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Biomedical subjects

R D Gordon

Publications and source records attributed to R D Gordon.

At least 235 records · Page 13Linked to original sources
PubMed1986

Unstimulated renal venous renin ratio predicts improvement in hypertension following nephrectomy for unilateral renal disease.

The ability of renal venous renin ratio (RVRR) to predict the blood pressure response to nephrectomy was studied in 45 hypertensive patients followed for at least 1 year after nephrectomy. Twenty patients had unilateral chronic parenchymal renal disease (UCPR) and 25 patients had unilateral renal artery stenosis (RAS). The RVRR procedure was performed according to a strict protocol which included sodium restricted diet (40 mmol daily) and hospital admission, with one set of unstimulated samples collected after overnight recumbency, and at least one further set collected after sympathetic nervous system stimulation induced by tilting or i.v. diazoxide. In only 3 of 12 patients with serum creatinine 0.15 mmol/l or higher and presumed bilateral renal disease was hypertension improved. If these 12 patients are excluded, RVRR was a good predictor of outcome, but only if the question of unstimulated and stimulated ratios was considered. Whereas inclusion of stimulated ratios increased the predictive accuracy to 81% in RAS, and avoided two false-negatives, in UCPR the stimulated ratio created four false-positives. Since there were no false-negatives and six true-negatives in UCPR, overnight recumbent RVRR was a perfect predictor of outcome in this sub-group. It appears that RVRR without sympathetic stimulation is most reliable in UCPR, and RVRR during sympathetic stimulation in RAS, raising the question that renin regulation may be different in these two conditions.

Adolescent↗
PubMed1986

The syndrome of hypertension and hyperkalaemia without renal failure: long term correction by thiazide diuretic.

An excellent response to treatment with thiazide diuretic for twelve years is described in a patient with Gordon's Syndrome, the first to be reported from Scotland, and only the second to manifest the full clinical picture of short stature, hypertension, hyperkalaemia and hyperchloraemic acidosis without renal failure. The hypertension and biochemical abnormalities were reversed during therapy. Temporary withdrawal after seven years was followed by the immediate return of all the biochemical abnormalities, but not of the hypertension.

Benzothiadiazines↗
PubMed1986

Elevated levels of plasma atrial natriuretic peptide in Bartter's syndrome fall to normal with indomethacin: implications for atrial natriuretic peptide regulation in man.

Plasma atrial natriuretic peptide (ANP) levels were inappropriately elevated in Bartter's syndrome, in contrast with appropriately low levels in patients with Addison's disease and bulimia, with similar hyper-reninaemia and volume contraction. Inappropriate overproduction of ANP in Bartter's syndrome may be important in the pathophysiology. Prostaglandin inhibitors cause sodium retention and might be expected to increase ANP levels, based on their volume effects. Surprisingly, therefore, both indomethacin and aspirin lowered elevated levels of ANP in Bartter's syndrome to normal, indomethacin achieving this within 24 h. Single doses of indomethacin and aspirin also lowered plasma ANP levels in normal subjects. Saline infusion in Bartter's syndrome increased already-elevated levels of ANP further. When repeated during indomethacin treatment, despite suppression of basal levels to normal, even higher levels were achieved in three of four subjects. These results are consistent with a role for prostaglandins in ANP release in man, but suggest that another mechanism is also operative. They may help to explain the variable renal effects of prostaglandin inhibition.

Addison Disease↗
PubMed1986

The metabolic significance of pentose cycle measurements in perfused liver.

The controversial dissension concerning the nature of the pentose cycle in liver is investigated. The metabolism of [2-14C]Glc and [1-14C]Rib in chronically perfused normal and regenerating rabbit liver and acutely perfused rat liver are used to test the mechanistic predictions and contribution of the F-type pentose cycle. 14C was traced in Glc, Glc 6-P, Fru 6-P, glycogen and Rib 5-P. None of the data complied with the critical theoretical limits set for the C-1/C-3 ratio (the identity badge of the F-type pentose cycle or pathway) for all values of F-type PC from 0-100%. Thus apparent F-type PC measurements using the Katz & Wood method gave a wide scatter of calculated values. The 14C distributions in Rib 5-P do not conform with the predictions of the F-type PC but are in agreement with the many previous results of similar experiments reported by Hiatt and co-workers. In perfused rat liver the C-1/C-3 constants in Glc 6-P and glycogen also failed to conform with F-PC theory following the metabolism of [2-14C]Glc. The metabolism of [5-14C]Glc and distribution of 14C in Glc 6-P and glycogen showed that L-type PC was 18%, in close agreement with a previous published value of 22% for rat hepatocytes. Metabolism of [6-14C]Glc and [4-14C]Glc (as [4,5,6-14C]Glc) showed that Pyruvate Recycling was active in perfused rat liver. None of the data from these comprehensive investigations can confirm the results of the recent study reported by the Landau laboratory on the pentose pathway metabolism of Glc and Rib in perfused rat liver.

Animals↗
PubMed1986

Liver transplantation across ABO blood groups.

Six hundred seventy-one first, second, and third orthotopic liver allografts in 520 patients were reviewed to determine the effect of donor-recipient mismatches or incompatibilities for the ABO blood groups on graft survival. A significant advantage for ABO donor-recipient identity was found, especially in adults and for first grafts. However, a surprisingly large number of ABO incompatible grafts were successful. We recommend that nonidentical or incompatible grafts be limited to patients such as small children for whom the supply of available donors is severely limited or for patients in urgent need of transplantation or retransplantation.

ABO Blood-Group System↗
PubMed1986

The antibody crossmatch in liver transplantation.

Six hundred sixty-seven first, second, and third orthotopic liver allografts in 520 patients were reviewed to determine the effect of recipient panel-reactive antibody (PRA) and donor-recipient antibody crossmatch on 2-year patient and liver allograft survival rates. Neither a high panel-reactive antibody nor a positive crossmatch for donor-specific preformed antibody was associated with decreased patient or liver allograft survival for primary grafts or retransplants. Two patients have been given kidney transplants immediately after a liver allograft from a donor with whom each patient had an initial strongly positive donor-specific antibody crossmatch. The liver apparently removed or neutralized circulating anti-donor antibody, since the renal allografts functioned promptly and did not experience hyperacute rejection.

Actuarial Analysis↗
PubMed1986

Liver resection for metastatic colorectal cancer.

From 1975 to 1985, 60 patients with isolated hepatic metastases from colorectal cancer were treated by 17 right trisegmentectomies, five left trisegmentectomies, 20 right lobectomies, seven left lobectomies, eight left lateral segmentectomies, and three nonanatomic wedge resections. The 1-month operative mortality rate was 0%. One- to 5-year actuarial survival rates of the 60 patients were 95%, 72%, 53%, 45%, and 45%, respectively. The survival rate after liver resection was the same when solitary lesions were compared with multiple lesions. However, none of the seven patients with four or more lesions survived 3 years. The interval after colorectal resection did not influence the survival rate after liver resection, and survival rates did not differ statistically when synchronous metastases were compared with metachronous tumors. A significant survival advantage of patients with Dukes' B primary lesions was noted when compared with Dukes' C and D lesions. The pattern of tumor recurrence after liver resection appeared to be systemic rather than hepatic. The patients who received systemic chemotherapy before clinical evidence of tumor recurrence after liver resection survived longer than those who did not.

Actuarial Analysis↗
PubMed1986

Serial hemodynamic assessment of aortobifemoral bypass.

Clinical, arteriographic, and vascular diagnostic laboratory (VDL) data on 157 patients undergoing aortobifemoral bypass (ABF/BP) more than 5 years previously were compared in terms of the perspective provided by noninvasive testing, particularly when performed in the face of superficial femoral artery (SFA) occlusion. To the traditional outcome criteria (operative mortality rate, 3.2%; amputation rate, 1.4%; early patency rate, 98%; and late patency rate, 86%), VDL data added an initial hemodynamic failure rate of 14% and a late deterioration rate of 8%. Those patients with occluded SFAs fared worse in regard to initial patency (94% vs. 100%), initial hemodynamic failure (29% vs. 2%), late deterioration (8.8% vs. 5.4%), and late failure rates (16% vs. 10%), whereas those patients with open SFAs suffered more distal disease progression (11.5% vs. 1.3%). "Prediction" of postoperative ankle/brachial index (ABI) from preoperative thigh/brachial index (TBI) and ABI was 92% accurate for limbs with open SFAs but only 84% for limbs with occluded SFAs; prediction was made with a formula based on proportional transmission and with TBI measured with a regularly sized cuff (best combination). Neither additive transmission formula nor measurement of TBI with a large cuff allowed accurate prediction when the SFA was occluded. No advantage, in terms of initial hemodynamic result or late outcome, could be demonstrated for limited profundaplasty in the absence of significant profunda femoral stenosis and end-to-end vs. end-to-side proximal anastomosis.

Amputation, Surgical↗
PubMed1985

Cyclosporine-steroid combination therapy in 84 cadaveric renal transplants.

Sixty-three primary and 21 retransplant cadaver kidney allografts were placed in 77 patients over a one-year period with three- to six-month follow-up. Eight primary grafts (12.7%) and six retransplants (28.6%) were lost to rejection. Patient mortality was 3.9%. There were no grafts lost and no deaths due to opportunistic infections. Renal function at 6 months after transplantation was similar in all primary transplant recipients regardless of risk factors, including advanced age, diabetes, or the need for postoperative dialysis.

Administration, Oral↗
PubMed1985

Immunosuppression and other nonsurgical factors in the improved results of liver transplantation.

During the last 5 years, liver transplantation has become a service as opposed to an experimental operation. The most important factor in making this possible has been the introduction of cyclosporine-steroid therapy. At the same time, liver transplantation has been made more practical by improvements in diagnosing and managing other causes of postoperative hepatic dysfunction. Tissue typing and matching have played no role in improving the results of liver transplantation. With the demonstration that performed antibody states are irrelevant, even avoidance of positive cross-matches caused by cytotoxic antibodies and observance of ABO blood group barriers have become unnecessary if the recipient's needs are great. With the exceptions of malignancy and cirrhosis, the nature of the underlying hepatic disease has not profoundly influenced the results. Retransplantation has played an important role in improving survival, although the costs of retransplantation have been extremely high.

Age Factors↗
PubMed1985

Liver rejection and its differentiation from other causes of graft dysfunction.

Numerous causes can lead to hepatic dysfunction following orthotopic liver transplantation. The most common cause is rejection, which is usually nonpreventable. The clinical presentation, time of onset, and even treatment are variable. Other causes, such as perioperative ischemic injury, vascular thrombosis, and complications of bile duct reconstruction may be preventable with good surgical technique. Infections can also be minimized by careful adjustment of immunotherapy, avoidance overimmunosuppression, and the judicious use of antibiotics. Hepatic dysfunction following orthotopic liver transplantation requires rapid assessment and proper treatment in order to prevent serious and possibly fatal complications.

Bile Duct Diseases↗