[Kinetics of leukocytes during hemodialysis].
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Biomedical subjects
Publications and source records attributed to A Wolf.
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The clinical findings in three patients with renal thrombohemolytic microangiopathy are presented. The triad of microangiopathic hemolytic anemia, disseminated intravascular coagulation and microangiopathic changes of the kidney leading to renal insufficiency is the characteristic feature of this disease. Beside the usual classification based on etiological factors (distinguishing between primary and symptomatic forms) a topographical classification (distinguishing between generalized forms and localized forms occuring in isolated organs) is suggested. The pathogenesis and therapy of this disorder are discussed.
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The neuropathological features are presented of an autopsy series of 43 renal transplant recipients. Inflammatory CNS lesions were found in 18 cases and were attributable to secondary CNS involvement in bacterial or fungal septicaemia (8 cases) or in localized extraneural infections (5 cases). Mixed bacterial-fungal infection and bacterial-fungal-viral triple infection were seen in one case each. Isolated toxoplasmic granulomas were observed in two cases. No tissue changes typical of CNS viral infections, including cytomegaly, were found except for small glial nodules in the brain stem in 7 cases. Massive intracerebral haemorrhages were seen in 2 cases after haemodialysis; subdural haematoma occurred once. Non-specific changes including brain oedema and diffuse glial poliodystrophy were found in many cases; vascular lesions and purpura occurred only seldom. A meningocerebellar malignant lymphoma, probably of metastatic origin was found in one case. Clinico-pathological correlation was poor in 5 cases; this is considered to be due to immunosuppressive therapy, which may mask either clinical expression of severe CNS lesions or morphological expression of viral encephalitis.
During the past 2 years 7 children received kidneys from cadaveric donors. 2 transplants had to be removed because of irreversible chronic rejection and 1 recipient died on the 4th day after surgery. The remaining 4 recipients are doing well. In the evaluation of the results special emphasis is placed on the normalization of growth and puberty. The difficulties of psychosocial rehabilitation are stressed.
Material with a molecular weight of less than 10(5) daltons has been isolated and partially purified from the ascitic fluid of DBA2 mice bearing a syngeneic lymphoma (SL2). This substance inhibits the cytotoxic action of an allogeneic antiserum directed specifically against SL2 cells. Material has been rendered radioactive with 125I and between 20 and 25% of the radioactivity is bound in a specific manner to the antiserum. The material which is referred to as 125I-TSTA has been used in a radioimmunoassay to measure the level of TSTA in the sera of mice bearing both ascitic and subcutaneous SL2 tumours. The level of circulating TSTA was found to be high immediatley following inoculation of live SL2 cells, probably because a large proportion of the injected cells autolyse. The serum concentration of TSTA then falls but 6-10 days later begins to rise again in parallel with the growth of the SL2 tumour either in the peritoneal cavity or subcutaneously. Following surgical removal of an intradermal SL2 tumour the level of TSTA in the serum falls rapidly. No evidence could be found that a significant proportion of the TSTA in the serum of tumour-bearing mice is completed with antibody. However, in the serum of DBA2 mice which have been hyperimmunized with irradiated SL2 cells there are antibodies which bind 125I-TSTA although syngeneic anti-SL2 sera, unlike alloantisera, do not show complement dependent lysis of SL2 cells.
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In the arteries of 17 rejected renal grafts 'activated' smooth muscle cells (ASMC) were discerned from a 'resting' type. Proliferation and fibre production by ASMC resulted in a marked thickening of intima. Each of four normal Wistar rats received 20 mg prednisolone i.v./day for one week and the development of hypertension was therapeutically prevented. Changes similar to those in the graft arteries were found in the rat aortas. We assume that SMC were stimulated by several mechanisms in rejection but also by extremely high dosed corticoids.
20 cases of primary carcinoma of the fallopian tube from 1958 to 1974 are reported. An operation was performed in all cases. A post-operative intra-peritoneal installation of radioactive gold was done in 14 cases. 6 patients which had radioactive gold treatment survived for more than 5 years. None of the patients survived for more than 5 years who did not have radioactive gold treatment. The positive effect on treatment of carcinoma of the fallopian tube of a complete operation with post-operative intra-peritoneal administration of radioactive gold is discussed in detail.
A report is given on 57 patients with pseudomucinous ovarian carcinomas. The prognosis of the disease depends on two decisive factors, if the FIGO stages are not taken into consideration: 1. the operation which should be executed as radically as possible, 2. the intraperitoneal instillation of radiogold which shall be repeated two times. The following therapeutic results were realized under this treatment: a five-year survival rate of 76,9% and a ten-year survival rate of 72.7%. There were no serious side-effects of the radiogold therapy since the introduction of routine peritoneographies before instillation of 198Au.
Report on 88 cases of sarcomas of the female genital organs. The sarcomas were confined to the uterine body in 72 cases. The prognosis of this disease depends primarily on the adequacy of the treatment. The treatment consists of as radical an operation as possible followed by external radiation and intra-vaginal application of radium. The microscopic type of the sarcoma of the uterus is of secondary importance. Patients who survived for 3 years following this treatment have a good prognosis for a 5 year or a 10 year cure. Other sarcomas of the female genital tract are mentioned.
A report is given of the treatment of three patients with advanced malignant tumors. Combined percutaneous irradiation and application of adriamycine produced severe side effects which, in one case, took a lethal end. A combination of relatively good tolerance consisting of an irradiation therapy and stosstherapy with cyclophosphamide is presented as an alternative treatment of the advanced ovarian carcinoma. The authors express a warning of simultaneous application of radiation and adriamycine therapy.
An artificial kidney (HFAK 5) was evaluated as an ultrafiltration device and was found to efficiently remove water from fluid-overloaded patients. The fluid removal rate was quantitated on a chronically hemodialyzed patient and an example of clinical application on a patient without renal insufficiency, is reported. It is suggested that ultrafiltration is a helpful method for treating refractory edematous states.
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