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Biomedical subjects

U Nydegger

Publications and source records attributed to U Nydegger.

At least 37 records · Page 2Linked to original sources
PubMed1991

High-dose intravenous IgG treatment and renal function.

In an open trial of high dose intravenous IgG (IVIG) treatment in nephrotic patients with glomerulonephritis, the first six patients so far studied showed a transient rise in plasma creatinine. This increase was not associated with any symptoms and the urinary deposit remained unchanged. Two other patients with pre-existing renal impairment but without nephrotic syndrome had a transient and reversible rise in plasma creatinine immediately after IVIG. These observations suggest that high-dose IVIG infusion can produce short-lived disturbances in renal function in patients with kidney diseases.

Adult↗
PubMed1991

Fluctuation of anti-A and anti-B histo-blood-group antibodies in a patient after liver transplantation.

The concentrations of anti-A and anti-B IgM and IgG antibodies have been studied in the serum of a patient with blood group AB who received a type A donor liver. A newly developed ABO-ELISA was used for this purpose and the values were compared to hemagglutination titers. During the postoperative study period over 8 weeks, the anti-A and anti-B levels showed a higher fluctuation than was measured in preoperative samples. Thus, in this AB-type patient, anti-A IgM varied 10-fold, anti-A IgG 20-fold and anti-B IgG 16-fold. Peak values corresponded to rejection episodes. Immunoactivation in the patient was further documented by the presence of abnormally high levels of soluble interleukin-2 receptors (sIL-2R) in serum samples. The study shows that monitoring of anti-A/B antibodies may represent a further criterion to follow-up transplanted patients during the critical postoperative graft acceptance period.

ABO Blood-Group System↗
PubMed1991

[Orthotopic liver transplantation at the Island Hospital. Initial experiences 1985-1990].

Between 1985 and 1990 22 orthotopic liver transplantations (OLT) were realized in 19 patients. Active infection and diffuse splanchnic venous thrombosis were the only contra-indications to the intervention. Sixteen patients were transplanted electively; three had to be retransplanted urgently. Three patients had an urgent primary transplant. The incidence of surgical complications related to liver implantation was fair. One patient (5%) developed a late portal vein thrombosis; another patient (5%) had to be retransplanted because of hepatic artery thrombosis. All patients presented one or more major postoperative complications. All, but one, patients had a rejection of the allograft; five of them needed treatment with mono- or polyclonal antilymphocytic sera to reverse the rejection. One patient was retransplanted because of a hyperacute rejection. The six-month survival in this series is 68.5% (13 of 18 patients); one patient died 7 months post-OLT due to a neurological complication of her Wilson disease. Quality of life (from 6 to 64 months post-OLT) is excellent in the 12 long-term survivors. This small experience of the Bernese transplantation program shows that liver transplantation is a safe surgical procedure allowing excellent quality of life in a majority of patients.

Adult↗
PubMed1991

[Effects and side effects of intravenous gamma globulin I: the problem of immune complex formation].

This is an original contribution to the side effects of i.v. gamma globulin in patients with immunodeficiency. 73 therapies were carried out, 9 patients suffered from partially life-threatening complications. All side effects were fully reversible and occurred during the transition from antigenaemia to antibody-excess. Immunecomplexes could be quantified and C4 decreased. In view of these results we have modified our protocol giving 5 S prior to 7 S. No further complication was seen in the following 148 therapies. Hence we can conclude, that at least some complications of the i.v. gamma globulin-therapy is due to the formation of immunecomplexes and can be prevented by the application of 5 S prior to 7 S.

Adolescent↗
PubMed1990

[Quantitative and qualitative analysis of various blood-preserving measures in heart surgery].

We assessed quantitative aspects of blood salvage retrospectively in 270 consecutive coronary bypass patients over one year. They were assigned either to group A (n = 10, Cellsaver [Haemonetics]), B (n = 189, centrifugated oxygenator blood), C (n = 107, retransfusion of shed mediastinal blood) or D (n = 74, combination of method B and C). In addition, blood quality was studied prospectively in group A (n = 5), B (n = 10) and C (n = 10) and each group compared to a control group. Results (mean values/patient) were: Blood salvage with A yielded 570 +/- 230 ml (hematocrit = 50%), B 509 +/- 156 ml (69%) and C 593 +/- 430 ml (26%). The required homologous blood products, i.e. packed cells (PC) and fresh frozen plasma (FFP) diminished significantly when combined autologous blood salvage was used (PC 6.0 +/- 3.4 vs 3.4 +/- 1.9, p less than 0.05; FFP 3.4 +/- 3.8 vs 2.6 +/- 3.0). Autologous erythrocyte function assessed by 2,3DPG was normal in all three methods (range 14.77-16.03 mumol/gHb). ATP was nearly normal in A (3.34 +/- 0.45 mumol/gHb), reduced by 20% in B (3.21 +/- 1.14 mumol/gHb) and by 30% in C (2.56 +/- 0.78 mumol/gHb) compared to the corresponding preoperative patient value. Hemolysis (free plasma hemoglobin) (was elevated in A (63 +/- 7 mg/dl), B (202 +/- 57 mg/dl) and C (211 +/- 44 mg/dl). However, no increase of free plasma hemoglobin was encountered in our patients after retransfusion of either A, B or C. No side effects were detected and bacteriology remained negative in all examined blood samples in C.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1990

[Retransfusion of thoracic drainage blood: qualitative analysis].

In a prospective randomized study 10 patients received their shed mediastinal blood after elective coronary artery bypass surgery and were compared to 10 control patients without retransfusion. The quality assessment can be summarized as follows (mean +/- 1 SD): 1. Hemoglobin concentration of the shed blood was 9.6 +/- 1.45 g/dl. 2. The energy rich phosphate compounds of the shed blood erythrocytes were 2.6 +/- 0.8 mumol/gHb ATP (70% of the patients preoperative value) and 14.8 +/- 4.2 mumol/gHb 2.3-DPG (normal). 3. Proteins, immunoglobulins and especially albumin in the shed blood were not significantly different from the patients own values. 4. No electrolyte changes, safe for a slight increase in potassium (5.7 +/- 0.7 mmol/l). 5. The activated clotting time of the patient did not change during retransfusion. 7. Plasma free hemoglobin was elevated to 211.1 +/- 44.3 mg/dl in the shed blood; however, no significant increase could be noted in the retransfused patients and no hemoglobinuria occurred. Postoperative retransfusion of shed mediastinal blood is a simple and safe method of autologous transfusion early after cardiac surgery and should be combined with other methods of blood salvage. The qualitative advantages of blood retransfusion consist in the absence of storage damage and in the preservation of autologous proteins and immunoglobulins.

Blood Chemical Analysis↗
PubMed1990

[Current overview of diagnostic possibilities of complement analysis].

The complement system is composed of at least 21 serum proteins and 8 cell surface receptors sensitive to complement components or their fragments. Qualitative and quantitative analysis of complement components in clinical samples has become standard procedure in many laboratories thanks to the availability of easy-to-perform test kits. However, interpretation of results is still a task that requires great skill and the situation are rare, in which analysis of the complement system goes beyond diagnosis into therapeutic consequences. The present paper is an update of previous similar reviews now available in the international literature; in addition, the author attempts at bringing the often complicated world of complement and clinical practice together and thus contributes to answering the question: what should the clinician know about complement?

Antigen-Antibody Complex↗
PubMed1988

[Platelet-associated immunoglobulin G (PAIgG) and circulating immune complexes in asymptomatic and symptomatic HIV-seropositive patients].

Circulating immune complexes and platelet associated immunoglobulins G (PAIgG) were measured in 14 clinically asymptomatic and 9 diseased HIV infected subjects and compared to their platelet counts in the peripheral blood. In both groups, circulating immune complexes were found to be increased even in the presence of normal platelet counts. Increased PAIgG levels were found in symptomatic HIV infected subjects, along with thrombocytopenia. This study indicates that the mere occurrence of circulating immune complexes is an insufficient finding for induction of thrombocytopenia. Either the molecular composition of the complexes is different in both patient groups, or the thrombocytopenia is induced by additional platelet damaging compounds, e.g. specific antiplatelet antibodies induced by the viral infection.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Pathophysiological aspects and clinical indications for plasma exchange treatment].

After a rather long initial period fraught with difficulties, plasma exchange has become an adjunct to the treatment of numerous diseases in medicine, such as hyperviscosity syndrome, where it alleviates disease symptoms, hemophilia due to inhibitors to clotting factor VIII, thrombotic thrombocytopenic purpura, rapidly progressing and Goodpasture glomerulonephritis, myasthenia gravis and Guillain Barre syndrome. As yet there are no formal indications for plasmapheresis, i.e. randomized placebo controlled studies are rare and proof of efficacy is often based on clinical criteria only. Therefore this treatment may be a transient means of removing noxious substances from plasma, giving way to more specific apheresis procedures such as plasma filtration, cascade filtration or immunoadsorption over charcoal or over solid-phase bound antibodies against the substance it is desired to remove. The present study presents the various plasmapheresis techniques, outlines the pathophysiological background to this treatment and adopts the now standard classification of indications into hematological, nephrological, neurological and miscellaneous indications. The English speaking reader will find an updated reference list of work published mainly in that language.

Absorption↗
PubMed1986

Biocompatibility of different hemodialysis membranes: activation of complement and leukopenia.

The ability of three hollow-fiber dialyzers (Cuprophane [CU], polymethylmethacrylate [PMMA], and polyacrylonitrile [PAN]) to activate complement and to induce leukopenia was studied prospectively in six patients on long-term hemodialysis. CU membranes caused the most intense complement activation with C3a, C3d, and C5a levels peaking 15 min after beginning dialysis. Total white blood cell (WBC) counts dropped simultaneously by 76%, and the decrease in leukocytes was inversely correlated with the levels of C3a and C5a. In contrast, PMMA membranes led only to slight complement activation with an associated fall in WBC counts of 29%, and PAN membranes induced very little complement activation without leukopenia. In vitro studies involving incubation of normal human plasma with each of the three membranes corroborated these findings. The results suggest that the biocompatibility of PMMA and PAN dialyzers is superior to CU.

Acrylic Resins↗
PubMed1983

[The role of complement and specific antibodies in the development and defense mechanism of sepsis and septic shock].

Sepsis, abscess formation or development of purulent exudates in closed cavities expresses insufficient host defense against pyogenic infections. An attempt is made to analyse the reasons for diminished host resistance and/or increased virulence of the invading microbes. While the role of cellular defense mechanisms is not considered, a number of humoral components, such as lysozymes glycolipids, lactoperoxidase, fibronectin, esterases and haptoglobin, participate in efficient defense. Special emphasis is placed on serum complement, both with regard to its unspecific but nevertheless efficient alternative pathway, and with respect to its phylogenetically much more recent classical pathway. Recognition of bacteria by either mechanism of complement activation leads to C3b deposition on the microbial surface for efficient opsonization, while the juxtaposition of at least two molecules of antibodies contained in the immunoglobulin fraction of plasma safely leads to complement activation via the classical pathway. Therefore, specific recognition of bacteria by immunoglobulin-antibodies remains the core of anamnestic antimicrobial defense, the more so since some antibodies may also confer on the bacterial surface the capacity to activate the alternative pathway. The recent description of monoclonal antibody directed at bacteria relevant in sepsis opens perspectives in the near future when such components will eventually be used for therapeutic purposes, along with antibodies also directed towards the pathogenetic bacterial products endo- and exotoxin.

Antibodies, Bacterial↗
PubMed1982

Deficient phagocytosis secondary to breakdown of opsonic factors in infected exudates.

Pleural empyema, a clinical entity characterized by the simultaneous presence of large number of PMNLs and viable bacteria, is a biological paradox which has not been fully explained yet. Our preliminary studies suggest that receptor and bactericidal functions of PMNL isolated from purulent exudates, can be close to normal in this condition. Supernatants of these empyemas however have been shown to be low in heat labile opsonic activity and complement hemolytic activity. These observations have been extended by the demonstration of breakdown of IgG, C3 and factor B in infected pleural effusions as opposed to pleural fluids obtained under other conditions. The breakdown of Ig and C3 seems to be enzymatic and to occur, at least for C3, even in the absence of Ca and Mg ions: thus, direct cleavage of C3, possibly by PMNL enzymes, has to be postulated to explain these results. Present work in our laboratory is trying to explore this possibility.

Abscess↗