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Biomedical subjects

H M Kauffman

Publications and source records attributed to H M Kauffman.

At least 37 records · Page 2Linked to original sources
PubMed1986

Gastrointestinal complications in renal transplant recipients.

In a 16-year study, 101 gastrointestinal (GI) lesions (16 fatal) developed in 580 renal transplant recipients seen in the authors' institution. Lesions were seen at all levels of the GI tract, but colonic lesions were the most common (42 patients) and were fatal in 8. Segmental ischemic colitis was the single most common morphologic diagnosis (14 patients). Seven of these patients had an unusual syndrome that clinically, at surgery, and on gross examination resembled inflammatory bowel disease. Lesions were segmental; involved bowel was thickened and erythematous with creeping peritoneal fat. Histologically, mucosa adjacent to the frank necrosis showed simplification and striking epithelial atypia. Specific identifiable viral infections caused 28% of the GI complications in this series. This incidence is higher than that in other reported series. Most of these infections can be diagnosed from endoscopically obtained material. These findings have therapeutic implications.

Colon↗
PubMed1986

Early diagnosis of acute postoperative renal transplant rejection by indium-111-labeled platelet scintigraphy.

A prospective evaluation of 111In-labeled platelet scintigraphy (IPS) for the early diagnosis of acute postoperative renal transplant rejection (TR) was undertaken. The results of IPS were compared with in vitro biochemical tests, the clinical finding of graft tenderness, and combined [99mTc]DTPA and [131I]orthoiodohippurate scintigraphy. With a sensitivity of 0.93 and a specificity of 0.95, IPS provided otherwise unavailable diagnostic information. Furthermore, postoperative IPS was a good predictor of long-term allograft survival.

Acute Disease↗
PubMed1986

Indirect inguinal hernia in patients undergoing peritoneal dialysis.

There is an increasing number of patients whose permanent renal failure is managed by chronic peritoneal dialysis. Four adult male patients developed symptomatic indirect inguinal hernias shortly after the institution of dialysis. The hernia sac in each of the patients was both narrow and elongated. We postulate that in each patient the hydrostatic pressure of the dialysis fluid converted a patient processus vaginalis into a symptomatic indirect hernia.

Adult↗
PubMed1985

Severe bleeding diathesis associated with invasive aspergillosis in transplant patients.

A severe bleeding disorder developed in eight renal transplant patients with invasive aspergillosis. The hemorrhagic diathesis was characterized by wound oozing, severe upper and lower gastrointestinal tract hemorrhage, and mucosal bleeding at other sites. This unusual coagulopathy was characterized by a prolonged thrombin time, which was corrected with protamine sulfate, and an abnormal Reptilase time. The bleeding disorder antedated the diagnosis of invasive aspergillosis in all cases. The probability that the coagulopathy was due to proteolytic enzymes elaborated by Aspergillus sp. is discussed.

Adult↗
PubMed1985

Successful second kidney transplantation in a patient with focal glomerulosclerosis. A case report.

We report a woman who developed renal failure due to focal glomerulosclerosis (FGS). This disease recurred immediately in a kidney transplant from her brother resulting in removal of that graft. She subsequently received a cadaver kidney transplant, and FGS has not recurred after 24 months. This is the first report of nonrecurrence in a second kidney graft, when the first was lost due to recurrent FGS. Whether timing or tissue typing of the second graft in relationship to the first is important is not known. Recurrence of FGS in a first kidney graft should not, however, preclude future transplantation.

Adult↗
PubMed1985

Colonic perforation in renal transplant patients.

Review of 713 renal transplant patients at the Medical College of Wisconsin yielded 17 (2.3%) with spontaneous colon perforation. The cause seemed to be related to nonocclusive ischemia in the majority of cases (nine). The sigmoid colon was the most common site of perforation (nine cases). The early detection of colon perforation suspected on radiographic examination was associated with improved survival statistics.

Adolescent↗
PubMed1985

Unexpectedly high incidence of cytomegalovirus infection in apparent peptic ulcers in renal transplant recipients.

Gastroduodenal ulcers in renal transplant recipients are usually accepted as being acid-peptic in origin. In a series of 573 renal transplant recipients there was histologic material available for examination from eight patients with gastroduodenal ulcers and three patients with gastric erosions. All ulcers had originally been diagnosed as peptic or stress ulcers. However, on review, five of them proved to contain cytomegalovirus (CMV); CMV was also present in all the stomachs with erosions. We suggest that CMV infection plays as important a role in upper gastroduodenal ulcers and erosions in renal transplant recipients as it does in similar lesions elsewhere in the gastrointestinal tract of these immunosuppressed patients.

Adult↗
PubMed1984

Effect of primary renal disease in patients with renovascular insufficiency.

The effect of laboratory evidence of renal parenchymal abnormality on the results of renal revascularization in 83 patients with renovascular hypertension was determined. Primary renal disease (PRD) was defined as an abnormal urinalysis (proteinuria, hematuria, or casts) in the absence of urinary infection, or decreased renal function (elevated serum creatinine level greater than 1.5 mg/dl and/or decreased creatinine clearance). All patients were hypertensive on medical therapy preoperatively. Patients were defined as cured if postoperative diastolic blood pressure (BP) was less than 90 mm Hg on no medication and improved if BP less than 90 mm Hg on medication. Sixty-six patients (80%) were cured or improved following revascularization. Of 45 patients (63%) with evidence of PRD preoperatively, 28 (62%) were cured or improved compared with 33 patients without PRD, of whom all (100%) were cured or improved (p less than 0.001). Each of five patients with transplant renal artery stenosis had two operations; four were cured or improved. The serum creatinine level was elevated preoperatively in 37 cases. Eighteen of the 37 (49%) improved to within normal limits following operation. Fifteen patients had simultaneous bilateral renal artery revascularization, and 12 (80%) were cured or improved. Fourteen patients (17%) had concomitant vascular procedures: aortobifemoral bypass (seven), abdominal aneurysm resection (five), femoral endarterectomy (one), and aortoiliac bypass (one). Twelve of these 15 patients had PRD, and 8 of the 12 (67%) were cured or improved. Only one death occurred in the perioperative period. Thirty-eight patients (46%) had been treated for hypertension for more than 12 months before referral.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1982

Bilateral pheochromocytoma and islet cell adenoma of the pancreas.

An 18-year-old woman with bilateral pheochromocytomas and an asymptomatic islet cell adenoma of the pancreas represents the 11th patient to be described with this combination of endocrine tumors. No other components of any multiple endocrine adenomatosis (MEA) syndromes were present. Because of this "overlap syndrome," in which tumors that have traditionally been considered to be components of separate and mutually exclusive MEA syndromes have occurred concomitantly in the same patient, a question is raised regarding the validity of a rigid classification of these various MEA syndromes. The possibility of a pancreatic tumor should be kept in mind in any patient with a pheochromocytoma, especially if it is bilateral of multicentric in origin.

Adenoma, Islet Cell↗
PubMed1980

Stability of renal transplant function with alternate-day corticosteroid therapy.

Fifty-three renal transplant recipients with good to excellent renal function, while receiving daily maintenance or near-maintenance doses of azathioprine and methylprednisolone, were gradually converted to alternate-day corticosteroid therapy. Stability of allograft glomerular filtration rate (GFR) in each patient was assessed by calculating the slope of a plot of the reciprocal of the serum creatinine concentration vs time. After conversion to alternate-day therapy, GFR was stable in 80% but deteriorated in 20% of patients. However, most of the patients who experienced deteriorating GFR during alternate-day therapy regained stable renal function when given the same total corticosteroid dose but on a daily basis. This suggests but does not prove that maintenance-level daily corticosteroid therapy is better than maintenance-level alternate-day therapy in stabilizing allograft function. We conclude that maintenance-level alternate-day corticosteroid therapy should be used cautiously until a long-term prospective study determines whether there is an increased risk of losing renal function with this schedule and whether this potential risk is offset by reduced corticosteroid toxicity.

Adrenal Cortex Hormones↗
PubMed1980

Association of MB compatibility with successful intrafamilial kidney transplantation.

The MB system is a newly defined system of B-cell alloantigens closely associated with HLA-DR. We assessed the role of MB compatibility in renal transplantation in a retrospective study of 21 patients who had received a kidney transplant from a related donor matched for a single HLA haplotype. One-year transplant survival was closely correlated with the presence of a compatibile MB antigen in the unshared haplotype of the donor: Eight of eight rejected kidneys were obtained from MB-incompatible donors, and 12 of 13 successful transplants were from MB-compatible donors. The association between MB compatibility and allograft acceptance was highly significant (P = 4.4 x 10(-5)), but no significant relation could be demonstrated between transplant survival and donor-recipient compatibility for antigens of the HLA-A, B or DR loci. These findings suggest that match matching for MB may be critical for the selection of donors in intrafamilial kidney transplantation.

B-Lymphocytes↗