Jean M. Morgan

Cadmium and zinc abnormalities in bronchogenic carcinoma

During a study of renal cadmium content in hypertension, it was coincidentally observed that renal cadmium was elevated in persons with neoplasia. Therefore, a detailed study was made of cadmium concentration in renal and hepatic tissue and blood of persons with bronchogenic carcinoma. Cadmium was significantly increased in all 3 tissues in bronchogenic cancer. Because of the close relationship between zinc and cadmium in nature, zinc concentrations were also measured. Zinc levels were not significantly different in liver, tended to be high in kidney, and were significantly lower in blood. Similar changes in cadmium concentration were not seen in a group of other neoplastic diseases. The significance of these observations is not clear.

Gastrointestinal and hepatic complications affecting patients with renal allografts

Of 126 renal allograft recipients, 34 were found to have gastrointestinal and hepatic complications. In order of frequency, these included: mild liver dysfunction, severe hepatitis usually associated with cytomegalovirus infection, peptic ulceration complicated by bleeding, intestinal obstruction, and pancreatitis. These complications did not appear to influence the long-term survival or function of the renal allograft, but proved to be fatal when massive infection of cytomegalovirus affected the gastrointestinal tract and especially the liver. Gastrointestinal and pancreatic complications occurring in renal allograft recipients can be managed in the same manner as in patients who are not receiving immunosuppression. When surgical intervention is required, it should be performed promptly. The fact that these patients are receiving immunosuppressive therapy should not be a contraindication to early surgical intervention. When the presence of ulcerative lesions of the gastrointestinal mucosa, pancreatitis, or hepatitis is confirmed, the possibility of these lesions being caused by viral agents, especially cytomegalovirus, should be considered and attempts to confirm this diagnosis should be made. If cytomegalovirus infection is confirmed and the patient is experiencing rejection of the allograft, careful consideration should be given to immediate discontinuation of immunosuppressive therapy followed by removal of the renal allograft. In this way the relentless and fatal course of the cytomegalovirus infection seen in some of the patients reported in this study may be avoided.

Tissue cadmium and zinc content in emphysema and bronchogenic carcinoma

INTRODUCTION THIS LABORATORY recently reported a significant increase in renal, hepatic and blood cadmium concentration in persons with bronchogenic carcinoma [l]. A report by Lewis et al has noted a significant increase in hepatic water-soluble protein-bound cadmium in emphysema and/or bronchitis [2]. Since the two diseases may coexist, it seemed important to re-examine our data in regard to the presence or absence of emphysema. Additional observations on persons with emphysema but without bronchogenic carcinoma are added for comparison. Cadmium has also been found in significant amounts in cigarette smoke [3]. An attempt was therefore made to correlate the findings with smoking history or industrial exposure to cadmium dusts. There is little cadmium in the body at birth, but since excretion is minimal it tends to accumulate during life. Storage is primarily in the liver and kidney; cadmium content in lung may be low even after known exposure by inhalation [4]. Since the content of cadmium in the liver and kidney reflect accumulative exposure during life [5], these organs, rather than lung tissue, were selected for examination.

Gastrointestinal hemorrhage secondary to cytomegalovirus after renal transplantation: A case report and review of the problem

Generalized cytomegalovirus infection was associated with massive and ultimately fatal upper gastrointestinal bleeding in a renal allograft recepient and persisted even after subtotal gastric resection. The surgical specimen and the remaining stomach at autopsy revealed multiple superficial ulcerations with cytomegalic inclusion bodies within the gastric mucosa. Renal failure in the terminal stages of the patients illness required hemodialysis but did not seem to be the sole result of allograft rejection, suggesting that the renal dysfunction may be caused by the systemic viral infection.

Uncoupling of oxidative phosphorylation by ultrafiltrates of uremic serum.

Summary The influence of substrates in serum ultrafiltrates of uremic individuals on isolated rat liver mitochondria has been determined. A substance or substances present in such an ultrafiltrate does uncouple oxi-dative phosphorylation, but only at the phos-phorylation site linked to the respiratory chain between NADH and cytochrome b. The inhibiting substance is cationic at pH 8.0 and is soluble in acidic ether.

Clinical Evaluation of Equine Antithymocyte Globulin in Recipients of Renal Allografts: Analysis of Survival, Renal Function, Rejection, Histocompatibility, and Complications

Equine antithymocyte globulin combined with azathioprine and prednisone as immunosuppressive therapy in 50 transplant recipients prolonged allograft survival and seemed to modify the severity of rejection episodes. Although nine patients died from a variety of causes, only three kidneys were lost to rejection, one of which was hyperacute. There were no serious untoward hematologic or systemic effects caused by the ATG, and all patients completed the course of therapy. Infection, a serious and frequent complication of transplant patients, was encountered no more often than in other transplant series not using ALG. The data pertaining to the clinical value of ATG, although suggestive in terms of its immunosuppressive effects, is still not conclusive; and a definitive answer to this question awaits further evaluation in a series of cadaveric recipients in a randomized-double-blind study.

Plasma Levels of Aromatic Amines in Renal Failure

Abstract Blood aromatic amine concentration has been determined in 51 nonazotemic subjects and 25 subjects with varying degrees of renal failure. Aromatic amine levels are elevated in uremia and loosely correlate with the BUN. Pre- and post-dialysis levels suggest a good clearance for these compounds on the artificial kidney.

Retrospective analysis of 100 consecutive patients undergoing related living donor renal transplantation.

One hundred consecutive patients receiving related donor kidneys were analyzed in regards to graft and patient survival, morbidity, mortality, histocompatibility and rehabilitation. The average followup was 3 years and 2 months with a minimum post transplant evaluation of one year. Donor morbidity was minimal and the mortality nil. Recipient mortality was 17%, all of which occurred after the first two post transplant months. The most serious life threatening complications after transplantation were due to infection. The greatest morbidity was secondary to aseptic necrosis. The overall graft survival at one year was 94%, 2 years—87%, 3 years—81% and 4 and 5 years—72%. Separation of patients according to tissue typing revealed 95% of recipients with A and B matched kidneys to be alive 5 years later compared to 55% of patients receiving C and D matched kidneys. Rehabilitation was good to excellent in 76% of the living patients and poor in only 4%. These results suggest related donor renal transplantation to be the treatment of choice for patients with chronic renal failure excluding only those individuals who are exceptionally high risks in terms of morbidity and mortality.

Scientific paperKidney transplantation in patients with end stage congenital renal disease: Report of eighteen cases and review of the organ transplant registry

Eighteen patients with end stage congenital renal disease requiring kidney transplantation constituted 12 per cent of the transplantation recipients at this institution over the past six years. The post-transplantation course in this group was remarkably satisfactory, with a 94 per cent graft survival at three years. In addition, we analyzed survival data from over 9,900 patients in the Organ Transplant Registry and demonstrated that transplant recipients with end stage congenital renal disease have equal or better five year patient survival compared with those with acquired end stage renal disease. Only those patients with adult polycystic disease had a less satisfactory prognosis, probably because of age-related factors. In contrast, there were few statistical correlations between renal allograft survival, age, and original disease.

Kidney transplantation in patients with end stage congenital renal disease: Report of eighteen cases and review of the organ transplant registry

Eighteen patients with end stage congenital renal disease requiring kidney transplantation constituted 12 per cent of the transplantation recipients at this institution over the past six years. The post-transplantation course in this group was remarkably satisfactory, with a 94 per cent graft survival at three years. In addition, we analyzed survival data from over 9,900 patients in the Organ Transplant Registry and demonstrated that transplant recipients with end stage congenital renal disease have equal or better five year patient survival compared with those with acquired end stage renal disease. Only those patients with adult polycystic disease had a less satisfactory prognosis, probably because of age-related factors. In contrast, there were few statistical correlations between renal allograft survival, age, and original disease.