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Biomedical subjects

R S Filo

Publications and source records attributed to R S Filo.

At least 37 records · Page 2Linked to original sources
PubMed1996

Metabolic problems in recipients of liver transplants.

We analyzed the metabolic problems in recipients of liver transplants. Immunosuppression consisted of cyclosporine, steroids and azathioprine. With a mean follow up of 3.5 yr, 37% of 71 recipients were rendered permanently diabetic and hyperlipidemic. Recipients who developed posttransplant diabetes had higher cholesterol levels and proteinuria, but decreased creatinine clearance. Transplant recipients who developed posttransplant hyperlipidemia had greater proteinuria, but their sugars and creatinine clearance were comparable to those who did not have hyperlipidemia. The most significant factor responsible for these metabolic complications was the total dosage of prednisone and cyclosporine. There was no effect of risk antigens on the development of diabetes.

Adult↗
PubMed1996

The arteriovenous fistula for hemodialysis access: gold standard or archaic relic?

A five year retrospective review was undertaken to evaluate the patency rates of arteriovenous fistulae (AVF) in patients with end stage renal disease. From July 1989 through June 1994, 150 fistulae were created in the wrists of 144 patients. Thirty-four percent of the patients had diabetes mellitus. Patient death or irreparable fistulae were considered end points in the study. Patency rates were calculated by the Kaplan-Meier Actuarial Analysis. An analysis to assess the impact of the demographic characteristics, underlying renal disease, and effect of revisions on patency rates was calculated. The results demonstrate a high initial failure rate (less than 1 month) of 13 per cent in the entire cohort undergoing fistulae replacement. The 1 and 5-year patency rates were 56 per cent and 30 per cent, respectively. Diabetics had a significantly lower patency rate at 1 and 5 years (42% and 18%) respectively. Others, who had poor patency rates, include patients 70 years old or greater (40% patency at one year). The results suggest that the AVF should not be the first choice of access in elderly diabetics and that these patients would be better served with other modes of access, such as synthetic conduits or permanent indwelling venous catheters.

Adult↗
PubMed1996

Zinc deficiency and its repletion following liver transplantation in humans.

Zinc deficiency is common in patients with end-stage liver disease but its prevalence and resolution in liver transplant recipients has not been reported. We hypothesized that with normalization of liver function after transplant, zinc levels should rapidly return to normal, obviating the need for oral supplementation. Serum zinc levels were obtained as part of routine laboratory studies just prior to liver transplantation in 34 patients. Of these, 22 had at least one additional zinc level obtained post-transplant. The charts of these 34 patients were retrospectively reviewed for pre- and post-transplant zinc, albumin, protein, and cholesterol levels, prothrombin times, use of oral zinc supplementation, and patient demographics including age, gender, cause of liver failure, UNOS status at the time of transplant, and the use of a pre-transplant trans-jugular intrahepatic portosystemic shunt (TIPS). Post-transplant, the patients received standard enteral formula for nutrition. The overall zinc level for the group was 37.4 +/- 9.0 micrograms/dl (mean +/- s.d., normal = 60-150 micrograms/dl). Thirty-two of the 34 patients (94%) had a zinc level in the subnormal range. There were no differences in zinc levels between patients with alcoholic and non-alcoholic liver failure, males versus females, UNOS status (low = status 1 and 2, high = 3 and 4), pre-transplant use of TIPS nor correlation between age and zinc level. All 22 patients who had a post-transplant zinc level demonstrated an increase from 40.1 +/- 9.7 micrograms/dl to 68.5 +/- 14.1 micrograms/dl (p < and = 0.0001, paired t-test). Our findings indicate that zinc deficiency, generally profound, should be assumed to be present in every patient with end-stage liver disease awaiting transplant. During the waiting period oral supplementation with zinc should be provided. The degree of deficiency is not effected by cause of liver failure, UNOS status, or the presence of TIPS. Following transplantation, zinc levels rapidly recover, obviating the need for checking levels and oral supplementation.

Administration, Oral↗
PubMed1995

Tube jejunostomy in liver transplant recipients.

BACKGROUND: Nutritional support after liver transplantation most often uses intravenous hyperalimentation followed by nasoduodenal tubes until adequate intake is achieved. Because of difficulties with nasoduodenal tubes, we place jejunostomy tubes (j-tube) at the time of the transplantation, allowing immediate postoperative enteral nutrition. This review analyzes the complications of this procedure in transplant recipients. METHODS: J-tubes were placed in 108 of 119 adults who underwent liver transplantation between October 1989 and June 6, 1994. These patients were retrospectively reviewed for the type and frequency of j-tube-related complications. J-tube feeds with a semielemental formula were started within 24 to 48 hours after transplantation. RESULTS: Eighteen complications occurred in 16 patients. Six were mechanical obstructions of the j-tube because of kinking by the fascia. Six exploratory laparotomies were required, two each for infection, small bowel obstruction, or catheter displacement. Four other infections were treated by local incision and drainage or percutaneous drainage. One tube required surgical removal in the operating room. CONCLUSIONS: Tube jejunostomies can be safely placed at the time of liver transplantation with a low risk of serious complications. We recommend the routine use of j-tubes in patients receiving a liver transplant for the immediate posttransplantation institution of enteral nutrition.

Abscess↗
PubMed1995

Nutrition support following liver transplantation: comparison of jejunal versus parenteral routes.

Liver failure patients are chronically malnourished at the time of transplant. We have used jejunostomy tubes (j-tube) placed at the time of liver transplantation for immediate postoperative enteral nutrition. We compared the effectiveness of this means of nutrition to total parenteral nutrition (TPN). Sixty-three adult patients fed enterally (ENT) with a semi-elemental diet were retrospectively compared to 21 adult controls alimented with TPN, both beginning after liver transplantation. Data collected included: day to initiation of nutrition, day of achieving goal nutrition, day of removal of nasogastric tube, day of initiation of oral nutrition, day of achieving oral nutritional goal, and serum albumin, cholesterol, SGOT, SGPT, GGT, and bilirubin. Intestinal complications of diarrhea, ileus, and perforation were analyzed. Statistical analyses used an unpaired t-test for continuous data, and Chi square for categorical data. Caloric requirements, percentage ideal body weight, age, and initial cholesterol and albumin were equal. Fifty-four of the ENT patients were fed only by j-tube; 9 ENT patients also required TPN. ENT patients started on nutrition sooner (3 +/- 1.7 vs. 1.7 +/- 0.9 days, p = 0.001), reached goal oral nutrition sooner (19.5 +/- 11 days vs. 38.6 +/- 24.6 days, p = 0.0061, Mann-Whitney U test), and had a lower frequency of prolonged postoperative ileus (8.3%, vs. 33%, p = 0.009) than TPN patients. ENT patients had a greater frequency of diarrhea than TPN controls (73% vs. 25%, p < 0.001). This diarrhea was self-limited, lasting 3 to 5 days, and responded to anti-motility drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ultrasound-guided pediatric liver transplant biopsy using a spring-propelled cutting needle (biopsy gun).

Biopsy is the best way to diagnose allograft rejection, the most common complication following liver transplantation. The authors reviewed 99 consecutive ultrasound-guided cutting needle biopsies in 19 infants and children. Conscious sedation was used with 95 biopsies. General anesthesia was used with four biopsies, all in patients undergoing percutaneous biliary procedures at the same time. Ninety-eight biopsies were diagnostic. Only one major complication occurred: biloma. Ultrasound-guided cutting needle biopsy of pediatric liver transplant patients can be performed safely and efficaciously.

Biopsy, Needle↗
PubMed1994

Comparison of Minnesota antilymphoblast globulin and Upjohn antithymocyte globulin for induction immunosuppression of human renal allografts.

BACKGROUND: An analysis of heterologous polyclonal antisera in first renal transplants was continued after replacement of Minnesota antilymphoblast globulin (MALG) with antithymocyte globulin (ATGAM), testing the hypothesis that these are functionally equivalent drugs. METHODS: Sequential induction immunosuppression used MALG (20 mg/kg/day, n = 33) or ATGAM (15 mg/kg/day, n = 14), corticosteroids, azathioprine and cyclosporine. White blood cell, platelet, and T-cell subsets were measured. Percent of patients with and time to first rejection were determined. Anti-horse antibody was measured by enzyme-linked immunosorbent assay. Minimum follow-up after transplantation was 1 year. RESULTS: Human leukocyte antigen mismatch, peak and current panel reactive antibodies, age, gender, percent cadaver donors and diabetic recipients were similar. Depletion of CD2, CD3, CD4, and CD8 T-cell subsets and platelet and white blood cells was similar. Early renal function was better with MALG than with ATGAM (p = 0.005, ANOVA), but by 2 weeks the groups were similar. The percent of patients receiving MALG versus patients receiving ATGAM with cytomegalovirus (28 versus 50), anti-horse antibodies (50 versus 62), and rejection (58 versus 50) and the median day of first rejection (48 versus 47) were similar. Three grafts were lost. CONCLUSIONS: MALG and ATGAM are equally effective in eliminating T cells and preventing and delaying the onset of renal allograft rejection.

Adult↗
PubMed1993

Acute lobar nephronia of renal transplant allograft.

Acute lobar nephronia (acute focal bacterial nephritis) has recently been recognized as an infectious process of the kidney. It is a radiologic diagnosis characterized as a nonliquifiable inflammatory renal mass associated with signs and symptoms of bacterial pyelonephritis. We present the successful management of a renal allograft recipient who had radiologic evidence of acute lobar nephronia within the graft six weeks after placement of an internalized ureteral stent.

Acute Disease↗
PubMed1993

Prospective study of magnetic resonance imaging and SPECT bone scans in renal allograft recipients: evidence for a self-limited subclinical abnormality of the hip.

We recently reported that typical abnormalities of avascular necrosis (AVN) in magnetic resonance images (MRI) of the hips of asymptomatic renal transplant recipients whose plain radiographs are normal may improve spontaneously and even disappear completely. We present the results of serial bone scans, most of which were performed with single-photon emission computed tomography obtained over periods as long as 24 mo after transplantation in 72 of these patients. Three paired imaging studies (i.e., MR and bone scan performed within 30 days of each other) were available for each of these patients. In three patients, both the MR images and the bone scans showed changes consistent with bilateral AVN within 4 mo after transplantation. All three patients developed hip pain which was bilateral in two and unilateral in one. Two patients (three hips) required surgical intervention at which time AVN was found on pathologic examination of all three hips. None of the remaining 69 patients developed hip pain during the study. However, in nine patients whose MR studies were consistently normal, at least one bone scan was abnormal (13 hips). The presence of AVN was pathologically confirmed in each of the hips subjected to surgery. Where the imaging findings were identical to those in the asymptomatic patients as well as those in whom the imaging abnormality regressed, we suggest that the subclinical imaging abnormalities represent mild AVN, which is reversible in some cases. Since the process was identified in 10 hips by MRI and in 13 hips by bone scan, both studies are needed to detect subclinical AVN. This may be important if treatment of subclinical disease is clearly shown to prevent progression to symptomatic AVN.

Adolescent↗
PubMed1992

An evaluation of the cyclosporine parent-compound-specific whole blood TDx assay.

The new Abbott TDx cyclosporine parent-compound-specific fluorescence polarization immunoassay (TDxP) was evaluated and compared to the cyclosporine-and-metabolites-specific TDx (TDxT) and a cyclosporine parent-compound-specific radioimmunoassay (RIA) (Sandimmun-Kit, INCSTAR). The TDxP assay was linear within the range of 31 to 1600 ng/ml (r = 0.985) with a lower limit of detection of less than 31 ng/ml. The TDxP had excellent intra- and interassay reproducibility (CV = 1.2 to 4.5) that was significantly better than that of the radioimmunoassay. 230 whole blood samples obtained from 65 kidney, 19 liver, and 8 pancreas transplant recipients were analyzed with each of the three assay methods. TDxP had a much stronger correlation with the RIA than did TDxT (r = 0.95 versus 0.83). The difference between the correlations was greatest for the liver and pancreas recipients. The mean ratio of the cyclosporine level determined by TDxP to RIA was 1.0 versus 2.4 for TDxT to RIA. The new TDxP assay provides results equal to a parent-compound-specific RIA but with the added advantages of decreased sample turn-around time and improved intra- and interassay coefficients of variation.

Cyclosporine↗
PubMed1991

Safety and efficacy of a spring-propelled 18-gauge needle for US-guided liver biopsy.

Two hundred three liver biopsies were performed on 114 patients suspected of having diffuse liver disease. More than one-half of the biopsies (107 of 203) were performed in liver allografts. Biopsies were performed under ultrasound (US) guidance with use of a spring-propelled 18-gauge cutting needle. Half of the biopsies were performed in patients with abnormal coagulation studies, decreased platelet counts, or both. The left lobe was chosen for biopsy over the right lobe in the majority of cases (112 vs 91). Sufficient tissue for diagnosis was obtained in 197 cases (97%). Four complications (2%) occurred that required treatment: one vasovagal reaction and three episodes of bleeding. All bleeding complications occurred in patients with coagulopathy. There was no difference in safety or efficacy between biopsies of native and transplanted livers; similarly, there was no difference in safety or efficacy between biopsies of the left and right lobe. Pain occurred less frequently with biopsies of the left lobe. US-guided biopsy with a spring-propelled 18-gauge needle is safe and efficacious in the diagnosis of diffuse liver disease.

Biopsy, Needle↗