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Biomedical subjects

V R Jablokow

Publications and source records attributed to V R Jablokow.

14 recordsLinked to original sources

The effect of chronic renal insufficiency on cyclosporine nephrotoxicity.

Despite cyclosporine's efficacy in preventing rejection, its use has been hampered by nephrotoxicity. Questions remain concerning its application in patients with decreased renal function. The purpose of this study was to 1) establish a reliable animal model with chronic renal insufficiency (CRI) to study cyclosporine (CyA) nephrotoxicity, and 2) compare the long-term (50 day) severity of CyA nephrotoxicity in CRI versus normal animals. Fischer 344 rats were divided into six groups (15 to 22 each). In three groups, CRI was induced by a 5/6th nephrectomy (three groups were sham operated). After three wks., daily i.p. injections of olive oil, CyA at five mg./kg., or CyA at 30 mg./kg. daily were administered. Serum and urine were collected at 10 day intervals for the determination of biochemical indices of renal function. Animals were sacrificed after 50 days of treatment and renal histology was evaluated by light and electron microscopy. Chronic CyA treatment was well tolerated by both intact and CRI rats, suggesting that this is a reliable model for long-term CyA toxicity studies. CyA decreased renal function at day 50 in both CRI and intact animals. CRI of mild to moderate degree had little effect on the biochemical and histological indices of CyA induced nephrotoxicity. CRI does appear to potentiate the metabolic toxicity that occurs after chronic treatment with high dose CyA.

Acetylglucosaminidase

Ureteral replacement using ileum in compromised renal function.

Ureteral replacement by ileum is an accepted technique in a highly selective patient population. Two major contraindications in using an ileal ureter are compromised renal function (serum creatinine greater than 2) and a functionally abnormal bladder. We used ileum to bridge a ureteral defect in animals with half of a solitary kidney and low grade azotemia to see if the antirefluxing mechanism of the lower ureter prevented further deterioration in renal function. Twelve female mongrel dogs underwent a right nephrectomy, followed by a left partial nephrectomy six weeks later. Group I (six dogs) had a six cm. segment of ileum interposed between the upper and lower ureteral segments (nonrefluxing). Group II (five dogs) had a ten cm. segment of ileum placed from the upper third of the ureter to the bladder (refluxing). Cystograms, intravenous pyelograms, serum electrolytes, BUN and creatinine were obtained preoperatively, six weeks after the right nephrectomy, one month after left partial nephrectomy and six months after ileal replacement prior to sacrifice. The BUN and creatinine deteriorated in Group II compared to Group I, p = .02 and p = 0.4 respectively (Mann-Whitney test). The BUN and creatinine also deteriorated between one month after left partial nephrectomy and six months after ileal replacement within Group II, p = .07 and p = .14, respectively (Wilcoxon matched-pairs test) but not in Group I. These data suggest that the antirefluxing mechanism of the lower ureter might prevent further deterioration in renal function. We feel that ileum can be used with caution, as an interposition in compromised renal function.

Animals

Primary choriocarcinoma of mediastinum with immunohistochemical study and review of the literature.

Primary germinal tumors of the mediastinum are extremely rare. Most germ cell tumors in that location occur as metastasis from testis. A case report with immunocytochemical studies is described. Histologically, the tumor had features of choriocarcinoma and with immunoperoxidase technique stained positively for Beta human chorionic gonadotropin (BHCG). The patient is alive and asymptomatic 2 years post surgery and chemotherapy.

Adult

Plantar verrucous carcinoma (epithelioma cuniculatum): case report with review of the literature.

Verrucous carcinoma is a rare highly keratinizing variant of squamous cell carcinoma that is a slow-growing, locally aggressive, and rarely metastasizing tumor. It may involve various body sites including oral, genital, and plantar areas. The tumor has a characteristic gross appearance with multiple sinuses opening on the surface and may present a difficult diagnostic problem. Multiple biopsies and close clinical correlation are frequently required before a definite diagnosis is possible. The differential diagnosis is especially difficult if only fragments or superficial portions of the lesion are submitted for histological evaluation. Reviewing surgical material from our institution from 1976 to 1983, we located four cases of verrucous carcinoma of the foot. These four cases were diagnosed on the bases of clinical, gross, and microscopic appearances. One of the cases had bilateral lesions. One of the cases is described with review of the literature.

Carcinoma, Papillary

Pseudomyxoma peritonei associated with colloid carcinoma of the pancreas.

A case of pseudomyxoma peritonei associated with a mucin-rich, "colloid" adenocarcinoma of the pancreas is described. This previously unreported association was characterized by an extremely rapid clinical course, transerosal spread of the neoplastic process, and the consistent presence of intracytoplasmic lumina in all cells, an ultrastructural feature thought to characterize malignant lesions.

Adenocarcinoma, Mucinous

Leiomyosarcoma of penile prepuce with ultrastructural study.

A case of a leiomyosarcoma developing in a penile prepuce of a young patient is presented with ultrastructural studies. The firm, well-circumscribed nodule was present for several years. Histologically and ultrastructurally the excised nodule showed features of a leiomyosarcoma. The incidence and morphology of this rare tumor is discussed.

Humans

Peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients dialyzed exclusively with lactate-buffered dialysate.

Peritoneal sclerosis occurred in two patients treated by continuous ambulatory peritoneal dialysis (CAPD) using only lactate-buffered dialysate. Both patients had recurrent peritonitis and the second patient had multiple, minor abdominal operations. Patients receiving lactate-buffered CAPD are not immune from peritoneal sclerosis. Recurrent peritonitis and repeated abdominal surgery might be important causative factors.

Adult

Urinary undiversion using the existing ileal loop and distal right ureter.

Urinary undiversion is an accepted technique in a highly selective patient population. We reconstructed the urinary tract in six female mongrel dogs. A 15 cm. segment of ileum was isolated, both ends were closed and bowel continuity re-established. The proximal two-thirds of each ureter were anastomosed to the proximal end of the ileal segment. The distal one-third right ureteral segment, in continuity with the bladder, was anastomosed end-to-side to the distal ileal segment. Information from the intravenous pyelograms, renal function tests, electrolytes and pathological studies showed normal upper tracts without dilatation or obstruction, preservation of renal function and normal electrolytes except for mild hyperchloremia in all 6 animals. There was chronic pyelonephritis in one animal and mild focal renal inflammation in two animals. The uretero-ileal anastomoses were patent and the ureters were not dilated. The interposed ileum functions well as a conduit and does not become a reservoir over time. We believe incorporating ileum into the urinary tract in this technique of undiversion is a safe and effective clinical alternative in selected patients.

Animals

Peritoneo-venous shunting in patients with cirrhotic ascites and end-stage renal failure.

End-stage renal failure supervened in two cirrhotic patients with ascites, necessitating maintenance hemodialysis therapy. One patient had a functioning LeVeen peritoneo-jugular shunt (Becton-Dickinson, Rutherford, NJ) in place at the time that hemodialysis was initiated. In the other patient, a LeVeen shunt was inserted 8 months after beginning hemodialysis, after extracorporeal ultrafiltration had failed to resolve his ascites. Both patients achieved control of their ascites and enjoyed relatively long survival. Our results suggest that, in patients with cirrhotic ascites who develop end-stage renal failure, successful long-term management can be obtained using a combination of peritoneo-venous shunting and maintenance hemodialysis.

Humans

Case report 94.

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Aged

Lipomatous hypertrophy of the cardiac interatrial septum. A report of 38 cases and review of the literature.

Thirty-eight cases of lipomatous hypertrophy of the cardiac interatrial septum are presented and analyzed, together with those previously reported. Available data indicate that this entity is more likely to be seen in the seventh to eighth decade of life, in Caucasians, and with age-associated increases of epicardial fat. It differs from cardiac lipoma, which is a true neoplasm occurring in a younger age group. It is probably more frequent than reported as it is usually not looked for. Atrial arrhythmias sometimetimes coexist with this lesion, but a cause-and-effect relationship would be difficult to prove. The lesion should be included in the differential consideration of atrial masses found by ultrasound, cineangiocardiogram, and gated radionuclide cardiac imaging.

Aged

Gold pneumonitis. A case report with electronmicroscopy and electron probe analysis.

A case of classical RA developed severe interstitial pulmonary disease and respiratory failure while on chrysotherapy. A high concentration of gold was found in lung tissue. Electron microscopic and electron probe examinations confirmed the presence of gold in the interstitial and intra-alveolar macrophages. The clinical course and possible pathogenic mechanism were discussed.

Aged