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Biomedical subjects

G K Kiroff

Publications and source records attributed to G K Kiroff.

26 records · Page 2Linked to original sources
PubMed1985

Lack of effect of splenic regrowth on the reduced antibody responses to pneumococcal polysaccharides in splenectomized patients.

The experiments were to determine if ectopic splenic tissue in humans would restore to normal those antibody responses which are reduced in patients who have been splenectomized. The IgM and IgG antibody response to subcutaneous injection of polyvalent pneumococcal polysaccharide vaccine (PNEUMOVAX) was determined in 34 patients who had been splenectomized for trauma and 14 controls, by measuring the concentration of antibody specific for five of the serotypes in the vaccine in serum samples taken before and 1 month after the immunization. The patients had significantly lower post-immunization concentrations of IgM antibody for three of the five serotypes measured, and IgG for two of the five. The antibody response to the immunization was assessed by comparing the post- to the pre-immunization concentration of antibody by analysis of covariance. The patients had a significantly lower IgM response to three of the five serotypes measured and IgG response to four of the five. It is concluded that in adult humans the spleen is important in the maintenance of normal humoral immune responses. The presence and degree of ectopic splenic regrowth (splenosis) in the splenectomized patients was assessed by a spleen-specific radio-isotopic scan. There was no difference between patients with splenosis and those without, or between those with different degrees of splenosis, in any of the parameters of the antibody response measured. This is in vivo evidence indicating that ectopic splenic tissue in humans does not normalize the altered antibody responses observed following splenectomy.

Adolescent↗
PubMed1984

A study of factors responsible for the efficacy of fundoplication in the treatment of gastro-oesophageal reflux.

Forty-one patients were followed up for a median 14 months after Nissen fundoplication. Patients were questioned regarding their symptoms and 83% considered the surgery a complete success. Oesophageal manometry was performed before and after surgery. Median pre-operative lower oesophageal sphincter pressure (LOSP) was 5.5 mmHg; following operation median LOSP was 14 mmHg. The ability of the lower oesophageal sphincter (LOS) to relax with swallow was impaired by fundoplication; the median residual lower oesophageal sphincter pressure (RLOSP) was 0 mmHg prior to surgery and 3.5 mmHg following operation. Fundoplication appears to superimpose a zone of constant pressure on the lower oesophageal sphincter and this may be a further factor responsible for the efficacy of surgery.

Adolescent↗
PubMed1984

The injured spleen: should consideration be given to conservative management?

This report is a retrospective study over a 13 year period of 267 patients who underwent splenectomy. The incidence of associated major abdominal injuries following blunt trauma in these patients was 8%. Over half of these associated injuries were diagnosed pre-operatively. Sixty-nine per cent of the patients were haemodynamically stable before operation. Patients who suffered splenic injuries whilst playing sport or who were conscious and did not have major extra-abdominal injuries or clear evidence of other intra-abdominal injury could possibly have been managed expectantly. Such a policy might have avoided splenectomy in a substantial number of cases and thus have eliminated the risk of Overwhelming Post-Splenectomy Infection (OPSI) in these patients.

Accidents, Traffic↗
PubMed1984

Symptomatic and asymptomatic ulcer recurrence following highly selective vagotomy.

An assessment of outcome has been made after highly selective vagotomy performed by two surgeons on 174 patients. The median time to followup was 36 months (range 3-94). The group comprised 74% males and 26% females (median age 45 years, range 19-75). Assessment was by review of medical history, endoscopy (irrespective of presence or absence of symptoms) and questionnaire. Symptomatic ulcer recurrence had already been diagnosed in 16 patients (9%). There were 2 unassociated deaths and 14 patients remained untraced. The remaining 142 patients were assessed by questionnaire and asked to undergo an endoscopy. One hundred and nineteen agreed to endoscopy and ulcers were found in 11 patients (9%). Five were sited in the duodenum and 6 in the stomach. Duodenitis was found in 30% of patients. Patients with ulcers in the pyloric region were at significantly greater risk than the general group for developing a recurrence. Patients who agreed to endoscopy (119) underwent Visick grading prior to endoscopy. A poor correlation was found between ulcer recurrence and Visick score. The "asymptomatic" recurrence rate of 9% following highly selective vagotomy should be considered when assessing the outcome of the surgery.

Adult↗
PubMed1984

Alterations in immunoglobulin synthesis by peripheral blood mononuclear cells from splenectomized patients with and without splenic regrowth.

Unstimulated and pokeweed mitogen (PWM)-stimulated immunoglobulin (Ig) synthesis by peripheral blood mononuclear cells (PBMC) in vitro, serum Ig concentrations, and the degree of splenic regrowth was studied in 33 patients who had been splenectomized following trauma. The concentration of IgG and IgA was significantly raised in the supernatants of unstimulated cultures of PBMC from the patients. The stimulation of Ig synthesis by PWM, measured as a stimulation index (SI), was significantly less in the culture of PBMC from the patients, compared with the controls. The SI was reduced both in those patients whose unstimulated PBMC secreted normal concentrations of IgG and IgA in culture, as well as in those whose cells secreted elevated concentrations of Ig. The concentration of IgM in the serum of the patients was significantly reduced compared with the controls, the serum IgG was raised, and the serum IgA was not altered. The degree of splenic regrowth (splenosis) was measured in the patients by splenic scanning, by using heat-damaged, radiolabeled autologous erythrocytes. The patients were allocated into four groups, depending on whether they had no (11 patients), minimal (11), moderate (seven), or large (four) splenosis. There was no difference between any of the groups with respect to the synthesis of IgG or IgA in culture or the serum Ig concentrations. These results indicate that Ig synthesis by PBMC in vitro, and serum Ig concentrations in vivo, are abnormal in patients who have been splenectomized for trauma, and that the generation of splenosis tissue does not correct these changes.

Adolescent↗
PubMed1984

Monocyte antibody-dependent cellular cytotoxicity in splenectomized subjects.

Monocyte antibody-dependent cellular cytotoxicity (ADCC) was determined in normal subjects by using human A1 erythrocytes and immune human anti-A1 antiserum. The experimental data were fitted to a mathematical model and the values for maximal cytotoxicity and monocyte numbers required to produce 15% specific cytotoxicity (MD15) were subsequently computed and compared with the values for these two parameters estimated from the dose response curves. The values for both were significantly associated, and the mathematical model permitted precise quantitation of cytotoxicity in instances where this was impossible by standard methods. Maximal monocyte ADCC was significantly reduced in a group of splenectomized subjects, whereas the MD15 was increased. These findings emphasize the possible influences of the method of quantitation of ADCC and provide one explanation for the apparent conflict of published data.

Adult↗
PubMed1983

Splenic regeneration following splenectomy for traumatic rupture.

Thirty-three patients previously splenectomized following traumatic rupture of the spleen were assessed using a radionuclide technique. Splenic tissue was detected by this means in 22 patients (67%). Peripheral venous blood was examined for the presence of erythrocyte surface vacuoles. Vacuolated red blood cells were detected more frequently than in the normal population. The incidence of vacuolated red blood cells was inversely related to the estimated volume of regenerated splenic tissue.

Adolescent↗