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Biomedical subjects

A Eid

Publications and source records attributed to A Eid.

At least 73 records · Page 4Linked to original sources
PubMed1996

Successful renal transplantation from two donors with methanol intoxication.

Two patients with acute methanol intoxication are reported, one with acute renal failure. Both were declared brain-dead and kidneys were harvested at 80 and 130 hr after hospital admission. All four kidneys were transplanted and subsequently functioned well. In both donors who had received ethanol treatment, thrombocytopenia was present. The reluctance to use kidneys from such donors and from donors with acute renal failure before harvesting is discussed. Waiting lists for renal transplantation are growing and there is a world-wide shortage of cadaver organs. We were recently surprised to find reluctance to consider two local patients dying from methanol intoxication as suitable organ donors, and we report the outcome of four kidneys transplanted from these donors. We were unable to find any similar cases reported in the English literature.

Adult↗
PubMed1996

Acute perigraft seroma simulating anastomotic bleeding of a PTFE graft applied as an arteriovenous shunt for hemodialysis.

Perigraft seroma is an uncommonly reported complication of polytetrafluoroethylene grafts applied as an arteriovenous shunt for hemodialysis. It usually presents as a soft tissue swelling around the arterial end of the graft and occurs within 30 days after implantation. An unusual presentation of perigraft seroma occurring immediately after implantation is reported herein.

Adult↗
PubMed1996

Reversal of fulminant-hepatitis-associated hypoglycaemia at the anhepatic stage during liver transplantation.

Hypoglycaemia is a known complication of fulminant hepatic failure. Massive destruction of liver tissue, along with hyperinsulinism and defective glucose storage in extrahepatic organs are some of the mechanisms contributing to the hypoglycaemia. We describe here a case of reversal of fulminant-hepatitis-associated hypoglycaemia at the anhepatic stage of liver transplantation. It is suggested that non-insulin hypoglycaemic factors secreted by the damaged liver may be responsible for this complication.

Child, Preschool↗
PubMed1996

Conservative treatment of a traumatic tear of the left hepatic duct: case report.

Injury to the extra-hepatic biliary system in blunt abdominal trauma is rare and difficult to diagnose. In adults, all reported cases were treated surgically. We report a case of a traumatic tear of the left hepatic duct that was treated successfully by endoscopic retrograde cholangiopancreatography and stenting.

Abdominal Injuries↗
PubMed1996

Differential diagnoses of bone marrow granuloma.

The finding of a granuloma on a bone marrow biopsy is not common. The etiologic spectrum encompasses a wide variety of disorders. We present the case of a young woman with a bone marrow granuloma and discuss the differential diagnosis, emphasizing the most common causes. This disorder can be associated with serious diseases.

Adult↗
PubMed1995

Hepatitis C-associated cryoglobulinemia after liver transplantation.

Mixed cryoglobulinemia is well known to be associated with hepatitis C virus (HCV) infection. We report two cases in which cryoglobulinemia appeared or became grossly exacerbated after orthotopic liver transplantation. In both cases, there was co-appearance of cryoglobulinemia with the reinfection of the grafted liver with HCV. It is postulated that the cryoglobulinemia might be related to secondary HCV infection in these patients.

Adult↗
PubMed1995

p53 expression in patients with cirrhosis with and without hepatocellular carcinoma.

BACKGROUND: Mutated p53 acts as a dominant oncogene, whereas the wild type (wt) p53 gene product suppresses cell growth. Abnormalities in the p53 gene are reported in more than 50% of malignant tumors. Recently, an allelic loss of chromosome 17p, where the p53 gene is located, was found to be more frequent in hepatocellular carcinoma (HCC) cell lines and human tumors. In addition, in half of the cases of HCC from endemic areas for hepatitis B virus and aflatoxin, a hot spot point mutation at codon 249 was detected, as previously reported. Missense mutations in p53, mdm-2 complex formation, and other unknown mechanisms may lead to stabilization of the gene product, thus rendering it detectable by immunohistochemistry. METHODS: To assess the relationship between p53 status at a premalignant stage and in HCC, the authors studied the immunohistologic expression of p53 in HCC and in the adjacent nontumorous resected liver tissue, using monoclonal antibody to wt and mutated p53. RESULTS: Twelve of the 14 patients with liver tumors had HCC. Of the 12 patients with HCC and underlying cirrhosis, 8 (67%) had increased p53 expression in HCC cells. Eight of the 12 patients with p53-positive HCC cells had p53 overexpression in the nontumorous hepatocytes within regenerative nodules adjacent to HCC tissue. Three of 21 cirrhotic livers without a detectable tumor had increased p53 expression in the regenerative nodules. None of the 12 patients with chronic active hepatitis without cirrhosis or the 13 with a normal liver histology had increased p53 expression. CONCLUSION: p53 overexpression in some cirrhotic livers and in nontumorous livers of patients with HCC may indicate a normal p53 gene response to cellular stress or, alternatively, to an abnormally or mutated p53 gene, and could occur before the development of HCC.

Adolescent↗
PubMed1995

[Kidney transplantation from living, related donors].

Kidney transplantation is the best treatment for selected end-stage renal patients. The shortage of cadaveric organs for transplantation has led to the development of a protocol for kidney transplantation from living, related donors. In the past 20 years, 58 living, related kidney transplantations were done in our department. Mean patient age was 30 +/- 10 (SD) years and mean donor age was 36 +/- 10. There were 34 transplantations between brothers or sisters, 15 from parent to child, 4 between cousins, 4 between spouses and 1 from son to father. Mean follow-up time was 4 years. 1 and 5 years after transplantation, patient survival rates were 85% and 80%, respectively, graft survival rates were 85% and 75%. The introduction of cyclosporin-A as an immunosuppressive agent in 1985 led to improvement in graft survival rates: from 77% and 51% after 1 and 5 years, respectively, to 88% and 84%. No correlation between HLA match or patient's age and graft survival rates was found. We conclude that living, related donor transplantation is effective for suitable cases of end-stage renal disease. It should be recommended to patients who have a healthy, interested family member.

Adult↗
PubMed1995

Acquired hepatocerebral degeneration in a liver transplant recipient.

A 47-year-old-man lapsed into coma 12 h after liver transplantation, and remained comatose until death 38 days later. Prior to transplantation he had repeated episodes of hepatic encephalopathy, but no fixed neurological signs. Autopsy revealed typical features of acquired hepatocerebral degeneration with diffuse but patchy pseudolaminar cortical necrosis, variable amount of neuronal loss in the cerebral cortex, basal ganglia and other areas, and proliferation of Alzheimer type II glia. In addition, there was central pontine and extensive extrapontine myelinolysis involving the lateral and medical geniculate bodies, the thalamus, internal capsule, fornix, mamillothalamic tract, white matter bundles in the caudate and pallidum, the oculomotor nuclei and the foliar white matter of the cerebellum. The distinction between myelinolytic lesions and lesions due to hepatocerebral degeneration was not always clear. Although neurological complications and brain lesions are rather common after liver transplantation, there have been no reports of acquired hepatocerebral degeneration in liver transplant recipients. Our data lend support to the idea that a single prolonged comatose episode, due to hepatic dysfunction, may induce permanent parenchymal brain damage.

Autopsy↗
PubMed1995

Disseminated Nocardia transvalensis infection resembling pulmonary infarction in a liver transplant recipient.

Infections due to Nocardia transvalensis are extremely rare: only four disseminated infections with this pathogen have been reported, three of which ended fatally. This is the first report of a liver transplant recipient with Nocardia transvalensis infection. The patient had disseminated infection with pulmonary involvement, which presented as pulmonary infarction. Despite a ten-day delay in the administration of correct therapy, he responded rapidly to trimethoprim-sulfamethoxazole. The pitfalls of differentiating nocardial infection from pulmonary thromboembolism in solid organ transplant recipients and the diagnostic considerations unique to liver transplant recipients are discussed.

Bacteremia↗
PubMed1995

Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma.

BACKGROUND: Anastomotic leak of the pancreaticojejunostomy is a major cause of morbidity and mortality following pancreaticoduodenectomy. Reports have described a large variety of techniques for performing this anastomosis and managing the pancreatic stump. In an attempt to obviate the pancreaticojejunostomy, we prospectively studied the technique of ligating the pancreatic duct and using external drains to create a temporary controlled pancreaticocutaneous fistula. PATIENTS AND METHODS: Thirty-five consecutive patients who were to undergo pancreaticoduodenectomy for periampullary carcinoma were prospectively randomized to one of two groups: pancreaticojejunostomy (PJ) (n = 18) or controlled pancreaticocutaneous fistula (CPF) (n = 17). The groups were well matched for age, sex, coexisting medical illnesses, type of tumor, and preoperative condition. Except for the management of the pancreatic remnant, all patients in both groups underwent an identical procedure. Major morbidity, length of hospitalization, duration of the controlled pancreatic fistula, and mortality were analyzed over a mean follow-up interval of 26 months (range 5 months to 7.5 years). RESULTS: The CPF group experienced lower overall operative morbidity rates than the PJ group (24% versus 56%, P < 0.01). Two patients (11%) in the PJ group and none in the CPF group died (P = NS). Half the morbidity in the PJ group and both mortalities were related to anastomotic leak. The CPF and PJ groups left the hospital after mean stays of 26.4 and 42.2 days respectively (< 0.01). CONCLUSIONS: Compared to pancreaticojejunal anastomosis, creation of a temporary controlled pancreaticocutaneous fistula in patients who undergo pancreaticoduodenectomy for periampullary malignancy has no appreciable risk. It is associated with reduced morbidity and shorter length of hospitalization.

Adult↗
PubMed1995

Hepatitis C virus viremia in SCID-->BNX mouse chimera.

Chimpanzees are currently the only nonhuman animal model for reproducible propagation of hepatitis C virus (HCV). A chimeric mouse model was used for the induction of hepatitis C viremia, using BNX (beige/nude/X-linked immunodeficient) mice preconditioned by total body irradiation and reconstituted with SCID mouse bone marrow cells. HCV-infected liver fragments from patients with HCV RNA-positive sera were transplanted under the kidney capsule of the chimeric mice. HCV-specific RNA sequences were detected by reverse transcriptase nested polymerase chain reaction (RT-PCR) in serum of approximately 50% of grafted animals. In addition, normal liver specimens were incubated with HCV serum and transplanted into chimeric mice, leading to viremia in approximately 25% of animals. Sequential histologic evaluation of the liver implants, from day 2 to week 14 after transplantation, revealed loss of lobular architecture within the implants. However, viremia persisted for 10-50 days after transplantation. These results offer a new HCV model.

Animals↗
PubMed1995

Long-term prevention of recurrent hepatitis B virus after liver transplantation.

Hepatitis B virus (HBV) reinfection is a major threat to HBV-infected patients undergoing orthotopic liver transplantation. Eleven HBsAg-positive patients with end-stage liver disease underwent liver transplantation. All were treated with high doses of anti-HBs antibodies, initiated first during the anhepatic stage of the operation and continued every 2-8 weeks thereafter according to anti-HBs levels in the serum. Attempts were made to keep anti-HBs levels above 400 IU/ml. Patients were followed for 8-42 months and only one of them had any evidence for recurrence of HBV infection 40 months post-transplantation. We conclude that continuous administration of anti-HBs and maintenance of high levels of anti-HBs in the serum prevent recurrence of HBV infection.

Adolescent↗
PubMed1994

Systemic chimerism in sex-mismatched liver transplant recipients detected by fluorescence in situ hybridization.

Fluorescent in situ hybridization (FISH) is a reliable, rapid, sensitive, and quantitative method for detection of residual host cells following sex-mismatched bone marrow transplantation. Recently, donor-derived long-term multilineage hematopoiesis was detected in a sex-mismatched liver transplant recipient. We therefore assessed chimeric status in 12 patients (F 9, M3), mean age 42.5 years (range 16-57), for a median period of 18 months (range 7-32) following sex-mismatched liver transplantation. Peripheral blood hematolymphoid cells were hybridized with Y- or X-chromosome fluorescently labeled specific probes, and the donor-typed hematopoietic cells were enumerated. In two F recipients 4-5% male hematolymphoid cells were detected in the peripheral blood at 15 and 22 months after sex-mismatched liver transplantation, respectively. These two patients with systemic chimerism suffered from primary biliary cirrhosis and fulminant Wilson's disease before transplantation. One of them had evidence of graft rejection only once during the posttransplant course and the other had no episode of graft rejection. Two other female patients who were found to have approximately 2% male hematolymphoid cells, which is considered to be in the false-positive range, also had no signs of graft rejection during the posttransplant follow-up period. Among the remaining eight patients, in whom systemic chimerism was undetectable, there was at least one episode of acute cellular rejection during the posttransplant period. In summary, the FISH technique enables us to detect systemic chimerism following sex-mismatched liver allografts. Inasmuch as balanced systemic chimerism after organ transplantation is of major importance for self tolerance, our findings may enable us to treat patients after liver transplantation without the need for immunosuppression.

Adult↗