==================================CMR06================================== 6. Neoplasia in kidney, heart, and liver transplant recipients. 1 UI - 87100799 AU - R:udlinger R ; Smith IW ; Bunney MH ; Hunter JA TI - Human papillomavirus infections in a group of renal transplant recipients. AB - One hundred and twenty renal transplant recipients were investigated. Fifty-eight (48%) were found to have warts, 13 (11%) keratoses and six (5%) to have, or recently to have had cancers. The longer the time of immunosuppression, the greater the prevalence of warts; of those patients who had had their transplant for at least 5 years, 87% had warts. Those with a graft survival time of 10 years or more are at special risk of warts, keratoses and malignancy. Five (10%) of 50 women had genital warts, four of whom had internal lesions (vaginal, cervical or anal) and one developed a carcinoma of the vulva. These findings indicate the advisability of colposcopy for all female renal transplant recipients, a high risk group. Eighty-eight specimens from 42 patients were examined by DNA restriction enzyme analysis and cross hybridization for the presence and type of human papillomavirus (HPV). HPV DNA was detected in 66% of the warts examined, HPV2 and HPV4 occurring most often and HPV1 and HPV3 only infrequently. In sequential specimens from common hand warts of one individual, an HPV was found which could not be precisely identified but was related to HPV4. HPV16 was detected in a vaginal wart from one patient and an HPV6-related virus in a vulval wart of another. HPV DNA of an unknown type was demonstrated in one of 11 keratoses examined. With the probes used to examine the few samples of skin cancers available, HPV16 was found in a squamous cell carcinoma of the vulva, and faint bands from an unidentified type of HPV were detected in two squamous cell carcinomata from a patient's hand. One woman had plaque lesions morphologically and histologically resembling those found in epidermodysplasia verruciformis (EV). HPV5 was identified in these lesions. This is only the third reported case of HPV5, previously thought to be unique to EV, in a renal transplant recipient. MH - Adolescence ; Adult ; Aged ; Autoradiography ; Carcinoma, Squamous Cell/MICROBIOLOGY ; Child ; DNA, Viral/ISOLATION & PURIFICATION ; Epidermodysplasia Verruciformis/MICROBIOLOGY ; Female ; Human ; Keratosis/MICROBIOLOGY ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Papillomaviruses/*ISOLATION & PURIFICATION ; Skin Neoplasms/MICROBIOLOGY ; Support, Non-U.S. Gov't ; Time Factors ; Tumor Virus Infections/*MICROBIOLOGY ; Warts/ MICROBIOLOGY SO - Br J Dermatol 1986 Dec;115(6):681-92 2 UI - 87074977 AU - el-Akkad S ; Bull CA ; el-Senoussi MA ; Griffin JT ; Amer M TI - Kaposi's sarcoma and its management by radiotherapy. AB - Thirteen patients with Kaposi's sarcoma were treated by radiotherapy between 1975 and 1984. Five patients were kidney transplant recipients receiving immunosuppressive drugs, while eight patients had spontaneous Kaposi's sarcoma. Eleven patients were followed up for periods from two to 63 months (mean, 27 months). All patients had complete response throughout the period of follow-up except one patient who developed recurrence one year after completion of radiotherapy. There was no difference in the response between transplant recipients and patients with spontaneous disease. This response was also unrelated to the dose or type of radiation used. Radiotherapy has been found effective in the local control of Kaposi's sarcoma with complete relief of symptoms and minimal morbidity. MH - Adult ; Aged ; Female ; Human ; Immune Tolerance ; Kidney/ TRANSPLANTATION ; Male ; Methods ; Middle Age ; Neoplasms, Multiple Primary/RADIOTHERAPY ; Radiotherapy Dosage ; Sarcoma, Kaposi's/*RADIOTHERAPY ; Skin Neoplasms/*RADIOTHERAPY SO - Arch Dermatol 1986 Dec;122(12):1396-9 3 UI - 87063288 AU - Tymstra T ; Bucking J ; Roorda J ; van den Heuvel WJ ; Gips CH TI - The psycho-social impact of a liver transplant programme. AB - Through in-depth interviews, an inventory has been made of the experiences of 18 liver patients who have been considered for or undergone a liver transplant. Interviews were also held with the patients' relatives. Chronic patients especially seem to regard a transplant as their last chance, and all their hopes become based on it. The strict selection procedure is distressing, and being turned down causes negative feelings. As far as the operation itself is concerned, patients are inclined to create high success rates for themselves in relation to their survival chances and the expectations of quality of life. For some patients a transplant means a marked improvement in the various aspects of their functioning. Others are not so fortunate, but do not give up hope of improvement. From the relatives of the patients who had died post-operatively, no negative feelings were encountered over the 'failure' of the technology'. MH - Adolescence ; Adult ; Chronic Disease ; Emotions ; Female ; Human ; Interpersonal Relations ; Liver Cirrhosis/SURGERY ; Liver Diseases/*PSYCHOLOGY/SURGERY ; Liver Neoplasms/SURGERY ; Liver/ *TRANSPLANTATION ; Male ; Middle Age ; Quality of Life SO - Liver 1986 Oct;6(5):302-9 4 UI - 87058283 AU - Randall BC ; Muraki AS ; Osborn RE ; Brown F TI - Epidural lipomatosis with lumbar radiculopathy: CT appearance. AB - Epidural lipomatosis is a relatively uncommon clinical entity in which large amounts of fat are deposited in the epidural space. In most of the previously reported cases of this entity an associated myelopathy has been reported. We describe a patient who presented with lumbar radiculopathy, which was probably caused by epidural lipomatosis. MH - Case Report ; Epidural Space ; Heart/TRANSPLANTATION ; Human ; Lipomatosis/CHEMICALLY INDUCED/COMPLICATIONS/*RADIOGRAPHY ; Lumbosacral Region ; Male ; Middle Age ; Postoperative Complications/ETIOLOGY/RADIOGRAPHY ; Prednisone/ADVERSE EFFECTS ; Radiculitis/ETIOLOGY/*RADIOGRAPHY ; Spinal Stenosis/ETIOLOGY/ RADIOGRAPHY ; *Tomography, X-Ray Computed SO - J Comput Assist Tomogr 1986 Nov-Dec;10(6):1039-41 5 UI - 87047699 AU - Gupta AK ; Cardella CJ ; Haberman HF TI - Cutaneous malignant neoplasms in patients with renal transplants. AB - There is an increased risk of developing cutaneous neoplasms in patients with renal transplants who are receiving immunosuppressive therapy. We studied 523 consecutive white patients who had received renal transplants at a Canadian medical center. Malignant neoplasms developed in 7.5% of these patients, and 72% of these neoplasms were cutaneous in origin. Compared with the general population, the rate of development of all skin cancers, squamous cell carcinoma, and basal cell carcinoma was 3.2, 18.4, and 1.4 times, respectively. In our study the squamous cell carcinoma to basal cell carcinoma ratio was 2.3:1, compared with 0.2:1 in the general population. There was no significant difference in the site of development of skin cancer in patients with renal transplants compared with the general population. There was, however, a propensity for the development of multiple skin cancers at an earlier age, especially on sun-exposed areas. The results of this study have been compared with those of other world medical centers. MH - Adult ; Aged ; Canada ; Carcinoma, Basal Cell/*ETIOLOGY/ OCCURRENCE ; Carcinoma, Squamous Cell/*ETIOLOGY/OCCURRENCE ; Female ; Human ; Immunosuppressive Agents/*ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Retrospective Studies ; Risk ; Skin Neoplasms/*ETIOLOGY/OCCURRENCE SO - Arch Dermatol 1986 Nov;122(11):1288-93 6 UI - 87045653 AU - Sherlock S ; Dick R TI - Cannon lecture. The impact of radiology on hepatology. AB - Because of remarkable advances in diagnostic imaging and the development of a variety of useful interventional techniques, radiology now plays a central role in the diagnosis and treatment of patients with hepatic disease. These include focal, vascular, and metabolic liver diseases, abnormalities of the biliary tract, and conditions associated with hepatic transplantation. Thus, optimal care of patients with liver disease now requires that there be close cooperation between the two specialties. MH - Angiography ; Biliary Tract Diseases/DIAGNOSIS ; Comparative Study ; Contrast Media ; Cysts/RADIOGRAPHY ; Hemangioma/ RADIOGRAPHY ; Human ; Liver Abscess/DIAGNOSIS ; Liver Circulation ; Liver Diseases/*DIAGNOSIS/RADIOGRAPHY/RADIONUCLIDE IMAGING ; Liver Neoplasms/DIAGNOSIS ; Liver/TRANSPLANTATION ; Metabolic Diseases/DIAGNOSIS ; Nuclear Magnetic Resonance/DIAGNOSTIC USE ; Radiology/INSTRUMENTATION ; Tomography, X-Ray Computed ; Ultrasonic Diagnosis SO - AJR 1986 Dec;147(6):1117-22 7 UI - 87039546 AU - Mandel J ; Kjellstrand CM TI - Long-term results of dialysis and transplantation in patients with end-stage renal failure from hypernephroma. AB - We analyzed long-term, 2- to 9-year results and risk factors in 13 patients treated with dialysis and transplantation for hypernephroma. Eight were dialyzed only, 6 died, 4 of them from metastatic disease that occurred in less than 8 months in 3. Five patients were also transplanted. Three died, 1 of metastatic disease. Two are alive, 1 with metastatic disease, 6 years after transplant, 3 years after diagnosis of metastasis. There were no differences in age and sex in those with early metastatic disease when compared to those without, but stage III-IV disease and time of less than 5 years between first and second nephrectomy were more common in those with early metastatic disease. These data indicate that a 7-month waiting time on dialysis is enough to avoid transplanting those with early recurrence, and that patients with stage III-IV and early reappearance of tumor in the second kidney are best treated with conservative management rather than a second total nephrectomy. MH - Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell/ *COMPLICATIONS/THERAPY ; Female ; *Hemodialysis ; Human ; Kidney Failure, Chronic/*ETIOLOGY/THERAPY ; Kidney Neoplasms/ *COMPLICATIONS/THERAPY ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Nephrectomy ; Prognosis SO - Nephron 1986;44(2):111-4 8 UI - 87028552 AU - Jirtle RL ; Michalopoulos G TI - Enhancement of the clonability of adult parenchymal hepatocytes with the liver tumor promoter phenobarbital. AB - An in vivo clonogenic assay system was utilized to investigate the effect of the tumor promoter, phenobarbital (PB), on adult parenchymal hepatocyte proliferation. Enzymatically dispersed hepatocytes from female Fischer 344 rats were injected into the interscapular and mammary fat pads of isogeneic recipient animals where they proliferate to form hepatocyte colonies within 3 weeks. The number of hepatocytes required to form a colony in 50% of the transplantation sites (LND50) was 23 700 cells and 520 cells when normal adult liver cells were injected into non-hepatectomized and 2/3 hepatectomized normal recipient animals, respectively. Thus, a partial hepatectomy increased the hepatocyte clonogenicity by a factor of 40. A 2-week pre-treatment of both the donor and recipient animals with PB (0.1% in the drinking water) significantly increased the clonogenicity of the liver cells when transplanted into non-hepatectomized (15-fold) and 2/3 hepatectomized (2-fold) animals. However, PB treatment of the recipient animals was not required for the majority of this mitogenic effect since the clonability of PB-treated donor cells was increased (92% of the maximum stimulation observed) even when they were transplanted into untreated control animals. Furthermore, the PB-induced effect on hepatocyte clonability was reversible since the removal of PB from the donor animals 2 weeks prior to their use reduced the clonability of the hepatocytes (LND50 = 20,500 cells) to that observed for cells which were never exposed to PB. These results are consistent with the postulate that rather than PB being directly mitogenic, it primarily increases the clonability of adult parenchymal hepatocytes by inducing a reversible cellular alteration which enhances their responsiveness to endogenous growth stimuli. MH - Animal ; Cell Division/DRUG EFFECTS ; DNA/BIOSYNTHESIS ; Female ; Hepatectomy ; Liver Neoplasms, Experimental/CHEMICALLY INDUCED ; Liver/*DRUG EFFECTS/PATHOLOGY/TRANSPLANTATION ; Phenobarbital/ *TOXICITY ; Rats ; Rats, Inbred F344 ; Support, U.S. Gov't, P.H.S. SO - Carcinogenesis 1986 Nov;7(11):1813-7 9 UI - 87028146 AU - Jensen SR ; Voegeli DR ; McDermott JC ; Crummy AB TI - Percutaneous management of lymphatic fluid collections. AB - Eight lymphatic fluid collections were drained percutaneously. There were no immediate or late complications. Seven patients had follow-up; 1 required surgical drainage of a residual or recurrent lymphocele, and another had reaccumulated fluid in a lymphocele which was detected on autopsy. The remaining lymphatic collections responded to percutaneous drainage. Percutaneous drainage is safe and can be an effective tool in the management of lymphatic collections. MH - Adult ; Aged ; Cysts/DIAGNOSIS/*SURGERY ; Drainage ; Female ; Human ; Kidney/TRANSPLANTATION ; Lymphatic Diseases/DIAGNOSIS/ *SURGERY ; Male ; Middle Age ; Ultrasonic Diagnosis SO - Cardiovasc Intervent Radiol 1986;9(4):202-4 10 UI - 87020442 AU - Falkenberg FW ; Mai U ; Puppe C ; Afifi MS ; Risse P ; Grimm V ; Harmann B ; Herrmann G ; Mondorf AW TI - Urinary kidney-derived antigens determined by tests built on monoclonal antibodies: new markers for kidney damage. AB - We have developed a series of sandwich ELISA for the quantitation of kidney derived urinary antigens (UA) utilizing monoclonal antibodies specific for antigens localized in cells of defined subunits of the nephron of human kidney. Antigens derived from the distal and proximal parts of the tubular system as well as antigens localized over its entire length can be detected and quantified in urine samples. Antigen excretion was measured in the urine of healthy individuals, patients with various diseases with and without kidney involvement, kidney transplant recipients, and healthy volunteers after receiving antibiotics. Low antigen excretion values were found in healthy individuals, patients with diseases primarily affecting the glomerulus, and inactive phases of chronic diseases. Toxic side effects of drugs were reflected by slightly (antibiotic drugs) or strongly (cytostatic drugs) enhanced antigenuria. Excretion of some or all of the antigens was always indicative of massive alteration of tubular structures, such as in acute phases of tubulointerstitial disease or during rejection episodes in kidney transplant recipients. The results obtained indicate that it is possible to obtain information on the location and extent of acute primary processes in the kidney with these tests. MH - Antibodies, Monoclonal ; Antigens/*URINE ; Enzyme-Linked Immunosorbent Assay ; Floxacillin/ADVERSE EFFECTS ; Graft Rejection ; Human ; Kidney Diseases/CHEMICALLY INDUCED/ *IMMUNOLOGY ; Kidney Glomerulus/IMMUNOLOGY ; Kidney Neoplasms/ IMMUNOLOGY ; Kidney Tubules/IMMUNOLOGY ; Kidney/*IMMUNOLOGY/ TRANSPLANTATION ; Monobactams/ADVERSE EFFECTS ; Support, Non-U.S. Gov't SO - Uremia Invest 1985-86;9(2):103-10 11 UI - 87012517 AU - Di Majo V ; Coppola M ; Rebessi S ; Bassani B ; Alati T ; Saran A ; Bangrazi C ; Covelli V TI - Radiation-induced mouse liver neoplasms and hepatocyte survival. AB - Transplantation of hepatocytes from CBA/Cne mice into the fat pads of isogeneic recipients has been used for the quantitative in vivo study of cell survival and risk of transformation after x-ray irradiation (1-7 Gy). A survival curve for liver cells was generated in vivo with a D0 of 3.08 Gy and an extrapolation number not significantly different from 1. Data on liver tumor incidence in whole-body irradiated CBA/Cne and C57BL/Cne X C3H/HeCne (BC3F1) mice are also reported. A statistical analysis of trend in both cases proved a significant induction of tumors by x-rays mainly for doses above 2 Gy. The risk of transformation per surviving cell was estimated for both mouse strains. For CBA mice the data points suggested the presence of a linear component in the dose-effect curve at low doses, whereas for BC3F1 mice a quadratic expression appeared to provide a better description of the points from 1 to 6 Gy. The data of this study suggested that liver tumors can be induced by radiation in mouse strains with either a high or low spontaneous hepatoma incidence. MH - Animal ; Cell Transformation, Neoplastic ; Liver Neoplasms, Experimental/*ETIOLOGY/FAMILIAL & GENETIC ; Liver/*RADIATION EFFECTS/TRANSPLANTATION ; Male ; Mice ; Mice, Inbred CBA ; Mice, Inbred C3H ; Mice, Inbred C57BL ; *Neoplasms, Radiation-Induced ; Support, Non-U.S. Gov't ; Whole Body Irradiation SO - JNCI 1986 Oct;77(4):933-9 12 UI - 86241334 AU - Maeda K ; Hawkins ET ; Oh HK ; Kini SR ; Van Dyke DL TI - Malignant lymphoma in transplanted renal pelvis. AB - A middle-aged man with chronic renal failure received a renal transplant from his healthy daughter. Two years later, malignant lymphoma developed in the transplanted renal pelvis. The lymphoma was found to be B-cell immunoblastic lymphoma bearing monoclonal IgG and kappa immunoglobulin, and it was of recipient origin. MH - B Lymphocytes/CLASSIFICATION/PATHOLOGY ; Case Report ; Human ; Immunoglobulins/ANALYSIS ; Karyotyping ; Kidney/*TRANSPLANTATION ; Kidney Failure, Chronic/COMPLICATIONS/SURGERY ; Kidney Neoplasms/ETIOLOGY/IMMUNOLOGY/*PATHOLOGY ; Kidney Pelvis/ *PATHOLOGY ; Lymphoma, Non-Hodgkin's/ETIOLOGY/IMMUNOLOGY/ *PATHOLOGY ; Male ; Middle Age SO - Arch Pathol Lab Med 1986 Jul;110(7):626-9 13 UI - 86192767 AU - Lillehoj EP ; Poulik MD TI - Normal and abnormal aspects of proteinuria. Part I: Mechanisms, characteristics and analyses of urinary protein.Part II: Clinical considerations. AB - Part I highlights the mechanisms of glomerular filtration and tubular reabsorption of plasma proteins, selected characteristics of urinary proteins based upon electrophoretic properties and recent advances in clinical laboratory analysis of proteinuria. Both structural characteristic of the glomerular capillary wall and molecular properties of plasma proteins are important determinants of glomerular filtration. Proteins filtered by the glomerulus subsequently appear in urine only after escaping the efficient mechanisms of tubular reabsorption. Albumin is one such protein and constitutes the major protein in normal urine although trace amounts of alpha, beta, and gamma globulins are also detectable. Several techniques of protein analysis have thus been developed to specifically measure albumin as well as other plasma proteins. Other methods have been adapted to measure total urinary protein content enabling the clinician to readily monitor renal function in health and disease.The second part of this review will consider conditions associated with proteinuria in both asymptomatic individuals and patients with renal disease. Asymptomatic proteinuria encompasses states of excess protein excretion during conditions of orthostasis, exercise, travel to high altitude of fever. Proteinuria during renal disease has received considerable interest as a means to monitor kidney function. It is therefore classified according to the type of damage incurred: (1) glomerular-type where large molecular weight proteins are excreted (2) tubular-type where small molecular weight proteins are excreted and (3) mixed-type characterized by both large and small molecular weight proteinuria. MH - Alpha Globulins/URINE ; Animal ; Balkan Nephropathy/COMPLICATIONS ; Beta Globulins/URINE ; Biomechanics ; Diabetes Mellitus/ COMPLICATIONS ; Female ; Gamma Globulins/URINE ; Glomerular Filtration Rate ; Hemoglobinuria/METABOLISM ; Human ; Immunoglobulins/METABOLISM ; Kidney/TRANSPLANTATION ; Kidney Diseases/CHEMICALLY INDUCED/COMPLICATIONS ; Kidney Glomerulus/ PATHOLOGY ; Metals/ADVERSE EFFECTS ; Molecular Weight ; Myoglobinuria/METABOLISM ; Neoplasms/COMPLICATIONS ; Nephritis/ METABOLISM ; Nephrotic Syndrome/COMPLICATIONS ; Pregnancy ; Pregnancy Complications ; Proteinuria/COMPLICATIONS/PATHOLOGY/ *URINE ; Review ; Serum Albumin/URINE ; Vascular Diseases/ COMPLICATIONS SO - Exp Pathol 1986;29(1):1-28 14 UI - 86322924 AU - Dickneite G ; Schorlemmer HU ; Walter P ; Thies J ; Sedlacek HH TI - The influence of (+/-)-15-deoxyspergualin on experimental transplantation and its immunopharmacological mode of action. AB - 15-Deoxyspergualin, a novel structure which was described to have anti-tumor activity, was tested on its influence on the survival time of transplanted organs. Prolongation of graft survival was demonstrated in rat skin (LEW----Fischer), islet cells heart and kidney transplantation (DA----LEW) as well as in allogeneic tumor transplantation in mice (C57Bl/6----Balb/c). Especially in the kidney transplantation a long-lasting transplant survival time was observed, indicating induction of tolerance. Examination of its immunopharmacological properties showed that the mononuclear phagocytes and not the lymphocytes are primarily affected by the substance, thus expressing a new mode of action for a substance being effective in transplantation immunology. MH - Animal ; Antibodies/ANALYSIS ; Guanidines/PHARMACODYNAMICS ; Heart/*TRANSPLANTATION ; Islands of Langerhans/*TRANSPLANTATION ; Kidney/*TRANSPLANTATION ; Lung Neoplasms/IMMUNOLOGY/PATHOLOGY ; Lymphocyte Transformation ; Macrophages/IMMUNOLOGY ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Monocytes/IMMUNOLOGY ; *Neoplasm Transplantation ; Rats ; Rats, Inbred F344 ; Rats, Inbred LEW ; Skin/*TRANSPLANTATION SO - Behring Inst Mitt 1986 Jun;(80):93-102 15 UI - 86320793 AU - George CD ; Morello PJ TI - Immunologic effects of blood transfusion upon renal transplantation, tumor operations, and bacterial infections. AB - Blood transfusions appear to exert a suppressive effect on many aspects of the immune system. In transplantation, this has been used to advantage; in other areas, the consequences can be deleterious. It is likely that various components of the immune system are affected by different mechanisms and possibly by different components of transfused blood. Before rational strategies can be evolved for minimizing the deleterious effects of blood transfusions, it is essential that these mechanisms be clearly defined. Studies must take into account any influence the underlying disease state might have on the immune system. In the absence of any satisfactory substitute, blood transfusion remains an essential therapeutic modality in the management of surgical patients. With current evidence, however, it seems reasonable to avoid the administration of small-volume transfusions whenever possible and encourage the use of autodonated blood for elective surgery. MH - Bacterial Infections/*IMMUNOLOGY ; Blood Cells/TRANSPLANTATION ; *Blood Transfusion ; Graft Survival ; Histocompatibility ; Human ; *Immune Tolerance ; Kidney/*TRANSPLANTATION ; Neoplasms/ IMMUNOLOGY/MORTALITY/*SURGERY ; Review ; Support, Non-U.S. Gov't ; Time Factors ; Tissue Donors SO - Am J Surg 1986 Sep;152(3):329-37 16 UI - 86306076 AU - Pr:ummer O ; Fliedner TM TI - The fetal liver as an alternative stem cell source for hemolymphopoietic reconstitution. AB - In mammalian ontogeny, the liver constitutes the primary hematopoietic organ for some time. Fetal liver cells (FLC) are rich in hematopoietic stem cells with a high proliferative potential but contain few post-thymic T cells. In animal studies, FLC restored hematopoiesis without severe graft-versus-host disease. However, genetic disparity between donor and host frequently limited durable engraftment and prevented or protracted complete immune reconstitution in most fully allogeneic recipients. Some children with severe combined immunodeficiency have been cured by FLC infusion, whereas favorable effects in aplastic anemia, acute leukemia, and inborn errors of metabolism have been limited and badly understood. Fetal liver transplantation in animals may serve as a model for the analysis and management of complications associated with the transfer of purified hematopoietic stem cell grafts and aid in the development of future therapeutic strategies requiring rapidly proliferating stem cell populations. MH - Anemia, Aplastic/THERAPY ; Animal ; Chimera ; Fetus/*CYTOLOGY ; Graft vs Host Disease/ETIOLOGY ; Graft Survival ; Hematopoietic Stem Cells/CYTOLOGY/*TRANSPLANTATION ; Human ; Immunologic Deficiency Syndromes/THERAPY ; Leukemia/THERAPY ; Liver/CYTOLOGY/ *TRANSPLANTATION ; Lymphocyte Depletion ; Lymphocytes/CYTOLOGY/ TRANSPLANTATION ; Review ; Transplantation, Homologous SO - Int J Cell Cloning 1986 Jul;4(4):237-49 17 UI - 86305714 AU - Van Thiel DH ; Gartner LM ; Thorp FK ; Newman SL ; Lindahl JA ; Stoner E ; New MI ; Starzl TE TI - Resolution of the clinical features of tyrosinemia following orthotopic liver transplantation for hepatoma. AB - The clinical history before transplantation and subsequent clinical and biochemical course of 3 children and one adult with hereditary tyrosinemia treated by orthotopic hepatic transplantation is described. All four patients are now free of their previous dietary restrictions and appear to be cured of both their metabolic disease and their hepatic neoplasm. MH - Adult ; Amino Acid Metabolism, Inborn Errors/COMPLICATIONS/ *THERAPY ; Case Report ; Child, Preschool ; Female ; Hepatoma/ COMPLICATIONS/*THERAPY ; Human ; Liver/*TRANSPLANTATION ; Liver Neoplasms/COMPLICATIONS/*THERAPY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Tyrosine/*BLOOD SO - J Hepatol 1986;3(1):42-8 18 UI - 86298233 AU - Sakellariou G ; Memmos D ; Alexopoulos E ; Tsobanelis T ; Sinakos Z ; Papadimitriou M TI - Cancer in renal transplant recipients. AB - The incidence of cutaneous malignancies and non-Hodgkin lymphomas is higher in transplant recipients than in the general population. From 1968 to 1984, 200 kidney grafts were transplanted to 180 patients with end-stage renal disease. All patients were on azathioprine (Aza) and prednisolone. In selected cases ALG and/or small doses of CsA were added. Six patients developed malignant tumors (two Kaposi sarcoma, one squamous cell and one squamous plus basal cell skin cancers, one reticulosarcoma, and one glioma). Mean age of patients was 43 years (range 35-53 years), and mean time of appearance of the tumor after transplantation was 62 months (range 24-98 months). Treatment consisted of reduction of the dosage of Aza, surgical removal or local irradiation of the tumor, and chemotherapy in case of systemic involvement (two cases). Three patients died (one Kaposi sarcoma, one reticulosarcoma, and one glioma) 3 to 6 months after diagnosis, and all three had previously been on high doses of Aza. The remaining three cases (one Kaposi) were cured by stopping or decreasing Aza, by excision, and/or local irradiation of the tumor. It seems that late diagnosis and Aza in high dosage are the main factors leading to the rapid dissemination of the initially localized tumor. MH - Adult ; Female ; Human ; Immunosuppressive Agents/*ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Kidney Failure, Chronic/ SURGERY ; Lymphoma/ETIOLOGY ; Male ; Middle Age ; Neoplasms/ *ETIOLOGY ; Sarcoma, Kaposi's/ETIOLOGY ; Skin Neoplasms/ETIOLOGY SO - Cancer Detect Prev 1986;9(3-4):389-93 19 UI - 86292127 AU - Tjugum J ; Jonassen F ; Olsson JH TI - Vaginitis emphysematosa in a renal transplant patient. AB - Transplant surgery is now a widely established practice and the associated immunosuppressive treatment is followed by various complications. The present report on vaginitis emphysematosa in a woman with renal transplantation indicates that even this benign condition may have a connection with immunosuppressive therapy. MH - Adrenal Cortex Hormones/ADVERSE EFFECTS ; Adult ; Case Report ; Cyclosporins/ADVERSE EFFECTS ; Cysts/ETIOLOGY/PATHOLOGY ; Female ; Human ; Immunosuppressive Agents/*ADVERSE EFFECTS ; Kidney/ *TRANSPLANTATION ; Mucous Membrane/PATHOLOGY ; Vaginitis/ *ETIOLOGY/PATHOLOGY SO - Acta Obstet Gynecol Scand 1986;65(4):377-8 20 UI - 86291125 AU - Fujii H ; Kotani M TI - Promoting effect of estrogen on regeneration of the liver transplanted to an ectopic site in mice. AB - A single oral administration of a pharmacological dose of estriol (E3) immediately after transplantation of small liver fragments of mice under the kidney capsule induced a remarkable growth of regenerating liver tissue. The hepatocytes were successfully arranged in cords with well developed sinusoids between them. The cytoplasm of the hepatocytes showed prominent basophilia. In mice injected with carbon intravenously, large numbers of carbon-laden endothelial lining cells and Kupffer cells appeared in the newly building sinusoids. E3 raised the mitotic activity of the regenerating hepatocytes markedly and for a long period. The act of E3 on mitosis was much more effective on the regenerating hepatocytes than on the recipient's own hepatocytes. MH - Animal ; Choristoma/*PATHOLOGY ; Estriol/*PHARMACODYNAMICS ; Female ; Kidney Neoplasms/*PATHOLOGY ; Liver/PATHOLOGY/ *TRANSPLANTATION ; Liver Regeneration/*DRUG EFFECTS ; Mice ; Mice, Inbred C57BL ; Mitotic Index ; Support, Non-U.S. Gov't SO - Virchows Arch [A] 1986;409(4):453-60 21 UI - 86285918 AU - Halpert R ; Fruchter RG ; Sedlis A ; Butt K ; Boyce JG ; Sillman FH TI - Human papillomavirus and lower genital neoplasia in renal transplant patients. AB - Lower genital cytopathology was evaluated in 105 immunosuppressed renal transplant recipients. Evidence of human papillomavirus infection was found in 17.5% and of lower genital neoplasia in 9.5%. The rate of the virus infection in the immunosuppressed was nine times greater than in a general population and 17 times greater than in a matched immunocompetent population. The rate of cervical neoplasia was 16 times greater than in a general population and nine times greater than in a matched immunocompetent population. In one-third of patients with human papillomavirus lesions and one-half of patients with neoplastic lesions, multiple lower genital sites were also involved. Of risk factors evaluated, only the number of sexual partners was associated with the development of human papillomavirus/lower genital neoplasia. MH - Adult ; Cervix Neoplasms/ETIOLOGY/OCCURRENCE ; Comparative Study ; Female ; Genital Neoplasms, Female/*ETIOLOGY/OCCURRENCE ; Human ; Immunosuppression/*ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Papillomaviruses/ISOLATION & PURIFICATION ; Risk ; Sex Behavior ; Tumor Virus Infections/*ETIOLOGY/OCCURRENCE ; Vaginal Neoplasms/ ETIOLOGY/OCCURRENCE ; Vaginal Smears ; Vulvar Neoplasms/ETIOLOGY/ OCCURRENCE SO - Obstet Gynecol 1986 Aug;68(2):251-8 22 UI - 86272780 AU - MacLean AB ; Lynn KL ; Bailey RR ; Swainson CP ; Walker RJ TI - Colposcopic assessment of the lower genital tract in female renal transplant recipients. AB - The incidence of epithelial or cutaneous abnormality of the lower genital tract was studied colposcopically in 31 women aged 35 (SD9) years on renal replacement therapy for one to 184 months (mean 73 months). Twenty-four women had a renal transplant and had received immunosuppressive therapy for two to 173 months (mean 61 months). Seven women (two with failed transplants) were on home hemodialysis (one to 48 months, mean 19 months) awaiting transplantation. In 22 women (17 transplant and 5 dialysis patients) no abnormality was found. One hemodialysis patient had an extensive area of vulval intra-epithelial neoplasia. Five transplant recipients had evidence of genital papilloma virus (HPV) infection. No patient had cervical intra-epithelial neoplasia or invasive genital tract malignancy. The high incidence of HPV-associated lesions in this group, and the increasing evidence that HPV changes may predispose to cervical neoplasia suggest that this high risk group require regular gynecological assessment. MH - Adult ; Cervix Neoplasms/DIAGNOSIS/ETIOLOGY ; *Colposcopy ; Female ; Genital Neoplasms, Female/*DIAGNOSIS/ETIOLOGY ; Hemodialysis, Home ; Human ; Immunosuppression/ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Kidney Failure, Chronic/SURGERY/THERAPY ; Papillomaviruses ; Precancerous Conditions/DIAGNOSIS ; Tumor Virus Infections/DIAGNOSIS/ETIOLOGY ; Vaginal Neoplasms/DIAGNOSIS/ ETIOLOGY ; Vulvar Neoplasms/DIAGNOSIS/ETIOLOGY SO - Clin Nephrol 1986 Jul;26(1):45-7 23 UI - 86271512 AU - Penn I TI - Cancers of the anogenital region in renal transplant recipients. Analysis of 65 cases. AB - There is a 100-fold increase in the incidence of carcinomas of the vulva and anus in renal transplant recipients compared with the general population. Anogenital (anus, perianal skin, and external genitalia of both sexes) carcinomas occurred in 65 of 2150 renal transplant recipients who presented with 2298 different types of malignancy. Two-thirds of the patients were female and one-third male. They were much younger than persons with similar tumors in the general population. The average age of the females at the time of diagnosis was 37 years (range, 20-64) and of the males, 45 years (range, 34-62). The neoplasms occurred late after transplantation, an average of 88 months (range, 9-215), compared with an average of 56 months (range, 1-225.5) for all other post-transplant malignancies. The lesions involved the vulva, penis, scrotum, anus, or perianal area. Two patients also had involvement of the urethral meatus. In several female patients, there was a "field effect: with multiple tumors of the squamous epithelium of the anogenital area, vagina, or uterine cervix. Lesions ranged from in situ carcinomas (in one-third of the cases) to those with invasion of adjacent organs and lymph node metastases. Treatment varied from local excisions to radical vulvectomy, abdominoperineal resection, or penile resection, sometimes combined with excision of the inguinal lymph nodes. In several patients, there was a previous history either of condyloma acuminatum or herpes genitalis, suggesting a possible viral etiology of these tumors. MH - Adult ; Age Factors ; Anus Neoplasms/MORTALITY/*OCCURRENCE ; Carcinoma in Situ/OCCURRENCE ; Carcinoma, Squamous Cell/MORTALITY/ *OCCURRENCE ; Female ; Genital Neoplasms, Female/MORTALITY/ *OCCURRENCE ; Genital Neoplasms, Male/MORTALITY/*OCCURRENCE ; Human ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Neoplasms, Multiple Primary/OCCURRENCE ; Sex Factors ; Support, U.S. Gov't, Non-P.H.S. SO - Cancer 1986 Aug 1;58(3):611-6 24 UI - 86267988 AU - Gassenmaier A ; Fuchs P ; Schell H ; Pfister H TI - Papillomavirus DNA in warts of immunosuppressed renal allograft recipients. AB - Renal allograft recipients were shown to have an increased incidence of warts and skin cancers. We examined 148 patients for evidence of wart virus infections and tested for papillomavirus types, which are known to be associated with human malignancies. Of the 148, 36 (24.3%) patients were afflicted with warts at the end of our study period, in contrast to 5 of 148 (3.3%) before transplantation. DNA from 16 different biopsies was extracted by phenol treatment for further virological studies. DNA of human papillomavirus (HPV) 2 was detected three times, DNA of HPV 4 and 10 twice, and DNA of HPV 3 and 16 once each by blot hybridization. One probe led to strong signals with HPV types previously found only in epidermodysplasia verruciformis patients. A correlation between histology and virus type existed in cases of HPV 2, 3, 4, and 10 infections. MH - Adolescence ; Adult ; Child ; DNA, Viral/*ISOLATION & PURIFICATION ; Female ; Human ; Immunosuppression/ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Papillomaviruses/ *ISOLATION & PURIFICATION ; Skin Neoplasms/ETIOLOGY/MICROBIOLOGY ; Support, Non-U.S. Gov't ; Warts/ETIOLOGY/*MICROBIOLOGY SO - Arch Dermatol Res 1986;278(3):219-23 25 UI - 86263066 AU - Stuck KJ ; Jafri SZ ; Adler DD ; Campbell DA ; Dafoe DC ; Silver TM TI - Ultrasound evaluation of uncommon renal transplant complications. AB - Twenty-five patients who had undergone renal transplants developed uncommon complications that were detected and followed serially with sonography. Two patients developed renal calculi, which produced hydronephrosis in both instances. Other uncommon causes of postoperative hydronephrosis occurred in 5 cases; the causes included ureteral necrosis, ureteral stricture, and a renocutaneous fistula. Eight cases of renal infarction, manifesting 3 different sonographic appearances, were encountered. The presence and disappearance of postoperative gas in the collecting system were documented in 3 patients. The other unusual abnormalities detected involving the transplanted kidney include tuberculosis, pyonephrosis, 3 solitary cysts, a corpus lutem cyst simulating a perinephric fluid collection, and massive urinary ascites. MH - Adolescence ; Adult ; Ascites/ETIOLOGY ; Child ; Child, Preschool ; Cysts/ETIOLOGY ; Female ; Human ; Hydronephrosis/ETIOLOGY ; Kidney/PATHOLOGY/*TRANSPLANTATION ; Kidney Diseases/ETIOLOGY ; Male ; Middle Age ; *Postoperative Complications ; Pyelonephritis/ ETIOLOGY ; Tuberculosis, Renal/ETIOLOGY ; *Ultrasonic Diagnosis SO - Urol Radiol 1986;8(1):6-12 26 UI - 86263051 AU - LiPuma JP ; Bryan PJ ; Butler HE ; Resnick MI TI - Magnetic resonance imaging of the genitourinary tract. AB - MRI is in its infancy as a clinical imaging tool. It is undergoing intensive investigation in various areas of the body. Evaluation of the brain and spine is superb, and in some areas of the brain, like the posterior fossa, it is thought to be superior to CT. Evolving indications for body scanning include staging of pelvic malignancies, evaluation of liver malignancy, evaluation and staging of musculoskeletal problems, and, to a lesser degree, staging of renal malignancies and evaluation of vascular disease. The main problem in body imaging stems from image degradation because of respiratory motion that is transmitted to upper abdominal organs. Respiratory gating of image acquisition or utilization of short heavily T1-weighted pulse sequences will likely overcome this problem in due time. Minimizing motion artifact will make MR images comparable to, if not better than, CT images with regard to transverse anatomic display, and MR images have the added advantage of multiplanar scanning, which can be done directly, without need of additional computer reconstruction time and without having to move the patient. The second major problem in MRI is the lack of understanding of equipment potential. Unlike conventional radiography and CT, in which the behavior of the X-ray beam is understood with regard to image formation, in MRI new parameters are used to generate images. As stated earlier, MR signal intensity is due to hydrogen concentration, T1 and T2 relaxation times of the tissue, and flow of protons through the imaged volume. How these factors are weighted depends on pulse sequence selection, and thus image contrast and information content of the scans change. On the surface, these images display anatomic information as do other imaging modalities, but manipulation of pulse sequences may ultimately lead to the ability to demonstrate physiologic and chemical parameters previously unavailable in imaging. Current research is geared to help extract this data by testing new pulse sequences, using different types of receiver RF coils, and using MR-specific contrast materials. Minor MRI problems such as long scan times are being dealt with to decrease time to an acceptable length. The nonvisualization of soft tissue calcifications will probably remain a problem that may have to be weighed against other known advantages. At this time further research and clinical experience are the key to what is needed in MRI, to gain further knowledge with regard to imaging physiologic phenomena, such as flow and spectroscopy, and possibly to monitor the chemical basis of disease.(ABSTRACT TRUNCATED AT 400 WORDS) MH - Bladder Diseases/DIAGNOSIS ; Calcinosis/DIAGNOSIS ; Female ; Graft Rejection ; Human ; Inflammation/DIAGNOSIS ; Kidney/ TRANSPLANTATION ; Kidney Calculi/DIAGNOSIS ; Kidney Cortex/ PATHOLOGY ; Kidney Diseases/DIAGNOSIS ; Kidney Medulla/PATHOLOGY ; Kidney Neoplasms/DIAGNOSIS ; Leiomyoma/DIAGNOSIS ; Male ; Nuclear Magnetic Resonance/*DIAGNOSTIC USE/METHODS ; Ovarian Diseases/DIAGNOSIS ; Prostatic Diseases/DIAGNOSIS ; Seminal Vesicles/ANATOMY & HISTOLOGY ; Urogenital System/*ANATOMY & HISTOLOGY/PATHOLOGY ; Uterine Neoplasms/DIAGNOSIS SO - Urol Clin North Am 1986 Aug;13(3):531-50 27 UI - 86252116 AU - Clements D ; Hubscher S ; West R ; Elias E ; McMaster P TI - Epithelioid haemangioendothelioma. A case report. AB - Epithelioid haemangioendothelioma of the liver is an extremely rare tumour which has only recently been recognised. This report describes the clinical, radiological and histological findings in a case of a primary epithelioid haemangioendothelioma of the liver. The case highlights some of the difficulties in establishing the diagnosis, and in its differentiation from Budd-Chiari syndrome and veno-occlusive disease. The patient has subsequently undergone successful orthotopic hepatic transplantation. MH - Case Report ; Diagnosis, Differential ; Female ; Hemangioendothelioma/*PATHOLOGY/RADIOGRAPHY/THERAPY ; Human ; Liver/TRANSPLANTATION ; Liver Neoplasms/*PATHOLOGY/RADIOGRAPHY/ THERAPY ; Middle Age SO - J Hepatol 1986;2(3):441-9 28 UI - 86247667 AU - Terrier F ; Hricak H ; Justich E ; Dooms GC ; Grodd W TI - The diagnostic value of renal cortex-to-medulla contrast on magnetic resonance images. AB - The diagnostic value of magnetic resonance contrast between the renal cortex and renal medulla as an indicator of renal disease was retrospectively studied in 38 patients (ten patients with a variety of diseases affecting the renal parenchyma, nine with renal obstruction, four with diffusely infiltrating renal-cell carcinoma, one with renal hematoma, nine with normally functioning renal allograft, and five with renal allograft failure). Twelve normal volunteers served as controls. On spin-echo (SE) images (TR 0.5 sec, TE 28 msec), the cortex-to-medulla contrast was present in the kidneys of all the normal volunteers (19% contrast +/- 2% S.D.) and in all the normally functioning allografts (17% contrast +/- 2% S.D.). Decrease or absence of cortex-to-medulla contrast (SE image with TR 0.5 sec and TE 28 msec) was found to be a sensitive but nonspecific sign of renal disease. It occurred in renal diseases of various causes and was produced by different pathophysiologic mechanisms such as edema, scarring, and tissue replacement by neoplasm or hematoma. Of the calculated T1 and T2 relaxation times and spin density of the cortex and the medulla, the T1 changes most consistently reflected renal disease. MH - Adolescence ; Adult ; Aged ; Carcinoma, Renal Cell/DIAGNOSIS ; Child ; Child, Preschool ; Female ; Graft Rejection ; Human ; Hydronephrosis/DIAGNOSIS ; Infant ; Kidney/TRANSPLANTATION ; *Kidney Cortex ; Kidney Diseases/*DIAGNOSIS ; Kidney Failure, Chronic/DIAGNOSIS ; *Kidney Medulla ; Kidney Neoplasms/DIAGNOSIS ; Male ; Middle Age ; Nephrotic Syndrome/DIAGNOSIS ; Nuclear Magnetic Resonance/*DIAGNOSTIC USE ; Support, Non-U.S. Gov't ; Ureteral Obstruction/DIAGNOSIS ; Wegener's Granulomatosis/ DIAGNOSIS SO - Eur J Radiol 1986 May;6(2):121-6 29 UI - 86244855 AU - Hueb WA ; Oliveira SA ; Bittencourt D ; Bellotti G ; Jatene AD ; Pileggi F TI - Coronary bypass surgery for patients with renal transplantation. AB - CABG was performed in a patient with severe angina pectoris who had previous successful renal transplantation. Renal function, blood biochemistry and lymphocytes T and B did not show significant changes in the postoperative period. No postoperative complications were observed. The use of immunosuppressive drugs did not add risk of infection. One year after the procedure the patient is asymptomatic. MH - Case Report ; Female ; Human ; Immunosuppressive Agents/ THERAPEUTIC USE ; Kidney/*TRANSPLANTATION ; Kidney, Polycystic/ *SURGERY ; Middle Age ; *Myocardial Revascularization SO - Cardiology 1986;73(3):151-5 30 UI - 86244707 AU - Osiason AW ; Polackwich RJ TI - Curative, platinum-based cytoxic drug therapy in a renal transplant recipient with metastatic testicular cancer. AB - Since June 1979, the authors have had the opportunity to treat a renal homograph recipient who developed primary embryonal cell testicular carcinoma with retroperitoneal and pulmonary metastases. This patient was treated with an induction chemotherapy protocol of vinblastine sulfate, bleomycin, and cisplatin and has remained free of disease through June 1985, without loss of his renal homograph. Cisplatin-based cytoxic drug therapy can be delivered safely to a renal transplant recipient without causing kidney damage, and, in this case, achieved a cure of metastatic testicular cancer. MH - Adult ; Antineoplastic Agents, Combined/*THERAPEUTIC USE ; Bleomycins/ADMINISTRATION & DOSAGE ; Case Report ; Cisplatin/ ADMINISTRATION & DOSAGE ; Follow-Up Studies ; Human ; Immunosuppressive Agents/THERAPEUTIC USE ; Kidney/ *TRANSPLANTATION ; Lung Neoplasms/SECONDARY ; Male ; Retroperitoneal Neoplasms/SECONDARY ; Teratoma/*DRUG THERAPY/ PATHOLOGY ; Testicular Neoplasms/*DRUG THERAPY/PATHOLOGY ; Vinblastine/ADMINISTRATION & DOSAGE SO - Cancer 1986 Aug 15;58(4):850-1 31 UI - 86236892 AU - Chapman JR ; Taylor HM ; Thompson JF ; Wood RF ; Morris PJ TI - The problems associated with conversion from azathioprine and prednisolone to cyclosporine. AB - Azathioprine and prednisolone may lead to intolerable long-term side effects in some patients with a renal allograft. We have converted 9 patients with stable grafts but severe side effects from conventional immunosuppression to cyclosporine alone. While the steroid side effects largely resolved and there were no problems with acute rejection associated with conversion, the long-term follow up of these patients has demonstrated a number of problems. The average follow-up period since conversion is now 2 years: 2 patients have died, 2 grafts have been lost, and 1 patient required conversion to azathioprine. Chronic nephrotoxicity, gout, indomethacin-induced acute oliguria, and squamous cell carcinomas were the most troublesome effects seen. The disadvantages of conversion outweigh the advantages in most of the patients that we converted. MH - Adult ; Alkaline Phosphatase/BLOOD ; Azathioprine/ADVERSE EFFECTS/ *THERAPEUTIC USE ; Carcinoma, Squamous Cell/ETIOLOGY ; Creatinine/ BLOOD ; Cyclosporins/ADVERSE EFFECTS/*THERAPEUTIC USE ; Female ; Follow-Up Studies ; Human ; Kidney/PATHOLOGY/*TRANSPLANTATION ; Male ; Middle Age ; Prednisolone/ADVERSE EFFECTS/*THERAPEUTIC USE ; Skin Diseases/ETIOLOGY ; Skin Neoplasms/ETIOLOGY ; Support, Non-U.S. Gov't SO - Uremia Invest 1985-86;9(1):19-25 32 UI - 86236675 AU - Hefty TR ; Barry JM TI - Renal transplantation in Saudi Arabia. AB - One-year actuarial patient and graft survivals of 98% and 95% were obtained. Donor-specific transfusions were widely used in both the living-related donor kidney recipients as well as recipients of kidneys from distantly and unrelated individuals. The underlying health problems that are still endemic to this region will probably be reflected to a greater extent in longer term follow-up. MH - Adolescence ; Adult ; Child ; Female ; Graft Survival ; Hepatitis B/COMPLICATIONS ; Human ; Immunosuppression/ADVERSE EFFECTS ; Kidney/*TRANSPLANTATION ; Kidney Diseases/MORTALITY/SURGERY ; Male ; Middle Age ; Postoperative Complications/ETIOLOGY ; Sarcoma, Kaposi's/ETIOLOGY ; Saudi Arabia ; Schistosomiasis/ COMPLICATIONS ; Tuberculosis/COMPLICATIONS SO - Transplant Proc 1986 Jun;18(3 Suppl 2):10-2 33 UI - 86235949 AU - Gordon RD ; Shaw BW Jr ; Iwatsuki S ; Esquivel CO ; Starzl TE TI - Indications for liver transplantation in the cyclosporine era. AB - One hundred seventy orthotopic liver transplants were performed under conventional immunosuppression with azathioprine and steroids with 1- and 5-year survivals of 32.9 per cent and 20.0 per cent, respectively. Since the introduction of cyclosporine-prednisone therapy in March 1980, 313 primary orthotopic liver transplants have been performed. Actuarial survivals at 1 and 5 years have improved to 69.7 per cent and 62.8 per cent, respectively. Biliary atresia is now the most common indication for liver replacement. In adults, primary biliary cirrhosis and sclerosing cholangitis have become more common indications for transplantation, and alcoholic cirrhosis and primary liver malignancy as indications have declined. Early enthusiasm for liver transplantation in patients with hepatic cancer has been tempered by the finding that recurrence is both common and rapid. An increasing number of patients with inborn errors of metabolism originating in the liver are receiving transplants, including patients with Wilson's disease, tyrosinemia, alpha-1-antitrypsin deficiency, glycogen storage disease, familial hypercholesterolemia, and hemochromatosis. Survival in this group of patients has been excellent (74.4 per cent at 1 and 5 years). A hemophiliac who received a transplant for postnecrotic cirrhosis has survived and may have been cured of his hemophilia. About 20 per cent of patients require retransplantation for rejection, technical failure, or primary graft failure. Only four of the patients receiving retransplants under conventional immunosuppression survived beyond 6 months, and all died within 14 months of retransplantation. Sixty-eight patients have received retransplants under cyclosporine-prednisone. Thirty-one patients are surviving, all for at least 1 year. Six of the twelve patients requiring a third transplant are alive 2 to 3 years after the primary operation. An aggressive approach to retransplantation in the patient with a failed graft is justified. MH - Adult ; Biliary Tract Diseases/THERAPY ; Child ; Cholangitis/ THERAPY ; Cyclosporins/*THERAPEUTIC USE ; Follow-Up Studies ; Human ; Liver/*TRANSPLANTATION ; Liver Cirrhosis/THERAPY ; Liver Cirrhosis, Biliary/THERAPY ; Liver Neoplasms/SURGERY ; Metabolism, Inborn Errors/THERAPY ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. SO - Surg Clin North Am 1986 Jun;66(3):541-56 34 UI - 86235510 AU - Dienstag JL ; Alter HJ TI - Non-A, non-B hepatitis: evolving epidemiologic and clinical perspective. AB - Evidence for the existence of human hepatitis agents besides HAV and HBV is compelling. Transmitted predominantly by transfusion and percutaneous inoculation, the type of NANB hepatitis encountered most frequently is epidemiologically similar to type B hepatitis. NANB hepatitis accounts for more than 90% of TAH, but can be transmitted by nonpercutaneous routes as well. Approximately 15 to 30% of sporadic hepatitis cases are attributable by serologic exclusion to NANB hepatitis agents, and, in addition, there is an epidemic form of NANB hepatitis that resembles hepatitis A epidemiologically in its transmission by the enteric route. Clinical features of the predominantly percutaneously transmitted forms of NANB hepatitis are similar to those of hepatitis B, but tend to be less severe during acute illness, on the one hand, but to lead more frequently to chronic hepatitis, on the other; 40 to 60% of patients with TAH have chronic elevations of aminotransferase activity, often in an episodic, fluctuating pattern. CAH can be identified histologically in a majority of patients with chronic NANB TAH. Despite a relatively quiescent course, progression of such chronic cases may be quite insidious; cirrhosis occurs in 10 to 20% of patients with chronic hepatitis after acute TAH. The frequency of chronic liver disease after nonpercutaneously acquired sporadic NANB hepatitis tends to be lower, on the order of 10% or less, and chronic hepatitis has not been recorded after the epidemic type of NANB hepatitis. Evidence supports the existence of an asymptomatic chronic NANB hepatitis carrier state that is several-fold more frequent than the chronic HBV carrier state. Neither viruses nor virus markers have been described that fulfill accepted criteria reproducibly for a specific causal association with NANB hepatitis; on the other hand, evidence suggests (but does not prove) the existence of two different blood-borne NANB hepatitis agents and, in addition, an enterically transmitted NANB hepatitis agent. Effective therapy for and immunoprophylaxis against NANB hepatitis are lacking. Until specific screening tests are developed, interim screening based on indirect, nonvirus-specific tests may be the only practical approach to minimizing the frequency of NANB hepatitis after transfusion. Identification of virus-specific serologic markers remains a high priority. MH - Biological Products/ADVERSE EFFECTS ; Blood Transfusion/ADVERSE EFFECTS ; Cross Infection/TRANSMISSION ; Female ; Hemodialysis/ ADVERSE EFFECTS ; Hemophilia/COMPLICATIONS ; Hepatitis, Chronic Active/ETIOLOGY ; Hepatitis, Viral, Human/*OCCURRENCE ; Hepatitis, Viral, Non-A, Non-B/MICROBIOLOGY/*OCCURRENCE/ TRANSMISSION ; Hepatoma/ETIOLOGY ; Human ; Kidney/TRANSPLANTATION ; Liver Neoplasms/ETIOLOGY ; Male ; Maternal-Fetal Exchange ; Occupational Diseases/TRANSMISSION ; Pregnancy ; Review ; Substance Abuse/COMPLICATIONS SO - Semin Liver Dis 1986 Feb;6(1):67-81 35 UI - 86218970 AU - te Strake L ; van Persijn van Meerten EL ; Trimbos JB ; Paul LC ; Langeveld JW ; Bloem JL ; Bluemm RG ; Doornbos J TI - Magnetic resonance imaging of the genitourinary tract. AB - This is an overview of the current applications of magnetic resonance imaging (MRI) in the genitourinary tract based on the experience with the 0.5-Tesla MR scanner (Gyroscan, Philips) at the Leiden University Hospital and on reports in the literature. MRI appears to share some of the limitations of CT. MRI cannot reliably differentiate between a malignant and a benign tumor. In the staging of ovarian malignancies by means of MRI, bowel preparation would be desirable. On the other hand, the soft-tissue contrast resolution of MRI is superior to that of CT and images can be obtained in any plane. Thus MRI promises to be an accurate method for staging malignancies. The results in the examination of transplant kidneys are encouraging. We expect that there will be a place for MRI as a complementary technique to ultrasonography in the diagnosis of scrotal disease. MH - Bladder Neoplasms/DIAGNOSIS ; Female ; Genital Diseases, Female/ *DIAGNOSIS ; Genital Diseases, Male/*DIAGNOSIS ; Human ; Kidney/ TRANSPLANTATION ; Kidney Diseases/DIAGNOSIS ; Kidney Neoplasms/ DIAGNOSIS ; Male ; Neoplasm Staging ; Nuclear Magnetic Resonance/ DIAGNOSTIC USE ; Ovarian Neoplasms/DIAGNOSIS ; Prostatic Hypertrophy/DIAGNOSIS ; Prostatic Neoplasms/DIAGNOSIS ; Scrotum/ PATHOLOGY ; Urologic Diseases/*DIAGNOSIS SO - Diagn Imag Clin Med 1986;55(1-2):77-83 36 UI - 86213848 AU - Bennett WM ; Norman DJ TI - Action and toxicity of cyclosporine. AB - Cyclosporine is a potent new immunosuppressive agent that has proven particularly useful in organ transplantation. The unique action of the drug on T-cell immunity without myelosuppression is summarized. Cyclosporine pharmacology and adverse reactions, particularly nephrotoxicity, are reviewed in this paper. MH - Blood Coagulation Disorders/CHEMICALLY INDUCED ; Cyclosporins/ ADVERSE EFFECTS/BLOOD/METABOLISM/*PHARMACODYNAMICS ; Gingival Hyperplasia/CHEMICALLY INDUCED ; Graft Rejection ; Heart/ TRANSPLANTATION ; Helper Cells/DRUG EFFECTS ; Hirsutism/ CHEMICALLY INDUCED ; Human ; Kidney/DRUG EFFECTS/TRANSPLANTATION ; Kidney Diseases/CHEMICALLY INDUCED ; Kidney Failure, Acute/ CHEMICALLY INDUCED ; Liver/DRUG EFFECTS ; Lymphoma/CHEMICALLY INDUCED ; Nervous System/DRUG EFFECTS ; Review ; Suppressor Cells/ DRUG EFFECTS ; T Lymphocytes/DRUG EFFECTS SO - Annu Rev Med 1986;37:215-24 37 UI - 86198043 AU - Ljungman P ; L:onnqvist B ; Gahrton G ; Ringd:en O ; Sundqvist VA ; Wahren B TI - Clinical and subclinical reactivations of varicella-zoster virus in immunocompromised patients. AB - The frequencies of reactivated disease due to varicella-zoster virus (VZV) in immunocompromised patients were determined by enzyme-linked immunosorbent assay for antibody and also by the lymphocyte proliferation response to VZV antigen. Subclinical reactivations were as common as classical herpes zoster in all patient groups. Among bone marrow transplant (BMT) recipients, 36% developed herpes zoster and 26%, a subclinical reactivation. The corresponding frequencies for patients with leukemia during induction therapy were 5% and 10%; in renal transplant recipients, 0% and 26%; and in patients with seminoma, 0% and 6%, respectively. Subclinical reactivation of VZV thus appears to be a common finding in severely immunocompromised patients. A regained lymphocyte proliferation response to VZV antigen is a sensitive indicator of subclinical reactivation of VZV in BMT recipients. None of 19 BMT recipients with subclinical disease due to VZV later developed clinical reactivation of VZV. Acyclovir given as prophylaxis against infection with herpes simplex virus reduced the number of clinical and subclinical reactivations of VZV during treatment in BMT recipients, but not thereafter. MH - Acyclovir/THERAPEUTIC USE ; Antibodies, Viral/ANALYSIS ; Antigens, Viral/IMMUNOLOGY ; Bone Marrow/TRANSPLANTATION ; Chickenpox/*ETIOLOGY/IMMUNOLOGY ; Dysgerminoma/COMPLICATIONS ; Graft vs Host Disease/COMPLICATIONS ; Herpes Zoster/*ETIOLOGY/ IMMUNOLOGY ; Human ; IgG/ANALYSIS ; *Immune Tolerance ; Kidney/ TRANSPLANTATION ; Leukemia/COMPLICATIONS/THERAPY ; Lymphocyte Transformation ; Male ; Recurrence ; Testicular Neoplasms/ COMPLICATIONS ; Varicella-Zoster Virus/IMMUNOLOGY SO - J Infect Dis 1986 May;153(5):840-7 38 UI - 86185835 AU - Chagnac A ; Zevin D ; Weinstein T ; Hirsh J ; Levi J TI - Combined tubular dysfunction in medullary cystic disease. AB - A patient with medullary cystic disease presented with a combined tubular dysfunction, including severe salt wasting, renal tubular acidosis types I and IV, and marked aldosterone resistance. High-dose mineralocorticoid treatment partially corrected the defect in potassium excretion and did not affect natriuresis. Plasma aldosterone level was more than 30 times the upper normal level and was decreased but not normalized by captopril administration and volume expansion. The severe hemodynamic and metabolic consequences of these defects were corrected by renal transplantation. MH - Acidosis, Renal Tubular/*COMPLICATIONS/PHYSIOPATHOLOGY/THERAPY ; Adult ; Aldosterone/BLOOD ; Case Report ; Fludrocortisone/ THERAPEUTIC USE ; Human ; Kidney/TRANSPLANTATION ; Kidney Medulla/ *PATHOLOGY ; Kidney, Cystic/*COMPLICATIONS/PHYSIOPATHOLOGY/ THERAPY ; Male ; Potassium/BLOOD/URINE ; Renin/BLOOD ; Sodium/ BLOOD/URINE SO - Arch Intern Med 1986 May;146(5):1007-9 39 UI - 86185291 AU - Schneiderman H ; Hager WD ; Gondos B TI - The endomyocardial biopsy. AB - Endomyocardial biopsy (EMB) provides a safe, simple method of gathering unique information. Although the role of EMB continues to evolve rapidly, present consensus includes the following indications, based on the ability of EMB to provide diagnoses unobtainable by other means: assessment of early rejection following cardiac transplantation; determination of myocarditis as etiology of clinically obscure cardiac dysfunction; quantification of chemotherapeutic (especially anthracycline) cardiotoxicity; and distinction between constrictive and restrictive heart disease. Each of these indications carries major therapeutic as well as prognostic implications. Methods of processing EMB are presented, complications listed, artifacts described, findings and uses illustrated, and suggestions for future development addressed briefly. MH - Antibiotics, Antineoplastic/TOXICITY ; Biopsy ; Endocardium/ *PATHOLOGY ; Fluorescent Antibody Technic ; Heart/DRUG EFFECTS/ TRANSPLANTATION ; Heart Diseases/*PATHOLOGY ; Heart Failure, Congestive/PATHOLOGY ; Human ; Immunoenzyme Technics ; Myocarditis/PATHOLOGY ; Myocardium/PATHOLOGY ; Naphthacenes/ TOXICITY ; Neoplasms/DRUG THERAPY SO - Ann Clin Lab Sci 1986 Mar-Apr;16(2):134-45 40 UI - 86184350 AU - Soreide O ; Czerniak A ; Bradpiece H ; Bloom S ; Blumgart L TI - Characteristics of fibrolamellar hepatocellular carcinoma. A study of nine cases and a review of the literature. AB - Clinical and laboratory data for nine patients with hepatocellular fibrolamellar carcinoma treated at our institution have been summarized with emphasis on the relevance of plasma neurotensin levels as a tumor marker. The mean age of the patients was 22 years. Seven underwent hepatic resection, and two of these had later surgical removal of recurrent disease. Plasma neurotensin levels were initially elevated in five of the seven patients in whom it was measured. Neurotensin levels were within normal limits in three of four patients with recurrent disease, but were elevated in one patient who also had elevated plasma neurotensin levels preoperatively. In addition, a review of 80 patients reported since 1980 was performed. The mean age of these patients was 23 years, and only 6 percent were older than 50. The male to female ratio was 3:4. Eight percent were positive for hepatitis B antigen and 11 percent had elevated alpha-fetoprotein levels. Four percent had cirrhosis of the liver. The resectability rate was 58 percent. Five year survival for patients who underwent hepatic resection was 56 percent. Patients treated nonsurgically had a median survival of 13 months, and none of these patients lived for 5 years. Fibrolamellar hepatoma seems to be a distinct clinical entity that mainly occurs in young patients. The prognosis in patients treated with a curative resection is good. Plasma neurotensin levels may be of value as a tumor marker, but further studies are necessary to substantiate this theory. MH - Adolescence ; Adult ; Female ; Follow-Up Studies ; Hepatoma/BLOOD/ *PATHOLOGY/SURGERY ; Human ; Liver/TRANSPLANTATION ; Liver Neoplasms/BLOOD/*PATHOLOGY/SURGERY ; Lymphatic Metastasis ; Male ; Neoplasm Recurrence, Local/BLOOD ; Neurotensin/BLOOD ; Palliative Treatment ; Prognosis SO - Am J Surg 1986 Apr;151(4):518-23 41 UI - 86184000 AU - Rao NA ; Dunn SA ; Romero JL ; Stout W TI - Bilateral carcinomas of the eyelid. AB - A 41-year-old man receiving long-term immunosuppressive therapy after renal transplantation developed progressive ulcerative lesions involving both lower eyelids. The lesions began as crusting and exfoliating masses and developed over a one-year period. A biopsy demonstrated that the lesions were invasive squamous cell carcinomas. MH - Adult ; Carcinoma, Squamous Cell/*ETIOLOGY/PATHOLOGY ; Case Report ; Eyelid Neoplasms/*ETIOLOGY/PATHOLOGY ; Human ; Immunosuppression/ADVERSE EFFECTS ; Kidney/TRANSPLANTATION ; Male SO - Am J Ophthalmol 1986 Apr 15;101(4):480-2 42 UI - 86181036 AU - Penn I ; First MR TI - Development and incidence of cancer following cyclosporine therapy. AB - Eighty-seven organ transplant recipients developed 88 tumors after immunosuppression with CsA. The neoplasms showed important differences from those seen following conventional immunosuppressive therapy (CIT). Malignancies appeared an average of 14 months (range, 1 to 82) after CsA and 59 months (range, 1.0 to 225.5) after CIT. Cancers were particularly common among recipients of extrarenal organs. NHLs were the most common neoplasms comprising 52%, compared with 12% in CIT patients. They appeared an average of 8.5 months after transplantation, compared with an average of 41 months after CIT. Unlike NHLs in CIT patients, they more often involved lymph nodes, were more widespread, more frequently involved the small intestine, rarely involved the brain, were more likely to regress, and had a better prognosis following reduction of immunosuppressive therapy. Skin cancers (13% of cancers) were less common than in CIT patients (40%). Kaposi's sarcomas were more common (10% v 3%). Some tumors commonly seen after CIT, including in situ uterine cervical carcinomas and carcinomas of the vulva/perineum, have not occurred in CsA patients. In this small series, there was a surprising frequency of endocrine-related malignancies (ovarian, testicular, breast, and thyroid) and renal cell carcinomas. Longer follow-up and study of larger numbers of patients will determine whether differences from CIT patients will persist. Only seven (8%) patients were treated only with CsA, the remainder received other immunosuppressive agents, mainly prednisone. The malignancies probably are not specific to CsA therapy but appear to be a complication of immunosuppression per se. MH - Adult ; Carcinoma, Squamous Cell/CHEMICALLY INDUCED ; Cyclosporins/*ADVERSE EFFECTS ; Female ; Human ; Immunosuppressive Agents/ADVERSE EFFECTS ; Kidney/TRANSPLANTATION ; Lymphoma/CHEMICALLY INDUCED ; Male ; Middle Age ; Neoplasms/ *CHEMICALLY INDUCED/OCCURRENCE ; Sarcoma, Kaposi's/CHEMICALLY INDUCED ; Skin Neoplasms/CHEMICALLY INDUCED ; Support, U.S. Gov't, Non-P.H.S. ; Time Factors SO - Transplant Proc 1986 Apr;18(2 Suppl 1):210-5 43 UI - 86172060 AU - Salcedo JR TI - Urinothorax: report of 4 cases and review of the literature. AB - Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. This recommendation is based on our experience with 4 cases and a review of the literature. In 2 patients urinary obstruction was owing to retroperitoneal fibrosis secondary to malignancy, including one who had a neuroectodermal undifferentiated small round cell tumor and the other who had a metastatic epithelial neoplasm. In the 2 other patients urinary obstruction resulted from a failed ureteroneocystotomy following renal allograft transplantation. All 4 patients had a urinoma, which may be a predisposing factor to urinothorax. MH - Adolescence ; Case Report ; Child ; Female ; Human ; Hydronephrosis/COMPLICATIONS ; Kidney/TRANSPLANTATION ; Nephrostomy, Percutaneous ; Pleural Effusion/*ETIOLOGY ; Retroperitoneal Fibrosis/COMPLICATIONS ; Retroperitoneal Neoplasms/COMPLICATIONS ; Retroperitoneal Space ; Review ; Thorax ; Ureteral Obstruction/*COMPLICATIONS ; *Urine ; Urologic Diseases/COMPLICATIONS SO - J Urol 1986 Apr;135(4):805-8 44 UI - 86167163 AU - van Diemen-Steenvoorde R ; Donckerwolcke RA ; Kluin PM ; Kapsenberg JG ; Lepoutre JM ; Fleer A ; Kuis W ; Stoop JW TI - Epstein-Barr virus related central nervous system lymphoma in a child after renal transplantation. AB - In this report, we describe the development of a rapidly progressive Epstein-Barr virus (EBV) related cerebral lymphoma in an 11 year old girl, eight months after renal transplantation. No serological evidence for a persistent EBV infection was found, but Epstein-Barr nuclear antigen (EBNA) could be demonstrated in the tumor. The clinical course of our patient was different from EBV-related syndromes in renal transplanted patients described in previous reports. Furthermore, pathological investigations of the biopsy specimen and tumor cells obtained at necropsy revealed a discrepancy in light chain expression. The possibility that lymphoproliferative disorders represent multiclonal B cell lymphomas is discussed. MH - Antigens, Viral/IMMUNOLOGY ; B Lymphocytes/IMMUNOLOGY ; Brain Neoplasms/*ETIOLOGY/IMMUNOLOGY ; Burkitt's Lymphoma/*ETIOLOGY/ IMMUNOLOGY ; Case Report ; Child ; Epstein-Barr Virus/IMMUNOLOGY ; Female ; Human ; Kidney/*TRANSPLANTATION ; Time Factors SO - Int J Pediatr Nephrol 1986 Jan-Mar;7(1):55-8 45 UI - 86165243 AU - Bencini PL ; Montagnino G ; Sala F ; De Vecchi A ; Crosti C ; Tarantino A TI - Cutaneous lesions in 67 cyclosporin-treated renal transplant recipients. AB - Sixty-seven out of 100 kidney transplant recipients treated with cyclosporin and methylprednisolone were evaluated for the presence of dermatological manifestations. Only 2 patients had no dermatological lesions; 80% had iatrogenic lesions, 38% infectious, 13% miscellaneous, 3% cancerous lesions, while 28% had cutaneous manifestations related to previous uremic state. Most of the lesions concerned the pilosebaceous unit: hypertrichosis (60%), epidermal cysts (28%), pilar keratosis (21%), acne (15%), folliculitis (12%) and sebaceous hyperplasia (10%). Among infectious manifestations, viral lesions were the most frequent and were very severe in the first month after transplantation. Two patients developed a squamous-cell epithelioma and a probable cutaneous lymphoma, respectively. MH - Adolescence ; Adult ; Child ; Cyclosporins/*ADVERSE EFFECTS/ THERAPEUTIC USE ; Dermatitis Medicamentosa/ETIOLOGY/PATHOLOGY ; Female ; Human ; Kidney/*TRANSPLANTATION ; Kidney Failure, Chronic/COMPLICATIONS/SURGERY ; Male ; Middle Age ; Skin Diseases/ CHEMICALLY INDUCED/ETIOLOGY/*OCCURRENCE ; Skin Diseases, Infectious/ETIOLOGY ; Skin Neoplasms/CHEMICALLY INDUCED/PATHOLOGY SO - Dermatologica 1986;172(1):24-30 46 UI - 86128658 AU - Busuttil RW ; Goldstein LI ; Danovitch GM ; Ament ME ; Memsic LD TI - Liver transplantation today [clinical conference] AB - Orthotopic liver transplantation is a therapeutic option for patients with end-stage liver disease in whom conventional forms of medical therapy have failed. Since the first successful liver transplantation in 1967, more than 1000 have been done in North America and Europe. Improvements in patient selection, operative technique, and immunosuppression--most importantly, the introduction of cyclosporine--have resulted in an overall 1-year survival rate of 68%. Immediate postoperative problems are ischemic graft injury, acute rejection reactions, and technical problems with biliary and vascular anastomoses. Later complications include sepsis from bacterial, fungal, or viral pathogens due to immunosuppression. Late morbidity and mortality occur primarily because of chronic rejection or recurrence of primary liver disease. Despite the problems, liver transplantation is an exciting, nonexperimental therapy for patients with end-stage liver disease and offers hope to many patients for whom no treatment was previously available. MH - Adult ; Bacterial Infections/ETIOLOGY ; California ; Child ; Costs and Cost Analysis ; Cyclosporins/ADVERSE EFFECTS/ THERAPEUTIC USE ; Graft Rejection ; Graft Survival ; Hepatectomy/ METHODS ; Human ; Immunosuppression/ADVERSE EFFECTS/METHODS ; Ischemia/ETIOLOGY ; Liver/BLOOD SUPPLY/*TRANSPLANTATION ; Liver Diseases/CHEMICALLY INDUCED/ETIOLOGY ; Liver Neoplasms/ETIOLOGY ; Mycoses/ETIOLOGY ; Pennsylvania ; Postoperative Complications ; Preoperative Care ; Prognosis ; Recurrence ; Reoperation ; Review ; Virus Diseases/ETIOLOGY SO - Ann Intern Med 1986 Mar;104(3):377-89 47 UI - 86123407 AU - Starzl TE ; Iwatsuki S ; Shaw BW Jr ; Nalesnik MA ; Farhi DC ; Van Thiel DH TI - Treatment of fibrolamellar hepatoma with partial or total hepatectomy and transplantation of the liver. AB - Fourteen patients with fibrolamellar hepatoma were treated with radical excision. In eight, a subtotal hepatic resection was performed from 16 months to more than 16 years ago. None of the patients have died and recurrences have been seen in only one patient. Six other patients had total hepatectomy and hepatic replacement. Two of these six patients have died of metastases and a third is living with recurrent tumor. This experience has justified the continuing use of quite aggressive extirpative procedures for the treatment of fibrolamellar hepatoma. MH - Adolescence ; Adult ; Child ; Female ; Follow-Up Studies ; *Hepatectomy/METHODS ; Hepatoma/*SURGERY ; Human ; Immunosuppression/ADVERSE EFFECTS ; Liver/*TRANSPLANTATION ; Liver Neoplasms/*SURGERY ; Male ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/ETIOLOGY ; Prognosis ; Support, U.S. Gov't, Non-P.H.S. ; Support, U.S. Gov't, P.H.S. SO - Surg Gynecol Obstet 1986 Feb;162(2):145-8 48 UI - 86107677 AU - Letsou G ; Ballantyne GH ; Zdon IM ; Cambria RM ; Modlin IM TI - Rectal carcinoma in a renal transplant patient. Long-term complication of immunosuppression? AB - The occurrence of a rectal adenocarcinoma in a 48-year-old man 11 years after he received a cadaveric renal transplant is reported. Since his operation, the patient had been receiving prednisone and azathioprine for immunosuppression. The occurrence of rectal carcinoma in this patient at an early age, after a decade of immunosuppression, suggests an association between the malignancy and his altered immunologic state. Although an increased incidence of skin and reticuloendothelial malignancies in the first five years following renal transplantation has been well documented, few colorectal carcinomas have developed in these patients. Follow-up of transplant patients, however, is only now passing ten years in large numbers of patients. This case suggests that there may be a ten year latency period before transplant patients develop colorectal carcinoma. Such a time course would be similar to that seen in patients with chronic ulcerative colitis, in whom colorectal carcinomas are found. Surveillance colonoscopy for transplant patients beginning ten years after surgery may be necessary. MH - Adenocarcinoma/*CHEMICALLY INDUCED/RADIOGRAPHY ; Azathioprine/ ADVERSE EFFECTS/THERAPEUTIC USE ; Barium Sulfate/DIAGNOSTIC USE ; Case Report ; Colonic Neoplasms/CHEMICALLY INDUCED ; Enema ; Human ; Immunosuppressive Agents/*ADVERSE EFFECTS/THERAPEUTIC USE ; Kidney/*TRANSPLANTATION ; Male ; Middle Age ; Prednisone/ ADVERSE EFFECTS/THERAPEUTIC USE ; Rectal Neoplasms/*CHEMICALLY INDUCED/RADIOGRAPHY ; Time Factors SO - Dis Colon Rectum 1986 Feb;29(2):133-5 49 UI - 86105804 AU - Pikler GM ; Say B ; Stamper S TI - Cytogenetic findings in acute monocytic leukemia in a renal allograft recipient. AB - Chromosome analysis of bone marrow cells from a patient with acute monocytic leukemia, who had had a renal transplant followed by immunosuppressive treatment 45 months prior to the onset of leukemia, showed an unusual karyotype: 48,XX,+8,+8, t(1q12----pter::11q12----qter), t(4p12----qter::6p11----pter),t(7p22----qter::12q23 ----qter?), t(1q11----qter::17p11----11qter). MH - Azathioprine/ADVERSE EFFECTS ; Case Report ; *Chromosome Aberrations ; Chromosomes, Human, 6-12 ; Female ; Human ; Immune Tolerance ; Kidney/*TRANSPLANTATION ; Leukemia, Monoblastic/ ETIOLOGY/*FAMILIAL & GENETIC ; Middle Age ; Postoperative Complications ; Translocation (Genetics) ; Transplantation, Homologous SO - Cancer Genet Cytogenet 1986 Feb 1;20(1-2):101-7 50 UI - 86066963 AU - Gartner JC Jr ; Bergman I ; Malatack JJ ; Zitelli BJ ; Jaffe R ; Watkins JB ; Shaw BW ; Iwatsuki S ; Starzl TE TI - Progression of neurovisceral storage disease with supranuclear ophthalmoplegia following orthotopic liver transplantation. AB - A 7-year-old girl with progressive ataxia, spasticity, supranuclear ophthalmoplegia, and sea-blue histiocytes in her bone marrow underwent orthotopic liver transplantation for hepatocellular carcinoma. After an initial period of stabilization, she has shown progression of neurologic symptoms with recurrence of storage material in the transplanted liver. MH - Case Report ; Child ; Female ; Hepatoma/COMPLICATIONS/SURGERY ; Human ; Lipoidosis/*COMPLICATIONS ; Liver/*TRANSPLANTATION ; Liver Neoplasms/COMPLICATIONS/SURGERY ; Ophthalmoplegia/ COMPLICATIONS ; Recurrence SO - Pediatrics 1986 Jan;77(1):104-6