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Biomedical subjects

W J Johnson

Publications and source records attributed to W J Johnson.

At least 91 records · Page 5Linked to original sources
PubMed1984

A four-year comparison of continuous ambulatory peritoneal dialysis and home hemodialysis: a preliminary report.

All patients who received initial dialysis therapy by either continuous ambulatory peritoneal dialysis (CAPD) or home hemodialysis between January 1979 and January 1983 were retrospectively compared for adequacy of dialysis, morbidity, and survival. In this study group, 30 patients had home hemodialysis and 21 patients had CAPD; the mean ages of the patients in these two groups were comparable. Both methods of treatment provided adequate dialysis, as shown by results of serial laboratory studies. The number of days of hospitalization per year at risk was twice as great for the patients on CAPD as for those on home hemodialysis; peritonitis was responsible for this difference. The survival was similar in both groups at 32 months of therapy. Death was clearly related to coexisting morbid events other than dialysis in the home hemodialysis group; however, one of the two deaths in the group on CAPD seemed to be indirectly related to the treatment of peritonitis. These findings suggest that CAPD, when compared with hemodialysis, (1) provides adequate dialysis, (2) is accompanied by greater morbidity (hospitalization), and (3) may introduce a morbid event (peritonitis) that may adversely affect survival.

Adult↗
PubMed1984

Results of treatment of renal failure by means of home hemodialysis.

Of 630 patients who began hemodialysis treatment for chronic renal failure between 1965 and 1977, 147 successfully completed training for home hemodialysis. Patient compliance was satisfactory, as reflected by the results of monthly blood chemical values, hematocrits, and weight gain between dialysis. Although only 15 patients had previous myocardial infarctions and 4 had had strokes before beginning dialysis, 9 patients subsequently experienced acute myocardial infarctions and 14 had strokes. Of the 45 patients who died while being maintained by hemodialysis, 24 had cardiopulmonary complications and 6 had strokes. Despite such complications, 70 patients were gainfully employed and 32 were active at home or at school, whereas 29 were totally disabled. At last follow-up, 74 remained on home hemodialysis, 53 had functioning renal allografts, and the rest of the patients were being maintained in our dialysis center, had transferred elsewhere, or were being maintained by peritoneal dialysis. The overall estimated 5-year survival rate was 56%, whereas the estimated 5-year survival rate for those maintained by home hemodialysis alone was 52%.

Adolescent↗
PubMed1984

Results of treatment of center hemodialysis patients.

Four hundred eighty-three patients were maintained by hemodialysis in an outpatient hemodialysis center at the Mayo Clinic between 1963 and 1977. Although only 18 patients had experienced a myocardial infarction and 6 had had a cerebral infarction before beginning dialysis, 30 subsequently had acute myocardial infarction and 45 had a stroke. These two complications accounted for 48 of the 98 deaths that occurred during maintenance dialysis. Despite such complications, 183 patients were employed, 124 remained active at home or at school, and 115 were totally disabled. Survival of patients maintained solely by dialysis was 52% at 5 years. For the group as a whole, including patients who received their first allograft, the survival rate at 5 years was 65%.

Adolescent↗
PubMed1984

Hospitalization in dialysis patients.

During 1981, 946 patients with advanced renal failure who were maintained by dialysis were studied to assess the frequency and the duration of hospitalizations and to identify complications that prompted hospitalization. Five hundred fifty-eight patients (59%) were hospitalized for a total of 1,207 times (mean of 1.8 stays/yr and 15 days/yr at risk for the entire group). The major reasons for hospitalization were dialysis access problems (25%), gastrointestinal complications (13%), and cardiac complications (13%). Both the rate of stays/yr and the rate of days/yr increased with advancing age and were highest in patients who died during the year of study. Both the rate and the duration of hospitalization were higher for patients maintained by peritoneal dialysis than for those on hemodialysis (P less than 0.001). In patients younger than 45 years of age, diabetics had more frequent and more prolonged hospitalizations than nondiabetics, whereas in those 46 to 60 years of age, complications other than diabetes predisposed to hospitalization. In those 61 years of age or older, in whom hospitalization rates were the highest, no single risk factor could be identified as predisposing to hospitalization other than age and peritoneal dialysis. Although the interactions of these factors were not assessed, considerable agreement existed with previous studies that had been analyzed in a more sophisticated manner.

Adolescent↗
PubMed1984

Survival rates of 2,728 patients with end-stage renal disease.

This multicenter regional study analyzes survival of a large group of patients who began chronic dialysis or received their first renal transplant during the 5 1/2-year period that ended in June 1983. Survival was determined from the onset of renal replacement therapy, irrespective of changes in treatment modality. Univariate life-table analysis was used to examine more than 35 risk factors. Age of patients at entry into the therapeutic program significantly affected survival. General survival rates were lower for patients with diabetes than for nondiabetics, irrespective of treatment modality, with the exception of those older than 60 years of age. Five-year graft survival was lower for diabetics than for nondiabetics in all age groups, irrespective of source. Patients with systemic lupus erythematosus, focal glomerulosclerosis, or glomerulonephritis had the highest survival rates, whereas those with primary renal malignant lesions, primary hypertensive disease, or diabetes mellitus as the cause of renal failure had the lowest. Concurrent morbid conditions that adversely affected survival included arteriosclerotic heart disease, peripheral vascular disease, noncutaneous malignant lesions, chronic pulmonary disease, and multiple coexisting morbid conditions. Although the objective of this study was to analyze survival for single patient characteristics, irrespective of treatment modality, analyses of survival rates by treatment modality for a control group indicated that minimal differences were evident by the third year among the four treatment groups: in-center hemodialysis, home hemodialysis, living related donor transplantation, and cadaver transplantation; however, recipients of cadaver grafts had lower survival rates than all other groups, even those maintained by in-center hemodialysis (P = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Improving results in primary diabetic renal transplantation.

One hundred seventeen patients with renal failure resulting from insulin-dependent diabetes mellitus received primary renal allografts from June 1970 to April 1983. Factors significantly associated with improved graft and patient survival were LRD sources (in particular, HLA-identical) and splenectomy. Variables such as transfusions, age, sex, and the administration of ALG were not significantly associated with transplant outcome. However, survival of patients and grafts has improved in recent years and continues to compare favorably with hemodialysis results. Although splenectomy might be the most important variable responsible for the improvement of our recent results, the use of ALG for rejection episodes might have contributed substantially to the improvement. Early transplantation, not analyzed in this study, might prove to be the most significant variable in the outcome of transplantation in patients with diabetic renal failure.

Adult↗
PubMed1984

Percutaneous epiphysiodesis.

Percutaneous epiphysiodesis has the advantages of relatively little postoperative pain and excellent cosmesis. With the aid of image-intensification fluoroscopy, it is safe, effective, relatively easy to perform, and compares favorably with the traditional alternative procedures. No complications were encountered in 12 patients.

Adolescent↗
PubMed1983

Primary and secondary renal transplantation in diabetic patients.

A total of 117 (101 primary and 16 secondary) renal transplants were performed on 101 diabetic patients. The mean duration of diabetes mellitus to the onset of end-stage renal disease was 17.5 years. After primary transplantation, overall one- and five-year patient survival was 77% and 55%, respectively; for grafts, it was 58% and 45%, respectively. One- and five-year living-related donor graft survival was 66% and 53%, respectively; for cadaveric kidneys, it was 45% and 33, respectively. One- and five-year graft survival for 20 HLA-identical living-related donor kidneys was 85% and 77%, respectively. Among the 16 recipients of secondary grafts, patient survival at one and five years was 65% and 29%, respectively; graft survival at one year was 24%. Acceptable patient and graft survival continues with primary renal transplantation. In view of the poor results with secondary transplantation in the diabetic patient, however, its continued application should be questioned.

Adult↗
PubMed1983

Splenectomy in high-risk primary renal transplant recipients.

One hundred sixty-five high-risk patients who were either 50 years of age or older or had diabetes mellitus, or both underwent primary renal transplantation. One hundred eight had splenectomy and 57 did not. Graft and patient survival were analyzed in regard to whether splenectomy had been performed at all and whether it had been performed 30 days or more before transplantation, less than 30 days before, or at the time of transplantation. Also, the influence of age, diabetes, blood transfusions, blood type, donor type, HLA mismatch, pretransplantation dialysis, and percentage of performed antibodies were analyzed, as were complications and causes of death. Differences in patient survival were not significant in any one of these categories, although survival in the splenectomized group was generally better. The incidence of infection and sepsis was comparable in both groups and was responsible for death in 34 percent of the patients who underwent splenectomy compared with 22 percent of those who did not (no significant difference). Splenectomy improved cadaver donor renal allograft survival (p = 0.001) in the diabetic patients (p = 0.015) and in those 50 years of age or older (p = 0.026) but it did not improve survival in those who received living related donor kidneys. No significant differences were detectable in regard to the timing of splenectomy. The effect of splenectomy was significant in the patients who had not received transfusions (p = 0.003). It also improved survival in the transfused patients. Splenectomy in high-risk diabetic patients and patients 50 years of age or older does not seem to be associated with increased mortality.

Adult↗
PubMed1983

Pseudomembranous colitis in Clostridium difficile-monoassociated rats.

Germfree rats were monoassociated with either a toxin-producing strain of Clostridium difficile (Tox+) or a variant of this strain (ToxR) which produced much less toxin (1/10,000) in vivo and in vitro. Monoassociation of germfree rats with C. difficile Tox+ resulted in mortality (17%) and in pathology to the small and large intestines, livers, and lungs. Cecal filtrates from the Tox+-monoassociated rats were cytotoxic for tissue culture cells. The cytotoxicity of cecal filtrates could be blocked by sera from Tox+-monoassociated rats. Monoassociation of rats with C. difficile ToxR resulted in no deaths or pathology, and much less toxin was detected in the cecal filtrates of these animals than in those of rats colonized with the Tox+ strain. This gnotobiotic model may be useful for investigating the etiology, prophylaxis, therapy, and exacerbation of C. difficile-induced pseudomembranous colitis.

Animals↗
PubMed1983

Sequential activation of murine mononuclear phagocytes for tumor cytolysis: differential expression of markers by macrophages in the several stages of development.

Murine mononuclear phagocytes in various stages of activation were elicited in vivo or induced in vitro. The cytolytic competence of each type of macrophage, before and after treatment with traces of endotoxin, was quantified. Populations of responsive, primed, and activated macrophages, but not resident macrophages, expressed five markers that have been reported to characterize inflammatory macrophages: increased spreading, increased phagocytosis via Fc and C3 receptors, increased secretion of plasminogen activator, and decreased content of the ectoenzyme 5' nucleotidase. Primed macrophages secreted cytolytic protease (CP) when pulsed with traces of endotoxin; the resident and responsive macrophages did not. The primed macrophages bound tumor cells to a considerable degree; the resident and responsive macrophages did not. The cytolytically activated macrophages bound tumor cells well and secreted lytic protease spontaneously. The capacity for augmented, selective binding of tumor cells is apparently induced in only one step by application of lymphokine(s). The capacity for secreting CP, however, is regulated in two steps; initial priming signals--lymphokine(s)--prepare the macrophages for secretion, and a second signal, such as endotoxin or endotoxin plus tumor cells, triggers the actual release of CP.

5'-Nucleotidase↗
PubMed1983

Continuous ambulatory peritoneal dialysis. Three years' experience at the Mayo Clinic.

From January 1979 through January 1982, 69 patients with end-stage renal failure of various causes were treated by continuous ambulatory peritoneal dialysis. The dialysis was adequate and stable in all except four patients; two of these four became irreversibly uremic, and the other two had inadequate ultrafiltration. Hemoglobin levels increased initially and remained stable in all but two patients. In our experience, metabolic problems included control of secondary hyperparathyroidism, adequate protein nutrition, progressive neuropathy, abnormal lipoprotein profiles, and excessive weight gain. Technical problems included recurrent peritonitis, maintenance of adequate peritoneal access, and development of abdominal hernias. In general, all but two patients remained enthusiastic about this type of therapy despite inherent problems. The long-term potential of continuous ambulatory peritoneal dialysis remains uncertain at this point, but for most patients, adequate short-term treatment by this method is a reasonable alternative to hemodialysis.

Adult↗
PubMed1983

Acute renal failure treated by slow continuous ultrafiltration. Preliminary report.

We report our initial experience with the use of slow continuous ultrafiltration in the treatment of acute renal failure. Advantages of slow continuous ultrafiltration over conventional hemodialysis are greater blood pressure stability, no need for systemic anticoagulation, augmented fluid input and removal, and enhanced ease of operation. Our results in two patients confirm other reports that this method can be successfully performed in hemodynamically unstable patients with acute renal failure.

Acute Kidney Injury↗
PubMed1983

Effect of pyran copolymer on activation of murine macrophages: evidence for incomplete activation by use of functional markers.

The degree of activation of peritoneal macrophages elicited by pyran copolymer (MVE-2) was studied in C57BL/6J mice. When cytotoxicity was examined under endotoxin-free culture conditions, the pyran-elicited macrophages could not complete cytolysis of tumor target cells. The macrophages, however, completed cytolysis when pulsed with endotoxin. These results were obtained when either the interval between injection of the pyran copolymer and harvest of the macrophage or the dose of pyran was varied. The pyran-elicited macrophages expressed five markers considered to be typical of inflammatory macrophages, and bound tumor cells to an augmented degree. The pyran-elicited macrophages were capable of secreting a potent cytolytic proteinase when pulsed with endotoxin, but did not secrete cytolytic proteinase spontaneously. The pyran-elicited macrophages, in contrast to inflammatory macrophages, could effect cytostasis of tumor cells; their cytostatic potential was also augmented by addition of endotoxin. Taken together, the results indicated that pyran copolymer elicits primed but not fully activated murine macrophages.

Animals↗
PubMed1982

Receptors for maleylated proteins regulate secretion of neutral proteases by murine macrophages.

Receptors for maleylated or acetylated proteins as well as for alpha-2-macroglobulin-protease complexes on macrophages serve as scavengers by mediating the uptake of macromolecules from the extracellular compartment. Described in this report is a novel function of these receptors on macrophages: regulation of neutral protease secretion. The binding of maleylated bovine serum albumin to macrophages triggered secretion of three neutral proteases: neutral caseinases, plasminogen activator, and cytolytic proteinase. Release of acid phosphatase, however, was not induced. An important biological consequence of protease secretion by macrophages, tumor-cytolysis, was also triggered by engagement of the receptor for maleylated bovine serum albumin. By contrast, the binding of alpha-2-macroglobulin-protease complexes to the macrophages suppressed secretion of all three proteases. Thus two receptors heretofore believed to serve principally as scavengers also regulate secretory functions of macrophages.

Animals↗