Search PubMed⌕ Search

Biomedical subjects

A G Sheil

Publications and source records attributed to A G Sheil.

At least 181 records · Page 10Linked to original sources
PubMed1984

Identification of the cellular subpopulations infiltrating rejecting cadaver renal allografts. Preponderance of the T4 subset of T cells.

In the rejection response against renal allografts, the relative importance of helper/inducer T cells mediating a delayed-type hypersensitivity response and of T cells with direct cytotoxicity has not been defined. These subpopulations were identified with commercially available monoclonal antibodies and an indirect immunoperoxidase technique in 31 renal biopsies from patients undergoing acute rejection episodes and in 9 rejected nephrectomy specimens. T lymphocytes were the predominant cell population in all biopsies and in 8 of 9 nephrectomies. The T4 helper/inducer subset was equal to, or greater than, the T8 cytotoxic/suppressor subset in 28 of the 31 biopsies and in the 8 nephrectomy specimens that had histological evidence of cellular rejection. T4 lymphocytes were found predominantly in large areas of cellular infiltrate. T8 lymphocytes had a more diffuse interstitial distribution and were a minority of the cells in the large areas of cellular infiltration. These results show that helper/inducer T lymphocytes are often more frequent than cytotoxic/suppressor cells in acute renal allograft rejection in humans and they suggest that helper/inducer T cells may play an important role in the mediation of graft destruction.

Antibodies, Monoclonal↗
PubMed1984

A prospective randomized trial of matching for HLA-A and B versus HLA-DR in renal transplantation.

A prospective randomized trial was performed comparing survival of cadaveric grafts allocated by HLA-A+B matching and HLA-DR matching. The two allocation methods resulted in very similar graft survivals. HLA-A matching had no significant effect on graft survival. HLA-B and HLA-DR matching were shown to have approximately equal, significant, independent, and additive effects on graft survival. Other factors that were demonstrated to have significant effects were blood transfusion, preformed antibodies, graft number, and recipient sex. The results indicate that neither allocation method alone is optimal, and that matching for HLA-B+DR is necessary. However a large pool size is necessary to obtain a high frequency of good matches.

Adolescent↗
PubMed1984

Renal biopsy morphology in renal transplantation. A comparative study of the light-microscopic appearances of biopsies from patients treated with cyclosporin A or azathioprine prednisone and antilymphocyte globulin.

Nephrotoxicity is a major side effect of cyclosporin A (CSA) when used in renal transplantation, and the distinction between nephrotoxicity and rejection is important in patient management. One hundred twenty-five renal biopsies were examined from 56 patients entered into a controlled clinical trial aimed at comparing the efficacy of CSA therapy alone to a combination of prednisone, azathioprine, and antilymphocyte globulin (AZA). In order to define the histopathology of rejection and nephrotoxicity, all the biopsies were evaluated in a semiquantitative manner by an observer unaware of the clinical state of the patient. Comparison of the morphological appearances of 32 biopsies from patients on CSA, and 22 biopsies from AZA-treated patients performed during clinically apparent rejection episodes showed that the histological patterns of rejection were the same in both treatment groups. Comparison of the morphological features of 34 biopsies from patients receiving CSA and 13 from patients receiving AZA, performed during prolonged periods of post-transplant renal failure, who eventually recovered on continuation of original therapy, showed that there were no morphological features specific to the CSA-treated group. Five patients on CSA had oliguria which was prolonged by CSA nephrotoxicity. Thirteen biopsies from all five patients showed a diffuse interstitial fibrosis that was peculiar to this group of patients.

Antilymphocyte Serum↗
PubMed1984

Limitations of human umbilical vein grafts.

Sixty modified human umbilical vein (HUV) grafts were used for arterial reconstruction in 48 patients between December 1979 and December 1981. Forty-four patients had limb-threatening ischemia (rest pain or tissue loss) and four had disabling claudication. Thirty-four patients had HUV grafting after a primary arterial reconstruction had failed. Fourteen had HUV used for their initial arterial bypass. The distal anastomosis was to the popliteal artery in 27 grafts (5 above and 22 below the knee) and the distal calf arteries in 33 (anterior tibial 10, posterior tibial 9, peroneal 14). The cumulative patency rate, calculated by the modified life-table method, was 34% at 1 year and 18% at 2 years. Fifteen patients required major amputation after graft failure; 13 of these healed below the knee. Preoperative and postoperative ankle/brachial systolic pressure indices and intraoperative blood flow did not correlate with graft failure. These results reflect the limitations of HUV as a graft material in patients with severe ischemia of the lower extremities. The prognostic factors that determined the outcome of arterial reconstruction with HUV in these patients remain to be defined.

Aged↗
PubMed1983

Sister chromatid exchange in lymphocytes from renal transplant recipients with and without cancer.

The frequency of sister chromatid exchange (SCE) was measured in peripheral blood lymphocytes from control, healthy subjects and immunosuppressed recipients of cadaveric donor kidneys with and without skin cancer. The mean SCE frequency in 43 control subjects was 9.2 per cell (range 5.4-12.3). In 30 transplant recipients with no history or evidence of cancer the mean SCE rate was 10.3 per cell (range 5.8-24.5); four (13%) of these patients had a mean SCE frequency outside the control range. In 7 transplant recipients with skin cancer, the mean SCE frequency was 14.3 per cell (range 9.1-19.9). This was significantly (P less than 0.01) higher than the mean value of control subjects. The mean SCE frequencies in 3 of these 7 patients fell within the control range and in 4 of these patients was above the control range. These results suggest that some immunosuppressed kidney transplant recipients are liable to chromosomal damage.

Azathioprine↗
PubMed1983

Proximal aortic cross clamping during non-aortic surgery.

Temporary control of the aorta at the level of the diaphragm above the origins of the major visceral arteries is of proven value in the management of complex aortic disease including ruptured aneurysm, 're-do' aortic surgery and for aortic trauma. The value of the technique in elective non-aortic surgery is less well known. Two patients, one with a massive leiomyosarcoma of the stomach and the other with blood loss complicating a distal splenorenal shunt, are described in which proximal aortic control was of use.

Adult↗
PubMed1983

Medico-legal aspects of renal transplantation.

Advances in clinical tissue and organ transplantation have enforced changes in legislation concerning the disposal of bodies and their parts. With the evolution of cardiopulmonary support systems came the concept of brain death. To enable physicians to withdraw support without transgressing the law, recognition in law of brain death was necessary. To ensure that the diagnosis of brain death was certain, eminent doctors in advanced communities have drawn up criteria of brain death which are widely recognised and applied with confidence by the medical profession. Organs for transplantation are best obtained from "heart beating cadavers". Despite public support for organ transplantation the requirements for organs to treat those presenting are not currently being met even though the number of patients who die and who could be suitable donors far exceeds that required. Increased public education to stimulate voluntary donation is necessary. Standardisation of care of comatose patients in hospitals is also required so that brain death may be diagnosed when it occurs. If the procedures for organ donation are familiar and well understood, suitable patients can then become donors according to their own or their relatives' wishes.

Australia↗
PubMed1982

Delayed complications of renal transplantation and their prevention.

The complications of cadaveric renal transplantation in a group of 10-year survivors are presented. Fifty-two (44%) of 119 graft recipients survived more than 10 years, 48 with their original allograft. The major causes of death in the others were bacterial (24%) and other (10%) infections, cerebral (12%) and myocardial (7.5%) vascular disease. Serious morbidity in the survivors included infectious episodes (55%), skin cancer (40%), vascular disease (30%), cataracts (45%) and aseptic necrosis of bone (13%). Only six (12%) patients had no complications. Although complications were frequent, 34 patients (72%) were fully rehabilitated to work or household duties. Several recipients have become parents. Prevention of the late complications of transplantation must be aimed at reducing the known risk factors early in the course of renal failure. These include hypertension, obesity, cigarette smoking and sun exposure.

Adolescent↗
PubMed1982

Long-term survival after cadaveric renal transplantation.

In a series of 404 consecutive first cadaver kidney transplants performed since 1967 the actuarial five- and 10-year survival of patients were 61% and 47% respectively and of grafts 46% and 36%. In more than four-fifths of the patients surviving these intervals the original cadaveric grafts were functioning at these times, and most of the remainder were sustained by subsequent grafts. Although graft survival has remained static since 1967, patient survival improved. Results for 43 consecutive second cadaver transplants were similar after five years to those of first grafts. These results promote the acceptability of cadaveric transplantation as a long-term treatment for chronic renal failure.

Adolescent↗
PubMed1982

Treatment of renal transplant artery stenosis by percutaneous transluminal dilatation.

Transluminal arterial dilatation using a balloon catheter was performed in four patients with renal allografts and transplant artery stenosis. In three patients the procedure was uncomplicated and resulted in reduction in mean blood pressure from 180/100 mm Hg to 135/85 mm Hg immediately after and 135/90 mm Hg at a mean of eight months after angioplasty; renal function remained stable. In one patient with two stenoses the procedure was abandoned because of inaccessibility of the stenotic sites to the dilatation catheter; however, reversible acute renal failure ensued. Percutaneous transluminal angioplasty may thus offer a successful alternative to conventional surgical techniques in renal transplant artery stenosis in suitable patients.

Adult↗
PubMed1980

Initial experience wit polytetrafluoroethylene for extraanatomic bypass.

Extraanatomic bypass using polytetrafluoroethylene is a satisfactory alternative to direct aortic surgery in poor risk patients and in patients who have had previous aortoiliac reconstruction. If the disease is limited to one side, a crossover graft gives very satisfactory results with a 1 year cumulative patency of 95.6 percent. Axillofemoral grafts also give satisfactory results, especially if episodes of thrombosis are treated promptly by thrombectomy, in which case flow will be restored in most cases, with an overall 1 year cumulative patency of 89.5 percent.

Aged↗