Low-dose cyclosporine and antithymocyte globulin improve renal allograft survival in highly sensitized patients.
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Biomedical subjects
Publications and source records attributed to S Snowden.
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Renal transplantation for diabetic nephropathy prolongs survival and the return of fertility makes pregnancy possible. We describe a successful pregnancy in a 38-year-old diabetic renal transplant recipient despite blindness, gangrenous toes, cardiac impairment, and both sensory and autonomic neuropathy. Renal function remained stable throughout the pregnancy which was complicated by supine hypertension, postural hypotension and increasing proteinuria. Fetal distress and increasing proteinuria precipitated delivery by Caesarean section at 29 weeks of a female infant weighting 1.1 kg. Following delivery, hypertension improved, gangrene resolved, proteinuria decreased, and renal function remained stable. Pregnancy in long-standing diabetic patients with renal transplants, although hazardous, may be successful yet the maternal morbidity and mortality makes them inadvisable.
Methods for the isolation of Clostridium botulinum from honey samples are described. A total of 9 of 90 honey samples were positive for C. botulinum; 6 of the positive samples had been fed to babies who developed infant botulism.
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Excess fluid in the lung can be quantified in chronic dialysis patients by using the double indicator dilution technique. The lung capillaries show an increased permeability to sodium when these patents develop pulmonary oedema.
An expert system for neonatal intensive care (ESNIC) for the management of mechanically ventilated neonates on intermittent positive pressure ventilation (IPPV) has been developed. The system uses the rule based expert system shell XiPlus (Inference Inc.) and runs on an IBM-compatible PC. The rules have been derived from the knowledge of two consultant paediatricians. The inputs to the system are the current ventilator settings, blood gas tensions and pH. The output of the system is a set of suggested new ventilator settings. The aim of the system is to provide ventilator settings which will maintain the arterial blood gas tensions within an acceptable range, reducing pressures whenever feasible and increasing pressures only as a last resort. In addition, ESNIC provides data archiving, graphical displays of all parameters, ventilation and discharge summaries. With the 63 patients in the study ESNIC was consulted for 76% of all ventilator adjustments and the advice given was accepted on 83% of these occasions.
A neural network has been developed to manage ventilated neonates. The network inputs are the current ventilator settings (inspiratory and expiratory times, peak inspiratory and positive end-expiratory pressures and inspired oxygen concentration), partial pressures of arterial blood gases and pH. Two hidden layers comprising 50 nodes each are employed in the network, which utilizes a standard back-propagation algorithm. The network provides the new ventilator settings as five outputs that represent the most appropriate ventilator settings projected to maintain blood gases within an acceptable range. The network has been trained using a data set derived from a rule-based expert system developed for the same purpose. Performances of both systems have been compared. The neural network is capable of learning and adapting to the individual patient's response, which in principle offers significant advantages over the rule-based system.
Renal failure is an important cause of morbidity and mortality in diabetic patients, who account for up to 25 per cent of new patients entering renal replacement therapy. Between 1980 and 1989, 651 patients with renal failure were treated at King's College Hospital, of whom 177 (27 per cent) had diabetes. Of these 177 patients 148 had diabetic nephropathy (65 non-insulin-dependent), while the rest had other renal diseases. Of the non-insulin-dependent diabetics, 45 per cent (29 of 65) were Asian or Afro-Caribbean compared to only 12 per cent (10/83) of the insulin-dependent diabetics. Ninety-two patients (62 per cent) have received a renal transplant with actuarial patient survival of 82 per cent at 1 year and 61 per cent at 4 years. Both patient and graft survival have been improved by the introduction of cyclosporin A. Continuous ambulatory peritoneal dialysis is the main form of dialysis and has allowed increasing numbers of patients to be dialysed, especially older individuals with non-insulin-dependent diabetes. Rehabilitation is best in those with functioning transplants: 21 patients (19 with functioning grafts) have survived for longer than 5 years. Diabetic complications before and after renal replacement therapy are described. Cardiovascular disease is especially common and may limit the success of renal replacement therapy.