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Biomedical subjects

W E Braun

Publications and source records attributed to W E Braun.

At least 19 recordsLinked to original sources
PubMed1979

Impaired renal allograft function: a comparative study with angiography and histopathology.

We reviewed 47 renal transplant recipients who had undergone angiography and transplant biopsy to evaluate impaired allograft function. Angiographic criteria for rejection were seen in all allografts with hyperacute rejection, accelerated rejection and chronic rejection, and in 13 of 17 allografts with acute cellular rejection. Angiography was normal in allografts with vasomotor nephropathy or transplant glomerulopathy. Angiography is an accurate method for the diagnosis of most causes of post-transplant dysfunction.

Biopsy↗
PubMed1979

Multiple-artery renal transplantation: emphasis on extracorporeal methods of donor arterial reconstruction.

The operative techniques to transplant kidneys with multiple renal arteries and our recent experience with them are reviewed. The preferred methods are anastomosis with a Carrel aortic patch and extracorporeal arterial repair before transplantation. These are simple and effective methods that avoid subjecting the kidney to prolonged ischemia. Revascularization of all renal arteries is important to obviate ischemic allograft complications.

Humans↗
PubMed1978

A subgroup of ankylosing spondylitis associated with HLA-B7 in American blacks.

In a study of 34 American black patients with primary ankylosing spondylitis, 18 were found to be HLA-B27-negative. Of these, 10 possessed HLA-B7 (55.6%) compared to 23.7% of 59 B27-negative black controls (P less than 0.025, relative risk = 4). On comparing these 10 B7-positive patients (group I) with 16 B27-positive black patients (group II), a difference in mean age at onset of disease was found: 33.6 years in group I and 22.2 years in group II (P less than 0.005). In addition, a family history of ankylosing spondylitis was absent in group I patients but present in 6 patients in group II (P = 0.034). These findings indicate an association between HLA-B7 and ankylosing spondylitis in American blacks and suggest that these patients who lack B27 but possess B7 represent a subgroup of patients with this disease.

Adult↗
PubMed1978

Avascular necrosis following renal transplantation. Experience with 449 allografts with and without high-dose steroid therapy.

From January 1, 1971, to January 1, 1976, 173 renal allografts were transplanted into 146 patients. Intravenous methylprednisolone (IVMP) was given to all mismatched recipients in a dose of 1 Gm. on the day of transplant and in varying amounts during acute allograft rejection. In 7 patients, 4.8 per cent of 146 patients and 4 per cent of 173 allografts, with a minimum follow-up of fifteen months avascular necrosis of one or more joints developed with an average of 9.4 months after transplantation and a range of five to eighteen months. The total dose of IVMP given to the patients with aseptic necrosis varied between 3 and 18 Gm. from the time of transplantation until the onset of skeletal symptoms. This incidence was nearly identical to the 5 per cent of 242 patients and 4.3 per cent of 276 renal allografts from the same center performed between January 1, 1963, and January 1, 1971, when intravenous steroid pulse therapy was not utilized. Since January, 1971, total joint replacement of the hip or knee were performed in 4 of the 7 affected patients six to sixteen months after the onset of symptoms. Renal function remained stable after surgery in all 4 patients. Virtually normal range of motion was present within three months after surgery. Although the controversy of steroid therapy in the pathogenesis of avascular necrosis still exists, judicious use of high-dose IVMP therapy does not appear to increase its incidence. Early surgery is recommended when the radiologic evidence confirms the clinical findings of avascular necrosis in order to ameliorate pain, correct restriction of movement, and promote full rehabilitation.

Adolescent↗
PubMed1978

Ruptured human renal allograft. Pathogenesis and management.

From January, 1963, to January, 1977, 4 cases of acute allograft rupture occurred in 474 renal transplants performed at the Cleveland Clinic, an incidence of 0.8 per cent. Rupture developed between the fifth and sixteenth day after transplantation during a period when the patients required dialysis because of poor allograft function. All patients had surgical exploration and successful repair of the laceration. Biopsies in each case at the site of laceration revealed findings consistent with acute allograft rejection. The rejections were mild in 2 cases, moderate in one, and severe in another. Two kidneys failed to sustain function, and the patients were returned to chronic hemodialysis two to five months later. None required a nephrectomy. The other two kidneys are functioning well, with serum creatinine values of 1.3 and 1.5 mg./100 ml. one year after allograft rupture. Since rupture of a renal allograft does not appear to increase the intensity of rejection nor does it represent a severe type of rejection, transplant nephrectomy can be avoided unless hemorrhage is uncontrollable from the site of laceration.

Adult↗
PubMed1978

HLA--B27 homozygosity in ankylosing spondylitis: relationship to risk and severity.

The observed frequency of apparent homozygotes for HLA--B27 (15.5%) was significantly greater than the estimated expected frequency (4.2%) among 58 B27-positive Caucasian patients with ankylosing spondylitis (AS) (P less than 0.0005). Search of the literature uncovered four other studies in each of which the frequency of apparent homozygotes was shown by our analysis to be greater than expected. These analyses indicated that B27 homozygotes are more susceptible to developing AS than are B27 heterozygotes. Comparison of the clinical features of AS showed no differences between heterozygotes and apparent homozygotes except for a higher frequency of involvement of peripheral joints in the latter group.

Gene Frequency↗
PubMed1978

Long-term results in 35 HLA-identical sibling and 3 HLA-identical parent-child renal allograft recipients.

35 recipients of a renal allograft from an HLA-identical sibling followed for 3 months to nearly 15 years have had 1- and 5-year allograft survivals of 93 and 76%, respectively, levels comparable to the 90 and 80% reported at 1 and 5 years for identical twins. Although high MLC stimulation was related to graft failure, intermediate degrees of stimulation were not. The most common cause of graft failure was chronic rejection (n=4) and of death, myocardial infarction (n=3). However, overall complications such as aseptic necrosis were distinctly lower than in mismatched recipients. 3 children received an allograft from an HLA-identical parent, possible because of a shared parental haplotype, and all have excellent function from 2 to nearly 9 years after transplantation.

Adolescent↗