The future of rural health care. Networks, managed care, and cost-management are key to growth and development.
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Biomedical subjects
Publications and source records attributed to J Lifton.
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Three cases of pulmonary aspergillosis in a "high risk" population of renal transplant recipients are presented. The source of infection was traced to the forced air exhaust system of the Transplantation Unit. Early definitive diagnosis of the infection was very important for effective management. Immunologic monitoring was demonstrated to be instrumental in indicating the early presence of infection, and as a guideline to reduced immunosuppression during therapy. Bronchoscopy with brushings and endobronchial cavitary biopsy were valuable methods for obtaining the infected tissue. Amphotericin B was effective when therapy was started early. Adequate levels of the drug were obtained by varying the dose and frequency of administration according to serum inhibitory titers. Control of infection was aided by immunologic monitoring at regular intervals.
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Blocking antibody directed against donor responding cells has been found to develop in HL-A-mixed lymphocyte culture-identical donor-recipient combinations after renal transplantation in which splenectomy was not performed. Cytotoxic antibody associated with rejection episodes and detected only by the discriminatory mixed lymphocyte culture developed in other HL-A-mixed lymphocyte culture-identical combinations as well. It disappeared as blocking antibody appeared and the post-transplant course became uneventful. In addition, both cytotoxic and blocking activity were shown to develop and coexist in a patient who received two successive renal transplants: cytotoxic against donor 1 (kidney rejected), and blocking against donor 2 (kidney accepted). These findings are taken to be strong evidence in favor of qualitatively demonstrable separate antibody molecules dealing with two separate functions, i.e., cytotoxicity versus enhancement or immunoregulation.
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