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Biomedical subjects

R N Fine

Publications and source records attributed to R N Fine.

At least 217 records · Page 12Linked to original sources
PubMed1977

Allograft survival in patients receiving anticonvulsant medications.

The use of phenobarbital and diphenylhydantoin in transplant recipients is associated with reduced cadaver allograft survival when compared to transplant recipients not receiving anticonvulsant medication. An attempt was made to overcome the adserve effect on allograft survival by either discontinuing the anticonvulsants (2 patients) or maintaining the dose of prednisone at greater than 1 mg/kg/day (2 patients). Discontinuation of phenobarbital was successful after transplantation, with subsequent stabilization of allograft function. Of the 2 patients receiving greater than 1 mg/kg/day of prednisone, renal function is normal in one patient; however, the second is undergoing chronic rejection. Neither patient appears cushingoid. Anticonvulsant medication should be discontinued prior to transplantation. If the patient has an active seizure disorder, prednisone dosage should be maintained at a higher level.

Adolescent↗
PubMed1977

Pretreatment of cadaver donors with methylprednisolone in human renal allografts.

Fifty cadaveric kidney donors were randomly allocated to two groups. Group 1 received 5 grams of intravenously administered methylprednisolone two to four hours prior to organ harvesting after the pronouncement of brain death. Group 2, which served as the control group, received no pretreatment. Of 100 kidneys harvested, 16 were discarded for various reasons, and 84 were transplanted and were available for evaluation, 40 from the pretreatment group and 44 from the control group. The transplant centers using these kidneys were unaware of the status of the kidney they received, that is, whether it was from a pretreated or a control group. The two groups of kidneys, pretreated and control, did not differ according to the length of warm or cold ischemia time or presence of preformed cytotoxic antibodies. The difference in graft failure between the two groups at three months was insignificant, even when the two groups were compared according to the method of preservation used.

Antibody Formation↗
PubMed1977

Long-term results of renal transplantation in children.

Of 81 children at risk for 5 to 11 yrs following an initial renal allograft, 62 (77%) are alive and 54 (67%) have a functioning allograft. Growth retardation remains a significant problem following transplantation in children; however, rehabilitation is excellent with 94% of recipients surviving with a functioning allograft engaged in age appropriate activities.

Adolescent↗
PubMed1976

Anti-B lymphocytotoxins in renal-allograft rejection.

To determine the possible role of the B lymphocyte alloantigen system in renal-transplant rejection, we examined serum specimens from 81 allograft recipients for cytotoxic activity against a panel of normal B lymphocytes. Specimens from 22 of 25 recipients undergoing allograft rejection demonstrated strong B-lymphocyte cytotoxicity whereas only 13 of 56 recipients with normal allograft function showed similar B lymphocyte cytotoxocitiy (P less than 0.0001). In the serum samples of recipients with graft rejection who were followed sequentially, B-lymphocyte cytotoxicity preceded or was concurrent with the onset of functional impairment. The results show that anti-B-lymphocyte antibodies are associated with rejection, but it is quite possible that they are the products of rejection rather than the cause.

Antibodies↗
PubMed1976

Hyperlipidemia in pediatric hemodialysis and renal transplant patients. Associated with coronary artery disease.

Fasting serum cholesterol and serum triglyceride levels were determined in 15 maintenance hemodialysis (MH) and 35 renal transplant (RT) patients. Fourteen of 15 MH patients (93%) had elevated triglyceride levels (greater than 140 mg/100 ml) compared to 11 of 35 RT recipients (31%) (P less than .001). Two of 15 MH patients (13%) had elevated cholesterol levels (greater than 230 mg/100 ml), compared to 18 of 35 RT recipients (51%) (P = .03). In MH patients, a positive correlation was noted between serum triglyceride levels and carbohydrate intake (P = .03). Autopsy material from 12 children who underwent MH or RT was compared to material from 16 age-matched controls; an increased collagenous content of intima, a possible early indicator of coronary artery disease, was noted more frequently (P less than .006) in index patients compared to controls. Our data demonstrate that hyperlipidemia is a frequent finding in pediatric patients treated with MH and RT, and may be associated with premature coronary artery disease.

Adolescent↗
PubMed1976

The adverse effect of anticonvulsant therapy on renal allograft survival. A preliminary report.

Administration of anticonvulsant medication to recipients of cadaver renal allografts appears to be associated with decreased allograft survival. The one-and two-year actuarial graft survival rates for 20 index grafts was significantly lower than for 92 control grafts. Since phenobarbital and diphenylhydantoin increase the metabolism of corticosteroids, it is proposed that renal allograft recipients receiving these anticonvulsants may have ineffective immunosuppression, leading to a higher incidence of graft failure.

Adolescent↗
PubMed1975

Hepatitis B in a pediatric hemodialysis unit.

Serial HB Ag determinations were obtained on 62 children undergoing hemodialysis during a 31/2-year period. Thirty six (58%) of the patients had atleast one positive HB Ag determination (titer larger than 1:8) either during the period of dialysis or within 2 months after transplantation. Of the children who became HB Ag positive during the period of dialysis, 89% demonstrated hepatitis B antigenemia during the initial 6 months of dialysis. Becuase of the temporal relationship between the development of HB Ag positivity and the duration of dialysis, contamination of equipment was proposed as a contributing source for transmission of HB Ag. Although 67% of the patients who were HB Ag positive during dialysis developed biochemical evidence of hepatic dysfunction, only two patients had clinical manifestations. The incidence of hepatic involvement appeared to be related to age; only one of nine children less than 12 years of age had evidence of hepatic disease. Intermittent persistence of HB Ag for periods larger than 3 years was observed. Both the incidence and persistence of HB Ag indicate the need to prevent its acquisition by pediatric patients undergoing hemodialysis.

Adolescent↗
PubMed1975

Hypertension after renal transplantation in children.

Hypertension persisted for longer than 6 mo or developed de novo after the first month following transplantation in seven of 77 pediatric recipients of renal allografts; concomitantly there were an elevation of PRA and renal angiographic abnormalities. In two of the four patients who developed RAS there was evidence of diminished allograft function. Successful correction of the stenotic lesion in these two recipients resulted in a return of the blood pressure, PRA, and biochemical function of the allograft to normal. Unsuccessful attempts at surgical repair led to loss of the allograft in the other two patients with RAS. Intrarenal vascular and/or parenchymal lesions were evident in the other three recipients with hypertension. Although an explanation was not apparent, subclinical rejection was hypothesized. Treatment effected reduction of the hypertension in these three patients and no deterioration of allograft function was observed for periods of 5, 34, and 38 mo, respectively. Renal angiographic studies and determinations of PRA are recommended in any pediatric recipient of an allograft who develops hypertension after the first month following transplantation or has hypertension which persists for longer than 6 mo after transplantation.

Acute Disease↗
PubMed1975

Posterior subcapsular cataracts: posttransplantation in children.

Posterior subcapsular cataracts (PSC) were noted in 41 of 69 (60%) recipients of renal allografts. The PSC were noted during the first posttransplant year (Group 1) in 21 (30%) recipients and after the first posttransplant (Group 2) year in 20 (30%) recipients. The dosage of prednisone during the first posttransplant year corrected for patient weight showed a significant correlation with the development of PSC during the first posttransplant year. The severity of the PSC were correlated with time of onset and prednisone dosage. Four recipients in Group 1 required cataract extraction to obtain sufficient vision to facilitate school work.

Adolescent↗