Blocking factors and successful live related donor renal allografts.
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Biomedical subjects
Publications and source records attributed to J E Castro.
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The effects of orchidectomy on the structure and function of lymphoid tissues in mice have been studied. Both pre- and postpuberal orchidectomy caused relative hypertrophy of the thymus. There was also an increase in size of peripheral lymph nodes to reach a sustained maximum (6 weeks). Sychronous thymectomy and orchidectomy prevented the lymph node enlargement that follows orchidectomy alone. Enlargement of the thymus was due to increased numbers of thymocytes, and it could be abrogated by administration of androgens. Orchidectomy was associated with an acceleration of rejection of skin allografts which was prevented by androgen administration and abrogated by antilymphocyte serum. The reactivity of orchidectomized mice to sheep red blood cells and the early response to oxazolone, which is limited by thymus-processed cells, was increased, whereas production of antibodies to oxazolone, skin allografts, and pneumococcal polysaccharide was unchanged. It is suggested that orchidectomy increases cell-mediated immune responses but has no direct effect upon responses that are mainly dependent on B cells. Orchidectomy prolongs the interval between the subcutaneous injection of methylcholanthrene and the appearance of subcutaneous sarcomas. In tumour transplantation experiments orchidectomy casued protection against the Meth A tumour grown in ascitic or subcutaneous form. This protection was counteracted by antilymphocyte serum and partially countered by adult thymectomy combined with orchidectomy. In contrast, the appearance in AKR mice of spontaneous leukaemia, a tumour known to be thymus dependent, was increased after orchidectomy. The results of experiments with hypopituitary mice suggested that the effects of orchidectomy on immune response result from androgen withdrawal rather than interference with the hormonal milieu.
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In recipients receiving oral azathioprine (50 mg. a day) the fate of skin grafts taken from live human prospective kidney donors correlates well with the outcome of kidney transplantation from the same donors. Correlation between the fate of skin grafts and HL-A serotyping is not nearly as good except in the case of complete HL-A identity. There is little or no correlation between the mixed-lymphocyte-culture test and the fate of skin grafts and the outcome of kidney transplantation. When the degree of compatibility does not exceed one haplotype the results of live human-kidney transplantation can be significantly improved if the fate of a preliminary skin graft from the prospective kidney donor is used as an index.
A study of 26 patients with primary hemospermia has been made. When primary hemospermia was the only symptom, urologic investigation was normal. It appears that such patients do not require detailed investigation whereas those presenting with hemospermia and other urologic symptoms require further investigations appropriate to those symptoms.
A case of horseshoe kidney complicated by hydronephrosis, renal calculi, urinary infection, and tumor of the renal pelvis is reported. The incidence and etiology of the complications are discussed and the frequency of tumors in horseshoe kidneys described.
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Orchidectomy caused a non-specific increase of immunological reactivity in mice evidenced by accelerated rejection of skin allografts, increased response to oxazolone and sheep erythrocytes. These changes were associated with an increase of thymic size. The response to pneumococcal polysaccharide, which depends upon B-cells, was not increased. Orchidectomised mice showed protection against induced methylcholanthrene sarcomas and transplantable tumours; tumours which are not obviously hormone dependent.
The responses to several skin test antigens of patients with bladder or prostatic cancer has been compared with responses of normal controls. All of the controls and all of the patients with prostatic cancer (irrespective of the stage of the tumour or the method of treatment) showed responses to dinitrochlorbenzene. 80% of all patients with bladder cancer responded to DNCB, but a highly significant number of patients with advanced disease showed no response. This test appears especially useful in predicting the prognosis in patients with bladder tumours and its routine use is recommended. Response to candida extract, streptokinase/streptodornase (SKSD) and purified protein derivative (PPD) were also studied. No conclusion could be drawn as to their value as a prognostic index.
Two patients with cyclophosphamide induced cystitis and co-existent bladder tumour are described. Possible mechanisms for these associated diseases are discussed and the difficulty of diagnosing bladder tumour in patients with haemorrhagic cystitis is stressed.
Ileal urinary diversion has been carried out on 8 occasions in 7/215 kidney transplant patients. In six instances the diversion was required either because the bladder had previously been removed or there was gross abnormality of the outflow tract: in 2 it was successfully employed to deal with difficult post-transplantation urinary fistulae. 4 patients died: 3 within 2 months and 1 at 9 months after the operation. Infection with organisms indistinguishable from those cultured from the ileal loop, was a common complication and, although there were other significant factors which contributed to the mortality, retrospective consideration suggests that energetic prophylactic antibacterial therapy should be instituted when kidney transplantation with ileal urinary diversion is undertaken.
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