Histopathology of cardiac allograft rejection

Hippokratia 1999, 3(1): 5 - 9

M. Leontsini

Abstract

Acute rejection remains a common cause of death, in the first year after heart transplantation. The essential histological features during the evolution of acute cardiac rejection comprises perivascular and interstitial mononuclear cell infiltrations, with myocyte damage. The intensity, immaturity and extension of mononuclear infiltrate, such as the severity of myocyte lesion define the grading of a rejection episode and the mode of immunosuppressive therapy. Arterio-occlusive disease, the main cause of death after the first year following transplantation, is characterized by concentric obliteration of coronary arteries.

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Lung allograft rejection. Histopathological parameters

Hippokratia 1999, 3(1): 10 - 16

M Leontsini

Abstract

The problem of differential diagnosis of lung allograft dysfunction is difficult, since pulmonary acute rejection episodes and opportunistic infections have a higher rate frequency than in other allografts. The histopathological lesion of acute pulmonary rejection is characterized by perivascular mononuclear cell infiltrates in the interstitium and bronchiolar inflammation. The grading system of lung rejection is based on histological parameters. An acute rejection episode is graded according to the nature and extent of mononuclear cell infiltrates. Perivascular and peribronchiolar mononuclear cell infiltrates are the common feature in pulmonary infections.
Special histochemical stains and molecular techniques facilitate the diagnosis. Chronic pulmonary rejection is characterized by obliterative bronchiolitis and chronic vascular rejection. Obliterative bronchiolitis has many other causes such as drugs, toxins and infections, so biopsy assessment is crucial for diagnosis and therapy.

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Ischemic nephropathy

Hippokratia 1999, 3(1): 17 - 22

G Efstratiadis

Abstract

As ischemic renal disease or ischemic nephropathy is defined renal failure due to significant obstruction to renal blood flow caused mainly by atherosclerotic renal artery disease. Ischemia, hypertention and atheroembolic disease seem to be the main pathogenetic mechanisms causing renal atrophy and leading patients with ischemic nephropathy to progressive renal failure.
Revascularization, in a fairly high proportion of patients, is not effective causing rather deterioration than improvement of renal function. The best results have been reported when revascularization is performed in patients with renal function in the "window" area of serum creatinine between 1,5 to 3 mg/dl.

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Use of recombinant human erythropoietin in renal transplant recipients

Hippokratia 1999, 3(1): 23-28

G Vergoulas, Gr. Miserlis, F. Solonaki, G. Imvrios, V. Papanikolaou, A. Antoniadis

Abstract

Fifteen renal transplant recipients, mean age 36 years (11 men) with chronic transplant nephropathy (serum creatinine 3,9 mg/dl) and renal anemia (Hb 7,34 g/dl) were treated with recombinant human erythropoietin β for four months. In all these patients anemia improved and mean hemoglobin level increased to 9,3 g/dl. Mean serum creatinine increased to 4,20 mg/dl but the progression of graft failure was not influenced when compared with pretreatment levels of serum creatinine measured three months before erythropoietin treatment. Mean blood pressure levels remained stable but 5 patients required additional antihypertensive medication.

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Changes of serum apolipoproteins and Lp(a) in patients with Parkinsonism

Hippokratia 1999, 3(1): 29 - 32

R. Tsitamidou, M. Bostantsopoulou, E. Babaliki, Od. Kourkoulis, Ath Salagoudis, K. Pinaka

Abstract

Abnormal serum apolipoprotein levels are reported in neurological disorders such as the genetic relationship between myotonic dystrophy and Apo CII. Recently increasing attention has been focused on the possible roles of Apo Ε in the nervous system. Lp (a) is a potential atherogenic and thrombogenic risk factor. Lp(a) levels have been reported to be associated with cerebral ischemia. The aim of the study was to investigate the changes of serum apolipoproteins and Lp(a) in neural degenerative disease (parkinsonism) and the clinical usefulness.We measured apoliproteins [AI, AII, Β, Ε and Lp(a)] in the serum of patients with Parkinsonism and compared them with healthy controls using the immunoturbidimetric method. Statistically significant decreases of serum Apo Al, increases of Apo Ε and increased of Lp(a) were observed.It is suggested that these parameters should be included in the laboratory control of patients with diseases of neural system, since it is known that they are associated with degenerative diseases of the CNS (Apo E) and atherosclerotic lesions [Lp(a)].

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The surgical management of soft tissue sarcomas (STS)

Hippokratia 1999, 3(1): 33 - 37

N. Sikas, JM Thomas

Abstract

Soft tissue sarcomas are rare, comprising only 1% of all malignancies. Excision of the tumour with clear margins both macroscopically and microscopically is the most effective way of management. In a 6-month time period, at The Royal Marsden Hospital of London, 59 patients with the diagnosis of primary or recurrent STSs, were treated. They were 29 men and 30 women and their age ranged between 18 and 80. Most of them were located in the upper and lower limbs. The main symptom was a palpable mass and in the diagnosis contributed the Tru-Cut biopsy as well as computed tomography and MRI. For the management of these STSs, wide excision was performed in 37 cases, re-excision of residual tumour in 6, debulking in 9, amputation in 5 and exploratory laparotomy in 3. Chemotherapy was given pre-operatively in 4 patients and post-operatively in 3. Radiotherapy was administered pre-operatively in 1 patient and post-operatively in 12. Histologically the commonest lesions were liposarcoma and leiomyosarcoma.In conclusion, the diagnosis of STS should be considered in toumours arising deeper to deep fascia and increase in size within a short period of time. Tru-Cut biopsy is the method of choice in pre-operative diagnosis. The accurate pre-operative diagnosis and the wide excision of the tumour followed by radiotherapy result in a very low recurrence rate.

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Rhabdoid tumor of the Kidney

Hippokratia 1999, 3(1): 38 - 41

A. Papanikolaou, B. Sidi, CG. Gunioti, F. Karasavidu, S. Agelidu

Abstract

A case of rhabdoid tumor of kidney, in a 2 month-old male infant, is presented. The first symptom was macroscopic hematuria. CT scan of the abdomen revealed a tumor to the left kidney and the infant underwent a left nephrectomy. The histological diagnosis was based on the characteristic "rhabdoid" appearance of the neoplastic cells. Rhabdoid tumor is considered to be one of the most malignant tumors of the early life (<2 years), comprasing 2% of childhood renal cancer. This tumor is characterized by early metastases and a poor response to therapy. In our case the patient was treated with five circles of chemotherapy, with CARBO, IFOS and ETOP. Because of no response, two circles with topotekane were added, without any results. The infant died 5 months after the diagnosis.

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