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Biomedical subjects

A B Cosimi

Publications and source records attributed to A B Cosimi.

At least 235 records · Page 13Linked to original sources
PubMed1976

Hyperparathyroidism during pregnancy.

Hyperparathyroidism during pregnancy is clearly associated with an increased incidence of neonatal morbidity and mortality. Although it is impossible to define the precise incidence of this entity, we believe that its occurrence will be seen more frequently with the increasing numbers of female patients who have successfully received renal transplants and with the routine determination of serum chemistries in the nontransplanted pregnant patient. A review of case reports since 1962 of women known to be hyperparathyroid during pregnancy revealed 80 per cent of these pregnancies to be complicated by neonatal tetany, death, or abortion. This review substantiates Ludwig's earlier report [1], which noted a 50 per cent incidence of neonatal complications despite the advances of prenatal and postnatal medical care. There have been only eight reported cases in which parathyroid resection was performed during pregnancy. Successful operation dramatically reduced the incidence of neonatal complications. An adaptive normocalcemic hyperparathyroidism occurs routinely during pregnancy. However, in the hypercalcemic hyperparathyroid pregnancy, transplacental passage of calcium leads to a profound hypercalcemia in the fetus. Since the fetal parathyroid glands are functionally responsive, parathyroid suppression is thought to occur in utero due to high calcium levels. This can lead to neonatal tetany or perhaps permanent neonatal hypoparathyroidism. When a patient presents with significant hypercalcemic hyperparathyroidism during pregnancy, we suggest that an explorative parathyroid operation be performed during the second trimester of pregnancy. After delivery, the baby's course should be carefully monitored with frequent calcium determinations. Cow's milk or other formula feedings high in phosphate content should be avoided in favor of feedings with a calcium:phosphorus ratio similar to that of human milk.

Adult↗
PubMed1976

Diagnosis and management of arterial stenosis causing hypertension after successful renal transplantation.

Renal artery stenosis causing hypertension has been noted in 11 patients after successful renal transplantations. We believe that all patients with moderate to severe post-transplant hypertension should be evaluated with angiography and selective renin determinations. However, because of definite risk to the graft we believe that operative intervention should be undertaken only if hypertension is uncontrolled or if declining renal function is present and attributable to the stenosis.

Adolescent↗
PubMed1976

Randomized clinical trial of antithymocyte globulin in cadaver renal allograft recipients: importance of T cell monitoring.

Despite incontrovertable evidence demonstrating the unique immunosuppressive capabilities of antihymocyte globulin (ATG) in animals, its value in clinical transplantation has remained inconclusive. A multicenter, prospective study was undertaken in an attempt to determine this value. Cadaver renal allograft recipients were randomized into two treatment groups: prednisone and azathioprine only, or prednisone, azathioprine, and ATG. Four to 36 month follow-up of our first 50 recipients, supported by results in over 200 patients from other centers, permits the following observations. (1) Allograft survival can be improved by nearly 20 percent in recipients treated with active ATG preparations. (2) Presently available assays performed in vitro and on subhuman primate allograft survival, though capable of excluding inactive preparations, cannot quantitate precisely the immunosuppressive capacity of active batches of ATG. (3) Monitoring circulating T cell levels in patients receiving ATG appears to offer the best means of defining immunosuppressive potency and the variation in response to the agent among identically treated individuals. It is concluded that ATG therapy can be beneficial in renal transplantation; but monitoring of recipients' T cell level is desirable during therapy to determine the dosage required. Furthermore, the optimal immunosuppressive protocol can be approximated by modifying the regimen according to individual variations in response, thus limiting the infectious complications of excessive immunosuppression.

Adolescent↗
PubMed1975

Renal transplantation in the older age group.

Previously reported results of renal transplantation in the older age group have been discouraging; thus this form of therapy has generally been denied to patients over 50 years of age, unless a living related donor was available. A review of our transplant patients aged 51 or older who received cadaver donor kidneys was performed, and comparison was made to the survival being achieved for this group through hemodialysis or transplantation from living related donors. Functional survival of the homograft in the older age group in the Massachusetts General Hospital series compared favorably to that reported by the National Transplant Registry for recipients of all ages. We conclude that cadaver donor transplantation should be offered to increasing numbers of end-stage renal failure patients older than 50 years of age.

Acute Kidney Injury↗
PubMed1975

Distribution of latex-ingesting cells, T cells, and B cells in the peripheral blood of patients with malignant melanoma.

The distribution among peripheral blood mononuclear cells of latex-ingesting cells, T cells, and B cells was determined with samples from 38 normal donors and 25 patients with malignant melanoma. The mean percentage of latex-ingesting cells, as well as B and T cells, was significantly reduced in the 25 patients with malignant melanoma, stages I and II, compared to the controls. Several explanations for these unexpected findings were considered; possibly the presence of occult neoplasm was responsible for the observed changes in cell distribution.

Adolescent↗
PubMed1975

Pyeloureterostomy reconstruction in human renal transplantation.

Pyelouretersotomy or ureteroureterostomy was the urinary tract reconstructive procedure in 114 of 132 consecutive renal transplants performed at the Massachusetts General Hospital from September 1967 to December 1973. Anastomotic leakage was the only complication related to failure of pyeloureterostomy or ureteroureterostomy. This occurred in nine transplants (7.9%). Since 1970, only four anastomotic leaks have occurred in 79 consecutive pyeloureterostomies or ureteroureterostomies. Six of the nine primary anastomotic leaks were corrected either by retrograde ureteral catheter drainage or re-suturing of the anastomotic defect. Only one patient died as a result of complications following a leak. The operative technique is described with emphasis on the important details believed necessary for consistent success in performing this procedure.

Humans↗
PubMed1975

Immunosuppression and temporary skin transplantation in the treatment of massive third degree burns.

A method of burn treatment (immunosuppression and temporary skin transplantation) for patients suffering from massive third degree burns is evaluated. The method is based on the prompt excision of all dead tissue (burn eschar) and immediate closure of the wound by skin grafts. Total wound closure is achieved before bacterial infection or organ failure takes place by carrying out all initial excision and grafting procedures within the first ten days post burn and supplementing the limited amount of autograft with allograft. Continuous wound closure is maintained for up to 50 days through immunosuppression. Both azathioprine and ATG have been used but ATG is preferred. During the period of immunosuppression, allograft is stepwise excised and replaced with autograft donor sites regenerate for recropping. Bacterial complications are minimized by housing the patient in the protected environment of the Bacteria Controlled Nursing Unit. Intensive protein and calorie alimentation are provided, and 0.5% aqueous AgNO3 dressings are used. A swinging febrile illness has been associated with large areas of allograft rejection. Eleven children have been treated and seven have been returned to normal, productive schooling.

Antilymphocyte Serum↗
PubMed1975

Studies on the rosette inhibition assay. Improvement of the method and correlation with monkey skin graft prolongation.

The rosette inhibition assay for immunosuppressive activity of antilymphocyte globulin or plasma has been studied in an effort to improve its reliability. Important changes include the elimination of calcium and magnesium ions from salt solutions used in the assay, the use of deoxyribonuclease to prevent lymphocyte clumping, and pretreatment of plasma samples (heating at 63 C for 10 min followed by acrinol precipitation) to prevent nonspecific inhibition of rosette formation. The use of a graded dose response potency assay against a house standard is discussed. A significant correlation was established between the in vitro activity of several series of antilymphocyte globulin or antithymocyte globulin preparations and their ability to prolong skin graft survival in primates. The best correlation was achieved using a potency estimate relative to a house standard, rather than the conventional titer estimate.

Animals↗
PubMed1975

Effect of immunosuppressive therapy for renal allografts on the number of circulating sheep red blood cells rosetting cells.

Patients receiving renal allografts from relatively incompatible donors were randomly assigned to one of two immunosuppressive regimens: azathioprine and prednisone with or without a 2-week course of horse antihuman thymocyte globulin (ATG). The number of circulating lymphocytes fell to about one-third of pretreatment values in both groups of patients. In patients given ATG, the proportion of sheep red blood cell-rosetting lymphocytes (SRBC-R) fell promptly to less than 10% of pretreatment values. In contrast, the percentage of SRBC-R remained at about 70% in patients receiving only prednisone and azathioprine. The addition of ATG reduced the number of SRBC-R/mm3 to one-tenth to one-thirtieth the number seen in non-ATG-treated patients. Plasma of patients undergoing therapy did not inhibit rosetting in vitro. It is proposed that the monitoring of circulating rosetting cells may be a useful clinical guide to the degree of T cell immunosuppression. It is also suggested that the regimen of azathioprine, prednisone, and ATG results in a more effective suppression of circulating T cells than that produced by azathioprine and prednisone alone.

Antilymphocyte Serum↗
PubMed1975

Tuberculosis outbreak in rhesus monkeys immunosuppressed with antithymocyte globulin.

Tuberculosis lesions were found in necropsied monkeys used in studies involving immunosuppression. Correlations were made between the demonstration of reduced numbers of circulating T cells, the duration of allograft survival and the appearance of T cell-dependent tuberculin sensitivity. The immunosuppressed state of these monkeys may have resulted in false tuberculin reactions. The report confirms the necessity for sequential tuberculin tests on rhesus monkeys prior to their being used in experiments.

Animals↗
PubMed1973

Evidence suggesting persistence of nephritogenic immunopathologic mechanisms in patients receiving renal allografts.

Direct immunofluorescent (IF) examinations and elutions were performed on native kidneys and allografts of 24 patients undergoing renal transplantation. Immunoglobulins (Ig) were detected by IF on native kidneys of 12 of the 24; 11 of the 12 later had Ig localized to allograft glomeruli by direct IF. In addition, three other patients also developed Ig deposition on allograft glomeruli, although direct IF of native kidneys was negative. Elution studies indicated: (a) that linear Ig deposition on allograft glomeruli was the result of antiglomerular basement membrane (GBM) antibodies, (b) Ig localizing to allograft glomeruli in many of these patients was the result of persistent immunopathogenetic mechanisms existing at the time of allograft placement, and (c) occasionally, kidneys negative for Ig localization by direct IF contain elutable nephritogenic antibodies.

Adult↗