Decreased effect of immunosuppression on immunocompetence in African--Americans after kidney and liver transplantation.

Several studies indicate that the poorer outcomes for African--Americans after transplantation may be due to decreased effectiveness of immunosuppressive agents. Using an in vitro test of immunocompetence (IMC), we measured the effects of immunosuppression on African-American, compared with Caucasian, kidney or liver transplantation recipients. The IMC result was the highest of three mixed lymphocyte culture responses using validated stimulator cell pools.

Consensus statement on the live organ donor.

Objective: To recommend practice guidelines for transplant physicians, primary care providers, health care planners, and all those who are concerned about the well-being of the live organ donor.

Participants: An executive group representing the National Kidney Foundation, and the American Societies of Transplantation, Transplant Surgeons, and Nephrology formed a steering committee of 12 members to evaluate current practices of living donor transplantation of the kidney, pancreas, liver, intestine, and lung. The steering committee subsequently assembled more than 100 representatives of the transplant community (physicians, nurses, ethicists, psychologists, lawyers, scientists, social workers, transplant recipients, and living donors) at a national conference held June 1-2, 2000, in Kansas City, Mo.

Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients.

Background: Hyperacute rejection (HAR) and acute humoral rejection (AHR) remain recalcitrant conditions without effective treatments, and usually result in graft loss. Plasmapheresis (PP) has been shown to remove HLA- specific antibody (Ab) in many different clinical settings. Intravenous gamma globulin (IVIG) has been used to suppress alloantibody and modulate immune responses.

Esophageal cancer prevention, cure, and palliation.

Adenocarcinoma of the esophagus and gastric cardia are the most rapidly increasing cancers in developed countries. Adenocarcinoma of the esophagus is associated with chronic gastroesophageal reflux, and Barrett's esophagus is a precursor. This disease most frequently affects middle-aged white men.

Shorter waiting times for hepatitis C virus seropositive recipients of cadaveric renal allografts from hepatitis C virus seropositive donors.

Introduction: The purposes of this study were: 1) to analyze the early results of cadaveric renal transplantation from either hepatitis C virus seropositive (HCV+ ) or hepatitis C virus seronegative (HCV-) donors into HCV + recipients; and 2) to determine whether HCV+ patients with end-stage renal disease (ESRD) might benefit from receiving renal allografts from HCV + donors.

Methods: From January 1997 to June 1999, 28 patients with ESRD and HCV infection underwent 29 cadaveric renal transplants. The data were reviewed retrospectively.

Plasmapheresis: an effective therapy for primary allograft nonfunction after liver transplantation.

Background: The role of plasmapheresis in liver failure and hepatic coma remains controversial. Also, its use as a salvage strategy for patients with severe allograft dysfunction after liver transplantation has not been defined. This report reviews the use of plasmapheresis in primary hepatic allograft nonfunction (PNF).

Surface and bulk modifications to photocrosslinked polyanhydrides to control degradation behavior.

A unique class of surface-eroding polyanhydrides was developed and explored for use in medical applications requiring high-strength biomaterials (e.g., orthopedics).

Laparoscopic live donor nephrectomy: the recipient.

Background: Laparoscopic live donor nephrectomy offers advantages to the donor in terms of decreased pain and shorter recuperation. Heretofore no detailed analysis of the recipient of laparoscopically procured kidneys has been performed. The purpose of this study was to determine whether laparoscopic donor nephrectomy had any deleterious effect on the recipient.

GenMapDB: a database of mapped human BAC clones.

GenMapDB (http://genomics.med.upenn.

Outcome of surgical and endoscopic management of biliary pancreatitis.

The aims of the study were to compare the outcomes of biliary pancreatitis after endoscopic and surgical treatment and define the demographic and clinical characteristics that affect the outcomes. All inpatients with biliary pancreatitis followed at hospitals of the Department of Veterans Affairs during 1988-1994 were included in a case-control study. Of 2075 patients with biliary pancreatitis, 650 were first treated by biliary endoscopy and 1425 by cholecystectomy.

Lymphocyte suppression by rolipram with other immunosuppressive drugs.

Pentoxifylline, a nonselective phosphodiesterase inhibitor, has immunomodulatory activity in vitro and in vivo and potentiates the suppressive effects of glucocorticoids and cyclosporine on lymphocyte proliferation in vitro. Since phosphodiesterase isotypes 3 and 4 predominate in lymphocytes, the authors measured the suppressive effect of rolipram alone and in combination with low concentrations of methylprednisolone and calcineurin enzyme inhibitors, compared to that of pentoxifylline on mitogen-stimulated lymphocyte proliferation. The percent inhibition of 3H-thymidine incorporation by both 10(-5) and 10(-8) mol/L concentrations of rolipram were significantly greater than that by both 10(-4) mol/L pentoxifylline and 10(-8) mol/L methylprednisolone.

Endoscopic removal of an esophageal fibrovascular polyp.

Fibrovascular polyps are intraluminal pedunculated esophageal polyps, which can produce devastating consequences if untreated. Therapy for these lesions is traditionally surgical, with esophagotomy. The present report describes a case of endoscopic removal of a fibrovascular polyp, alleviating the need for hospitalization or further interventions.

Reduced intrapatient variability of cyclosporine pharmacokinetics in renal transplant recipients switched from oral Sandimmune to Neoral.

Sixty-six renal transplant patients maintained on Sandimmune, the traditional formulation of cyclosporine, participated in an open-label, sequential trial to compare intrapatient variability in drug exposure before and after a switch to Neoral. Three 12-hour cyclosporine pharmacokinetic profiles were obtained over approximately 6 weeks while patients were receiving Sandimmune. Patients were then switched to Neoral, with the dose adjusted as necessary to maintain target trough blood cyclosporine concentrations.

Gastric leiomyosarcoma presenting as a gastric wall abscess.

Gastric abscess is a rare disorder with approximately 500 cases reported. Two variants are seen diffuse (Phlegemous) or localized. We report a spindle cell tumor (leiomyosarcoma) presenting as a localized gastric wall abscess.