Diagnostic markers and risk factors of cytomegalovirus infection and disease in renal allograft recipients.

In a prospective study, the incidences of CMV infection and disease were 56 and 23%, respectively, during the first 6 months following kidney transplantation. Viremia was found in all patients with CMV disease and arthralgia was present in 71% prior to the development of CMV disease. The positive predictive value for CMV disease reached up to 90% for viremia and arthralgia in combination. Viruria was poorly correlated to viremia and hence CMV disease. The majority of patients (93%) who developed CMV disease had a seropositive donor, and viremia was significantly more common in patients who received CMV-seropositive kidneys. CMV disease was more common in CMV-seronegative recipients than in seropositive recipients. The 1-year graft survival rate was 75% in the entire study group. In patients with CMV viremia and disease, the rates were 78 and 73%, respectively. Antiviral treatment was initiated within 3 weeks of viremia detection in the 6 patients with CMV disease who survived. We found that the combination of arthralgia and viremia was a useful predictor of CMV disease and that recipients of CMV-seropositive allografts were at a greater risk of developing CMV disease. To obtain an early diagnosis and commence an early treatment of CMV disease, patients prone to develop CMV disease should be identified and clinical examination and viremia surveillance should be performed regularly.

Pretransplantation immunoadsorption therapy in patients immunized with human lymphocyte antigen: effect of treatment and three years' clinical follow-up of grafts.

Sensitization against human lymphocyte antigen (HLA) occurs frequently in previously transplanted patients that lose a first cadaveric graft. To shorten their time on the waiting list and reduce the incidence of early rejection in such patients, we performed immunoadsorption therapy by a tryptophan column in 10 patients as an attempt to remove circulating antibodies prior to regrafting. Resynthesis of antibodies was suppressed with cyclophosphamide and prednisolone. Following the course of immunoadsorption therapy, the panel reactive antibodies (PRA) decreased by more than 50% from the pretreatment values. In the present study, 8 patients were transplanted with cadaveric renal grafts. At the time of follow-up, graft survival was 63% in these patients (2-36 months post-transplantation, mean 23 months). There was one incidence of acute rejection, one graft was lost within 48 h owing to renal artery thrombosis, and one was lost within 2 weeks as a result of stenosis. The serum creatinine levels were down to near normal during the first 3 weeks in hospital (p < 0.0001) and remained at this level during the period of follow-up. We conclude that immunoadsorption might be a beneficial pretransplantation therapy and an alternative to plasmapheresis in HLA-immunized patients awaiting kidney transplantation.

A comparison between diamine oxidases from human post-heparin blood serum, pregnancy blood serum and amniotic fluid.

Diamine oxidase (DAO) was purified from blood serum after intravenous heparin injection, from pregnancy blood serum and amniotic fluid. On DEAE-Sephadex, DAO from amniotic fluid as well as from pregnancy blood serum was separated in two active fractions with molecular weights of 245,000 and 485,000, respectively. Post-heparin blood serum contained only one active DAO fraction with a molecular weight of 185,000. The purified enzymes showed similar enzymatic properties.

Purification and properties of human amniotic fluid diamine oxidase.

Diamine oxidase (DAO) was purified from amniotic fluid. The activity was separated in two DAO fractions with pI values of 5.8 and 4.0. Molecular weight were found to be 245,000 and 485,000, respectively, with subunit molecular weight of 110,000. This indicated that they probably are dimer and tetramer of the same DAO subunit. The enzyme was active against putrescine and histamine and was strongly inhibited by carbonyl group reagents. A Ping Pong Bi Ter enzyme reaction mechanism is probable. The diamine, with one amino group protonized, is suggested to be responsible for interaction with the enzyme.

Treatment of traumatic arthritis in the horse with intra-articular orgotein (palosein).

A total of 134 horses of various breeds were treated for aseptic arthritis of traumatic origin using Orgotein (Palosein). The drug was injected into 192 affected joints of these animals. Recovery rates of 94 per cent were recorded in cases which had shown lameness for less than 2 months before treatment commenced and 49 per cent in those lame for longer than 2 months.

An experimental study of autologous digital tendon transplants in the horse.

Four autologous tendon grafting techniques, bipedicle, pedicle and free grafts of the deep digital flexor tendon and free grafts from the lateral digital extensor tendon were described. The vascularization and remodelling of the transplant and the reactions in the donor, as well as the recipient tendon, were studied by means of microangiographic and histochemical methods. The results indicated that regardless of the technique used the grafts were revascularized and replaced by a highly orientated and organized tendon. The use of free grafts may therefore be worthwhile in treatment of severe tendon lesions in valuable racehorses.