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Biomedical subjects

R A Straffon

Publications and source records attributed to R A Straffon.

At least 91 records · Page 5Linked to original sources
PubMed1977

Immunotherapy of disseminated renal cell carcinoma with transfer factor.

Ten patients with disseminated renal cell carcinoma have been treated with transfer factor as an immunostimulant. In 5 patients with metastatic disease evident at the time of initial diagnosis treatment involved removal of the primary tumor followed by transfer factor therapy. Of these patients 3 had a temporary stabilization of metastatic disease. Three patients with recurrent metastatic disease after previous nephrectomy were treated, 2 of whom showed a temporary stabilization of metastatic disease. There were 2 additional patients without clinically evident metastases but at a high risk for recurrent disease who were treated and remain free of disease. We used 5 immunologic parameters to evaluate the clinical effects of transfer factor. No objective clinical regression was noted in any patient treated with measurable disease.

Adenocarcinoma↗
PubMed1977

Renal revascularization in patients with severe atherosclerosis of the abdominal aorta or a previous operation on the abdominal aorta.

Renal revascularization has been performed in six patients in whom severe atherosclerosis or previous operative procedures on the abdominal aorta precluded the performance of a standard aortorenal bypass graft. Splenorenal anastomoses were performed in three patients, superior mesenterorenal anastomosis in one patient, long saphenous vein iliorenal anastomosis in one patient, and renal autotransplantation in one patient. Successful renal revascularization with preservation of renal function was accomplished in all patients. The natural history of severe atherosclerotic renovascular disease has demonstrated the relatively frequent occurrence of arterial thrombosis and renal failure in patients with solitary kidneys. Occasionally, the presence of severe aortic disease precludes the use of standard aortorenal bypass grafting. Fortunately, as reported herein, alternate methods of revascularization are available whereby renovascular hypertension can be corrected and renal function preserved, with minimal operative risk.

Adult↗
PubMed1977

Splenorenal bypass in the treatment of renal artery stenosis.

A retrospective study is presented of our experience from 1962 to 1976 with the splenorenal bypass procedure in the treatment of 32 patients with renovascular hypertension. The over-all results were 53 per cent of the patients cured, 28 per cent improved and 19 per cent failures. Improved results were noted when the splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better in men than in women and poor results were obtained in children. Intraoperative and early postoperative complications were minimal. There were 2 postoperative deaths, for a hospital mortality rate of 6.3 per cent. Late complications were limited to splenic artery graft stenoses, which developed in 3 patients (9.4 per cent). When performed in relation to specific clinical and operative indications the splenorenal bypass is believed to represent an excellent means to achieve safe and effective renal revascularization.

Adolescent↗
PubMed1977

Splenorenal bypass in the treatment of stenosis of the renal artery.

The over-all results obtained with splenorenal bypass in the treatment of 32 patients with renovascular hypertension were 17 patients cured, nine patients improved and six failures. Improved results were noted when splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better for men than for women; however, poor results were obtained in children. Intraoperative and early postoperative complications were minimal, and there were two postoperative deaths. Late complications were limited to stenoses of the splenic artery graft which developed in three patients. When performed in relation to specific clinical and operative indications, splenorenal bypass represents an excellent means of achieving safe and effective renal revascularization.

Adolescent↗
PubMed1976

In vitro assessment of cell-mediated immunity in patients with renal cell carcinoma.

We evaluated 25 patients with renal cell carcinoma for cell-mediated immunity using the microtoxicity assay. Normal controls frequently exhibited significant cell inhibition. The mean percentage cell inhibition in patients after nephrectomy was significantly higher than in patients before nephrectomy and significantly higher than normal male subjects. No other correlation was found with respect to the stage of the disease. The incidence of significant autoblocking activity was noted more commonly in patients after nephrectomy than in patients before nephrectomy.

Adenocarcinoma↗
PubMed1976

Renal autotransplantation: current perspectives.

Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included severe ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

Female↗
PubMed1976

Gram-hegative bacillemia.

Members of the Klebsiella-Enterobacter-Serratia group now appear to be the most common cuase of gram-negative bacillemia, followed in order of frequency by E. coli, Bacteroides, polymicrobic infection, Pseudomonas aeruginosa, and miscellaneous pathogens. However, E coli continues to be the organism most frequently responsilbe for bacteremia arising from the urinary tract. Although the urinary tract remains the most common portal of entry for gram-negative bacillemia, a wide variety of extraurinary lesions have assumed increased importance in the pathogenesis of this condition. There is marked variability in the clinical course and outcome of gram-negative bacillemia. Grade of underlying disease and grade of illness cuased by infection are major determinants of fatal outcome. When the patient with gram-negative bacillemia has severe illness due to infection, prompt and decisive action is necessary to prevent death. Antimicrobiol drugs are administered on the basis of a presumptive etiologic diagnosis after appropriate smears and cultures are obtained, but before the causal organism is definitively identified or its in vitro susceptibility is determined. The presumptive etiologic diagnosis is based upon knowledge of the anatomic location of the infection, the circujstances involved in its development, and certain clinical clues. Knowledge of the antimicrobial drugs most likely to be effective against the suspected pathogen(s) will provide a rational basis for selection of antimicrobial agents until the results of definitive microbiologic studies are available. Using this approach, the mortality of gram-negative bacillemia arising from the urinary tract has been reduced markedly from the mortality reported in earlier years.

Adult↗
PubMed1975

Microangiopathic hemolytic anemia in renal allotransplantation. Repart of a successfully treated case and review of the literature.

The development of microangiopathic hemolytic anemia after renal transplantation in a 17 year old white boy is reported, and the literature is reviewed. In this patient microangiopathic hemolytic anemia developed 6 weeks after renal transplantation during a second episode of rejection. Light, fluorescence and electron microscopy demonstrated the renal vascular lesion associated with this syndrome. In contrast to the other four previously reported cases of microangiopathic hemolytic anemia associated with renal allotransplantation, this patient had complete resolution of the microangiopathic hemolytic anemia with heparin therapy and improved allograft function, presumably with diminution of the vascular lesion. He survived a complicated early period after renal transplantation and has shown no recurrence of microangiopathic hemolytic anemia in the 18 months since transplantation. Special red blood cell and fibrinogen studies are discussed.

Adolescent↗
PubMed1975

Testis tumors: review of 125 cases at the Cleveland Clinic.

One hundred twenty-five cases of testicular tumor are reviewed. The prognostic significance of clinical features, certain laboratory test results, and histologic type are evaluated, and treatment results are presented. The most important prognostic clinical feature is the presence or absence of clinically evident metastases. The urinary gonadotropin levels are useful prognostically, but the intravenous pyelogram and lymphangiogram are statistically unreliable. The presence of tumor in retroperitoneal lymph nodes influenced survival only in the patients with embryonal carcinoma. Tumor type influenced survival more than any other pathologic factor. Vascular invasion, local extension, and Leydig cell hyperplasia did not correlate with tumor behavior in germinal neoplasms. Patients with clinical Stage IA or IB teratocarcinoma had an 85 per cent survival rate with a wide variety of treatment.

Adult↗
PubMed1975

Bilateral testicular tumors of germ cell origin.

Four cases of primary testicular tumor of germ cell origin are reported. Three cases were bilateral, while the remaining case involved a unilateral tumor in a non-twin brother of 1 patient with bilateral tumors. Because of the increased likelihood of a second primary tumor developing in a patient who has had a malignant germinal cell tumor and because the changes may be subtle, localized to the testis and occur after a tumor-free interval of many years, careful examination of the contralateral testis and long-term followup are indicated even when systemic chemotherapy for malignancy has been used. This is the seventh time familial occurrence of testis tumors in non-twin brothers has been reported but the first time that one of the brothers had bilateral tumors.

Adolescent↗
PubMed1975

Transcervical thymectomy in renal transplant recipients: surgical complications and possible effect on long-term allograft survival.

Between January 1963 and December 1967, 59 renal transplant recipients underwent thymectomy with or without splenectomy as an adjuvant to standard immunosuppression. All thymectomies were performed transcervically. By internal comparison long-term renal allograft survival was better in recipients who had thymectomy, when compared to those who did not. There were no significant surgical complications associated with transcervical thymectomy and the completeness of thymectomy was judged satisfactory. The role of thymectomy as an adjuvant operation in human renal transplant recipients should be re-examined.

Cadaver↗