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Biomedical subjects

S Sterioff

Publications and source records attributed to S Sterioff.

At least 55 records · Page 3Linked to original sources
PubMed1988

Results of subtotal parathyroidectomy in hemodialysis patients.

In 61 hemodialysis patients undergoing subtotal parathyroidectomy, there was a good correlation between the preoperative serum immunoreactive parathyroid hormone value (iPTH) and the weight of parathyroid tissue removed surgically (p less than or equal to 0.001). Postoperatively, iPTH decreased rapidly from an initial mean (+/- SD) of 2,928 +/- 1,600 muleq/ml and remained at 365 +/- 296 muleq/ml at last follow-up of patients still undergoing hemodialysis (normal, less than 50 muleq/ml). Of six patients who had recurrent hyperparathyroidism (10 percent of total), three required a second subtotal parathyroidectomy. Aluminum-related osteomalacia eventually developed in six patients with bone biopsy-proven hyperparathyroidism before parathyroidectomy. Nine patients with severe fracturing bone disease and hypercalcemia preoperatively but without clear evidence of hyperparathyroidism did not show a favorable response to subtotal parathyroidectomy (high mortality within 28 months, persistence of hypercalcemia, and symptomatic bone disease). Thus, subtotal parathyroidectomy can benefit patients with clearly established severe progressive hyperparathyroidism not responsive to medical therapy but is contraindicated in patients with low iPTH values and no bone biopsy evidence of severe hyperparathyroidism.

Aluminum↗
PubMed1988

Cyclosporine nephrotoxicity is minimized by adjusting dosage on the basis of drug concentration in blood.

Two immunosuppressive regimens-cyclosporine plus prednisone and azathioprine plus prednisone-were compared in 78 renal transplantation patients (39 in each treatment group) who were successfully managed for more than 15 months. In patients who received cyclosporine, the dosage was adjusted to achieve trough whole blood concentrations of 100 to 250 ng/ml measured by liquid chromatography. A greater number of haplotypes matched in the azathioprine-treated group than in the cyclosporine-treated group (P less than 0.026). Graft survival was similar in patients who received azathioprine (95%) and those given cyclosporine (94%). The azathioprine group had a higher mortality (7%) than the cyclosporine group (2%). In a comparison of the two treatment groups, no statistically significant difference was found in posttransplant renal function, based on either serum creatinine or iothalamate clearance. We conclude that renal toxicity due to cyclosporine can be minimized to statistical nonsignificance by using cyclosporine dosages that provide trough whole blood concentrations in the range of 150 to 250 ng/ml during the first 4 months of therapy and 80 to 200 ng/ml thereafter.

Adult↗
PubMed1988

Efficacy of ganciclovir in liver and kidney transplant recipients with severe cytomegalovirus infection.

Twelve liver and 5 kidney transplant recipients with severe cytomegalovirus infection were treated with Ganciclovir (7.5 mg/kg/day, intravenously). Ten were evaluable (compatible clinical picture, organ involvement shown histopathologically or by culture, viremia, and absence of concomitant infection). All 17 patients were studied for adverse drug side effects. A total of 9 evaluable patients survived the infection; 1 died during treatment due to infection or drug toxicity. A death 19 days after completion of treatment was due to unrelated causes. Patients became afebrile after 2-9 days (mean, 5.3 days) of treatment. Liver function improved, pulmonary infiltrates cleared, and hypoxemia reversed during therapy. Viremia ceased during therapy in 9 patients; asymptomatic viruria persisted or recurred in 6 of 7 patients studied. No relapses occurred during follow-up (7-17 months; mean, 13 months). Transient neutropenia and thrombocytopenia occurred in 3 and 1 patients, respectively. Ganciclovir appears promising for treatment of severe CMV infection in patients with kidney or liver transplants.

Acyclovir↗
PubMed1987

Renal transplantation in patients with indwelling continuous ambulatory peritoneal dialysis catheters.

Controversy exists regarding management of the continuous ambulatory peritoneal dialysis catheter in patients undergoing renal transplantation. We performed 30 transplants (23 cadaveric and 7 living related) in 27 patients with indwelling continuous ambulatory peritoneal dialysis catheters. Dialysis was necessary in the immediate post-transplantation period in 9 of 30 patients (30 per cent). Of these 9 patients 3 had temporary hemodialysis and 6 resumed continuous ambulatory peritoneal dialysis with the indwelling catheter. Two postoperative complications clearly were related to the continuous ambulatory peritoneal dialysis catheter: 1 patient required abdominal exploration for control of bleeding related to disruption of peritoneal adhesions at the time the continuous ambulatory peritoneal dialysis catheter was removed and 1 suffered an abscess at the catheter site 1 month after the catheter was removed. No patient experienced peritonitis during immunosuppression after transplantation. We support leaving the continuous ambulatory peritoneal dialysis catheter during and after transplantation to simplify pre-transplantation patient care and to avoid the possible need for temporary post-transplantation hemodialysis in many patients.

Abscess↗
PubMed1987

Graded exercise testing and training after renal transplantation: a preliminary study.

Aerobic exercise training has been used as part of the treatment for a variety of chronic disorders, most notably cardiovascular disease. In order to determine the feasibility and utility of regular exercise after renal transplantation, the responses of 10 patients to graded exercise testing were compared before training (T1), immediately after a program of supervised exercise training (T2), and a mean of 2.2 years after completion of the supervised program (T3). Supervised exercise sessions began a mean of 17 days postoperatively and continued for a mean of 5.5 weeks. Patients were encouraged to continue regular unsupervised exercise thereafter. All patients easily tolerated the supervised exercise sessions, which consisted of treadmill walking and cycle ergometry. Exercise capacity improved 90% between T1 and T2 and an additional 12% between T2 and T3. On the average, patients achieved a normal exercise capacity by 8 weeks after transplantation. Of the 10 patients, 7 had continued regular exercise training at T3. The observed increase in aerobic exercise capacity was probably related to improved renal function, an increased hemoglobin concentration, and the surgical healing process as well as the exercise training. We conclude that supervised exercise training for selected patients after renal transplantation is feasible and worthwhile.

Adolescent↗
PubMed1987

Frank C. Mann and transplantation at the Mayo Clinic.

Frank C. Mann, a world-renowned experimental physiologist, played a major role in the early laboratory investigation of organ transplantation procedures. During this centennial of his birth, we acknowledge the important contributions of Dr. Mann.

Animals↗
PubMed1986

Cyclosporine: a review of drug monitoring problems and presentation of a simple, accurate liquid chromatographic procedure that solves these problems.

Many studies involving large numbers of patients prove the efficacy of cyclosporine to accomplish immunosuppression following hetertopic organ transplant. In long-term follow-up, cyclosporine produces a higher level of nephropathy than does conventional immunosuppression consisting of azathioprine and prednisone. The degree of nephropathy appears to be related to blood concentration and the effect can be minimized by maintaining therapeutic trough blood concentrations. Other significant side effects (central nervous system toxicity and hirsutism) can also be minimized by low blood concentrations. Development of lymphoma secondary to Epstein-Barr virus exposure is unrelated to blood concentration. Two methods are available for therapeutic drug monitoring: radioimmunoassay (RIA) and high pressure liquid chromatography (HPLC). RIA on plasma is a standard, rapid means of obtaining a result, but that result is inaccurate due to metabolite cross-reactivity. The concentration of cyclosporine in plasma is widely variable and unrepresentative of the whole blood concentration. Plasma concentration is dependent upon the temperature of plasma separation. Whole blood analysis avoids this problem. HPLC procedures allow for whole blood analysis but are tedious and time-consuming. We present here a simple, accurate HPLC procedure that is reproducible (CV = 4.9%), sensitive (to 50 ng/mL), and fast (preparation time - 5.7 minutes, chromatography time - 20 minutes). This procedure correlates (r = 0.98) with a reference HPLC procedure and has been used in our clinical laboratory for analysis of more than 4000 specimens without apparent problem. No interferences have been identified.

Chromatography, High Pressure Liquid↗
PubMed1986

Current status of renal transplantation--1986.

During the course of 3 decades, and particularly during the past 5 years, clinical renal transplantation has improved to become a safe mode of therapy for end-stage renal disease. Currently, more than 95% 1-year survival can be expected, both in patients who receive allografts from living-related donors and in those who receive cadaver kidneys. One-year living-related donor graft survival is 98%, and 1-year cadaver graft survival is 87%. Cyclosporine has been an important adjunctive immunosuppressive agent not only because of improved results but also because it has shortened hospitalization time.

Antilymphocyte Serum↗
PubMed1985

Adaptation of existing cutaneous ureterostomy for urinary drainage after renal transplantation.

We adapted existing cutaneous ureterostomies for urinary drainage in 3 patients who underwent renal transplantation. Careful preoperative radiological evaluation of the ureteral anatomy and appropriate preoperative planning are necessary for such patients. The concentration of serum creatinine was 0.9, 1.3 and 1.5 mg. per dl. at 2 months, 3 years and 10 years, respectively, after transplantation. All 3 patients have had bacteriuria that necessitated therapy with chronic suppressive antibiotics but clinical pyelonephritis has not occurred.

Adolescent↗
PubMed1985

Use of radiographically abnormal kidneys in living-related donor renal transplantation.

A retrospective study was undertaken to evaluate the significance of anatomic variants in living-related donor kidneys, when used in renal transplantation. 301 arteriograms were performed in the evaluation of such potential living donors over an 8-year period. 51 (16.9%) were found to have one or more radiographic abnormalities. 20 of the 51 patients (39%) were judged as not suitable for transplantation because of radiographic abnormalities. 7 of 31 patients who were accepted as organ donors declined for personal reasons. The remaining 24 patients underwent donor nephrectomy with the abnormal kidney utilized as the donor organ. In follow-up, none of the kidneys were lost because of their primary radiographic abnormality, and allograft survival of abnormal kidneys was the same as for normal kidneys transplanted under parallel circumstances. We conclude, in properly selected living donors, kidneys with anatomic variants without pathological significance can be used safely in renal allotransplantation. We do not recommend, however, transplanting kidneys with the potential for the development of progressive disease.

Adult↗
PubMed1984

Meclofenamate treatment of recurrent idiopathic nephrotic syndrome with focal segmental glomerulosclerosis after renal transplantation.

Recurrent corticosteroid-resistant nephrotic syndrome with focal segmental glomerulosclerosis (FSGS) caused the failure of a first renal allograft in a 41-year-old man. Recurrence of the nephrotic syndrome in the second renal allograft was successfully controlled by the administration of meclofenamate, and the renal function has remained stable for 2 1/2 years. No accepted treatment is available for corticosteroid-resistant nephrotic syndrome with FSGS. This report suggests that administration of meclofenamate might be beneficial in some patients with corticosteroid-resistant nephrotic syndrome and FSGS. Because of the potential side effects, however, careful supervision of this therapy is of the utmost importance.

Adult↗