Three cases of diflunisal hypersensitivity.
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Aged↗
Biomedical subjects
D J Cook
Publications and source records attributed to D J Cook.
Dominant effect of histocompatibility on ten-year kidney transplant survival.
Using actuarial methods, factors influencing long-term graft survival were examined in 33,594 recent (since 1974) kidney transplants reported to the University of California, Los Angeles, Transplant Registry. One- and 10-year graft-survival rates as well as late (from 3 through 10 years) graft-loss rates (half-lives) were determined. The donor-recipient relationship had the greatest influence on long-term graft survival. Transplants between HLA-identical siblings had graft-survival rates of 89% at 1 year and 68% at 10 years, compared with 76% and 43% for parental donors, and 58% and 26% for cadaver donor transplants, respectively. These differences were also evident from the graft half-lives, which were 22 years for HLA-identical sibling, 12 years for parental, and 8 years for cadaver donor allografts. In cadaver donor transplants, matching for HLA-A,B antigens had the greatest influence on long-term graft survival, with a 15% 10-year graft survival (39% vs. 24%) and 7-year half-life (14 vs. 7 years) advantage seen with the best (zero HLA-A,B mismatches) compared with the worst (4 HLA-A,B) cases, respectively. Some of the factors studied, such as transplant number and pretransplant transfusions, tended to influence the short- rather than long-term graft-survival rates. Others, including HLA-A,B matching, early graft function and the recipient's original disease, influenced both early and late graft survival. Over all, histocompatibility between donor and recipient had by far the greatest influence on the long-term success of renal allografts.
Actuarial Analysis↗
Twenty-four-hour intragastric measurements in twenty healthy subjects: effect of enisoprost, a novel and potent antisecretory and antipeptic synthetic E1 prostaglandin.
Gastric aspiration was performed continuously overnight and at hourly intervals during the daytime in 20 healthy male volunteers. Medications used included enisoprost 100, 200 or 400 micrograms, misoprostol 200 micrograms and placebo, given at bedtime. Each dose of enisoprost markedly inhibited nocturnal mean acid output, hydrogen ion activity, pH and peptic activity. The duration of these effects was up to 10 h. Misoprostol, given at bedtime, also decreased acid secretion, but the effect was significantly less than that observed with any of the doses of enisoprost. A dose-response effect for enisoprost was found for the mean nocturnal hydrogen ion activity and pH, as well as for maximum pH attained. Although enisoprost, given at bedtime, had a marked inhibitory effect on acid and pepsin secretion for the overnight interval, this did not result in rebound hyperacidity or a rise in serum total gastrin concentration. The results of this study suggest that enisoprost should be tested by clinical trial for the treatment of peptic ulcer disease.
Adolescent↗
Somatostatin treatment for cryptosporidial diarrhea in a patient with the acquired immunodeficiency syndrome (AIDS).
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Acquired Immunodeficiency Syndrome↗
Late onset gold induced thrombocytopenia.
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Female↗
Immune responsiveness.
1. In 1987 transplants, the association between the DR1 antigen and increased graft survival appears to have been lost. 2. Average preformed panel reactive antibodies, peak or current, were higher in grafts that were lost in the early posttransplant period, when compared to grafts with excellent function. Increased HLA-DR mismatches and female donors were also associated with early graft losses. 3. Recipient sex (male), HLA-DR mismatches, and donor age appeared to influence later graft losses. 4. Recipient age, HLA-B,DR and HLA-A,B,DR mismatches, and CITs were elevated in all graft loss groups.
Age Factors↗
Flow cytometry crossmatching for kidney transplantation.
1. Overall, positive FCXM reactions were associated with graft losses in regrafts but not in primary transplants. 2. In transplants involving older female or CVA donors, a positive FCXM appeared to be deleterious in both first transplants and regrafts. If the donor were a younger male and not a CVA victim, only FCXM positive regrafts had low graft survival rates. 3. We presented a 3-color technique allowing the differentiation of antibody reactions against T cells, B cells, and monocytes. Another method allows the simultaneous evaluation of both IgG and IgM reactions against T cells. Using these kinds of methods may make better identification of antibodies that may be harmful to a transplant allograft possible.
Antilymphocyte Serum↗
Pauciarticular juvenile rheumatoid arthritis presenting in an adult.
Type I pauciarticular juvenile rheumatoid arthritis (PA-JRA) is characterized by a female predominance, chronic iridocyclitis and a positive antinuclear antibody (ANA) test. In contrast, patients with type II PA-JRA are usually male, have a negative ANA test, but are HLA-B27 positive. We report a patient with longstanding iridocyclitis who presented at age 20 with oligoarthritis, whom we believe has Type I PA-JRA. Slit lamp examination should be considered in patients with oligoarthritis; the detection of asymptomatic chronic iridocyclitis may aid in the diagnosis. Untreated, this condition may cause irreversible ocular damage.
Adult↗
Cyclosporine A and histocompatibility in kidney transplantation.
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Cyclosporins↗
Effect of cold air on aqueous humor dynamics in humans.
Several parameters of aqueous humor dynamics were measured in 11 human subjects before and after exposure of one eye to a continuous stream of cold air. In the treated eye, I.O.P. was found to decrease significantly from a mean +/- SD pre-treatment value of 14.1 +/- 2.3 mmHg to a post-treatment value of 12.6 +/- 2.6 mmHg. Episcleral venous pressure was found to decrease significantly from a pre-treatment value of 6.2 +/- 1.3 mm Hg. No significant changes were found in aqueous flow or total outflow facility, indicating that cold air exposure decreased I.O.P. by causing a decrease in episcleral venous pressure.
Air↗
Adenomyoma of the common bile duct.
We report an unusual case of biliary obstruction secondary to adenomyoma of the common bile duct. Adenomyomas are benign tumors, found infrequently in the biliary tree. Clinical presentation, biochemical, radiographic, and endoscopic investigations do not distinguish adenomyomas from malignant or other lesions; diagnosis requires histological examination. The natural history and optimal treatment of these tumors have not been established.
Aged↗
The major histocompatibility complex of primates.
The major histocompatibility complex (MHC) encodes cell surface glycoproteins that function in self-nonself recognition and in allograft rejection. Among primates, the MHC has been well defined only in the human; in the chimpanzee and in two species of macaque monkeys the MHC is less well characterized. Serologic, biochemical and genetic evidence indicates that the basic organization of the MHC linkage group has been phylogenetically conserved. However, the number of genes and their linear relationship on the chromosomes differ between species. Class I MHC loci encode molecules that are the most polymorphic genes known. These molecules are ubiquitous in their tissue distribution and typically are recognized together with nominal antigens by cytotoxic lymphocytes. Class II MHC loci constitute a smaller family of serotypes serving as restricting elements for regulatory T lymphocytes. The distribution of class II antigens is limited mainly to cell types serving immune functions, and their expression is subject to up and down modulation. Class III loci code for components C2, C4 and Factor B (Bf) of the complement system. Interspecies differences in the extent of polymorphism occur, but the significance of this finding in relation to fitness and natural selection is unclear. Detailed information on the structure and regulation of MHC gene expression will be required to understand fully the biologic role of the MHC and the evolutionary relationships between species. Meanwhile, MHC testing has numerous applications to biomedical research, especially in preclinical tissue and organ transplantation studies, the study of disease mechanisms, parentage determination and breeding colony management. In this review, the current status of MHC definition in nonhuman primates will be summarized. Special emphasis is placed on the CyLA system of M. fascicularis which is a major focus in our laboratory. A highly polymorphic cynomolgus MHC has been partially characterized and consists of at least 14 A locus, 11 B locus, 7 C locus class I allelic specificities, 9 Ia-like class II antigens and 6 Bf (class III) variants.
Animals↗
Characterization of a low molecular weight suppressor of lymphocyte proliferation from guinea pig L2C leukemia cells.
Conditioned medium (CM) from 24-hr culture of guinea pig L2C B lymphoblastic leukemia cells contained an inhibitor(s) of mitogen- and antigen-stimulated proliferation of syngeneic (strain 2 guinea pigs), allogeneic (Hartley guinea pigs), and xenogeneic (Balb/c mouse, NZW rabbit) lymphocytes. The proliferation of several lymphoid and nonlymphoid cell lines also was inhibited in the presence of CM. The inhibitor(s) in CM was not toxic to any of the cultures studied. CM inhibited the mitogen-stimulated proliferation of lymphocytes when added to cultures up to 52 hr after addition of mitogen. Normal responsiveness to mitogens could be restored by washing the CM-treated lymphocytes with medium during the first 6 hr of culture. The addition of exogenous IL-2 to lymphocyte cultures did not overcome the CM-mediated suppression of mitogen- or antigen-stimulated proliferation. CM also inhibited the IL-2-dependent proliferation of murine CTLL-2 cells. Preincubation of guinea pig lymphocytes in CM did not inhibit the capacity of these cells to release IL-2 after exposure to mitogen. The antiproliferative activity of CM was stable to heating at low pH (100 degrees C, 10 min, pH 4.0), was resistant to treatment with papain, pronase, DNase, and RNase and did not bind to Con A-Sepharose. Incubation of the L2C cells in indomethacin did not inhibit the release of the inhibitor(s). The inhibitor(s) in CM had an apparent molecular weight of 500-3500 Da as determined by dialysis and ultrafiltration analysis. The inhibitory activity was recovered in the organic phase after extraction with chloroform:methanol and eluted distinct from the thymidine standard after gel filtration on Sephadex-G 25. These data suggest that the inhibitor(s) in CM is a nonspecific, low molecular weight, lipid-like component (not prostaglandin) that exerts its antiproliferative effects subsequent to cell activation. The inhibitor(s) did not appear to suppress other biologic functions associated with activation, such as IL-2 secretion. The inhibitor in CM may be important in promoting tumor survival in vivo by suppressing potential anti-tumor cellular immune responsiveness.
Animals↗
The effect of levobunolol on aqueous humor dynamics.
We evaluated the acute effects of installation of 0.5% levobunolol on aqueous humor dynamics in a double-masked study in 18 patients with ocular hypertension. Aqueous flow was measured by fluorophotometry and total outflow facility by tonography. Aqueous flow decreased approximately 29% in the eyes treated with levobunolol. Total outflow facility and episcleral venous pressure measurements were similar in levobunolol-treated eyes and contralateral eyes treated with vehicle. A 36% decrease in intraocular pressure was observed in the levobunolol-treated eyes and a slight intraocular pressure reduction was seen in the vehicle-treated eyes. The results of this study indicate that, similar to timolol, levobunolol lowers intraocular pressure primarily by decreasing aqueous humour production.
Adrenergic beta-Antagonists↗
Medical students' attitudes toward AIDS and homosexual patients.
More than most diseases, acquired immune deficiency syndrome (AIDS) appears to elicit highly negative, fearful, and prejudicial attitudes. In the study reported here, medical students read one of four patient vignettes. The vignettes were identical in content except that the patient was identified as having either AIDS or leukemia as either homosexual or heterosexual. The students then completed a set of objective measures that assessed their attitudes toward the patient portrayed in the vignette. Multivariate and univariate analyses of variance of their responses revealed that the students held negative and prejudiced attitudes toward both the AIDS and homosexual patients. This finding suggests that medical educators should recognize that many students have stigmatizing, negative attitudes toward homosexuals and patients with AIDS. These educators should promote greater sensitivity, knowledge, and understanding among medical students of those at risk for AIDS and AIDS patients.
Acquired Immunodeficiency Syndrome↗
Stigmatization of AIDS patients by physicians.
A randomly selected sample of physicians in three large cities was asked to read one of four vignettes describing a patient. They then completed a set of objective attitude measures eliciting their reactions to the patient described in the vignette. The vignettes were identical except that the patient's illness was identified as either acquired immunodeficiency syndrome (AIDS) or leukemia and the patient's sexual preference as either heterosexual or homosexual. Harsh attitude judgements were associated with the AIDS portrayals, as well as much less willingness to interact even in routine conversation when the patient's illness was identified as AIDS. Increasing numbers of AIDS patients will be seeking medical attention from physicians in all areas of the country and it will be important for health care professions to develop programs which counter unreasonable stigma and prejudicial attitudes that may be associated with this illness.
Acquired Immunodeficiency Syndrome↗
Long-term survival of kidney allografts.
1. Late graft loss rates did not improve substantially in patients with functioning grafts one or 5 years posttransplant when compared with all patients in pre-CsA kidney transplants. Graft loss rates were the same for recipients of first and regraft transplants involving cadaver donors after the first year posttransplant. 2. Long-term graft survival rates have not improved over the years to any great degree, in contrast to one-year rates. 3. The long-term patient survival rates have improved dramatically over the years for both cadaver and living donor transplants. 4. In recent transplants, zero HLA-A,B mismatched grafts appear to have an advantage in terms of long-term graft survival both with and without CsA immunosuppression. Matching for HLA-DR alone did not influence long-term graft survival rates. 5. In cadaver donor grafts, those with zero mismatches for HLA-B,DR or HLA-A,B,DR antigens had the highest long-term graft survival rates, particularly with transplants involving CsA. 6. From these long-term projections, it would seem that histocompatibility continues to exert a major influence on transplants in the CsA era. Only living-related donor or well-matched cadaver donor transplants appear likely to have high long-term graft survival rates.
Cyclosporins↗
Original disease of the recipient.
1. The use of CsA in cadaver donor transplants has apparently overcome the effect of original disease one-year graft survival rates. Only SLE patients had lower than average graft survival rates in CsA-treated, first transplants. 2. Since 1970, the proportion of diabetics transplanted has increased tenfold. The proportions of transplants for glomerulonephritis and pyelonephritis have decreased over the years. 3. A beneficial effect of pretransplant blood transfusions, was observed in almost all of the disease groups. 4. HLA matching, particularly for HLA-B, DR antigens, has resulted in increased graft survival rates in the major disease categories. Small numbers of zero mismatched grafts prevented a more detailed analysis. 5. Whereas CsA consistently enhanced graft survival rates for first cadaver transplants, this drug had a much smaller effect in living donor transplants. A 14% increase was seen in cadaver donor transplants due to CsA, compared to 2% (siblings), 1% (parent), and 4% (child) for the living donor grafts.
Adolescent↗