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Biomedical subjects

J A Keogh

Publications and source records attributed to J A Keogh.

17 recordsLinked to original sources
PubMed1992

Skin cancer in an Irish renal transplant population.

One hundred and forty-nine renal transplant patients attending 2 centres in Dublin were examined. Twelve patients (8.1%) were found to have cutaneous malignancy while dysplastic lesions (premalignant and/or malignant) were identified in 34 (22.8%). The prevalence of cutaneous malignancy in this study is substantially greater than that of previous Irish studies. The introduction of cyclosporin A (CyA) as a new and more effective immunosuppressive agent in renal transplantation may in part explain this increase.

Adult↗
PubMed1991

Reduction of proteinuria with captopril therapy in patients with focal segmental glomerulosclerosis and IgA nephropathy.

Angiotensin-1 converting enzyme inhibitors (ACEI) have been shown to reduce proteinuria in azotaemic diabetics and in other glomerulopathies, and such treatment has also slowed the development of experimentally-induced glomerulosclerosis in animals. We have treated 13 patients with focal segmental glomerulosclerosis (FSGS) and IgA nephropathy (IgAN) with Captopril 12.5 mg twice daily for six months and assessed their response in terms of 24 hour urinary protein excretion, blood pressure, glomerular filtration rate, effective renal plasma flow and derived values for filtration fraction and renal vascular resistance. A mean fall of 29 per cent in urinary protein excretion was observed over the six months treatment schedule. No significant changes were observed in other parameters of renal haemodynamics measured. We conclude that Captopril therapy in patients with FSGS and IgAN reduces urinary protein excretion consistently over a six month period, and that this may in the longer term retard the progression of their renal failure.

Adolescent↗
PubMed1990

The effect of peritoneal dialysate on pulmonary function and blood gasses in C.A.P.D. patients.

There have been many reports showing diminished vital capacity (VC), total lung capacity (TLC), and functional residual capacity (FRC), after the infusion of peritoneal dialysate in patients on continuous ambulatory peritoneal dialysis (C.A.P.D.) for chronic renal failure. We also examined the effects of the infusion of two litres of dialysate on airways resistance (Raw) using total body plethysmography and on arterial blood gasses. Ten patients on C.A.P.D. were selected. The mean results of dialysate infused (in) and dialysate drained (out) are as follows: FVC 3.66 l (in) and 3.73 l (out) (not significant); VC 3.81 l (in) and 3.99 l (out) (p less than 0.05); FEV1 3.02 l (in) and 2.94 (out) (n.s.); TLC 5.89 l (in) and 6.33 l (out) (p less than 0.05); FRC 3.56 l (in) and 3.78 l (out) (p less than 0.05); Raw 4.79 cmsH21/l/s (in) and 4.72 cmsH20/l/s (out) (n.s.); Pa02 11.03 kPA (in) and 11.35 kPA (out) (p less than 0.001). We conclude that two litre dialysate causes significant reduction of TLC, VC and FRC, and a reduction in Pa02 and A-a02 but has no effect on airways resistance.

Airway Resistance↗
PubMed1990

Acute epidemic aluminium osteomalacia secondary to water supply contamination.

When the aluminium content of the water supply to our Haemodialysis Unit rose from less than 0.5 mumol/l to 6 mumol/l over a two month period, we carried out bone biopsies and desferrioxamine infusion tests on twelve (12) patients who had been on haemodialysis for less than one year (mean 8 months) and had normal serum aluminium levels. The patients had no bone symptoms. Eight patients had positive aluminium bone stains. The aluminium osteomalacia group (n = 8) had a mean PTH of 1.4 ng/ml s.e. 0.3 whereas the non-ALO group had a mean PTH of 2.9 ng/ml s.e. 0.7. The difference in mean PTH is significant (p less than 0.05). There was no evidence of encephalopathy, fractures or microcytic anaemia in the ALO positive group. The aluminium contamination of the water supply occurred because of a change in the reservoir purification system from sand-filtration to alum.

Adolescent↗
PubMed1990

Aluminium osteomalacia in chronic renal failure patients neither on dialysis nor taking aluminium containing phosphate binders.

The incidence of aluminium osteomalacia (ALO) in patients with chronic renal failure neither on dialysis nor taking aluminium-containing phosphate binders (ACPB) is not well documented. Biochemical and histological bone investigations were performed in 35 patients fulfilling the above conditions, among whom we found an incidence of ALO of 17%. In the ALO group, salient findings were PTH level (mean +/- s.d.) of 3.1 +/- 1.4 ng/ml (normal less than 0.5 ng/ml); elevated home tap-water aluminium levels of 6.5 +/- 1.2 umol/l (normal less than 2 umol/l); and a GFR of 20.5 mls/min/1.73m, (range 2-50 mls/min/1.73m). We conclude that the aetiology of ALO in this group involves the absorption of toxic home water aluminium in the presence of an elevated PTH level and a GFR less than 50 mls/min/1.73m.

Adult↗
PubMed1990

Haemolytic uraemic syndrome with shigella.

A 49-year-old male developed bloody diarrhoea whilst on a visit to India. Sigmoidoscopy and rectal biopsy showed acute colitis. Shigella dysentery type I was isolated from stool culture. Cytotoxin production by the organism was demonstrated. The patient developed acute renal failure, thrombocytopaenia and microangiopathic haemolytic anaemia. He required mechanical ventilation, haemodialysis, blood transfusion and antibiotic therapy and achieved a complete recovery. This is an unusual case of haemolytic uraemic syndrome complicating shigellosis in an adult.

Cefuroxime↗
PubMed1989

A case of IgA nephropathy associated with vitiligo, primary hypothyroidism and primary adrenocortical insufficiency.

A 14 year old boy presented with recurrent attacks of macroscopic haematuria preceded by tonsillitis. Clinical examination revealed generalised vitiligo. Renal function was normal with microscopic haematuria. Percutaneous renal biopsy showed mesangial proliferation on light microscopy with deposition of IgA and IgM in a granular pattern in the mesangium and glomerular basement membrane compatible with a diagnosis of IgA nephropathy. Biochemical investigations revealed primary hypothyroidism and primary adrenocortical insufficiency with negative organ specific autoimmune screen. Renal function has not deteriorated after three years follow-up. This particular association has not been previously described to our knowledge.

Adolescent↗
PubMed1987

The use of intravenous and intraperitoneal desferrioxamine in aluminium osteomalacia.

A 32-year-old male with aluminium osteomalacia was changed from haemodialysis to chronic ambulatory peritoneal dialysis (CAPD) because of vascular access problems. Desferrioxamine (6 g) was administered intravenously on a once-weekly basis and the quantity of aluminium removed from each dialysate was calculated weekly. Aluminium concentration was estimated using the electrothermal atomic absorption spectrophotometer. The total aluminium removed after one week was 191 mumol, giving a clearance for aluminium of 4.2 ml per min. Subsequently intraperitoneal desferrioxamine 0.5 g per dialysate was administered to a total dose of 6 g and the cumulative aluminium loss was 134.1 mumol giving a clearance of 3.1 ml per min. The weekly loss of aluminium from dialysate when no desferrioxamine was administered was 58.3 mumol, giving a clearance of 2.5 ml per min. This is the first documented comparison of clearance rates for aluminium between CAPD alone, CAPD plus intravenous desferrioxamine and CAPD plus intraperitoneal desferrioxamine.

Adult↗
PubMed1979

Anaphylactoid reaction to mannitol.

A 16-year old boy with a lesion of the right eye developed, during the preoperative administration of a mannitol infusion, an anaphylactoid reaction characterized by hypotension, periorbital oedema and bronchospasm. This quickly resolved following cessation of the infusion and appropriate therapeutic measures. There were no long-lasting effects. We considered mannitol the causative agent because of its temporal relationship to the reaction and our inability to seriously implicate any other medication. A history of childhood atopy may have been a predisposing factor.

Adolescent↗