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Biomedical subjects

G Thiel

Publications and source records attributed to G Thiel.

At least 271 records · Page 15Linked to original sources
PubMed1977

[Kidney biopsy from the viewpoint of a clinician].

Technique, indications, contraindications and complications of percutaneous biopsy of the kidney and the renal transplant are reviewed. In Basle, after introducing fluoroscopic control, 347 consecutive percutaneous biopsies were followed by two serious complications only: persistent bleeding led to partial nephrectomy of the lower pole in one case and nephrectomy in a second case where spontaneous hemorrhage had occurred at the upper pole (temporally but not causally related to the biopsy of the lower pole). A further 110 biopsies of renal transplants done also with fluoroscopic control resulted in no complication whatsoever.

Biopsy↗
PubMed1976

[Studies on the heredity and pathogenesis of familial combined hyperlipidemia ("multiple lipoprotein type" hyperlipidemia)].

A family with familial combined hyperlipidemia (multiple-lipoprotein type hyperlipidemia) was investigated with regard to mode of inheritance, phenotypic expression, presence of genetic markers, and biochemical parameters related to lipid metabolism. The family of 22 subjects (13 males, 9 females) was composed of 5 type IIa, 8 type IIb, 1 type IV hyperlipoproteinemias and 5 normolipidemics. The distribution of serum cholesterol and serum triglyceride concentration was bimodal. No relationship was observed between hyperlipidemia and blood groups or histocompatibility antigens. Subjects with high HLA 8 or W 15 had, on the average, higher lipid levels than others. However, these antigens were observed in normolipidemics too. The response to therapy with alufibrate (2g/day) was not uniform. Subjects with marked triglyceride lowering exhibited only moderate cholesterol lowering, and marked cholesterol lowering was associated with poor triglyceride lowering. The reduction in serum lipids was observed in unaffected family members as well. It is therefore concluded that alufibrate does not exert an effect on the defect in familial combined hyperlipidemia but on some unspecific sites probably on lipoprotein lipase. The familial combined hyperlipidemia appears to be transmitted in an autosomal dominant mode and very probably determined by more than one gene.

Adolescent↗
PubMed1976

Hyperlipidemias in patients with kidney transplants.

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.

Age Factors↗
PubMed1976

[Diagnosis and pathophysiology of renal concentration disorders].

Basic physiology and pathophysiological mechanisms of renal concentrating ability and its defects are discussed. Normal urinary concentration depends on the concerted action of a variety of factors. Consequently, many different causes may underly the symptom of polyuria. Clinical tests of concentrating ability (water deprivation, pitressin test) are of diagnostic importance in diabetes insipidus and polydipsia, but have little practical value in the work-up for chronic renal disease. A critical analysis of maximal concentrating capacity (TcH2O) during induced osmotic diuresis is conducted. It is inferred that the height and shape of the normal TcH2O curve results basically from two physiological processes: It is raised by increasing NaCL transport out of the medullary parts of the ascending limbs of Henle's loops and lowered by influx of hypotonic tubular urine into the collecting ducts. Preponderance of hypotonic influx may result in hypotonic final urine in the absence of tubular functional abnormalitiy. It is not appropriate, therefore, to classify renal concentrating defects according to the shape and height of the TcH2O curve. A synopsis and short description of the known renal concentrating defects is given. They are classified into hereditary, metabolic, diuretic-induced, and toxic disturbances, as well as those seen in renal disease of various etiology. Each defect is discussed in terms of the underlying pathophysiological mechanism as far as currently understood. The most important mechanisms are either disturbed NaCL transport in the ascending limb of Henle's loop, or antidiuretic hormone (ADH) dependent or ADH independent decrease in water permeability of the enddistal convolutions and collecting ducts, or osmotic diuresis.

Diabetes Insipidus↗
PubMed1976

Etiologic and prognostic significance of isolated acute renal hypoxic change (so-called tubular necrosis or shock kidney) in kidney transplants.

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.

Acute Kidney Injury↗
PubMed1975

[Dialysis and kidney transplantation in Switzerland in 1973].

A separate computer print-out for Switzerland of the EDTA registry concerning all patients on dialysis or carrying a renal transplant has been analysed. Of a total number of 857 registered patients, 584 or 91 per million inhabitants were alive on 31 December 1973; 306 patients were on hospital hemodialysis, 68 on home hemodialysis and 2 on peritoneal dialysis. 353 patients had received 385 renal transplants, 208 of which were still functioning at the end of 1973. No major change was noted in cumulative survival rates of Swiss patients, who, as expected, showed lower survival with increasing age. Graft survival in a group of 148 first cadaver transplants with poor tissue match (2 or fewer HL-A identities) was better with 66+/-4% at one year than the 53+/-7% survival in the 63 grafts with at least 3 HL-A identities. The number of patients alive on home dialysis increased by 74% through 1973; one year survival equalled the European average at 93+/-4%. Rehabilitation was rather poor in dialysed patients, 21% of whom were reported to be working full time in the hospital-dialysed group and 42% in the home-dialysed group. Patients with functioning transplants, on the other hand, showed very satisfactory rehabilitation (75% working full time). Hepatitis among staff appeared be on the decrease, with only 9 cases in 1973 despite the fact that some 20% of dialysed and transplanted patients were still reported as hepatitis B antigen carriers. The number of new patients accepted for treatment in Switzerland has stabilized at 25-27 per million population per year since 1971. Average mortality was 15.3% in 1973. At the beginning of 1980 we can thus expect to be treating some 135 patients per million population with dialysis and renal transplantation.

Female↗
PubMed1975

Pattern of core and surface expression in liver tissue reflects state of specific immune response in hepatitis B.

A series of 67 liver biopsies (20 kidney transplant recipients and 47 outpatients with hepatitis) was investigated for the presence of hepatitis B antigen core (HBc) and surface (HBs) components by immunofluorescence and electron microscopy. The variable appearance of the core in liver cell nuclei and of the surface in the cytoplasm allowed the recognition of expression patterns which, together with histologic parameters, could be integrated into four reaction types of diagnostic and prognostic implications: Type I (Elimination Type). No components or only occasional expression of HBc; histologically, classic lobular hepatitis; clinically, acute, self-limited viral hepatitis. Type II (HBc Predominance, or Immunosuppression Type). Abundant core expression in each liver cell nucleus and moderate appearance of HBs; histologically, nonaggressive inflammation (nonspecific reactive or portal hepatitis); clinically, mild, chronic, persistent hepatitis in transplant patients. Type III (HBs Predominance, or Nonaggressive Type). Prominent HBs expression largely in the absence of HBc; histologically, nonaggressive inflammation (nonspecific reactive and portal hepatitis) or normal liver tissue, together with ground-glass hepatocytes in light microscopy, as a correlate of HBs-containing hepatocytes; clinically, hepatitis B antigen carrier, or chronic persistent hepatitis. Type IV (HBc+s Equivalence, or Aggressive Type). Spotty expression of both components, especially of core; histologically, periportal hepatitis; clinically, mainly corresponds to chronic aggressive hepatitis and to acute hepatitis with possible transition to chronicity. As a unifying concept for these types, it is suggested that immune responsiveness determines the reaction pattern, the key mechanism being immune elimination of affected cells. Between efficient elimination (type I) and effective immunosuppression (type II), a graded elimination insufficiency is found in chronic forms (types III and IV), explaining the persistence and probably also the aggressiveness of hepatitis B virus infection.

Acute Disease↗
PubMed1975

Virus infections in renal transplant recipients.

534 serum samples from 73 renal transplant recipients, 41 haemodialysis patients, and 99 blood and organ donors were examined serologically for antibodies against Cytomegalo, H. simplex (types 1 and 2), Varicella-zoster, Epstein-Barr, Adeno, Influenza, Parainfluenza, Respiratory syncytial, Measles, Picorna- and human Polyoma- Viruses. Serum specimens were stored in the lyophilized state until examined thus enabling a simultaneous testing of all samples belonging to one patient. All antigens, complement, and control antisera were prepared, lyophilized, and standardized in this laboratory. This has enabled the use of single batches of any preparation throughout the study. Serologic results with antigens of the Herpesvirus group (CMV, HSV and VZV) compared favourably with previous results showing that infections with these agents, especially with CMV, can frequently be encountered among transplant recipients. Our results have indicated a moderately increased incidence of infections with some Herpesviruses in haemodialysis patients as well. Infections with VZV, for instance, were as frequently demonstrated in these patients, as in transplant patients although the former received no immunosuppressive therapy. Serologic results with non-Herpesvirus antigens indicated an increased incidence of infections with Polyomavirus, Myxoviruses (Influenza, Parainfluenza and RS) and Picornaviruses among transplant recipients. The incidence of acute infections with RS virus among adults was unusually high and there is no evidence so far to indicate such a high frequency of RS infections in any other group of adults. We were unable to demonstrate acute infections with non-Herpesviruses among haemodialysis patients, even though most of the patients were followed over a period of more than 2 years. Virus isolation attempts were performed with samples of urines and biopsy or autopsy samples. 23 out of 28 cytopathic agents recovered from urines, throat-swabs and/or from organs of transplant recipients were identified as CMV. Two HSV type 1, 1 HSV type 2, and 2 Coxsackie B type 3 viruses were also isolated. No viruses were isolated from a series of 31 kidneys randomly selected among autopsy cases.

Antibodies, Viral↗