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Biomedical subjects

J A Myburgh

Publications and source records attributed to J A Myburgh.

At least 73 records · Page 4Linked to original sources

Immunological compatibility between the chacma baboon and man.

Predictions of an increasing shortage of donor organs for the future has led to a resurgence of interest in xenotransplantation. We have methodically assessed the immunological compatibility of humans against the chacma baboon with a view to narrowing the gap of concordance by careful immunological screening. The necessity of major blood group compatibility in xenotransplantation is now established. While no group O universal donor exists in the baboon, groups A (45%), B (15%), and AB (40%) are well represented. Baboon histocompatibility antigens could not be precisely defined using human antisera. This does not necessarily imply lack of homology between the species, as we have shown specific crossreactivity of numerous antihuman monoclonal antibodies with baboon leukocytes. Normal humans do not exhibit preformed agglutinins to erythrocytes of the chacma baboon (Papio ursinus orientalis)) but cytotoxic antibodies are occasionally found. Sera from allosensitized patients may contain crossreacting hemagglutinins, leukoagglutinins and complement-dependent cytotoxic antibodies. Binding of human immunoglobulin-G and -M to baboon targets was demonstrated by flow cytometry. Negative crossmatch combinations for antibodies of the IgG subclass were easily found, but IgM antibodies from allosensitized patients were polyspecific in their action. In vitro assessment of lymphocyte mediated cytotoxicity showed that preformed cellular immunity between the species was rare. The response of human lymphocytes to xenoantigen stimulation in mixed lymphocyte cultures showed a normal distribution, permitting the selection of low-responding combinations. Screening for viruses, especially HTLV-1 and Coxsackie-BL34, is important. These findings demonstrate a closer degree of concordance than has previously been suspected.

Animals↗

Selective shunts: the Johannesburg experience.

My personal 15-year experience with 141 selective shunts (127 elective, 14 emergency) for portal hypertension is reported. Alcoholic cirrhosis comprised 54% of elective operations, and of the nonalcoholic patients, 22% were cirrhotic and 24% were noncirrhotic. Adequate and, if necessary, prolonged (mean 6 weeks) in-hospital preparation resulted in Hospital mortality and long-term actuarial survival were better in nonalcoholics compared with alcoholics, but there was no significant difference between cirrhotic nonalcoholics and alcoholics. Variceal rebleeding was rare (4% of Warren procedures) and, when present, was usually related to shunt failure. Gastric fundal variceal rebleeding did not occur in 44 patients undergoing splenopancreatic disconnection. Postoperative encephalopathy occurred in 13% of patients; however, it did not occur at all in noncirrhotic patients. Prograde portal venous perfusion was preserved in 77% of patients. Fifteen alternate selective operations to the Warren shunt were performed, usually because of antecedent splenectomy. Shunt failure and variceal rebleeding occurred more frequently with these more vulnerable shunts, but 66% had a satisfactory outcome. Selective shunts have produced highly satisfactory results in appropriately selected patients.

Emergencies↗

An explanation of the noncorrespondence between assessment methods of cyclosporin.

Various methods of determining cyclosporin (CyA) levels in patients after kidney transplantation were compared. These included polyclonal antibody (pcAb-), specific and nonspecific monoclonal antibody (S- and NmcAb-) radioimmunoassays (RIA), and high performance liquid chromatography (HPLC). The results obtained by the various methods when compared showed some correlation but did not correspond. A probable explanation for part of this noncorrespondence is the presence of monoclonally crossreactive metabolites (CyA-M). Another reason was that the concentration of CyA in the standards supplied with the RIA kits was found to be higher than stated.

Antibodies, Monoclonal↗

Time-dependent changes in serum gastrin measurements after parathyroidectomy.

A prospective study involving 7 patients with primary hyperparathyroidism and hypergastrinaemia was conducted to assess the time-dependent change in serum gastrin value before and after parathyroidectomy and to determine at which postoperative stage persistent hypergastrinaemia may be indicative of an associated gastrinoma (Zollinger-Ellison syndrome). Five of the 7 patients had hypergastrinaemia in the early postoperative period. One patient had a strikingly high serum gastrin level pre-operatively (1,500 pg/ml). The mean serum gastrin value declined to within the normal range 6 weeks after parathyroidectomy, except in 1 patient who had a gastrinoma. It is concluded that hypergastrinaemia in patients with primary hyperparathyroidism should only be considered significant if pre-operative gastrin levels are strikingly supranormal and/or levels fail to normalise by the 6th postoperative week.

Adult↗