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Biomedical subjects

H Kapila

Publications and source records attributed to H Kapila.

13 recordsLinked to original sources
PubMed2004

Human hand transplantation: what have we learned?

Hand transplantation may become an important procedure for upper limb functional restoration. To date, 18 patients have been undergone 24 hand operations in the world. Initial results are extremely promising; the functional results are apparently superior to those obtained with prostheses. We report on the combined French and Italian experience of six patients (eight hands), which is based on a jointly devised protocol and represents the largest available clinical series. Six male patients aged 43, 33, 35, 32, 33, and 22 years received either a single right hand-dominant transplantation (four cases) or a simultaneous double hand transplantation (two cases). The time since the amputation ranged from 3 to 22 years. The level of transplantation was at the wrist in five cases (six hands) and at the distal forearm in two cases (two hands). Cold ischemia averaged 11.5 hours. Three patients simultaneously received additional full-thickness skin taken from the donor and transplanted onto their left hip area. This skin served as a source for biopsies and as an additional area to monitor rejection (distant sentinel skin graft). The immunosuppressive protocol included polyclonal antibodies (three patients) or monoclonal anti-CD 25 antibody (three patients), tacrolimus, mycophenolate mofetil, and prednisolone. No surgical complications occurred. Skin rejection occurred at least once in all patients at a mean of 40 days postoperatively. Three patients recovered protective and some discriminative sensation in their palm and fingers. Two patients are recovering sensation, but are still in the early phases of the regenerative process, due to the short time since the transplantation. One patient was not compliant with the immunosuppressive therapy, and underwent uncontrolled rejection and reamputation.

Adolescent↗
PubMed1999

Human hand allograft: report on first 6 months.

BACKGROUND: Long-term survival of animal limb allografts with new immunosuppressant combinations and encouraging results of autologous limb replantations led us to believe that clinical application of hand transplantation in human beings was viable. METHODS: On Sept 23, 1998, we transplanted the right distal forearm and hand of a brain-dead man aged 41 years on to a man aged 48 years who had had traumatic amputation of the distal third of his right forearm. The donor's arm was irrigated with UW organ preservation solution at 4 degrees C, amputated 5 cm above the elbow, and transported in a cool container. We dissected the donor limb and the recipient's arm simultaneously to identify anatomical structures. Appropriate lengths of viable structures were matched. Transplantation involved bone fixation, arterial and venous anastomoses (ischaemic time 12.5 h), nerve sutures, joining of muscles and tendons, and skin closure. Immunosuppression included antithymocyte globulins, tacrolimus, mycophenolic acid, and prednisone. Maintenance therapy included tacrolimus, mycophenolic acid, and prednisone. Follow-up included routine post-transplant laboratory tests, skin biopsies, intensive physiotherapy, and psychological support. FINDINGS: The initial postoperative course was uneventful. No surgical complications were seen. Immunosuppression was well tolerated. Mild clinical and histological signs of cutaneous rejection were seen at weeks 8-9 after surgery. These signs disappeared after prednisone dose was increased (from 20 mg/day to 40 mg/day) and topical application of immunosuppressive creams (tacrolimus, clobetasol). Intensive physiotherapy led to satisfactory progress of motor function. Sensory progress (Tinel's sign) was excellent and reached the wrist crease (20 cm) on day 100 for the median and ulnar nerves, and at least 24 cm to the palm by 6 months when deep pressure, but not light touch sensation, could be felt at the mid palm. INTERPRETATION: Hand allotransplantation is technically feasible. Currently available immunosuppression seems to prevent acute rejection. If no further episode of rejection occurs, the functional prognosis of this graft should be similar to if not better than that reported in large series of autoreconstruction.

Adenosine↗
PubMed1999

[The first transplantation of a hand in humans. Early results].

The first hand allograft was performed on September 23, 1998. The right distal forearm and hand of a brain dead donor was transplanted to a 48 year old recipient who had undergone a traumatic amputation of the distal third of his right forearm. The donor's arm was irrigated with organ preservation solution (UW) and transported to Lyon in a cool container. Two teams simultaneously dissected the donor's limb and the recipient's stump to identify anatomical structures. Transplantation involved bone fixation, arterial and venous anastomoses, nerve sutures, joining of the muscles and tendons, and skin closure. Immunosuppression consisted of anti-lymphocyte, polyclonal and monoclonal antibodies, tacrolimus, mycophenolic acid, and prednisone. Mild clinical and histological signs of rejection occurred at week 9 after surgery. They disappeared with adjustments of the immunosuppressant doses. Seven months after surgery the patient was in good general condition. Intensive physiotherapy led to satisfactory progress of motor function. Sensory progress is excellent, reaching the fingertips. A longer follow-up is necessary to appreciate the final result. In the absence of further rejection, the functional prognosis of the graft should be similar to that reported after successful autoreconstruction.

Adenosine↗
PubMed1986

Immunologic tools to decipher efficacy of BCG immunotherapy in advanced breast cancer: a one year follow up study.

We report the clinical outcome of conventional therapy and BCG immunisation therapy for 40 patients with advanced breast carcinoma. The clinical outcome was better for the 20 patients receiving BCG immunisation therapy. All patients were assessed for cell mediated immunologic competence before starting treatment and after completion of treatment. Thereafter they were followed for one year. Those patients who showed good local response to BCG vaccination before starting therapy had better prognosis, and those for whom anergy to PPD and DNCB could be reversed by BCG immunotherapy showed clinical improvement. Another interesting finding was that IgA was the predominating immunoglobulin located in normal breast tissue and benign breast tumours while IgG was deposited in most of the malignant breast tumour. This indicated that malignant tumours of the breast jeopardise the secretory immune system of the mammary gland.

B-Lymphocytes↗
PubMed1984

Vasectomy reversal. Review of 475 microsurgical vasovasostomies.

Over a 10-year period, routine vasectomies were reversed, and a very high rate of return of patency and potency was obtained in a series of 475 patients. The patients who presented for the reversal of vasectomy were, on average, about 33 years of age and had undergone vasectomy five years previously. An original, meticulous, microsurgical technique enabled the return of sperms to the ejaculate in over 90% of patients; the subsequent pregnancy rate in their spouses was over 82% in the first two years after the operation. The reversal of routine vasectomies which have been performed in the mid-scrotal area, at least 3 cm away from the epididymis, has the best chance of success; damage to the epididymis may preclude the reconstructive procedure.

Adult↗
PubMed1983

Investigation of hypertension.

Ferguson (1975) calculated that if 5 per cent of the estimated 20 million patients with hypertension in the USA had a secondary cause, the cost of their investigation would amount to $2 billion at 1975 prices. For the majority of patients a careful clinical appraisal together with simple biochemical screening tests and a baseline ECG and chest film are adequate before embarking on therapy. For those patients in whom there are clinical or other grounds to suspect a treatable secondary cause, a wide range of modern investigative techniques are available. Even if there are no clues to a secondary cause initially, the possibility of such a cause is occasionally suggested by failure of response to triple therapy with, for example, a thiazide, a beta blocker, and a vasodilator. Whether the hypertensives are being treated in general practice or in hospital, a careful initial assessment together with regular supervision is essential to allow the identification of those with potentially curable disease.

Adrenal Gland Neoplasms↗