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Biomedical subjects

J Najarian

Publications and source records attributed to J Najarian.

17 recordsLinked to original sources
PubMed1992

Management of testicular seminoma following organ transplantation.

An increased incidence of malignancies has occurred in recipients of organ transplantation who are immunosuppressed. Although testicular cancers have been uncommon, seminomas are extremely rare. Two patients with long-standing diabetes mellitus and renal transplants developed clinical stage I seminoma of the testis. These patients posed a therapeutic problem with respect to the use of radiation therapy. In one, none was given because of a combination of kidney rejection and antibiotic-induced renal damage. The second patient received radiation therapy with shielding of the transplanted kidney. The surgical distortion of lymph node architecture increases the problems in the use of radiation therapy. Individual factors need to be considered in the use of postorchiectomy radiation therapy for seminoma in transplant patients.

Adult↗
PubMed1991

Long-term results of renal transplantation in children.

The results of renal transplantation in 37 children, 3 through 16 years of age, who received transplants prior to June, 1970 in our center, were examined. Twenty-three received kidneys from living-related donors and 14 received kidneys from cadaver donors. Patient survival rates were 78% at 10 years and 68% at 20 to 26 years. Graft survival rates were 56% at 10 years, 31% at 20 years, and 23% at 22 to 26 years. Twenty children received on or more retransplants. At follow-up, 23 (62%) of the patients had functioning grafts and two (5%) were undergoing dialysis. Cataracts, hypertension, and aseptic necrosis of bone were the most common medical complications and most of the patients were more than two standard deviations below average height. Most enjoyed good rehabilitation, however: more than 70% were employed or performing full time housework, more than 50% were married, 24% had children, and all had normal activity at least part of the time. These results, achieved with immunosuppressive methods now considered obsolete, indicate that renal transplantation is a satisfactory long-term treatment for children with renal failure.

Adolescent↗
PubMed1987

Early graft function.

1. Most of the first rejections occurred between the first and third weeks after transplantation, with the peak at 7 days. 2. Average serum creatinine values of 2 mg/dl were achieved in 2 days for living-related donor transplants. Cadaver donor grafts reached an average of 4 mg/dl by the tenth day, but in patients without rejection serum creatinine values of almost 2 mg/dl were achieved. 3. Cadaver donor grafts with cold ischemia times less than 12 hours led to the best early serum creatinine values. Cold ischemia times up to 48 hours and possibly beyond led to slightly higher creatinine levels but did not produce damage in proportion to the cold ischemia time. 4. Patients who were sensitized to more than 50% of the panel showed evidence of sensitization by having higher serum creatinine levels from one week to 3 weeks. 5. Even in the first few days after transplantation with a cadaver donor, black recipients had a higher serum creatinine than white recipients. The donor's race did not have a marked effect. 6. CsA doses given to cadaver donor recipients were about 2-4 mg/kg higher than living-related donor transplants. Patients experiencing a rejection episode were found to have been treated with about 1 mg/kg more than those without rejections. The corresponding blood levels of CsA were higher in the cadaver donor grafts and those with rejections. 7. Early serum creatinine levels were very strongly correlated with the one-year graft survival rate. Even one day after transplantation, the difference between patients with the best and worst one-day serum creatinine levels was as much as 30% in the one-year graft survival rate. At 2 weeks, the group with the best serum creatinine had a one-year survival rate that was 50 percentage points higher than the worst creatinine group. At one month, the best serum creatinine group had a one-year survival rate that was about 80 percentage points higher than the worst serum creatinine group. 8. Patients with high CsA levels of over 400 ng/ml in the early one-month posttransplant period, had poorer one-year graft survival than those with lower levels. The optimum level appeared to be less than 100 ng/ml by the tenth day and about 100-200 ng/ml to the third week posttransplant.(ABSTRACT TRUNCATED AT 400 WORDS)

Creatinine↗
PubMed1986

Early graft function.

1. The average serum creatinine level during the first 20 days after transplantation was lower in HLA-identical siblings than in parental donor transplants, suggesting an early effect of histocompatibility. 2. In rather small numbers of patients, the daily average serum creatinine values were not different with HLA-DR mismatching and HLA-B,DR mismatching, but were lower in the better matched transplants for the HLA-A,B loci and the HLA-A,B,DR loci. 3. The average serum creatinine values in the first 20 days after transplantation were correlated with the one-year graft survival rates. Those patients with serum creatinine levels less than 2.4 mg/dl had one-year graft survival rates of over 80% compared with those with serum creatinine levels above 7.5 mg/dl after the first week who had one-year graft survival rates about 30% less. Intermediate serum creatinine values yielded intermediate one-year graft survival rates. 4. The cyclosporine dosage in the first month after transplantation varied considerably among the four centers studied here. These values were not directly correlated with the one-year graft survival rate, average serum creatinine levels or cumulative rejection rates in this preliminary examination. 5. Patients who rejected transplants 11 to 60 days posttransplant had been given lower cyclosporine dosages than those who rejected early or who had no rejections. 6. Although firm conclusions cannot be drawn from the small numbers of patients encompassed in this study, we hope the potential value of this type of analysis will be realized.

Creatinine↗
PubMed1977

Primary uterine tumors and multiple endocrine adenomatosis, type I.

Multiple endocrine adenomatosis, Type I was initially diagnosed in a 35-year-old woman with primary chief cell hyperplasia of the parathyroids. Approximately 5 years later, vaginal bleeding developed and a well-differentiated endometrial adenocarcinoma was recognized. An adenomatoid tumor of the uterus was discovered in addition to a nonfunctional islet cell tumor of the pancreas. Multiple endocrine adenomatosis is reviewed in relation to possible gynecologic neoplasms.

Adenocarcinoma↗
PubMed1976

Antilymphoblast globulin in renal transplant patients. No allergic reactions.

The incidence and type of allergic reactions to antilymphoblast globulin (ALG) and their relationship to skin testing, histamine release, and serum levels of ALG and anti-ALG antibodies were studied prospectively in 50 patients receiving high-dose ALG therapy intravenously for the first two weeks after renal transplantation. No clinically apparent allergic reactions occurred in the patients studied.

Antibodies, Anti-Idiotypic↗
PubMed1976

Recurrence of membranoproliferative glomerulonephritis following kidney transplantation. Serum complement component studies.

Sixteen patients with membranoproliferative glomerulonephritis who required kidney transplantation because of renal failure were evaluated for evidence of recurrence of the original disease by serologic and morphologic studies. Of the 12 patients with transplant tissue available for study, seven showed membranoproliferative glomerulonephritis by light morphology. Four of these seven also had hypocomplementemia, and this hypocomplementemia was characterized by decreased serum CH50, C3 beta1A or C3-C9 but norma serum C1, C4 and C2 by hemolytic assay. Immunofluorescent microscopy demonstrated more intense glomerular deposition of C3 and properdin in the hypocomplementemic patients. Ultrastructural studies demonstrated intramembranous deposits typical of dense deposit disease in one patient who also had marked hypocomplementemia. One patient who had two transplant biopsies and persistent hypocomplementemia showed progression from predominantly mesangial glomerular changes to both capillary wall and mesangial abnormalities. This study has shown a high rate of recurrence of membranoproliferative glomerulonephritis in the transplanted kidneys. A high death rate was noted in persistently hypocomplementemic patients. The serum C profile in hypcomplementemic patients who received translants was similar to that seen before transplantation, but the signficance of this finding remains unknown.

Adolescent↗
PubMed1976

Histocompatibility (HLA) antigens and diabetic microangiopathy.

To gain further insight into the genetic determinants of diabetic small vessel disease, we studied 22 HLA antigens in 110 juvenile-onset, insulin-dependent diabetics with terminal glomerulosclerosis and retinopathy, who were being prepared for kidney transplant. HLA antigens were comtemporarily determined in non-diabetic kidney transplant recipients and healthy controls. The frequency of antigens A1 and B8 were significantly higher in diabetics than in controls (P less than .02 and .011), but the frequency of BW15 was normal. The data are compatible with the concept that juvenile diabetes with microangiopathy is one of the HLA-B8 associated disorders.

Adult↗