Toxicology and adverse effects of drugs used for immunosuppression in organ transplantation

The main mechanism causing catabolite repression by glucose and other carbon sources transported by the phosphotransferase system (PTS) in Escherichia coli involves dephosphorylation of enzyme IIA(Glc) as a result of transport and phosphorylation of PTS carbohydrates. Dephosphorylation of enzyme IIA(Glc) leads to 'inducer exclusion': inhibition of transport of a number of non-PTS carbon sources (e.g. lactose, glycerol), and reduced adenylate cyclase activity. In this paper, we show that the non-PTS carbon source glucose 6-phosphate can also cause inducer exclusion. Glucose 6-phosphate was shown to cause inhibition of transport of lactose and the non-metabolizable lactose analogue methyl-beta-D-thiogalactoside (TMG). Inhibition was absent in mutants that lacked enzyme IIA(Glc) or were insensitive to inducer exclusion because enzyme IIA(Glc) could not bind to the lactose carrier. Furthermore, we showed that glucose 6-phosphate caused dephosphorylation of enzyme IIA(Glc). In a mutant insensitive to enzyme IIA(Glc)-mediated inducer exclusion, catabolite repression by glucose 6-phosphate in lactose-induced cells was much weaker than that in the wild-type strain, showing that inducer exclusion is the most important mechanism contributing to catabolite repression in lactose-induced cells. We discuss an expanded model of enzyme IIA(Glc)-mediated catabolite repression which embodies repression by non-PTS carbon sources.     

The legal basis of organ transplantation (author''s transl)

Report on the legal basis of organ transplantation in Belgium, France, Italy, Luxembourg, the Netherlands, Great Britain, Sweden, Denmark, Norway, Iceland and Finland. Reference is made to the legal uncertainty in the Federal Republic of Western Germany. The Federation probably has no legislative competence for an adequate transplantation law. Amendments of the xi 168 StGB suggested by individual Federal States are discussed. The synopsis of the existing legal rules in the above mentioned countries suggests the proposal of general legal principles which should guarantee 1. the best medical care in transplantation medicine especially in renal explantates 2. a legal protection for the physician 3. a protection for personal rights of the donor. The author feels that the rights of those persons who provide for the corpses should be superceded by these considerations.     

On the putative mechanistic basis for intraoperative propofol-induced penile erections

Virus adsorption and uptake of human rhinovirus 14 (HRV14) were studied with HeLa cells and baby hamster kidney (BHK) cells which were transfected with the HRV14 receptor intercellular adhesion molecule-1 (ICAM-1). Transmission electron microscopy of HeLa cells revealed that HRV14 was internalized via clathrin-coated pits and -coated vesicles. A minority of virus particles also used uncoated vesicles for entry. The internalization showed the characteristics of receptor-mediated endocytosis. Presence of the carboxylic ionophore monensin inhibited viral uncoating, indicating a pH-dependent entry mechanism. The expression of ICAM-1 on the surface of the ICAM-1 transfected baby hamster kidney cells (BHK-ICAM cells) allowed extensive virus adsorption and internalization through membrane channels. Virus particles were lined up in these channels like pearls on a string, but did not induce a productive infection. Although ICAM-1 was expressed to the same degree on BHK-ICAM and HeLa cells, HRV14 induced neither viral protein and RNA syntheses nor infectious virus progeny in BHK-ICAM cells. ICAM-1 on the transfected BHK cells was a functional active receptor as it rendered these cells permissive to coxsackievirus A21. These results suggest that HRV14 uptake into BHK-ICAM cells is blocked directly in or shortly after its final step of internalization, the uncoating. Our findings underline that the receptor ICAM-1 determines virus uptake into cells, however, is not sufficient to confer susceptibility of BHK cells to HRV14 infection.     

Radionuclide imaging in organ transplantation

This article addresses the utility of radionuclide imaging for evaluating functional and anatomic integrity of transplanted liver, kidney, pancreas, heart, and lung. Information about how to interpret routine nuclear medicine procedures for vascular and surgical complications as well as rejection after transplantation is also presented. The role of new radiopharmaceuticals is discussed briefly.     

An emerging cancer risk: organ transplantation

Advancements in surgical techniques, procurement, and immunosuppressant therapy have made organ transplantation a major treatment modality with increasing survival posttransplantation. However, this longevity has placed individuals with transplanted organs at an increased risk for developing cancer. This article examines the following pertinent issues. First, what is the prevalence of malignancies among transplant recipients? Second, are organ recipients told that they may be at risk for developing cancer? Third, is the medical community trading one lethal disease for another? And finally, are oncology nurses properly trained to handle the maintenance of a transplanted organ while caring for a person with cancer? This article looks at several ethical issues, including the ethical principle of autonomy, which examines the respect for a patient's right to choose or refuse treatment. Within this text, autonomy will be the basis for informed consent and the need for cancer risk disclosure. The ethical principle of beneficence is also examined, in regards to the health-care community trading one illness for another. The final ethical principle of nonmaleficence is considered and the need for future oncology nurses to examine their practice to determine if they are ready to care for these posttransplant cancer patients.     

Culture and psychology in organ transplantation

Neurological, cardiac, and systemic complications during the first days to weeks after ischaemic stroke can cause substantial morbidity and mortality. The reported 30-day case fatality rate for cerebral infarction varies between 10 and 17%. The incidence and effects of the various complications vary with time after stroke: transtentorial herniation and other cerebral complications prevail during the 1st week, whereas medical complications are more prominent in the weeks thereafter. Many complications are treatable, and some are preventable. The goal of this report is to provide information on their incidence, consequences, and management.     

Psychological assessment of candidates for solid organ transplantation.

The role of psychologists, who can assist in preparing clients for transplant surgery and support them postsurgery to sustain the complex maintenance protocol, is outlined. An overview of specific procedures used in the psychological evaluation and treatment of solid organ transplant patients, a discussion of general issues involved in treating these patients, and case vignettes are provided. As transplants become more common, the need for additional psychologists as part of multidisciplinary treatment teams increases. Because many patients live great distances from the transplant center, community psychologists may be enlisted to treat organ transplant patients and to collaborate with psychologists on transplant teams. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diet therapy for organ transplantation. A problem-based approach

Nutrition plays a vital role in the recovery, health, and life expectancy of transplant recipients. Because the medical problems differ between the acute recovery and chronic maintenance phases following transplantation, nutrient requirements and nutrition therapies are unique and distinctly different between these 2 periods. Nutrition therapy during the acute post-transplant phase is aimed at promoting healing. Nutrition and pharmaceutical therapies during the long-term post-transplant phase are intended to prevent and treat common problems such as obesity, diabetes, hyperlipidemia, hypertension, and osteoporosis. Nutrition goals and therapies should be individualized based on the specific complications each patient experiences.