Biomedical subjects
Publications and source records attributed to J E Castro.
We report a case of bladder cancer developing in a patient after renal transplantation in whom it was possible to demonstrate DNA evidence for infection of the tumour with HPV Type 11. The significance of the observation is discussed in relation to the hypothesis that immunosurveillance can control the development of malignancy.
Seven patients who developed peptic ulceration following renal transplantation have been treated by cimetidine. One died before its value could be assessed. The remaining 6 were symptom-free within 48 h. In 3 patients the ulcer appeared healed on gastroscopy, in one there was no change, another required operation for gastrointestinal bleeding 1 month after beginning cimetidine and the other patient has been lost to follow-up after 5 months' treatment. Two patients had a significant rise of serum creatinine whilst on the drug, but there is no evidence of increased immunological reactivity towards the graft and no agranulocytosis.
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We report the effect of rectal examination of the prostate and transurethral resection of the prostate (TURP) on the serum level of tartrate labile acid phosphatase (TLAP) in 18 normal cases, 31 with benign enlargement of the prostate and 20 with carcinoma. Rectal examination had no effect on TLAP in normal patients, those with benign enlargement and those with carcinoma, either after 5 min or the following morning. TURP for both benign and malignant disease raised the TLAP transiently with a rapid return to normal. We believe that there is no justification for postponing estimation of TLAP following rectal examination.
A strain of C. parvum, CN6134, known to have antitumour activity, caused thrombosis in the sites where the organism is phagocytosed. It bound to macrophages in vitro and activated the alternate pathway of complement. A strain of C. parvum, CN5888, which fails to show antitumour activity, did not show thrombosis. It did not bind to macrophages or activate guinea-pig complement. It did, however, cause marrow infarction which seems to result from a diminished clearance of the organism from the circulation.
The effects of Corynebacterium parvum and cortisone acetate (CA) on the primary Lewis lung carcinoma and its pulmonary metastases were investigated. C. parvum given IV either on the same day or 7 days after tumour inoculation, reduced primary tumour growth, while 2.5 mg CA (high-dose) given SC 4 and 11 days after tumour, alone or in combination with C. parvum, administered on day 0, reduced primary tumour growth to the same extent as C. pravum alone. High-dose CA given on days 2 and 6 had no effect on primary tumour growth or the action of C. parvum, administered on day 7, while 0.05 mg CA (low-dose) given on days 4 and 11 did not alter tumour growth or the action of C. parvum given at the same time as tumour. High-dose CA given 4 and 11 days after tumour caused a significant enhancement in metastases. C. parvum given to these mice on the same day as tumour significantly reduced the pulmonary nodules but only to the level found in control, saline-treated mice. In mice given C. parvum alone, metastases were significantly reduced when compared with controls. Similarly, high-dose CA given on days 2 and 6 significantly enhanced metastases, and C. parvum on day 7 reduced their level to that found in control mice. Low-dose CA had no effect on the number of metastases or the antimetastatic action of C. parvum. The relevance of these results to the clinical situation is discussed.
A consecutive series of 260 renal transplants was analysed to find the outcome of different arterial anastomoses. In 177 cases the renal vessel was anastomosed to the end of the internal iliac artery; 15 per cent developed vascular complications. Thirty-eight of these patients subsequently underwent allograft nephrectomy; none died from haemorrhage. In 83 patients the renal vessel was anastomosed end to side to the iliac artery, and vascular complications occurred in 14 per cent. Thirty-two patients subsequently underwent allograft nephrectomy; 8 were associated with severe haemorrhage and 5 of these were fatal.
Pelvic lipomatosis and florid cystitis glandularis are rare. We report a case in which these two conditions were associated.
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Twenty-four patients with end stage renal failure due to polycystic renal disease have been treated with hemodialysis and transplantation. While on dialysis, the incidence of complications did not differ from a similar group of patients with other causes of renal failure. Bilateral pretransplant nephrectomy is not mandatory except in cases of persistent infection or hemorrhage. A much higher incidence of HLA A3 and HLA B7 was noted in patients with polycystic disease when compared with the general population. Following cadaver renal transplantation, kidney function was significantly better in patients with polycystic disease when compared with those with other forms of renal failure. Patient survival was the same in both groups. We conclude that hemodialysis and transplantation are acceptable forms of treatment for a patient with end stage polycystic renal disease.
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The effects of operation (lower-limb amputation) on the growth of the Lewis lung tumour and its metastases were studied. The role of C. parvum in counteracting these effects was investigated. Anaesthesia alone or with amputation did not affect primary tumour growth. C. parvum depressed this growth. Anaesthesia did not affect the number of pulmonary metastases, but amputation caused a significant increase. C. parvum inhibited metastases and completely counteracted the effects of operation on them. Large doses of cortisone acetate significantly increased metastases but small doses had no effect. Experiments with adrenalectomized mice suggested the effects of operation were due to non-specific stress.
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Three patients who underwent live donor renal transplantation subsequently developed calculi in their allografts. Hypercalcaemia and secondary hyperparathyroidism were present in 2 cases and these were treated by subtotal parathyroidectomy. Urinary stagnation and infection were contributory factors in the third case and reimplantation of the ureter was necessary. In all patients no further calculi have developed following treatment and allograft function remains satisfactory.
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Fifty-four patients on haemodialysis for chronic renal failure underwent renal transplantation. Basal and maximum acid output and the incidence of peptic ulcer before transplantation were not significantly different from those of controls. But after renal transplantation the incidence of symptoms of peptic ulcer was high (22%) and four out of six patients who developed gastrointestinal bleeding died from this complication. In men peak acid output was significantly increased after renal transplantation and was associated with a 30% incidence of symptoms of peptic ulcer compared with 10% in women, who showed no significant change in mean basal or peak acid output. Peptic ulceration after transplantation was not associated with steroid dosage, hyperparathyroidism, or the height of blood urea concentrations. Given criteria of a history of dyspepsia, abnormal barium meal findings, or gastric hypersecretion, it was not possible to identify patients at risk from peptic ulceration or life-threatening complications after renal transplantation. Thus the routine screening of these patients for peptic ulcer has no practical value, and the incidence of fatal complications is not high enough to justify routine prophylactic anti-ulcer surgery aimed at reducing acid secretion before renal transplantation.