Glucocorticosteroids in renal transplantation. II. Impact of high- versus low-dose postoperative methylprednisolone administration on graft survival and on the frequency and type of complications.

In a previous clinical trial we demonstrated that, by increasing the postoperative administration of methylprednisolone from 1.0 to 3.5 mg/kg/day, the onset of the first inflammatory rejection episode was significantly delayed and the size of the inflammation was reduced.

Measurement of serum amyloid A protein concentrations as test of renal allograft rejection in patients with initially non-functioning grafts.

Serum amyloid A protein concentrations were monitored in 10 renal transplant recipients who required dialysis after transplantation because of an initially non-functioning graft. Fifteen rejection episodes were identified by repeated fine needle aspiration biopsies of the grafts. All rejections were characterised by pronounced increases in serum amyloid A concentrations, the mean peak value being 363 (SE 57) mg/1 as compared with a mean preoperative concentration of 14 (5) mg/1.

The effect of relative bowel rest on healing of colonic anastomoses. Collagen synthesis and content in the colonic wall after left colon resection and anastomosis in the rat.

Collagen metabolism was studied in the colonic wall of rats after standardized resection and anastomosis. Diminished faecal loading was obtained by feeding rats low-residue diet (Bisorbin MCT). The postoperative increase of collagen synthesis and collagen content was on a lower level in these rats than in rats on standard laboratory diet.

Extended high-frequency hearing loss in children with cleft palate.

Hearing sensitivity for frequencies 250 through 20 000 Hz was compared between children with repaired cleft palate and a history of otitis media, and children without cleft palate or middle ear disease. All subjects were clear of middle ear effusion during the evaluation. Although children in the cleft palate group had consistently poorer hearing throughout the auditory range, statistical analysis demonstrated significant differences in hearing levels above 9 000 Hz only.

Angiotensin I-converting enzyme inhibition after renal transplantation.

The angiotensin I-converting enzyme inhibitor captopril was administrated to 15 renal transplant patients for a minimum period of 14 weeks after transplantation. The object was to decrease ischaemic damage caused by secondary activation of the renal renin-angiotensin system after rejection and associated vascular damage. Captopril patients had lower s-creatinine values than controls in the immediate phase after rejection.

Serum amyloid A protein: a sensitive indicator of renal allograft rejection in humans.

Acute human renal allograft rejection induces a dramatic elevation of serum amyloid A protein (SAA). To evaluate the clinical significance of this finding we monitored 31 consecutive recipients of cadaveric renal allografts by daily SAA measurements. SAA increased significantly during 37/38 rejection episodes.

Serum amyloid A levels in human renal allograft rejection.

Serum amyloid A (SAA) levels were studied in 35 recipients of cadaveric renal transplants. Marked SAA elevations were seen during all acute allograft rejection episodes. The mean peak SAA level in well-documented rejections was 446 mg/l (median 415 mg/l, range 132-1040 mg/l; controls less than 1 mg/l).

Effect of cyclosporine on wound healing.

Two prophylactic immunosuppressive drugs, cyclosporine and methylprednisolone (MP), were compared for their effect on the in situ inflammatory reaction of granulation tissue formation and on wound healing. Granulation tissue was generated via implantation of viscous cellulose sponges in Sprague-Dawley rats. The rats were divided into six groups: One group received 40 mg/kg/day of cyclosporine, the second 10 mg/kg/day of cyclosporine, the third 2.

Cyclosporine in treatment of corticosteroid-resistant episodes of rejection.

We used cyclosporine (formerly called cyclosporin A) to treat established episodes of kidney-transplant rejection in six patients in whom the use of corticosteroids either was ineffective or was precluded by preestablished side effects. All patients were followed up by using fine-needle aspiration biopsy and transplant aspiration cytology. In four episodes of rejection with typical blast cell--dominated inflammation, the response to cyclosporine was apparently favorable: the inflammatory cells disappeared within days and the transplant resumed its normal function.

Five-year results of proximal gastric vagotomy.

Between February 1972 and December 1976 100 proximal gastric vagotomies (PGV) were performed on duodenal ulcer patients after failure of conservative treatment. The diagnosis was verified by preoperative barium meal and endoscopy and by peroperative examination. There was no operative mortality.

Connective tissue changes and collagen metabolism in syngeneic vena caval grafts in rats.

An attempt was made to determine if changes occurring in connective tissue and collagen metabolism of vein-to-artery grafts arose from the trauma of transplantation as such or from the higher pulsatile pressure. Segments of the supradiaphragmatic inferior vena cava were therefore transplanted to the infrarenal vena cava in syngeneic pairs of rats. The sequential changes in hydroxyproline concentration, 3H-proline incorporation and the histologic appearance of collagen, elastic fibres and fibronectin were noted.

Differential diagnosis of Cyclosporin A nephrotoxicity versus rejection by fine needle aspiration biopsy.

Twelve transplants with signs of graft failure and five with good function on CyA, were aspiration biopsied and analysed for (a) the presence of inflammation, (b) morphological changes in the graft parenchymal cells and (c) by indirect immunofluorescence for the presence of CyA in the renal tubular cells. Four reaction patterns were recorded: (i) good transplants with a normal serum creatinine, no evidence of inflammation, no parenchymal cell changes and no deposits of CyA in the graft; (ii) patients with elevated serum creatinine, no inflammation but distinct parenchymal cell changes and massive deposits of CyA (i.e.

Ranitidine and cimetidine in renal transplantation: a clinical trial.

Sixteen patients were randomized for treatment with ranitidine and seventeen for treatment with cimetidine to prevent the appearance of upper gastrointestinal (UGI) complications after renal transplantation. The two operated groups were comparable with regard to age, sex, number of pre-operative blood transfusions, and HLA match. All patients were treated with a similar immunosuppressive regime, consisting of azathioprine and methylprednisolone, and underwent endoscopic examination ten and thirty days following surgery.

Is uremia immunosuppressive in renal transplantation?

We have quantitated the impact of post-transplantation uremia on the antiallograft immune response by transplant aspiration cytology. Sixty-four consecutive renal transplants, treated with a similar immunosuppresive regimen, were aspiration biopsied at 2-day intervals during the first 15 days postoperatively. The patients were allocated into three groups on the basis of their serum creatinine level on the 3rd postoperative day: transplants with a delayed onset of function (highly uremic group, serum creatinine level greater than or equal to 600 mumol/liter; 24 cases), transplants with a partially delayed onset of function (partially uremic group, 200 to 600 mumol/liter; 21 cases), and transplants with an immediate onset of function (nonuremic group, less than or equal to 200 mumol/liter; 14 cases).

The desmoid tumor. III. A biochemical and genetic analysis.

We have carefully examined four patients with desmoid tumor (DT) and their 31 relatives. In three of four cases, biopsies of the DT demonstrated low yet significant amounts of estrogen but not progesterone receptors in the tumor cytosol. In the fourth case, where the receptors were not demonstrable, the affected patient was a menopausal woman and the receptors may have been blocked by endogenous estrogen.

Gastric blood flow, tissue gas tension and microvascular changes during hemorrhage-induced stress ulceration in the pig.

Various features of blood supply to the gastric mucosa were studied in the piglet stomach during stress ulceration induced by hemorrhagic shock. Gastric blood flow, as measured by the radioactive microsphere technique, significantly decreased during shock, but no major change occurred in the gastric function of total cardiac output. There was no difference in the magnitude of the decrease of mucosal blood flow between the nonulcerating antral mucosa and the more readily ulcerating corpus or fundic mucosa.

Varying course of hypertension following renal trauma.

Hypertension developed in 5 patients after unilateral renal injury. The time-lag from injury to development of hypertension varied from 6 weeks to more than 3 years. In 2 of 3 patients with partial renal injury blood pressure normalized spontaneously.

Influence of zinc on synthesis and the accumulation of collagen in early granulation tissue.

Chronic zinc deficiency causes a delay of reparative processes. The rate of repair is normalized by the administration of zinc. An acute lowering of the serum zinc level follows trauma.

The effect of methylprednisolone and vitamin A on wound healing. I.

The effect of methylprednisolone and vitamin A on wound healing was studied by analysing various relevant granulation tissue components in rats. The granulation tissue development was induced by viscose cellulose sponges implanted subcutaneously. Methylprednisolone and vitamin A were applied either locally into the sponge at the time of operation or systemically and daily throughout the observation period of 3 weeks.

Connective tissue changes in autogenous vein graft used as a mesocaval shunt.

Autogenous jugular vein was used as a mesocaval shunt in dogs with ligated portal vein. Nine out of fifteen animals survived the operation and could be used for further studies one month postoperatively. Immediately after the shunt procedure an increased portosystemic pressure gradient was observed.