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  • 1
    ISSN: 1432-1084
    Keywords: Key words: Aneurysm – Right subclavian artery – Ultrasound – Duplex studies – MR angiography – Digital subtraction angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. True aneurysms of otherwise normal subclavian arteries are uncommon peripheral vascular anomalies. Most patients with subclavian artery aneurysms are symptomatic by presenting neurologic signs. We report a young woman who had an asymptomatic true aneurysm of the right subclavian artery assumed to be of congenital origin. This case is unique in that the aneurysm was in the extremely rare anatomic location of the right supraclavicular fossa between the origins of the right subclavian artery and the vertebral artery. Aneurysms of the right subclavian artery may represent a potential pitfall in conventional gray-scale ultrasound of the neck particularly the supraclavicular fossa. Differential diagnosis includes cervical cyst, pharyngo-esophageal diverticulum, vascular anomalies, struma, enlarged lymph node, as well benign or malignant neoplasms. Color duplex ultrasound should be performed as the method of choice for further analysis of suspected aneurysms. In this report the role of B-mode ultrasound and color duplex ultrasound is discussed in relation to digital subtraction- and MR angiography in confirmation of the diagnosis.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2277
    Keywords: Key words Small bowel transplantation ; Split tolerance ; FK 506 ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Functional long-term allograft survival after experimental small bowel transplantation (SBT) is limited by chronic rejection. Initial application of high-dose FK 506 has been shown to induce stable long-term graft function. In order to examine whether this long-term function is associated with donor-specific tolerance, we analyzed the functional status of recipient T cells in vivo and in vitro. One-step orthotopic SBT was performed in the allogeneic Brown Norway (BN)-to-Lewis rat strain combination. FK 506 was given daily at a dose of 2 mg/kg from days 0–5 in the rejection model and from days 0–9 in the long-term functional model. Mean survival time in the rejection model was 98 ± 2.8 days. Histological examination of these small bowel allografts disclosed signs of chronic rejection. In contrast, all animals of the long-term functional model survived long term ( 〉 250 days) without clinical signs of chronic rejection. The latter model, furthermore, produced evidence of donor-specific tolerance. Whereas heterotopic Dark Agouti (DA) hearts were rejected regularly within 7 days, BN hearts survived indefinitely ( 〉 70 days). In vitro, mixed leukocyte reactivity of CD4 + T cells was similarly strong against donor (BN) antigens as against third-party (DA) antigens. The split tolerance revealed by our in vivo and in vitro results enabled acceptance of both the small bowel allograft without signs of chronic rejection and of donor-specific heart allografts.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2277
    Keywords: Key words Chimerism ; Graft chimerism ; Tolerogenic effect of liver graftsRID=""ID="" 〈E5〉Correspondence to〈/E5〉 S. Löffler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Spontaneous tolerance induction after liver transplantation also supports additional transplants, e. g. a small bowel graft, from the same donor (tolerogenic effect). Chimerism serves as a possible explanation of this phenomenon. Isolated liver (LTx) and combined liver/small bowel transplantation (LSBTx) are compared. LSBTx and LTx were performed in the BN → LEW rat strain combination without immunosuppression. Parenchymal damage during rejection was monitored by sequential standard histology. Donor/recipient populations were identified and further differentiated for immunhistochemical single and double staining. A small number of donor specific leukocytes can be detected on all days in host organs (microchimerism). A significantly larger donor leukocyte population survives long-term in the sinusoids of liver (graft chimerism). Sinusoidal donor leukocytes survive rejection and recover in number after tolerance induction. Rejection of liver allografts and infiltration by host leukocytes are more pronounced after LSBTx than after LTx. Accordingly, during rejection a steeper decline of sinusoidal donor leukocytes is observed after LSBTx and recovery after tolerance induction is not as marked. Microchimerism apparently plays no significant role in either transplantation model. The number of sinusoidal donor leukocytes, however, mirrors closely host immune responses.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Small bowel transplantation ; Tolerogenicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A newly developed liver/small bowel transplantation model (LSBTx) was used to investigate the tolerogenic effect of a liver allograft toward a simultaneously transplanted small bowel. Small bowel transplantation (SBTx) under high-dose immunosuppression was compared to LSBTx with a lower FK506 dosage. Syngeneic Lewis [(LEW) to LEW] and two fully allogeneic rat strain combinations (Brown Norway-to-LEW and Dark Agouti-to-LEW) were used. Clinical course and histological findings after SBTx demonstrated a chronic rejection of the small bowel allograft within 100 days. However, after LSBTx long-term acceptance (〉 150 days) was achieved after a transient rejection crisis, although initial immunosuppression was significantly lower. Furthermore, indicator heart transplantations demonstrated the induction of donor-specific tolerance in both allogeneic strain combinations. In contrast to other LSBTx rat models, these results reflect observations after human LSBTx, in which the rate of acute and chronic rejection is also significantly lower than after human SBTx.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-2277
    Keywords: Key words Liver/small bowel transplantation ; Tolerance ; Dendritic cells ; Kupffer cells ; Antigen-presenting cells ; Chimerism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The predictive value of chimerism was evaluated in three different transplantation models in the rat without immunosuppression: small bowel- (SBTx), liver- (LTx), and liver/small bowel transplantation (LSBTx) were performed in the Brown Norway (BN)-to-Lewis- (LEW) strain combination. Immunohistochemistry and flow cytometry were used to identify donor cells in the recipient's spleen. Their number did not change significantly during transient rejection or tolerance after LTx and LSBTx. However, the amount of donor-derived nonparenchymal cells within the liver allograft including antigen-presenting cells (APCs), such as dendritic and Kupffer cells, clearly mirrored the recipient's immune status: as expected, their number decreased during rejection, but recovered considerably during and after tolerance induction. We conclude that donor cells in the periphery of the recipient correlate with the presence of the allograft, but do not seem to influence graft acceptance actively. However, the kinetics of the detected donor APC population in the liver suggests their important role in modifying the recipient's immune response towards tolerance.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1432-2277
    Keywords: Key words Rat liver transplantation ; Intrahepatic leukocytes ; Dendritic cells ; T lymphocytes ; Chimerism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Long-term graft acceptance and tolerance induction after allogeneic rat liver transplantation are well described. However, the underlying mechanisms remain unclear. In this study we investigated the cellular events within the liver graft during initial immunosuppression and long-term acceptance. Orthotopic liver transplantation was performed in the Dark Agouti (DA)-to-Lewis (LEW) and LEW-to-DA rat strain combination. In order to achieve long-term acceptance, LEW recipients of DA livers were treated with two different short-term therapies. Non-parenchymal cells (NPC) were isolated from liver allografts on days + 10 and + 100 after transplantation and donor-specific leukocytes were immunophenotyped by flow cytometry. Both the monotherapy and triple therapy prolonged graft survival (〉 100 days). Liver allografts from LEW donors into DA recipients were spontaneously accepted across a complete MHC mismatch without immunosuppression. Liver allograft rejection was induced by infiltrating alloreactive immunocompetent cells. But the intensities of cell infiltration in the early and late phases after transplantation did not correlate with eventual outcome. Donor-specific NPC decreased to 18–25 % on day + 10 in both therapeutic groups, but had rebounded to up to 40 % by day + 100. Recurrence of donor-specific cells was caused almost exclusively by rising T cell counts. The persistence of dendritic cells in the late phase after transplantation could be clearly demonstrated. Repopulation by donor-specific T lymphocytes was observed in long-term accepted liver grafts. This recurrence may be based on the differentiation of liver-derived progenitor cells. The persistent coexistence of donor and recipient cells within the liver allograft (intrahepatic chimerism) appears to be characteristic and may be important for long-term acceptance.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 382 (1997), S. 61-63 
    ISSN: 1435-2451
    Keywords: Familial adenomatous polyposis ; Gardner's syndrome ; Thyroid carcinoma ; Familiäre adenomatöse Polyposis ; Gardner-Syndrom ; Schilddrüsenkarzinom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Wir berichten über eine 23jährige Patientin mit einem seit 5 Jahren bekannten Gardner-Syndrom, die ein bifokales, papilläres Schilddrüsenkarzinom entwickelte. Bei diesem kombinierten Vorliegen einer Polyposis coli mit einem Schilddrüsenmalignom handelt es sich um eine seltene, aber beschriebene Assoziation. Typischerweise liegt histologisch ein multifokaler, papillärer Tumor mit überwiegend guter Prognose vor. Betroffen sind fast ausschließlich Frauen der 2. Lebensdekade. Die Schilddrüsenmanifestation kann der Diagnose einer familiären Polyposis vorausgehen. Bei Patienten mit einer Polyposis coli sollte daher eine konsequente, routinemäßige, klinische Schilddrüsenkontrolle erfolgen, damit bei Verdacht auf das Vorliegen eines Malignoms unverzüglich eine nuklearmedizinische Abklärung, ggf. mit Punktion suspekter Befunde, durchgeführt werden kann. Kann ein Karzinom gesichert werden, u.U. durch eine intraoperative Schnellschnittdiagnostik, sollte— wegen der häufig angetroffenen Multizentrizität dieser Malignome— therapeutisch eine totale Thyreoidektomie mit Ausräumung der zentralen Lymphknotenkompartimente durchgeführt werden.
    Notes: Abstract We report on the case of a 23-year-old female with a 5-year history of Gardner's syndrome, who developed a bifocal, papillary carcinoma of the thyroid. The combination of familial adenomatous polyposis with a thyroid cancer is a rare but well-documented association. Typically, histology reveals a multifocal, papillary tumour with a predominantly good prognosis. This type of carcinoma is almost exclusively confined to females in their second decade of life, and it may, in fact, precede the onset of the polyposis manifestation. Patients suffering from familial adenomatous polyposis should therefore undergo regular clinical examination of the thyroid gland. If a neoplastic lesion is suspected, immediate scintigraphic evaluation should be carried out, with fine-needle aspiration of equivocal foci if necessary, and/or intraoperative frozen section. When a carcinoma is found, total thyroidectomy with dissection of the central lymph compartments should be considered the treatment of choice because of the high likelihood of the tumour being multicentric.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1435-2451
    Keywords: Liver transplantation ; Spontaneous tolerance ; Suppressor cells ; Macrophage replacement ; Lebertransplantation ; Spontantoleranz ; Suppressorzellaktivierung ; Makrophagenaustausch
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Nach orthotoper Rattenlebertransplantation in der voll allogenen BN (RT-1n) -LEW (RT-11) Kombination tritt das Phänomen der Spontantoleranz gegen Spenderantigen auf. Es können zwei verschiedene Immunmechanismen dieser Spontantoleranz gezeigt werden: mit Hilfe von adoptiven Transfer-Versuchen können T-Suppressorlymphocyten in der Milz langzeitüberlebender Lebertransplantatempfänger nachgewiesen werden. Sie verlängern - adoptiv in syngene vorbestrahlte Empfänger übertragen - die überlebenszeit von spenderspezifischen (BN) nicht aber Drittstammnieren-transplantaten auf mehr als 100 Tage (Kontrolle: 11 Tage). Zweitens kann der Austausch von Kupfferschen Sternzellen des Transplantats durch empfängereigene Makrophagen im Verlauf der Toleranzentwicklung gezeigt werden. Dieser Austausch immunkompetenter Zellen könnte zur Transplantatadaptation und damit zur Langzeitakzeptanz des allogenen Gewebes beitragen.
    Notes: Summary After orthotopic rat liver transplantation in the fully allogeneic BN (RT-1n) to LEW (RT-11) combination, the phenomenon of spontaneous tolerance of donor antigen occurs. We demonstrate two different immune mechanisms that may account for this process. Using adoptive transfer assays we show the presence of donor-specific T-suppressor lymphocytes in the spleens of long-term surviving liver graft, recipients. These cells prolong - adoptively transferred into irradiated syngeneic hosts — the survival of donor-specific (BN) but not third-party (DA) renal allografts (I00 days vs 1I days in control groups). Secondly, we demonstrate the replacement of Kupffer cells in the graft by recipient macrophages using polymorphic monoclonal antibodies in an immunoperoxidase technique. This may contribute to graft adaptation and thus to long-term graft acceptance.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 382 (1997), S. 61-63 
    ISSN: 1435-2451
    Keywords: Key words Familial adenomatous polyposis ; Gardner's syndrome ; Thyroid carcinoma ; Schlüsselwörter Familiäre adenomatöse Polyposis ; Gardner-Syndrom ; Schilddrüsenkarzinom
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Wir berichten über eine 23jährige Patientin mit einem seit 5 Jahren bekannten Gardner-Syndrom, die ein bifokales, papilläres Schilddrüsenkarzinom entwickelte. Bei diesem kombinierten Vorliegen einer Polyposis coli mit einem Schilddrüsenmalignom handelt es sich um eine seltene, aber beschriebene Assoziation. Typischerweise liegt histologisch ein multifokaler, papillärer Tumor mit überwiegend guter Prognose vor. Betroffen sind fast ausschließlich Frauen der 2. Lebensdekade. Die Schilddrüsenmanifestation kann der Diagnose einer familiären Polyposis vorausgehen. Bei Patienten mit einer Polyposis coli sollte daher eine konsequente, routinemäßige, klinische Schilddrüsenkontrolle erfolgen, damit bei Verdacht auf das Vorliegen eines Malignoms unverzüglich eine nuklearmedizinische Abklärung, ggf. mit Punktion suspekter Befunde, durchgeführt werden kann. Kann ein Karzinom gesichert werden, u.U. durch eine intraoperative Schnellschnittdiagnostik, sollte – wegen der häufig angetroffenen Multizentrizität dieser Malignome – therapeutisch eine totale Thyreoidektomie mit Ausräumung der zentralen Lymphknotenkompartimente durchgeführt werden.
    Notes: Abstract We report on the case of a 23-year-old female with a 5-year history of Gardner's syndrome, who developed a bifocal, papillary carcinoma of the thyroid. The combination of familial adenomatous polyposis with a thyroid cancer is a rare but well-documented association. Typically, histology reveals a multifocal, papillary tumour with a predominantly good prognosis. This type of carcinoma is almost exclusively confined to females in their second decade of life, and it may, in fact, precede the onset of the polyposis manifestation. Patients suffering from familial adenomatous polyposis should therefore undergo regular clinical examination of the thyroid gland. If a neoplastic lesion is suspected, immediate scintigraphic evaluation should be carried out, with fine-needle aspiration of equivocal foci if necessary, and/or intraoperative frozen section. When a carcinoma is found, total thyroidectomy with dissection of the central lymph compartments should be considered the treatment of choice because of the high likelihood of the tumour being multicentric.
    Type of Medium: Electronic Resource
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