Urgent surgery for ulcerative colitis: early colectomy in 132 patients.
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Adolescent↗
Biomedical subjects
A Flatmark
Publications and source records attributed to A Flatmark.
Influence of HLA matching in cadaveric renal transplantation: experience from one Scandiatransplant center.
The outcome of 461 prospectively HLA-A, -B and -C typed and 193 prospectively HLA-DR typed cadaveric kidney transplants in one center was followed. We found a significant beneficial effect on graft survival both of HLA-A and -B as well as of HLA-DR matching between donor and recipient, while no effects of HLA-C compatibility could be detected. The effect of HLA-DR matching was clearly more pronounced than that of HLA-A and -B matching, and a possible influence of matching for HLA-A and -B could only be seen in the HLA-DR mismatched combinations. Pretransplant blood transfusions were associated with an increased graft survival only in patients receiving HLA-DR mismatched transplants. We conclude that major emphasis should be laid on obtaining HLA-DR compatibility in clinical renal transplantation.
Blood Grouping and Crossmatching↗
Elective surgery for ulcerative colitis: colectomy in 158 patients.
Chronic ulcerative colitis was treated by elective colectomy in 158 patients. Proctocolectomy and ileostomy was performed in 140 patients and colectomy and ileorectal anastomosis (CIRA) in 18 patients. The operative mortality was 2.5%, and postoperative complications, mostly infections, occurred in 38%. Within a 2-year postoperative period another 1.9% of the patients died, and late complications occurred in 18%. Colorectal carcinoma was present at the time of colectomy in 5.1% and developed some years later in another two patients primarily operated on with CIRA. Half of the cancer patients died of malignancy. Most extracolic complications, present in 25% of patients before colectomy, regressed or disappeared after operation. Half of the patients operated on with CIRA needed to have their rectum removed within a few years because of cancer or proctitis, and few of the rest had lasting relief of symptoms.
Adolescent↗
Prednisolone in renal transplantation: a comparison between two dosage regimes.
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Adolescent↗
A controlled trial with AHLG Behring: lack of effect on cadaveric renal graft survival.
To assess the effect of Pressimmune (AHLG-Behring), in high doses, (30 mg/kg/bdw for 21 days) as an adjuvant immunosuppressive drug a prospective, randomized controlled trial was carried out in 60 recipients of first time cadaveric renal allografts. There was no improvement in graft survival in the treatment group, and there was no steroid sparing. In the patients receiving Pressimmune, the T-lymphocyte count fell to about half pretransplant levels, and the first rejection episode occurred later than in the control patients, but eventually equally many kidneys were lost from rejection.
Adolescent↗
Important of HLA matching in cadaveric renal transplantation. A prospective one-center study.
Matching for the HLA-A and -B antigens was found to have a significant influence on the outcome of 459 cadaveric first transplants, with a difference in graft survival of 21% at one year between best and worst matched grafts (p = 0.003). Matching for the HLA-DR antigens seemed to have an even greater influence. In a material of 226 prospectively typed transplants, a difference in graft survival of 35% at one year between best and worst matched transplants was found (p = 0.03). In the HLA-DR matched transplants there was no significant effect of matching for the HLA-A and -B antigens. An effect of pre-transplant blood transfusions was possibly seen only in DR mismatched transplants, but the effect was not statistically significant. The results indicate that major emphasis should be placed on obtaining HLA-DR compatibility in renal transplantation.
Adult↗
Influence of HLA-A, B, C, D, and DR matching in renal transplantation.
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Blood Transfusion↗
Importance of HLA-DR matching in cadaveric renal transplantation: a prospective one-center study of 170 transplants.
To investigate the influence of matching for HLA-DR antigens in renal transplantation, we assessed the outcome of 170 prospectively HLA-typed cadaveric kidney transplantations performed since 1977 in one center. We found a beneficial effect on graft survival of HLA-DR compatibility between donor and recipient (P < 0.05). A possible effect of matching for the HLA-A and B antigens could be seen only in the HLA-DR-mismatched combinations. Pretransplantation blood transfusions were associated with increased graft survival only in patients receiving HLA-DR mismatched transplants (P < 0.02). We conclude that major emphasis should be placed on obtaining HLA-DR compatibility renal transplantation. (N Engl J Med. 1980; 303:850-4).
Blood Transfusion↗
Goodpasture's syndrome. A report of seven patients including long-term follow-up of three who received a kidney transplant.
Seven patients with Goodpasture's syndrome are presented. Bilateral nephrectomy was performed in five patients, and postnephrectomy pulmonary hemorrhage occurred in three. Three nephrectomized patients underwent a successful renal transplant, renal transplantation being postponed until circulating antiglomerular basement membrane antibody had disappeared. The argument is made that pretransplant bilateral nephrectomy in patients with Goodpasture's syndrome is indicated.
Adolescent↗
Effect of blood transfusions on renal transplantation: study of 191 consecutive first transplants from living related donors.
One hundred ninety-one consecutive living related transplants performed from 1969 to the end of 1978 have been analyzed for the effect of pretransplant blood transfusions. Superior graft survival was observed in transfused patients transplanted with a one HLA haplotype-disparate kidney, whereas no effect of blood transfusions could be observed on the survival of HLA-identical transplants. The frequency of first rejection episodes was significantly reduced in transfused compared to nontransfused one haplotype-mismatched transplants, while no influence of blood transfusions was seen in patients with HLA-identical transplants. The survival of patients was, however, not influenced by previous transfusions. Pretransplant hemodialysis improved graft survival and patient survival; the difference was, however, only significant at 2 years in the one haplotype-mismatched group. When analyzed separately, both blood transfusions and hemodialysis had a beneficial effect on graft survival in one haplotype-mismatched transplants.
Adult↗
The effect of blood transfusions on renal transplantation. Studies of 395 patients registered for transplantation with a first cadaveric kidney.
Three-hundred-and-ninety-five candidates registered for a first cadaveric renal transplant have been analyzed for the effect of pre-graft blood transfusions. Of these, 348 patients were transplanted, 45 died prior to transplantation and two patients have not yet received a transplant. Slightly less than half of the transplanted patients had been transfused, and those received five or more transfusions demonstrated a superior graft survival. This was pronounced in all HLA incompatible transplants who had received five or more transfusions. In patients who received less than five transfusions, only one-two HLA antigen incompatible transplants demonstrated increased graft survival. The frequency of rejection episodes was significantly decreased in all transfused compared to non-transfused groups. Among the patients dying while waiting for a transplant, the majority had been transfused, and a significantly higher proportion of them had cytotoxic HLA antibodies, compared to those who were transplanted.
Adult↗
Long-term endocrine function of duct-ligated pancreas isotransplants in rats.
Duct-ligated pancreas transplants were used to study the long-term B cell function after total acinar atrophy. Vascularized whole-organ pancreas transplantation was performed in 47 streptozotocin-diabetic inbred Wistar rats. Of 31 recipients which survived the first week, 30 were permanently cured of the diabetic state with restoration of normal blood glucose levels within 24 h. Metabolic and morphologic studies were performed for up to 16 months after transplantation, i.e. for most of the normal life span of the rats. The recipients of duct-ligated, heterotopic transplants demonstrated plasma insulin (IRI) values slightly above normal. Median blood glucose values were significantly lower than in the normal controls. Basal and stimulated IRI as well as glucose tolerance tests failed to reveal any reduction in the endocrine capacity of the transplants as compared to nondiabetic control. Light-microscopic examinations of grafts showed total acinar atrophy after the first weeks of duct occlusion. No apparent reduction of islet tissue was noted. The results demonstrate that total occlusion of the exocrine ductal system does not impair B cell function of the rat pancreas. The duct-ligated pancreatic transplant permanently reverses induced diabetes when pancreatitis and immunologic reactions are avoided.
Animals↗
Oxygen consumption during phagocytosis by leucocytes in renal transplant patients.
Oxygen consumption during phagocytosis by leucocytes in renal transplant patients and in normal persons was studied. A significant decrease in oxygen consumption was observed in patients receiving immunosuppressive treatment. This may partly explain the increased susceptibility to infections in these patients.
Adolescent↗
Endocrine tumors of the pancreas.
A review of 33 patients operated on between 1951 and 1978 for endocrine tumors of the pancreas is presented. The series consists of 25 patients with hyperinsulinism, 6 with the Zollinger-Ellison syndrome, and 2 with the WDHA syndrome. Clinical features and diagnostic problems are discussed. A noticeable feature is that the average time lapse between onset of symptoms and final diagnosis in insulinoma patients has not been significantly reduced during the years covered by this review. This is in spite of the progress made in testing procedures and laboratory methods designed to diagnose hyperinsulinism. Resection of the tumor has been the preferred treatment in insulinoma patients, of whom 22 are still alive. Insulinomas were associated with other endocrinopathies in 3 cases. Patients with the Zollinger-Ellison syndrome had raised serum gastrin levels and increased basal acid output. Four patients are still alive. Two patients had other endocrinopathies. Both patients with the WDHA syndrome died shortly after the operation. One had biochemical evidence of multiple endocrinopathies.
Achlorhydria↗
Surgical correction of renovascular hypertension in patients with one kidney. A report of 9 cases.
Nine patients with severe renovascular hypertension underwent surgical revascularisation of their single kidney. The blood pressure normalized postoperatively in seven patients. Four of them no longer required antihypertensive medication and three required only moderate doses. One patient died of myocardial infarction three days after the operation. The ninth patient also became normotensive, but preoperative renal failure progressed and she died of cardiac failure while on haemodialysis 16 months postoperatively. The results suggest that single-kidney renovascular hypertension is more amenable to surgery than is unilateral disease in patients with two kidneys, because the hypertensive effect of the other kidney is lacking.
Adult↗
HLA-DR typing and B cell cross-match tests in cadaveric renal transplantation.
Prospective HLA-DR typing and B cell cross-match tests were performed in 177 cadaveric transplants using a modified NIH technique, 24 selected HLA-DR typing sera and B cells separated from peripheral blood in recipients and from spleen in donors. Actuarial graft survival after one year was 60% in HLA-DR compatible transplants and 30% and 18% in transplants mis-matched for 1 and 2 HLA-DR antigens. The favorable prognostic influence of HLA-DR compatibility was observed both among HLA-A, -B compatible and incompatible transplants. Sharing of HLA-DR antigen(s) between donor and recipient was also prognostically beneficial. Standard cross-match tests were negative in all transplants. B cell cross-match tests were positive in 17 cases, and one of these transplants was very acutely rejected. Actuarial graft survival after three months was 35% in B cell cross-match positive grafts versus 53% in negative ones.
B-Lymphocytes↗
The effect of 3-4 HLA-A and -B antigen mis-matched cadaveric kidney transplants on graft and patient survival.
During the period 1969 to 1978 survival of recipients of 1st cadaveric renal grafts improved. This improvement occurred in spite of a sharp increase in high risk patients accepted for transplantation, including patients with high age, diabetic nephropathy and advanced arteriosclerotic disease. In the same period 1st graft survival decreased. The declining graft prognosis was related to the acceptance of 3-4 HLA-A and B incompatible grafts from 1973 onwards. Grafts with 0-2 incompatibilities had a stable survival during the whole 10-years period. The group of patients receiving grafts with 3-4 incompatibilities, however, included significantly more patients with diabetic nephropathy and age above 55 years. Further analysis demonstrated that the inferior graft prognosis was caused by a combined effect of HLA-mismatched grafts and the number of high risk patients. The distribution of antibodies at retransplantation (2nd graft) was similar whether the lost 1st graft was compatible for 0-2 or 3-4 HLA antigens. Also the prognosis of retransplantation was similar in the two groups.
Adult↗
Effect of blood transfusions on first cadaveric graft and uremic patient survival.
The 404 cadaveric first transplant candidates registered in Norway at the end of 1977, have been analyzed for blood transfusions; 346 of these patients have been transplanted, 45 died prior to transplantation, while 4 patients have not yet received a transplant and 9 were excluded from the analysis. Slightly less than half of the transplanted patients had been transfused, and these demonstrated significantly better graft survival, most pronounced in those receiving 5 or more transfusions. The majority of the patients dying while waiting for a transplant had been transfused, and in these also a significantly higher frequency of cytotoxic HLA antibodies was observed. All 4 still waiting patients are transfused and have multispecific antibodies. The increase in graft survival after blood transfusions was most pronounced in 1-2 HLA incompatible transplants, less in 3 and 4 antigen incompatible transplants, and no increase was seen in compatible transplants. When analyzing for rejection episodes, however, significant decrease was seen in all transfused groups compared to non-transfused.
Adult↗