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PubMed1979

Toxicity of amphotericin b in children with cancer.

The pattern of amphotericin B toxicity was assessed retrospectively in a group of 20 children with cancer who had received one or more courses of the drug for treatment of systemic fungal infection. Azotemia was the most frequent complication, developing during 23 of 24 treatment courses. Other major toxic effects, in decreasing order of frequency, were anemia, hypokalemia, thrombocytopenia, and neutropenia. Infusion side effects, including drug-related fever, chills, and nausea, were also frequently seen. Seventeen of 20 patients were treated for disseminated histoplasmosis. Nineteen of 20 patients had acute leukemia. Although interaction with other agents could not be excluded, amphotericin B appeared to be the major causative agent for the toxic reactions noted. In no patient, however, was administration of amphotericin B stopped because of drug toxicity.

Adolescent↗

PubMed1980

CNS manifestations of the hemolytic-uremic syndrome. Relationship to metabolic alterations and prognosis.

To define the CNS manifestations of the hemolytic-uremic syndrome (HUS), the records of 61 consecutive episodes of HUS in 60 patients were reviewed. Major CNS signs (seizures and/or coma) occurred in 30 of the 61 episodes. Twenty-four children had seizures. Analysis of blood pressure and metabolic parameters or admission to the hospital did not predict which child would exhibit CNS signs. However, during the subsequent course of the illness, children with CNS dysfunction had lower minimum serum sodium concentrations and more severe azotemia and were more likely to require dialysis than children without CNS signs. Of the 61 episodes, there were three deaths, and three children suffered major CNS sequelae. Coma at the time of admission and elevated CSF protein levels were features associated with poor outcome.

Adolescent↗

PubMed1981

Critical weight loss and malnutrition in breast-fed infants.

In four infants of primiparous mothers, critical dehydration, hypothermia, and azotemia developed while they were being breast-fed exclusively. Three had significant hypernatremia, one had a perforated duodenal ulcer, and one had transient renal failure. Although the causes of the inadequate nutrition are unclear, these cases emphasize the necessity of close follow-up for breast-fed babies, especially those of primiparous mothers and those in whom there has been excessive weight loss while in the hospital.

Acute Kidney Injury↗

PubMed1989

Acute systemic organ injury in term infants after asphyxia.

The systemic manifestations of "asphyxia" were evaluated prospectively in 35 consecutively intubated term newborn infants. The following systemic organ injuries were identified most often: (1) renal, ie, oliguria less than 1 mL/kg per hour for at lest 24 hours (40%), an elevated urinary beta-2-microglobulin concentration (57%), azotemia (11%), and an elevated serum creatinine level (17%); (2) central nervous system, ie, hypoxic-ischemic encephalopathy (including seizures) (31%) or an abnormal cranial ultrasound scan, ie, diffuse parenchymal echogenicity, slitlike ventricles, and poor visualization of the sulci, and/or intracranial hemorrhage (26%); (3) cardiovascular, ie, an abnormal echocardiogram (25%) or abnormal electrocardiogram (11%); (4) pulmonary complications, including persistent pulmonary hypertension (23%); and (5) gastrointestinal complications, which were rare. Traditional markers of fetal distress were not related to the frequency and/or distribution of systemic organ injury. An important implication of this study relates to the recognition of the extent and distribution of organ injury in the "asphyxiated" infant.

Apgar Score↗

PubMed1976

Is 80 years too old for aneurysmectomy?

The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n=19) and in the elective surgery group (n=44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.

Age Factors↗

PubMed1978

Hemolytic-uremic syndrome confused with acute appendicitis.

Hemolytic-uremic syndrome (HUS) may have signs that are clinically indistinguishable from acute surgical diseases of the abdomen. A 2-year-old girl had HUS and physical findings leading to appendectomy. Various pediatric surgical and medical conditions are mimicked by HUS. Attention to specific diagnostic clues (anemia, evidence of hemolysis, thrombocytopenia, azotemia) may lead to the correct diagnosis of HUS and avoidance of an unnecessary operation.

Acute Disease↗

PubMed1994

Antrectomy. A safe and effective bypass for unresectable pancreatic cancer.

BACKGROUND: Pancreatic cancer is most often diagnosed too late for curative resection. Operative therapy, therefore, involves relief of biliary obstruction and relief or prevention of gastric outlet obstruction. Previous studies show that gastrojejunostomy done either therapeutically or prophylactically often causes delayed gastric emptying. OBJECTIVE: To describe the results of antrectomy with Billroth II reconstruction (A/BII) as the palliative operation for gastric outlet obstruction. SUBJECTS: Fifty patients with unresectable pancreatic cancer underwent A/BII without vagotomy from 1987 through 1993. Of these patients, 42 underwent simultaneous biliary bypass; six had undergone biliary bypass from 3 weeks to 34 months previously; and two with cancer originating in the uncinate process had no biliary bypass. RESULTS: One 87-year-old patient died on day 12 of azotemia and pulmonary insufficiency. The other 49 patients were discharged tolerating an oral diet an average of 11.3 days (range, 5 to 29 days) after A/BII. The length of stay following A/BII was not related to the extent of disease or to preoperative weight loss but was increased in older patients. CONCLUSION: The A/BII is a safe and effective bypass in patients with unresectable pancreatic cancer.

Aged↗

PubMed1976

The FENa test. Use in the differential diagnosis of acute renal failure.

The FENa test, a determination of the excreted fraction of the filtered sodium, was performed in patients in the oliguric phase of acute renal failure. Patients with prerenal azotemia had an FENa of less than 1, and patients with acute tubular necrosis had an FENa of more than 3 (P less than .001). This simple test clearly differentiates between these two conditions and, thus, is of considerable clinical value.

Acute Kidney Injury↗

PubMed1982

Sulindac. A potentially renal-sparing nonsteroidal anti-inflammatory drug.

Three patients experienced rapidly reversible azotemia related to the use of naproxen or ibuprofen but tolerated full-dose sulindac. This article discusses renal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs), with emphasis on the role of inhibition of prostaglandin synthesis, and reviews evidence supporting a renal-sparing property of sulindac. The current literature assumes that all NSAIDs possess a similar potential for renal toxicity. The data presented suggest that sulindac has less potential for renal toxicity and may be the preferred NSAID for use in patients with impaired renal function.

Aged↗

PubMed1983

Systolic hypertension in the elderly. Hemodynamic response to long-term thiazide diuretic therapy and its side effects.

Twenty-three patients older than 50 years, with systolic hypertension, underwent hemodynamic study. Cardiac output and stroke volume varied widely, with several high values. An elevated systemic vascular resistance, when considered as a function of the cardiac output, was the most prevalent hemodynamic abnormality. After administration of hydrochlorothiazide, 50 mg/day, for one month in 20 patients, 18 had a significant fall in BP, systemic vascular resistance, and stroke volume. After one year of continuous therapy, the hemodynamics, studied in 14 patients, did not change further. There were no clinical difficulties with carbohydrate intolerance, azotemia, hyperuricemia, or hypokalemia. No patient had symptoms of orthostatic hypotension or cardiac arrhythmias. Thus, thiazide therapy effectively and safely lowers the BP in most patients with systolic hypertension by reducing systemic vascular resistance.

Aged↗

PubMed1999

Phase II clinical trial of SKI-2053R, a new platinum analog, in the treatment of patients with advanced gastric adenocarcinoma.

BACKGROUND: SKI-2053R (SK Chemicals, Kyungki-Do, South Korea) is a new platinum derivative with antitumor activity against various cell lines, including cisplatin-resistant tumor cell lines. Preclinical studies have suggested that it is less nephrotoxic than cisplatin. This study evaluated the efficacy and toxicity of SKI-2053R in the treatment of patients with advanced gastric adenocarcinoma. METHODS: Thirty-seven patients with advanced gastric adenocarcinoma that was unresectable or metastatic were treated. No prior chemotherapy or radiotherapy was allowed. Patients received SKI-2053R 360 mg/m(2) by 1-hour infusion on Day 1. After the first cycle, subsequent doses were adjusted according to the toxicity. Courses were repeated every 28 days. RESULTS: Thirty-five patients were evaluable for response and toxicity. Six patients achieved a major response (17%; 95% confidence interval, 8-33%); 2 were complete and 4 were partial responses. The median duration of response was 7.2 months, with a range of 1-20 months. Patients could tolerate the treatment without significant toxicity. No patients had Grade 3 or 4 toxicity. The most frequent toxicity was Grade 1 or 2 proteinuria (26% of cycles), but it was mild and transient. Leukopenia, thrombocytopenia, azotemia, nausea and vomiting, and neurotoxicity were not frequent. These low toxicity profiles indicated that the dose of SKI-2053R could be increased in future studies. CONCLUSIONS: SKI-2053R was active in the treatment of patients with gastric adenocarcinoma and had favorable toxicity profiles.

Adenocarcinoma↗

PubMed1996

Murine autosomal recessive polycystic kidney disease with multiorgan involvement induced by the cpk gene.

BACKGROUND: Autosomal recessive (AR) polycystic kidney disease (PKD) is characterized in humans and mice as a rapidly progressive, collecting duct cystic disease usually leading to uremia in the neonatal or infantile period. In humans, ARPKD renal pathology can be variable in severity and is associated with the development of prominent bile duct and liver pathology. The C57BL/6J-cpk/cpk mouse model of ARPKD is the most extensively studied murine model of inherited infantile PKD; however, these mice lack extrarenal pathology. METHODS: In the present study, the cpk gene was backbreed onto CD1 mice to examine the development of cpk-induced ARPKD in this outbred mouse background. Resulting cystic offspring were examined morphologically and their serum urea nitrogen levels were assessed. RESULTS: The rapid development of PKD in CD1 mice homozygous for the cpk gene appears to be slightly more rapid but otherwise comparable to that seen in inbred C57BL/6J mice. In CD1-cpk/cpk mice, the principal renal pathological finding is collecting duct cysts, which are lined by a relatively uniform epithelium. This epithelium appears to be relatively undifferentiated based on almost total absence of intercalated cells. Proximal tubule cysts are prominent in the first postnatal week while collecting duct cysts predominate in the later stages of the disease. Extrarenal manifestations of the cpk gene are evident in the CD1 strain and include cysts of pancreatic, common bile, and major hepatic ducts. Intrahepatic bile ducts also have focal dilations. Primary (thymus) and secondary (spleen) lymphoid tissues become hypoplastic as azotemia progresses. The strain-related variability in renal and liver changes in cpk-induced ARPKD may reflect the influence of other genes (possibly modifier genes) expressed in this mouse strain. In older CD1-cpk/+ mice, renal (proximal tubular) cysts and prominent liver cysts (lined by a biliary epithelium) develop, indicating that the heterozygous state (cpk/+ genotype) causes renal and hepatic pathology. CONCLUSIONS: The cpk gene, when placed on an appropriate mouse strain background, causes multiorgan disease that more closely mimics human ARPKD than when the cpk gene is expressed on the C57BL/6J strain. A gene dose effect is present as cystic pathology is present in kidney and liver of both suckling homozygous (cpk/cpk) and old heterozygous (cpk/+) mice.

Animals↗

PubMed1999

Developmental expression of urine concentration-associated genes and their altered expression in murine infantile-type polycystic kidney disease.

Currently, there is little understanding of what factors regulate the development of urine concentrating capability in normal or polycystic kidney. The present study examined the developmental expression of genes associated with urine concentration in developing mice, including C57BL/6J-cpk/cpk mice with autosomal recessive-infantile (AR) polycystic kidney disease (PKD). Concentration of urine requires: 1) medullary collecting ducts (CD) located within a hypertonic interstitium, 2) CD cell expression of functional arginine vasopressin V2 receptors (AVP-V2R), and 3) the presence of appropriate CD water channels (aquaporins, AQP 2 and 3). An increase in urine osmolarity, normally seen between 1 and 3 weeks of age, was absent in cpk cystic mice. Aldose reductase mRNA expression (a gene upregulated by medullary hyperosmolarity) increased in normal mice, but remained low in the cystic kidney, suggesting the absence of a hypertonic medullary interstitium. AVP-V2R, AQP2, and AQP3 mRNA expression normally increase between 7 and 14 days. However, all were dramatically overexpressed even at 7 days of age in the cpk kidney in vivo, but decreased in vitro. Activation of the AVP-V2 receptor stimulates the production of cAMP, a substance known to promote cyst enlargement. To determine if CD cAMP, generated from increased AVP-V2Rs, was accelerating the PKD, cystic mice and their normal littermates were treated with OPC31260, a relatively specific AVP-V2R antagonist. OPC31260 treatment of cystic mice led to an amelioration of the cystic enlargement and azotemia. Treatment also decreased renal AQP2 mRNA but increased AVP-V2R and AQP3 mRNA expression in vivo. AVP upregulates the expression of AVP-V2R, AQP2, and AQP3 mRNAs in vitro. Renal EGF, known to inhibit AVP-V2R activity, downregulates AVP-V2R mRNA in vitro. Brief in vivo EGF treatment, known to decrease PKD in cpk mice, led to increased expression of AVP-V2R, AQP2, and AQP3 mRNAs at 2 weeks in both normal and cystic mice but no change was evident at 3 weeks of age. In conclusion, the development of urinary concentration ability correlates with the development of an increased medullary osmotic gradient which is diminished in murine ARPKD. However, CD genes associated with this process are overexpressed in vivo but underexpressed in vitro in the cystic kidney. The overexpression and/or overactivity of the AVP-V2R appears to contribute to the progression of PKD since an AVP-V2R antagonist inhibits cystic renal enlargement in the cpk mouse.

Aldehyde Reductase↗

PubMed2000

Abolition of anti-glomerular basement membrane antibody-mediated glomerulonephritis in FcRgamma-deficient mice.

Several recent studies have demonstrated the central role of Fc receptors (FcR) rather than the complement system in triggering hypersensitivity reactions. We investigated the role of FcR for IgG (FcgammaR) using a murine model of accelerated anti-glomerular basement membrane (GBM) antibody-mediated glomerulonephritis as a representative of type II hypersensitivity diseases. Intravenous injection of rabbit anti-GBM antibody after preimmunization with normal rabbit IgG induced proteinuria and azotemia in wild-type C57BL/6 and CD40(+/-) mice but not in FcR gamma chain (FcRgamma)(-/-) mice or CD40(-/-) mice. Light microscopic findings revealed marked tissue damage in the glomeruli of wild-type C57BL/6 and CD40(+/-) mice. However, no tissue damage except polymorphonuclear cell infiltration was observed in the glomeruli of FcRgamma(-/-) mice. The glomeruli of CD40(-/-) mice were almost normal. Immunohistochemistry revealed the binding of rabbit IgG to the GBM in all mice injected with anti-GBM antibody. However, depositions of mouse IgG and complement to the glomeruli were not observed in CD40(-/-) mice, and deposition of fibrin was not observed in FcRgamma(-/-) or CD40(-/-) mice. These findings suggest that FcgammaR may initiate anti-GBM antibody-mediated renal disease. We conclude that FcgammaR rather than the complement system is critically involved in the development of type II hypersensitivity diseases.

Animals↗

PubMed1975

Streptozotocin therapy in 22 cancer patients.

Twenty-two cancer patients were treated with streptozotocin (SZN) in six weekly intravenous doses of 1.0-1.5 g/m2. The results of the initial courses of therapy include 3 complete and 2 partial responses, 11 patients with no change, 4 with progression, and 2 deaths due to tumor progression. Three additional deaths also due to tumor progression occurred in previously responding patients. All responses were in patients with pancreatic tumor. Toxicity consisted of transient proteinuria in 11/15 patients, transient azotemia in 11/18 patients, marked reduction of creatinine clearance in 1 patient, burning pain at site of injection, nausea, and vomiting in 20/22 patients, change of FBS from pretherapy to post-therapy of at least 10 mg/100 ml in 11/17 patients, significantly decreased platelet count in 1/22 patients, decreased Hgb in 2/22 patients, and duodenal ulcer in 2/22 patients. A reduced dosage schedule and combination with other drugs known to be effective in pancreatic tumors deserves further investigations.

Aged↗

PubMed1975

Prognostic factors in multiple myeloma.

The effect of certain disease parameters on remission and survial time was evaluated in 482 patients with multiple myeloma treated with intermittent courses of melphalan-prednisone combinations. Increasing degrees of anemia, hypercalcemia, azotemia, and high serum myeloma protein levels were associated with progressive lifespan shortening. The short survival of patients with anemia and hypercalcemia was associated with short remissions in responding patients with these abnormalities. The extent of tumor mass was defined from specific laboratory parameters reported by Durie to be associated with large numbers of plasma cells. More advanced stages of myeloma were associated with higher frequencies and degrees of normal immunoglobulin depression. The response rate was not affected by the tumor mass grade, but increasing tumor mass was associated with a shorter lifespan. Greater degrees of tumor reduction were associated with longer remission and survival times. Patients in whom a marked tumor reduction was rapid had shorter survival and remission times than patients who responded more slowly.

Aged↗

PubMed1976

Combination chemotherapy with adriamycin and cis-diamminedichloroplatinum in patients with neoplastic diseases.

Forty-eight patients with a variety of advanced solid tumors were treated with a combination of adriamycin 50 mg/m2, and cis-diamminedichloroplatinum 50 mg/m2, every 2 to 4 weeks. Fifteen patients responded with a greater than 50% regression of measurable tumor; six with lung cancer; one, carcinoma of the breast; one, ovary; one, cervix; one, prostate; one, testis; one, maxillary sinus; and one, salivary gland, plus one patient with chemodectoma and one with adenocarcinoma of unknown primary. Responses lasted 1 to 18 months, with a median of 6 months. An additional six patients, including two with adenocarcinoma of the lung three with carcinoma of the cervix, and one with embryonal cell testicular carcinoma improved (25-50% regression of the tumor). Toxicity encountered included myelosuppression, azotemia, alopecia, nausea, vomitting, and stomatitis. Severe hematologic toxicity occurred only in those with compromised marrow function or with concurrent active hepatitis. Major potentiation of toxicity by the combination does not appear to have occurred.

Adolescent↗

PubMed1976

Nephrotoxic and cytoproliferative effects of streptozotocin: report of a patient with multiple hormone-secreting islet cell carcinoma.

The nephrotoxic and cytoproliferative side effects observed in a patient with Streptozotocin-treated, multiple hormone-secreting, pancreatic islet cell carcinoma are described. Streptozotocin induced prolonged partial remission of the patient's multiendocrine syndrome but resulted in progressive azotemia, which was controlled by temporary hemodialysis. A renal biopsy, the first to be reported in detail in such a condition, demonstrated a tubulo-interstitial nephritis and a glomerular alteration consisting of cellular nodules. At autopsy there were numerous bilateral renal cortical spindle cell "tumors" and cellular aggregates in glomeruli. These findings suggest that the tumorigenic effects of Streptozotocin demonstrated in animals may also occur in man.

Adenoma, Islet Cell↗