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Biomedical subjects

R J Taylor

Publications and source records attributed to R J Taylor.

At least 145 records · Page 8Linked to original sources
PubMed1994

The evaluation of the living renal donor, surgical techniques and results.

Living-donor renal transplants from either genetically related or unrelated donors have proven to have superior short- and long-term results when compared with cadaveric transplants. Meticulous and comprehensive evaluation of the donor is necessary to eliminate all donors with possible underlying renal disease, and to minimize the risk of post-operative complications. Operative strategies are aimed at obtaining excellent exposure to the kidney and reducing trauma to the renal vessels. Techniques to use kidneys that in the past may not have been used (eg, multiple renal arteries, short right renal vein, ureteropelvic junction obstruction) are described. Vigilance during the preoperative medical and radiological evaluation, nephrectomy, and postoperative period needs to be maintained in order to eliminate any and all preventable morbidity associated with this procedure. Long-term follow-up of all living donors is important to continually reassess postnephrectomy risk.

Adult↗
PubMed1994

Orthotopic hepatic transplantation in patients with type I diabetes mellitus.

Six transplantations of the liver were performed over a period of six years in five adult patients with Type I diabetes mellitus (DM). The diabetic group included two males and three females with a mean age of 36 years and a mean duration of DM of 20 years. Primary diseases of the liver included two instances of primary biliary cirrhosis, two instances of sclerosing cholangitis and one instance of autoimmune chronic hepatitis. Three patients also received a simultaneous whole organ pancreatic transplant. All patients were managed with cyclosporine and prednisone immunosuppression with selective OKT3 induction. Patient and hepatic allograft survival rates were 80 and 67 percent, respectively, after a mean follow-up period of 4.7 years. One of the three pancreatic grafts was successful and resulted in euglycemia for two years. Three patients have subsequently undergone successful renal transplantation at one, two and one-half, and six and one-half years after hepatic transplantation. Although transplantation of the liver can be performed safely in carefully selected patients with Type I DM, these patients are still at risk for the development of progressive nephropathy. Renal transplantation is an acceptable therapeutic alternative when this occurs.

Adult↗
PubMed1994

Kidney/pancreas transplantation: a review of the current status.

KPT has become the treatment of choice for many Type I diabetics with impending or actual end-stage renal disease. The techniques of organ procurement, surgical transplantation, and postoperative management are well established. The current 1- and 3-year patient and graft survival rates are at least equal to those obtained in both diabetic and nondiabetic patients receiving kidney transplants alone. Although there is significant associated morbidity unique to the pancreas transplant, this is usually manageable without influencing the outcome. With the improvement in quality of life and the potential for arresting diabetic complications, KPT is a procedure that should be seriously considered for many Type I diabetic patients with advanced nephropathy.

Diabetes Mellitus, Type 1↗
PubMed1994

Factors influencing general practitioners' referral to hospital of adults with presumed infective diarrhoea.

BACKGROUND: Acute infective diarrhoea is one of the commonest reasons for admission to hospital with an infectious disease. AIM: This study set out to describe the clinical features of infective diarrhoea at the time of presentation in adults managed in the community or admitted to hospital in 1990-91, in order to try to understand the decision-making process which led to referral to hospital. METHOD: Data were collected from general practitioners by computer assisted telephone interview for 114 patients with presumed infective diarrhoea referred to the infection unit at the City Hospital, Aberdeen from all practices in the Grampian region and for 121 non-referred patients managed within seven practices. RESULTS: General practitioners appeared to use examination, investigation and referral selectively in patients presenting with diarrhoeal illness. A comparison of referred and non-referred patients identified differences in patients' reasons for consultation and the general practitioners' clinical findings, suggesting these were important in the decision to refer the patient for hospital admission. General practitioners were more likely to refer adult patients with infective diarrhoea if the patients were older, were seen at home and were more acutely unwell with fever, dehydration and abdominal tenderness. CONCLUSION: The identification of these criteria may help general practitioners to decide when to refer a patient with infective diarrhoea to hospital.

Diarrhea↗
PubMed1993

Selective use of Sandostatin in vascularized pancreas transplantation.

Despite improving results, the management of exocrine complications after pancreas transplantation remains problematic. During a 30-month period, we performed 65 pancreas transplants with bladder drainage. A total of 23 patients (35%) were managed with a long-acting somatostatin analogue (Sandostatin) for persistent hyperamylasemia or allograft pancreatitis. Sandostatin was begun at a mean of 29 days after transplant with a mean duration of therapy of 13 days. Sandostatin therapy was associated with significant reductions in the serum, urine, and peritoneal fluid amylase levels (p < 0.05). Sandostatin also caused a decrease in cyclosporine levels during oral cyclosporine use. In patients receiving Sandostatin, pancreas allograft survival was 83%. We conclude that pancreatitis remains a major cause of morbidity after pancreas transplantation. The selective use of Sandostatin can result in excellent graft salvage with low morbidity. Sandostatin appears to be safe and effective in reducing the exocrine output of the denervated pancreas allograft but also reduces cyclosporine levels.

Adult↗
PubMed1993

Correlation of preoperative urodynamic findings to postoperative complications following pancreas transplantation.

Urological complications are common following pancreas transplantation with bladder drainage. Some investigators have excluded patients from pancreas transplantation because of abnormal preoperative urodynamics. To determine the risk of an abnormal bladder in bladder-drained pancreas transplantation, we prospectively evaluated 23 type I diabetic patients undergoing pancreas transplantation with preoperative urodynamics. For study purposes, criteria for an abnormal urodynamic evaluation were a bladder capacity of greater than 1,000 cc, absence of normal detrusor contractility and an abnormal voiding pattern. In addition, an abnormal study was defined by the presence of 2 or more of the following: 1) suppressed proprioception at 250 cc or at a volume of greater than 50% of bladder capacity, 2) peak flow of less than 10 cc per second, 3) interval to peak flow of greater than 30 seconds or 4) post-void residual of greater than 150 cc. Of the 23 patients 10 (43%) had abnormal preoperative urodynamic studies. All 23 patients underwent pancreas transplantation with bladder drainage, alone or in combination with a kidney transplant. The incidence of urological complications was 3.1 and 3.4 per patient, respectively, in the normal and abnormal groups (p = 0.126). Patient and graft survival rates were similar between the 2 groups (p > 0.5). We were unable to show that abnormal preoperative urodynamic studies preclude successful pancreas transplantation with bladder drainage or predict an increase in postoperative complications.

Adult↗
PubMed1993

The 3'-keto-diol equilibrium of trospectomycin sulfate bulk drug and freeze-dried formulation: solid-state carbon-13 cross-polarization magic angle spinning (CP/MAS) and high-resolution carbon-13 nuclear magnetic resonance (NMR) spectroscopy studies.

Understanding how moisture interacts with a drug or formulation is a critical component of product development. This study demonstrates how water affects the 3'-gem-diol<==>3'-keto equilibrium in trospectomycin sulfate bulk drug and freeze-dried formulation, as probed by solid-state carbon-13 cross-polarization magic angle spinning (CP/MAS) and high-resolution nuclear magnetic resonance (NMR) spectroscopy. Drying the bulk drug or formulation to low water levels dehydrates trospectomycin sulfate from the diol to the keto form. Carbon-13 CP/MAS NMR spectroscopy measures the keto drug concentration in solid samples directly. The bulk drug, which contains approximately 16% water, is more than 90% in the 3'-diol form. Oven drying to < 3% water converts approximately 75% of the drug to the 3'-keto form. The drug is formulated as a freeze-dried, sterile powder that can contain up to 12% water depending on the freeze-drying conditions. These studies show that the 3'-keto concentration rises uniformly (up to 75%) with decreasing residual water in the freeze-dried cake. The keto-diol equilibrium was also studied in solution by high-resolution carbon-13 NMR experiments, and it was found that raising the temperature or using dimethyl sulfoxide (DMSO) as a solvent also dehydrates the drug. For example, in aqueous solution at 25 degrees C, nearly all (> 95%) of the drug is in the 3'-diol form. After equilibration at 60 degrees C, however, the 3'-keto content increases to 7%, and in d6-DMSO solvent at 25 degrees C the drug is mostly (60%) in the 3'-keto form.

Carbon Isotopes↗
PubMed1993

The use of Fourier transform and spectral analysis in the detection of distension-induced gastric arrhythmias in dyspeptic patients.

The electrogastrograms of a cohort of normal controls and a group of functional and postvagotomy dyspeptic patients, recorded under conditions of varying gastric distension applied via a gastric barostat, have been captured and stored on a portable PC. Retrospective quantitative and qualitative analysis of the waveforms have been carried out in the frequency domain. Gastric distension induced a reduction in gastric baseline frequency levels, which recovered after removal of the bolus. Controlled distension at a moderate level (240-480 ml) caused more symptoms in patients than in controls, but did not seem to affect the electrogastrograms. However, under conditions of high gastric distension (> 480 ml), there was a significant difference between the controls and patients predominant electrogastrographic frequencies (mean difference = 0.013 Hz; 95% CL = 0.001 Hz to 0.025 Hz; p = 0.014). We conclude that functional and postvagotomy dyspeptic patients have greater gastric electrical instability than controls, which seems to be more apparent under conditions of high gastric distension. The use of the Fourier transform and running spectral analysis method of analysis allowed this difference to be detected and measured.

Adult↗
PubMed1993

Gender and age differences in religiosity among black Americans.

Gender and age differences were examined in over a dozen religious indicators using cross-sectional data from the National Survey of Black Americans (N = 2,107). Although both genders manifested moderate to high levels of organizational, nonorganizational, and subjective religiosity, black women significantly exceeded black men in levels of religiosity at all ages, even when controlling for the effects of education, marital and employment status, region, urbanicity, and health satisfaction.

Adolescent↗