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Treatment of Ovarian Vein Thrombosis
922
TRANSPLANTATION
Nuclear Medicine, National Institutes of Health, Bethesda, Maryland, Harrison Department of Surgical Research, and Department of Chemistry and Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, ahd Division of Nuclear Medicine, University of Maryland Hospital, Baltimore, Maryland J. Surg. Oncol., 27: 189-195 (Nov.) 1984
The authors found a new 111 indium (111 In) bleomycin complex, which has high affinity to tumor, does not bind to transferrin and is stable in vivo. Distribution in animals bearing glioma, hepatoma or mammary adenocarcinoma at 48 hours showed that the ratios of tumor of the blood, brain, heart, lung, liver, pancreas, stomach and femur were 1.4 to 22.4 times as high for 111 In-bleomycin complex as for 67 gallium (67 Ga) citrate. In mammary adenocarcinomas 111 In-bleomycin complex bound more to viable and "7cobalt (57 Co) bleomycin bound more to necrotic tumor. In viable tumors the concentration of 111 Inbleomycin complex was similar to that of 57 Co-bleomycin. The ratios of tumor of the stomach and pancreas were higher, and the ratios to the blood, brain, muscle, heart and femur were lower for 111 In-bleomycin complex than for mco-bleomycin. The ratios of tumor of the lung, liver, spleen, skin and kidney were similar for the 2 compounds. Tumors were imaged more distinctly with the new 111 In-bleomycin complex and 57 Cobleomycin than with 67 Ga-citrate. The 111 Ih-bleomycin complex is promising for tumor imaging. W. W. K. 4 figures, 3 tables, 11 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR SURGERY Treatment of Ovarian Vein Thrombosis M. B. COHEN, Department of Obstetrics and Gynecology, Tulane University Medical Center, New Orleans, Louisiana N. Y. State J. Med., 84: 542 (Nov.) 1984 The author comments on an article appearing in the same issue, in which the subject of ovarian vein thrombosis is discussed. This condition is misdiagnosed easily owing to confusing, and often contradictory signs and symptoms. Ectopic pregnancy is one source of confusion. f:l-Human chorionic gonadotropin is an essential test to determine and to confirm pregnancy. Serial f:l-human chorionic gonadotropin levels and ultrasound of the uterine cavity can help to rule out intrauterine pregnancy or impending abortion. The risks of anesthesia on early pregnancy, and the necessity of detailed discussion of all possible surgical outcomes with the patient and family are underscored. The need for individualized treatment also is emphasized. J. H. N.
TRANSPLANTATION The Improving Prognosis After Kidney Transplantation: New Strategies to Overcome Immunologic Rejection A. S. LEVEY, Department of Medicine, Tufts University School of Medicine, and Division of Nephrology, New England Medical Center, Boston, Massachusetts Arch. Intern. Med., 144: 2382-2387 (Dec.) 1984
Major advances in the immunological management of transplant recipients have led to dramatic improvements in patient and graft survival. Indeed, 1-year patient and graft survival rates approach 95 and 85 per cent, respectively, for living related recipients, and 90 and 65 per cent, respectively, for cadaveric transplant recipients. Despite these favorable statistics, of the 70,000 patients treated for end stage kidney disease in the United States in 1982 only 4,900 (7 per cent) received transplants. A more enlightened understanding of the immunology of graft rejection has contributed greatly to subsequent major advances. Found within the donor kidney on endothelial cells, tubular epithelial cells and lymphocytes are cell surface histocompatibility locus (HLA) antigens, which are encoded by genes of the major histocompatability complex located on chromosome .6. The antigenic discrepancies between recipient and donor cells initiate cellular and humoral responses in the recipient cells that lead to the acute rejection episodes, usually associated with graft swelling, increasing serum creatinine and fever. The HLA antigens consist of 2 structurally distinct types. Class 1 antigens, including the A, B and C antigens, are found on the surface of all nucleated cells. The class 2 antigens, which include the D, D-related (DR), MT and MB antigens, are restricted primarily to B lymphocytes. The HLA phenotypes of the recipient and donor can be determined by the analysis of peripheral blood lymphocytes using standard immunological techniques. The coding of the gene for these HLA antigens is related closely to the major histocompatibility complex and is inherited as a group or haplotype, with each parent contributing 1 haplotype. It appears that matching for class 2 antigens is the most efficacious method in living related and cadaver transplantation. In particular, D-antigen compatibility as assessed by the mixed lymphocyte response appears most important. Two-haplotype-matched siblings share both D genes and have the best outcome. One-haplotype-matched donor-recipient pairs with a low mixed lymphocyte response have a transplant outcome that approaches that of 2-haplotype-matched pairs. A highly reactive mixed lymphocyte response in this group predicts graft outcome similar to that for unrelated cadaver transplants. Until recently, D-antigen matching has not been feasible in cadaver transplantation because the initial techniques required 5 days for a positive mixed lymphocyte response to develop. The identification of DR cell surface antigens has allowed the constructions of immunological probes similar to those used to identify HLA and ABO types. It is not clear what impact DR matching will have upon cadaveric renal transplantation. Some reports have shown the difference in early outcome in matched and mismatched recipients to be as great as 40 per cent. Although transplantation from a well matched, related, living donor continues to provide superior long-term results and remains the ideal therapy for chronic renal failure, suitable donors are available for only 2 per cent of the patients. Consequently, cadaver kidney transplantation remains the only viable alternative to long-term dialysis. However, even with the advent of novel immunological probes that allow for the rapid determination of DR surface antigens, a recipient without DR mismatches can be found for only 30 per cent of the cadaver donor kidneys without prolonging recipient waiting time. The author discusses a variety of approaches that have allowed for enhanced patient/cadaveric graft survival in less than ideally matched recipients. The concept of pre-transplant blood transfusions was intro-
TRANSPLANTATION
Nuclear Medicine, National Institutes of Health, Bethesda, Maryland, Harrison Department of Surgical Research, and Department of Chemistry and Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, ahd Division of Nuclear Medicine, University of Maryland Hospital, Baltimore, Maryland J. Surg. Oncol., 27: 189-195 (Nov.) 1984
The authors found a new 111 indium (111 In) bleomycin complex, which has high affinity to tumor, does not bind to transferrin and is stable in vivo. Distribution in animals bearing glioma, hepatoma or mammary adenocarcinoma at 48 hours showed that the ratios of tumor of the blood, brain, heart, lung, liver, pancreas, stomach and femur were 1.4 to 22.4 times as high for 111 In-bleomycin complex as for 67 gallium (67 Ga) citrate. In mammary adenocarcinomas 111 In-bleomycin complex bound more to viable and "7cobalt (57 Co) bleomycin bound more to necrotic tumor. In viable tumors the concentration of 111 Inbleomycin complex was similar to that of 57 Co-bleomycin. The ratios of tumor of the stomach and pancreas were higher, and the ratios to the blood, brain, muscle, heart and femur were lower for 111 In-bleomycin complex than for mco-bleomycin. The ratios of tumor of the lung, liver, spleen, skin and kidney were similar for the 2 compounds. Tumors were imaged more distinctly with the new 111 In-bleomycin complex and 57 Cobleomycin than with 67 Ga-citrate. The 111 Ih-bleomycin complex is promising for tumor imaging. W. W. K. 4 figures, 3 tables, 11 references
DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR SURGERY Treatment of Ovarian Vein Thrombosis M. B. COHEN, Department of Obstetrics and Gynecology, Tulane University Medical Center, New Orleans, Louisiana N. Y. State J. Med., 84: 542 (Nov.) 1984 The author comments on an article appearing in the same issue, in which the subject of ovarian vein thrombosis is discussed. This condition is misdiagnosed easily owing to confusing, and often contradictory signs and symptoms. Ectopic pregnancy is one source of confusion. f:l-Human chorionic gonadotropin is an essential test to determine and to confirm pregnancy. Serial f:l-human chorionic gonadotropin levels and ultrasound of the uterine cavity can help to rule out intrauterine pregnancy or impending abortion. The risks of anesthesia on early pregnancy, and the necessity of detailed discussion of all possible surgical outcomes with the patient and family are underscored. The need for individualized treatment also is emphasized. J. H. N.
TRANSPLANTATION The Improving Prognosis After Kidney Transplantation: New Strategies to Overcome Immunologic Rejection A. S. LEVEY, Department of Medicine, Tufts University School of Medicine, and Division of Nephrology, New England Medical Center, Boston, Massachusetts Arch. Intern. Med., 144: 2382-2387 (Dec.) 1984
Major advances in the immunological management of transplant recipients have led to dramatic improvements in patient and graft survival. Indeed, 1-year patient and graft survival rates approach 95 and 85 per cent, respectively, for living related recipients, and 90 and 65 per cent, respectively, for cadaveric transplant recipients. Despite these favorable statistics, of the 70,000 patients treated for end stage kidney disease in the United States in 1982 only 4,900 (7 per cent) received transplants. A more enlightened understanding of the immunology of graft rejection has contributed greatly to subsequent major advances. Found within the donor kidney on endothelial cells, tubular epithelial cells and lymphocytes are cell surface histocompatibility locus (HLA) antigens, which are encoded by genes of the major histocompatability complex located on chromosome .6. The antigenic discrepancies between recipient and donor cells initiate cellular and humoral responses in the recipient cells that lead to the acute rejection episodes, usually associated with graft swelling, increasing serum creatinine and fever. The HLA antigens consist of 2 structurally distinct types. Class 1 antigens, including the A, B and C antigens, are found on the surface of all nucleated cells. The class 2 antigens, which include the D, D-related (DR), MT and MB antigens, are restricted primarily to B lymphocytes. The HLA phenotypes of the recipient and donor can be determined by the analysis of peripheral blood lymphocytes using standard immunological techniques. The coding of the gene for these HLA antigens is related closely to the major histocompatibility complex and is inherited as a group or haplotype, with each parent contributing 1 haplotype. It appears that matching for class 2 antigens is the most efficacious method in living related and cadaver transplantation. In particular, D-antigen compatibility as assessed by the mixed lymphocyte response appears most important. Two-haplotype-matched siblings share both D genes and have the best outcome. One-haplotype-matched donor-recipient pairs with a low mixed lymphocyte response have a transplant outcome that approaches that of 2-haplotype-matched pairs. A highly reactive mixed lymphocyte response in this group predicts graft outcome similar to that for unrelated cadaver transplants. Until recently, D-antigen matching has not been feasible in cadaver transplantation because the initial techniques required 5 days for a positive mixed lymphocyte response to develop. The identification of DR cell surface antigens has allowed the constructions of immunological probes similar to those used to identify HLA and ABO types. It is not clear what impact DR matching will have upon cadaveric renal transplantation. Some reports have shown the difference in early outcome in matched and mismatched recipients to be as great as 40 per cent. Although transplantation from a well matched, related, living donor continues to provide superior long-term results and remains the ideal therapy for chronic renal failure, suitable donors are available for only 2 per cent of the patients. Consequently, cadaver kidney transplantation remains the only viable alternative to long-term dialysis. However, even with the advent of novel immunological probes that allow for the rapid determination of DR surface antigens, a recipient without DR mismatches can be found for only 30 per cent of the cadaver donor kidneys without prolonging recipient waiting time. The author discusses a variety of approaches that have allowed for enhanced patient/cadaveric graft survival in less than ideally matched recipients. The concept of pre-transplant blood transfusions was intro-