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Biomedical subjects

R Jaffe

Publications and source records attributed to R Jaffe.

At least 145 records · Page 8Linked to original sources
PubMed1988

Acute humoral rejection of an ABO-unmatched liver allograft in a pediatric recipient.

Acute humorally mediated rejection of organ allografts has long been recognized in kidney transplantation as the syndrome of hyperacute rejection. This reaction precludes renal transplantation across the major blood-group system and in many other instances in which preformed antibodies are present in the host. There is increasing evidence of the importance of humoral rejection in graft survival following liver transplantation. Although the antibodies responsible for this process have seldom been definitively identified, it is clear that the antibodies of the major blood-group system are of particular importance. Humoral rejection of a transplanted liver has not been well documented previously in a pediatric recipient. We present a case illustrating acute hepatic graft failure resulting from circulating anti-B IgM isohemagglutinins following an ABO-unmatched liver transplantation.

ABO Blood-Group System↗
PubMed1988

Endothelial proliferation in paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a disorder of stem cells that is associated with venous thrombosis in multiple organ sites. We present a patient with necrotizing pharyngitis and intestinal infarction who has classic laboratory findings for PNH: positive complement-mediated acid and sucrose hemolysis and absence of decay accelerating factor (DAF) in peripheral blood leukocytes. Histopathologic examination of tissue from tonsil and large bowel demonstrated not only venous thrombosis but unusual proliferation of endothelial cells (papillary endothelial hyperplasia). This has not been described previously. We speculate that the endothelial cell in PNH may share in the defective regulation of complement activity. Venous thrombosis could precipitate or be a consequence of these vascular changes.

Adolescent↗
PubMed1988

Sonographic monitoring of ovarian volume during LHRH analogue therapy in women with polycystic ovarian syndrome.

Polycystic ovarian disease is characterized by menstrual disorders, infertility, obesity, and large ovaries. Large ovaries with multiple cysts are the direct cause of the high incidence of ovarian hyperstimulation during ovulation induction. Lately, gonadotropin-releasing hormone (GnRH) analogues have been employed to decrease ovarian steroidogenesis and thus reduce the incidence of ovarian hyperstimulation. In this study the ovarian size was ultrasonographically assessed during chronic GnRH analogue treatment, revealing a significant reduction in ovarian volume. This decrease in volume results in a reduced incidence of hyperstimulation, and we think the ultrasonic scanning can be effectively used to assess the success of GnRH treatment.

Female↗
PubMed1988

The pathology of posttransplant lymphoproliferative disorders occurring in the setting of cyclosporine A-prednisone immunosuppression.

Posttransplant lymphoproliferative disorders (PTLDs) were diagnosed in 43 patients from the Pittsburgh-Denver series between June 1980 and March 1987. This constitutes a detection rate of 1.7%. Major categories of clinical presentation included a mononucleosislike syndrome, gastrointestinal/abdominal disease, and solid organ disease. The median time of onset in patients initially immunosuppressed with cyclosporine-A (CsA)-containing regimens was 4.4 months after transplant, regardless of tumor clonality. A strong association of PTLD with Epstein-Barr virus (EBV) was observed. A histologic spectrum of lesions from polymorphic to monomorphic was observed. Whereas polymorphic lesions could be either clonal or nonclonal, monomorphic lesions appeared to be clonal in composition. The presence of large atypical cells (atypical immunoblasts) or necrosis did not appreciably worsen the prognosis. Twelve patients had clonal, 13 had nonclonal, and five had both clonal and nonclonal tumors. Clonality was indeterminate in 13 cases. Most patients were treated with a regimen based on reduced immunosuppression and supportive surgery. Almost all nonclonal and about half of the clonal lesions respond to this conservative therapy, indicating that it is an appropriate first line of treatment. This behavior suggests that a spectrum of lesions ranging from infectious mononucleosis to malignant lymphoma constitutes the entity known as PTLD. Some monoclonal tumors can undergo regression, however, apparently in response to host immune control mechanisms. Because of its short latency and strong association with EBV, PTLD is an important model for the study of virus-associated tumor progression in humans.

Adolescent↗
PubMed1988

Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers.

A clinicopathologic analysis of liver transplantation across major ABO blood group barriers was carried out 1) to determine if antibody-mediated (humoral) rejection was a cause of graft failure and if humoral rejection can be identified, 2) to propose criteria for establishing the diagnosis, and 3) to describe the clinical and pathological features of humoral rejection. A total of 51 (24 primary) ABO-incompatible (ABO-I) liver grafts were transplanted into 49 recipients. There was a 46% graft failure rate during the first 30 days for primary ABO-I grafts compared with an 11% graft failure rate for primary ABO compatible (ABO-C), crossmatch negative, age, sex and priority-matched control patients (P less than 0.02). A similarly high early graft failure rate (60%) was seen for nonprimary ABO-I grafts during the first 30 days. Clinically, the patients experienced a relentless rise in serum transaminases, hepatic failure, and coagulopathy during the first weeks after transplant. Pathologic examination of ABO-I grafts that failed early demonstrated widespread areas of geographic hemorrhagic necrosis with diffuse intraorgan coagulation. Prominent arterial deposition of antibody and complement components was demonstrated by immunoflourescent staining. Elution studies confirmed the presence of tissue-bound, donor-specific isoagglutinins within the grafts. No such deposition was seen in control cases. These studies confirm that antibody mediated rejection of the liver occurs and allows for the development of criteria for establishing the diagnosis.

ABO Blood-Group System↗
PubMed1988

Huge mesenteric mucinous cystadenoma in normal pregnancy.

A 36-year-old woman required laparotomy early in the puerperium after a normal delivery because of the presence of a large abdominal cyst. At laparotomy, a large mucinous cystadenoma was found attached to the root of the ileal mesentery; the ovaries were normal. This is the third case of mesenteric cyst published in association with pregnancy, but the first with a mucinous pattern. Pathologic aspects, possible complications, and treatment are discussed.

Adult↗
PubMed1987

Malignant ectomesenchymoma of soft tissue. Report of two cases and review of the literature.

The clinical and pathologic findings of two patients with malignant ectomesenchymomas of soft tissue are reported. Malignant ectomesenchymomas are a composite of ganglion cells or neuroblasts and one or more malignant mesenchymal elements, usually rhabdomyosarcoma. Our first case was composed of ganglioneurosarcoma plus rhabdomyosarcoma, the second composed of neuroblastoma plus rhabdomyosarcoma. The name is derived from the suggestion that they arise from pluripotential ectomesenchyme. An English language literature search revealed 11 other cases that arose in soft tissue and had adequate clinicopathologic data. Of the 13 cases, 10 occurred in infants, three occurred in adults, and nine were males. Six patients were alive and free of disease at last follow-up (range, 0.6-12 years; mean, 3.4 years), four patients had died of tumor (within 0.5-3.3 years; mean, 1.3 years), one case had died of Adriamycin (doxorubicin) toxicity, and two cases had been lost to follow-up. Complete surgical resection is the mainstay of treatment and chemotherapy appears to be important.

Abdominal Muscles↗
PubMed1987

Detection of SSEA-1 on human renal tumors.

Stage-specific embryonic antigen-1 (SSEA-1) was localized on paraffin embedded, formalin fixed specimens of human renal tumors by immunoperoxidase staining using a monoclonal antibody. Of 19 renal cell carcinoma (RCC) samples tested, 12 were positive for SSEA-1; SSEA-1 was also found on distinct elements in two samples of Wilms' tumor. No correlation was found between expression of SSEA-1, and RCC morphology or pattern of growth. Because SSEA-1 is found on proximal tubules in the normal kidney, these results support the hypothesis that RCC arises from the cells of the proximal tubule. Furthermore, since greater than 60% of the RCCs examined expressed SSEA-1, this antigen may prove to be a useful target for immunolocation or therapy of metastatic RCC.

Antigens, Neoplasm↗
PubMed1987

Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy.

Data maintained by medical insurance plans can be used to evaluate the incidence of death and nonfatal complications following medical care, to test hypotheses about the outcomes of care, and to identify hospitals with unusually high or low death rates. These uses are illustrated for prostatectomy, utilizing claims data from the Maine Medicare and Manitoba Health Services Commission files. The study shows important differences in death rates between individual hospitals and higher cumulative probability of reoperation following transurethral compared with open prostatectomy. The advantages of claims data are low cost, ease of patient follow-up over long periods, and the absence of reporting bias. The limitations are the adequacy of the data used to control for patient comorbidity and the lack of outcome information on functional status. The effective use of claims data for monitoring requires the active participation of physicians in improving the data base and interpreting the findings.

Aged↗
PubMed1987

Immunocytochemical localization of lingual lipase in serous cells of the developing rat tongue.

The ontogeny of the rat lingual serous and mucous glands was explored by light and electron immune microscopy using the peroxidase-antiperoxidase and streptavidin-gold techniques. Tissues from fetal and neonatal rats from day 18 of gestation through 4 wk after birth were fixed and embedded in paraffin or Epon for light and transmission electron microscopy, respectively. Electron microscopy revealed that the only cells containing lingual lipase were the developing serous cells; secretory granules containing lingual lipase of varying degrees of maturity were seen. Mucous cells did not show immunospecific staining in rats of any age. The neonatal "mixed" lingual glands secrete lingual lipase from serous components immediately after birth to aid in fat digestion.

Animals↗
PubMed1987

Hepatic infarction and acute liver failure in children with extrahepatic biliary atresia and cirrhosis.

Acute hepatic failure developed in four patients (aged 7 to 13 months) who had extrahepatic biliary atresia treated initially by portoenterostomy. Two were stable outpatients with minimal jaundice, while the other two were hospitalized for metabolic or nutritional complications. Postmortem examination in each patient revealed massive acute hepatic infarction with few surviving hepatocytes. In all cases, the hepatic failure had been preceded by an episode of hypotension and/or hypovolemia. The exact pathogenesis of the infarction remains unclear but it may be related to decreased hepatic blood flow secondary to biliary obstruction. The only effective treatment for these patients is intensive supportive care and urgent liver transplantation.

Biliary Atresia↗
PubMed1987

Use of OKT3 with cyclosporin and steroids for reversal of acute kidney and liver allograft rejection.

OKT3 monoclonal antibody therapy was added to preexisting baseline immunosuppressive treatment with ciclosporin and steroids to treat rejection in 52 recipients of cadaveric livers and 10 recipients of cadaveric kidneys. Rejection was controlled in 75% of patients treated, often after high-dose steroid therapy had failed. Rejection recurred during the 17-month follow-up period, after completion of OKT3, in only 25% of the patients who had responded. The safety and effectiveness of this monoclonal therapy, added to ciclosporin and steroids, has been established in this study.

Adolescent↗
PubMed1987

Correlation between the endocrine profile of ovulation and the ultrasonically detected 'double contour' of the preovulatory follicle.

The exact prediction of ovulation is becoming more important in the management of infertile couples. The routine methods used to monitor ovulation are plasma levels of estradiol and luteinizing hormone, and ultrasonic scanning of graafian follicle diameter. Ovulation is known to occur at a wide range of follicular diameters and it cannot be used as a single predictor of ovulation. In a previous study we described the preovulatory double contour of the dominant follicle occurring a few hours before ovulation. The purpose of this study was to correlate this sign with the hormonal profile to determine whether it can be used as a single parameter in predicting ovulation. The results demonstrate a close relationship between the LH peak and the appearance of the double contour which can be used as a reliable predictor of impending ovulation.

Estradiol↗
PubMed1987

Early detection of cytomegalovirus in the allograft liver biopsy: a comparison of methods.

Cytomegalovirus (CMV) hepatitis can be distinguished from allograft rejection only by biopsy. It is important to document CMV hepatitis early, before inclusions become visible, since antirejection therapy can aggravate the hepatitis. CMV was isolated from 50 patients, 9 of whom had a biopsy-proven CMV hepatitis that was preceded by an apparently uninfected biopsy within 3-33 days (mean = 18 days). A monoclonal antibody to an intermediate early CMV antigen (Chemicon) was compared with a commercially available CMV DNA-hybridization kit (ENZO) for their ability to demonstrate virus in the earlier, apparently uninfected biopsies. All of the biopsies with CMV hepatitis and 3 of the 9 preceding biopsies revealed CMV nuclear antigen in both transformed and nontransformed cells in paraffin-embedded tissues. DNA hybridization revealed viral DNA in the hepatitis biopsies but not in the preceding ones. Thus, in this study CMV was detectable by means of antibody before there was overt histologic evidence of CMV effect. The monoclonal antibody stain was more sensitive, less expensive, and easier to perform and interpret in this study than the DNA hybridization. Demonstration of early CMV antigen is more rapid and sensitive than culture of the liver specimen (which grew CMV in only 3 of 5 attempts) and should be considered in all allograft liver biopsies in which rejection is suspected.

Antibodies, Monoclonal↗