Biomedical subjects

J W Slaton

Publications and source records attributed to J W Slaton.

7 recordsLinked to original sources

PubMed1996

Case report--sirolimus rescue therapy for refractory renal allograft rejection.

Sirolimus not only displays prophylactic activity, it also reverses acute rejection in rats with ongoing renal allograft rejection. The present case of a human renal allograft recipient documents the utility of dual-drug cyclosporine (CsA)/sirolimus therapy for a patient experiencing ongoing acute rejection and renal dysfunction that had not abated after treatment with corticosteroids equine antilymphocyte globulin (ATGAM), or the mouse anti-human CD3 monoclonal antibody OKT3. The patient described herein underwent induction therapy with 7 days of OKT3, and anti-rejection treatment with 14 days of ATGAM followed by 6 days of OKT3 therapy for biopsy-proved rejection episodes that rendered the patient dependent on dialysis treatments, oliguric with a urine output less than 650 ml per day, and uremic with a serum creatinine (sCr) value above 7 mg/dl. When OKT3 therapy was ceased because of the presence of human anti-mouse antibodies, sirolimus was added to the CsA/steroid regimen to treat the ongoing rejection and to reverse the markedly decreased renal perfusion, as revealed by a 99mTc-DTPA scan. Within 6 weeks the patient's sCr value decreased to 1.4 mg/dl, and urine output returned to greater than 2000 ml per day. To date the patient has exhibited no significant side effects after over 4 months of sirolimus therapy and the withdrawal of corticosteroids.

Cyclosporine↗

PubMed1996

Proximal ureteral stent migration: an avoidable complication?

PURPOSE: The parameters responsible for proximal ureteral stent migration were quantitated. MATERIALS AND METHODS: We compared 16 patients seen between 1990 and 1993 with stent migration to 32 patients whose stents did not migrate. RESULTS: The stent indwelling time and number of stents with a proximal curl of less than 180 degrees were similar between the groups. More patients with migration had stents that were shorter than the ideal length, with a distal curl of less than 180 degrees and a proximal curl in the upper calix versus the renal pelvis. CONCLUSIONS: A shorter than ideal stent, inadequate distal curl and a proximal curl in the upper calix appear to be significant factors in the process of stent migration.

Case-Control Studies↗

PubMed1995

Use of ileal urinary diversion in conjunction with intraoperative radiotherapy.

Intraoperative radiotherapy (IORT) was introduced in the 1970s as a new modality of cancer therapy. It has been especially useful after local irradiation or surgical failure. We report on the use of IORT in 13 patients with pelvic tumors requiring urinary diversion. All 13 were managed with ileal conduits. Despite the associated problems of prior abdominal procedures (11/13 patients), prior external beam radiation to the pelvis (11/13 patients), systemic chemotherapy (4/13 patients), and prolonged operative time (> 10 hours), perioperative mortality (1/13) and morbidity rates were low. We conclude that in cases of prior colonic resection and pelvic radiation, potentially irradiated ileum can be safely used for urinary diversion.

Aged↗

PubMed1994

Exposure to alkyllysophospholipids inhibits in vitro invasion of transitional cell carcinoma.

Alkyllysophospholipids (ALP) are a group of synthetic analogs of a naturally occurring 2-lysophosphocholine. They are directly cytotoxic to a variety of neoplastic cell lines and can modulate the activation of macrophages against tumor cells. Moreover, recent reports have demonstrated the ability of racemic 1-octadecyl-2-methyl-sn-glycero-3-phosphocholine (ET-18-O-CH3) to prevent tumor cell invasion when given in noncytotoxic concentrations. Using an in vitro model, we studied the ability of ET-18-O-CH3 to prevent transitional cell carcinoma invasion. Cytostatic activity was determined by clonal growth assay (25,000 cells per plate). Suppression of colony growth was found at concentrations greater than 4 micrograms/ml. of ET-18-O-CH3 in rat and mouse transitional cell carcinoma (TCC) cell lines and greater than 2 micrograms/ml. in a human TCC line. Inhibition of tumor cell invasion was assessed by the effects on cell migration through Matrigel-coated 8 microns-pore polycarbonate filters (using 1 x 10(5) cells per chamber). Invasion was reduced to 50 to 70% of controls in both the mouse and rat TCC lines at the highest concentration (4.0 micrograms/ml.). In the human TCC line, invasion was reduced to less than 30% of controls at concentrations as low as 0.5 micrograms/ml. Motility (without invasion) of the human TCC line, as measured by cell migration through the micropore filter without the Matrigel coating, was inhibited at the same concentration of ET-18-O-CH3 found to inhibit invasion. The anti-invasive effect seen with noncytotoxic concentrations of ALP may prove useful in the treatment of transitional cell carcinoma.

Animals↗

PubMed1994

Conservative management of suspected bladder rupture after augmentation enterocystoplasty.

Bladder rupture after augmentation enterocystoplasty is a potentially life-threatening condition. We reviewed our experience with 13 patients who presented to our institution with 15 episodes of sudden onset of abdominal pain and rebound tenderness, and were diagnosed on clinical grounds to have peritonitis secondary to a suspected bladder augmentation rupture. (Three patients had had similar episodes treated previously elsewhere with abdominal exploration and repair of an augmentation rupture.) These episodes were initially managed with hospitalization, bladder drainage with an indwelling catheter, intravenous antibiotics and serial abdominal examinations. Cystogram and/or computerized tomography was diagnostic in only 3 of 7 cases in which it was performed. In 13 of 15 instances signs and symptoms of peritonitis quickly resolved, and intermittent catheterization was resumed after a mean of 12 days. In the remaining 2 patients delayed surgical repair of a bladder rupture was done in 1, and exploration and repair of an incarcerated internal hernia were done in 1. Although prompt abdominal exploration is the gold standard for suspected bladder augmentation rupture, treatment of peritonitis as bladder rupture in patients with a bladder augmentation by nonoperative techniques was successful in 87% of episodes.

Adolescent↗

PubMed1994

Cyclosporine versus azathioprine: a 5-year followup of 200 consecutive cadaver renal transplant recipients.

When cyclosporine was introduced as an immunosuppressive agent, there was concern that cyclosporine could be detrimental to long-term renal allograft function and survival. In response to this concern, we report a 5-year followup of 200 consecutive renal transplant recipients among whom initial immunosuppression and risk factors were similar except for the substitution of cyclosporine for azathioprine in the second 100 recipients. The azathioprine and cyclosporine groups had similar 1-year (89% versus 91%) and 5-year (74% versus 80%) patient survival rates. Cyclosporine treated patients had superior 1-year (83% versus 58%) and 5-year (61% versus 29%) graft survival rates. At the 5-year interval, cyclosporine treated grafts had an elevated, yet stable, mean serum creatinine level compared to azathioprine treated grafts. Despite ongoing mild renal dysfunction in cyclosporine treated grafts, cyclosporine does not induce an inexorable decrease in graft function and continues to provide long-term graft survival superior to azathioprine.

Azathioprine↗

PubMed1993

Massive necrotizing pancreatitis in an immunosuppressed renal transplant recipient (successful therapy).

Severe pancreatitis may be associated with massive necrosis of the pancreas and/or retroperitoneal adipose tissue. Toxicity results from the dead tissue and secondary infection. A 45 year old patient, while fully immunosuppressed, developed this complication following cadaveric renal transplantation. He survived continued immunosuppression, 16 operative debridements of the retroperitoneum, and maintained a functioning renal transplant. In view of the previously reported high mortality rates from mild pancreatitis after transplantation, the current experience warrants further evaluation of the open method of treatment.

Acute Disease↗