Biomedical subjects
Publications and source records attributed to F Brunner.
Mucormycosis is a very serious complication of debilitating diseases, and particularly of diabetes. Presently the treatment of choice is amphotericine B. A patient is described who, like most other renal transplant patients with mucormycosis, had cranial localization of this disease and diabetes. The clinical findings were classical and the diagnosis was confirmed histologically.
Patients with chronic renal failure under regular hemodialysis may present porphyria cutanea tarda-like dermatoses without, however, exhibiting a disturbed porphyrin metabolism. Based on a personal observation and the literature the anamnestic, clinical and histological features of this distinct dermatosis are discussed. Metabolic disturbances due to chronic renal failure, with or without hemodialysis, are possible etiopathogenetic factors, while in the light of the latest findings it seems improbable that any such role is played by frusemide therapy.
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The non-transfusion policy for potential recipients of kidney allografts that has been followed in recent years has not proven successful. There is now ample clinical evidence of improved transplant function in the transfused recipients category. This has also been confirmed in recipients of a first cadaver kidney in Basel and Geneva. If the conditions valid for human kidney transplantation are matched as closely as possible in animal experiments, prolongation of graft function rather than accelerated rejection is usually observed after blood transfusions. Potential kidney graft recipients should be more liberally transfused and experimental evidence ought to be accumulated in order to establish a rationale for optimal host conditioning, while avoiding the hazards of blood transfusions to the greatest extent possible.
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Serum lipids in 58 renal transplant recipients were related to duration of follow-up, relative body weight, steroid medication, proteinuria and graft performance. Hyperlipidemia was observed between the 4th month and the end of the first year after transplantation in 83% of the patients. Thereafter, the frequency of hyperlipidaemia appeared to decrease: at 4 to 7 years only 61% of the subjects continued to exhibit abnormal high serum lipids. Three mechanisms leading to hyperlipidaemia were identified: 1) overweight, 2) steroid mediation, 3) proteinuria. A forth apparent mechanism was impaired transplant function.
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20 biopsies were studied in order to determine whether or not the pathologist is able to predict on morphological grounds the etiology and prognosis of acute renal hypoxic change in renal transplants. We concluded that: 1) Intertubular blood stasis seems to be pathognomonic of peripheral vascular rejection and/or renal artery thrombosis. 2) A focal distribution of acute tubular luminal dilatation suggests peripheral vascular rejection. 3) The finding of lymphatic casts suggests the presence of ureteric obstruction. 4) Linear fluorescent staining of the peripheral glomerular basement membrane appears to be due to leakage of plasma proteins in the presence of endothelial damage. 5) The histological distinction between camouflaged rejection and genuine shock kidney is impossible in a biopsy. 6) The precise cause of acute renal hypoxic change and the prognosis of kidney transplants with this alteration often cannot be determined.
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