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Biomedical subjects

S Meijer

Publications and source records attributed to S Meijer.

At least 235 records · Page 13Linked to original sources
PubMed1985

The use of cyclosporine only in cadaveric renal transplant recipients: conversion to prednisolone and azathioprine after four months.

After conversion from cyclosporine (Cys) only to prednisolone and azathioprine four months after cadaveric renal transplantation, effective renal plasma flow (ERPF), glomerular filtration rate (GFR) and filtration fraction (FF) all improve. However, this improvement is not uniform. GFR and FF improve in all patients after one week of combined Cys and prednisolone treatment. ERPF improves under the same circumstances only in recipients without previous rejection episodes. After discontinuation of Cys and addition of azathioprine ERPF improves further in all patients. These findings suggest the presence of a low grade rejection, together with Cys nephrotoxicity. The conversion procedure seems to be safe at least during a follow-up period of 9-14 months.

Azathioprine↗
PubMed1985

Classification of amyloidosis: immunohistochemistry versus the potassium permanganate method in differentiating AA from AL amyloidosis.

As systemic AA and Al amyloidosis differ considerably with regard to prognosis and therapeutic approach, it is of importance to make an accurate histochemical classification with regard to the amyloid protein involved. In the present study the results of the potassium permanganate (KMnO4) method, an indirect histochemical procedure based on differences in cross-beta-potential of different amyloid fibril proteins, were compared with the results of an immunohistochemical method utilizing anti-AA and anti-AP antibodies. Renal biopsy sections of patients with systemic amyloidosis related to inflammatory conditions, systemic amyloidosis associated with plasma cell dyscrasia, idiopathic systemic amyloidosis, and nonamyloidotic controls were studied. Positive reaction of anti-AA was observed on all KMnO4-sensitive amyloid deposits, whereas the KMnO4-resistant amyloid deposits remained unstained, provided that highly purified anti-AA antiserum was used. Anti-AP produced not only comparable staining of both KMnO4-sensitive and -resistant amyloid deposits, but also of glomerular basement membranes and elastin layers of blood vessels in amyloid and control biopsies. The intensity of anti-AP reactivity was comparable with the reaction of anti-AA on KMnO4-sensitive amyloid deposits. The present results confirm the specificity of the KMnO4 method, which is a simple method available to every laboratory, in differentiating between AA and AL amyloidosis. Furthermore, the results indicate that, at least in renal biopsy specimens, anti-AP may serve as a general marker for AA and AL amyloid deposition; this finding is in contrast to the results of a recently published report.

Amyloid↗
PubMed1984

Prospective randomised trial of early dietary protein restriction in chronic renal failure.

In a prospective randomised study of 228 patients with various renal diseases, early moderate dietary protein restriction retarded the development of end-stage renal failure. 149 patients were followed up for at least 18 months; the protein-restricted patients showed falls in serum urea and phosphate concentrations and in the 24 h excretion of urea, phosphate, and protein. Regression analysis of the reciprocals of serum creatinine against time showed that the average rate of decrease in reciprocal creatinine was three to five times lower in the protein-restricted groups than in the control groups. These results confirm that moderate dietary protein restriction is an acceptable and effective way of delaying functional renal deterioration. The finding has implications for the management of chronic renal insufficiency.

Adolescent↗
PubMed1984

Acute effects of cis-diamminedichloroplatinum (CDDP) on renal function.

Ten previously untreated patients with metastatic non-seminomatous testicular carcinoma received cis-diamminedichloroplatinum (CDDP). Renal function studies were performed before and following the first CDDP infusion. A decrease in effective renal plasma flow (ERPF) and an increase in filtration fraction (FF) was found in all patients. These findings suggest primary changes in renal hemodynamics during CDDP infusion.

Adult↗
PubMed1984

Is the relative 99mTc-DMSA clearance a useful marker of proximal tubular dysfunction?

The clearance of 125I-sodium iothalamate, 131I-sodium hippurate, 99mTc-DMSA, and beta 2-microglobulin were determined in 20 patients with proven or suspected proximal tubular dysfunction and in 18 control patients with various renal diseases. A clear distinction in the relative 99mTc-DMSA clearance was observed between patients with proximal tubulopathy (14%-35%) and control patients (less than 14%). A similar difference between the two groups was found in the relative beta 2-microglobulin clearance. Nine patients with proximal tubulopathy showed an elevated filtration fraction versus only two control patients. The renal handling of 99mTc-DMSA seems to be an indicator of proximal tubular function.

Adolescent↗
PubMed1984

Serum total bile acids monitoring after experimental orthotopic liver transplantation.

The aim of this study was to evaluate the usefulness of serum total bile acids estimation in monitoring liver allograft recipients. To this end frequent blood samples and simultaneous needle biopsies of the liver were taken after orthotopic liver transplantation in unimmunosuppressed pigs. Serum bile acids were found to rapidly increase during the anhepatic phase of the transplantation procedure and to decrease after implantation of the liver graft. A normal serum bile acids level in the early postoperative phase was indicative of a technically successful transplantation procedure. A total of 28 successful transplantations was performed. Six recipients accepted the allograft without any histological sign of rejection. In 18 pigs the liver was rejected, the survival time of these animals ranged from 6 to 80 days. Four animals showed a transient rejection episode during the first months after transplantation. In nonrejecting animals serum bile acids remained undisturbed during the entire 4-month study period. In all cases of rejection serum bile acids promptly increased to very high levels of 100 to 700 mumol/liter (reference range 1 to 14 mumol/liter). Serum bile acids were found to be superior to standard liver function tests in detecting the process of liver rejection at an earlier stage. These results indicate that serum total bile acid estimation is a simple and useful test to monitor liver allograft recipients.

Animals↗
PubMed1984

Liver allograft rejection in pigs: histology of the graft and role of swine leukocyte antigen-D.

The porcine liver is often considered an immunologically privileged organ as liver allografts in unrelated pigs can survive without any form of immunosuppression. When donor and receptor animals were mismatched for swine leukocyte antigen-D (SLA-D) antigens as tested in mixed-lymphocyte culture (MLC), liver allografts were rejected in all but one of the 14 cases studied. In contrast, from the 10 animals receiving a liver from an MLC-matched donor 8 survived without any significant sign of rejection. The diagnosis of rejection was made by histologic examination of serial needle biopsies of the liver. Based on survival time and histological type of cellular infiltrate an early and a late form of rejection could be distinguished. The early form, with a survival time from 6 to 10 days, was characterized by lymphocytic infiltration of the portal tracts and the liver parenchyma. The late form, with a survival time ranging from 15 to 80 days, showed a lymphocytic and plasma cellular infiltration of the portal tracts. These results show that the outcome of liver allotransplantation in pigs is strongly dependent on SLA-D histocompatibility. It is concluded that porcine liver allografts are under immunological control.

Animals↗
PubMed1984

Pneumatosis intestinalis in patients after cadaveric kidney transplantation. Possible relationship with an active cytomegalovirus infection.

Four patients are described with pneumatosis intestinalis following cadaveric kidney transplantation, all with severe cytomegalovirus (CMV) infection. Two patients had a primary infection and 2 patients had a reactivation of CMV. One patient died because of disseminated CMV infection. Multiple inclusion bodies were found at postmortem examination in lungs and liver, and at the site of the ulcers in the gastrointestinal tract. Two patients had, concomitantly, an active, nonobstructive duodenal ulcer. In a control population of 17 patients who suffered from a duodenal ulcer post-transplant without any evidence of CMV-infection, we could not demonstrate pneumatosis intestinalis. We suggest a possible causal relationship between pneumatosis intestinalis and active CMV infection. The mechanisms that could be responsible for this relationship are discussed.

Adult↗
PubMed1984

Cyclosporin A in orthotopic porcine liver transplantation. Long-term survival after short-term treatment.

The aim of this study was to evaluate the efficacy of cyclosporin A (CyA) in prolonging graft survival after orthotopic porcine liver transplantation in mixed lymphocyte culture (MLC) mismatched couples. CyA was given intramuscularly for a period of 21 days, starting on the day before transplantation. In order to study the fate of the graft, frequent liver biopsies and blood samples were taken after transplantation. 4 pigs received CyA at a dose of 10 mg/kg/day, and 10 animals were treated with 20 mg/kg CyA per day. In the low-dose group 1 pure plasma cellular rejection was noted, while the grafts of 2 pigs showed a transient plasma cellular infiltration in the portal tract. By doubling the dose, only 1 out of 10 animals rejected the liver graft. The livers of the other 9 animals did not show any noteworthy histological sign of rejection, and also the liver function tests were normal. Total serum bile acids and routine liver function tests remained undisturbed in animals that accepted the MLC-mismatched graft and increased in cases of rejection. No nephrotoxicity was noted due to CyA treatment. The main complications encountered were infections leading to death in 4 CyA-treated pigs, while the liver graft was functioning well. Short-term treatment with CyA can overcome the rejection of a MLC-mismatched porcine liver graft and induces a state of long-term acceptance.

Animals↗
PubMed1984

Phytohemagglutinin skin test for the immunological assessment of the surgical patient.

The use of phytohemagglutinin (PHA) as skin test agent was investigated. The test was performed in 42 healthy individuals and in 32 patients with malignant disease undergoing surgery. To establish immunosuppression in the direct postoperative period 15 patients undergoing cholecystectomy were tested sequentially. All healthy adults had a positive delayed response. No systemic or permanent local reactions were encountered. In healthy adults the PHA skin test had no influence on the in vitro PHA blastogenesis, the number of leukocytes, lymphocytes and E-rosette-forming cells. A reversion of the immunosuppressed state to normal in some cancer patients upon surgery was substantiated as well. The PHA skin test is an easy and a reliable method to give an impression of the immune response of surgical patients. It has many advantages above the commonly employed primary and secondary antigens.

Cholecystectomy↗
PubMed1984

The role of A-O-incompatible blood transfusions in porcine orthotopic liver transplantations.

The consequences of administrations of A-O-incompatible blood transfusions during porcine orthotopic liver transplantations (OLT) are described. Two series, both subjected to the same standard procedure except for the administration of compatible or incompatible blood, are compared. The striking differences in peroperative and direct post-operative morbidity, mortality, and causes of death between the two series are presented. Although not generally applied, blood transfusions in experimental surgery should undergo the same precautionary measures as blood transfusions in humans.

ABO Blood-Group System↗
PubMed1984

Anaesthetic management in experimental orthotopic liver transplantation in the pig.

Anaesthesiological experiences are described with 103 porcine orthotopic liver transplantations. The animals were operated in neurolept anaesthesia. After premedication and induction, fentanyl and pancuronium were administered as a continuous infusion until hepatectomy was completed. Haemodynamic and metabolic changes during the procedure were monitored. Metabolic acidosis should be avoided by administration of sodium bicarbonate before declamping. Corrections of alterations in serum electrolytes and in blood glucose levels seem to be unnecessary. These above-mentioned observations have led to a safe anaesthetic procedure and management in experimental orthotopic liver transplantation.

Anesthesia, General↗
PubMed1984

Influence of platinum-induced renal toxicity on bleomycin-induced pulmonary toxicity in patients with disseminated testicular carcinoma.

Pulmonary function tests, including T1CO, and renal function tests were performed and GFR and ERPF measured in 18 patients with disseminated testicular non-seminoma before and after remission induction according to the Einhorn regimen. We found a significant positive correlation between delta GFR and delta T1CO (p less than 0.05). No significance could be demonstrated between delta ERPF and delta T1CO. It is concluded that caution should be exercised in administrating bleomycin to patients with severely impaired renal function.

Adult↗
PubMed1984

Surgical treatment of pseudocysts of the pancreas--guidelines for management.

From 1968 to 1983 123 patients were admitted with a diagnosis of pancreatitis; in 28 patients a pseudocyst developed. To evaluate results of surgical therapy a study of the literature and a chart review were performed. From this study we conclude that asymptomatic patients with a pseudocyst of 4 cm or less in diameter can initially be treated expectantly. If the pseudocyst is larger than 4 cm in diameter and in those cases where the cyst shows no tendency to spontaneous resolution, operative intervention seems mandatory. If no complications occur, surgery is postponed until six weeks' observation to allow maturation of the cyst and facilitate cystenteric anastomosis. In pseudocysts related to blunt abdominal trauma, endoscopic retrograde cholangiopancreatography (ERCP) should be performed. If ERCP reveals a major duct lesion, resection should be considered.

Adolescent↗