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  • 1
    Electronic Resource
    Electronic Resource
    Improved outcome of renal transplantation with cyclosporine compared with azathioprine —Experience in 33 recipients followed for over one year— (1986)
    Springer
    Surgery today 16 (1986), S. 181-188 
    Details
    ISSN: 1436-2813
    Keywords: renal transplantation ; cyclosporine ; azathioprine ; graft survival ; complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Long-term clinical aspects after kidney transplantation using cyclosporine (CsA) were studied in 33 patients who received kidney grafts from one haplotype identical living related donor and who were followed for at least one year. Both actual graft and patient survival rates were 97 per cent at one year. Incidence and severity of acute rejection were reduced to a greater extent in patients treated with CsA than in patients treated with azathioprine (AZ). The incidence of infections was low, and no serious bacterial infection occurred in these 33 patients. In 17 of 33 patients with a deteriorative graft function caused by intractable nephrotoxicity, CsA was converted to AZ. The mean serum creatinine level of converted patients was significantly higher than that of patients maintained with CsA at each time when a dose of CsA was stepwise reduced from 14 mg/kg/day to 6 mg/kg/day. Conversion to AZ improved graft function dramatically, although it resulted in reversible acute rejections in 4 patients. CsA induced hepatotoxicity occurred in 10 patients, but in all normal liver function was restored with decrease in the dose. The potent immunosuppressive effect of CsA compensates for its side effects. However, CsA should be converted to AZ when the chronic nephrotoxicity persists at a late stage of post-transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471091
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  • 2
    Electronic Resource
    Electronic Resource
    The effect of cyclosporine on mortality and renal function in living related pediatric kidney transplant recipients (1988)
    Springer
    Surgery today 18 (1988), S. 187-193 
    Details
    ISSN: 1436-2813
    Keywords: cyclosporine ; pediatric kidney transplantation ; nephrotoxicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The outcome, incidence of acute rejection episodes, complications and cyclosporine (CyA) induced nephrotoxicity were studied in 10 pediatric kidney transplant recipients who were grafted from one-haplotype indentical parent with immunosuppression of CyA and prednisolone (Pred). Excellent patient and graft survival could be achieved in this population with low incidences of acute rejection or serious complications as when compared with the results of azathioprine (AZ) treated pediatric patients. With a mean follow-up of 12.9 months (range 1 to 50 months), the patient survival rate was 100 per cent and the graft survival rate was 100, 84, 84 and 84 per cent at 1, 2, 3 and 4 years post transplantation, respectively. Serum creatinine levels in the group were 0.97, 1.17, 1.14 and 1.2 mg/dl at 3, 6, 12 and 24 months post transplantation, respectively. The incidence of treated acute rejection episodes was 20 per cent (2 out of 10) in the CyA-treated children, whereas it was 53 per cent (9 of 17) in the Az-treated children. Five children who had undergone transplant surgery before they were 11 years old displayed linear growth in height after their transplantation. There have been no opportunistic infections, aseptic necrosis or peptic ulcers in this group and cyclosporine nephrotoxicity has not been a serious problem in the pediatric recipients. Only 10 per cent (1 out of 10) of the recipients displayed acute nephrotoxicity and only one recipient has converted from CyA+Pred to CyA+AZ+Pred (Three drug therapy) due to persistent nephrotoxicity. Cyclosporine and prednisolone have therefore constituted a relatively safe, effective immunosuppressive regimen for pediatric renal allograft recipients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471429
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  • 3
    Electronic Resource
    Electronic Resource
    Breast cancer arisingde novo in recipients of kidney allograft (1989)
    Springer
    Surgery today 19 (1989), S. 370-375 
    Details
    ISSN: 1436-2813
    Keywords: kidney transplantation ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Immunosuppressive therapy is not only an etiologic factor ofde novo malignant disease but it also accelerates progression of the already developed malignant disease in immunosuppressed recipients. Two cases ofde novo breast cancer arising in kidney transplant recipients are reported herein. A 25 year-old woman, transplanted one haploidentical kidney transplant 4 years and 9 months ago, developed a left breast tumor. Within one month the tumor had rapidly enlarged from 3.5 cm to 8 cm in diameter by the time she underwent a radical mastectomy. Nine axillary lymph nodes were positive for metastasis. Although her graft function had been poor due to chronic rejection, she was treated with standard immunosuppressive therapy, but not adjuvant therapy. Since local recurrent disease appeared two months postoperatively, the immunosuppressive therapy was ceased and60Co therapy started. Recurrent disease progressed rapidly, however, and she died 7 months after her operation. A 27 year-old woman, having allograft from an identical sibling, noted a right breast tumor, 8 years and 7 months later. Again the tumor had grown rapidly from 1.8 cm to 3 cm in diameter within one month. She underwent a standard radical mastectomy. One axillary lymph nodes was positive for metastasis. She has been treated with standard immunosuppressive therapy and adjuvant endocrinochemotherapy. Presently, she is alive with a well functioning graft and no disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471416
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  • 4
    Electronic Resource
    Electronic Resource
    Spontaneous blastogenesis assay for detection of renal allograft rejection in man (1983)
    Springer
    Surgery today 13 (1983), S. 196-201 
    Details
    ISSN: 1436-2813
    Keywords: renal transplantation ; immunological monitoring ; spontaneous blastogenesis ; acute rejection crisis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In attempts to assess the possibility of allograft rejection, serial assays of spontaneous blastogenesis (SB) by uptake of tritium thymidine in 50 μl whole blood were performed in 72 consecutive renal allograft recipients. Of 79 clinically diagnosed rejection episodes, 65 (82 per cent) had an associated elevation of SB values, and 14 (18 per cent) showed false negative results. In 38 (59 per cent) of 65 episodes in which the elevations of SB values were observed, the elevations preceded the clinical diagnosis by 1–7 days. Although large doses of steroids did not affect the values of SB, false positive elevations which were mainly caused by systemic infections occurred in 12 cases. There was no significant association between severity of rejection crisis and the maximum value of SB in the course. The SB assay requiring only a small amount of blood can be accomplished within 4–5 hours and provides a simple means of assessing and predicting host's immune responsiveness to the histocompatibility antigens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02469476
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  • 5
    Electronic Resource
    Electronic Resource
    Analysis of data on 170 consecutive patients transplanted with kidneys from living relatives (1983)
    Springer
    Surgery today 13 (1983), S. 493-501 
    Details
    ISSN: 1436-2813
    Keywords: kidney transplantation ; living donors ; graft survival rate ; HLA typing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Graft survival, mortality, histocompatibility and rehabilitation were studied in 170 consecutive patients receiving kidneys from living relatives. Average follow-up was 5 years and one month with a mininum post-transplant evaluation of 6 months. Overall patient survival was 93 per cent at one year and there was a remarkable decline thereafter. Overall graft survival was 84 per cent at one year, 73 per cent at three, and 67 per cent at five years. Among the 76 patients treated since 1979, both patients and graft survival have improved: 93 per cent and 80 per cent at three years, respectively, because of a decrease in serious complications. Although no correlation was found between HLA-A and B loci matching and graft survival in patients with no mismatch in the HLA-DR locus, there was a significantly higher gratt survival. Infection, the leading cause of death especially in the early post-transplant period, has been brought under control. Aseptic necrosis of the femoral head which occurred in 27 (16 per cent) patients proved to be the most difficult problem. The majority of patients are functioning well socially and vocationally and reproductive functions have been restored. Transplantation offers a better quality of life for patients with chronic renal failure, as compared to hemodialysis. The increased procurement of cadaver kidneys must be given attention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02469492
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  • 6
    Electronic Resource
    Electronic Resource
    Results of kidney transplantation in 25 pediatric patients (1987)
    Springer
    Surgery today 17 (1987), S. 334-341 
    Details
    ISSN: 1436-2813
    Keywords: kidney transplantation in children ; growth retardation ; rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Outcome, long-term prognosis, growth activity and rehabilitation after kidney transplantation were studied in 25 pediatric patients transplanted with a kidney graft from one-haplotype identical parent. Excellent patient and graft survival with low incidences of acute rejection or serious complications could be achieved in this population, as compared with the results of adult recipients. Growth retardations in height and weight were observed in these patients before transplantation, and were significantly correlated with the duration of low or no kidney function. In 12 recipients who were transplanted at ages of younger than 15 years and followed up over two years, a dramatic increase in weight appeared within one year after transplantation and a greater increase in height was exhibited in the second and third year than in the first. Increase in height was significantly greater in those children transplanted at ages of younger than 10 years than in those transplanted at ages of older than 11 years. Catch-up growth was observed in one-third of these children. Retrospectively, there was no difference in the doses of prednisolone given between the two groups of patients with, and without catch-up growth, but the incidence of acute rejection was higher in the group without catch-up growth. Currently, 18 recipients have functioning grafts and 16 (88.9 per cent) of them are in full-time school or working. From these results it is concluded that kidney transplantation is the first feasible manoeuvre for those children with chronic renal failure and it should be performed as soon an possible in order to preserve their growth activity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02470631
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  • 7
    Electronic Resource
    Electronic Resource
    Cyclosporine-associated microangiopathic hemolytic anemia in a renal transplant recipient (1989)
    Springer
    Surgery today 19 (1989), S. 223-228 
    Details
    ISSN: 1436-2813
    Keywords: microangiopathic hemolytic anemia ; cyclosporine ; kidney transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of microangiopathic hemolytic anemia (MHA) associated with the immunosuppressive agent, cyclosporine, is reported herein. The patient manifested anemia with red blood cell fragmentation, hypertension, thrombocytopenia, elevation of serum LDH levels and glomerular capillary thromboses within a few days of his transplantation. Extensive treatments with urokinase and heparin proved ineffective and graftectomy was performed 7 days after his transplantation. Immunofluorescent staining failed to show immunoglobulin (IgG or IgM) or complement (C3) deposition within the glomeruli, which discriminated MHA from acute humoralvascular rejection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471590
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  • 8
    Electronic Resource
    Electronic Resource
    A kidney transplant recipient with renal cell carcinoma derived from a native kidney (1988)
    Springer
    Surgery today 18 (1988), S. 208-212 
    Details
    ISSN: 1436-2813
    Keywords: renal cell carcinoma ; kidney transplantation ; azathioprine ; metastasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A case of renal cell adenocarcinoma which originated from a left native kidney following kidney transplantation, with widespread metastases, including multiple bone and liver metastases, is presented herein. An extensive clinical investigation, including bone marrow biopsy, liver biopsy abdominal computerized tomography, excretory urography and examination of the gastiointestinal tract failed to determine the site of the primary lesion in this patient. Examination at autopsy revealed a small adenocarcinoma of the left native kidney with lobulated nodular capsular invasion and metastases to the bone and liver.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471432
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  • 9
    Electronic Resource
    Electronic Resource
    Experience with 247 living related donor nephrectomy cases at a single institution in Japan (1988)
    Springer
    Surgery today 18 (1988), S. 252-258 
    Details
    ISSN: 1436-2813
    Keywords: living related donor ; nephrectomy ; kidney transplantation ; complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is currently much concern over the morbidity and mortality of donors undergoing nephrectomy for living related renal transplants. Between April, 1970 and July, 1986, 247 cases of living related renal transplants were performed at the Second Department of Surgery, Kyoto Prefectural University of Medicine. The average age of the donors was 50.3±9.7 years, 81 per cent of the donors being parents of the recipients. Minor abnormalities which did not affect the donors suitability were found in 71 cases. Nephrectomies were performed extraperitoneally in all cases. Peri-operative complications, including wound complications in 13 cases, urinary infection in 12 cases and pulmonary complications and arrythmia in 4 cases, were considered to be minor in nature. A variety of renal function tests, carried out two weeks after nephrectomy revealed normal levels, although they had become slightly worse than those estimated pre-operatively. Long-term sequalae in the follow-up period from 18 months to 16 years and 2 months, was studied on 124 donors who answered questionnaires. Currently, there are 5 late deaths, none of which are directly related to the nephrectomy. Of the 124 donors, 85.5 per cent stated that there had been no change in their physical states following surgery. Pain or a feeling of discomfort at the wound site was reported by 10 donors (8.1 per cent) and hypertension was observed only in 3 (2.4 per cent). No major complication directly related to the donor nephrectomy was found, except for one case of incisional hernia. The donor nephrectomy operation thus appeared to be quite safe, and successful long-term sequelae can be obtained if the donor is selected carefully, according to the strict prospective evaluation of medical state and renal functions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471441
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  • 10
    Electronic Resource
    Electronic Resource
    Infiltrating ductal carcinoma developing within cystosarcoma phyllodes —A case report— (1988)
    Springer
    Surgery today 18 (1988), S. 326-329 
    Details
    ISSN: 1436-2813
    Keywords: ductal carcinoma ; cystosarcoma phyllodes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Malignancy in cystosarcoma phyllodes is uncommon and often confined to the stromal element. An extremely rare case of infiltrating ductal carcinoma developing within the stroma of cystosarcoma phyllodes is reported herein. A breast tumor with a diameter of 15 cm, which was diagnosed as cystosarcoma phyllodes, was excised from the right breast of a 47-year old woman. The histopathological examination revealed that hyperplastic ductal epithelial cells with dark cytoplasm and enlarged hyperchromatic nuclei were infiltrating the stroma. Thus, a diagnosis of ductal carcinoma within cystosarcoma was made. Subsequently, a standard radical mastectomy was performed. No recurrence or metastasis has been observed over the post-operative period of 5 years and 6 months.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02471450
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