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Biomedical subjects

B Eklund

Publications and source records attributed to B Eklund.

At least 73 records · Page 4Linked to original sources
PubMed1988

Fine-needle aspiration biopsy in the monitoring of liver allografts. II. Applications to human liver allografts.

Serial fine-needle aspiration biopsies (FNAB) were used for clinical monitoring of human liver allografts. Nine liver allograft recipients were monitored with FNAB at 1-3 day intervals. No complications were recorded. All patients underwent at least 1 inflammatory episode of acute rejection; altogether 11 episodes, all reversible, were recorded. The inflammatory infiltrate consisted mainly of lymphoid cells, including lymphoid blasts, with minor involvement of monocytes, monoblasts, and macrophages. Further analysis of lymphoid cell subpopulations by immunoperoxidase techniques demonstrated an increase of T cells during rejection, both the CD4 (T4) and CD8 (T8) subsets were increased. A slight increase of B cells in the graft was also seen. The CD4/CD8 (T4/T8) ratio was first low, peaked at the onset, and decreased toward the end of the episode. No clear correlations to the intragraft cellular events were recorded in corresponding blood specimens. However, an episode of eosinophilia was seen in the blood at the beginning of rejection, correlating with fever in the recipient. Degenerative changes in the parenchymal cells and bile droplets in the hepatocytes, indicating cholestasis and hepatocyte damage, were seen during all episodes of rejection, and these changes persisted even 10 days after the inflammation had subsided. The FNAB-findings correlated well with biochemical laboratory parameters, but the diagnosis of rejection could be established by the FNAB already 1-5 days earlier than elevated serum values indicated liver dysfunction.

Alkaline Phosphatase↗
PubMed1988

Effects of cyclosporine, azathioprine, and steroids on the renal transplant, on the cytologic patterns of intragraft inflammation, and on concomitant rejection-associated changes in recipient blood.

We have investigated the impact of various immunosuppressive drugs and their combinations on the graft, on the intragraft inflammatory patterns of rejection, and on rejection-associated effects in the recipient circulation by fine-needle aspiration biopsy and an extensive computer program. The patients were randomized into three treatment groups, 32 patients each, with the following postoperative immunosuppression: (1) Aza (2.1 mg/kg/d) plus MP (3.6 mg/kg/d tapered to 0.5 mg/kg/d by day 15), (2) CsA (10 mg/kg/d tapered to 8 mg/kd/d by day 28) and, (3) CsA (as above) plus MP (3.6 mg/kg/d tapered to 0 mg/kg/d by day 9). The groups were homogeneous in regard to all tested pretransplantation parameters. Graft parenchymal cell morphology was significantly (P less than .05) deteriorated and urine output reduced in CsA-treated patients, compared to those receiving Aza + MP; concomitant administration of steroids partially (P = NS) protected against the CsA-associated effects. The first episode of inflammation occurred significantly earlier (P less than .001) in patients receiving initially only CsA, compared to those receiving Aza + MP or CsA + MP, the total duration of intragraft inflammation was longer and the clinical signs of rejection were significantly prolonged (.001 less than P less than .05). Although the influx of lymphocytes and monocytes into the graft and the peak intensity of intragraft inflammation was similar in the three groups of patients, the inflammatory patterns of rejection were distinctly different. The number of (T) lymphoblasts in CsA-treated grafts was significantly (P less than .05) lower and their appearance delayed, compared to those treated with Aza + MP and even lower and more delayed in grafts treated initially with CsA + MP. The number of (B) plasmablasts was also reduced and their appearance delayed, but the differences to conventional treatment with Aza + MP were smaller and no longer significant. On the other hand, a significant (P less than .01) early maturation of blood-borne monocytes into tissue macrophages was observed in the CsA-treated grafts in context of first rejection, which was lacking from those treated with CsA + MP or Aza + MP. In the blood, the first episodes of inflammation under CsA were associated with significant (P less than .001) thrombocytosis, which was lacking from the Aza + MP- and CsA + MP-treated patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

Concentration and chemical composition of plasma lipoprotein subfractions in patients with peripheral vascular disease. Evidence for normal apolipoprotein B but low cholesteryl ester content in small VLDL.

Subfractionation of the 3 major plasma lipoprotein classes was performed in 20 male patients with symptomatic peripheral vascular disease (PVD) and 18 male healthy controls of similar age and serum lipid levels as the patients in order to investigate if, at comparable levels of total serum lipids, any difference in the distribution or the chemical composition of the lipoprotein subfractions existed between patients and controls. Concentrations of free and esterified cholesterol, triglycerides, phospholipids, apolipoprotein B (apo B) and soluble apolipoproteins did not differ significantly in any lipoprotein subfraction of PVD patients compared to controls. Calculated molecular weights and numbers of lipoprotein particles/ml plasma were also similar in the 2 groups except that there were more heavy LDL particles in the patient group. Plotting concentrations of apo B against cholesteryl ester in the VLDL-D subfraction (Sf 20-100) yielded a linear regression in both groups. The PVD regression line was significantly steeper than that of controls. Calculation of the molecular mass of the various constituents of the VLDL-D fraction in the subjects with the highest content of esterified cholesterol in VLDL-D, where this difference was most pronounced, suggests that this difference was due entirely to a decreased number of cholesteryl ester molecules per lipoprotein particle in PVD. The findings suggest that a disordered metabolism of plasma cholesteryl esters may be present in certain PVD patients.

Aged↗
PubMed1985

Prophylactic oral acyclovir after renal transplantation.

In a double-blind, controlled study 35 herpes simplex virus (HSV) antibody-positive patients were randomized to receive oral acyclovir 200 mg X 4 daily or placebo for 28 days following renal transplantation. The incidence of herpes virus infection was compared in both groups by weekly virus demonstration/isolation testing from throat swabs and urine, and by serum antibody demonstration. None of the 18 patients allocated to acyclovir showed any signs of HSV or varicella zoster virus (VZV) infection during the trial period, whereas 9 of 17 receiving placebo had signs of HSV (P less than 0.001) and 2 of VZV (P less than 0.05) infection. Because of systemic as well as local symptoms of infection in five of the placebo patients, the trial was interrupted and treatment with oral acyclovir instituted. All of them responded well with rapid disappearance of all symptoms. Cytomegalovirus (CMV) was isolated from the urine of two patients in both groups during the trial period; a significant antibody rise was seen later in three of them. There was no evidence of drug-related toxicity during the study.

Acyclovir↗
PubMed1985

Acyclovir and renal transplantation.

The efficacy of oral acyclovir to prevent reactivation of herpes simplex virus (HSV) in seropositive renal allograft recipients was tested in a double-blind placebo controlled study. None of the 18 patients allocated to acyclovir showed any signs of HSV infection. In contrast, 11/17 on placebo (p less than 0.001), had signs of HSV or varicella zoster virus (VZV) infection--in 5 patients severe enough to interrupt the trial and initiate treatment with oral acyclovir. Soon after cessation of the trial, HSV was isolated from the throats of 6 patients on acyclovir, and 1 developed shingles 3 months later. Oral acyclovir prophylaxis thus effectively protected the patients from reactivation of HSV and VZV while they were receiving the drug, but could not prevent disease once off the drug. Treatment with acyclovir brought rapid relief of both local and general symptoms in all patients. No adverse reactions were seen. As a consequence of these experiences our goal in subsequent transplant patients has been either early therapeutic intervention with oral acyclovir whenever signs of HSV or VZV infection have been noted, or prophylactic remedy in patients at particular risk to develop troublesome herpetic lesions after renal transplantation.

Acyclovir↗
PubMed1984

Glucocorticosteroids in renal transplantation. II. Impact of high- versus low-dose postoperative methylprednisolone administration on graft survival and on the frequency and type of complications.

In a previous clinical trial we demonstrated that, by increasing the postoperative administration of methylprednisolone from 1.0 to 3.5 mg/kg/day, the onset of the first inflammatory rejection episode was significantly delayed and the size of the inflammation was reduced. The 'high initial' steroid treatment specifically depleted blast cells and macrophages from the in situ inflammatory infiltrate. In this trial we demonstrate that the 'high initial' glucocorticosteroid administration significantly improves 1-year cadaver allograft survival from 44% to 68% (P = 0.003) without increasing the number of complications. Although the 'high initial' steroid administration only partially overcomes the impact of HLA-AB incompatibility, it seems to overcome entirely the impact of absence of blood transfusions. The 'high initial' steroid administration also makes the first episodes of inflammation easier to overcome: less steroids are needed to counteract the first rejection, and, as a consequence, only 30% more steroids were used in the 'high initial' versus the 'low initial' steroid programme.

Blood Transfusion↗