The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients.

Adolescent age at time of transplant has been recognized as a risk factor for renal allograft loss. Increased risk for graft failure may persist from adolescence to young adulthood. Transfer of care is hypothesized as a risk factor for non-adherence and graft loss.

A quality improvement initiative to increase pneumococcal vaccination coverage among children after kidney transplant.

Pneumococcal vaccination rates among children receiving a kidney transplant remain suboptimal. Current practice guidelines in the United States recommend giving the PPSV23 after priming with the PCV13. We conducted a QI initiative to increase pneumococcal vaccine rates in our kidney transplant recipients by developing an age-based vaccine algorithm, obtaining vaccine records, and generating reminders for patients and clinicians.

The natural history of autoimmune hepatitis presenting with jaundice.

Background: Forty percent of patients with autoimmune hepatitis (AIH) present with acute jaundice/hepatitis. Such patients, when treated promptly, are thought to have a good prognosis.

Objectives: The objective of this study was to describe the natural history of AIH in patients presenting with jaundice/hepatitis and to determine whether the diagnosis could have been made earlier, before presentation.

Incidence and predictive features of pharyngeal pouch in a dysphagic population.

Pharyngeal pouch patients often present with dysphagia and risk perforation when undergoing gastroscopy. Knowledge of pharyngeal pouch incidence and predictive demographic features in patients referred for dysphagia would help determine those patients who should have barium swallow as an initial investigation. The prospectively collected data of 2,797 consecutive referrals were analysed.

Clinical and laboratory features and natural history of seronegative hepatitis in a nontransplant centre.

Background: Seronegative hepatitis is a recognized cause of liver failure requiring transplantation. The aetiology is unknown, but might relate to an unidentified virus or immune dysregulation. There are few data on seronegative hepatitis presenting to nontransplant centres.

The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study.

Background: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.

Aim: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.

Longitudinal relations between obesity and hypertension following pediatric renal transplantation.

Obesity and hypertension frequently complicate renal transplantation (RTxp). The objective was to assess relations among obesity, hypertension, and glucocorticoids in pediatric RTxp recipients. A retrospective cohort study was carried out in 141 RTxp recipients, 2-21 years of age, with >or=12 months of follow-up.

Safety and efficacy of a calcineurin inhibitor avoidance regimen in pediatric renal transplantation.

Thirty-four children were entered into a pilot trial of calcineurin inhibitor avoidance after living-donor kidney transplantation, the CN-01 study. Patients were treated with anti-CD25 mAb, prednisone, mycophenolate mofetil, and sirolimus. Twenty patients were maintained on the protocol for up to 3 yr of follow-up.

Erosive adenomatosis of the nipple: histology, immunohistology, and differential diagnosis.

Erosive adenomatosis of the nipple (EAN) is a complex benign mammary proliferation that has a variety of histologic appearances. All forms of this lesion are thought to be composed of two apparent cell types: epithelial luminal cells and basal myoepithelial cells. A panel of immunohistochemical reagents was employed to determine whether this divergence of differentiation could be confirmed immunohistochemically.

Carcinoma arising within fibroadenomas of the breast. A clinicopathologic study of 105 patients.

The authors report the clinicopathologic features of 105 carcinomas arising within fibroadenomas (FAs) of the breast. The mean age of the patients was 44 years. The presentation and gross characteristics of these tumors rarely differed from those of uncomplicated FAs.

Immunohistochemistry in the differential diagnosis of breast diseases.

Immunohistochemical techniques provide previously unavailable information about the composition of breast lesions. These data must be evaluated in the pathologic context and must not be used to support a diagnosis inconsistent with the morphological appearance. In the diagnosis of breast lesions, we have found immunohistochemistry of most use in classifying poorly differentiated and spindle-cell tumors.

Preparation of 14,15-secoestra-1,3,5(10)-trien-15-ynes, inhibitors of estradiol dehydrogenase.

The conversion of estrone to 14,15-secoestratrien-15-ynes, inactivators of estradiol dehydrogenase from human term placenta, is described. The optically pure precursor 7-acetoxy-octahydro-2-phenanthrenecarboxylic acid methyl ester is prepared from estrone in five steps and 40% yield. The unsubstituted propargylic secoestratriene diol, a mechanism-based inactivator of estradiol dehydrogenase, and the corresponding acetylenic ketone, an affinity label inactivator of the same enzyme, arise from the phenanthrene ester in three and four steps.

Flow cytometric analysis of breast needle aspirates.

This study investigated two hypotheses: (1) sufficient cells may be obtained by needle aspiration of breast nodules to produce good flow cytometric DNA profiles; and (2) benign breast lesions do not produce aneuploid G0G1 peaks, and therefore a distinct aneuploid peak is sufficient for a diagnosis of malignancy. Breast specimens received in Surgical Pathology between December 1985 and February 1987 were aspirated, and the cells stained with propidium iodide for flow cytometric DNA analysis. A total of 344 specimens were aspirated, of which 204 (59%) were malignant and 140 (41%) benign.

Intravesical Bacillus Calmette-Guérin therapy for murine bladder tumors: initiation of the response by fibronectin-mediated attachment of Bacillus Calmette-Guérin.

Intravesical Bacillus Calmette-Guérin (BCG) is considered to be one of the most effective treatments for superficial bladder cancer. Although the mechanisms by which BCG inhibits tumor growth are not known, previous studies have shown that systemic immunization to BCG and the local expression of the immune response in the bladder are associated with a favorable response to BCG therapy. We have investigated the conditions required for the initiation of an immunological response after the intravesical instillation of BCG.

Multiple granular cell tumors. A familial occurrence in children.

A 23-year-old black woman and her 6-year-old son, both with multiple granular cell tumors, are described herein. The mother and son both presented as children with multiple granular cell tumors. This is the first reported case of multiple lesions arising in childhood in successive generations.

DIRECT AND CORRELATED RESPONSES TO SELECTION AMONG LIFE-HISTORY TRAITS IN MILKWEED BUGS (ONCOPELTUS FASCIATUS).

Offspring-parent regressions provided initial estimates of heritabilities and genetic correlations among wing length, body length, pronotum width, head-capsule width, development time, age at first reproduction, and fecundity in an Iowa population of the large milkweed bug, Oncopeltus fasciatus. Replicated, bidirectional selection for wing length was imposed for nine generations. The direct response to selection revealed the existence of substantial additive genetic variance for wing length in this population.

A proposed classification of breast cancer based on kinetic information: derived from a comparison of risk factors in 168 primary operable breast cancers.

Flow cytometric DNA analysis was performed on 168 consecutive primary operable breast cancers and the results correlated with thymidine labeling, estrogen receptor (ER) and progesterone receptor values, and various histologic parameters. Seventy-five cancers (45.0%) were diploid and 93 (55.

Short-term cryopreservation of human breast carcinoma cells for flow cytometry.

A procedure is described for short-term cryopreservation of primary human tumor cells and tissue slices for later analysis by flow cytometry. Cells were mechanically dispersed into a freezing medium, which was then frozen at either -20 degrees C or -70 degrees C for delayed cell cycle analysis. The results show that a correlation coefficient of greater than 0.

Differentiation of Medulloblastoma. Studies including immunohistochemical localization of glial fibrillary acidic protein.

A series of medulloblastomas was studied by light microscopy. The tumors were variable; astrocytic, ependymal, neuronal, and probable oligodendroglial differentiation was present. Features of glioblastoma multiforme occurred in one case.

Glioma of the acoustic nerve.

We report a case of astrocytoma of the acoustic nerve. Most gliomas arise from the brainstem, and seldom originate in the acoustic or other "true" cranial and spinal nerves. Clinical features of this rare acoustic tumor differ from those of brainstem gliomas, but are indistinguishable from typical acoustic neurilemoma.