Successful clinical small-bowel transplantation.
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Biomedical subjects
Publications and source records attributed to G Leimenstoll.
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Deterioration of renal transplant function due to rejection is accompanied by changes in renal blood flow that can be measured by duplex ultrasound (DU). In the present study, 60 transplanted patients were followed up. A total of 233 duplex examinations, 68 percutaneous biopsies, 44 renal scintigraphies, and 6 transplant nephrectomies were performed on these patients. Diagnoses were made on the basis of clinical and histological data. Renal perfusion was calculated by means of DU. In addition, the arterial Doppler signals were quantified using a pulsatility index (PI). Mean perfusion of normal renal allografts was 0.47 l/min. A decrease in blood flow could be found in acute vascular and chronic rejection but not in acute cellular rejection. A lack of renal perfusion due to acute vascular rejection was observed in four patients. Mean PI, used as a parameter of DU, rose significantly in all forms of rejection, which could be diagnosed with a sensitivity of 93% and a specificity of 86%. Cyclosporin overdosage did not alter the Doppler flow shape.
A 34-year-old patient prophylactically received tuberculostatic treatment with ethambutol and isoniazide after having had an allogenic renal transplant and immunosuppression with methylprednisolone and cyclosporine. The tuberculostatic treatment was discontinued 165 days after the transplantation. The cyclosporine blood level, which was measured daily thereafter, gradually rose from 250 ng/ml to 400 ng/ml. It is possible that enzyme induction due by the tuberculostatic drugs was responsible for the increased breakdown of cyclosporine.
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An IgA-IgM positive, rapidly progressive glomerulonephritis developed in two successive transplants in a 28-year-old patient. Both transplants failed. In the prevention and treatment of rejection corticoids and cortisone, antithymocyte globulin and cyclosporin A were administered but could not prevent the development of this form of glomerulonephritis. It remains to be shown whether it presents a contraindication to transplantation.
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A 15-year-old girl suffering from acute dermatomyositis was treated with cyclosporin A after conventional therapy had failed. During this treatment there was a marked decrease of the myolysis and improvement of the paresis.
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Healthy young volunteers ingested one liter of cows' milk; then the contents of the small intestine were aspirated through an intestinal tube at various times and assayed for the presence of bovine beta-casomorphin immunoreactive materials. Considerable amounts of beta-casomorphin-7, but no beta-casomorphin-5 and only small amounts of beta-casomorphin-4 or -6 immunoreactive materials were found. Chromatographical characterization showed that most of the beta-casomorphin-7 immunoreactive material was not identical with beta-casomorphin-7, whereas the major part of the beta-casomorphin-4 or -6 immunoreactive materials might be identical with their corresponding beta-casomorphins. Analogous results were obtained for in vitro digestion of bovine milk which had been designed as a rough imitation of the gastrointestinal digestion process. A regulatory influence of beta-casomorphins as "food hormones" on intestinal functions is suggested.