The Banff classification of renal allograft pathology: where do we go from here?
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Biomedical subjects
Publications and source records attributed to S Olsen.
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Cellular DNA contents of consecutive hydatidiform moles were analysed by flow cytometry of unfixed samples, freed of maternal tissue and treated with detergent and trypsin, using two external controls. DNA-diploidy was found in 62 moles, DNA-triploidy in 42 and DNA-tetraploidy in one. Two non-molar placentas and two invasive moles were found to be DNA-diploid. In 28 of 42 DNA-triploid moles, trophoblastic hyperplasia was not noted, making the discrimination between vesicular abortions with or without trophoblastic hyperplasia unwarranted on genetic grounds. A good fit was obtained to a distribution with one G0-1 peak in 49 cases, whereas 60 cases showed two peaks. Technical artifacts, created by flow cytometry, were excluded. Differences in the nuclear accessibility for the dye and degradation of DNA are unlikely causes of this heterogeneity. The existence, in vivo, of two or more cell populations with different DNA contents is a reasonable explanation. The criteria for persistent trophoblastic disease were standardised. Eight cases of persistent trophoblastic disease were observed among the 62 DNA-diploid moles (13%); no case was observed after DNA-triploid or DNA-tetraploid moles. Combining these data, with those of other studies where ploidy was determined using optimal techniques [10,13], allows the calculation of 95%-confidence-limits for the risk of persistent trophoblastic disease after a triploid mole to 0-2.7%.
Endocapillary glomerulitis is characterized by an increase in number of mononuclear cells in the glomerular capillary lumina. This lesion has been described in the early posttransplant period, but its pathogenesis, relation to conventional rejection, and prognostic impact is not well known. Using the definitions, scorings, and gradings of the Banff system for classification and grading of histopathologic changes in the renal allograft, we have analyzed 444 consecutive renal allograft biopsies from the first 90 days posttransplant. Moderate or severe glomerulitis occurred in 13.5% of the biopsies. There was a strong tendency toward clustering of glomerulitis: if one biopsy from a patient had glomerulitis, there was a high probability that it occurred in other biopsies from the same patient. There was some correlation with conventional acute rejection, but 40% of all biopsies with glomerulitis had no rejection and 53% of all biopsies with rejection had no glomerulitis. Graft function at biopsy was nil or decreased in many patients, but this could largely be explained by the independent presence of primary graft dysfunction or conventional rejection, these conditions being a frequent indication for performing a graft biopsy. Moderate or even severe glomerulitis was, however, compatible with a functioning graft. No correlation between glomerulitis and active CMV infection was found. The one-year graft survival of grafts with early posttransplant glomerulitis was 66%. If early conventional acute rejection is taken into consideration, graft survival does not seem to be influenced by the presence of glomerulitis. Early posttransplant endocapillary glomerulitis may be a peculiar pattern of rejection with a pathogenesis different from that of conventional rejection, but the present investigation does not demonstrate any adverse effects on graft function or graft prognosis.
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A semiquantitative light microscopic study of 274 renal biopsy and 12 nephrectomy specimens was carried out to assess the frequency and severity of tubulitis (mononuclear leukocytes in the renal tubular wall) in all common glomerular diseases, diabetic nephropathy, renal amyloidosis and renal artery stenosis. The extent of interstitial inflammatory infiltrates and severity of interstitial fibrosis were also graded. Tubulitis was 1) frequent in crescentic glomerulonephritis (GN) with pauci-immune, linear and granular immune deposits, renal artery stenosis, diabetic nephropathy, lupus GN of WHO type IV, and IgA GN; 2) rare in minimal change and idiopathic membranous nephropathy; 3) usually severe in crescentic GN and renal artery stenosis; and 4) predominantly located in atrophic tubules in renal artery stenosis, diabetic nephropathy and IgA GN. The most important parameter for the grading of tubulitis was interstitial infiltration. However, no correlation was found between the grades of tubulitis, interstitial infiltrates and interstitial fibrosis in crescentic and lupus GN. It is suggested that renal ischemic injury, by eliciting expression of proinflammatory cytokines and neo-antigens in the tubulointerstitial space, might play a role in the development of tubulitis in vascular and glomerular renal diseases.
Pure-tone Reference Equivalent Threshold Sound Pressure Level (RETSPL) of the ipsilateral stimulus receiver for acoustic reflex measurements on Madsen Electronics type Zodiac 901 impedance audiometer is provided. The results, obtained from 20 normal-hearing subjects, are achieved by comparing hearing threshold levels measured using a TDH 39 telephone (calibrated to ISO 389) with thresholds recorded using the ipsilateral stimulus insert phone. The calibration is referenced to an IEC-711 ear simulator and comprises the following frequencies: 125, 250, 500, 750, 1000, 1500, 2000, 3000, 4000, 6000, 8000 Hz.
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The authors report three cases of peritoneal dialysis catheter obstruction in children. The catheters were successfully cleared by a combination of urokinase and Fogarty catheter manipulation. This technique can be used to clear fibrin and omentum from obstructed peritoneal dialysis catheters.
The inter-observer variation of the WHO classification of glomerulonephritis (GN) was studied using Kappa statistics. One hundred renal biopsies were selected with almost equal representation of the following types of GN: minimal change nephropathy, membranous GN, focal proliferative GN, diffuse mesangial proliferative GN, endocapillary GN, membranoproliferative GN, and crescentic GN. Slides stained with silver-methenamine and PAS-hematoxylin were circulated among the members of the panel, who made their diagnoses without knowing those of the other participants and without knowledge of the clinical conditions. There was a very good overall diagnostic agreement of 0.67 with a Kappa value of 0.61, figures which compete very well with other diagnostic systems analysed with Kappa statistics. Analysing the single types of GN, we found that the highest Kappa values were obtained for crescentic GN (0.81), endocapillary GN (0.79) and membranous GN (0.74) and the lowest Kappa values for membranoproliferative GN (0.40) and diffuse mesangial proliferative GN (0.44). Basically, the international classification of GN is founded upon light microscopy. Our results demonstrate that this system works generally well. The diagnostic reproducibility of the types with less satisfactory Kappa values can be expected to be improved by including immunopathology and electron microscopy.
Condylomata in the urethra usually occur as a complication to genital warts on the external genitals and are most often situated in the distal part of the urethra. This is a report of a male patient with recurring papillomatous transitional cell tumors, stage Ta and T1, grade 2 and 3 in the bladder and the right ureter, who presented with extensive condylomatosis in the urethra from the meatus to the verumontanum, without simultaneous presence of condylomata at the external genitals. Condylomatous fragments were also present in the TUR specimen from the bladder, but may have been displaced from the urethra during cystoscopy. Using PCR technique and in situ hybridisation, HPV types 6/11 were detected in the condylomata, but no virus was present in the transitional cell tumors.
The occurrence of a congenital neurological disorder "spinal dysmyelination" in cross-bred calves in Denmark is reported. A total of 36 affected calves of the Red Danish Dairy breed X American Brown Swiss were detected. The calves occurred in a clear familiar pattern consistent with an autosomal recessively inherited trait, and the parents could be traced to a common ancestor. Clinically the disease was characterized by congenital lateral recumbency, opisthotonos, extension of the limbs, normal to increased reflexes, and normal alertness. At histological examination dysmyelination occurred constantly in specific spinal tracts.
We developed an experimental in vitro model of dental plaque to assess the potential efficacy of antiplaque agents. The model used a chemostat, which provided a continuous source of 5 species of oral bacteria grown in an artificial "saliva-like" medium. This mixture was pumped through six flow cells, each containing two types of surfaces on which plaque formed and was subsequently measured. Formation of bacterial plaque on hydroxyapatite surfaces was assessed by measurement of the DNA and protein content of the plaque film. The amount of bacterial plaque formed on germanium surfaces was measured by attenuated total reflectance (ATR/FT-IR) spectroscopy. Plaque viability was also assessed by a fluorescent staining technique. The quantity of plaque formed on both types of surfaces gradually increased with the duration of flow (from 24 to 72 h) through the cells during a 72-hour experimental period. The flow cells were then pulsed with experimental treatment solutions for 30 s, twice daily. Parallel to results of human clinical studies, the model was capable of discriminating among water, a placebo mouthrinse, and an active antimicrobial mouthrinse formulation containing 0.03% triclosan. It therefore offers a valuable alternative to animal model testing and allows for more rapid evaluations under well-controlled experimental conditions.
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A dentifrice containing triclosan/PVM/MA, copolymer/NaF (Total) combination was compared with dentifrices containing triclosan without the copolymer system. A variety of laboratory, animal and human studies indicated that Total provided higher uptake and retention of triclosan on teeth, and was more effective in reducing plaque in chemostat and flow cell models. The retention of triclosan in dental plaque was significantly higher with Total as compared with other dentifrices 2 hours post brushing. The triclosan retained in the plaque after using Total was effective against plaque bacteria for up to 12 hours. Other dentifrices did not provide a sustained antibacterial effect against plaque. The results indicated that the delivery system with the copolymer significantly enhanced the efficacy of triclosan against plaque, gingivitis and plaque related diseases in vivo.
Although frequently considered synonymous with acute tubular necrosis, acute renal failure may be brought about by primary disease in any of the four histologic components of the kidney: glomerular, tubular, interstitial, or vascular. It is reasonable to ask whether our current classification system of renal pathology and descriptive approach to renal biopsy interpretation in this setting is optimal. Assessment of renal transplant biopsies performed in the setting of acute dysfunction is becoming much more quantitative, therapy-oriented, pathogenesis-based, and standardized. It would be highly beneficial to the field if similar changes occurred in the approach to native kidney biopsies in acute renal failure. Tighter linkage should be established between promising new developments in the research laboratory and the clinical practice of renal pathology with creation of therapy-oriented classifications which employ standardized quantitative lesion assessment. In a field largely limited to traditional empirical therapies, new pathogenesis-oriented therapeutic approaches to native kidney acute renal failure and allied conditions should be developed based on the products of enlightened renal pathology research.