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Biomedical subjects

J C Gartner

Publications and source records attributed to J C Gartner.

52 records · Page 3Linked to original sources
PubMed1983

Long-term use of cyclosporine in liver recipients. Reduction of dosages in the first year to avoid nephrotoxicity.

Cyclosporine is a potent immunosuppressive drug, which has dose-related nephrotoxicity. In renal transplantation, the differentiation between rejection and toxicity is difficult and even with the aid of blood levels of the drug, it may be difficult to establish a chronic maintenance dose. Long-term survivors after liver transplantation can provide modes with which to establish maintenance doses, as these are dictated by nephrotoxicity in these patients. Twenty-nine liver transplant patients who survived one year or more were followed for changes in their cyclosporine doses. Daily oral cyclosporine dose, BUN, serum creatinine and bilirubin were monitored. The reductions in cyclosporine were dictated almost entirely by the findings of nephrotoxicity.

Adolescent↗
PubMed1982

Lactose malabsorption in recurrent abdominal pain of childhood.

In order to evaluate the role of lactose malabsorption in children with recurrent abdominal pain, we performed a prospective controlled double-blinded study in 40 children with RAP of at least three months' duration. Children were studied for lactose malabsorption by breath hydrogen determinations after ingestion of lactose (2 gm/kg of body weight; maximum 50 gm). Lactose malabsorbers were retested with 12.5 gm lactose; lactose absorbers were retested with lactose for ability to produce hydrogen. All children underwent a dietary trial which included two lactose elimination periods. Although 12 children (30%) were lactose malabsorbers, only three malabsorbed part of the smaller, more physiologic, lactose load. Improvement rates of lactose malabsorbers and absorbers during lactose elimination were not significantly different as judged by their physicians and as determined by a 50% or more decrease in pain frequency. These results suggest that lactose malabsorption is of little importance in children with RAP.

Abdomen↗
PubMed1982

Liver and kidney transplantation in children receiving cyclosporin A and steroids.

The new immunosuppressive agent, cyclosporin A, was used with low doses of steroids to treat eight patients undergoing hepatic transplantation and three patients undergoing cadaveric renal transplantation. Seven of the eight liver recipients are well, including one who was given two livers. The three kidney recipients who had developed cytotoxic antibodies after previously rejecting grafts with conventional immunosuppressive therapy, have had good results despite conditions which usually preclude attempts at transplantation. The ability to control rejection effectively and safely without chronic high-dose steroid therapy may make the described therapeutic regimen valuable for pediatric recipients of whole organs.

Adolescent↗
PubMed1981

Water intoxication in normal infants: role of antidiuretic hormone in pathogenesis.

Eight infants, 2 to 5 months of age, who were seen somnolence or irritability, seizures, and hypothermia are described. The symptoms developed following the ingestion of dilute formula. All infants were hyponatremic. Three patients were identified by the symptom complex and were evaluated prior to any therapeutic intervention. Plasma arginine vasopressin concentration and urinary osmolality were either normal or increased despite hyponatremia and decreased serum osmolality. These data, coupled with rapid biochemical and clinical improvement following fluid restriction and/or administration of 3% NaCl, strongly implicate the excessive release of arginine vasopressin in the pathogenesis of this syndrome of water intoxication.

Arginine Vasopressin↗
PubMed1980

The intraoperative medical management of childhood pheochromocytoma.

The intraoperative medical management of eight children, ages 6--15 yr, with familial benign pheochromocytoma is described. All patients received a standardized regimen of alpha- and beta-adrenergic blocking drugs during a preoperative period ranging from 5 to 20 days. In six patients, all symptoms, including diaphoresis, palpitations and hypertension became well-controlled and the operative course was uneventful. In two others the cardiovascular symptoms persisted despite gradual increases in the above medications; in these two patients, the addition of sodium nitroprusside resulted in satisfactory titration of blood pressure and permitted performance of the operation with minimal complications. The specific treatment guidelines used in our patients may reduce the intraoperative complications previously encountered in this tumor.

Adolescent↗
PubMed1980

Pitfalls on the diagnosis of acute osteomyelitis by bone scan.

Two patients with acute osteomyelitis had technetium 99m methylene diphosphonate bone images that were misinterpreted. A review of six prospective evaluations of technetium scanning in the diagnosis of acute osteomyelitis shows that bone image interpretation may be misleading in five to seven per cent of pediatric patients. Definitive diagnostic procedures and management should not be delayed until a positive bone scan is obtained, if the clinical findings are persuasive.

Acute Disease↗
PubMed1979

Meningitis from a pneumococcus moderately resistant to penicillin.

Strains of pneumococci moderately resistant to penicillin were recovered from three patients at the Children's Hospital of Pittsburgh during 1978. One of these children had meningitis and showed signs of early relapse despite high doses of penicillin G potassium. Routine screening of pneumococci for penicillin resistance is recommended.

Chloramphenicol↗
PubMed1978

Pneumococcal empyema in childhood.

Two serotypes, uncommon in pediatric infections, accounted for a disproportionately large number of cases of pneumococcal empyema at the Children's Hospital of Pittsburgh. Eight of ten empyemas were caused by types 1 or 3, and two additional cases of mixed infection involved the type 3 pneumococcus. The type 3 pneumococcal empyemas tended to be more severe than those due to other serotypes. Counterimmunoelectrophoresis (CIE) appeared to be more useful than culture in establishing the cause of this condition; in seven of ten cases, the pleural fluid was CIE positive while cultures of blood and pleural fluid were negative. In each of the seven culture-negative cases, antibiotics had been given prior to hospitalization. One case of type 7 pneumococcal empyema illustrated the potential value of the Ouchterlony test for the etiologic diagnosis of this condition.

Child↗
PubMedDate not supplied

Analysis of liver transplantation.

Liver transplantation has been developed to the point of a service operation, the exploitation of which depends upon the establishment of multiple regional centers. The increased use of this procedure will permit the delivery of optimum health care to victims of endstage liver disease.

Cyclosporins↗
PubMedDate not supplied

Cyclosporine absorption following orthotopic liver transplantation.

Blood concentrations of cyclosporine were determined in adult and pediatric patients following orthotopic liver transplantation to quantitate cyclosporine blood clearance and oral absorption. Seventeen bioavailability studies were performed following transplantation surgery in nine children and seven adults. The intravenous cyclosporine study was performed following an average dose of 2.1 mg/kg. The patients were again studied when they received the same intravenous dose plus an oral dose of cyclosporine of 8.6 mg/kg or an oral dose alone. Blood samples were collected and analyzed for cyclosporine using high-performance liquid chromatography. Cyclosporine blood clearance ranged from 29 to 203 mL/min (1.9-21.5 mL/min/kg) in children and from 253 to 680 mL/min (3.2-7.6 mL/min/kg) in adults. The mean cyclosporine clearance value was 9.3 mL/min/kg in the pediatric patients and 5.5 mL/min/kg in the adults. Cyclosporine bioavailability was less than 5% in six studies on five pediatric patients in the immediate postoperative period. The bioavailability varied from 8% to 60% in adult liver transplant patients (mean, 27%). We conclude that: cyclosporine clearance is highly variable between patients, pediatric patients clear the drug more rapidly than adults and therefore need a higher cyclosporine dose on a body weight basis, cyclosporine is poorly and variably absorbed in liver transplant patients, and cyclosporine blood concentration monitoring is essential following orthotopic liver transplantation.

Adult↗