Primary care physicians' perceptions of adolescent pregnancy and STD prevention practices in a Nova Scotia county.

Introduction: This study was carried out to determine the predisposing, enabling, and reinforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs), and to assess physicians' "ideal" history taking and service provision versus their actual practice in this clinical area.

Methods: Twenty-six of 37 physicians in a single county in Nova Scotia took part in a face-to-face interview.

Results: Analysis of predisposing factors found that, for seven of 10 areas related to knowledge of the epidemiology of adolescent pregnancy and STDs, fewer than 50% of male physicians were able to give correct responses.

Lymphocyte function in patients treated with monoclonal anti-T3 antibody for acute cadaveric renal allograft rejection.

We are participating in a multicenter trial testing the efficacy of a murine monoclonal antihuman peripheral T lymphocyte antibody (OKT3.PAN) as immunosuppressive therapy for the treatment of acute cadaveric renal allograft rejection. Although clinical data indicate that administration of this antibody clears the circulating lymphocyte pool of T3-positive cells, some in vitro studies have called into question whether the antibody is indeed lymphocytotoxic.

Progressive multifocal leukoencephalopathy in a renal transplant recipient. Increased diagnostic sensitivity of computed tomographic scanning by double-dose contrast with delayed films.

A progressive, deteriorating neurologic disorder developed in a 28-year-old white man 10 years after he successfully received a living related donor kidney transplant. An extensive neurologic evaluation was unrevealing, including normal results of computed tomographic scanning of the brain with and without contrast medium. Repeated computed tomographic scanning after a double dose of radiocontrast medium in conjunction with delayed imaging revealed multiple areas of abnormal enhancement.

Prospective evaluation of renal allograft dysfunction with 99mtechnetium-diethylenetriaminepentaacetic acid renal scans.

A prospective, single-blinded study was done to determine the ability of serial 99mtechnetium-diethylenetriaminepentaacetic acid scans to diagnose renal allograft rejection. Among 28 transplant recipients 111 renal scans were obtained 1 day postoperatively and every 3 to 4 days thereafter for 3 weeks in all patients retaining an allograft. Computer-generated time-activity blood flow curves were analyzed semiquantitatively for the 1) interval between curve peaks of the allograft and iliac artery, 2) renal transit time and 3) renal washout of radionuclide.

Perturbation of epidermal Langerhans cells in immunosuppressed human renal allograft recipients.

As an initial attempt to gain a better understanding of the basis for the increased incidence of ultraviolet-light-related skin cancer in chronically immunosuppressed human renal allograft recipients, we have compared both morphological and functional characteristics of epidermal Langerhans cell (LC) populations present in the forearm skin of nine such patients with those of age, sex, and race-matched controls. The LC surface densities in vacuum-induced blister-derived epidermal sheets taken simultaneously from extensor and flexor forearm skin of the patients were significantly lower than those observed in the controls. The most abnormal LC densities seen were in the patients' extensor forearm skin.

Transplantation 1983.

Renal transplantation has entered a new era of optimism characterized by steady increases in our scientific appreciation of the transplant event and improving allograft survival rates. Advances in tissue typing, methods of preventing rejection including an appreciation of the blood transfusion effect and the discovery of new immunosuppressive drugs such as cyclosporin A, and methods of rejection treatment have been responsible for this new era. With renewed impetus, continued advances can only increase an optimistic approach to renal transplantation.

Disease due to cytomegalovirus and its long-term consequences in renal transplant recipients. Correlation of allograft survival with disease due to cytomegalovirus and rubella antibody level.

We prospectively studied 52 consecutive renal allograft recipients who retained their grafts at least three months. The transplant recipients were observed for five years or longer. Disease due to cytomegalovirus (CMV) occurred in nine (17.

Urologic complications in 505 renal transplants with early catheter removal.

Of 505 consecutive renal transplants urologic complications occurred in 4.1 per cent of cadaver, 2.6 per cent of living related, 1.

Renal transplantation in diabetic patients: the end result does justify the means.

There were 49 insulin-dependent diabetics who received 52 renal allografts: 13 from living related and 39 from cadaveric donors. The mean age and time on dialysis were similar for both recipient groups. Patient survival at 1 and 2 years was 100 per cent for living related donor recipients, and 76 and 56 per cent at 1 and 2 years for cadaveric recipients.

Role of humoral presenitization in human renal transplant rejection.

A prospective study of 31 cadaveric renal allograft recipients was performed to determine the significance of pretransplant presensitization undetected by the conventional microlymphocytotoxicity crossmatch. Donor-specific humoral presensitization revealed by the antibody-dependent cell-mediated cytotoxicity assay (ADCC) was associated with a high incidence of early graft rejection. Six-month graft survival was 20% in recipients with positive pretransplant ADCC and 75% in ADCC-negative recipients (P < 0.

Acute renal failure following cardiac operations.

The incidence and course of acute renal failure following cardiopulmonary bypass (CPB) was retrospectively analyzed. The incidence of oliguric acute renal failure was 1.5% and the mortality rate was 27%, a figure substantially lower than previously reported.

Epidemic renal transplant rejection associated with influenza A victoria.

1) IAV infection seems to trigger acute renal allograft rejection frequently, especially in the first few months post-transplant, and these rejections are severe with a high rate of ultimate graft loss; 2) seroconversion occurred in most cases despite high dose steroids; 3) the course of IAV was prolonged and associated with a high incidence of complications in patients on high dose steroids.

Vestibular toxicity of gentamicin. Incidence in patients receiving long-term hemodialysis therapy.

Twenty-three patients on long-term hemodialysis regimens who received gentamicin sulfate were reviewed retrospectively to assess the incidence of ototoxicity and to identify potential risk factors. Dosage of gentamicin sulfate was 1.0 to 1.

Immunologic monitoring of transplant rejection: correlation of in vitro assays with morphologic changes on transplant biopsy.

The assays of lymphocyte-mediated cytotoxicity (LMC), antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) were correlated with histopathologic criteria of refection in 35 transplant biopsies. A positive LMC was seen with 6/8 biopsies showing moderate to severe cellular rejection and in 8/17 with mild cellular rejection. Positive ADCC and/or CDC assays were associated with 14/14 biopsies containing rejection vasculitis.

Pretransplant assays of alloimmunity in predicting renal graft outcome.

Forty-one renal allograft recipients were studied for evidence of specific antidonor alloimmunity prior to transplantation. Pretransplant evidence of antibody to the donor as detected by ADCC correlated with the occurrence of early graft loss. This suggests that the ADCC may serve as a useful pretransplant corssmatching procedure.