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Biomedical subjects

S Emre

Publications and source records attributed to S Emre.

At least 127 records · Page 7Linked to original sources
PubMed1994

Efficacy of captopril treatment in children with steroid-resistant nephrotic syndrome.

We studied the efficacy of captopril, an angiotensin-converting enzyme inhibitor in treating persistent moderate or severe proteinuria in children with various glomerular diseases other than minimal-change nephrotic syndrome. Captopril was administered for 3 months to 15 normotensive and nonazotemic or mildly azotemic patients (12 boys, 3 girls) in whom corticosteroid and cytotoxic treatment had failed to induce remission. Urinary protein excretion decreased from 2873.14 +/- 1937.50 (mean +/- s.e.m.) to 1684.71 +/- 1463.13 mg/day (P < 0.05). The reduction in proteinuria was not related to a significant fall in systemic blood pressure or a change in renal function. Serum albumin did not rise and side effects due to captopril were not observed. We concluded that, in the short term, captopril can be used safely and effectively for decreasing the proteinuria of nephrotic children unresponsive to conventional therapy.

Adolescent↗
PubMed1994

Liver transplantation at Mount Sinai Hospital.

Liver transplantation is an exciting field of research in which evolution in surgical techniques and immunosuppression and preservation have dramatic effects on overall patient survival. Our research at Mount Sinai is focused on preventing recurrent disease, optimizing the use of new immunosuppressive agents, and improving graft function. It is our hope that our research will eventually make it possible for us to overcome the supply-demand disparity and permit us to ask "When should this patient be transplanted?" rather than the very difficult question, "Who should be transplanted?"

Adult↗
PubMed1994

Neurologic complications of orthotopic liver transplantation.

Neurologic complications are frequent after liver transplantation and are the cause of significant morbidity and mortality. A substantial proportion of the neurologic complications encountered after transplant is iatrogenic--the consequence of the harsh therapeutic interventions required to maintain function of the transplanted liver. The preoperative condition of the patient is also a major determinant of the incidence and impact of neurologic complications, as is the occurrence of poor early graft function or of repeated rejection episodes that require augmented immunosuppression. By recognizing the early signs of drug-related neurotoxicity, it is often possible to preempt the development of more severe trouble. Careful perioperative fluid management, specifically related to sodium and glucose levels, may reduce the risk of CPM. As effective treatment modalities have emerged, an aggressive approach to the diagnosis of central nervous system infection has assumed increased importance. With persistent attention to the details of basic patient care as well as to the specific neurologic diagnosis, and with a commitment to intensive rehabilitation therapy, the large majority of patients who suffer neurologic complications after transplant can ultimately return to a productive life.

Cerebrovascular Disorders↗
PubMed1993

Liver resection under total vascular isolation. Variations on a theme.

Total vascular isolation (TVI) of the liver was employed during parenchymal transection in 16 patients undergoing hepatic resection for large tumors (mean diameter, 10.7 cm) located near hilar structures, hepatic veins, or the inferior vena cava (IVC). In 14 cases, TVI was achieved by clamping the suprahepatic and infrahepatic IVC and the porta hepatis, with or without aortic occlusion; in two, selective hepatic vein clamping was possible, obviating IVC occlusion. Procedures included standard and extended right and left lobectomies and caudate lobe resections. Concomitant resection and reconstruction of the portal vein (one case), IVC (one case), and bile duct (three cases) was required. Postoperative hepatic and renal failure did not occur. Mean intensive care unit and hospital stays were 2.8 +/- 1.9 and 12.5 +/- 5.2 days, respectively. There were two perioperative deaths. Total vascular isolation permits safe resection of large, critically located tumors that would otherwise present prohibitive operative risks.

Adolescent↗
PubMed1993

Prolonged preservation in University of Wisconsin solution associated with hepatic artery thrombosis after orthotopic liver transplantation.

Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually mandates retransplantation. Prolonged preservation with Eurocollins solution has been associated with HAT. We reviewed our experience with 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven patients were asymptomatic; four presented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injury. Technical problems accounted for 4 cases; in the remaining 8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One patient maintains normal graft function 3 years after LTx without intervention. Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. Overall graft and patient survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P < .05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can often be restored and retransplantation averted.

Adenosine↗
PubMed1991

An epidemiological approach to acute renal failure in children.

The records of 630 pediatric patients with acute renal failure were analysed. Of all patients admitted to the hospital during the same period, 5 per cent had acute renal failure. Newborns and infants constituted 79 per cent of the patients with ARF although this age group comprised only 44 per cent of the general pediatric patients. Acute gastroenteritis and septicaemia were the leading causes of ARF up to 8 years of age. Acute glomerulonephritis took the first place after 8 years of age. Mortality rate of our patients with acute renal failure was 28 per cent.

Acute Kidney Injury↗
PubMed1990

Beneficial effect of thalidomide and ciclosporin combination in heterotopic cardiac transplantation in rats.

The effect of thalidomide on the prevention of early rejection was studied in heterotopic cardiac transplants between ACI (donors) and Lewis (recipients) rats, in combination with subtherapeutic doses of ciclosporin. Although allografts treated solely with thalidomide (5 mg/kg/day intraperitoneally) survived longer than controls (9.4 +/- 2.7 and 6.3 +/- 0.6 days, respectively, p less than 0.001), the survival rates of animals treated with low dose ciclosporin (1.25 mg/kg/day intraperitoneally) plus thalidomide (1.25, 2.5 and 5 mg/kg/day) were significantly better at 21 days (70, 88.9 and 88.9%, respectively), compared to 55.6% in those treated with ciclosporin (1.25 mg/kg/day) alone. Graft survival rates at 90 days were not significantly different in the thalidomide-ciclosporin combination groups (60, 77.8 and 55.6%, respectively) compared to the ciclosporin group alone (55.6%). We conclude that thalidomide is effective in preventing early rejection of rat cardiac allograft when combined with subtherapeutic doses of ciclosporin, thus avoiding the dose-dependent side effects of ciclosporin in the early posttransplant period.

Animals↗