The utility of fine-needle aspiration biopsy in organ transplantation.
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Biomedical subjects
Publications and source records attributed to Z Shapira.
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Five out of 430 patients (1.16%) undergoing kidney transplantation developed an atypical clinical picture of herpetic dendritic keratitis within four weeks after surgery. It was manifested by multiple dendrites, located mainly in the corneal periphery or the limbus, developing in relatively uninflamed eyes. The response to acyclovir therapy was prolonged and took at least three weeks. Additionally, subepithelial infiltrates with ultimate scarring developed in all patients. Disciform keratopathy was not found. This clinical course is ascribed to the patients' immunosuppressed state.
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In routine fine needle aspiration (FNA) of the kidney, the glomeruli are seldom visualized. They appear as multi-layered, cellular conglomerates and, therefore, are unsuitable for morphological analysis. A novel plasma-clot technique for collection of glomeruli from FNA samples was used in a study of 6 native and 24 transplanted human kidneys with suspected glomerular lesions. This technique produced a satisfactory yield of well preserved glomeruli and enabled the identification of glomerular pathology with the accuracy comparable to that of renal core biopsy. The FNA plasma clot method may prove useful in the study of glomerular pathology under conditions where the use of percutaneous biopsy is conventionally limited or avoided.
Psychosocial adjustment and psychological distress was compared in 31 male nondiabetic successful renal transplant and 31 hospital hemodialysis patients, matched for duration of treatment, age, education, and family status. The only significant difference between the two groups was that the transplant patients were more satisfied with the medical staff. Vocational rehabilitation was similar in both groups. Sexual interrelationships, as reported by the patients, were slightly, but insignificantly, better in the transplanted group. Thus, the psychological adjustment of transplant and hemodialysis patients is similar when demographic differences are accounted for.
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Cyclosporin is poorly tolerated in patients with amyloidosis due to familial mediterranean fever who are receiving colchicine. There is a high incidence of gastrointestinal side-effects and muscle weakness, both of which are reversible on stopping cyclosporin. Thus in patients with amyloidosis secondary to familial mediterranean fever treated with colchicine, the use of cyclosporin as an immunosuppressive agent may be restricted.
For the quantitation of kidney-derived Urinary Antigens (UA) monoclonal antibodies specific for antigens localized in cells of defined subunits of the nephron were applied in sandwich ELISA. Antigen excretion was measured in the urine of healthy individuals, patients suffering from various diseases, kidney transplant recipients, and healthy volunteers receiving therapeutic doses of antibiotic drugs. In healthy individuals, in patients with diseases primarily affecting the glomerulus, and in inactive phases of chronic diseases antigen excretion was low. Toxic drug effects enhanced antigenuria. Excretion of some or all of the antigens always indicated tubular alterations. The tests thus provide information on location and extent of acute primary tubular damage.
A case of severe duodenal hemorrhage in a septic renal allograft recipient is presented in which successful occlusion of the gastroduodenal artery by Gelfoam emboli also resulted in severe hepatic infarction and gallbladder necrosis. These complications were caused by reflux of emboli from the gastroduodenal artery into the distal branches of the hepatic artery.
Ten patients with familial Mediterranean fever (FMF) and histologically confirmed amyloidosis received cadaver kidney transplants for treatment of terminal renal disease. Colchicine, 1 mg daily, was included in the routine postoperative regimen from 1974 for amyloidotic patients. Graft and patient survival were compared with ten nonamyloidotic recipients of renal grafts matched for age, sex, type of allograft, and HLA compatibility. In the FMF group, five of ten grafts have survived from 20 to 64 months; in the control group, six of ten. While only recipients with functioning grafts survived in the FMF group, patient survival in the control group is eight of ten after one year. In all five FMF survivors, graft function is satisfactory, proteinuria is absent, and blood creatinine levels are normal. Amyloid involvement of an allograft was documented 16 months after transplantation in the only patient whose maintenance colchicine dosage had been reduced to 0.5 mg daily.
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