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Biomedical subjects

R S Fennell

Publications and source records attributed to R S Fennell.

At least 73 records · Page 4Linked to original sources
PubMed1980

The role of various risk factors in living related donor renal transplant success.

Assessment of living related donor (LRD) survival statistics offers the opportunity to gauge the effects of recipient characteristics without the perturbations of viability, function, and antigen sharing that are inherent in cadaveric organ grafting. From January 1, 1969 to January 1, 1979, 167 LRD grafts were performed. Crude patient survival at one year is 92% and 84% at five years. Graft function at one year is 79%, and at five years it is 64%. One year patient survival has steadily improved: 1969-73: 83%, 1973-75: 91%, 1975-79: 98%. Graft survival improved during the first two periods and has since remained unchanged. HLA identical grafts showed the expected advantage compared with single haplotype grafts (93 vs 74%). Recipient age was without effect until 50 years, all younger subgroups having one-year patient survival of 92-95%, while those older than 50 had a one-year survival of 60%. Juvenile diabetes was associated with a one-year patient survival of 85% and graft survival of 74%. Glomerulonephritis did not affect early graft survival statistics, but there was a greater frequency of graft loss after 2.5 years, with function at five years of 51 versus 68% for recipients with all other diagnoses. Cadaveric graft statistics vary with recipient race when adjusted to exclude older patients and diabetics, white recipient one-year graft survival 74%, black 38%. No meaningful difference exists among LRD recipients as to graft function, but there is a trend toward improved black patient survival. This suggests that there is not an inherent difference in immune response to genetically similar grafts, but that the disparate results with racially mixed donor-recipient combinations rests with other factors.

Adolescent↗
PubMed1980

Urinary tract infections in children: effect of short course antibiotic therapy on recurrence rate in children with previous infections.

Eighty-five girls, ages 3-16, with a past history of recurrent urinary tract infections were treated for 10 days with either trimethoprim/sulfamethoxazole, ampicillin or cephalexin. Patients with normal roentgenograms as well as those with reflux and cortical scarring were included. In the 12 weeks following completion of treatment, a significantly lower recurrence rate was noted in children who received trimethoprim/sulfamethoxazole. There was no difference in the recurrence rate whether or not radiographic abnormalities were present. No serious side effects were noted with any drug regimen.

Adolescent↗
PubMed1980

Clinical significance of the presence of cryoglobulins in patients with glomerulopathies not associated with systemic disease.

Serial serum samples from 102 children with glomerulopathies not associated with systemic diseases and from 23 normal controls were examined for the presence of cryoglobulins. Sera from controls, from patients with glomerulopathies thought to be mediated by immune complexes, and from those with non-immunologically mediated glomerulopathies demonstrated similar incidence of cryoglobulins. There was no correlation between cryoglobulin concentration or composition and the glomerular immunohistologic findings. Furthermore, persistence of cryoglobulinemia could not be correlated with progression of renal disease. Although cryoglobulins may contain immune complexes, determination of serum cryoglobulin concentration appears to be of little value in the diagnosis of immune complex mediated renal disease, nor in the assessment of disease activity or monitoring therapy in patients with glomerulopathies unassociated with systemic disease.

Cryoglobulins↗
PubMed1978

Pattern of response to prednisone in idiopathic, minimal lesion nephrotic syndrome as a criterion in selecting patients for cyclophosphamide therapy.

Twenty-three children with idiopathic, relapsing minimal lesion nephrotic syndrome were divided according to their pattern of response to prednisone: (1) steroid dependent, if the relapse occurred while the dosage of prednisone was being decreased; and (2) frequent relapser, if the relapse occurred at variable periods of time (one week to two months) after discontinuing prednisone therapy. All patients received cyclophosphamide for eight weeks in a single daily dose of 2 mg/kg, in order to prolong the length of the remission. The percentage of patients who continued in remission at the end of the first year and thereafter was greater in the frequent relapser group (P = 0.05). This study suggests that the pattern of response to prednisone may be another criterion for the selection of patients who will benefit from cyclophosphamide therapy.

Child↗
PubMed1978

Indomethacin in the treatment of idiopathic minimal lesion nephrotic syndrome.

Ten patients with idiopathic minimal lesion nephrotic syndrome were treated with indomethacin. Nine patients received the drug for five weeks and one patient for nine weeks. Indomethacin was administered in a dose of 1 mg/kg/day during the first week and 2 mg/kg/day, thereafter. At the end of the study, nine patients remained edematous and all had a urinary protein excretion greater than 50 mg/kg/day, within the nephrotic range. Indomethacin did not change the course of the disease and its use in the treatment of IMLNS is not advised.

Adolescent↗
PubMed1977

A pathophysiologic basis for the diagnosis and treatment of the renal hypertensions.

Hypertension is a major medical problem with significant short- and long-term sequelae. Previous investigators have reported childhood hypertension to be secondary and when sexondary, renal. However, recent studies have shown primary (essential) hypertension to be more prevalent than secondary. Children with blood pressures at the 95th percentile for age deserve comprehensive evaluation and follow-up. Those with systemic evidence of side-effects will require therapy. Modern therapy should be based on pathophysiologic principles which include an understanding of volume-dependent and renin-dependent hypertension. The stepwise approach to therapy will produce the maximal therapeutic benefit.

Aldosterone↗
PubMed1976

Home culturing program for children with recurrent bacteriuria.

One hundred forty-one children were selected from a clinic for children with recurrent bacteriuria to participate in a home culturing program. The parent was taught to employ a semiquantitative method to test the child's urine for bacteria. The degree and persistence of bacteriuria as detected by the parent strongly correlated with results obtained in the clinic, although there was a significant incidence of false-positive results as detected by the parent. Home culturing proved to be an inexpensive, reliable technique for following up children with recurrent urinary tract infections.

Bacteria↗
PubMed1976

Nephritis in systemic lupus erythematosus in children.

Twenty-five patients, aged six to 18 years, with lupus nephritis, followed for two to 103 months (median 22 months), have been classified according to renal histology into groups with diffuse proliferative glomerulonephritis (18), focal proliferative nephritis (2), and membranous nephropathy (5). Correlations have been made among specific histologic groups, clinical findings, renal function studies, urinary findings, and response to therapy. In sequential renal biopsies, lesions progressed in most patients with diffuse proliferative and membranous changes; however, chronic renal failure occurred in only one patient and the five-year survival rate (60.9%) is better than previously reported in pediatric patients.

Adolescent↗
PubMed1975

Cephalexin in the management of bacteriuria.

This report evaluates the effectiveness of cephalexin in the treatment of bacteriuria in 93 children. Cephalexin therapy eradicated sensitive organisms in 97 per cent of the cases regardless of recurrence, structural abnormality, or status of renal function. Nevertheless, recurrences with a new, resistant organism occurred significantly in certain patients, expecially those with major anatomic abnormalities, during a six-week follow-up period. The incidence of drug reactions was low.

Adolescent↗
PubMedDate not supplied

Transplantation in children. A longitudinal assessment of mothers' stress, coping, and perceptions of family functioning.

This study examined the parenting stress, coping resources, and family functioning among 27 mothers of children undergoing bone marrow, liver, kidney, and heart transplantation. The mothers completed a comprehensive battery of psychological instruments at the pretransplant stage and at 1- and 6-month posttransplant stages. Increased parenting stress, financial strain, caregiver burden, and family stress were reported following transplantation and persisted for several months. The mothers reported using coping strategies characterized by attempts to maintain family integration and to understand the child's medical situation. Development and evaluation of intervention programs to enhance parents' ability to cope with stress and maintain family stability are warranted.

Adaptation, Psychological↗
PubMedDate not supplied

Effects of changing therapy on cognition of children in renal failure.

To assess the effects of changing therapy for treatment of chronic renal failure on cognitive function, 56 renal failure children were matched to healthy control subjects. Neuropsychological tests were administered every 6 months for up to four testing sessions. The renal subjects had reduced function on medical management, were being dialyzed or had transplants. Those renal patients who changed treatment groups over the course of the study were classified as good or bad change depending upon medical criteria. Those patients who remained in the same treatment group were classified as no change. Differences in performance between last and first sessions were analyzed for each pair. Renal subjects exhibited less improvement on memory function than controls but greater improvement on choice reaction time and vigilance. Renal subjects making a good change did not exhibit significantly greater improvement than other groups on neuropsychological tests.

Adolescent↗
PubMedDate not supplied

The use of the kidney biopsy to predict allograft loss in a pediatric transplant population.

Forty-seven biopsy specimens of renal allografts from pediatric transplant recipients were evaluated by light microscopy using a 117 item survey of histopathologic changes. The presence and distribution of immunofluorescent staining were also evaluated. Histopathologic findings associated with irreversible allograft rejection were determined using statistical methods and then correlated with one another. The effect on allograft survival when several of these features were present on the same specimen was assessed. Glomerular, arteriolar and small artery changes were associated with irreversible rejection. When several of these histologic findings occurred on the same biopsy specimen the allograft was always lost. Interstitial and tubular changes generally not predictive of rejection and immunofluorescent staining was not associated with graft loss.

Adolescent↗
PubMedDate not supplied

The effects of various modes of therapy for end stage renal disease on cognitive performance in a pediatric population--a preliminary report.

Visuomotor, visuoanalytic, vigilance, and verbal memory functions of sixty-eight children and adolescents with renal disease were assessed. All patients with renal disease either had successful kidney transplants, were receiving dialysis therapy by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD), or had advanced renal failure not yet requiring dialysis. The patients showed a deficit in visuomotor skills related to attentional and visuoanalytic function. The transplant recipients appeared to be the least affected. Children undergoing dialysis therapy by CAPD or who had received a successful kidney transplant showed better performance on vigilance and memory tasks than the patients who received therapy by hemodialysis. There were correlations in all groups between performance on the memory tasks and performance on the vigilance tasks suggesting that the memory dysfunction in uremia is related in part to an attentional deficit.

Adolescent↗