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Biomedical subjects

R Wilkinson

Publications and source records attributed to R Wilkinson.

At least 343 records · Page 19Linked to original sources
PubMed1984

Haematuria in rheumatoid arthritis: an association with mesangial glomerulonephritis.

Twenty-four patients with rheumatoid arthritis and isolated haematuria were investigated for the cause of their haematuria. In 3 patients local urological disorders were identified, including a pelvicaliceal carcinoma. Renal biopsies were performed on the remaining 21 patients, and the most common abnormality found was a mild mesangial glomerulonephritis (71%). Immunofluorescence and electron microscopy in these patients usually gave normal results. The lesions occurred independently of gold or D-penicillamine therapy and were not associated with impairment of glomerular function.

Adult↗
PubMed1984

Severe postural hypotension following home canoe construction from polyester resins.

On two occasions a 36-year-old man developed severe postural hypotension and neurological signs after working with a polyester resin canoe building kit in an unventilated shed. It is likely that his recurrent illness was caused by styrene intoxication. Postural hypotension secondary to styrene exposure has not previously been reported.

Hobbies↗
PubMed1984

Extrarenal arteriovenous fistula. An unusual complication of percutaneous renal transplant biopsy.

A percutaneous allograft biopsy in a renal transplant recipient with declining function was followed by haemorrhage from the external iliac artery requiring repair of the puncture site. A common iliac arteriogram performed subsequently showed an external iliac arteriovenous fistula. In retrospect, an isotope scan performed at 48 h post-transplant, showed the upper pole of the graft overlying the iliac vessels. To avoid such complications we recommend a careful assessment of the anatomical relationships of the transplant kidney to major blood vessels prior to biopsy.

Adult↗
PubMed1984

Isolated C3 deposition in patients without systemic disease.

Deposition of C3 without immunoglobulins ("isolated C3") was found in 9.8% of 540 renal biopsies performed between 1976 and 1982. Thirty-two of these samples were from patients with systemic diseases (16), well defined forms of glomerulonephritis (9), other renal diseases (4) or renal allografts (4). The remaining 22 patients are described. Five had nephrotic syndrome, three of them with minimal changes on light microscopy and good response to corticosteroids. We were left with a group of 17 patients who presented with gross (4) or microscopic (12) hematuria or asymptomatic proteinuria (1) whose biopsies showed mesangial proliferation or/and hyperplasia and who followed a benign course over the mean 3 years of follow-up, with the exception of one whose renal function is declining. This clinicopathological picture is similar to that described in two previous publications suggesting that "Isolated C3 mesangial proliferative nephritis" is a recognizable sub-group within the spectrum of glomerulonephritis.

Adolescent↗
PubMed1983

Is anaemia during continuous ambulatory peritoneal dialysis really better than during haemodialysis?

The level of anaemia in 22 patients on continuous ambulatory peritoneal dialysis (CAPD) was compared with that in 12 patients maintained on intermittent haemodialysis. Contrary to previous reports, the haematocrit did not differ between these groups, nor did it increase progressively with time in those on CAPD. Total red cell volume (RCV) and plasma volume were also similar in the two groups. Clearance of radioactive iron from plasma (plasma iron turnover) was higher in haemodialysis than in CAPD patients but erythrocyte radioiron utilisation (FeU) did not differ in the two groups. RCV in both CAPD and haemodialysis patients correlated positively with erythrocyte iron turnover and FeU but not with red cell survival, suggesting that the rate of production rather than destruction of red cells is the major determinant of total RCV in dialysis patients. Red cell survival was slightly but significantly higher in CAPD than in haemodialysis patients and increased with time on dialysis, but this difference was insufficient to increase total RCV in CAPD patients above that in haemodialysis patients.

Anemia↗
PubMed1983

Cold pressor test in diagnosis of coronary artery disease: echophonocardiographic method.

The cold pressor test was used to induce myocardial ischaemia in patients with coronary artery disease and the rise in left ventricular filling pressure used as the index of myocardial ischaemia. Left ventricular filling pressure was derived from a non-invasive echophonocardiographic method. A study group of 19 consecutive patients with chest pain underwent the cold pressor test before coronary angiography. Eighteen responded with a rise in filling pressure exceeding 30% and, of these, 17 had serious coronary artery disease (three single vessel, one two vessel, and 13 triple vessel disease; one had coronary artery spasm only). The remaining patient, who showed no rise in filling pressure, did not have coronary artery disease. None of 15 normal controls showed a rise greater than 5% (patients with coronary artery disease versus normal controls p less than 0.001). The cold pressor test would be suitable for patients who cannot or should not exercise and may be combined with exercise electrocardiograms to improve the information content, as it uses a different marker of myocardial ischaemia.

Adolescent↗
PubMed1983

The frequency of hepatitis A and B viruses as the offending viral type in suspected hepatitis.

Three hundred and thirty blood samples from patients suspected of having hepatitis on clinical grounds but in whom the aetiology of the hepatitis was unknown (93 Whites and 237 Blacks) were tested for the presence of hepatitis B surface antigen (HBsAg), anti-HBs, total anti-hepatitis A virus (HAV) activity and anti-HAV of the IgM class. These tests identified the offending hepatitis virus whenever this was type A or type B, and also revealed the patient's immune status in respect of these viruses. Among the White patients HAV was the cause of 32,2% of the cases of hepatitis and was found commonly in patients up to the age of 35 years, with 1 further example being identified among the patients over the age of 50 years. In contrast, among the Black patients this infection was found only in children, with none of the patients over the age of 5 years remaining susceptible to the disease. Hepatitis B virus (HBV) was found frequently in Blacks of all ages and caused 39,7% of the cases of hepatitis, but was far less common among the Whites, in whom it was responsible for only 10,7% of cases. Serological evidence of exposure to HBV in the combined forms of HBsAg and anti-HBs reached 85,7% in Blacks aged between 36 and 50 years, while the highest level to be found in Whites was 45,5%, in the same age group. Active hepatitis A or B infections were diagnosed in 43% of the White patients and 50% of the Black patients in the study.

Adolescent↗
PubMed1983

Comparative study of available medical therapy for hypercalcemia of malignancy.

The relative efficacy of five drugs in the treatment of hypercalcemia of malignancy was assessed in a randomized study. The drugs were oral phosphate, mithramycin, glucocorticoids, indomethacin, and ethane-1-hydroxy-1, 1-diphosphonate (EHDP). No single agent was universally effective. Oral phosphate and mithramycin were the most efficacious, each producing a decrease in serum calcium concentrations in four of five patients, although there were serious disadvantages with the use of each. Glucocorticoids were effective in only two of five patients who received randomized treatment. A further five patients received nonrandomized treatment with glucocorticoids, and only three of these showed response. Indomethacin was effective in only one of five patients to whom it was given, and EHDP was effective also in only one of five patients. The new diphosphonate, 3-amino-1-hydroxypropane-1, 1-diphosphonate (APD) was evaluated in the treatment of hypercalcemia in 13 patients with malignant disease and two with primary hyperparathyroidism. APD caused a significant decrease in serum calcium concentration in nine of 12 patients within 72 hours. These results indicate that there is no currently available pharmacologic agent that is entirely satisfactory in the treatment of hypercalcemia. The most effective agents were mithramycin, oral phosphate, and APD. Glucocorticoids and orally administered EHDP showed limited effectiveness, and indomethacin was ineffective in the majority of patients.

Administration, Oral↗
PubMed1983

Frequency and persistence of serologic markers following three different manifestations of hepatitis B virus infection.

30 asymptomatic chronic carriers of hepatitis B surface antigen (HBsAg), 6 asymptomatic blood donors transiently infected with hepatitis B virus, and 38 patients with acute hepatitis B were tested for HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc. Comparison of these results revealed significant variation in the frequency of HBeAg which was present in 1 (3.3%) carrier, 2 (33.3%) of the transiently positive donors, and in 24 (63.2%) of the patients with acute hepatitis. Anti-HBe was found in 28 (93.3%) of the carriers, 4 (66.6%) of the transiently positive donors, and in 8 (21%) of the patients. Variation was also seen in the strength of anti-HBc, with only the chronic carriers having titres which were consistently high (above 1,000). Retesting the two groups of donors after a period of approximately 2 years showed no change in the serologic status of the chronic carriers, while amongst the transient HBsAg positives the 2 HBeAg reactives had seroconverted, 1 of the anti-HBe positives had become non-reactive, and 2 of the 6 had developed anti-HBs. 6 of the patients with acute hepatitis B were serologically reexamined during convalescence and showed results similar to those seen in the transiently HBsAg-positive donors, with clearance of HBsAg in all, seroconversion from HBeAg to anti-HBe in 4, and the production of anti-HBs in 4.

Acute Disease↗
PubMed1983

The effect of beta-blockade therapy on serum thyroxine binding globulin (TBG) concentration.

Non-specific beta-blockade with either propranolol or nadolol was shown not to reduce serum TBG concentration in 20 untreated thyrotoxic patients, but to cause significant reductions in the same subjects once they were rendered euthyroid. Similar reductions were also seen in a group of 10 clinically and biochemically euthyroid subjects, who were under investigation for anxiety or mild angina. Since nadolol does not possess the membrane stabilising properties of propranolol, nor is it metabolized like propranolol, the effect on TBG concentration would appear to be due to beta-blockade.

Adrenergic beta-Antagonists↗
PubMed1983

Intravenous methylprednisolone at the time of renal transplantation.

Ninety-five consecutive transplants performed prior to the introduction of methylprednisolone bolus at transplantation were compared to 136 consecutive transplants performed after the policy change. No difference was found in the incidence of reversible or irreversible rejection in the two groups. The treated group were exposed to a higher total dose of steroid than the non-treated group. Routine bolus methylprednisolone therapy at transplantation is not recommended.

Adult↗
PubMed1983

Experience in the management of hypertension with unilateral chronic pyelonephritis: results of nephrectomy in selected patients.

We report the experience of a regional centre serving a population of 3 millions in the management of patients with hypertension and unilateral scarred kidneys between 1972 and 1981. Thirty one patients were studied, fifteen have been subjected to nephrectomy and sixteen managed conservatively. The medically and surgically treated patients differed only in that the diseased kidney was smaller, 7.7 +/- 1.9 vs 9.9 +/- 1.7 cm, (p less than 0.01), and systolic blood pressure higher, 224 +/- 34 vs 198 +/- 30 mmHg, (p = 0.05), in the surgically treated group. Following nephrectomy blood pressure was normal without drugs in four patients, control was made easier in 10 patients and only one patient, who had bilateral disease, failed to benefit. In the non-surgical group drugs could be withdrawn in only one patient and control became easier in only five. Serum creatinine did not increase following nephrectomy, but had increased significantly at the time of the most recent follow up in the medically treated patients (89 +/- 20 to 102 +/- 32 mumol 1(-1), p less than 0.05). We conclude that nephrectomy is of value in the management of some patients with unilateral chronic pyelonephritis and need not result in loss of renal function. Renal vein renin studies may be helpful in selecting patients for surgery but examination of the effect of nephrectomy in patients without differences in renal vein renin is necessary to establish this.

Adolescent↗
PubMed1983

Continuous ambulatory peritoneal dialysis: three years' experience.

We review the experience of the Renal Unit at Newcastle upon Tyne over the three years 1979-1981, during which 122 patients with chronic renal failure were treated by continuous ambulatory peritoneal dialysis (CAPD). Advantages of the technique included wide acceptability to a cross-section of patients reaching the renal unit, including the elderly and diabetics. Patients who experienced both techniques preferred CAPD to haemodialysis because of the greater freedom and sense of well-being. Patient survival was 94 per cent at two years and rehabilitation was as good as could be expected for the age and primary medical complications of the patients. Control of plasma potassium and phosphate was easier than with haemodialysis. Renal osteodystrophy responded well to a combination of CAPD and alfacalcidol therapy over the two year period for which we have performed serial bone biopsies. Serum aluminium was slightly raised as a result of consumption of phosphate binders and presumed uptake from dialysis fluid but no aluminium related disease has yet been encountered. Anaemia was partly corrected by CAPD with haemoglobin rising to about 10 g/dl on average. CAPD was less costly than home haemodialysis over the first three years and has been adopted as our standard treatment for patients who can expect an early transplant. Disadvantages were persisting problems with peritonitis which still occurred at an incidence of one attack per 39 patient weeks over the last two years, and an actuarial success rate for the technique of only 63 per cent at two years. Twenty patients developed hernias. Weight gain was common and occasionally gross. There was a significant rise in serum cholesterol. The arrival of CAPD has allowed us to increase the intake to our renal failure programme by 50 per cent. However, continued expansion of the technique demands advances in prevention of peritonitis, adequate facilities for admission and particularly an expanding hospital haemodialysis programme to accept the less successful patients from CAPD.

Adolescent↗