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Biomedical subjects

J M Pattison

Publications and source records attributed to J M Pattison.

13 recordsLinked to original sources
PubMed2001

Drugs in pregnancy. Renal disease.

The management of pregnant women with renal impairment presents a major challenge to obstetricians, nephrologists, and ultimately paediatricians. As renal failure progresses there is an increase in both maternal and fetal complications. Often these women have intercurrent medical conditions and, prior to conception, are receiving a broad range of prescribed medications. A successful obstetric outcome relies upon careful pre-pregnancy counselling and planning, obsessive monitoring during pregnancy, and close liaison between different specialist teams. Experience is mounting in the management of pregnant transplant recipients, but the introduction of newer immunosuppressive agents which have great promise in prolonging graft survival present new problems for those recipients of a kidney transplant who are planning to conceive. We review drug prescription for pregnant patients with renal impairment, end-stage renal failure, or a kidney transplant.

Female↗
PubMed2001

Spontaneous abdominal hemorrhage with AA-amyloidosis and vasculitis in a patient with rheumatoid arthritis.

Both rheumatoid vasculitis and amyloidosis in rheumatoid arthritis (RA) are uncommon. We describe a patient in whom they occurred together and were associated with fatal intra-abdominal hemorrhage. A 56-year-old Caucasian woman was referred because of increasing lethargy, edema, and proteinuria. She had suffered from seropositive, erosive, nodular RA for 14 years. Previously, she had undergone numerous joint replacements, a thyroidectomy for amyloid-associated (AA) amyloidosis of the thyroid that caused a large goiter and a renal biopsy that showed renal AA-amyloidosis in the context of nephrotic syndrome. As her condition deteriorated, this patient became increasingly reluctant to go to the hospital and to take drugs beyond analgesics. Thus, her RA was chronically under treated. While in the hospital for evaluation, this patient suddenly developed hypotension, tachycardia, and a severe colicky left-sided abdominal pain radiating from the left upper quadrant/epigastric region to the left iliac fossa. Computed tomography (CT) showed a large amount of echogenic free fluid within the abdomen and marked thickening of the omentum. At laparotomy, 2 liters of free blood was found adjacent to a hematoma of the greater omentum, and it was evacuated without identification of a discrete bleeding point. All solid and hollow organs were normal. The omentum was noted to be very friable. She developed a more disseminated bleeding diathesis and persistent peritoneal hemorrhage via her abdominal drains. She succumbed shortly afterward. Histology revealed extensive omental hemorrhage and one large vessel within the area of hemorrhage showed a severe necrotizing vasculitis. Extensive amyloid deposition was also found within the walls of the smaller omental arterioles. Vasculitis in the context of RA is relatively rare and is associated with under treated, seropositive disease. Skin and nerve involvement are most common, but bowel involvement has been reported, with a highly significant morbidity (partly due to late presentation/recognition). Similarly, AA-amyloidosis is a rare but feared long-term concomitant of under treated RA. Early recognition can permit successful anti-inflammatory therapy to affect a clinical and pathological remission; continued inflammatory stimulation is associated with rapid progression and demise. Chronically under treated patients with RA are more prone to rare but potentially devastating complications. Gastrointestinal catastrophes are a feature of both rheumatoid vasculitis and of amyloidosis, here uniquely co-localized.

Journal Article↗
PubMed2000

Successful medical treatment of acute bilateral emphysematous pyelonephritis.

Emphysematous pyelonephritis most often presents as an acute medical emergency, typically in a septic diabetic patient with acute renal failure. The management of this condition has traditionally been surgical, with nephrectomy. However, some recent reports have described successful medical interventions. We describe a case of acute bilateral emphysematous pyelonephritis in a frail patient not suitable for bilateral nephrectomy and long-term dialysis. This condition was managed medically, not surgically, with intensive antibiotic and circulatory support. The outcome was complete recovery after months of hospital-based treatment. We discuss the management of this rare but important condition in detail.

Acute Kidney Injury↗
PubMed1997

New insights into mechanisms of allograft rejection.

Understanding of the molecular basis of organ allograft rejection has increased tremendously in the past decade. Insight into the nature of the alloantigen and the mechanisms underlying T cell recognition, activation, and differentiation provide novel targets for immunotherapy. Appreciation of the role that peptides present in the human leukocyte antigen groove play in allorecognition provides a new target for synthetic peptide therapy. Elucidation of signal transduction pathways downstream from the T-cell receptor helps to explain the mechanism of action of immunosuppressive agents and impacts the design of new drugs. An understanding of the role of costimulatory molecules, such as CD28, has given rise to new therapies, such as CTLA4-Ig. Information about the mechanisms of cytotoxicity, chemoattraction, and vascular biology similarly has provided new targets for rational drug design. This article highlights new insights into the mechanism of allograft rejection relevant to the design of new immunotherapies.

Animals↗
PubMed1997

The role of transesophageal echocardiography in patients with chronic renal failure at low and high risk of endocarditis.

BACKGROUND AND AIMS OF THE STUDY: The benefits of transesophageal echocardiography (TEE) may depend on the clinical likelihood of infective endocarditis, but little data exist on patients at low risk. METHODS AND RESULTS: We studied 32 patients with renal failure with either a low (n = 21) or high (n = 11) level of clinical suspicion for infective endocarditis. In the low-risk cases, TEE provided no new information whether the transthoracic echo was normal or abnormal, although it did confirm that an echogenic mass was more likely to be a calcific deposit than a vegetation. In the high-risk cases, transthoracic echocardiography was always abnormal but TEE added new information in seven out of 11 cases-positively in six, and by exclusion in one. TEE detected signs of complications of infective endocarditis in one case. CONCLUSIONS: We conclude that, when the clinical suspicion of endocarditis is low, TEE is rarely necessary.

Echocardiography↗
PubMed1996

Identification of a novel regulatory region critical for expression of the RANTES chemokine in activated T lymphocytes.

The RANTES chemokine is a T cell-expressed, proinflammatory cytokine recently implicated as a suppressive agent of HIV replication. We have identified tandem kappaB-like sequences within the promoter for RANTES that are critical for RANTES promoter-reporter gene activity in both the T cell tumor line Hut78 and in PHA-activated PBL. This region binds not only Rel family members (including p50-p65 heterodimers and p50-p50 homodimers) but also non-Rel factors up-regulated in PBL 3 to 5 days following activation. The expression of these "late" expressed nuclear factors correlates with an up-regulation of RANTES message found at this point in T cell activation. These factors are also constitutively expressed in functionally mature CD8+ T cells. We hypothesize that these apparently novel proteins are responsible in part for the temporal regulation of RANTES seen in peripheral blood T cells and represent a component of transcriptional regulatory machinery newly expressed at this "late" stage of peripheral T cell development.

Base Sequence↗
PubMed1996

RANTES chemokine expression in diseased and normal human tissues.

RANTES is a member of a large family of cytokines, called chemokines, which are thought to play a regulatory role in inflammatory processes. We have made recombinant human RANTES protein which was used to generate a panel of anti-RANTES monoclonal antibodies. Following characterization, select anti-RANTES monoclonal antibodies were used for immunohistologic staining of a large panel of normal, diseased and fetal tissue sections. Diseased tissues included eleven lymphomas and eight renal tumors. Most tissues were also tested in parallel for RANTES mRNA by in situ hybridization using RANTES mRNA specific oligomeric probes. As expected, most normal adult tissues contain few, if any, RANTES positive cells. In contrast, RANTES expression dramatically increases in inflammatory sites. In addition, megakaryocytes, some tumours, and select fetal tissues express high levels of RANTES message and protein. These results indicate a wider expression of RANTES than previously appreciated and suggest multiple physiologic roles for this soluble factor.

Animals↗
PubMed1996

RANTES chemokine expression in transplant-associated accelerated atherosclerosis.

BACKGROUND: The pathogenesis of transplantation-associated accelerated atherosclerosis is poorly understood, but it is likely to be an alloimmune response involving infiltration of the vessel wall by T lymphocytes and monocytes leading to smooth muscle cell proliferation and extracellular matrix deposition. RANTES is a chemokine that selectively chemoattracts T lymphocytes, NK cells, monocytes, and eosinophils. The expression of RANTES in accelerated atherosclerosis was investigated by in situ hybridization and immunohistochemistry. METHODS: Coronary arteries from six patients undergoing accelerated atherosclerosis were obtained at the time of retransplantation. Normal coronary arteries from two patients with idiopathic dilated cardiomyopathy were used as controls. Messenger RNA for RANTES was localized with digoxigenin-labeled complementary DNA probes. RANTES protein was detected by use of a monoclonal antibody and a three-step horseradish peroxidase method. RESULTS: RANTES mRNA and protein were detected in the lymphocytes, macrophages, myofibroblasts, and endothelial cells of arteries undergoing accelerated atherosclerosis but not in normal coronary arteries. CONCLUSIONS: In view of its in vitro biologic activity and in vivo expression pattern, RANTES may be a pivotal mediator of the cellular infiltrate seen in graft atherosclerosis. This information may help in the design of novel diagnostic and therapeutic approaches to this increasingly important disease process.

Adult↗
PubMed1995

The incidence of renal failure in one hundred consecutive heart-lung transplant recipients.

Between March 1981 and November 1992, 100 heart-lung transplantations were performed at our institution. We report on the renal function in the 67 patients who survived a minimum of 6 months posttransplantation, and who were aged more than 10 years at the time of transplant. Renal function was determined by serial measurement of serum creatinine. Mean serum creatinine increased from 0.96 +/- 0.03 mg/dL at baseline to 1.55 +/- 0.07 mg/dL at 6 months posttransplantation, to 1.88 +/- 0.11 mg/dL at the end of follow-up (mean follow-up, 50.0 months; range, 6 to 140 months). The decline in renal function was biphasic, with a rapid decrease in the first 6 months, followed by a much slower decline. Three patients developed end-stage renal failure. This compares with 14 of 416 cardiac transplant recipients at Stanford who developed end-stage renal failure over the same period. We conclude that in our large series at a single center the incidence of renal impairment and end-stage renal failure is low and similar between heart-lung and heart transplant patients.

Adolescent↗
PubMed1993

Monocyte haptotaxis induced by the RANTES chemokine.

BACKGROUND: Soluble mediators and inducible cell-surface molecules coordinate the ordered cascade of events giving rise to inflammation. The specific mechanisms underlying the attraction of antigen-specific cells into a site of inflammation remain sketchy, however. In particular, it is unclear how chemoattractants cause rapidly moving immune cells to adhere to the blood vessel wall and to enter inflamed tissues. RESULTS: Here we show that RANTES, a potent chemo-attractant for monocytes and T lymphocytes, is inducibly expressed within an inflamed organ, binds to endothelial cells, and promotes haptotaxis, the migration of cells induced by surface-bound gradients. CONCLUSION: These findings lead us to propose a model for the role of RANTES in the migration of antigen-specific immune cells into an inflammatory site.

Journal Article↗
PubMedDate not supplied

Percutaneous transluminal renal angioplasty in patients with renal failure.

Renovascular disease is a common cause of end-stage renal failure in the elderly population. We assessed the role of percutaneous transluminal renal angioplasty in the treatment of patients with renal failure due to renovascular disease by analysing our results in 60 patients treated between 1982 and 1991. All the patients had a baseline serum creatinine level greater than 150 mumol/l; improvement in renal function was defined as a 20 per cent reduction in this level. Seventy-five angioplasty procedures were attempted on 70 arteries in 60 patients. There was an improvement in renal function in 24 patients (40 per cent), whilst six (10 per cent) showed deterioration. The most dramatic improvement was seen in a small group of patients who had suffered an acute deterioration in renal function prior to angioplasty. There was a low incidence of serious complications. Renovascular disease is an important reversible cause of chronic renal failure and should be investigated aggressively so that percutaneous transluminal renal angioplasty can be undertaken in selected patients.

Aged↗