Effect of cyclosporine and delayed graft function on posttransplantation erythropoiesis.

The effect of delayed graft function and immunosuppressive drugs on posttransplant erythropoiesis was studied prospectively in 18 living-related (LR) and 84 cadaver-donor (CD) recipients. Eight of 18 LR and 20 of 84 CD recipients received antilymphoblast globulin (ALG) in addition to azathioprine and prednisone. Sixty-four CD recipients received cyclosporine (CsA) with prednisone. In the absence of rejection reticulocytosis began 6.7 +/- 0.2 days following graft implantation in azathioprine-only-treated LR recipients. This was lengthened by ALG to 9.4 +/- 0.3 and 9.9 +/- 0.7 days in LR and CD recipients, respectively, whose grafts functioned immediately. Delayed graft function prolonged onset of reticulocytosis to 15.9 +/- 0.9 days in ALG-treated but not in CsA-treated recipients (5.8 +/- 0.4 days). The shortest latency was noted in CsA-treated recipients (4.9 +/- 0.5 days) with immediately functioning grafts. The earlier onset of reticulocytosis of CsA-treated recipients was followed by statistically significant blunting of peak reticulocytosis, which correlated with a slower rate of correction of anemia (delta Hct = 0.19/day) compared with non-CsA-treated recipients (delta Hct = 0.34/day). Early rejection was associated with abrogation of reticulocytosis and correction of anemia without regard to immunosuppressive regimen) until rejection was reversed. Erythropoietin (EPO) was measured sequentially in 5 patients with immediate function. In 4 of 5 cases changes in EPO preceded those in reticulocytosis. EPO rose from a mean of 13 mU/ml pretransplant to a peak of 50 within 3 weeks and decreased to 18 mU/ml within 6 weeks of graft implantation. At six months posttransplant, normalized reticulocyte counts were only 55% higher (1.75 vs. 1.13%) but hematocrit had increased from 26 +/- 1% to 42 +/- 1%. Hematocrit varied inversely with serum creatinine, which was highest in CsA-treated patients with initial delayed graft function. We conclude that correction of anemia posttransplantation is driven by EPO but other factors may also be important, that neither ATN nor ALG-therapy have clinically important effects on erythropoiesis, and that CsA reduced "effective" erythropoiesis and influences correction of anemia--particularly if delayed graft function complicates the initial course posttransplantation.

[Quantitative exercise scintigraphy of the myocardium with 201Tl--methods and normal values (author's transl)]. / Quantitative Belastungs-Szintigraphie des Myokards mit 201Tl--Methodik und Normalverhalten.

Quantitative myocardial scintigraphy was performed in 20 normal individuals after maximum exercise and after two hours of rest. A mobile Anger camera with converging collimator and a Data-General computer with a 128 x 128 matrix were used. Quantitative analysis of data was performed on the basis of a 14-halfsegment model. Quantitative normal values after exercise and after redistribution of activity during rest are presented.

Gas transport during different modes of high-frequency ventilation.

Gas transport during high-frequency oscillation (HFO) and high-frequency jet ventilation (HFJV) was compared in a simple lung model of human conducting airways. The delivery of gas to distal airways was assessed by measuring the dilution of 5% CO2, introduced separately into the model. Increasing frequency from 1.0 to only 1.7 Hz redistributed gas into straighter airway paths during HFO. Gas flow rates during HFO were sinusoidal, and CO2 dilution at the most distal airway sampling site was a function of both mean and peak flow rates. CO2 dilution increased as frequency increased, even though tidal volume (VT) was constant. Peak flow increased as either VT or frequency was increased (range 132 to 2167 ml/sec). During HFJV, flow approximated a square-wave function. Peak flows during HFJV were lower than during HFO, except at mean flows less than 167 ml/sec. Although CO2 dilution at the most distal airway sampling site increased as VT increased during HFJV, CO2 dilution actually decreased as frequency was increased at any given VT. Thus, in this model, gas transport in large airways differed during HFO or HFJV, and was related to peak as well as mean flows. Also, the distribution of gas within the airways changed as frequency increased.

[Influence of nitroglycerin on hemodynamics, wall tension and oxygen consumption of the left ventricle]. / Der Einfluss von Nitroglycerin auf Hämodynamik, Wandspannung und Sauerstoffverbrauch des linken Ventrikels

The effects of nitroglycerin on left ventricular hemodynamics were determined in ten patients from biplane cineventriculograms and simultaneous pressure measurements. Before and after nitroglycerin (1.6 mg sublingually) the following parameters were measured: Systolic (PLV) and enddiastolic pressure (PLVED), enddiastolic (EDV) und endsystolic volume (ESV), cardiac output (SV), ejection fraction (EF) and ejection rate (ER), ejection time (tej), heart rate (HR), dp/dtmax, dp/dtmax Pi-Ped, maximal systolic wall stress (sigmamax), integrated systolic wall stress (sigma), outflow resistance (Rsys) and ventricular compliance (a). Nitroglycerin leads to a reduction of both, pre- and afterload, with a significant fall of PLV (10.8%), PLVED (21.8%), EDV (9.1%) ESV (13.3%) AND Rsys (14.4%). The changes of ventricular pressure and geometry result in a diminution of left ventricular wall stress (sigmamax- 11.8%, sigma - 26.4%), representing a decrease of calculated total oxygen-consumption of 11.5%. In six patients with reduced left ventricular diastolic compliance nitroglycerin leads to a remarkable increase of the compliance. This is probably due to the reversal of a latent ischemia by the decreased myocardial oxygen-consumption.