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Biomedical subjects

G T Cook

Publications and source records attributed to G T Cook.

At least 19 recordsLinked to original sources
PubMed1990

Primary yolk sac (endodermal sinus) tumor of the prostate: case report and review of the literature.

A primary yolk sac (endodermal sinus) tumor of the prostate is described in a 40-year-old male. This is the second documented case of a yolk sac tumor occurring in the prostate gland. Treatment included surgical removal and subsequent combination chemotherapy. Four months following diagnosis, the patient died of complications. At autopsy, no residual tumor was detected. The role of combination chemotherapy as potentially curative therapy in the treatment of extragonadal yolk sac tumors is discussed.

Adult↗
PubMed1990

Low dose ciclosporin from the early postoperative period yields potent immunosuppression after renal transplantation.

This study sought to determine if low doses of ciclosporin (CS) designed to give fasting serum levels of 50-100 ng/ml achieve effective immunosuppression when used from the early postoperative period after renal transplantation. Ninety-four primary renal transplant recipients were studied. Group 1 patients were treated with CS 100 ng/ml and prednisone (0.15 mg/kg/day). Group 2 patients received CS 50 ng/ml, prednisone (0.15 mg/kg/day) and azathioprine (1 mg/kg/day). These patients were compared to a control group of 26 patients (group 3) maintained on only prednisone and azathioprine. CS-treated patients suffered significantly fewer rejection episodes than control subjects (rejection episodes per patient in first year: group 1: 0.3 +/- SD 0.6; group 2: 0.7 +/- SD 0.7; group 3: 1.3 +/- SD 1.1, p less than 0.005). In addition, a greater number of CS-treated patients were completely free of rejection episodes during the first year posttransplant (group 1: 63%; group 2: 64%; group 3: 19%, p less than 0.005). Patient and graft survival were similar in all groups after 1 year (group 1: 92 and 92% respectively; group 2: 95 and 87% respectively; group 3: 96 and 85% respectively). These data suggest that the dose of CS required for effective immunosuppression in vivo is lower than has been previously thought.

Adult↗
PubMed1989

Percutaneous needle biopsy of the transplanted kidney: technique and complications.

Over 11 1/2 years, 420 percutaneous needle biopsies were obtained from the transplanted kidneys of 205 patients at one institution. The procedure was performed by one nephrologist and 55 nephrology trainees. No limit was placed on the number of biopsies performed on one kidney, and the highest number was seven. The complications were macroscopic hematuria in 28 biopsies, prolonged hematuria (greater than 24 hours) in eight, transient anuria in five, and prolonged anuria requiring surgical intervention in one. Perinephric hematoma occurred in three patients; retroperitoneal hematoma led to compression of the iliac vein in one. None of these complications led to loss of the transplant. It is suggested that the freedom from serious complication is related to the safety of the technique and the precautions applied to preparation of the patient. These are described in detail.

Adolescent↗
PubMed1988

Management of end-stage autosomal dominant polycystic kidney disease with hemodialysis and transplantation.

This is an analysis of the outcome of 35 patients with end-stage autosomal dominant polycystic kidney disease (ADPKD) at Toronto Western Hospital (TWH) during a 10-year period. The primary treatment in each case was hemodialysis. In the 15 patients managed exclusively with hemodialysis the one- and five-year actuarial survival was 93% and 77% respectively. Twenty patients ultimately received a total of 26 cadaveric renal allografts. Graft survival at one year was 76%. One- and five-year patient survival was 92% and 73% respectively. Beyond 5 years a trend towards increased survival in the transplant group was seen, compared with the exclusively hemodialyzed group. Bilateral nephrectomy prior to transplantation was associated with high morbidity and mortality, and did not change either graft or patient survival. In view of the similar survival and because it is accepted that transplantation offers the highest quality of life amongst the modalities of treatment for end-stage renal failure, transplantation should be considered the treatment of choice for end-stage ADPKD. There is no justification for routine bilateral nephrectomy before renal transplantation.

Adult↗
PubMed1982

Successful renal transplantation in patients with T-cell reactivity to donor.

A positive crossmatch due to T-cell reactivity against donor cells is considered a strong contraindication to renal transplantation because of the risk of graft loss from rejection. However, the significance of T-cell reactivity before but not at the time of transplantation is unknown. To determine whether transplantation can be successful under these circumstances, graft survival was observed in 15 highly sensitised patients whose T cells were reactive to donor sera before but not at the time of transplantation. All patients have been followed up for at least 1 year post transplant. Immunosuppression was by azathioprine, prednisone, and rabbit antithymocyte sera. 9 (60%) have functioning grafts and a mean serum creatinine of 1.6 mg/dl. Early non-function occurred in 12 patients. One graft was lost to early acute humoral rejection and two other to chronic rejection. 14 of the 15 had a fall in reactivity to a panel of normal lymphocytes before transplant. 4 of the 15 had donor-specific B-cell antibodies at the time of transplantation and 3 of these lost their grafts because of rejection.

Adult↗
PubMed1982

Ten years of experience with vascular complications in renal transplantation.

From 1970 to 1980, 341 consecutive renal transplants were performed in 307 patients at our hospital. Operative technique was uniform and performed by a single surgeon. Acute arterial thrombosis occurred in 12 kidneys (3.5 per cent) and venous thrombosis occurred in 3 (0.9 per cent). All of these kidneys were lost. Renal artery stenosis, diagnosed in 17 kidneys (4.9 per cent), resulted from surgical technique or rejection and was associated with hypertension in all cases. Of these kidneys 5 responded to drug therapy alone, 4 to transluminal angioplasty and 5 to surgical reconstruction. Three grafts were lost. Vascular complications occurred in 9 per cent of our patients. The results suggest that factors other than surgical technique alone can contribute to the incidence of vascular complications.

Adolescent↗
PubMed1982

The role of percutaneous transluminal dilatation in the treatment of transplant renal artery stenosis.

The assessment of percutaneous transluminal dilatation (PTD) as a new therapeutic approach for transplant renal artery stenosis (TRAS) was prompted by allograft loss following surgical treatment. Seventeen (7.0%) of 243 allograft patients had TRAS greater than 80% diagnosed by angiography. The outcome of PTD in 4 TRAS patients was compared to antihypertensive drugs alone in 5 and attempted surgical repair in 8. Patients receiving antihypertensive drugs alone required 3.2 drugs at optimal doses to maintain diastolic BP less than or equal to 90 mm Hg. Malignant hypertension developed in 1 non-compliant patient. Three of the 8 surgical repairs resulted in loss of functioning grafts due to postoperative renal artery thrombosis; the remaining 5 had substantial reduction in diastolic BP (pre 112 +/- 8 mm Hg, post 93 +/- 8 mm Hg, P less than .05). Four patients with main renal artery stenosis had successful, uncomplicated PTD with no graft loss, a significant reduction in diastolic BP (pre 108 +/- 10 mm Hg, post 88 +/- 5 mm Hg, P less than .05) and less antihypertensive drug requirement (pre 3.0 +/- .8 drugs, post 1.0 +/- .8 drugs, P less than .05). Restenosis occurred in 1 patient during the 6 to 10 month follow-up period. PTD compared favourably with conventional management of TRAS as a new therapeutic approach.

Angioplasty, Balloon↗
PubMed1980

Adrenal hemorrhage in neonates: report of 5 cases and review of the literature.

The differential diagosis of masses in the suprarenal area in neonates is discussed in relation to clinical, laboratory and radiologic findings. Neonatal adrenal hemorrhage can be accurately diagnosed clinically. In the neonate neuroblastoma in situ is self-limiting and exploration to exclude it is unnecessary. Operative intervention should be reserved for controlling massive adrenal hemorrhage or if an abscess forms.

Adrenal Gland Diseases↗
PubMed1980

A controlled trial evaluating intensive plasma exchange in renal transplant recipients.

Sixty patients have been entered into a controlled trial evaluating the use of intensive plasma exchange (IPE) in renal transplant recipients. During the first three months post-transplant, patients receive either conventional anti-rejection therapy alone (control group) or conventional anti-rejection therapy and IPE (IPE group) for all rejection episodes. Twenty percent of the grafts in the control group versus 10% in the IPE group have been lost to rejection (p = NS). The actual three month patient and graft survival in the control group (97% and 70%), respectively, is similar to the IPE group (94% and 80%), as is the one year actuarial graft and patient survival in the two groups. No statistically significant benefit of IPE has yet been demonstrated but the trend is encouraging and the complication rate sufficiently low so as to justify continuing the study.

Clinical Trials as Topic↗
PubMed1979

Primary massive reflux in children.

Over a ten-year period, of more than 1,000 children whose primary vesicoureteral reflux was treated surgically, there were 54 children with 80 single ureters which were massively dilated. Primary reconstruction with ureteral tailoring was done in 25 ureters with a success rate of 92 per cent. Forty-five ureters were temporarily diverted because of uncontrolled infection and/or azotemia. In almost half of these instances, temporary diversion resulted in improvement in ureteral caliber to such an extent that nontailored reimplantation could be performed with a success rate of 87 per cent. Six kidneys were removed and four have been maintained in the diverted state with severe renal dysplasia. Eighty-eight per cent of the refluxing megaureters were reconstructed with a success rate of 89 per cent.

Child↗
PubMed1979

Surgical management of massive neurogenic hydronephrosis.

Permanent urinary diversion has been the standard recommended treatment of massive dilatation of the upper tracts in the child with neurogenic vesical dysfunction. Reimplantation of relatively normal caliber ureters into neurogenic bladders has been shown to be effective. However, attempts to save urinary diversion in 39 neurogenic megaureters have been unrewarding, with the salvage rate of 15 per cent, and 64 per cent have been diverted permanently. Upper tract decompression by continuous or intermittent catheterization, nephrostomy or end cutaneous ureterostomy was used in this series. When ureteral caliber responded to decompression a reasonable success rate from non-tailored reimplantation may be anticipated. However, in those instances in which ureteral caliber failed to respond or when tailoring or ureteral caliber was done in conjunction with reconstruction the success rate was much lower.

Adolescent↗
PubMed1979

Upper tract management when posterior urethral valve ablation is insufficient.

Of 105 boys with posterior urethral valves managed during a 10-year period most were managed by primary valve ablation. However, 39 of these boys required concomitant or additional procedures to 71 massively dilated ureters because of azotemia, infection and/or progressive upper tract deterioration. In 17 boys 25 ureters could be reconstructed primarily by varying degrees of ureteral tailoring. When there was severe infection, azotemia and/or doubt as to the function of the affected renal unit, staged reconstruction was initiated by cutaneous ureterostomy. One-fourth of these ureterostomy diverted children died of azotemia despite free urinary drainage. Those who went on to have staged reconstruction, despite multiple surgical procedures, retained intact urinary systems with acceptable function.

Bacterial Infections↗
PubMed1979

Salvaging the iatrogenic megaureter.

From 1965 through 1975 we treated 30 children with 44 megaureters that were acquired after the reimplantation of normal caliber ureters. One-third of these children had had at least 2 prior surgical procedures on the bladder and 30 per cent were azotemic. There was no difference in the salvage rate of acquired megaureters with reflux versus obstruction. Temporary proximal diversion often was useful in the short-term management. Only 70 per cent of the patients completed reconstruction and only 70 per cent of those reconstructed were successful by all parameters. Ureteral tailoring was generally a necessary adjunct to successful repeat reimplantation. There was a significantly lesser salvage rate in those ureters that had had more than 1 prior surgical procedure. The best results were obtained when all surgical maneuvers were done transvesically because there was a significant incidence of acquired atonic vesical dysfunction after repeated dissections in the perivesical area.

Adolescent↗
PubMed1978

The influence of etiology on the surgical management and prognosis of the massively dilated ureter in children.

The massively dilated ureter is a major therapeutic challenge that faces the pediatric urologist. In those instances when more conservative measures, such as control of infection or correction of the primary pathology, have failed or are likely to fail surgical treatment must be directed to the massively dilated ureter itself. The goals of reconstructive procedures are the elimination of residual urine, effective ureteral peristalsis, and efficient and/or urgent urinary drainage. We encountered these clinical settings in 244 children with 366 massively dilated ureters from 1965 through 1974. The underlying pathologic processes included primary megaureter, refluxing megaureter, posterior urethral valves, ureteral duplication with upper role ectopic ureterocele or lower pole refluxing megaureter, simple ureterocele, ureterovesical junction obstruction, neurogenic vesical dysfunction, prune belly syndrome and acquired (iatrogenic) megaureter. The results of several reconstructive techniques are reviewed according to the excretory urogram, cystogram, renal function studies and the presence or absence of urinary infection. Analysis of the results with respect to the underlying pathologic entity responsible for the massively dilated ureter indicates that the etiology is a crucial factor in determining whether surgical treatment should be recommended and the type of surgical treatment that will most likely be successful.

Abdominal Muscles↗
PubMed1977

Ocular complications in renal transplant recipients.

The occurrence of ocular complications among 62 recipients of functioning renal transplants was reviewed 6 months to 7 1/2 years after transplantation. Posterior subcapsular cataracts were found in 29 (46.7%). A positive correlation was found between the development of cataracts and the total dose of corticosteroid, the number of days on which the dose exceeded 100 mg, and the number of rejection episodes treated with high doses of corticosteroid. Identification of specific high-risk periods in regard to cataract formation could lead to use of preventive therapy, as yet undetermined, during these periods. Lower doses of corticosteroids should be used to treat rejection episodes.

Adolescent↗