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Biomedical subjects

R B Freeman

Publications and source records attributed to R B Freeman.

At least 109 records · Page 6Linked to original sources
PubMed1978

An analysis of cytomegalovirus infection and HLA antigen matching on the outcome of renal transplantation.

Eighty-five recipients and donors of renal allografts were examined for evidence of cytomegalovirus infection before and repeatedly after transplantation. The recipients were also divided into two group on the basis of HLA antigen matching. Better allograft survival was noted in patients well matched for HLA antigens (0-2) mismatched antigens) compared to those poorly matched (three or more antigens mismatched), and in patients free of cytomegalovirus compared to those infected. Cytomegalovirus infection had a more marked influence on allograft survival than did HLA antigen matching. The differing rates of success of transplantation, apparently dependent on blood relationship between donor and recipient, have been assumed largely to be due to inherited factors. This study, however, revealed an important factor to be the disparate incidence of cytomegalovirus infection in sibling, parental, and cadaveric categories of transplantation. The mechanism of this disparity can be explained on the basis of the incidence of latent CMV infection in the recipients and various categories of kidney donors.

Adult↗
PubMed1978

Clearance of meprobamate by hemoperfusion over columns of charcoal and Amberlite resin. Studies in a patient.

Perfusion of the blood of a patient with toxic levels of meprobamate through an activated charcoal cartridge resulted in efficient early clearance of the drug, then a decline in extraction. Perfusion through a resin column resulted in total drug extraction without a decline in clearance over four hours. Both procedures were stable with minimal disturbance in hematological values or blood chemistries. This is the first report of in vivo hemoperfusion over resin for meprobamate poisoning. The efficacy and safety of the procedure need emphasis.

Adolescent↗
PubMed1978

Deficiency of T and B lymphocytes in uremic subjects and partial improvement with maintenance hemodialysis.

Lymphopenia of a group of uremic patients was associated with normal percentages of T cells but reduced percentages of B cells. Lymphocyte counts improved after a period of maintenance hemodialysis, although not to control levels, and B cell percentages returned towards normal. Uremia is therefore associated with depression of total T and B cell numbers, with a relatively more pronounced effect on B cells. A period of maintenance hemodialysis produces increase in numbers of both cell types and depression becomes nonselective.

Adolescent↗
PubMed1978

Lymphocyte subpopulations in maintenance hemodialysis patients.

Lymphocyte counts and T,B and null cell proportions were analyzed in forty non-splenectomized, non-nephrectomized maintenance hemodialysis patients, and compared with those in controls. The patients were lymphopenic, but had normal T, B and null cell percentages, regardless of tehir primary renal disease. It is postulated that their lymphocyte suppression is non-selective and may be related to the state of controlled azotemia or to the dialysis procedure.

Adult↗
PubMed1977

Histoplasmosis with hypercalcemia, renal failure, and papillary necrosis. Confusion with sarcoidosis..

A 56-year-old man with a three-month history of fever, malaise, anorexia, mental confusion, and weight loss had hypercalcemia and azotemia. The chest roentgenogram was normal. Biopsy material removed 2 1/2 years previously showed noncaseating granulomas. Sarcoidosis was diagnosed, and prednisone was administered. Fever persisted, and the patient died 49 days after admission. Postmortem examination showed evidence of extensive disseminated histoplasmosis, interstitial nephritis, and papillary necrosis. This communication emphasizes the difficulty in diagnosing the etiology of disseminated, noncaseating granulomatous disease.

Body Weight↗
PubMed1977

Clinical manifestations of renal allograft derived primary cytomegalovirus infection.

Seventy seven patients, thirteen younger than 20 years of age, were followed up prospectively for the first three months after renal transplant for evidence of infection and illness due to cytomegalovirus (CMV). Thirty-two developed reactivation of latent CMV and 29 did not develop any CMV infection and wn, five had pneumonia, and four underwent nephrectomy. Of these, 16, eleven received a kidney from a parent, whereas of the other 61 patients, five received parental kidneys (P less than .001). Hence, CMV seronegative individuals who received a kidney from a CMV seropositive parent developed clinical illness and sometimes lost the allograft.

Adolescent↗
PubMed1977

Massive proteinuria and its effects on renal tubular functions.

Studies of renal tubular functions were made in two groups of patients with biopsy-proven primary glomerulonephropathies to assess the effects of proteinuria on the tubules. Group I (n = 9) had had minimal proteinuria and Group II (n = 8) had massive proteinuria. At the time the studies were made, all patients were normotensive, free of oedema, and on no dietary or drug therapy; they had normal glomerular filtration rates, serum albumin and total protein concentrations. Patients in Group II had diminished urine concentrating ability, impaired acidifying mechanism, but elevated maximum tubular secretory capacity compared with patients in Group I.

Glomerular Filtration Rate↗
PubMed1976

Toxicity following methoxyflurane anaesthesia. IV. The role of obesity and the effect of low dose anaesthesia on fluoride metabolism and renal function.

Seven obese and five normal weight patients were studied before, during and after one hour of methoxyflurane-nitrous oxide anaesthesia during peripheral surgical operations and compared with eight patients of normal weight anaesthetized with nitrous oxide-meperidine and d-tubocurare. Estimates were made of renal function, including serum and urinary electrolytes, osmolarity, uric acid, urea and creatinine. Renal clearances for the latter three substances were also calculated. Serum and urinary inorganic and organic fluoride concentrations were measured, as were renal clearances. This low dose methoxyflurane anaesthesia resulted only in a decrease in uric acid clearance among all the measures, when compared to the meperidine-nitrous oxide controls. The clearance of uric acid remained depressed for longer in the obese patients, but otherwise they did not differ from the normal weight patients. It is possible but not proven that depressed uric acid clearance may be related to the organic fluoride metabolite and an early indicator of methoxyflurane renal toxicity. The previously documented biotransformation of methoxyflurane was seen in this study. A double peak in serum inorganic fluoride was shown in all patients but one. Rather large differences in peak levels of serum inorganic fluoride occurred. The only significant difference between the obese and normal weight patients as far as fluoride metabolism was concerned was a greater variability in the serum inorganic fluoride levels in the obese patients. It would appear that the obese patient metabolizes methoxyflurane in a quantitatively if not qualitatively different fashion than the normal weight patient, perhaps because of fatty infiltration of the liver. Caution is advised in the use of methoxyflurane for more than 90 minutes of low concentration administration in view of the unpredictability of the biotransformation.

Anesthesia↗
PubMed1976

Comparative activity of immunofluorescent antibody and complement-fixing antibody in cytomegalovirus infection.

Three different tests for detection of antibodies to human cytomegalovirus (CMV), complement fixing with antigen prepared by freeze-thaw disruption (CF-FT) or with antigen prepared by extraction with alkaline glycine buffer (CF-GE) and immunofluorescent staining (FA), were compared in renal transplant recipients and their healthy donors, FA and CF-GE tests yielded positive results at an identical and significantly higher frequency than CF-FT in both donors and recipients. CF-GE and FA performed on donors and recipients predicted all virus shedding post-transplant, whereas CF-FT did not. In the individuals who developed primary infection concurrent with the transplanted kidney, FA developed earlier than other antibodies in about one-half and at the same time in the remainder. In addition, the FA test could be completed more quickly and all sera could be interpreted, which made the FA test more useful than the CF-GE, but both of these tests were clearly superior to CF-FT.

Antibodies, Viral↗
PubMed1976

Antibody response to influenza vaccination in renal transplant patients: correlation with allograft function.

Thirty renal transplant recipients received 0.5 ml of Influenza Virus Vaccine, Bivalent, USP, intramuscularly. Serum hemagglutination-inhibiting and nasal secretory neutralizing antibodies were measured before and 3 to 4 weeks after vaccination. Creatinine clearance and urinary protein excretion were measured before and weekly for 4 to 8 weeks after vaccination. Ten of 13 patients (77%) with creatinine clearance of greater than or equal to 70 ml/min-1.73m2 (group I) had greater than or equal to a fourfold increase in hemagglutination-inhibiting antibody titers to influenza A or B virus after vaccination, while only six of 17 patients (35%) with creatinine clearance of greater than 70 ml/min-1.73m2 (group II) had a similar increase (chi-square = 5.129; P less than 0.05). Six of 13 patients (46%) in group I had greater than or equal to a fourfold increase in neutralizing antibody titers to influenza A or B virus after vaccination, whereas none in group II had a similar increase (chi-square = 7.135; P less than 0.01). There were no adverse effects on the allografts. Only minor side effects were noted in a few patients. Because of its safety and antigenicity, influenza vaccination should be offered to renal transplant recipients particularly during threats of epidemic outbreaks.

Adolescent↗
PubMed1976

Long-term effect of dialysate glucose on the lipid levels of maintenance hemodialysis patients.

The long term use of a glucose free dialysate in a group of 15 maintenance hemodialysis patients is associated with a significant decrease in serum cholesterol in 50% of the patients and a significant decrease in serum triglycerides in 25%. The lipid changes appear to be independent of changes in body weight. Hyperlipidemia is believed to be an associated risk factor in the genesis of atherosclerosis in the general population and perhaps in maintenance hemodialysis patients. The long term correction or palliation of the hyperlipidemia of some maintenance hemodialysis patients by the use of glucose free dialysate may be beneficial.

Adolescent↗
PubMed1975

Spontaneous remission of the nephrotic syndrome in diabetic nephropathy.

A 28 year old woman, with diabetes since age 18, had the nephrotic syndrome, hypertension and renal insufficiency. The initial renal biopsy specimen revealed diffuse glomerulosclerosis with early nodular changes. After an initial decline in renal function, her creatinine clearance progressively improved and has remained normal. Within 2 years she had a spontaneous remission of the nephrotic syndrome despite the presence of more pronounced nodular glomerular lesions. Although the renal hemodynamic functions were normal, certain tubular functions were impaired. Since we found no etiology for the nephrotic syndrome other than diabetic glomerulopathy, the complete remission of the nephrotic syndrome and improvement in renal function were very unusual events.

Adult↗
PubMed1975

Effects of furosemide on low-dose mercuric chloride acute renal failure in the rat.

The use of potent diuretics in acute renal failure remains controversial. Both beneficial and detrimental effects have been reported. In the present study, the effects of both low and high doses of furosemide administered in the developmental and established stages of mercuric chloride-induced acute renal failure were evaluated. Both low and high doses of furosemide produced a significant diuresis when given early in the course of experimental acute renal failure. Despite this diuresis, furosemide did not modify the development of the acute renal failure. Continued administration of a low dose of furosemide had no effect on renal function; however, prolonged administration of high doses of furosemide resulted in significantly lower creatinine clearances 48 hr after induction of acute renal failure. This detrimental effect was due to sodium depletion by the diuretic since it was prevented by continuous replacement of urinary sodium losses. In the absence of sodium depletion, high doses of furosemide produced a significant diuresis, both in the developmental and established phases of acute renal failure, but it had no effect on the degree of renal functional impairment.

Acute Kidney Injury↗