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Biomedical subjects

R Wilkinson

Publications and source records attributed to R Wilkinson.

At least 307 records · Page 17Linked to original sources
PubMed1986

Imaging.

Imaging of the musculoskeletal system includes many modalities and is an area that is changing rapidly. Selection of the most accurate techniques and avoidance of duplication are vital to both good patient care and cost containment.

Acetabulum↗
PubMed1986

Intact parathyroid hormone assay offers increased sensitivity over C-terminal assays in the study of parathyroid graft function.

Serum parathyroid hormone (PTH) levels in 6 patients who had received parathyroid tissue autografts were studied. Samples were taken from graft and non-graft arms both pre- and post-dialysis. Each sample was analysed using two PTH assays, one measuring C-terminal PTH and the other measuring the intact PTH molecule. For both pre- and post-dialysis samples an appreciably greater difference was seen between the graft and non-graft arms using the intact assay. A patient with suspected ectopic PTH production showed a very much reduced differential between the two sampling sites with both assays. We suggest that the intact PTH assay is of greater clinical utility in the localisation of ectopic glands and monitoring of graft function than the commonly used C-terminal assays.

Forearm↗
PubMed1986

Hypothalamic-pituitary-adrenocortical suppression and recovery in renal transplant patients returning to maintenance dialysis.

Sixty-six per cent of a group of 21 renal transplant recipients with chronic renal failure were shown to have adrenal suppression due to glucocorticoid treatment. Gradual withdrawal of steroids in these patients returning to maintenance dialysis therapy was achieved with few symptoms of hypoadrenalism. Adrenal recovery occurred in 52 per cent of patients after three months and 71 per cent after six months. However, the plasma cortisol response to insulin-induced hypoglycaemia, studied in patients in whom adrenal recovery had been demonstrated, was impaired in 46 per cent of cases. These results indicate that corticosteroids in renal transplant recipients induce profound hypothalamic-pituitary-adrenal suppression which is slow to recover. Such patients returning to maintenance dialysis are at risk of acute adrenocortical insufficiency for several months. Although withdrawal of steroids can be achieved safely, cover during periods of stress should be given until the hypothalamic-pituitary-adrenal axis has been shown to respond normally.

Adolescent↗
PubMed1986

Renal functional reserve in kidney donors.

The glomerular filtration rates of 28 subjects, who had undergone donor nephrectomy up to 22 years previously, were measured before and after ingestion of an 80 g protein meal. A renal functional reserve was demonstrated in all cases. There was no evidence of loss of this reserve with time after nephrectomy. This study supports the view that long-term compensatory hyperfiltration of the remaining kidney after donor nephrectomy is not damaging, at least over this time scale.

Adult↗
PubMed1986

The high morbidity of CAPD fungal peritonitis--description of 10 cases and review of treatment strategies.

Fungal infection is an uncommon cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). This report describes the clinical and microbiological features of 10 cases of fungal peritonitis. Although all patients survived, morbidity was high. Abscess and adhesion formation were particular problems. Only two patients were able to return to CAPD after microbiological cure. Currently available treatment strategies for fungal peritonitis are reviewed.

Adult↗
PubMed1986

Severe primary hyperparathyroidism in a neonate with two hypercalcemic parents: management with parathyroidectomy and heterotopic autotransplantation.

A neonate with severe primary hyperparathyroidism was successfully managed by parathyroidectomy and heterotopic autotransplantation (one third of one gland of the infant was implanted in the forearm). In vitro studies of parathyroid tissue from the infant revealed a severe defect in parathyroid suppressibility. Postoperatively, the infant had modest hypercalcemia, normal serum immunoreactive parathyroid hormone levels, hypermagnesemia, and relative hypocalciuria. The parents were related and both had asymptomatic hypercalcemia with mean serum immunoreactive parathyroid hormone levels that were within the normal range. Similar to the findings in the infant postoperatively, relative hypocalciuria in the presence of hypercalcemia was found in the mother; in contrast, the father had hypercalciuria. The presumed dominantly transmitted hypercalcemia in this kindred is consistent with familial hypocalciuric hypercalcemia with a confounding factor of ethanol possibly accounting for the hypercalciuria in the father.

Acute Disease↗
PubMed1985

Loss of pulsatile luteinising hormone secretion in men with chronic renal failure.

In an attempt to determine the nature of hypothalamic and pituitary dysfunction in renal failure the secretory patterns of luteinising hormone were measured in men with end stage renal disease and compared with those in healthy controls and renal transplant recipients of similar age distribution. Mean luteinising hormone and oestradiol concentrations were significantly higher and the number of luteinising hormone secretory pulses was significantly lower in uraemic men compared with controls. Plasma testosterone and oestradiol concentrations were significantly lower in renal transplant recipients than normal men, but there were no significant differences in mean gonadotropin concentrations or the number of pulses of luteinising hormone between the two groups. As pulses of luteinising hormone are thought to reflect episodic gonadotropin releasing hormone from the hypothalamus these data suggest that uraemia interferes with central mechanisms controlling synchronised release of gonadotropin releasing hormone. This defect appears to be reversible after successful transplantation.

Adult↗
PubMed1985

Continuous ambulatory peritoneal dialysis and renal transplantation: a five year experience.

Continuous ambulatory peritoneal dialysis is a new and increasingly popular method of routine dialysis, but its effect on renal transplantation is uncertain. A non-randomised comparison was made of the outcome of grafting in patients who had been treated before transplantation with continuous ambulatory peritoneal dialysis with that in patients treated with haemodialysis. During the five years, 1979-84, after continuous ambulatory peritoneal dialysis was introduced to Newcastle upon Tyne 220 patients have received transplants after either continuous ambulatory peritoneal dialysis (61 patients) or haemodialysis (159 patients). During follow up no significant differences occurred in survival of patients or grafts between the two treatment groups. One year after transplantation the percentages of survivors who had received continuous ambulatory peritoneal dialysis and haemodialysis were 88% and 91% respectively, and overall graft survival was 66% and 72%, respectively. A multiple regression model was used to allow for differences among patients--for example, duration of dialysis and number of preoperative transfusions--on the survival of grafts. When only first cadaver grafts were considered (in 152 patients) graft survival (non-immunological failures excluded) was not significantly different between the patients treated with continuous ambulatory peritoneal dialysis and haemodialysis. Continuous ambulatory peritoneal dialysis is not a risk factor in renal transplantation, and its continued use in treatment of potential renal graft recipients is recommended.

Adolescent↗
PubMed1985

Urographic findings in adults with chronic pyelonephritis.

The radiological findings in a cohort of 138 adults with chronic pyelonephritis are presented and the following conclusions made. Scarring is commoner in the right kidney than the left and is found in the upper, middle and lower poles with decreasing frequency from above down. Agreement between observers in the grading of scarring in urograms taken without standardisation or routine tomography, is sufficiently high to justify the continued use of the intravenous urogram as a screening test but is not high enough to detect any progression of scars in the group over a 6.5-year period. Repetition of urograms seldom reveals the development of calculi or other new abnormalities and is not justified as a clinical routine. The combination of extensive bilateral renal scarring and proteinuria is associated with the worst renal function.

Adult↗
PubMed1985

Compensatory renal hypertrophy after donor nephrectomy.

Renal length was measured radiographically in 65 living kidney donors, aged 27-69 years, who had undergone unilateral nephrectomy during the past 20 years. In 34 of these subjects, pre- and post-operative kidney length, glomerular filtration rate (GFR) and blood pressure were available for analysis. Male donors developed greater compensatory hypertrophy than female donors. The extent of renal enlargement correlated negatively with the age of the subject at the time of nephrectomy and with the current mean arterial blood pressure. However, no correlation was found between the percentage change in renal length and either GFR or time since nephrectomy.

Adult↗
PubMed1985

Captopril in the hepatorenal syndrome.

Five patients with hepatorenal syndrome were treated with the orally active angiotensin-converting enzyme inhibitor captopril (25 or 50 mg 6 hourly) for up to 48 hours. Only one patient showed a significant increase in urinary sodium concentration (from less than 10 to 70 mmol/liter), but without associated diuresis; renal function continued to deteriorate in all patients with persistent oliguria and rising serum creatinine. The outcome was uniformly fatal. These results suggest that in the hepatorenal syndrome, captopril in standard dosage is without benefit, and provide further evidence that the changes in the renin-angiotensin system are probably secondary to reduced renal perfusion from some other cause.

Adult↗
PubMed1985

Renal vein renin studies in renovascular hypertension--do they really help?

Measurement of the renal vein renin ratio (RVRR) is commonly used to predict the response of blood pressure to surgery in hypertensive patients with unilateral renovascular disease. We have reviewed our experience in 37 such patients in whom renal vein renin levels were measured basally and after stimulation of renin secretion with intravenous diazoxide or tilting. Twenty-four patients were cured or improved. When a basal ratio of greater than or equal to 1.5 (diseased: normal kidney) was taken as a positive test the false positive rate was 39% and the false negative rate 71%, there being little difference in outcome between those with ratios above or below 1.5. No other threshold value of RVRR identified those responding to surgery, and acute stimulation of renin secretion did not increase the value of the test. We conclude that the RVRR is of no prognostic value in the surgical treatment of hypertension due to unilateral renovascular disease.

Adult↗
PubMed1985

Prognosis for pregnancy after correction of renovascular hypertension.

Renal artery stenosis was diagnosed in 3 women when hypertension of pregnancy persisted beyond the puerperium; all had poor obstetric histories and 2 had been hypertensive in the first trimester. A fourth case presented as hypertension associated with oral contraceptive use. After corrective procedures 6 further pregnancies were embarked upon, all of them successful and with only minor hypertensive complications in 2. Renal artery stenosis is an important cause of pregnancy hypertension persisting after the puerperium, since its correction greatly improves the prognosis for future pregnancies.

Adult↗