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Biomedical subjects

A D Cohen

Publications and source records attributed to A D Cohen.

At least 19 recordsLinked to original sources
PubMed1988

Long-term follow-up of cyclosporine-treated renal allograft recipients.

Results in 355 Cs-treated renal graft recipients have been analyzed. The majority of graft losses occurred early. Prior sensitization and repeat grafts were clear-cut early risks for cadaver recipients but not live-related donor grafts. In neither group was presensitization clearly a risk factor for late losses, although repeat grafts were much more at risk late. The majority of late losses was due not to chronic rejection but to deaths from cardiovascular disease and cancer, and a surprisingly high number from noncompliance.

Actuarial Analysis↗
PubMed1987

Repeat cadaver kidney transplantation using cyclosporine A immunosuppression.

Repeat cadaver kidney transplantation using azathioprine immunosuppression carried a higher risk of graft loss than primary transplants. We analyzed the results of repeat cadaver kidney grafting with cyclosporine A immunosuppression. A total of 33 cyclosporine A-treated patients received the second kidney transplant at varying intervals after failure of the first transplant. Graft survival at 1 year was 66 per cent. A concurrent group of 189 cyclosporine A-treated first cadaver kidney recipients had a 1-year graft survival rate of 75 per cent, although this better result was not statistically significant (p greater than or equal to 0.25). A historical group of 31 azathioprine-treated second graft recipients had a significantly worse 1-year graft survival rate of 45 per cent compared to the cyclosporine A second graft group (p less than 0.1). Patient age, sex, early first graft loss, interval between transplants and the presence of panel reactive antibodies were not factors in predicting second graft outcome. A complete DR mismatch appeared to worsen the second transplant survival. These findings indicate that early graft survival of cyclosporine A-treated repeat cadaveric transplants is acceptable and is better than azathioprine-treated first or second grafts.

Actuarial Analysis↗
PubMed1985

Goodpasture's syndrome associated with skin involvement.

To our knowledge, skin lesions associated with Goodpasture's syndrome have not been reported to date. A patient developed discrete, macular, erythematous lesions on the instep of his foot, noted at the time of his admission to the hospital for treatment of Goodpasture's syndrome. Investigation showed perivasculitis and significant deposits of IgM and C3 at the dermoepidermal junction in the lesion site but not in the nearby skin. IgM deposits in the skin are unusual and the same immunoglobulin is found in the kidney in this syndrome. IgM deposit was absent from control samples of skin from four other patients with this syndrome. It is possible that these findings are significant.

Anti-Glomerular Basement Membrane Disease↗
PubMed1984

Lymphokine responses to concanavalin A stimulation: association with HLA DR antigens.

Stimulation of human lymphocytes with concanavalin A (Con A) resulted in variable lymphokine responses as indicated by factors inhibiting macrophage migration (MIF) or stimulating macrophage migration (MStF), or resulted in negligible responses. These responses were consistent for a given individual when repeated after several months. MIF responses were observed more frequently than MStF responses in patients with renal failure who had demonstrable alloantibodies. MStF responses were statistically associated with the presence of HLA DR1 antigens in patients with renal failure and two separate groups of healthy individuals, while MIF responses were associated with DR7 in the three groups studied. There was no correlation between immunoglobulin allotypes and lymphokine responses. These results suggest that lymphokine responses to Con A are indicators of nonspecific immunological responsiveness and are influenced by genes associated with the major histocompatibility complex.

Adolescent↗
PubMed1983

Pneumonia in renal transplant patients.

Between January 1976 and March 1982, 28 episodes of pneumonia occurred in 26 renal transplant patients. The overall mortality rate was 46%. Of the 16 patients with nosocomial pneumonia 9 (56%) died, whereas of the 12 patients with community-acquired pneumonia 4 (33%) died. In all 9 cases of unknown cause the response to empiric treatment was prompt, whereas in 4 of the 10 cases of monomicrobial pneumonia and 8 of the 9 cases of polymicrobial pneumonia the patient died. Cytomegalovirus was the sole cause of the pneumonia in two patients and a contributing cause, along with aerobic gram-negative bacteria, in another five, four of whom also had a fungal infection. Two patients, both of whom survived, had nosocomial Legionnaires' disease.

Adult↗
PubMed1982

Lymphokine responses to mitogenic and antigenic stimulation. Predictive value in renal transplantation.

Immune responsiveness of recipients of renal transplants from cadaver donors was monitored by measuring lymphokine responses to specific (donor antigen) and nonspecific (concanavalin A (Con A)) stimuli. Production of migration inhibition factor (MIF) in response to stimulation by Con A before and 3 days after transplantation correlated strongly with graft rejection and production of migration stimulation factor (MSTF) with graft acceptance. This pattern continued at later time intervals but was more variable. An initial vigorous MIF response to donor cell extract was associated with rejection but subsequent responses to donor extract in the 1st month after transplantation were variable and not predictive of the outcome. In some cases, there was clearly a dissociation of lymphokine responses to donor-specific and nonspecific stimuli.

Animals↗
PubMed1982

Cardiac function in end-stage renal disease.

To assess cardiac status in end-stage renal disease, we compared clinical, ECG, and echocardiographic data from 37 patients on maintenance hemodialysis with data from 42 patients with functioning renal transplants. Cardiovascular symptoms and abnormal cardiovascular findings were more common in dialysis-maintained patients than in those with transplants. Follow-up studies indicated that despite a high prevalence of cardiac symptoms, abnormal physical signs, and dilated left ventricles among patients with end-stage renal disease, systolic left ventricular function was generally well preserved irrespective of renal failure therapy. Compared with maintenance hemodialysis, however, successful renal transplantation is associated with an overall enhancement of cardiac status, the majority of which is probably secondary to transplant-associated improvement in hemoglobin level and control of intravascular volume.

Adolescent↗
PubMed1974

On the mechanism of lithium-induced diabetes insipidus in man and the rat.

The mechanism of lithium-induced diabetes insipidus was investigated in 96 patients and in a rat model. Polydipsia was reported by 40% and polyuria (more than 3 liter/day) by 12% of patients receiving lithium. Maximum concentrating ability after dehydration and vasopressin was markedly impaired in 10 polyuric patients and was reduced in 7 of 10 nonpolyuric patients studied before and during lithium therapy. Severe polyuria (more than 6 liter/day) was unresponsive to trials of vasopressin and chlorpropamide, but improved on chlorothiazide. Rats receiving lithium (3-4 meq/kg/day) developed massive polyuria that was resistant to vasopressin, in comparison to rats with comparable polyuria induced by drinking glucose. Analysis of renal tissue in rats with lithium polyuria showed progressive increase in the concentration of lithium from cortex to papilla with a 2.9-fold corticopapillary gradient for lithium. The normal corticopapillary gradient for sodium was not reduced by lithium treatment. The polyuria was not interrupted by brief intravenous doses of vasopressin (5-10 mU/kg) or dibutyryl cyclic AMP (10-15 mg/kg) capable of reversing water diuresis in normal and hypothalamic diabetes insipidus rats (Brattleboro strain). The present studies suggest that nephrogenic diabetes insipidus is a common finding after lithium treatment and results in part from interference with the mediation of vasopressin at a step distal to the formation of 3',5' cyclic AMP.

Animals↗