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Biomedical subjects

M Bewick

Publications and source records attributed to M Bewick.

At least 91 records · Page 5Linked to original sources
PubMed1981

Endocrine function of the heterotopic pancreatic allotransplant in dogs. II. Immediate post-transplant period.

Pancreatic endocrine function was investigated in dogs after heterotopic pancreatic allotransplantation. A marked hyperinsulinemia was found in peripheral venous blood within the first 60 min postoperatively. This was associated with hypoglycemia and hypokalemia occurring within the next 2 to 3 hr resulting eventually in death. The hypoglycemia could be corrected by parenteral dextrose and potassium given during the first 2 hr postoperatively or prevented by parenteral hydrocortisone given at the time of transplantation.

Animals↗
PubMed1981

Endocrine function of the heterotopic pancreatic allotransplant in dogs.

After pancreatectomy and heterotopic pancreatic allotransplantation in dogs, there was a pattern of endocrine activity similar to that found following a combination of pancreatic denervation and total transposition of the pancreatic venous effluent from the portal of the systemic venous circulation. Denervation of the pancreas alone or total venous transposition alone did not mirror these results. The mechanism of the effect of these two factors is discussed.

Animals↗
PubMed1981

Recurrence of focal segmental glomerulosclerosis in renal allografts.

Thirty-one renal allografts placed in 25 recipients with renal failure from biopsy-documented focal segmental glomerulosclerosis (FSGS) were reviewed. These represent all of the cases with this renal histology transplanted over 13 years. Recurrence of the lesion was demonstrated histologically in five recipients. A nephrotic syndrome occurred in all five patients and failure of the graft in two. Of 20 recipients who did not show a nephrotic syndrome, allograft histology in 12 did not show FSGS in any. From these data and a review of the literature, the risks of transplantation in patients with FSGS are assessed. Recipients under the age of 15 and with a course into renal failure of less than 3 years show recurrence in about 50% of cases. Of this 50%, about one-half will lose their grafts from the recurrence within 5 years, but some may show good function for many years, despite proteinuria or a nephrotic syndrome.

Adolescent↗
PubMed1981

The urological complications of 1000 renal transplants.

Two hundred and one urological complications have been diagnosed and treated in 123 transplant recipients in a series of 1000 consecutive renal transplant operations (overall incidence 12.5%). Obstructive uropathies and urinary fistulae accounted for 95% of these complications and all of the mortality (22%). Details of management and patient and graft survival are given. A relationship between mortality from a urological complication and steroid dosage was found. A 30% incidence of recurrent or secondary urological complications was also noted with correspondingly worsened prognosis. Early diagnosis followed by early aggressive surgical treatment is advocated.

Adolescent↗
PubMed1981

Congenital hepatic fibrosis and polycystic kidney disease; Role of porta-caval shunting and transplantation in three patients.

Three patients with congenital hepatic fibrosis and childhood-type autosomal recessive polycystic kidney disease are reported. Portal hypertension in two of the children was decompressed surgically by lieno-renal shunting, and the renal failure in two children has been successfully treated with renal transplantation. Prophylactic porta-caval shunting followed by renal transplantation is ideally suited to the sequence of events occurring clinically in the intermediate form of this condition, preventing complications of bleeding from oesophageal varices and hyperplenism. The relationship of congenital hepatic fibrosis with the various forms of polycystic kidney disease is discussed and classified.

Child, Preschool↗
PubMed1980

Short term suppression of hyperacute renal allograft rejection in presensitised dogs with prostacyclin.

One of the main features of hyperacute renal allograft rejection in presensitised dogs is platelet aggregation within the kidney as detected by light microscopy and renal arterio-venous platelet counts. Graft failure, as determined by reduction and ultimate cessation of renal blood flow and urine production, can be abrogated in the short term by prostacyclin which is the most potent inhibitor of platelet aggregation yet discovered. After 4 h of extracorporeal perfusion, by which time all control kidneys had been rejected, all prostacyclin treated kidneys had normal or above normal blood flow rates, were producing urine and were similar histologically (light microscopy) to 4-hour autografts.

Animals↗
PubMed1980

Experimental assessment of prostacyclin in the harvesting of kidneys for transplantation.

Prostacyclin is a potent vasodilator and the most potent inhibitor of platelet aggregation yet discovered. A possible role for prostacyclin in the harvesting of kidneys in experimental canine transplantation has been investigated. Prostacyclin gives a 52.6% increase in renal blood flow prenephrectomy despite inducing a 23% drop in mean arterial blood pressure, without changing the rate of urine output. There is an associated drop in renal vascular resistance of 50.2% and an increase in renal blood volume of 25%. The value of heparin treatment before donor nephrectomy is confirmed as it improves the flow of flushing solution through the kidney after nephrectomy and improves red blood cell washout from the kidney. Prostacyclin and heparin together improve these parameters further. After a warm ischemic period of 45 min, autotransplanted kidneys in dogs pretreated with prostacyclin had normal renal function within 48 hr as judged by the serum creatinine whereas untreated dogs had permanent impairment of function.

Animals↗
PubMed1980

10 years' experience with regular haemodialysis and renal transplantation.

75 children aged under 15 years have entered the regular haemodialysis/renal transplant programme at Guy's Hospital in the 10 years since its inception; 13 children have subsequently died. A combination of hospital and home haemodialysis and renal transplantation was used. 64 children received 80 renal allografts; 37 1st grafts were from live, related donors and 27 were from cadaver donors. The 5-year acturial patient survival for the whole group and for those who had transplants was 76%. Live donor graft survival was 65% at 3 years, and 55% at 5 years; 1st cadaver graft survival was 42% at 3 years. Results obtained during the last 6 years of the 10-year period showed an improvement with a live related donor graft survival rate of 71%, and a 1st cadaver graft survival rate of 47% at 3 years. Particular experience was gained with home haemodialysis and live, related donor transplantation. Despite growth, and psychosocial and rehabilitation problems, the overall results were encouraging, particularly for the 46 children who had successful transplants. These children grew better, had fewer psychosocial difficulties, and were rehabilitated more successfully into normal life than those on long-term dialysis. We conclude that dialysis and transplantation should be offered to all suitable children with terminal renal failure.

Adolescent↗
PubMed1980

Risks and benefits of bilateral nephrectomy: an analysis of 134 cases.

In a retrospective survey of 134 patients undergoing bilateral nephrectomy from 1969 to 1980 it was found that the commonest indications were hypertension (60%) and infection/reflux (22%). Operation in hypertensive dialysis patients was followed by a fall in blood pressure in 70% (SE 9%) at one and 3 months while normotensive patients having their kidneys out for other reasons had a 47% (SE 11%) incidence of hypertension at one month and 7 out of 10 were still hypertensive at 3 months. When operation was performed in transplanted patients, 7 of 10 hypertensives had a fall in pressure, one of 6 normotensive persons had an increase, an use of antihypertensive drugs fell from 13/16 to 4 of 16 patients. The mortality was 10.4% (SE 2.6%) overall, the mortality of operations which included an unplanned splenectomy was significantly higher. There were 34 other complications in 25 patients. Complications, but not deaths, were more frequent in operations performed in dialysis patients rather than at the same time as, or after, a transplant. Over 12 years the ratio of bilateral nephrectomy to renal transplant operations has fallen from 8% (1969-1971) to 18% (1978 to present). The decrease is partly due to a fall in the number of operations for hypertension in dialysis patients and may be related to the appearance of beta-blocker and new vasodilator drugs.

Blood Pressure↗
PubMed1979

Survival on home haemodialysis: its relationship with physical symptomatology, psychosocial background and psychiatric morbidity.

An entire group of 32 home dialysis patients from one hospital renal unit was assessed for psychiatric morbidity on a standardized interview of proven reliability. A rating of physical symptomatology and an enquiry into the childhood and psychosocial background were made at the same time. Psychiatric morbidity, physical symptomatology and a history of good relationships with both natural parents in childhood were inter-related. They were all related to survival on haemodialysis 3 1/2 years later. Survival was also associated with a coping spouse and full-time employment or housework by the patient. These findings are discussed in the light of current concepts of the psychosocial setting for physical illness.

Adaptation, Psychological↗
PubMed1979

Serial quantitative imaging with 99Tcm-DTPA in pediatric renal transplantation.

Three hundred and fifty-eight renal imaging studies with quantitation of renal perfusion were performed following injection of 99Tcm-DTPA in 22 children aged 6--15 years with renal transplants. In 58 of 62 scans performed at the onset of a rejection episode, renal perfusion was decreased. This was the only feature of rejection in 6 episodes, in 5 of which the patient was oliguric due to post-operative acute tubular necrosis. In 4 episodes perfusion fell, but antirejection treatment was not given as a repeat scan was normal. On 18 occasions the plasma creatinine concentration (Pc) rose, but the scan was unchanged; no treatment was given and repeat Pc was normal. Three patients had a ureteric obstruction and 2 patients a lymphocoele detected from the images. There was no morbidity. Sequential renal scintigraphy was valuable in the early diagnosis of rejection and in the avoidance of unnecessary therapy.

Adolescent↗