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Biomedical subjects

E S Spencer

Publications and source records attributed to E S Spencer.

At least 19 recordsLinked to original sources
PubMed1998

Impact of clinical pathways for total hip replacement: a community-based analysis.

The implementation of clinical pathways for total hip replacement was carried out by five hospitals in the metropolitan area of Syracuse, New York. This process occurred under the leadership of clinical nurse specialists and nurse managers. It was supported by preadmission patient education programs and active physician involvement. The participating hospitals shared utilization quality assurance data and benchmarked with respect to the experience of Sacramento, California, and each others' progress. The effort produced substantial reductions in hospital stays without adverse impacts on quality of care.

Arthroplasty, Replacement, Hip↗
PubMed1997

A comparison of the effect of ramipril, felodipine and placebo on glomerular filtration rate, albuminuria, blood pressure and vasoactive hormones in chronic glomerulonephritis. A randomized, prospective, double-blind, placebo-controlled study over two years.

The effects of an ACE-inhibitor (ramipril), a calcium antagonist (felodipine) and placebo on glomerular filtration rate (GFR), urinary albumin/creatinine ratio, blood pressure (BP) and vasoactive hormones were investigated in a randomized, prospective, double-blind, placebo-controlled study of patients with chronic glomerulonephritis and hypertension, with measurements at entrance and after 12 and 24 months. In total, 33 patients were included: 21 completed the study with 7 patients in each group. GFR was measured as 51Cr-EDTA clearance and the vasoactive hormones with radioimmunoassays. The reduction in GFR was significantly more pronounced in the felodipine group (-7 ml/min) than in the ramipril group (0 ml/min) but the same as in the placebo group (-6 ml/min). The urinary albumin/creatinine ratio was significantly more reduced in the ramipril group (-74 mg/mmol) than in the placebo group (-11 mg/mmol), which did not deviate from the felodipine group (-10 mg/mmol). BP was significantly reduced by ramipril and felodipine, but not by placebo. Angiotensin II and aldosterone in plasma increased or tended to increase in the felodipine and placebo groups, but were unchanged in the ramipril group. Endothelin increased only in the placebo group, and vasopressin, atrial natriuretic peptide, and brain natriuretic peptide were not significantly changed in any of the groups. It is concluded that ramipril seems to be superior to felodipine in chronic glomerulonephritis owing to better preservation of GFR.

Adolescent↗
PubMed1996

Diagnosing renal artery stenosis: a comparison between conventional renography, captopril renography and ultrasound Doppler in a large consecutive series of patients with arterial hypertension.

The purpose of the study was to compare the positive and negative predictive values of conventional renography (Reno-A), captopril renography (Reno-B) and ultrasound Doppler (UD) with regard to the diagnosis renal artery stenosis. These three tests, and in addition a renal angiography, were performed in consecutively admitted patients with arterial hypertension, owing to either suspicion of renovascular hypertension or refractoriness to treatment. Patients with occlusion of a renal artery or a serum creatinine level higher than 300 mumol/l, or a previous investigation for renovascular hypertension at another hospital, were excluded from the analysis. The European Multicenter Study (EMS) criteria and local criteria for abnormal renography were compared. Of 131 patients, 28 had a renal artery stenosis (RAS) exceeding 50% reduction in diameter of the artery and 19 exceeding 70%. Using the EMS criteria for renography the predictive values of a negative test for a RAS more than 50% were 0.88 for Reno-A, 0.90 for Reno-B, 0.86 for changes from Reno-A to Reno-B, 0.92 for abnormalities either in Reno-A, Reno-B or changes from Reno-A to Reno-B, and 0.91 for UD. The corresponding values for a RAS more than 70% were 0.94, 0.97, 0.93, 0.98 and 0.96, respectively. The predictive values of a positive test were clearly lower, ranging from 0.20 to 0.75, but best when changes from Reno-A to Reno-B were used, 0.69-0.75. Using local criteria for renography the predictive values of a negative test were almost equal to those obtained by using the EMS criteria, but the predictive values of a positive test were slightly lower. It is concluded that conventional renography, captopril renography and ultrasound Doppler all are very good screening tests for renal artery stenosis, but the positive predictive values are clearly highest when using changes from conventional renography to captopril renography. It is suggested that captopril renography always should be performed when conventional renography is abnormal and vice versa to obtain the highest positive predictive value, on the assumption that total renal function is normal or almost normal, and that renal function is not absent in the affected kidney.

Humans↗
PubMed1993

Mutations in the codon for a conserved arginine-1563 in the COL4A5 collagen gene in Alport syndrome.

We have screened 110 unrelated Alport syndrome kindreds for mutations in the exon 48 region of the COL4A5 collagen gene. Denaturing gradient gel electrophoresis (DGGE) of the PCR-amplified region of exon 48 revealed sequence variants in DNA from affected males and carriers of three unrelated kindreds. All three kindreds have classical Alport syndrome of the juvenile type. DNA-sequencing analyses demonstrated two different single base changes in the codon for arginine-1563 located in exon 48. In Utah kindred 2103, there was a substitution of C by T resulting in the change of the CGA codon for arginine to the translation stop codon TGA. In Utah kindred 2123 and in the Danish kindred A13, there was a C-->T mutation in the noncoding strand changing the same codon to CAA for glutamine. Both mutations were confirmed by allele-specific hybridization on PCR-amplified DNA from other family members.

Adult↗
PubMed1991

Multipoint linkage analysis in X-linked Alport syndrome.

In order to localize the gene for the X-linked form of Alport syndrome (ATS) more precisely, we performed restriction fragment length polymorphism analysis with nine different X-chromosomal DNA markers in 107 members of twelve Danish families segregating for classic ATS or progressive hereditary nephritis without deafness. Two-point linkage analysis confirmed close linkage to the markers DXS17(S21) (zeta max = 4.44 at theta = 0.04), DXS94(pXG-12) (zeta max = 8.07 at theta = 0.04), and DXS101(cX52.5) (zeta max = 6.04 at theta = 0.00), and revealed close linkage to two other markers: DXS88(pG3-1) (zeta max = 6.36 at theta = 0.00) and DXS11(p22-33) (zeta max = 3.45 at theta = 0.00). Multipoint linkage analysis has mapped the gene to the region between the markers DXS17 and DXS94, closely linked to DXS101. By taking into account the consensus map and results from other studies, the most probable order of the loci is: DXYS1(pDP34)-DXS3 (p19-2)-DXS17-(ATS,DXS101)-DXS94-DXS11 -DXS42(p43-15)-DXS51(52A). DXS88 was found to be located between DXS17 and DXS42, but the order in relation to the ATS locus and the other markers used in this study could not be determined.

Female↗
PubMed1990

[Nephropathia epidemica. Hantavirus and acute renal insufficiency].

Puumala virus belongs to the hantavirus group and as other members of the group it can cause acute renal insufficiency. Other hantaviruses are responsible for Korean hemorrhagic fever and other hemorrhagic fevers with renal involvement. In Scandinavia, hantavirus nephropathy is better known as nephropathia epidemica. Hantavirus cause asymptomatic infections in mice and rats and the virus is thought to be transmitted to man via inhalation of desicated saliva, urine or feces from infected animals. In the other Nordic countries, the bank vole (Clethrionomys glareolus) is the commonest natural host. Laboratory infections from rats have been reported from all over the world. The disease presents with fever, back and/or abdominal pain, acute renal insufficiency and a bleeding tendency. The latter is usual less pronounced in the European than in the Asian forms of hantavirus infection. The disease is commoner in men and is endemic in forested areas. The greatest incidence is seen in those years when the numbers of mice are greatest. The mortality in nephropathia epidemica appears to be less than 0.5% in contrast to a mortality of about 10% in Korean hemorrhagic fever. Diagnosis is made by demonstration of a significant increase in antibody titer to hantavirus. Treatment is symptomatic and consists primarily of restitution of fluid and electrolyte balance, at times with dialysis. After recovery from hantavirus infection renal function returns to normal. The incidence and prevalence of nephropathia epidemica in Denmark are unknown. The first two cases of Puumala virus infection in Denmark are reported.

Acute Kidney Injury↗
PubMed1989

[The thin membrane syndrome. A cause of asymptomatic microscopic hematuria].

The use of urinary diagnostic strips with high sensitivity for hemoglobin has revealed microscopic hematuria in individuals with no symptoms or signs of illness. The thin membrane syndrome may be a frequent cause of such asymptomatic hematuria, and this diagnosis is particularly topical in the case of glomerular hematuria, i.e. with a dysmorphic erythrocyte picture on urinary microscopy. The thin membrane syndrome represents a new entity with an uncertain prognosis. The distinction between thin membrane syndrome and Alport's disease is important but difficult. Modern immunochemical investigations may be helpful in this regard. Until more information is available concerning the thin membrane syndrome, regular control of blood pressure, serum creatinine, urinary sediment and urinary protein is recommended in these patients.

Adult↗
PubMed1989

Glomerulopathy in renal allografts from patients with and without active Cytomegalovirus infection.

Cytomegalovirus (CMV) infection may affect renal graft survival, and a distinctive diffuse glomerulopathy has been described in renal grafts from patients with an active CMV infection. Fifty renal graft biopsies taken 30 to 180 days post-transplant from patients with primary, reactivated, inactive and no CMV infection were examined retrospectively for evidence of this glomerulopathy without knowledge of CMV status. The lesion was found in seven of 30 patients with reactivated CMV infection, one of 12 with primary infection, two of two with no evidence of active infection but evidence of previous infection, and in four of six with no evidence of past or present infection. The differences were not statistically significant. We concluded that the previously described distinctive diffuse glomerulopathy is not specifically associated with CMV infection, but may be a sign of graft rejection.

Adult↗
PubMed1988

Herpes simplex infection in relation to kidney allograft survival.

Active infection with one of the herpes viruses, Cytomegalovirus, clearly worsens renal allograft survival. In the present study serologic evidence of infection with another herpes virus, Herpes simplex, was compared with graft survival in 89 cadaveric renal graft recipients transplanted during a two-year period at the Aarhus Center. With respect to Herpes simplex complement-fixing serum antibody status post-transplant, three groups could be identified: 1) No change in antibody titer (25 patients); 2) Significant (4-fold) or more antibody rises (41 patients); 3) No demonstrable antibody (23 patients). Actuarial graft survival was not significantly different in the three groups and thus Herpes simplex infection, in contrast to Cytomegalovirus, does not appear to influence the outcome of renal allograft transplantation.

Adolescent↗
PubMed1987

A prospective study on infection with cytomegalovirus in renal allograft recipients immunosuppressed with cyclosporine A and low dose prednisone.

To investigate the course of infection with cytomegalovirus (CMV) in renal allograft recipients treated with cyclosporine A, 10 patients were followed for 1 year after transplantation. Virus cultures from blood, urine and throat washings were performed employing a quantitative technique. Complement-fixing and IgM antibodies to CMV were measured at scheduled intervals. The incidence 90% and course of CMV infections were found not to differ from those reported in patients receiving conventional immunosuppressive therapy. The quantitative virus cultures showed a consistent pattern with viremia most prominent at the beginning of an infection, and the highest concentration found in the one patient who developed symptoms of viral disease. It is suggested that information about the concentration of virus in a specimen will improve the diagnostic value of virus cultures in this group of patients.

Adolescent↗
PubMed1984

Effect of indapamide on renal plasma flow, glomerular filtration rate and arginine vasopressin in plasma in essential hypertension.

Renal plasma flow (RPF), glomerular filtration rate (GFR), arginine vasopressin in plasma (AVP), free water clearance (CH2O) and blood pressure (BP) were determined in 11 patients with essential hypertension at the end of 3 consecutive periods of observation each of 6 of weeks duration; indapamide 2.5 mg daily was given in period 2 and placebo in periods 1 and 3. RPF and GFR were reduced by 9% and BP by 9%/14% supine and 14%/12% standing during indapamide treatment. Changes in renal haemodynamics were not correlated with those in BP. AVP was not significantly altered by indapamide and was not correlated with BP. Indapamide reduced CH2O possibly due to the reduction in GFR. It is concluded that indapamide evidently induces redistribution of the cardiac output, with enhanced muscle blood flow and reduced renal perfusion, and that AVP does not seem to be involved in blood pressure regulation in mild to moderate essential hypertension under basal conditions.

Adult↗
PubMed1984

Effect of indapamide on the renin-aldosterone system, and urinary excretion of potassium and calcium in essential hypertension.

The effect of indapamide, 2.5 mg daily, on blood pressure, electrolyte balance and the renin-aldosterone system was studied in 11 patients with essential hypertension. During indapamide treatment blood pressure decreased and the renin-aldosterone system was stimulated. A moderate hypokalaemia seen during indapamide treatment was not correlated to changes in plasma aldosterone concentration. Fractional excretion of potassium was unchanged during treatment, while renal calcium excretion was reduced. No effect on calcium in serum was observed.

Adult↗
PubMed1981

Cytomegalovirus infection and kidney graft survival.

Among 123 cadaveric renal allograft recipients transplanted in the period 1971-79, there were 18 with no evidence of past or present cytomegalovirus infection, 34 with primary infection and 71 with reactivated infection. One-year actuarial graft survival was 68%, 32% and 54%, respectively. The reasons for the better graft prognosis in the group without CMV infection were less rejection and fewer infections.

Adult↗
PubMed1979

Viral infections in renal allograft recipients treated with long-term immunosuppression.

Thirty-nine renal allograft recipients who had received continuous immunosuppression for six to 13 years were examined clinically and virologically for evidence of past or present viral infection. Twenty-five had common warts, usually on the hands. In most the warts had appeared about one year after transplantation; once present, they never disappeared. Six patients had had a zoster rash from two months to four years after transplantation. None had had jaundice, and there was no change in the frequency of colds or non-specific fibrile illness. Four patients had no cytomegalovirus complement-fixing antibodies throughout the observation period; in the other 35 the antibody titre had risen appreciably during the first three to four months after transplantation. Antibody titres were high (mean 64) at follow-up, being only slightly lower than the highest titres achieved during the immediate postoperative period. None of the patients had had symptomatic cytomegalovirus infection, and in only two was the virus isolated from the urine at follow-up; the titres were extremely low. No changes occurred in the frequency of herpes simplex eruptions. Although all patients had herpes simplex humoral antibody, none excreted the virus. Although cytomegalovirus antibody titres were high, virus excretion was rare, indicating that chronic cytomegalovirus infection in these patients is immunologically well controlled.

Adult↗
PubMed1979

Cell-mediated and humoral immune responses to herpes simplex virus and cytomegalovirus in renal transplant patients.

Cell-mediated immunity to herpes simplex virus and cytomegalovirus, using the lymphocyte transformation test and interferon induction in lymphocytes, was studied in 59 patients from 1 day to 7 years after allotransplantation and compared with the results in normal subjects. Both parameters were permanently depressed with regard to cytomegalovirus. With herpes simplex virus, interferon production was also permanently depressed, whereas the transformation reaction was normal during the first year after transplantation and only slightly depressed in patients more than 1 year after transplantation. In 6 patients the above-mentioned assays and the complement fixation reaction were performed serially and related to the clinical signs of herpes simplex virus and cytomegalovirus infection. The relationship between depression of the transformation reaction and interferon production in lymphocytes and the occurrence of clinically evident herpes simplex virus and cytomegalovirus infections was, however, equivocal. The humoral immune response to herpes simplex virus was measured by the complement fixation test and the more sensitive antibody-dependent, cell-mediated cytotoxicity reaction, and a good correlation was found between these two tests, although only a few persons were found to be negative in the antibody-dependent, cell-mediated cytotoxicity reaction. The suggestion is made that only a few adults are "true" herpes simplex virus seronegative.

Adolescent↗
PubMed1977

Antibodies against cytomegalovirus-induced early antigens (CMV-EA) in immunosuppressed renal-allograft recipients.

Antibodies against cytomegalovirus-specific early antigens (CMV-EA) were followed in sera, obtained from fifteen immunosuppressed renal-allograft recipients. Eight patients (sixty-two sera) showed seroconversion 47--137 days post-transplantation. Five patients (forty sera) with CMV antibodies at the moment of renal implantation all showed CMV-EA antibody rises. Two patients remained seronegative until 4 years after transplantation. Thus, in immunosuppressed patients, antibodies against CMV-EA remained a high titres during many years (4--8 years) after transplantation as distinct from the apparently transient nature in acutely infected previously healthy adults with CMV mononucleosis or post-perfusion syndrome. These results support the view that CMV-EA antibodies reflect an active viral proliferation in the host.

Adolescent↗