Corneoscleral transplantation for end stage corneal disease

AIM: To describe the prognosis and complications of corneoscleral transplantation in the management of end stage eye disease. METHODS: A case series is presented of 23 patients who have undergone corneoscleral transplantation (> or = 11 mm). Patients were examined for visual acuity, intraocular pressure, recurrence of disease process, epithelialisation of the graft, signs of rejection, and other potential complications. RESULTS: 14 patients retained their eye, with six maintaining a clear graft. Vision ranged from 6/30 to no perception of light. 13 patients developed glaucoma (range 25-69 mm Hg), with six patients requiring surgical intervention. 12 patients required tarsorrhaphy to promote epithelialisation. Only two grafts resulted in typical rejection. CONCLUSIONS: The technique of corneoscleral transplantation can salvage otherwise end stage eye disease, but the results are poor with respect to maintenance of vision. These patients need careful follow up because of potential complications of glaucoma, epithelial defects, rejection, and recurrence of disease.     

Sleep apnea in end stage renal disease

Antibodies directed against the beta chain of the T-cell receptor (TCR) have been detected in animals and in humans in a number of distinct immune states that do not involve direct immunization with either T cells or TCR epitopes. When C57B1/6 mice are infected experimentally with the LP-BM5 retrovirus mixture they produce increased titres of autoantibodies directed against TCR V beta complementarity determining region 1 (CDR1) epitopes. Here, the authors utilized hybridoma technology to isolate monoclonal immunoglobulin (Ig)M antibodies (MoAbs) that arose at the peak of infection. The authors characterized the binding specificity tested using synthetic peptides modelling the CDR1 segments of 24 distinct V beta gene products and determined the VH gene usage by two such monoclonals. One binds to a restricted set of TCR V beta CDR1 peptides, and the second reacts with approximately half of the CDR1 peptide homologues. These MoAbs are specific for T-cell receptor beta chains and do not bind to immunoglobulin light chains or to unrelated protein molecules. Both MoAbs bind to intact T cells expressing the V beta domain (human V beta 8 and mouse V beta 11) from which selection peptides were derived, and costimulate a V beta specific in vitro T cell proliferative response induced by the staphylcoccal enterotoxin E (SEE) superantigen.     

Liver transplantation in children with chronic end stage liver disease: factors influencing survival after transplantation

To identify pretransplant factors that are influencing survival after orthotopic liver transplantation a Cox proportional hazards regression model was applied to 118 children with chronic terminal liver failure transplanted at Medical School Hannover during the period of 1978 to 1994. The response variable was survival, as covariates a total of 19 pretransplant variables were entered--i.e. age, diagnosis (biliary cirrhosis, metabolic cirrhosis, postnecrotic cirrhosis, cryptogenetic cirrhosis) sex, laparotomy prior to OLT, height, weight, standard deviation scores for height and weight, date of first OLT, serum alanine aminotransferase, asparagine aminotransferase, albumin, total bilirubin, cholinesterase activity, glomerular filtration rate, and prothrombin time. Significant independent predictors of survival after OLT were bilirubin (P=0.0024), SDS for weight (P=0.034), and albumin (P=0.039). In a subsequent discriminant analysis cut off points for these variables could be identified--i.e., bilirubin >340 micromol/L, SDS for weight <-2.2 and albumin < 33 g/L. Patients with one or more of these risk factors were grouped as urgent indication group (n=76) and those with no risk factor as elective indication group (n=42). Comparing the posttransplantation survival in these groups there is a statistically significant difference at 1 year (57% vs. 90.5%) and 4 years (49% vs. 90.5%) after OLT (P=0.0001, log rank test). It is concluded that the risk of OLT is much higher if liver function is very poor. Optimal nutritional support prior to transplantation is mandatory to optimise the clinical status of the children and to improve the results of OLT.     

Reticulocyte indices in patients with end stage renal disease on hemodialysis

From 1986 to 1996, 20 patients underwent aortic root replacement. All of the patients had annulo aortic ectasia (AAE); Six had DeBakey type I aortic dissection, three were acute dissections associated with Marfan's syndrome; three had previously undergone the Koster-Collins operation. During 11 years, the original Bentall procedure (1986-91), the Cabrol procedure (1991-), and the modified Bentall procedure (Carrel patch or Piehler technique) were performed. There was only 1 hospital mortality (5.0%). Four patients died during the follow-up period (mediastinitis, myocardial infarction, cerebral bleeding, and rupture of the arch aneurysm). Only 2 patients required reoperation (repair of a pseudoaneurysm of the right coronary artery and paravalvular leakage of the aortic valve replacement). The satisfactory outcomes were the result of the full-thickness anastomoses performed during coronary artery reconstruction.     

Genetic polymorphisms of cytochrome P4502E1 related to the development of alcoholic liver disease

BACKGROUND/AIMS: Because heavy drinkers do not always develop alcoholic liver disease (ALD), genetic factors may be involved. Cytochrome P4502E1 is the main enzyme that oxidizes ethanol in the non-alcohol dehydrogenase pathway. Recently, the presence of genetic polymorphisms of this enzyme was confirmed. In the present study, the genotypes of P4502E1 were analyzed in patients with or without ALD. METHODS: After extraction of DNA from white blood cells, genotypes of P4502E1 were determined by restriction fragment length polymorphisms using two endonucleases. The genotypes were separated into three types: type A, type C (homozygous for the c1 or c2 gene), and type B (heterozygous for both genes). RESULTS: In 50 patients with ALD, the prevalence of type A was 16% and that of the c2 gene was 84%. The genotypes in 10 heavy drinkers without ALD were all type A. In 34 patients with non-alcoholic liver disease and in 88 patients without hepatobiliary disease, the prevalence of type A was 65% and 71%, respectively, indicating a significantly higher prevalence of the c2 gene in ALD. In healthy nonalcoholics, the prevalence of type A was 62%-68%. CONCLUSIONS: These results suggest that polymorphisms of P4502E1 may be related to the development of ALD.     

Antagonism to noradrenaline-induced lethality in rats is related to affinity for the alpha1A-adrenoceptor subtype

The potency of several alpha1-adrenoceptor antagonists in preventing the noradrenaline-induced lethality in conscious rats, their binding affinity for the native alpha1A- and alpha1B-adrenoceptors, the recombinant animal alpha1a-, alpha1b- and alpha1d-adrenoceptor subtypes, as well as their functional affinity for the alpha1L-adrenoceptor subtype were evaluated. The potency of the tested compounds as antagonists of noradrenaline-induced lethality was correlated with the affinity for the alpha1A- (and alpha1a-) adrenoceptor subtype, but not with the affinity for the other subtypes. On the contrary, the hypotensive effects of the compounds, assessed in anesthetized rats, were not clearly related with the affinity for any of the alpha1-subtypes. These results suggest that the alpha1A-subtype plays a determining role in preventing lethality induced by noradrenaline in the rats, and that this activity is unrelated to the hypotensive effect of the compounds, which cannot be clearly correlated with affinity for a particular alpha1-adrenoceptor subtype.     

The art of survival: unleashing the talents of end stage renal disease patients to increase their wellness

Patients with end stage renal disease (ESRD) often suffer compromised self-esteem and lowered self-confidence, isolation from the larger community and increased dependence on the health care system. Despite improved technology and medical care, such concepts as "quality of life" and "feeling well" still elude these patients. There is a growing realization in the health care field that other interventions and approaches are needed. This article will describe how the creative arts can activate, motivate and promote wellness for ESRD patients. The focus is on the use of professional artists, dancers and writers to help restore a sense of wholeness, health, and happiness to patients' lives. This preliminary work which explores the belief that art and artistic experiences have healing properties, will hopefully result in a more comprehensive research project in the near future.     

Characterization of the alpha 1-adrenoceptors of dog liver: predominance of the alpha 1A-subtype

Using dog liver membranes we observed that [125I]HEAT ((+/-)-beta-([125I]iodo-4-hydroxyphenyl)-ethyl-aminomethyl-tetralone) binds with high affinity (KD 97 pM) to a discrete number of sites (Bmax 40 fmol/mg protein) with the pharmacological characteristics expected for alpha 1-adrenoceptors. Such sites were inactivated by pretreatment with chloroethylclonidine. Binding competition experiments indicated the following order of potency: (a) for agonists: oxymetazoline > epinephrine > or = norepinephrine > methoxamine and (b) for antagonists: WB4101 > or = 5-methyl-urapidil = prazosin > or = benoxathian > or = (+)-niguldipine > phentolamine. Northern analysis indicated that total RNA isolated from dog liver hybridized with an alpha 1c selective probe (bovine brain). The orders of potency for agonists and antagonists, their Ki values and the Northern analysis suggest that dog liver expresses alpha 1A-adrenoceptors.     

An easier technique for end to end pancreaticojejunostomy

The effect of a wild measles virus circulating in a childhood collective body on the immune status of 80 children has been studied over time. Only using enzyme immunoassay was it possible to fully record and assess the degree of booster effect of the virus on children in case of infection transmission. In 25% cases the increment of antibodies was at the expense of specific IgM antibodies appearing in the sera of children. By the end of the first month 60% of children developed a relative measles immunodepression. Analysis of the index of cell stimulation with phytohemagglutinin in the presence of suppressors enabled us to single out a group of children (30%) with weakly expressed suppressive factor. The observed phenomenon with a high degree of reliability may be used as an index of immune response development.     

Quantitative and qualitative changes in serum oligopeptide components of patients with end stage malignant tumour disease

A number of changes in peptide components could be demonstrated in sera of patients with end stage malignant diseases. Total and free alfa amino-N content of such sera was shown to be significantly higher than those in sera of patients with no sign of malignancy. In addition, a significant increase was found in one of the serum fraction obtained by Sephadex G-25 chromatography. This increase was shown to be due to an increase in the amount of one of the isotachophoretically separated serum components of anionic character as well as to the appearance in sera of tumour bearing patients of two additional isotachophoretic components never detected in non tumour bearing patients. Based on their chromatographic behavior as well as on observations made in earlier experiments, the peptide nature of the two isotachophoretic serum components seemingly characteristic of sera of tumour bearing patients is highly probable.     

Cutaneous gangrene secondary to metastatic calcification in end stage renal failure--a case report

The belief that oestrogens are involved in the pathogenesis both of testicular cancer in young men and of cancers of the endometrium and female breast has become widespread. In a search for possible hormonal links between these cancers, we investigated the cancer pattern in a cohort of women who had given birth to sons who developed testicular cancer. Particular focus, was given to oestrogen-related cancers. The present retrospective population-based cohort study is based on data from the Danish Cancer Registry. Mothers of 2,204 testicular-cancer patients were followed for the occurrence of cancer over a total of 70,063 person years. The ratio of observed cancers in the cohort over the expected numbers based on cancer incidence in the underlying female population served as measure of the relative risk (RR). The RR of developing breast cancer among mothers of testicular-cancer patients was 0.8 (95% confidence interval 0.6-1.1), the relative risk of endometrial cancer 0.6 (0.3-1.0) and of ovarian cancer 1.0 (0.6-1.6). Mothers of testicular-cancer patients are not at increased risk of developing oestrogen-related cancers.     

Left ventricular mass index in patients of end stage renal disease (non-diabetic) on regular haemodialysis

Echocardiography in patients of end stage renal failure (non diabetic) on regular haemodialysis revealed increase in left ventricular mass index in comparison to healthy controls. Anaemia, chronic uraemic state and hypertension were the probable contributory factors.     

The assessment of the nutritional status of patients in the terminal stage of liver disease who are candidates for orthotopic liver transplantation

We evaluated the intravenous infusion of a cocktail of I-131 anti-CEA and anti-CA19-9 monoclonal antibody F(ab')2 (IMACIS-1) in patients with gastrointestinal neoplasm and liver metastases in order to assess its efficacy in detecting the presence of cancer. Seven patients with primary or recurrent gastrointestinal cancer in whom liver metastases were also detected were studied. Accumulation of radioactivity in the primary tumor was seen in only one patient. Visualization of the liver metastases was achieved in all patients. Thus detection of liver metastasis was better than in primary or recurrent tumors. While tumor visualization was most often seen in the 3 day image, optimal visualization of the tumor was seen at 5-7 days. There was no correlation between the serum concentration of CEA or CA19-9 and the visualization of tumors. Serum kinetics of I-131 IMACIS-1 showed biexponential components with a 1st phase T1/2 of 5.0 hours and 2nd phase T1/2 of 34.7 hours. The mean whole body (I-131) half-life determined from the whole-body scans was 1.95 days. The mean urinary excretion of I-131 in 7 days was 85%. This value agreed closely with total radioactivity retention detected by scanning. This series of studies demonstrated the potential utility of a cocktail of antibodies consisting of an anti-CEA and an anti-CA19-9 monoclonal F(ab')2.