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Biomedical subjects

R E Lordon

Publications and source records attributed to R E Lordon.

At least 19 recordsLinked to original sources
PubMed1993

Gastrointestinal bleeding caused by angiodysplasia: a difficult problem in patients with chronic renal failure receiving hemodialysis therapy.

Anemia in patients with renal failure is a common problem. Bleeding from small angiodysplastic lesions within the gastrointestinal tract appears to be a significant source of blood loss in some patients with renal failure receiving chronic hemodialysis. We describe a group of patients treated with estrogen therapy who had amelioration of their bleeding tendency. Correction of bleeding time may be one potential mechanism for this action.

Adult↗
PubMed1984

The early posttransplant prognosis of acute renal allograft rejection as determined by detection of cytotoxic antibodies to lymphoid B cell lines.

We have studied serial samples of pretransplant and posttransplant sera for cytotoxic antibodies to lymphoid B cell lines (LCL) in 45 renal allograft recipients. A total of 48 rejection reactions occurred in 31 patients. A comparison of each patient's most reactive posttransplant serum showed a significantly higher reactivity in the ten patients with early allograft failure when compared with the 21 patients with reversible rejections and the 14 patients who had no rejections. Rejection reactions were easily differentiated by comparing the change in cytotoxic reactivity to LCL of recipients' sera drawn at the time of a rejection episode with the reactivity of their pretransplant sera. In 32 rejections considered non-antibody-associated cytotoxic reactivity of recipients' sera to LCL either decreased or remained essentially unchanged during the rejection. In 16 rejections considered antibody-associated the recipients' sera drawn during the rejection episode showed an increase in cytotoxic reactivity ranging from 40% to 100%. Response to antirejection therapy and three month graft survival had a significant correlation with changes in LCL antibody reactivity during a rejection. Only two of the 32 rejections considered non-antibody-associated failed to reverse compared with eight of the 16 antibody-associated rejections (P less than .001). Graft survival at three months in patients with non-antibody-associated rejections was 90% compared with 27% in the 11 patients who had antibody-associated rejections (P less than .001) Other parameters possibly related to the severity of a rejection reaction or to early allograft prognosis did not differ appreciably between the two types of rejections. This included the time posttransplant to the first rejection episode, the number of patients with multiple rejections in the first three months, and rejections requiring dialysis therapy. Determination of a change in cytotoxic reactivity to LCL during a rejection reaction enables one to predict the response to antirejection therapy and early allograft prognosis. This may ultimately be useful in selecting different types of antirejection therapy for individual patients.

Acute Disease↗
PubMed1984

HL-A 27 in Reiter's syndrome and psoriatic arthritis: a genetic factor in disease susceptibility and expression.

The role of HL-A antigens in determining predisposition and clinical expression of variant forms of spondylitis was examined in 52 patients. HL-A 27, an antigen significantly correlated with ankylosing spondylitis, was found in 19 (63 per cent) of 30 patients with Reiter's syndrome. In 14 patients with psoriatic arthritis, this antigen was present only in the six patients who had spondylitis. The presence of HL-A 27 in Reiter's syndrome was correlated with the presence of uveitis, severe constitutional manifestations, and a chronic or relapsing course. The presence of HL-A 27 is associated with a genetic predisposition to Reiter's syndrome and with certain similarities in clinical expression of the variant forms of spondylitis.

Arthritis↗
PubMed1982

Occult dental infection causing fever in renal transplant patients.

Fever secondary to odontogenic infection following successful renal transplantation is reported in three patients. All three patients initially lacked signs or symptoms localizing to the oral cavity, and two of the three patients did not have x-ray evidence of abscess formation. Two patients received antibiotic therapy without any apparent clinical response, and all three patients responded promptly to surgical extractions. Our patients illustrate that fever can be the only sign of dental sepsis in renal transplant recipients, and tooth extraction as empiric therapy may be necessary. Most important, however, is that the dental pathology responsible for their fever could have been detected and treated prior to transplantation. We recommend pretransplant dental evaluation of all patients with extraction of partially impacted molars and treatment of all periodontal disease and dental caries.

Adolescent↗
PubMed1982

Pulmonary sarcoidosis. Long-term follow-up of the effects of steroid therapy.

Fifteen years ago we began a prospective study using alternate case treatment with prednisone in patients with pulmonary function abnormalities due to sarcoidosis. Twenty-five patients were divided into treatment and control groups that were similar in sex, age, race, degree of pulmonary dysfunction, and duration of disease. Evaluation included complete spirometric studies, single-breath carbon monoxide diffusion capacity, and arterial blood gases. Follow-up studies at six months, one to two years, and ten to 15 years show no difference between the treated and untreated groups. Improvement or deterioration in pulmonary function of individual patients in the treated group was reflected in the control group, even in those patients with a diffusing capacity and forced vital capacity less than 65 percent of predicted. Data from this long-term study fail to show any benefit of short-term use of steroids in therapy for pulmonary sarcoidosis.

Adult↗
PubMed1982

Fixed and reproducible orthostatic proteinuria: results of a 20-year follow-up study.

A 20-year follow-up evaluation of young men with fixed and reproducible orthostatic proteinuria showed no evidence of progressive renal disease. Follow-up information was obtained on 43 of the original 64 patients and detailed information was secured on 36. All had normal renal function and only six patients continued to show qualitative proteinuria. The prevalence of hypertension found was similar to that of a comparably aged group of the general population. The 20-year prognosis of patients with fixed and reproducible orthostatic proteinuria is excellent.

Adult↗
PubMed1981

Humoral immunity in renal transplantation Detection of cytotoxic antibodies to lymphocyte antigens other than HLA-A,B,C and Ia-like antigens in patients with vascular graft rejection.

By using a Fab2 fragment blocking assay with cultured human B lymphoid cells and peripheral lymphocytes as targets, cytotoxic antibodies to Ia-like antigens, to HLA-A,B,C antigens, and to lymphocyte structures other than these two types of histocompatibility antigens were identified in serial post-transplant sera from 18 renal allograft recipients. Multiple combinations of these three types of antibodies were seen in 78% of the sera. A higher reactivity as well as higher titers of antibodies were found in patients with graft failure from rejection. The occurrence of anti HLA-A,B,C or anti Ia-like antibodies did not show any relationship to graft outcome. However, cytotoxic antibodies to other antigens (referred to as non-HLA antibodies) were detected in five of the six patients with graft failure and in only one patient with graft survival. In this latter patient, non-HLA antibodies occurred with a chronic rejection episode and were no longer detectable when the rejection ceased. This study shows that the Fab2 fragment blocking assay is a useful method to identify antibodies to multiple specificities in sera from kidney graft recipients, and suggests that non-HLA cytotoxic antibodies may be associated with graft rejection.

Antibody Formation↗
PubMed1976

Placenta previa and preeclampsia complicating the management of renal transplant patients.

Presented are three patients who have delivered full-term normal infants after renal transplants from living related donors. One patient had a placenta previa with excessive vaginal hemorrhage. Another patient manifested preeclampsia. Management of these and other complications should be aggressive and thorough with special precautions taken to preserve graft function. In our patients, pregnancy was not harmful to the renal transplant. No fetal complications from immunosuppressive drugs were noted and the patients' dosage requirements did not change. Counseling regarding family planning is essential in patients with renal transplant.

Adult↗
PubMed1976

Incomplete Reiter's syndrome: discriminating features and HL-A W27 in diagnosis.

Reiter's syndrome (nonspecific urethritis, conjunctivitis, and arthritis) may present with arthritis alone. There are, however, other discriminating clinical features that contribute to diagnosis. Additionally, the presence of HL-A W27 provides a new diagnostic aid. Thirteen patients were studied and support the validity of the concept of incomplete Reiter's syndrome. Peripheral arthritis was the presenting complaint in all, and none had urethritis or conjunctivitis. The majority were young white men. The arthritis was oligoarticular and asymmetric with lower extremity involvement predominantly. Heel pain was a prominent symptom in 10, with periostitis of other sites in 5, and "sausage digits" in 8. Mucocutaneous lesions occurred in 1 and significant weight loss in 6. Only 2 had sacro-illiitis. Chronicity has characterized the course in 12. HL-A W27 was present in 12 of 13. Additional data suggest that Reiter's syndrome may be one of the most common forms of inflammatory arthritis in young men.

Adolescent↗
PubMed1976

The association of maternal lymphocytotoxic antibodies with obstetric complications.

The immunologic relation between mother and fetus has become of interest to those concerned with reproductive physiology. One method to assay this type of relation is to determine the immunologic response to HLA antigens expressed by the fetus which are of paternal origin. Although 20 to 50% of multiparous women develop lymphocytotoxic antibodies during pregnancy, the effect of these antibodies on gestation or the fetus has not been established. In a prospective study, 23 patients at the time of spontaneous abortion had negative cytotoxic antibodies. Of 129 obstetric patients followed with antibody screening over a 6 to 7 month period until delivery, 28 developed positive lymphocytotoxic antibodies (22%). These 28 patients with cytotoxic antibodies delivered male infants by a ratio of 4 to 3, and 11 patients (39.3%) had complications during the gestation. The responsiveness to the paternal histocompatibility antigens is valuable information for furthering the understanding of the fetal-maternal relation.

Antibodies↗
PubMed1973

Evidence suggesting persistence of nephritogenic immunopathologic mechanisms in patients receiving renal allografts.

Direct immunofluorescent (IF) examinations and elutions were performed on native kidneys and allografts of 24 patients undergoing renal transplantation. Immunoglobulins (Ig) were detected by IF on native kidneys of 12 of the 24; 11 of the 12 later had Ig localized to allograft glomeruli by direct IF. In addition, three other patients also developed Ig deposition on allograft glomeruli, although direct IF of native kidneys was negative. Elution studies indicated: (a) that linear Ig deposition on allograft glomeruli was the result of antiglomerular basement membrane (GBM) antibodies, (b) Ig localizing to allograft glomeruli in many of these patients was the result of persistent immunopathogenetic mechanisms existing at the time of allograft placement, and (c) occasionally, kidneys negative for Ig localization by direct IF contain elutable nephritogenic antibodies.

Adult↗