Biomedical subjects
Publications and source records attributed to H K Johnson.
The role of HLA match in donor--recipient selection has been studied in 271 patients who received cadaver transplants during a 10-year period. This series included 36 four-antigen matches, 181 three-antigen matches and 54 two-antigen matches. Our results support the concept that better results can be expected when better matched kidneys are utilized for transplantation.
The daily rearrangement of a profoundly retarded child's routine shower was effective in eliminating his low-frequency faeces smearing and coprophagic behaviour during the late afternoon/early evening part of the day. The effects appeared to generalise such that both types of behaviour were reduced at other times of the day and night. These results are discussed in terms of a social learning framework. A model for analysing the motivations and reinforcing conditions for rectal digging, coprophagy, and smearing faeces is also presented.
Renal failure is a common cause of death in patients with progressive systemic sclerosis (PSS). The present paper describes two patients with chronic renal failure secondary to PSS whom we have treated by a combination of chronic hemodialysis and renal transplantation. Also reviewed are reports of six additional patients who have undergone renal transplantation. We conclude that chronic hemodialysis and renal transplantation are successful life-sustaining treatment modalities in some patients with end-stage renal disease due to PSS.
Although cadaver allograft contamination occurs frequently, the potential danger to the transplant recipient varies. Usually the results of culture from the donor and kidney perfusates are not available at the time of transplantation. A positive culture result often necessitates the use of prophylactic antibiotics. The antibiotic may be potentially nephrotoxic, and in the setting of minimal or changing renal function this effect may be potentiated. If significant contamination with virulent organisms is found prior to transplantation, clinical judgment often dictates that the graft be discarded. Perfusion and storage with solutions containing broad-spectrum antibiotics would substantially reduce the incidence of contamination in perfused kidneys. This would in turn reduce the requirement for potentially nephrotoxic antimicrobial therapy in the transplant recipient. Since the antibiotics tested are effective against a wide range of contaminants and apparently cause no detrimental effects, it would seem reasonable to add them routinely to the perfusate solution.
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We report 3 cases of a series of 372 (0.8 per cent) renal transplant recipients in whom urinary tract calculi developed as a complication of the procedure. In each patient symptoms were minimal and not classic of calculous disease. We disagree with the contention that all such patients have either hypercalcemia, infection, or tubular acidosis, although thorough evaluation is indicated. We believe this entity should be considered in problematic renal transplantation patients. Conservative therapy is advocated when the situation permits.
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A review of 251 renal transplants done at the Vanderbilt University Medical Center since October 1962 revealed three patients who had suffered subsequent skeletal injuries sufficient to cause hospitalization. In a 37-year-old woman, a closed fracture of the pelvis healed satisfactorily in the usual period of time. In a 30-year-old man, closed fractures healed well, but there was prolonged delay in the healing of massive open wounds resulting from crushing injuries of the lower extremities. He required prolonged hospitalization, but satisfactory result was achieved after early amputation and close cooperation between orthopedic and renal teams. No significant alterations in the function of either patient's transplanted kidney occurred. It is postulated that severe trauma in transplantation patients may become more common in the future, and certain guidelines for its management are set forth. With close cooperation between the orthopedic surgical and medical renal teams, a successful outcome can be expected.