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Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

At least 253 records · Page 14Linked to original sources
PubMed1980

Survival and rehabilitation after orthotopic liver transplantation.

Between May, 1968, and April 27, 1980, 94 patients have been treated by orthotopic liver transplantation. During this time operative techniques and the management and selection of patients have changed. Healing of the biliary-tract anastomoses has been better since the introduction of a gallbladder conduit procedure and early irrigation of the donor biliary tract largely prevents damage to biliary-tract mucosa and sludge formation. Partial cardiopulmonary bypass in selected cases can provide control of the circulation during surgery. Many patients have been operated on too late, and an earlier selection is indicated. Of the 94 patients, 18 lived for over one year and 11 for two years, with 2 surviving for more than five years. 13 patients are currently alive. Rehabilitation of long-term survivors has been excellent, and although tumour recurred in more than 60% of patients grafted for primary hepatoma, worthwhile palliation can still be achieved.

Adult↗
PubMed1980

Prolongation of canine pancreas allograft survival with cyclosporin A: preliminary report.

Studies were conducted on dogs to test the efficacy of cyclosporin A (CyA) in prolonging normoglycaemia and graft survival after whole-organ pancreas allograft transplantation. Five dogs subjected to pancreatectomy alone served as controls. Withholding immunosuppression after transplantation (five animals) resulted in the same median duration of survival as occurred in the controls (13 days). Azathioprine and steroids (seven animals) produced median durations of normoglycaemia and survival of 9 and 23 days respectively. Animals given CyA 18 mg/kg/day (five) and 25 mg/kg/day (10), however, showed median durations of normoglycaemia of 18 and 55 days (p less than 0.05 and p less than 0.02) respectively and median survival times of 36 and 85 days (NS and p less than 0.02). If CyA proved effective in controlling rejection of pancreas allografts in man it would offer unstable diabetics in renal failure a more hopeful outlook than conventional immunosuppression.

Animals↗
PubMed1980

The influence of ischaemia on the biliary tract.

Damage of the biliary tract at the end of a period of hepatic preservation prior to liver transplantation has been observed in man. This damage may be important in the development of early biliary complications. A model of hepatic biliary ischaemia in the pig has been developed which permits comparison between the influences of warm and cold ischaemic damage on the biliary tract. The major damage to the biliary tract in the pig in this model appears to occur after prolonged cold preservation.

Animals↗
PubMed1980

Abdominal aortic aneurysm--the forgotten diagnosis?

A review of all cases of abdominal aortic aneurysm presenting to Addenbrooke's Hospital, Cambridge, in a 4-year period revealed that there were 118 such patients and confirmed the relatively low operative mortality for elective aneurysmal surgery (6.6%) compared with the high mortality (66.6%) for ruptured or leaking abdominal aneurysm. In only 50% of the cases was the correct diagnosis made during the lifetime of the patient; nor was the correct diagnosis always made after admission to hospital. The need for an early and accurate diagnosis of abdominal aneurysms is stressed and an increased awareness of this condition, based on well established clinical features, would undoubtedly reduce the overall mortality.

Aged↗
PubMed1979

Cyclosporin A initially as the only immunosuppressant in 34 recipients of cadaveric organs: 32 kidneys, 2 pancreases, and 2 livers.

34 patients treated with cyclosporin A received 36 cadaveric organ allografts (32 kidneys, 2 pancreases, and 2 livers), 26 kidneys are still supporting life, 3 after more than a year; the pancreases and livers are also functioning. 20 patients are not receiving steroids, and 15 of these have not had any additional immunosuppressive agents. In these patients infectious complications have not been severe, but a gastroduodenal lymphoma has developed in 1 patient. 6 patients were given 'Cytimum' (a cyclophosphamide derivative) and steroids in addition to cyclosporin A: 5 of these died of infections and 1 also had a lymphoma. 11 patients received additional steroids: 1 of these died from septicaemia and lymphoma. Nephrotoxicity can be avoided by perioperative hydration and forced diuresis. Cyclosporin A is effective on its own and is a very potent immunosuppressive drug. Additional immunosuppressive agents may lead to severe complications.

Adult↗
PubMed1979

Use of partial cardiopulmonary bypass during the anhepatic phase of orthotopic liver grafting.

Femoro-femoral partial cardiopulmonary bypass has been used in two patients under going orthotopic liver allografting who had severe cardiovascular disturbances on trial clamping of their venae cavae. Flows of 2-3 litres/min resulted in satisfactory cardiovascular control during the anhepatic phase in each ase. A third patient who tolerated caval clamping withstood the grafting without bypass. Having bypass available for use in critical cases could increase the safety of orthotopic liver transplantation.

Adult↗
PubMed1979

The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment.

Four patients are reported in whom massive haemorrhage from severe hepatic trauma was managed initially by conservative surgery and packing. The patients were then transferred by ambulance to Addenbrooke's Hospital where further treatment involved elective surgery and removal of packs. All 4 patients were discharged from hospital and have made full recoveries. It is felt that the management of liver trauma should be to do the minimum that is necessary to staunch bleeding, by suture, arterial ligation, lobectomy, resectional debridement or simply by packing. This allows the patient's haemodynamic state to be restored to normal before further surgery is attempted.

Adolescent↗
PubMed1979

Technique of organ removal and fate of kidney grafts from liver donors.

The fate of 42 kidney grafts taken from heart-beating, ventilated donors at the same time as removal of the liver for allografting is reported, and is compared with 50 kidney grafts taken from heart-beating, ventilated donors whose ventilators were electively switched off either during or immediately before kidney removal. The fate of 32 kidney grafts taken from donors classified as "dead on arrival" at the admitting hospital is also reported. Onset of life-supporting graft function was significantly earlier among kidneys from the "liver donor" group. Consequently, immediate postoperative dialysis requirements were significantly less in recipients of this group of kidneys. Early graft survival, the incidence of graft primary nonfunction, failure of first and second kidney grafts, and recipient survival were not significantly different when comparing liver donor and "ventilator switch off" kidneys. No constant relationship was apparent in any donor group between graft fate and the anoxic and ischaemic times the graft was exposed to during organ removal and reimplantation.

Adolescent↗
PubMed1979

Damage to the biliary tract during preservation.

Biliary complications following liver transplantation continue to present major difficulties. Damage to the biliary tract has been reported after preservation of the liver before transplantation. Studies in the rabbit are reported that confirm the extensive biliary autolysis during preservation. This damage is directly related to the presence of bile in the biliary tract and can be reduced by the washout of bile and biliary perfusion.

Animals↗
PubMed1979

The influence of vagotomy on bile kinetics in the rhesus monkey.

An increased incidence of gallstones has been reported following truncal vagotomy and gastric drainage but never conclusively proven. In the Rhesus monkey, bile composition and flow is similar to man. A model of biliary drainage was established which permits continuous monitoring of bile kinetics. Following truncal vagotomy and pyloroplasty, a significant fall in the bile acid concentration was observed, accompanied by a rise in cholesterol concentration. This resulted in an overall rise in cholesterol saturation. Similar changes in hepatic bile composition were, however, also seen following pyloroplasty alone, and suggests that the vagotomy itself may not be the important factor in producing bile changes.

Animals↗