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Biomedical subjects

I R Hardie

Publications and source records attributed to I R Hardie.

At least 19 recordsLinked to original sources
PubMed1995

Effect of OKT3 in steroid-resistant renal transplant rejection.

Between January 1, 1982, and November 1, 1986, 169 cadaver renal graft transplantations were performed at this hospital with CsA as induction therapy. OKT3 was not available in this period. Of these grafts, 15.9% were lost within 6 months, 10.7% from acute rejection (AR). Between November 1, 1986, and October 1, 1992, 483 cadaver renal graft transplantation were performed. Induction therapy included CsA and OKT3 was available. Of these grafts, 8.7% were lost inside 6 months, 3.1% from AR. Of these last 483 grafts, 113 received 125 courses of OKT3. Ten courses were prophylactic, and 115 courses in 103 patients were for rejection resistant to steroid therapy (biopsy proven in all but 2 cases. Ninety-three percent of rejection episodes treated with OKT3 responded, at least initially. Graft survival in OKT3-treated patients was 81%, 77%, and 76% at 6 months, 1 year, and 2 years, respectively. In contrast, graft survival in steroid-resistant rejection during the first period (without OKT3) was 59%, 57%, and 57% at these intervals. There were 8 infective deaths within 6 months in the 113 OKT3-treated patients, compared with 2 in the 343 who did not receive OKT3 (P < 0.001). There were 7 viral deaths in the OKT3 group compared with none in those not receiving OKT3 (P < 0.001). Prophylaxis with oral acyclovir and cotrimoxazole was instituted in October 1990 in OKT3-treated patients and ganciclovir use was increased. Since this change, no further viral deaths have occurred. OKT3 is a very effective antirejection agent, but its use is associated with an increased mortality from viral infections. With appropriate prophylaxis and treatment, however, this mortality can be reduced.

Cyclosporine↗
PubMed1995

Long-term bone loss after renal transplantation: comparison of immunosuppressive regimens.

Serial measurements of serum and urine markers of bone metabolism and of forearm bone density (BMD) by dual photon absorptiometry were performed in 22 patients undergoing renal transplantation in 1986. Patients were randomised to immunosuppression with (1) cyclosporin alone (CsA group, n = 10), (2) cyclosporin for 3 months followed by azathioprine-prednisone (CsA/AzP group, n = 3) or (3) long-term azathioprine-prednisone (LT AzP group, n = 9). As no reduction in bone mineral density (BMD) was noted in the first 6 months, groups 2 and 3 were considered together (AzP group, n = 12). Mean +/- SEM BMD fell by 19 +/- 2% at 36 months (n = 19, p < 0.01), with similar reductions seen in the CsA and AzP groups. At 60 months, BMD of the AzP group was 25 +/- 3% below baseline (p < 0.01), while the CsA group were only 5 +/- 4% below baseline (p = NS vs baseline, p < 0.05 vs AzP group). The degree of reduction in BMD over 5 years correlated with total glucocorticoid dose (r = 0.63, p < 0.05), but not with biochemical markers of bone turnover. Serum alkaline phosphatase fell post-transplant in patients treated with AzP, but not in the CsA group. These results demonstrate significant loss of forearm bone mineral with long-term follow-up after renal transplantation, but suggest that patients treated with cyclosporin monotherapy may be at lower risk of this complication.

Absorptiometry, Photon↗
PubMed1991

Effects of four cryoprotectants in combination with two vehicle solutions on cultured vascular endothelial cells.

The necessary first step in successful organ cryopreservation will be the maintenance of endothelial cell integrity during perfusion of high concentrations of cryoprotective agents (CPAs). In this report we compare the effects of incubation on cultured porcine endothelial cells at 10 degrees C for 1 h with the CPAs glycerol, dimethyl sulfoxide (Me2SO), ethanediol (EG), and propane-1,2-diol (PG) in the vehicle solutions RPS-2 (high potassium, high glucose) and HP-5NP (low potassium, high sodium), both with and without added colloids. Tritiated adenine uptake and acid phosphatase estimation of cell number were used as indicators of cell viability. HP-5NP was superior to RPS-2 except with Me2SO when the differences in viability were not significant. Adding Haemaccel to HP-5NP improved the results, but adding albumin to RPS-2 was of no significant benefit. Osmotic stress appeared to be the major problem with glycerols use. Beyond 3.0 M the toxicity of Me2SO increased dramatically but it could not be determined if this was osmotic or chemical toxicity. PG was remarkably well tolerated to 3.0 M but a sharp decrease in cell viability beyond this concentration suggests that PG may be most useful with mixtures of other CPAs. Overall, EG appeared to be the least toxic CPA and in the context of vascular preservation warrants further investigation.

Adenine↗
PubMed1990

Hepatic acyl-coenzyme A:cholesterol acyltransferase activity is decreased in patients with cholesterol gallstones.

Altered hepatic cholesterol metabolism has been implicated in the etiology of cholesterol gallstones. This hypothesis has been examined by determining acyl-coenzyme A:cholesterol acyltransferase (ACAT) activity in liver biopsies from 31 cholesterol gallstone patients and 12 control subjects. Hepatic ACAT activity in gallstone patients was decreased to one-third that in controls (P less than 0.001). No differences in hepatic homogenate or microsomal free and total cholesterol concentrations were observed between the two groups. However, marked increases in free (107%) and total (98%) cholesterol concentrations were found in the cytosolic fraction of liver biopsies from gallstone patients. The total phospholipid concentration of the liver homogenate fraction was unchanged in both groups; however, the microsomal total phospholipid concentration was reduced by 17% (P less than 0.01) in gallstone samples compared with controls. This difference did not result in a significantly increased microsomal cholesterol/phospholipid ratio for the gallstone group (0.180 +/- 0.030) compared with the control group (0.169 +/- 0.042). These results show that hepatic ACAT activity is significantly decreased in cholesterol gallstone patients. These changes in ACAT activity in livers of patients with cholesterol gallstones are consistent with the known increase in the amount of free cholesterol secreted in the bile of these patients. Thus, the changes in ACAT activity may contribute to the pathogenesis of cholesterol gallstones.

Adult↗
PubMed1989

Effect of ischaemia on the activities of human hepatic acyl-CoA:cholesterol acyltransferase and other microsomal enzymes.

The effect of ex vivo ischaemia at 37 degrees C on the activities of human hepatic acyl-CoA:cholesterol acyltransferase (ACAT), acyl-CoA hydrolase and carboxylesterase and on the microsomal cholesterol and total phospholipid concentrations was determined in liver tissue from two patients. ACAT activity decreased exponentially with ischaemia, corresponding to half-lives of 59 and 54 min in the two samples. Acyl-CoA hydrolase activity of microsomes was not affected by ischaemia, whereas carboxylesterase activity of microsomes decreased with a corresponding increase in cytosolic carboxylesterase activity. No changes in microsomal cholesterol and total phospholipid concentrations corresponding to the changes in ACAT or carboxylesterase activity were observed. ACAT activity was also determined in microsomes prepared from twenty human liver samples obtained at surgery with in vivo warm ischaemia times ranging from 5-120 min. The data obtained agree well with the ex vivo results, showing a half-life of 57 min for the loss of ACAT activity. Therefore, in comparing ACAT activities in liver samples with different ischaemia times, an appropriate correction must be made for warm ischaemia time.

Adult↗
PubMed1989

Vascular changes following hypothermic preservation.

This study identifies ultrastructural changes in the endothelium due to hypothermic HP-5 perfusion. These changes appear to be reversible and a manifestation of hypothermic hypoxia. This data provides a basis for improving perfusion techniques in both hypothermic preservation and cryoprotectant introduction and removal for cryopreservation.

Animals↗
PubMed1986

Hepatic acyl-CoA:cholesterol acyltransferase. Development of a standard assay and determination in patients with cholesterol gallstones.

A standard assay was developed for human liver acyl-CoA:cholesterol acyltransferase (ACAT, EC 2.3.2.26) which is more sensitive than previous methods and allows accurate activity determinations on crude microsomal fractions. ACAT activity was measured in microsomes from livers of four gallstone patients and five controls. Preincubation with exogenous cholesterol produced an increase in ACAT activity in all liver samples: gallstone samples showed a mean increase of 1.8-fold, whereas non-gallstone samples showed a mean increase of 8.2-fold. The mean ACAT activity measured in the presence of exogenous cholesterol was 52.8 +/- 22.8 (n = 4) pmol . min-1 . mg-1 for gallstone samples and 82.8 +/- 13.5 (n = 4) pmol . min-1 . mg-1 for non-gallstone samples. These results suggest that patients suffering from cholesterol gallstones have a reduced ability to esterify potentially harmful free cholesterol compared with controls. They support the proposition that cholesterol gallstone formation is related to altered hepatic cholesterol metabolism.

Acyl Coenzyme A↗
PubMed1986

An isolated perfused rat mesentery model for direct observation of the vasculature during cryopreservation.

An intact vasculature is essential for successful hypothermic perfusion and cryopreservation of solid organs, but few studies have specifically assessed the vascular effects of these procedures. A technique was therefore developed for continuous, direct observation of an isolated vascular bed during hypothermic perfusion with cryoprotectants, and during freezing and thawing. The isolated rat mesentery was spread across a controlled low temperature microscope stage and perfused with solutions containing fluorescein isothiocyanate (FITC)-Dextran 70 as an indicator of macromolecular permeability of the vessels. Hypertonic citrate washout, HP-5 perfusion (23), rapid and slow addition and removal of glycerol, and freezing/thawing were studied. Control perfusion with HP-5 produced slow FITC-Dextran leakage, reflecting normal physiological macromolecular permeability of vessels. Rapid addition of glycerol dramatically increased vascular permeability, consistent with osmotic damage to vessels. Rapid removal stopped flow through capillaries and decreased vascular dimensions, suggesting overhydration of endothelial cells and extravascular tissue. Venules and capillaries were the most susceptible vessels to osmotic stress. Slow addition and removal of glycerol (80 mmol/liter/min) produced results similar to control perfusions. During slow freezing (0.5 degree C/min to -5 degrees C) extravascular ice compressing vessels was more obvious than intravascular ice. Glycerol afforded some protection to the microvasculature during freeze/thaw cycles since flow was reestablished in venules and arterioles after thawing, although FITC-Dextran leakage indicated that damage had occurred.

Animals↗
PubMed1986

Algal peritonitis complicating continuous ambulatory peritoneal dialysis.

A 41-year-old woman on continuous ambulatory peritoneal dialysis (CAPD) presented with algal peritonitis. Prototheca wickerhamii was isolated from multiple dialysate effluent cultures. Despite treatment with amphotericin B, catheter removal was required. An attempt to reinsert a Tenckhoff catheter 3 months later was unsuccessful because of dense intraperitoneal adhesions. Prototheca sp are a rare cause of human disease, this being the first reported case of algal peritonitis complicating CAPD.

Adult↗
PubMed1986

Abdominal hernias complicating continuous ambulatory peritoneal dialysis.

Twenty-five percent of all CAPD patients reviewed in this study developed abdominal hernias. Eleven hernias (32.4%) occurred at the catheter insertion site, 17.6% were inguinal, 26.5% were epigastric and umbilical and 23.5% occurred at the site of previous abdominal incisions. The risk of developing a hernia was significantly greater in patients over 40 years of age, women of parity greater than 3, patients who had had undergone more than 3 laparotomies and those with a previous hernia repair. Three hernias became incarcerated, one with intestinal strangulation. Early surgical repair is advisable to avoid these complications.

Abdomen↗
PubMed1984

Acute obstructive suppurative cholangitis.

Acute obstructive suppurative cholangitis is an uncommon condition which, if unrecognized, carries a high rate of mortality. This study of 12 patients highlights the clinical features as well as the poor outcome of delayed surgical decompression. Endoscopic and percutaneous drainage of the obstructed biliary tree in acutely ill patients may improve the results of subsequent surgery.

Acute Disease↗
PubMed1984

A prospective randomized trial of low-dose versus high-dose steroids in cadaveric renal transplantation.

Low-dose steroid regimens, in combination with azathioprine, have become increasingly common for immunosuppression of renal transplant recipients. The change from conventional high-dose steroid regimens was prompted by the results of several prospective trials that showed similar graft survivals with high-dose and low-dose steroids, but a lower incidence of steroid-induced complications in low-dose-steroid--treated patients. However, the number of patients entered into the trials was small, and consequently there remained a possibility that a clinically relevant difference in graft survival could have remained undetected. A multi-center prospective trial was performed to compare graft survival with high-dose (91 patients) and low-dose (98 patients) oral steroids in combination with azathioprine. There was significantly worse graft survival in the low-dose group. The difference was largely due to a poor graft survival in patients receiving low-dose steroids and azathioprine less than 1.75 mg/kg/day. Graft survivals were similar in the high-dose and low-dose steroid patients who received azathioprine doses of greater than 1.75 mg/kg/day. The results indicate that the combination of low doses of both steroids and azathioprine provides inadequate immunosuppression in renal transplantation, although higher doses of azathioprine allow the use of low-dose steroids without significantly more graft losses than with high-dose steroids.

Adult↗
PubMed1984

Inactivation of acyl-CoA:cholesterol acyltransferase by ATP+Mg2+ in rat liver microsomes.

The molecular modulation of acyl-CoA:cholesterol acyltransferase (EC 2.3.2.26) was studied in the microsomes of rat liver. Acyl-CoA: cholesterol acyltransferase was specifically inactivated by ATP and ADP, requiring Mg2+ as a cofactor. The inactivation was not due to substrate diminution nor to inhibition by the activity of acyl-CoA hydrolase, which was not affected by Mg2+ or ATP+Mg2+. Enhancement of inactivation of acyl-CoA: cholesterol acyltransferase by ATP+Mg2+, NaF and a heat-labile cytosolic factor (or factors) is consistent with a protein-kinase catalyzed phosphorylation being involved in the short term regulation of this enzyme.

Acyltransferases↗
PubMed1983

Regulation of rat liver microsomal cholesterol 7 alpha-hydroxylase by MgATP: effect of pH.

Cholesterol 7 alpha-hydroxylase when assayed under conditions that favour phosphorylation can be activated or inactivated by MgATP, depending on ATP concentration and the pH of the incubation medium. Maximum stimulation of 7 alpha-hydroxylase was obtained with 0.5 mM ATP in both acidic and alkaline pH. At a pH lower than 7.4, 7 alpha-hydroxylase was inactivated by 2.0 and 3.0 mM MgATP. The inactivation by 3 mM MgATP was significantly greater at pH 6.7 than pH 7.4. Protein kinases enhanced these effects, suggesting covalent modification of the enzyme by phosphorylation. These findings are consistent with a protein kinase catalyzed phosphorylation, and suggest that MgATP may have a dual role in the activation and inactivation of 7 alpha-hydroxylase in vivo.

Adenosine Triphosphate↗