Post-transplantation morphological and functional changes in kidneys from expanded criteria donors.

Introduction Despite an increase in the number of cadaver donors and overall organ transplantations, the dramatic increase in the waiting list makes it necessary to reconsider donor criteria. The authors wanted to examine whether differences could exist in the function and/or morphology of transplanted kidneys originated from expanded criteria donors (ECDs) and ideal donors 1 and 5 years after transplantation. Methods Kidney function and histopathologic findings were analyzed and compared 1 and 5 years after transplantation in 97 patients having ECD kidneys and in 178 patients who received ideal donor kidneys (IDK). Results Serum creatinine level was significantly higher (p = 0.001) and estimated glomerular filtration rate was significantly lower (p = 0.003) in patients having ECD kidneys as compared with those with IDK 5 years after transplantation. Morphological changes in the transplanted kidneys, such as tubulitis (p = 0.025) and interstitial inflammation (p = 0.002), were significantly more frequently present in patients with ECD kidneys than in those with IDK 1 year after transplantation. Conclusion Despite an absence of differences in kidney function 1 year after kidney transplantation between patients having ECD and IDK, morphological differences in the transplanted kidneys can be detected between the two groups of patients.

Effect of high-dose endotoxin on glucose production and utilization.

The purpose of the present study was to determine how a high dose of endotoxin (lipopolysaccharide [LPS]), which produces hypoglycemia, alters in vivo glucose uptake by individual tissues. Catheterized conscious fasted rats were injected intravenously (i.v.) with either saline, LPS (1 mg/100 g body weight [BW], lethal dose [LD] 100), or 3-mercaptopicolinic acid (3-MP), an inhibitor of gluconeogenesis. In the latter two groups, blood glucose levels were clamped at either 6 mmol/L (euglycemia) or 3 mmol/L (hypoglycemia). In the first series of experiments, whole-body glucose flux was determined using [3-3H]glucose, and in the second study in vivo glucose uptake (Rg) by individual tissues was estimated by the tracer [U-14C]-2-deoxyglucose technique. The relative contribution of hypoglycemia per se to the LPS effect was determined by comparing the values from LPS- versus 3-MP-treated animals. There was no difference in the rate of whole-body glucose utilization (Rd) between saline-infused control rats and LPS-treated animals that were hypoglycemic. However, Rg by diaphragm, spleen, liver, and lung was increased in hypoglycemic LPS-treated rats. The increased Rg in these tissues was not observed in 3-MP-treated rats with a comparable hypoglycemia. Only the gastrocnemius muscle showed a reduction in Rg under hypoglycemic conditions, and the decrease was similar in both LPS- and 3-MP-treated animals. When sufficient glucose was infused into LPS-injected rats to maintain euglycemia, whole-body glucose Rd was increased compared with that in hypoglycemic LPS-treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in the serum lipid levels in males with ischemic heart disease under the effect of diets with various cholesterol and fat contents]. / Ischaemiás szívbetegségben szenvedö férfiak szérum lipidszintjeinek változása különbözö koleszterin- és zsírtartalmú diéták hatására.

In the treatment of hyperlipoproteinaemia the diet still has a primary importance. The authors have investigated the effect of different fat, cholesterol and unsaturated/saturated fatty acid content diets on the lipid levels of men suffering from coronary heart disease during 3 weeks long hospital treatment in the Cardiac Rehabilitation Department. On a diet containing daily 65 g fat, 230 mg cholesterol with a 1.23 unsaturated/saturated fatty acid ratio the total cholesterol level of 66 patients showed a 5.8% decrease (P < 0.05). The 1% decrease of triglyceride, the 3.9% decrease of HDL-cholesterol, the 7.3% decrease of LDL-cholesterol levels were not significant. There was a positive correlation between the cholesterol level at the beginning and the degree of its change (0.7043): the patients with 6.5 mmol/l or less cholesterol level at the entry in the study showed a 2.8% decrease in serum cholesterol level, the patients with more than 6.5 mmol/l 8.1%. On a diet containing daily 105 g fat, 420 mg cholesterol, with a 0.7 unsaturated/saturated fatty acid ratio the triglyceride level showed a 20.6%, the total cholesterol 0.5% increase, at the same hand the HDL-cholesterol 1.1%, the LDL-cholesterol 5.1% decrease (only the change of triglyceride level was significant). The results emphasise the strong relation between diet and level of serum lipids.

[Splenic infarction and abscess as a complication of atrial fibrillation]. / Pitvarfibrilláció szövödményeként kialakuló lépinfarktus és tályog.

The case of a 64 year old man is presented by the authors whose spleen infarction developed in connection with atrial fibrillation was transformed into splenic abscess in spite of the applied conservative treatment. According to the overviewed literature the etiology, symptoms, diagnostic and therapeutic possibilities, as well as prognosis of these two entities related to spleen are described hereby.

[Rare late complication of transcystic drainage]. / A transcysticus drainage ritka késöi szövödménye.

The authors performed 3539 successful endoscopic retrograde cholangio-panreatographies between 1982 and 1992. In 1160 (32.7%) of the cases was revealed some kind of pathological condition. In connection with one case, following conventional cholecystectomy, a very rare complication was diagnosed by endoscopic means. There was a stent-like object, hanging into the duodenal lumen, through a parapapillar fistula. This was surgically removed. It turned retrospectively out that the removal of K-32 feeding tube used as a transcystic drain 18 years earlier had managed only partially. After this period of time did it cause a biliary flow obstruction and a choledocho-duodenal fistula. The endoscopic diagnostic possibilities, course of disease and treatment is presented hereby.

Side effects of the calcineurin inhibitor, such as new-onset diabetes after kidney transplantation.

New-onset diabetes after transplantation (NODAT) is one of the frequent complications following kidney transplantation. Patients were randomized to receive cyclosporine A- or tacrolimus-based immunosuppression. Fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), or NODAT. NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p = 0.0002). Albumin levels were similar, but uric acid level (p = 0.002) and the age of the recipient (p = 0.003) were significantly different comparing the diabetic and the normal groups. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/tubular atrophy (IF/TA) were significantly different in the NODAT group. The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before the development of any sign of functional impairment.

Role of platelet-activating factor in glucose uptake and utilization of different tissues.

The purpose of the present study was to elucidate the role of platelet-activating factor (PAF) in influencing the glucose metabolism of selected rat tissues. The in vivo glucose utilization rate in different tissues assessed by the 2-deoxyglucose tracer technique was determined 80 min following the intravenous injection of human serum albumin in saline or intravenous administration of a known amount (130 ng/100 g BW) of PAF. PAF administration resulted in significant hyperglycemia (8.89 +/- 0.29 mmol/l) and increased the in vivo glucose utilization rate by the polymorphonuclear leukocytes (435%), monocytes (218%), liver (58%), lung (53%), intestine (52%) and spleen (51%). Owing to the accentuated hyperglycemia the metabolic clearance rate (MCR) for glucose was also calculated; this rate is an indicator of the avidity of tissues for this metabolite. There were significantly elevated MCR values in the polymorphonuclear leukocytes (211%), monocytes (229%), spleen (79%), intestine (71%) and liver (67%). These findings indicate that tissue glucose metabolism is deeply affected by the administration of PAF and according to data obtained it is thought that this mediator may also be involved in the upregulation of host defense-related cellular functions.

Intraoperative ultrasonography for common bile duct exploration during laparoscopic cholecystectomy.

The "Endomedix Laparoscan Diagnostic Ultrasound" from the Medilas Ltd. and the "Leopard" and "Panther" type intraoperative ultrasound instruments from the Green Sound Ltd. have been used with success in sixty cases during laparoscopic cholecystectomy (LC) by the authors. Of these patients in four cases common bile duct (CBD) stones and in one case only sludge have been found. Of those with CBD stones, in one case four little stones have been observed despite of negative intraoperative cholangiography (IC) and in one case calculus in the retropancreatic CBD part was detected. On the basis of preoperative findings the CBD stones have not been expected. According to the authors the intraoperative ultrasound (IOUS) can be used with no exception in all cases eligible for LC, and also it can be used for the examination of neighboring organs (liver, pancreas, hepatoduodenal ligament). The method is extremely useful, performance quick, simple and informative as well as it can replace IC during LC.

Adrenergic blockade attenuates endotoxin-induced hepatic glucose uptake.

The purpose of the present study was to elucidate the role of catecholamines in mediating the endotoxin-induced increase in glucose uptake of individual tissues. In vivo glucose utilization by selected tissues, assessed by the 2-deoxyglucose (2dGlc) tracer technique, was determined 3 hr following the i.v. injection of Escherichia coli lipopolysaccharide (LPS; 100 micrograms/100 g bw) or saline. Catecholamine action was inhibited by the combined administration of alpha and beta receptor antagonists, phentolamine and propranolol. Adrenergic antagonists alone did not change plasma glucose levels or the glucose metabolic rate (Rg) of the investigated tissues; however, adrenergic blockage resulted in mild hypoglycemia in endotoxemic animals. LPS administration increased in vivo Rg by the liver (571%), lung (229%), spleen (210%), intestine (76%), skin (82%), fat (181%), gastrocnemius muscle (70%), and kidney (61%). There was a significant elevation in the glucose metabolic clearance rate (MCR) by these tissues as well. LPS did not increase Rg by brain and testis. Adrenergic blockade completely prevented the LPS-induced Rg increase in the liver and partially inhibited the elevation in other tissues. The LPS-induced increase in the MCR in spleen, lung, intestine, skin, fat, muscle, and kidney was not altered by adrenergic blockade, indicating that the attenuated Rg in these tissues was the consequence of the decreased plasma glucose concentration observed under this condition. However, in the liver, adrenergic antagonists markedly inhibited the LPS-induced increase in both Rg and MCR. Thus our data indicate that the glucose metabolic response to LPS is partially mediated by catecholamines through the accompanying changes in plasma glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Kupffer cells play a major role in insulin-mediated hepatic glucose uptake in vivo.

The effect of insulin on the in vivo glucose utilization by different hepatic cells was investigated using the euglycemic, hyperinsulinemic clamp, combined with the 2-deoxyglucose tracer technique. Rats were infused with insulin at a rate of 2.8 or 9.0 mU/min/kg for 220 min, resulting in plasma concentrations of the hormone of about 80 microU/ml and 340 microU/ml, respectively. Glucose use by the whole liver was elevated by more than 200% following insulin. However, glucose uptake by the parenchymal cells was only elevated by 50-60%. By contrast nonparenchymal cells were more responsive to insulin. Glucose uptake by endothelial cells was increased 100% and Kupffer cells displayed the most marked response to insulin showing a 3- to 6-fold increase in glucose uptake. These data indicate that the sinusoidal nonparenchymal cells are the major sites of the insulin-mediated increased glucose utilization by the liver.

Sepsis- and endotoxin-induced increase in organ glucose uptake in leukocyte-depleted rats.

Both gram-negative infection and bacterial endotoxin (lipopolysaccharide, LPS) produce a marked neutropenia and increase glucose disposal by peripheral tissues. The purpose of the present study was to determine whether leukocyte depletion before these insults would diminish the commonly observed increases in tissue glucose uptake. Rats were depleted of circulating and marginated leukocytes with cyclophosphamide (CPA). Under basal postabsorptive conditions the subcutaneous injection of live Escherichia coli into control animals enhanced whole body glucose disposal that resulted in part from a stimulation of glucose uptake by the liver, spleen, intestine, and lung. These increases in tissue glucose uptake were not associated with an increase in neutrophil number, as assessed by myeloperoxidase (MPO) activity. CPA-induced leukopenia did not alter the sepsis-induced increase in glucose uptake by these tissues and whole body glucose use remained elevated. In contrast, skin and muscle proximal to the site of infection showed an increase in both glucose uptake and MPO activity. Furthermore, leukocyte depletion attenuated the elevated glucose uptake by skin and muscle near the inflammatory focus. The intravenous injection of LPS also increased whole body glucose disposal and enhanced glucose uptake by the lung, liver, spleen, intestine, and skin in saline-treated rats. Of these tissues the lung, liver, and spleen had a corresponding increase in neutrophil number. The LPS-induced increases in tissue glucose uptake in leukopenic rats were comparable, with the exception of liver and lung. In these tissues the incremental increase in glucose uptake after LPS was reduced 40-50% in leukopenic animals.(ABSTRACT TRUNCATED AT 250 WORDS)