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Biomedical subjects

R J Stratta

Publications and source records attributed to R J Stratta.

At least 109 records · Page 6Linked to original sources
PubMed1995

Influence of end-stage renal disease and renal transplantation on serum prostate-specific antigen.

OBJECTIVE: To evaluate the effect of dialysis and kidney transplantation on serum prostate-specific antigen (PSA) levels, and to compare these results with those from normal age-matched controls. In addition, to evaluate the efficacy of PSA and digital rectal examination (DRE) for detection of prostate cancer in patients on dialysis and following kidney transplantation. PATIENTS AND METHODS: Between January 1990 and July 1993 all men in the transplant programme over the age of 40 years who were undergoing pre-transplant evaluation or post-transplant follow-up underwent a yearly DRE and PSA evaluation. Twelve patients were evaluated pre-transplant and 70 patients were evaluated post-transplant. A total of 136 PSA levels were obtained (1.7 per patient). Patients with suspicious findings underwent further evaluation with transrectal ultrasound and biopsies if indicated. Controls were patients without known prostate cancer who had been evaluated in a Prostate Cancer Awareness Clinic. RESULTS: The average PSA values in the study groups were unaffected by either dialysis or transplantation when compared with age-matched controls. In addition, 12 patients who had been on dialysis at the time of their initial evaluation and who subsequently underwent transplantation did not show any difference in their average PSA values pre- or post-transplant. Three patients (4%) were found to have prostate cancer and two underwent radical retropubic prostatectomy. They are free of disease 24 and 36 months post-operatively and neither has experienced any decline in renal function. Immunosuppression was not modified. CONCLUSION: Transplantation and dialytic therapy do not appear to affect clinical serum PSA levels. PSA and DRE appear to be equally valid for detection of prostate cancer in patients on dialysis and post-transplant when compared with the general population. Finally, radical prostatectomy appears to be a safe and feasible treatment option in this group of patients.

Adult↗
PubMed1995

Pancreas transplantation for diabetes mellitus.

Vascularized pancreas transplantation has assumed an increasing role in the treatment of diabetes mellitus. Through 1993, over 5500 pancreas transplants have been performed worldwide, with over 80% being combined pancreas-kidney transplants. Overall one-year patient survival exceeds 90% and graft survival (complete insulin independence) exceeds 70%. Although successful pancreas transplantation achieves euglycemia and complete insulin independence, this occurs at the expense of hyperinsulinemia and chronic immunosuppression. The net result of these changes on diabetic complications in the long term remains to be determined. In the short term, improvement in the quality of life and possible prevention of further morbidity associated with diabetes makes pancreas transplantation an important therapeutic option, particularly when combined with a kidney transplant, in appropriately selected diabetic patients.

Blood Glucose↗
PubMed1995

Evaluation of the pharmacokinetic interaction between cimetidine or famotidine and cyclosporine in healthy men.

OBJECTIVE: To investigate the potential interaction between cimetidine or famotidine and cyclosporine in healthy men. DESIGN: All subjects received oral cyclosporine at baseline, after the first week of 1 histamine2 (H2)-blocker, and a third time after a 1-week washout plus 1 week of the second H2-blocker. Blood samples were collected just before each dose of cyclosporine and for up to 36 hours afterward for pharmacokinetic analysis. SETTING: A college of pharmacy in a university teaching hospital. PARTICIPANTS: The study population consisted of 8 healthy men at least 19 years of age. MAIN OUTCOME MEASURES: Cyclosporine concentrations in whole blood were measured using a polyclonal fluorescence polarization immunoassay. Cyclosporine pharmacokinetic parameters during each of the 3 treatment periods were compared. RESULTS: The average times to maximum cyclosporine concentrations were similar between baseline (3.2 h), cimetidine (2.9 h), and famotidine (3.6 h) dosing periods. There were no significant differences in area under the curve, half-life, or maximum concentration during the 3 dosing periods. CONCLUSIONS: Neither cimetidine or famotidine produced a significant change in the pharmacokinetics of single-dose oral cyclosporine in healthy men.

Adult↗
PubMed1995

Pancreas transplantation.

Vascularized pancreas transplantation has assumed an increasing role in the treatment of diabetes mellitus. Through 1994, over 6000 pancreas transplants had been performed worldwide, with over 80% being combined pancreas-kidney transplants. Overall 1-year patient survival exceeds 90% and graft survival (complete insulin independence) exceeds 70%. Although successful pancreas transplantation achieves euglycemia and complete insulin independence, this occurs at the expense of hyperinsulinemia and chronic immunosuppression. The net effect of these changes on diabetic complications in the long term remains to be determined. In the short term, improvement in the quality of life and possible prevention of further morbidity associated with diabetes makes pancreas transplantation an important therapeutic option, particularly when combined with a kidney transplant, in appropriately selected diabetic patients.

Diabetes Mellitus, Type 1↗
PubMed1995

Rejection with duodenal rupture after solitary pancreas transplantation: an unusual cause of severe hematuria.

A common urologic complication after pancreas transplantation with bladder drainage is hematuria. However, hematuria is usually mild and self-limiting and rarely requires open surgical intervention. We report an unusual case of refractory hematuria that began 17 days after solitary pancreas transplantation due to severe rejection. The patient developed severe duodenal segment swelling with mucosal rupture that eventually required operative therapy. This case is illustrative of the diagnosis and management of gross hematuria after pancreas transplantation and demonstrates the limitations of cystoscopic techniques. This unusual complication must be considered in the differential diagnosis of refractory hematuria with pancreas allograft dysfunction and may represent a problem unique to solitary pancreas transplantation until better immunosuppressive strategies are available.

Drainage↗
PubMed1994

Pravastatin reduces serum cholesterol and low density lipoprotein concentrations following pancreas transplantation.

Hyperlipidemia is a significant risk factor for atherosclerotic vascular disease. We have shown previously that pancreas transplantation (PTX) improves but does not normalize lipids in most PTX recipients. We studied whether pravastatin was effective in treating 10 patients with elevated low density lipoprotein (LDL)-cholesterol (LDL-C) following PTX. Seven men and 3 women were studied. Six received combined kidney-pancreas transplantations, while 4 received PTX alone. Age at time of PTX was 37.2 +/- 2.2 years (mean +/- SEM), and 4 had established coronary artery disease before PTX. Mean cholesterol (C), LDL-C, triglycerides (TG), and high density lipoprotein (HDL)-cholesterol (HDL-C) were 236 +/- 12, 142 +/- 6, 222 +/- 50, and 49 +/- 4 mg/dl before PTX. The LDL to HDL ratio was 3.0 +/- 0.3. After PTX, excluding the first 45 days, mean C, LDL-C, and HDL-C increased to 278 +/- 10, 178 +/- 7, and 63 +/- 6 mg/dl (all P < or = 0.05), respectively. TG, LDL to HDL ratio, and weight were unchanged. Pravastatin (11.7 +/- 0.8 mg/day, mean +/- SEM) was initiated 250 +/- 53 days after PTX. During therapy, C and LDL-C decreased on average to 231 +/- 10 and 134 +/- 8 mg/dl, respectively (both P < 0.01), while HDL did not change. The decreases in C and LDL-C were unexplained by a decrease in weight, cyclosporine dose or concentration, or increase in serum creatinine. However, prednisone dose decreased over the same interval, so a contribution from this variable cannot be excluded. No evidence of toxicity was identified during therapy. This is one of the first reports demonstrating that pravastatin is a safe and effective treatment for elevated C and LDL-C in patients following PTX. However, pravastatin did not increase HDL or decrease TG, as observed in the nontransplantation setting. Whether pravastatin or any hypolipidemia therapy can prevent cardiovascular events or mortality following PTX remains to be established.

Adult↗