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Biomedical subjects

W Land

Publications and source records attributed to W Land.

At least 217 records · Page 12Linked to original sources
PubMed1983

Renal changes in cytomegalovirus infection.

Renal biopsy was performed in 20 graft recipients to characterise the histological features associated with poor renal function concomitant with cytomegalovirus infection (CMV). Eight patients presented with proteinuria, three had microscopic haematuria at onset, and five were hypertensive. Infection was accompanied by clinical symptoms (fever, leucopenia, mild hepatic damage, or pneumonitis) in 15 patients. In all cases, serum creatinine was greater than 2 mg/dl. All patients showed some glomerular alteration on biopsy, and vascular changes were the predominant feature in seven cases. IgM and complement (C3) were found in the glomeruli of five of six patients studied by immunofluorescence. Serum creatinine was below 2 mg/dl at ten to 26 months following the infectious episode in four patients and between 2-3 mg/dl in three patients. The remaining 13 developed irreversible rejection and end-stage renal failure. We conclude that CMV, the most commonly recognised viral infection following transplantation, can cause renal changes, both glomerular (CMV glomerulopathy) and vascular (transplant vasculopathy), which may induce poor graft function.

Antibodies, Viral↗
PubMed1983

Pancreatic grafts. Nuclear perfusion imaging to detect vascular complications and rejection crises.

Perfusion studies with 99m-Tc-DTPA were used routinely to investigate renal grafts. Efforts were made to employ this technique in monitoring the perfusion of pancreatic grafts. A total perfusion failure is as reliably detectable as in renal grafts. Smaller perfusion alterations could be demonstrated by follow up studies. It appears to be feasible to differentiate the salivary edema, well known from animal experiments, from a rejection reaction with the help of other parameters (e.g. creatinine). Further clinical studies, however, are necessary to confirm these results.

Adult↗
PubMed1982

[Report on a successful orthotopic cardiac transplantation in Germany].

The first successful heart-transplantation carried out in the Department for Cardiovascular Surgery of the University of Munich, Klinikum Grosshadern is reported. The recipient, 32 years old at the time of operation, had sustained a large antero-lateral-septal myocardial infarction in June 1980; thereafter the left ventricular ejection fraction was severely impaired (e.f. = 19%). Yet, the operation was definitely planned some year later, after the patient had survived an embolus to the right lung, an acute left heart failure and a small ulcer of the stomach. The operation was performed on 8-19-1981. The donor was a 23 year old young man, who had met a fatal motorcycle accident 10 days ago. The man was pronounced dead in the afternoon of the preoperative day according to the criterions of the German Society for Surgery by means of a carotid angiogram. Donor and recipient were well matched in regard to blood group, HLA-A2-System and finally cross-match-test. Transplantation was carried out according to the technique of Lower and Shumway. Immediately p.o., immunosuppressive therapy was started using azathioprine, cortisone and antihuman thymocyte globulin. Two acute rejections were noted, the first from p.o. day 6 to 15, the second from p.o. day 22 to 34. The second acute rejection was complicated by a pneumatosis cystoides intestinii, which caused a change of the immunosuppressive therapy to Cyclosporin A. No further complications were registered in the following p.o. course, the patient is discharged since Christmas 1981.

Adrenal Cortex Hormones↗
PubMed1982

[Bilateral stage nephrectomy as a preparation for kidney transplantation].

The indication for nephrectomy prior to kidney transplantation has changed. Contrary to the formerly in nearly all transplantation centres practiced one-time two-sided nephrectomy, at present the removal of the patient's own kidneys prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation, since 1977 the transplantation centre of Munich prefers the two-time bilateral nephrectomy. Technique, surgical approach, indication and results of our method are presented. In the course of the discussion the disadvantages of the one-time bilateral nephrectomy are opposed to the advantages of the two-time method.

Candidiasis↗
PubMed1982

[A gas chromatographic determination of 6-mercaptopurine in the serum of immunosuppressed transplantation patients].

The knowledge of serum levels of azathioprine or its metabolite 6-mercaptopurine is important for the monitoring of the immunosuppressive therapy after kidney transplantation, especially when kidney function is low. For this reason, the work of Bailey et al. was modified. 6-Mercaptopurine was extracted from the serum with a mixture of isopropanol-ethylacetate (1:1 v:v), derivatized with trimethylaniliniumhydroxyde and measured gaschromatographically. Sulfhydryl-protecting reagents were added to prevent loss of substance. Oxyethyltheophylline was used as the internal standard. The extraction and clean-up method recovered 80% of the 6-mercaptopurine present, the lower limit of sensitivity was 20 ng/ml, i.e., ten times lower than that of Bailey et al. The method could be realized on eight patients treated with azathioprine, the half life of the drug was about 20-40 min within the first hour i.v. application.

Azathioprine↗
PubMed1982

[Operative management of spontaneous kidney transplant rupture. Personal experiences and literature review].

Spontaneous rupture of the cadaver kidney is not rare in the early post-transplant period. In the literature the rupture complication rate varies between 0.3% and 8.5%. in our series 4.2% (12 of 285) of transplanted kidneys ruptured spontaneously. All transplant ruptures occurred as an early complication within 6 weeks postoperatively in the clinical setting of oliguria. In 8 of 12 patients we tried to preserve the graft by covering it with dehydrated solvent-dried human dura that is then sutured in place. In these cases surgical repair resulted in diuresis and restoration of normal graft function with long-term survival. This study emphasizes the possibility and necessity of conservation and repair of the ruptured allograft.

Adolescent↗
PubMed1982

[Organizational and technical aspects of organ removal].

The only efficient way to obtain adequate numbers of kidneys for transplantation is to perfect the technical and organisational method or organ harvesting. Careful attention to the details of organ procurement is as essential to the outcome of the transplantation as the procedure itself. To obtain optimal results, an effective collaboration between the central and peripheral hospital is necessary. A mobile medical and surgical team, coming from the central hospital for donor procurement was found to be most effective. Success in a major transplantation program requires continued improvement in the relationship between peripheral hospital physicians and the central transplant unit.

Brain Death↗
PubMed1982

[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up].

In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease. The operation was performed according to the technique of Lower and Shumway. Immunosuppression, in the early postoperative phase, was carried out with antithymocyte globulin, azathioprine and corticosteroids with administration oriented on the T-lymphocyte and total leukocyte counts as well as analysis of myocardial biopsies. In the late postoperative course, dosage of immunosuppressive agents was based almost exclusively on biopsy findings. Within the course of immunosuppressive therapy for cardiac transplantation, in particular, initial experience was gained with the use of antithymocyte globulin which was given in dosages of up to 12 mg/kg daily. The antithymocyte globulin proved effective for more than six weeks postoperatively. The alterations in immunosuppressive treatment necessitated by two gastrointestinal complications (perforated gastric ulcer, perforation of the small intestine) enabled a comparative analysis of the results of therapy with cyclosporin A given orally, intravascularly and intravenously. The Patient continues to be maintained on a regimen of cyclosporin A and corticosteroids and his general condition is good. For future cardiac transplantations, in the early postoperative course, alternating treatment with antithymocyte globulin, azathioprine and corticosteroids, on the one hand, with cyclosporin A and corticosteroids, on the other hand, would seem meaningful both to minimize adverse reactions as well as to provide effective immunosuppression. The experience rendered would promise to facilitate management of patients after cardiac transplantation.

Adolescent↗
PubMed1981

[Pancreas grafts. Nuclear medical perfusion to exclude vascular complications and rejection crises (author's transl)].

Perfusion studies with 99m Tc-DTPA, which has hitherto been used routinely to investigate renal grafts, have also proved useful for monitoring the perfusion of pancreas grafts. A total perfusion failure is equally reliably demonstrable as in renal grafts. Quantitatively smaller perfusion alterations can be demonstrated by monitoring the course. It seems possible to differentiate the salivary edema of a rejection reaction, well known from animal experiments, with the help of other parameters (e. g. creatinine). Further clinical studies are however necessary to confirm these results.

Adult↗
PubMed1981

[Significance of ultrasonography in diagnosing complications following renal transplantations (author's transl)].

Routine follow-up examinations by ultrasonography after renal transplantation were performed in 72 patients from December 1978 until March 1980. The aim of these controls was to recognize local complications in the area or surgery in order to differentiate from a rejection reaction in patients with unclear clinical symptoms. 22 out of 72 patients had local complications. 15 out of those 22 were detected by ultrasound in a state without clinical symptoms, which then could be treated by surgical or urological intervention. We therefore believe that routine follow-up examinations after renal transplantation by ultrasound are indicated in order to recognize local complications. Nuclear procedures should be employed if alteration of blood flow or disturbed function of the transplanted kidney are considered.

Graft Rejection↗
PubMed1981

[Gynaecological problems in women patients on dialysis treatment and in women following renal transplants (author's transl)].

Women patients on permanent dialysis treatment or after transplants display on the whole an increased rate of malignomas; however, it has so far not been possible to assess the relevant incidence in a uniform manner. Hence, regular gynaecological examination should be the rule in order to detect and treat carcinoma risk changes in the genital region. Within the framework of a special gynaecological consultation for renal patients we found in 81 women patients under dialysis treatment one patient with carcinoma of the cervix and one patient with corpus carcinoma. In two cases a cystic ovarial tumour was operated on. To date the 21 patients who had undergone renal transplant surgery did not show any malignant change in the genital region. Choice of contraceptives should rule out the intrauterine device because of the increased hazard of infection under immunosuppressive treatment. Ovulation inhibitors with higher oestrogen doses represent an additional hypertensive risk. Treatment with low-dosage gestagens should produce the lowest rate of side effects.

Adolescent↗
PubMed1981

Suppressor cell activity in human renal allograft recipients.

Eighty-nine kidney allograft recipients with one or more graft rejection episodes were monitored for suppressor cell activity in the peripheral blood at two day intervals. The impact of rejection and immunosuppressive therapy (ALG) on the one hand and the recovery of suppressor activity on the other hand during long-term graft survival could be demonstrated. The suppressor activity of peripheral lymphocytes after amplification in vitro by Concanavalin A was measured on PHA stimulated cultures. It is reduced after operation trauma and during rejection episodes when tested in PHA stimulated cultures. This loss of suppressor activity is even more marked when suppressor cells are added to allogeneic mixed lymphocyte reactions. Depletion of adherent cells reduces this suppressor activity, indicating that two different populations of mononuclear cells are responsible for this in vitro effect. Immunosuppressive therapy and additional ALG treatment abolishes suppressor activity in most cases. Highest suppressor activity was monitored in seven patients with excellent long term graft survival after ALG therapy.

Concanavalin A↗