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Biomedical subjects

J Kemnitz

Publications and source records attributed to J Kemnitz.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Heart transplantation--postoperative management].

Heart transplantation represents a widely accepted therapeutic modality for patients with end-stage myocardial failure. With increasing experience, 1-year survival rates of over 75% and 5-year survival rates of over 60% have been achieved, mainly due to patient selection, standardized surgical techniques as well as improved postoperative management. During early follow-up, particular attention should focus on diagnosis and treatment of graft rejection and infection, which require individualized immunosuppression, while in the later postoperative course coronary atherosclerosis, hypertension, chronic renal insufficiency and malignancy become more important as potential complications. The general principles in the management of these patients are discussed.

Adolescent↗
PubMed1986

[Acquired immunodeficiency syndrome with chronic granulomatous inflammation. Clinically definable special form of the variable immunodeficiency syndrome].

Five cases (3 men, 2 women) of late-onset variable immunodeficiency syndrome (CVID), characterized by similar clinical and immunological findings as well as histological demonstration of chronic granulomatous infection, are reported. All patients had frequent attacks of respiratory infections with recurrent bronchitis and pneumonia. In addition to predominating basally localized streaky-nodular lung changes all patients had hepatosplenomegaly and granulomatous infections of other organs. Immunologically, marked hypogammaglobulinaemia of all Ig classes, lymphopenia, and absence of terminal B-cell maturation were predominant. In-vitro tests under pokeweed-mitogen failed to demonstrate terminal plasma-cell differentiation of B-lymphocytes and thus Ig synthesis. Without pokeweed-mitogen there were largely nonsecretory B-blasts with abnormal granulated cytoplasmic Ig formation. Skin testing with Multitest application revealed almost complete anergy, both in the Arthus (24 h) and the late reactions (48 and 72 h). Nonetheless, T-cell reaction in-vitro was much less affected than B-cell function. "Natural killing" and antibody-dependent cytotoxicity were normal or slightly increased.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Auxiliary partial orthotopic liver transplantation (APOLT) for fulminant hepatic failure: first successful case report.

Fulminant hepatic failure is a life-threatening event with a high mortality rate up to 80%. Orthotopic liver transplantation has markedly decreased this mortality rate and is therefore a well established procedure for hepatic failure. However, this treatment neglects the fact that patients surviving hepatic failure without liver transplantation experienced a complete morphologic and functional recovery of their own liver. Temporary support of liver function in such cases could therefore be desirable and adequate therapy. Auxiliary liver transplantation could fulfill this demand. However, the standard technique of auxiliary grafting, transplanting a graft in a heterotopic position, is burdened by problems such as elevated venous back-pressure, insufficient respectively competing portal blood supply for both livers with an unpredictable long-term outcome. In order to cope with these problems, we performed an auxiliary transplantation in an orthotopic position. To accomplish this procedure we had to reduce the size of both the recipient and the donor livers. We, thus, performed an auxiliary partial orthotopic liver transplant (APOLT). The first patient was a 33 year old female who was transplanted on November 25, 1989. She developed a HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and fell into a deep coma. At the time of transplantation histologic examination of her own liver revealed 80% confluent necrosis. We resected segments 2 and 3 of the recipient liver and transplanted the whole left lobe of the donor liver into this position.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMedDate not supplied

Multidrug resistance in heart transplant patients: a preliminary communication on a possible mechanism of therapy-resistant rejection.

Multidrug resistance refers to a complex cellular phenotype, the hallmark of which is cross-resistance to multiple drugs, for example, chemotherapeutic agents, that are unrelated to the selecting agent in structure, cellular target, and mode of action. The expression of this multidrug resistance is connected with the overexpression of P-glycoprotein. By applying the method of immunocytochemical assay, we have demonstrated the appearance of the multidrug-resistant phenotype (P-glycoprotein+ cells, multidrug-resistant cells) in mononuclear cells of the peripheral blood from 32/49 patients receiving triple-drug (azathioprine, steroids, cyclosporine) immunosuppressive therapy after heart transplantation. In the group of patients showing not only the presence of cells with multidrug-resistant phenotype in the peripheral blood, but also a significant increase in the number of these cells during the interval of observation (0 to 767 days)-16/32/49 cases--a significantly increased incidence of acute rejection episodes could be demonstrated. This supports the hypothesis of a possible existence of a therapy-resistant form of acute rejection, with an involvement of mechanisms of multidrug-resistance playing a role in its causal development.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMedDate not supplied

Some aspects of changed histopathologic appearance of acute rejection in cardiac allografts after prophylactic application of OKT3.

The histopathologic findings of therapy-requiring acute rejection in the cardiac allograft observed in endomyocardial biopsy specimens taken from patients under prophylactic administration of OKT3 show certain differences in comparison with the classic description of acute rejection. These differences are characterized above all by a distinctly reduced cellularity of the infiltrates, with a relative decrease of T cells, as well as edema and retrogressive changes, up to necroses of myocytes with marked fragmentation; some patients also have increased vascular reactions. Furthermore, an earlier occurrence of and an increased frequency of changes corresponding to the so-called lymphoma-like lesions ("Quilty" effect) were observed in patients who received immunosuppressive prophylaxis with OKT3. The changed histopathologic findings of therapy-requiring acute rejection under prophylactic application of OKT3 may, to a certain extent, explain the discrepant results reported by different transplant groups with respect to the frequency of rejection episodes and the time when the first episode of therapy-requiring rejection occurs after heart transplantation.

Antibodies, Monoclonal↗
PubMedDate not supplied

Lung growth after experimental pulmonary transplantation.

Replacement of the heart and both lungs or single lung transplantation has been performed in a few cases of terminal (cardio) pulmonary disease in childhood. It remains unclear whether pulmonary allografts will meet the demands of a growing organism. Six domestic pigs (mean body weight, 24 kg) underwent left lung transplantation from donors of equal weight. Immunosuppression consisted of cyclosporine, azathioprine, and corticosteroids. After the pigs doubled their body weight, growth of the lung was assessed by bronchography and pulmonary angiography. In transplant animals it took 11 weeks (normal animals, 6 weeks) for their weight to double. At that time, the bronchial tree showed similar growth when compared with nontransplant animals of equal weight. The diameter of the left lower lobe bronchus (9.2 +/- 0.4 mm) was significantly greater than that of animals of 24 kg body weight (7.5 +/- 0.3 mm; p less than 0.01) but comparable to that of normal pigs of similar weight (9.0 +/- 0.5 mm). The same applied for length of the left lower lobe bronchus (transplants, 95 +/- 6.7 mm; controls 24 kg, 67 +/- 2 mm [p less than 0.01]; controls 48 kg, 93 +/- 3 mm). Similar growth tendencies were observed in the pulmonary vascular tree. The diameter of the left lower lobe artery was 9.4 +/- 98 mm in 48 kg transplant pigs, compared with 9.7 +/- 1.2 mm in 24 kg control pigs and 8.5 +/- 0.8 mm in 48 kg control pigs. In one case of recurrent severe pulmonary rejection, the lung did not grow. We conclude from this study that growth is retarded by immunosuppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMedDate not supplied

Some histopathologic aspects regarding onset of antirejection therapy after heart transplantation.

The histopathologic indication for starting antirejection therapy has so far been given by the diagnosis of moderate rejection in endomyocardial biopsies, that is, rejection with necroses of myocytes and predominantly lymphocytic infiltrates (corresponding to the descriptive diagnosis of moderate rejection in the Stanford classification, grade 4 and more in the Texas classification, and A-3 moderate rejection in the Hannover classification). Our present results, however, have shown that the critical limit for the onset of antirejection therapy may be fixed somewhat higher on the scale of severity of acute rejection and that it may be reasonable to define an affection of more than 20% of the total biopsy material by morphologic changes corresponding to the traditional definition of moderate acute rejection as the decisive histopathologic finding that should induce antirejection therapy. This means that the diagnosis of moderate rejection has to be divided into two groups: (1) A-3a moderate acute rejection not yet requiring therapy that, however, does necessitate bioptic control within 7 to 10 days; (2) A-3b moderate acute rejection requiring antirejection therapy. The introduction of this differentiation of histopathologic diagnoses is not just another sophisticated scientific theorem; its practical significance may be seen in a definitive restriction of the application of antirejection therapy, which means a reduction of the risks and side effects imposed on heart-transplanted patients by chemotherapy and particularly by steroid therapy.

Biopsy↗