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Biomedical subjects

R Pollak

Publications and source records attributed to R Pollak.

At least 127 records · Page 7Linked to original sources
PubMed1985

The spectrum of peritonitis in renal transplant recipients.

Peritonitis in immunosuppressed renal transplant recipients continues to be associated with a high mortality. Twenty-four patients with intraperitoneal infections were identified in 542 consecutive renal transplant recipients over a period of 15 years (4.4%). Sixteen of the 24 (66.6%) died as a result of these infections. Transplant wound sepsis and the complications and surgery of gastrointestinal diseases accounted for the majority of instances. During the period 1980-1983 only four cases occurred with no episodes being due to wound complications. Symptoms and signs were vague and nonspecific, and in three patients the diagnosis was made only at autopsy. Surgery aimed to eliminate the septic focus with the drainage of abscesses and the avoidance of large bowel anastomoses. In 22 patients, a polymicrobial flora was obtained from the contaminated peritoneal cavity, with an average of 2.25 organisms per patient. These data suggest that the prohibitive mortality of peritonitis in renal transplant recipients may be lowered by prophylactic gastrointestinal surgery prior to transplantation, as well as by measures designed to lower the incidence of transplant wound sepsis. Peritoneal lavage, computed tomography, and laparotomy in the face of an undiagnosed source for sepsis may be warranted in these high-risk patients.

Adolescent↗
PubMed1985

Parathyroid allotransplantation in the treatment of complicated idiopathic primary hypoparathyroidism.

Parathyroid allotransplantation was performed in a 25-year-old woman with idiopathic hypoparathyroidism that had been diagnosed at age 4 years. Long-term medical management of the primary condition with vitamin D and oral calcium supplementation was complicated by multiorgan calcinosis and renal failure. At the age of 21 years she received a successful cadaver renal allograft. Four years later she developed calcinosis cutis with widespread skin necrosis. Medical control of calcium and phosphate metabolism was unsatisfactory and the skin necrosis became progressive and life threatening. A parathyroid allograft that was performed with tissue from a parathyroid adenoma resulted in normalization of the serum calcium and phosphorus levels with arrest and subsequent healing of the skin necrosis. Later failure of the parathyroid allograft was followed by successful retransplantation of normal parathyroid tissue from a cadaver organ donor.

Adult↗
PubMed1984

Partial splenic embolization, an alternative to splenectomy--results of a prospective, randomized study.

UNLABELLED: We conducted a prospective, randomized study comparing transcatheter partial splenic embolization (PSE) with splenectomy (SX) in 53 renal transplant candidates. An additional 112 PSE procedures were performed for various indications in 101 patients. STUDY RESULTS: A mean +/- SD of 65% +/- 16% of splenic mass was ablated in the PSE group. The early postoperative morbidity rate was similar in the two study groups, as was the duration of hospital stay. Abscess or rupture of the spleen were not encountered. Severe pancreatitis occurred only in the SX group. Renal transplantation was carried out in equivalent numbers in both groups, with a similar long-term (2.5 to 4.0 years) graft survival (60% versus 66%). No difference in long-term patient mortality was noted. Splenic "regeneration" occurred frequently after PSE. PSE experience exclusive of study: Embolization attempts failed in nine patients. Repeat PSE was performed in 11 of the 101 patients. Where hypersplenism was the primary indication, PSE resulted in significant improvement in the hematologic parameters. The incidence of serious complications was acceptably low. There were two late procedure-related deaths. Our conclusion from the study and the total experience of 137 PSE procedures is that PSE offers an acceptably safe alternative to SX in selected high-risk patients in whom both the surgical intervention and the resulting asplenic state carry a prohibitive risk.

Adolescent↗
PubMed1982

Cholelithiasis in childhood and adolescence. A review.

Cholelithiasis and cholecystitis are uncommon in childhood and adolescence. Misconceptions as to the aetiology, natural history, diagnosis, and therapy of these conditions prompted us to review our experience. Nineteen patients ranging in age from 7 to 18 years underwent cholecystectomy for gallstones at the University of Illinois Hospital, Chicago, between June 1970 and June 1979. Seventeen patients were female and 2 male (ratio 8.5:1). The cause was unknown in 12 patients (63%) but in 7 patients (37%) haematological disease was the underlying disorder. The most common presenting symptom (95%) was vague right upper quadrant or epigastric pain, often ignored or mistaken for peptic ulcer pain. Oral cholecystography demonstrated gallstones in 15 of 16 patients. Ultrasonography, used more recently, was positive in 3 patients intra-operative cholangiography in 12 patients, and common duct exploration in 1 additional patient, failed to demonstrate calculi. No patients were readmitted for recurrent or retained biliary calculi after cholecystectomy.

Adolescent↗
PubMed1978

Early diagnosis of the fat embolism syndrome.

One hundred consecutive cases of trauma with associated fractures of the lower limb long bones were studied for the subsequent development of the fat embolism syndrome (FES). This is to be differentiated from the intravascular fat embolism which often occurs without clinical FES becoming manifest. Seventeen of the patients developed the clinical picture, with a further 16 patients being considered to have had the syndrome subclinically. Clinical and biochemical features were studied to determine pointers to the early diagnosis and patient "at risk" of developing FES. Young males under the age of 30 with significant hypoxemia occurring early in the course of the disease were considered the most likely candidates "at risk" for developing FES. These results favor the concept that FES is essentially a form of respiratory insufficiency syndrome similar to that which occurs following trauma in other situations, e.g., shock lung.

Adolescent↗
PubMed1976

Physical illness and the psychiatric patient.

The significance and seriousness of physical illness in mentally ill patients are often not appreciated by those responsible for the immediate care of these patients. This study highlights the nature and prevalence of physical illnesses in a large group of psychiatrically ill patients.

Adult↗
PubMedDate not supplied

Pancreas-kidney transplantation for intensivists: perioperative care and complications.

Simultaneous pancreas-kidney transplantation is a therapeutic option for type I diabetics with end-stage renal disease. It aims to correct the uremic state, to normalize glucose hemeostasis, and to ameliorate diabetic complications. Careful donor-recipient selection and meticulous intra-operative and postoperative care will substantially impact recipient morbidity. An understanding of the technical aspects of the surgical procedure and its metabolic and immunological consequences is necessary to successfully manage a pancreas-kidney transplant recipient, many of whom are nursed in intensive care units. A successful outcome is predicted in early recognition of technical complications and aggressive management of rejection to achieve the current 1-year graft survival rates of 75% for pancreas transplants and 84% for kidney transplants.

Adult↗
PubMedDate not supplied

Transplantation of hepatocytes: an in-vitro and in-vivo study in canines.

We isolated and transplanted hepatocytes in the canine, large animal model to evaluate hepatocyte yield and purity as well as the optimal site for hepatocyte engraftment (i.e., the spleen or the portal bed). We obtained viable, pure, single hepatocyte suspensions that were readily preserved at 4 degrees C in University of Wisconsin (UW) solution for up to 3 days. Both intrasplenic and portal vein injection were well tolerated, with minimal recipient morbidity and mortality when 1-2 x 10(9) hepatocytes were injected into immunosuppressed allogeneic hosts. We noted the embolization of hepatocytes into the parenchyma of the native liver within 7 days of intrasplenic transplantation that produced a mild reversible derangement of liver function and histology. These results warrant consideration prior to clinical trials of hepatocyte transplantation in man.

Adenosine↗
PubMedDate not supplied

Bovine chromaffin cells for CNS transplantation do not elicit xenogeneic T cell proliferative responses in vitro.

Adrenal chromaffin cells have been utilized for several neural grafting applications, but limitations in allogeneic donor availability and dangers inherent in autografting limit the widespread use of this approach clinically. While xenogeneic donors offer promise as a source for cell transplantation in the central nervous system (CNS), immunologic responses to cellular components of the adrenal medulla have not been well characterized. To further study the host T cell xenogeneic response to chromaffin and passenger cells of the adrenal medulla, an in vitro lymphocyte proliferation assay was used. Lymphocyte proliferation was determined by mixing rat lymphocytes with potential stimulator cell subpopulations of the bovine adrenal medulla: isolated chromaffin cells, isolated endothelial cells, or passenger nonchromaffin cells, which include a mixture of fibroblasts, smooth muscle cells, and endothelial cells. As a positive control, bovine aortic endothelial cells were also used. 3[H]-thymidine incorporation, corresponding to lymphocyte proliferation, was measured. Results indicated that isolated bovine chromaffin cells produce only a mild, statistically insignificant stimulation of rat lymphocytes. In contrast, there was a significant response to passenger nonchromaffin cells of the adrenal medulla, especially endothelial cells. The inclusion of low levels of cyclosporin A in the cultures completely eliminated the mild proliferative response to isolated bovine chromaffin cells, while near toxic levels were necessary to abrogate the response to endothelial cells. Immunocytochemical analysis revealed that routine chromaffin cell isolation procedures result in the inclusion of a small percentage of endothelial cells, which may be responsible for the slight lymphocyte stimulation. The results of this study indicate that isolated chromaffin cells possess low immunogenicity, and suggest that passenger cells in the adrenal medulla, particularly endothelial cells, may be primarily responsible for progressive rejection in CNS grafts. Thus, removal of passenger nonchromaffin cells from xenogeneic donor tissues prior to transplantation may produce a more tolerated graft in rodent models of neural transplantation.

Adrenal Medulla↗
PubMedDate not supplied

The transfusion effect is influenced by the nature of MHC antigen presentation.

We designed a study to determine whether the mode of presentation of major histocompatibility antigens is important for the ability of donor-specific blood transfusions to prolong organ allograft survival. Donor BN rat whole blood, isolated RBC, RBC ghosts, RBC membrane fragments, or whole blood lysates were administered to Lewis rat recipients 7 days before heterotopic allotransplantation of BN hearts. Only allogeneic whole blood or RBC significantly prolonged cardiac allograft survival in this histoincompatible donor-recipient pair. Whole blood lysates or RBC ghosts and membrane fragments transfused pretransplant did not prolong cardiac allograft survival when compared with syngeneic, transfused control rats. These results suggest that the immunosuppressive effects of donor-specific pretransplant blood transfusion may depend on a three-dimensional spatial relation between cells bearing donor major histocompatibility antigens and recipient responder cells responsible for the transfusion effect.

Animals↗