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Biomedical subjects

R A Ulan

Publications and source records attributed to R A Ulan.

At least 37 records · Page 2Linked to original sources
PubMed1981

Chronic plasma exchange therapy in SLE nephritis.

Eight patients who met the clinical, immunological and renal morphologic criteria for systemic lupus erythematosus with diffuse proliferative nephritis were plasma exchanged on a monthly basis for a total of 119 months. Renal function, episodes of disease activity, hospitalizations, frequency of immunological abnormalities, and monthly quantity of steroid and azathioprine therapy were compared with their course up to one year prior to the onset of the plasma exchange program. The changes noted in these parameters indicate that chronic plasma exchange therapy is safe, may be beneficial and requires controlled prospective study to determine the role in the treatment of patients with systemic lupus erythematosus and diffuse proliferative glomerulonephritis.

Azathioprine↗
PubMed1978

Beneficial effect of operation-day blood-transfusions on human renal-allograft survival.

In 56 patients 1-year renal-graft survival was significantly better (71% vs 40%) in those who had received blood before operation, confirming previous observations. In addition, transfusion on the day of operation proved to have been beneficial, both in those previously transfused (82% vs 64%) and in those never previously transfused (71% vs 28%). Irrespective of pretransplant transfusion, 1-year graft survival was significantly better (79% vs 44%) in those transfused on the day of operation.

Blood Transfusion↗
PubMed1977

Anemia in hemodialysis patients.

The association between anemia and chronic renal failure has been recognized since the early 19th century. With the introduction of regular dialysis treatment, an understanding of all aspects of this uremic complication has become of great importance, including an appreciation of the hazards of multiple blood transfusions. This analysis of hemoglobin levels and transfusion requirements in 84 dialysis patients focuses specific attention on hemolytic mechanisms, blood loss, and the effect of bilateral nephrectomy on erythropoiesis. Because no replacement for renal erythropoietin is available, particular attention must be paid to less important, but partially correctable factors that contribute to anemia. Blood transfusion requirements can then be reduced to a minimum, together with the risks of hypersplenism, hepatitis, and sensitization of the patient to alloantigens.

Adolescent↗
PubMed1976

Anti-donor immune responses in prediction of transplant rejection.

We assessed various immune responses against donor tissue to determine their value in the diagnosis and prediction of clinical rejection episodes. Twenty-six consecutive clinical renal-transplant recipients were examined. Cell-mediated lymphocytotoxicity preceded and accompanied 41 of 45 rejection episodes (P less than 0.001). Complement-dependent antibody was present in 12 of 15 rejections (P less than 0.002)--four not accompanied by, and eight in association with, cell-mediated lymphocytotoxicity. Mixed lymphocyte reactivity or nonreactivity and inhibition by autologous serum occurred equally often in rejection and quiescence. Lymphocyte-dependent antibody occurred during both rejection episodes and quiescent phases, with a greater frequency during quiescence (P = 0.05). Cell-mediated lymphocytotoxicity was the best predictor of rejection (P less than 0.05). Cell-mediated lymphocytotoxicity was the best predictor of rejection (P less than 0.001), and was more easily suppressed by standard immunosuppressive therapy, than complement-dependent antibody. If specific cell-mediated lymphocytotoxicity, with or without antibody, recurred after rejection therapy, the graft underwent further rejection.

Antigen-Antibody Reactions↗
PubMed1976

Spontaneous rupture of the renal pelvis: complication of renal homotransplantation.

The first reported case of rupture of the renal pelvis associated with transplantation is presented. The obstruction was in the ureteral tunnel of the hypertrophic bladder. The cause of the weakness in the pelvic wall could not be determined. Differential diagnosis was acute rejection and lymphocele. Excretory urography was diagnostic. Treatment included revision of the ureteroneocystostomy with repair of the defect and internal stenting. Postoperative morbidity was minimal and satisfactory graft function was maintained.

Adult↗
PubMed1976

Transplant monitoring: patterns of the immune response.

Immune responses, specific to the stored donor tissue, were measured in 26 recipients over 4,000 days. CML positive crossmatches were associated with accelerated rejections (three cases). LDA positive crossmatches resulted in primary non-functioning kidneys (three cases). Post-transplantation. CML (16 hour inculation) was associated with rejection (p equals 0.001), highly predictive of rejection (p equals 0.001), and when positive after rejection treatment, was associated with a failure to respond (p equals 0.005 - 0.01). 51Cr-CDA was also associated with rejection (p equals 0.002). Recovery of these immunologic participants from the explanted kidney substantiated that they were important effector mechanisms in vivo.

Antibodies↗
PubMed1975

Lymphocyte-dependent antibody and renal graft rejection.

A patient with preformed cytotoxic lymphocyte-dependent antibody (L.D.A.) against the specific renal transplant donor rapidly rejected the grafted kidney. The characteristics of rejection were not those of hyperacute rejection due to cytotoxic complement-dependent antibody or of acute rejection is attributed to the cytotoxic activity of L.D.A. The avoidance of transplants based on positive crossmatches by the L.D.A. test or at least the carrying out of the L.D.A. crossmatch is advised.

Adult↗
PubMed1973

City-wide screening for urinary abnormalities in schoolgirls.

Screening for urinary tract infection was carried out in 23,427 schoolgirls, aged 5 to 14 years, using Uricult and, for hematuria, glycosuria and proteinuria using Hema-combistix. Cultures of 10(5) colonies per ml. or more on two occasions were obtained in 2.3% and a positive culture was confirmed by the family physician using standard culture techniques in 82.7% of cases, giving an overall incidence of infection of 1.9%. Fifty-eight percent of these children had no previous history of any urinary tract symptoms. Of the infected group 9.5% had pyelonephritic scarring, 58.7% chronic cystitis and 58.7% urethral stenosis. Two additional cases had unilateral ureteropelvic junction obstruction with hydronephrosis. Reflux occurred in 26.6% of those investigated by voiding cystogram. In 58% of cases the urinary tract infection was not accompanied by significant proteinuria, hematuria or pyuria.Proteinuria was detected on two occasions in 1.6% of the children and confirmed by the family physician in 33% of cases, giving an overall incidence of 0.5%. In this group 9.2% had evidence of pyelonephritic scarring without a positive urine culture.Hematuria was detected on two occasions in 0.6% of the children and was confirmed by the family physician in 53%, giving an overall incidence of 0.3%. Only one case with pyelonephritic scarring was seen in this group.Of the 25 cases with pyelonephritic changes only six had been previously diagnosed radiologically.Four previously unrecognized diabetics were also detected.

Adolescent↗
PubMed1973

Effects of chronic hemodialysis on thyroid function in chronic renal failure.

Thyroid function was studied in 54 patients undergoing chronic hemodialysis. Serum thyroxine, triiodothyronine and free thyroxine and the free thyroxine index were significantly lower than normal. The levels of both serum thyroxine and the free thyroxine index tended to fall progressively the longer the patients were on hemodialysis. These findings, in association with low serum TSH levels and normal increase in radioactive iodine uptake by the thyroid after TSH injection, suggest that a defect in pituitary secretion of TSH may be responsible. Although some patients experienced symptomatic improvement after treatment with L-thyroxine the efficacy of this form of treatment in patients on chronic hemodialysis has not yet been established.

Adolescent↗
PubMed1970

Experiences with high doses of furosemide in renal disease and resistant edematous states.

Six cases of edema, three due to the nephrotic syndrome, one to congestive heart failure and two to chronic renal failure, are reported in which furosemide was administered in oral doses higher than those usually prescribed (up to 720 mg. a day), in order to obtain a satisfactory diuresis. In one case of severe prerenal failure secondary to cardiogenic shock and in one case of acute tubular necrosis secondary to hypotension at the time of operation, intravenous doses up to 990 and 1400 mg. per day respectively were able to reverse the oliguria. In eight additional patients who were on chronic hemodialysis, furosemide was administered to the amount of 1000 mg. per day orally in divided doses for two weeks, and produced a moderate diuretic response.The use of high doses of furosemide in edema and renal failure resistant to the usual therapeutic measures appears to be safe and effective.

Adult↗