfatal cardiac events and recurrent infarction in the year after acute myocardial infarction.

The occurrence and importance of nonfatal cardiac events in the year after an acute myocardial infarction were studied in 866 patients who were enrolled by nine hospitals with a broad geographic distribution. The extensive clinical data acquired on each patient included special tests, such as radionuclide-determined ejection fraction, 24 hour ambulatory electrocardiogram and a low level exercise tolerance test. Recurrent events were frequent in the first 5 months, and certain events were significant indicators of a poor prognosis. An ejection fraction less than 40% and angina after discharge from the coronary care unit predicted patients at high risk of rehospitalization. Recurrent infarction was similarly predicted by angina, but not by any features of an exercise test. This study demonstrates the considerable morbidity that occurs after an acute myocardial infarction and its relation to and role in subsequent mortality.

Coronary Artery Bypass↗
PubMed1983

Hyperkalaemia in cyclosporin-treated renal allograft recipients.

Mean serum potassium levels were significantly higher for 9 months in renal allograft recipients receiving cyclosporin than in those receiving prednisolone and azathioprine. Sustained hyperkalaemia (serum potassium 6.0-7.1 mmol/l) inappropriate for their renal function (glomerular filtration rate 21-36 ml/min) developed in seven of forty-three cyclosporin-treated patients. All seven patients had hyperchloraemic acidosis; four were able to acidify their urine to pH less than or equal to 5.4. Six of the seven patients were hypertensive and receiving beta-blockers; one had had bilateral nephrectomy. Despite hyperkalaemia, plasma aldosterone levels were within the normal range in five patients and raised in two. During moderate sodium restriction, plasma renin activity was low or low-normal in five of the seven patients. In these patients a combination of hypoaldosteronism and renal tubular damage leading to a tubular defect of potassium and hydrogen ion secretion is the apparent cause of the hyperkalaemia and hyperchloraemic acidosis. Hyporeninaemia caused by beta-blockade probably blunts the aldosterone response to hyperkalaemia, thereby worsening it.

Acidosis↗
PubMed1983

Renal and pancreatic transplantation in the treatment of diabetic renal failure.

Twenty-two diabetic patients with renal failure have entered an integrated dialysis and transplant programme in 30 months. Ten have subsequently undergone combined renal and segmental pancreatic transplantation, and have been followed for between one month and 25 months. Currently 80 per cent of the kidneys and 40 per cent of the pancreatic grafts are functioning. Four of the 22 patients have died from myocardial disease. Pancreatic transplantation at the time of renal grafting in diabetics does not significantly increase morbidity, and currently offers a 40 per cent chance of freedom from exogenous insulin. The successful treatment of diabetic renal failure is not compromised by the addition of this developmental procedure.

Adolescent↗
PubMed1981

[Does the number of treated rejection episodes in the first transplantation influence the survival of the patient with kidney re-transplantation?].

The records of 77 patients who received a second kidney transplant at the Surgery Department of Addenbrooke's Hospital, Cambridge, have been re-examined to assess the influence of the number of rejection episodes treated during the first transplant on the survival of the second. 61 of the 77 retransplanted patients lost their first kidney for immunological reasons. 6 did not present any treated episode of rejection, 45 one episode only and in 10 greater than 1 episode was treated during the first transplant. P less than 0.05 from 1 to 5 years as regards survival of the second transplants in patients whose first kidney did not present treated rejection episodes by comparison with those presenting 1 or greater than 1. No significant difference was noted in patient survival in the various groups under examination. On the basis of the results obtained, it is concluded that, in addition to the cause of failure and duration of the first transplant, the number of treated rejection episodes during the first transplant should be considered as a critical parameter for better selection of the most suitable candidates for receiving a second transplant.

Graft Rejection↗
PubMed1981

[Influence of ischemia time on the long-term survival of kidney re-transplants].

The influence of warm and cold ischemia times on the long term survival of subsequent renal allografts has been evaluated. The retrospective study has involved 77 patients who in the year period 1966-1977 were submitted to 86 subsequent renal allografts at the Department of Surgery of the Addenbrooke's Hospital-Cambridge. Although a trend to do better was found in the group of allografts having warm ischemia time greater than 45' and less than 90' and cold ischemia time greater than 200' and less than 400', no statistical difference resulted in the survival curves among the various groups at examination.

Body Temperature↗
PubMed1981

Cyclosporin A in cadaveric organ transplantation.

The use of cyclosporin A (CyA) with a protocol designed to avoid the effects of nephrotoxicity resulted in a one-year survival of 86% in recipients of renal allografts from unmatched cadaveric donors. The drug also controlled rejection of liver and pancreatic allografts. It was possible to change patients initially treated with CyA to azathioprine and corticosteroids and vice versa, thus enlarging the potential value of CyA in organ allografting. Of 34 recipients of renal allografts, 29 were currently receiving only CyA as immunosuppressive treatment. Twelve patients never required any adjuvant steroid treatment. These results suggest that CyA is an effective immunosuppressant, and if used with care side effects need not be severe.

Adult↗