216 results on '"Reemtsma, K."'
Search Results
2. Murine streptozotocin diabetes: influences of the major histocompatibility complex, genetic background and blood transfusion
- Author
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Weber, C., Pernis, B., Ting, W., Rosenkrantz, K., and Reemtsma, K.
- Published
- 1984
- Full Text
- View/download PDF
3. CARDIAC TRANSPLANTATION FOLLOWING MECHANICAL CIRCULATORY SUPPORT
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Hardy, M. A., Dobelle, W., Bregman, D., Drusin, R., Schwartz, A., Edie, R., and Reemtsma, K.
- Published
- 1979
4. A NEW COUNTERPULSATION DEVICE FOR THE TREATMENT OF ACUTE PULMONARY EMBOLUS — CANINE CIRCULATORY DYNAMICS
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Avery, G. J., II, Spotnitz, H. M., Reemtsma, K., Malm, J. R., and Bregman, D.
- Published
- 1977
5. IMPAIRED RESPONSIVENESS OF LYMPHOCYTES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS.
- Author
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Suciu-Foca, Nicole, Buda, J. A., Thiem, Traute, and Reemtsma, K.
- Subjects
IMMUNE response ,LYMPHOCYTES ,SYSTEMIC lupus erythematosus ,HISTOCOMPATIBILITY ,ANTIGENS ,BLOOD plasma - Abstract
Cellular immune responsiveness, as measured by lymphocyte transformation in one-way mixed leucocyte cultures (MLC) and in phytohaemagglutinin (PHA) stimulated cultures was evaluated in forty patients with systemic lupus erythematosus (SLE) and in seventy-four normal controls. The effect produced by sera from these subjects on in vitro lymphocyte reactivity was tested on autologous cells and on homologous responding cells from a constant panel of ten healthy volunteers. The reactivity of lymphocytes from SLE patients to PHA and to a battery of allogeneic cells was significantly lower than that of normal controls. Sera from some SLE patients inhibited the MLC reactions, while in other cases a distinct stimulatory effect was found. It is suggested that virus-induced modifications of normal histocompatibility antigens cause the appearance of blocking antibody that might bind to the surface of T lymphocytes, impairing their function. [ABSTRACT FROM AUTHOR]
- Published
- 1974
6. Alternatives in pancreatic islet transplantation: tissue culture studies.
- Author
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Reemtsma, K, Weber, C J, Pi-Sunyer, F X, Lerner, R L, and Hardy, M A
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- 1980
- Full Text
- View/download PDF
7. Hyperinsulinemia and hyperglucagonemia following pancreatic islet transplantation in diabetic rats.
- Author
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Weber, C. J., Hardy, M. A., Lerner, R. L., Felig, P., and Reemtsma, K.
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- 1976
- Full Text
- View/download PDF
8. New HLA-D Alleles Associated with DRI and DR2.
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Suciu-Foca, N., Godfrey, M., Khan, R., Woodward, K., Rohowsky, C., Reed, E., Hardy, M., and Reemtsma, K.
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- 1981
- Full Text
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9. Quantitation of HLA-D Differences.
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Suciu-Foca, N., Rubinstein, P., Susinno, E., Broell, J., Weiner, J., and Reemtsma, K.
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- 1978
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10. Pancreatic polypeptide (PP) immunoreactivity in human parathyroid culture media
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Weber, C., Modlin, I., DiBella, F., LoGerfo, P., Hardy, M., Feind, C., and Reemtsma, K.
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- 1983
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11. The economics of instant medical news.
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Reemtsma, K. and Maloney Jr., J. V.
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- 1975
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12. New HLA-D alleles associated with DRW1 and DRW2
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Suciu-Foca, N., Godfrey, M., Khan, R., Woodward, K., Rohowsky, C., Sawczuk, A., Hardy, M., and Reemtsma, K.
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- 1980
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13. Endocrine Transplantation
- Author
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Reemtsma, K. and Weber, C.J.
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- 1982
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14. The role of human parathyroid cryopreservation
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Weber, C., Feind, C., DiBella, F., logerfo, P., Hardy, M., Hriata, R., Strong, D.M., Light, J., Gamez, A., Wilkinson, D., Ozzello, L., Fenoglio, C., and Reemtsma, K.
- Published
- 1982
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15. Murine islet cryopreservation and corticosteroids: Functional studies
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Weber, C., Pi-Sunyer, F.X., and Reemtsma, K.
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- 1982
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16. Selective lymphoid irradiation: III. Prolongation of cardiac xenografts and allografts in presensitized rats
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Reemtsma, K
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- 1982
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17. Xenotransplantation of piscine islets into hyperglycemic rats
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Reemtsma, K
- Published
- 1975
18. Role of TAP-1 and/or TAP-2 antigen presentation defects in tumorigenicity of mouse melanoma.
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Agrawal S, Reemtsma K, Bagiella E, Oluwole SF, and Braunstein NS
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- ATP Binding Cassette Transporter, Subfamily B, Member 2, ATP Binding Cassette Transporter, Subfamily B, Member 3, ATP-Binding Cassette Transporters genetics, Animals, Antigen Presentation genetics, Blotting, Northern, Cytotoxicity Tests, Immunologic, Flow Cytometry, Histocompatibility Antigens Class I immunology, Immunotherapy, Lung Neoplasms genetics, Lung Neoplasms pathology, Male, Melanoma, Experimental genetics, Melanoma, Experimental pathology, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, RNA, Neoplasm chemistry, RNA, Neoplasm genetics, T-Lymphocytes, Cytotoxic, Transfection, ATP-Binding Cassette Transporters immunology, Antigen Presentation immunology, Lung Neoplasms immunology, Melanoma, Experimental immunology
- Abstract
Mutations in transporters associated with antigen processing (TAP-1 and -2) required for the transport of cytosolic endogenous peptides to the endoplasmic reticulum correlate with increased metastatic potential and reduced host survival in several malignancies. To address the possible function of TAP as a "tumor suppressor" gene, we show that correction of TAP-1 and/or TAP-2 defects in B16 mouse melanoma enhanced the cell surface expression of MHC class I molecules and significantly reduced the rate of subcutaneous tumor growth and pulmonary metastatic burden. Cytotoxic assays confirmed increased sensitivity of TAP-1 and/or TAP-2 transfected clones of B16 melanoma to cytotoxic T lymphocytes. These results indicate that the expression of TAP limits the malignant potential of tumors with implications for CD8(+) T cell-based immunotherapy in controlling growth of certain TAP-deficient malignancies.
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- 2004
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19. Results of crossmatch between chimpanzee lymphocytes and sera of highly sensitized potential renal transplant recipients.
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Rabkin DG, Nowygrod R, Hardy MA, and Reemtsma K
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- Animals, Antibodies, Heterophile blood, Humans, Isoantibodies blood, Nephrectomy, Species Specificity, Tissue and Organ Procurement, Antibodies, Heterophile immunology, Antigens, Heterophile immunology, Blood Grouping and Crossmatching, HLA Antigens immunology, Histocompatibility Antigens immunology, Isoantibodies immunology, Isoantigens immunology, Kidney Transplantation immunology, Lymphocytes immunology, Pan troglodytes immunology
- Abstract
Background: We tested the hypothesis that patients with a high frequency of lymphocytotoxic antibodies against human cells are not highly sensitized to major histocompatibility complexes expressed by chimpanzee cells., Methods: Sera from six "hopelessly" sensitized patients (percentage reactive antibodies (PRA) > 99%) on the renal transplant waiting list were crossmatched with peripheral blood lymphocytes from 10 chimpanzees. Lymphocytotoxic antibodies reacting with chimpanzee peripheral blood lymphocytes were identified., Results: Three of the six patients with a high frequency of lymphocytotoxic antibodies against human cells had no xenospecific antibodies., Conclusion: Patients with a high frequency of lymphocytotoxic antibodies against human cells are not all panel-reactive to chimpanzees. Unilateral donor nephrectomy in non-human primates may offer an opportunity for safe expansion of the donor organ pool for these patients.
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- 2002
- Full Text
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20. Address by the Honorary Founding President of the Xenotransplantation Society. The eye of an eagle: xenobiology and the quest for bioadvantage.
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Reemtsma K
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- Animals, Humans, Zoonoses transmission, Transplantation, Heterologous methods, Transplantation, Heterologous trends
- Abstract
My purpose in these remarks is to stimulate us to consider the vast array that nature has provided us in the differentiation of species, and to examine the possibility that some of these differences might prove useful in other species, including man.
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- 2000
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21. Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995.
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Sollano JA, Gelijns AC, Moskowitz AJ, Heitjan DF, Cullinane S, Saha T, Chen JM, Roohan PJ, Reemtsma K, and Shields EP
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- Adolescent, Adult, Aortic Aneurysm, Abdominal mortality, Cardiac Surgical Procedures statistics & numerical data, Child, Child, Preschool, Coronary Artery Bypass mortality, Female, Heart Defects, Congenital mortality, Humans, Infant, Infant, Newborn, Male, New York epidemiology, Outcome Assessment, Health Care, Vascular Surgical Procedures statistics & numerical data, Aortic Aneurysm, Abdominal surgery, Coronary Artery Bypass statistics & numerical data, Heart Defects, Congenital surgery, Hospital Mortality
- Abstract
Background: It has been known for nearly 20 years that, in cardiovascular operations, a significant inverse relationship exists between clinical outcomes and the volume of procedures performed. Interestingly, this relationship persists 2 decades after it was recognized., Objective: The purpose of this study was to examine the relationship between hospital volume and in-hospital deaths in 3 cardiovascular procedures: coronary artery bypass grafting, elective repair of abdominal aortic aneurysms, and repair of congenital cardiac defects., Methods: The database includes all patients who were hospitalized in New York State during the years 1990 to 1995. Using standard logistic regression techniques, we analyzed the relationship between hospital volume and outcome., Results: No correlation exists between hospital volume and in-hospital deaths in coronary artery bypass grafting. Statewide, 31 hospitals performed 97,137 operations over the 6-year period (overall mortality rate, 2. 75%). By contrast, most of the hospitals statewide (195 of 230 hospitals) performed 9847 elective abdominal aortic aneurysm repairs with an overall mortality rate of 5.5%. In abdominal aortic aneurysm operations, a significant inverse relationship between hospital volume and in-hospital deaths was determined. Sixteen hospitals performed 7199 repairs for congenital cardiac defects. A significant inverse relationship (which was most pronounced for neonates) was found between volume and death., Conclusions: The importance of these findings lies in the rather striking difference between the volume-outcome relationship found for operations for abdominal aortic aneurysms and congenital cardiac defects and the lack of such a relationship for coronary artery bypass grafting. This observation may be largely explained by the quality improvement program in New York State for bypass operations since 1989. If so, these results have important implications for expanding the scope of quality improvement efforts in New York State.
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- 1999
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22. Cost-effectiveness of coronary artery bypass surgery in octogenarians.
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Sollano JA, Rose EA, Williams DL, Thornton B, Quint E, Apfelbaum M, Wasserman H, Cannavale GA, Smith CR, Reemtsma K, and Greene RJ
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- Age Factors, Aged, Aged, 80 and over, Cohort Studies, Coronary Artery Bypass mortality, Cost-Benefit Analysis, Female, Humans, Male, Quality of Life, Retrospective Studies, Surveys and Questionnaires, Survival Rate, Coronary Artery Bypass economics
- Abstract
Objective: The objective of this retrospective cohort study was to determine whether coronary artery bypass graft (CABG) surgery is effective and cost-effective relative to medical management of coronary artery disease (CAD) in the elderly., Summary Background Data: The aging of the U.S population and the improvements in surgical techniques have resulted in increasing numbers of elderly patients who undergo this surgery. The three randomized, controlled trials (RCTs) that established the efficacy of CABG surgery completed patient enrollment from 19 to 24 years ago excluded patients older than 65 years. Although information regarding outcomes of CABG in this population is mainly available in case series, a major lacuna exists with respect to information on quality of life and cost effectiveness of surgery as compared with medical management., Methods: The authors retrospectively formed surgical and medically managed cohorts of octogenarians with significant multivessel CAD. More than 600 medical records of patients older than 80 years who underwent angiography at our institution were reviewed to identify 48 patients who were considered reasonable surgical candidates but had not undergone surgery. This cohort was compared with 176 patients who underwent surgery., Results: The cost per quality-adjusted life year saved was $10,424. At 3 years, survival in the surgical group was 80% as compared with 64% in the entire medical cohort and 50% in a smaller subset of the medical cohort. Quality of life in patients who underwent surgery was measurably better than that of the medical cohort with utility index scores, as measured by the EuroQoL, (a seven-item quality of life questionnaire) of 0.84, 0.61, and 0.74, respectively., Conclusions: Performing CABG surgery in octogenarians is highly cost-effective. The quality of life of the elderly who elect to undergo CABG surgery is greater than that of their cohorts and equal to that of an average 55-year-old person in the general population.
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- 1998
- Full Text
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23. Implantable left ventricular assist devices: an evolving long-term cardiac replacement therapy.
- Author
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DeRose JJ, Argenziano M, Sun BC, Reemtsma K, Oz MC, and Rose EA
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- Ambulatory Care, Cardiomyopathies mortality, Cardiomyopathies surgery, Cause of Death, Hospitalization, Humans, Patient Selection, Shock, Cardiogenic, Survival Analysis, Time Factors, Treatment Outcome, Heart-Assist Devices adverse effects
- Abstract
Objective: The authors' 8-year experience with both inpatient and outpatient left ventricular assist device (LVAD) support is presented to show the possibilities and limitations of long-term outpatient mechanical circulatory assistance., Summary Background Data: The limitation of suitable cardiac donors has led to the use of LVADs as a temporizing measure for patients awaiting cardiac transplantation. The success of such devices in the short and medium term as a bridge to transplantation has led to their evaluation as a long-term destination therapy for end-stage heart disease., Methods: Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implantable LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device., Results: Patients were supported for a mean of 109+/-13 days for an overall survival to transplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41+/-4 (range, 17-68) for an outpatient support time of 108+/-30 days (range, 2-466). Of 12 patients supported after postcardiotomy cardiogenic shock, 10 (82%) survived to hospital discharge. Perioperative right ventricular failure was treated in most patients with inotropic agents and inhaled nitric oxide with only six patients requiring right ventricular assist device support. Thromboembolic rate was low (0.016 events/patient-month) despite minimal or no anticoagulation in all cases., Conclusions: Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Accordingly, wearable LVADs should be studied as permanent treatment options for patients who are not transplant candidates.
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- 1997
- Full Text
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24. Cardiac transplantation for auxiliary circulatory support.
- Author
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Reemtsma K
- Subjects
- Humans, Assisted Circulation, Heart Transplantation, Transplantation, Heterotopic
- Published
- 1997
- Full Text
- View/download PDF
25. Using surgical outcomes data.
- Author
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Reemtsma K and Heath NP
- Subjects
- Clinical Competence, Data Collection, Data Interpretation, Statistical, Managed Care Programs standards, United States, Outcome Assessment, Health Care statistics & numerical data, Quality of Health Care standards, Surgical Procedures, Operative standards
- Abstract
The measurement of expanded outcomes data is continuing. As managed care continues to spread through the United States and competition increases, an increased emphasis will be placed on the importance of collecting and analyzing outcomes data as a way to assess and ensure quality of care. Surgeons must familiarize themselves with the concepts behind the measurement of outcomes data and involve themselves in the development of outcomes indicators for surgery in order to ensure a continuing high level of surgical care is provided to their patients.
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- 1997
26. Outcomes assessment: a primer.
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Reemtsma K and Morgan M
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- Cost-Benefit Analysis, Data Collection, Humans, Managed Care Programs standards, Outcome Assessment, Health Care trends, Patient Satisfaction, Quality of Life, Research Design, United States, Outcome Assessment, Health Care standards, Specialties, Surgical standards
- Abstract
The routine assessment of outcomes, including clinical and functional outcomes, charges, cost and effectiveness data, and complications of treatment, as well as HRQOL and patient satisfaction, are essential to demonstrate and ensure the quality of care. Secondary to patient-related concerns, outcomes data provide a tool for use by the surgeon in proving (and improving) the quality of care rendered. These tools, as well as surgical input into the development of outcomes indicators, will allow surgeons to practice more effectively in a managed care environment.
- Published
- 1997
27. Assessment of submaximal exercise capacity in patients with left ventricular assist devices.
- Author
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Foray A, Williams D, Reemtsma K, Oz M, and Mancini D
- Subjects
- Adult, Aged, Dobutamine therapeutic use, Female, Humans, Male, Middle Aged, Oxygen Consumption, Exercise, Heart-Assist Devices
- Abstract
Background: Long-term implantable left ventricular assist devices (LVADs) are increasingly used as a bridge to cardiac transplantation and may be used as long-term therapy for end-stage heart failure. After insertion of an LVAD, patients frequently become ambulatory. Sensors contained within these devices can measure the hemodynamic demands of submaximal exercise. In this study, we performed serial assessment of submaximal exercise capacity in patients with LVADs early (< 3 months), mid (3 to 6 months), and late (> 6 months) after device implantation to determine whether submaximal exercise capacity increased over time and whether this was related to improvements in the cardiac output response. Moreover, we compared the sub-maximal exercise capacities of these patients with those of normal subjects and patients with mild to severe heart failure., Methods and Results: An encouraged 6-minute walk test with metabolic measurements was used to assess submaximal exercise capacity in 14 patients with LVADs, 20 patients with mild to moderate congestive heart failure (CHF), 14 patients with severe heart failure dependent on dobutamine (DB), and 6 normal subjects. Cardiac output measurements at rest and during exercise were obtained in the patients with devices. Distance walked was significantly greater for LVAD patients than DB patients and was similar to that for patients with mild CHF (LVAD, 1562 +/- 404; DB, 948 +/- 241; and CHF, 1358 +/- 278 ft; P < .01). Vo2 was also greater in the LVAD than DB or CHF patients (LVAD, 16.3 +/- 6.5; DB, 9.8 +/- 4.8; and CHF, 11.2 +/- 2.0 mL.kg-1.min-1; P < .05). Vo2 (23.4 +/- 7.4 mL.kg-1.min-1) and distance walked (2142 +/- 408 ft) in normal subjects was significantly greater than for all patient groups (all P < .01). Serial assessment of submaximal exercise capacity in LVAD patients demonstrated continued sustained improvement over time (early, 1261 +/- 341; mid, 1538 +/- 345; and late, 1867 +/- 265 ft; P < .05). However, peak cardiac output response was unchanged (early, 8 +/- 1.3; mid, 8.6 +/- 1.4; and late, 8.6 +/- 1.4 L/min; P = NS)., Conclusions: The submaximal exercise capacity of LVAD patients is comparable to that of patients with mild CHF but significantly better than that of dobutamine-dependent patients. Hemodynamic and metabolic assessment during 6-minute walk tests demonstrates that in patients with heart failure and LVAD, cardiovascular demands are generally > 85% of maximum. A significant sustained improvement in submaximal exercise capacity occurs with chronic LVAD therapy. Lack of alteration of the cardiac output response to exercise suggests that this functional improvement results from peripheral mechanisms.
- Published
- 1996
28. Multivariate analysis of factors affecting waiting time to heart transplantation.
- Author
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Chen JM, Weinberg AD, Rose EA, Thompson SM, Mancini DM, Ellison JP, Reemtsma K, and Michler RE
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- ABO Blood-Group System, Adult, Aged, Female, Humans, Male, Middle Aged, Multivariate Analysis, New York City, Patient Selection, Proportional Hazards Models, Health Care Rationing, Heart Transplantation statistics & numerical data, Waiting Lists
- Abstract
Background: The growing clinical success of cardiac transplantation has resulted in a dramatic increase in the number of patients referred and subsequently listed for cardiac transplantation. Paradoxically, in the presence of a limited donor organ pool, such expansion has increased both the waiting time for transplantation and the number of patients dying while on the waiting list., Methods: We performed univariate and multivariate analyses of the waiting times of 301 patients listed for transplantation using a Cox proportional hazards model to evaluate the simultaneous effect of multiple variables on the waiting time of heart transplant candidates. Variables considered included age, sex, race, blood type, weight at listing, United Network for Organ Sharing (UNOS) status at listing, UNOS status at transplantation, and proportion of time on the waiting list as UNOS status 1., Results: The mean waiting time for patients ultimately having transplantation was 170.2 +/- 206.0 days; the median waiting time was 103.5 days. Age, sex, weight, blood type, and percent of time as UNOS status 1 all had a significant impact on waiting time in the univariate analysis. By multivariate analysis, proportion of time as UNOS status 1, lower weight at listing, and blood type AB were all highly associated as predictors of a shorter waiting time. Weight at listing represented a continuous variable whose risk ratio for a shorter waiting time correlated in such a way that the risk of a longer waiting time increased 2.3 per 22.5-kg (50-pound) increase in weight. Blood types A and B, although associated with a shorter waiting time, correlated less strongly than the other three variables., Conclusions: Our findings from this multivariate analysis demonstrate that UNOS status, blood type, and weight were the variables that most strongly affected overall waiting time for transplantation. It is our hope to define more accurately a group of patients with both a high likelihood of a long waiting time and a prohibitive risk of death while on the waiting list, who therefore may benefit from surgical alternatives to transplantation.
- Published
- 1996
- Full Text
- View/download PDF
29. Xenotransplantation: A Historical Perspective.
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Reemtsma K
- Published
- 1995
- Full Text
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30. Supporting future surgical innovation. Lung transplantation as a case study.
- Author
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Reemtsma K, Gelijns AC, Sisk JE, Arons RR, Boozang PM, Berland GK, Evans CM, and Smith CR
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- Centers for Medicare and Medicaid Services, U.S., Diffusion of Innovation, Health Care Costs, Heart-Lung Transplantation economics, Heart-Lung Transplantation trends, Humans, Lung Transplantation trends, Outcome Assessment, Health Care economics, United States, General Surgery, Insurance, Surgical, Lung Transplantation economics, Research Support as Topic
- Abstract
Objective: Using lung transplantation as a case study, this article addressed the problem of supporting innovative clinical surgery in an era of increasing pressures for cost containment., Summary Background Data: After sporadic attempts at lung transplantation during the 1960s and 1970s, its clinical development began in earnest during the early 1980s. As a result of a wide range of incremental advances, the results have improved significantly. The Health Care Financing Administration, however, has not yet issued a national policy covering lung transplants and has left the coverage decision to the discretion of its regional contractors., Methods: The authors surveyed the major commercial insurers, the Blue Cross Blue Shield Association, and a sample of Medicare intermediaries to evaluate the coverage of lung transplantation. They also interviewed the National Heart, Lung, and Blood Institute and industrial firms about their support for clinical research., Results: Government and industry funding were limited, and the development and assessment of lung transplants have been financed predominantly by academic institutions through cross-subsidization from patient care and teaching funds. The major private payers and Blue Cross Blue Shield decided to cover this procedure in the early 1990s. Coverage decisions by Medicare intermediaries, however, revealed considerable variability. Moreover, the absence of a specific diagnosis-related group for lung transplants had considerable consequences for institutions in all-payer states, in which payments appeared to be considerably lower than the mean costs of a transplant procedure (about $110,000)., Conclusions: This analysis indicated that there was a growing disparity between the increasing demand for outcomes data about new procedures and the limited resources available for supporting the development and assessment of new operations. It this disparity is not addressed, the rate of surgical innovation may be jeopardized, and timely outcomes data may not be acquired. It was concluded that provisional coverage within a predetermined research protocol may be a promising mechanism to remedy this situation, providing timely assessment of new procedures before widespread application.
- Published
- 1993
- Full Text
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31. Effect of anti-HLA antibodies on the long-term survival of heart and kidney allografts.
- Author
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Barr ML, Cohen DJ, Benvenisty AI, Hardy M, Reemtsma K, Rose EA, Marboe CC, D'Agati V, Suciu-Foca N, and Reed E
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- Arteriosclerosis etiology, Arteriosclerosis immunology, Biomarkers blood, Graft Rejection immunology, HLA-D Antigens analysis, Histocompatibility Antigens Class I analysis, Humans, Retrospective Studies, Transplantation, Homologous, Antibodies, Anti-Idiotypic blood, Antibody Formation, Graft Survival immunology, HLA Antigens immunology, Heart Transplantation immunology, Kidney Transplantation immunology
- Abstract
Study of anti-HLA antibodies in a population of 238 primary renal and 199 primary heart allograft recipients showed significant association between development of anti-HLA antibodies and that of chronic allograft rejection. The 5-year renal allograft survival was 70% in recipients without antibodies and 53% in recipients who developed anti-HLA alloantibodies during the first year following transplantation. Heart allograft survival at 5 years was 91% in patients without and 78% in patients with antibodies during the first 12 months posttransplantation. Development of antibodies is associated with acute rejection episodes and probably with the release of soluble HLA antigens.
- Published
- 1993
32. Humoral reaction to microencapsulated rat, canine, and porcine islet xenografts in spontaneously diabetic NOD mice.
- Author
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Weber C, D'Agati V, Ward L, Costanzo M, Rajotte R, and Reemtsma K
- Subjects
- Animals, Blood Glucose analysis, Diabetes Mellitus, Type 1 blood, Dogs, Fluorescent Antibody Technique, Graft Rejection, Immunoglobulin M analysis, Islets of Langerhans Transplantation pathology, Islets of Langerhans Transplantation physiology, Mice, Mice, Inbred NOD, Rats, Swine, Transplantation, Heterologous pathology, Transplantation, Heterologous physiology, Antibody Formation, Diabetes Mellitus, Type 1 surgery, Islets of Langerhans Transplantation immunology, Transplantation, Heterologous immunology
- Published
- 1993
33. Sixteen years of cardiac transplantation: the Columbia Presbyterian Medical Center experience 1977 to 1993.
- Author
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Michler RE, Chen JM, Mancini DM, Reemtsma K, and Rose EA
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- Academic Medical Centers, Actuarial Analysis, Adult, Anti-Bacterial Agents therapeutic use, Child, Female, Graft Rejection therapy, Graft Survival, Heart Transplantation mortality, Heart Transplantation trends, Humans, Immunosuppression Therapy, Infections drug therapy, Male, New York City epidemiology, Reoperation, Survival Rate, Tissue Donors, Heart Transplantation statistics & numerical data
- Abstract
Cardiac transplantation is currently recognized as the best therapy available for the treatment of endstage heart disease. Since 1977, more than 650 cardiac transplants have been performed at CPMC, with a one-year survival rate currently approaching 85% and a 5-year survival rate approaching 65%. Throughout the 16-year experience with cardiac transplantation at CPMC, the criteria of eligibility for both donor and recipient candidates have been expanded to include older patients. In addition, pediatric patients requiring complex arterial or venous reconstruction and patients with elevated, but reversible pulmonary vascular resistance have been transplanted with excellent results. With the evolution of prolonged posttransplant survival has come a new group of complications associated with chronic long-term immunosuppressive therapy. These, and issues relating to cardiac retransplantation, continue to increase, largely because of the critical lack of organ donors. Continued efforts are being developed to optimize and reduce the total amount of immunosuppression administered postoperatively. Currently, research interests at CPMC include therapy for transplant coronary artery disease, left ventricular assist devices, and xenotransplantation. Ongoing investigations in these and other areas of transplantation have been established to encourage continued growth both within the field and at CPMC through the 21st century.
- Published
- 1993
34. Effect of recipient gender and race on heart and kidney allograft survival.
- Author
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Reed E, Cohen DJ, Barr ML, Ho E, Reemtsma K, Rose EA, Hardy M, and Suciu-Foca N
- Subjects
- Actuarial Analysis, Age Factors, Cadaver, Follow-Up Studies, Graft Rejection mortality, HLA Antigens immunology, Heart Transplantation mortality, Histocompatibility Testing, Humans, Kidney Transplantation mortality, Postoperative Complications mortality, Sex Factors, Survival Rate, Black People, Graft Rejection immunology, Graft Survival immunology, Heart Transplantation immunology, Kidney Transplantation immunology, Postoperative Complications immunology, White People
- Abstract
Study of long-term survival of heart allografts shows that AA males and females have lower graft survival rates than those observed in NAC recipients. Primary kidney allografts in AA males, but not females, also display lower 5-year survival rates compared to those observed in the corresponding populations of NAC. Comparison of graft survival in the overall population of male and female recipients of kidney allografts shows that females have higher graft survival rates, probably as a result of better HLA matching. The level of alloantibody activity in posttransplantation sera is similar in the two populations, suggesting that factors other than HLA mismatching may contribute to the higher degree of graft failure in AA recipients.
- Published
- 1992
35. Management of peripheral vascular problems in recipients of cardiac allografts.
- Author
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Benvenisty AI, Todd GJ, Argenziano M, Buda JA, Reemtsma K, Smith CR, and Rose EA
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- Adolescent, Adult, Aortic Aneurysm, Abdominal epidemiology, Aortic Aneurysm, Abdominal surgery, Arteriosclerosis epidemiology, Arteriosclerosis surgery, Catheterization, Central Venous adverse effects, Child, Preschool, Female, Humans, Immunosuppression Therapy, Intra-Aortic Balloon Pumping adverse effects, Male, Middle Aged, Peripheral Vascular Diseases epidemiology, Risk Factors, Treatment Outcome, Heart Transplantation, Peripheral Vascular Diseases surgery
- Abstract
Five hundred and twenty consecutive heart transplant cases (458 adult, 62 pediatric) were reviewed to assess the impact of peripheral vascular problems. Peritransplant interventions requiring vascular cannulation (e.g., intraaortic balloon pump procedures, catheterization of the right and left sides of the heart, femoral bypass) resulted in 10 complications that necessitated nine surgical procedures. Five aortic aneurysms (three infrarenal and two suprarenal) were resected. There was one death unrelated to the aneurysm resection. Sixteen patients had evidence of peripheral vascular disease (PVD). There were three deaths in this group, none directly related to the PVD. Three patients required vascular reconstruction (axillobifemoral, bilateral femoral distal and popliteal endarterectomy) in the posttransplant period, all for advanced ischemic symptoms. Except for one patient in whom ischemia-related ulcers developed on the heels, all patients had improved or stable symptoms that did not require intervention. There were no limb losses or vascular infections. We conclude that despite the rigors of posttransplant immunosuppression, patients with stable manifestations of PVD may successfully undergo heart transplantation and subsequent vascular reconstruction, when indicated, without prohibitive risk.
- Published
- 1992
36. Evaluation of surgical procedures. Changing patterns of patient selection and costs in heart transplantation.
- Author
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Reemtsma K, Berland G, Merrill J, Arons R, Evans C, Drusin R, Smith CR, and Rose EA
- Subjects
- Costs and Cost Analysis, Critical Care, Evaluation Studies as Topic, Heart Transplantation mortality, Heart Transplantation rehabilitation, Heart Transplantation trends, Humans, Length of Stay, Survival Rate, Heart Transplantation economics
- Abstract
During the past 4 years we have observed a marked increase in costs of heart transplantation in our center. This trend coincides with a shift in our recipient population toward the more severely ill patients. The percentage of patients bound for the intensive care unit has doubled. In analyzing the components of cost, we find that the length of stay, both in special care and regular nursing units, accounts for most of the cost increase. In our study of outcomes we find no significant difference in survival, at 1 month and 1 year, between recipients operated on from the intensive care unit and those not in intensive care. We find that at 1 year after transplantation, approximately 80% of patients are rehabilitated, which we define as the ability to work or to go to school. Only 20% of patients are off disability rolls, however, primarily because of problems related to insurance and the cost of continuing care, including drugs. We conclude that the comprehensive evaluation of surgical procedures requires an approach that balances costs with results on a continuing and long-term basis.
- Published
- 1992
37. Xenografts.
- Author
-
Reemtsma K
- Subjects
- Animals, Graft Rejection prevention & control, Humans, Pan troglodytes, Papio, Primates, Transplantation, Heterologous
- Published
- 1992
38. Lymphocyte xenoantigens recognized by preformed antibodies.
- Author
-
Ratner AJ, Canhui H, Pepino P, Sanchez JA, Edwards N, Watkins JF, Xu H, Reemtsma K, Rose EA, and Berger C
- Subjects
- Animals, Antigens, Heterophile analysis, Blotting, Western, Endothelium, Vascular immunology, Goats, Myocardium immunology, Papio, Spleen immunology, Swine, Antibodies, Heterophile immunology, Antigens, Heterophile immunology
- Published
- 1992
39. Vascular (humoral) rejection in human cardiac allograft biopsies: relation to circulating anti-HLA antibodies.
- Author
-
Cherry R, Nielsen H, Reed E, Reemtsma K, Suciu-Foca N, and Marboe CC
- Subjects
- Adult, Biopsy, Female, Fluorescent Antibody Technique, Graft Survival immunology, Humans, Immunosuppressive Agents therapeutic use, Male, Myocardium pathology, Antibodies analysis, Graft Rejection immunology, HLA Antigens immunology, Heart Transplantation immunology
- Abstract
Vascular or humoral rejection (as defined by linear deposits of immunoglobulin and complement in myocardial capillaries) and the presence of circulating lymphocytotoxic anti-HLA antibodies are each associated with reduced long-term graft or patient survival. The relationship between these two factors has not been determined. We used immunofluorescent techniques to study 46 cardiac biopsy specimens in 16 patients from 15 to 412 days after transplantation. Biopsy specimens were selected from the first 2 months, and at approximately 6 and 12 months after transplantation and did not include episodes of acute cellular rejection. Each specimen studied was compared to a serum sample drawn an average of 1.8 days (range, 0 to 9 days) from the time of biopsy to assay for circulating anti-HLA antibodies. Of the specimens obtained at or near a positive anti-HLA antibody test, 90% (27 of 30) were found to have linear deposits of immunoglobulin (not necessarily with complement) versus 75% (12 of 16) of specimens obtained at the time of a negative test. Twenty-one cases of vascular rejection were documented. Both immunoglobulin M and immunoglobulin G were deposited along with complement in 13 instances; immunoglobulin M and complement were deposited in eight cases; no case had only immunoglobulin G and complement. The presence of circulating anti-HLA antibody in the serum was associated with 14 of the 21 cases of vascular rejection. Linear deposits of immunoglobulin in the capillaries of myocardium were frequently observed when anti-HLA antibodies were present in the serum.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1992
40. Discovery in surgery: reflections on a golden age.
- Author
-
Reemtsma K
- Subjects
- Forecasting, Societies, Medical, United States, Thoracic Surgery trends
- Published
- 1991
41. Immunomodulation of kidney and heart transplants by anti-idiotypic antibodies.
- Author
-
Hardy MA, Suciu-Foca N, Reed E, Benvenisty AI, Smith C, Rose E, and Reemtsma K
- Subjects
- Actuarial Analysis, Antibodies blood, Antibodies immunology, Antibodies, Anti-Idiotypic physiology, Follow-Up Studies, Graft Survival immunology, HLA Antigens blood, Heart Transplantation mortality, Humans, Kidney Transplantation mortality, Postoperative Period, Survival Rate, Time Factors, Antibodies, Anti-Idiotypic blood, HLA Antigens immunology, Heart Transplantation immunology, Kidney Transplantation immunology
- Abstract
To explore the possibility that circulating HLA antigens from the graft and anti-anti-HLA (anti-idiotypic) antibodies influence the long-term survival of renal and cardiac allografts, analysis of 330 renal allograft recipients and 174 recipients of cardiac allografts was conducted. Anti-donor-HLA antibodies (Ab1) present before or after transplantation are associated with graft failure, whereas irrelevant anti-HLA antibodies had no impact on actuarial graft survival. Ab1 may be uncovered by dissociation of immune complexes and depletion of soluble antigens with monoclonal antibody-coated magnetic beads. Of the 421 sera tested from 65 heart recipients, 97 showed Ab1 before depletion and 178 after depletion; similar rise in positive sera was seen in 39 renal transplant recipients. Three distinct patterns of appearance of Ab1 and Ab2 (anti-Ab1 antibody) were recognized. Patients with cyclic variations of Ab1 in association with Ab2 had 100% graft survival, whereas patients with cyclic variations of Ab1 but no detectable Ab2 had 2-year graft survival of 36% for kidneys and 71% for hearts. Presence of Ab1 in all sera after transplantation led to 47% and 56% 2-year renal and heart allograft survival, respectively.
- Published
- 1991
- Full Text
- View/download PDF
42. Migration patterns of dendritic cells in the rat: comparison of the effects of gamma and UV-B irradiation on the migration of dendritic cells and Lymphocytes.
- Author
-
Oluwole SF, Engelstad K, De Rosa C, Wang TS, Fawwaz RA, Reemtsma K, and Hardy MA
- Subjects
- Animals, Cell Movement radiation effects, Dendritic Cells radiation effects, Gamma Rays, Indium, Lymph Nodes cytology, Lymphocytes radiation effects, Mice, Rats, Rats, Inbred Strains, Splenectomy, Ultraviolet Rays, Dendritic Cells physiology, Lymphocytes physiology
- Abstract
To further define the underlying mechanisms of immune suppression induced by UV-B irradiation, we have examined the kinetics of homing patterns of in vitro UV-B-irradiated and gamma-irradiated-thoracic duct lymphocytes (TDL) compared to dendritic cells (DC). Our findings show that 111In-oxine-labeled TDL specifically home to the spleen, liver, lymph nodes, and bone marrow with subsequent recirculation of a large number of cells from the spleen to lymph nodes. In contrast, DC preferentially migrate to the spleen and liver with a relatively insignificant distribution to lymph nodes and an absence of subsequent recirculation. Splenectomy prior to cell injection significantly diverts the spleen-seeking DC to the liver but not to the lymph nodes, while the homing of TDL to lymph nodes is significantly increased. In vitro exposure of 111In-oxine labeled TDL to gamma irradiation does not significantly impair immediate homing to lymphoid tissues but inhibits cell recirculation between 3 and 24 hr. In contrast, gamma irradiation does not affect the tissue distribution of labeled DC, suggesting that DC are more radioresistant to gamma irradiation than TDL. Unlike the findings in animals injected with gamma-irradiated cells, UV-B irradiation virtually abolished the homing of TDL to lymph nodes and significantly reduced the homing of the spleen-seeking DC to the splenic compartment while a large number of cells were sequestered in the liver. The results of in vitro cell binding assay show that TDL, unlike DC, have the capacity to bind to high endothelial venules (HEV) within lymph node frozen sections while gamma and UV-B irradiation significantly inhibit the binding of TDL to lymph node HEV. These findings suggest that: (i) DC, unlike TDL, are unable to recirculate from blood to lymph nodes through HEV; (ii) although gamma irradiation impairs TDL recirculation, it does not affect DC tissue distribution; and (iii) UV-B irradiation impairs both TDL and DC migration patterns. We conclude that the lack of capacity of irradiated TDL to home to lymph nodes is due to damage to cell surface homing receptors and that the failure of DC to home to the lymph node microenvironment is related to the absence of HEV homing receptors on their cell surface.
- Published
- 1991
- Full Text
- View/download PDF
43. The role of anti-HLA antibodies in heart transplantation.
- Author
-
Suciu-Foca N, Reed E, Marboe C, Harris P, Yu PX, Sun YK, Ho E, Rose E, Reemtsma K, and King DW
- Subjects
- Antigen-Antibody Complex analysis, Autoantibodies analysis, Biomarkers blood, Follow-Up Studies, Graft Rejection, Humans, Isoantibodies immunology, Retrospective Studies, Autoantibodies immunology, Graft Survival, HLA Antigens immunology, Heart Transplantation immunology
- Abstract
The major threat to long-term survival of heart allograft recipients is the development of graft atherosclerosis, which seems to be a manifestation of chronic rejection. To assess the role of anti-HLA antibodies in heart allograft rejection we studied 107 patients and compared the survival of recipients who formed anti-HLA antibodies with the survival of recipients who developed no antibodies. At 4 years the actuarial survival was 90% in the nonproducer group and 38% in antibody-producers (P = 0.038). We further explored the possibility that HLA antigens from the injured graft are released into the circulation and can be found in the serum either free or complexed with anti-HLA antibodies. This hypothesis was confirmed by the finding that the frequency of sera containing soluble HLA antigens from the graft or immune complexes of HLA alloantigens with anti-HLA antibodies was significantly higher in patients who rejected compared with patients with successful heart allografts (P less than 0.05). Following depletion of soluble HLA antigens, anti-HLA antibodies became detectable in 53% and 74% sera obtained during the first and second year posttransplantation, respectively, from patients undergoing chronic rejection. Long-term survivors showed a significantly lower (P less than 0.001) frequency of anti-HLA antibodies in sera depleted of HLA antigens. Lastly, studies of anti-anti-HLA-A2 and A3 antibodies in recipient sera suggest that quiescence is maintained by antiidiotypic antibodies.
- Published
- 1991
- Full Text
- View/download PDF
44. Prolonged functional survival of rat-to-NOD mouse islet xenografts by ultraviolet-B (UV-B) irradiation plus microencapsulation of donor islets.
- Author
-
Weber C, Krekun S, Koschitzky T, Zabinski S, D'Agati V, Hardy M, and Reemtsma K
- Subjects
- Animals, Blood Glucose metabolism, Diabetes Mellitus, Experimental genetics, Diabetes Mellitus, Experimental surgery, Islets of Langerhans radiation effects, Islets of Langerhans Transplantation pathology, Islets of Langerhans Transplantation physiology, Mice, Mice, Mutant Strains, Rats, Rats, Inbred Lew, Transplantation, Heterologous pathology, Transplantation, Heterologous physiology, Graft Survival radiation effects, Islets of Langerhans Transplantation immunology, Transplantation, Heterologous immunology, Ultraviolet Rays
- Published
- 1991
45. Elimination of preformed antibody activity to xenoantigens utilizing dithiol-reducing agents.
- Author
-
Sanchez JA, Fong JC, Watkins JF, Berger CL, Xu-He, Reemtsma K, and Rose EA
- Subjects
- Animals, Cytotoxicity, Immunologic drug effects, Lymphocytes drug effects, Papio, Swine, Dithiothreitol pharmacology, Immunoglobulins immunology, Lymphocyte Transfusion, Penicillamine pharmacology, Transplantation, Heterologous immunology
- Published
- 1991
46. The accuracy of CT scanning in the diagnosis of abdominal and thoracoabdominal aortic aneurysms.
- Author
-
Todd GJ, Nowygrod R, Benvenisty A, Buda J, and Reemtsma K
- Subjects
- Aged, Aorta, Abdominal diagnostic imaging, Aorta, Abdominal surgery, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Aneurysm surgery, Humans, Male, Middle Aged, Aortic Aneurysm diagnostic imaging, Tomography, X-Ray Computed standards
- Abstract
As CT scanning has evolved as a reliable clinical tool, the use of angiography in the diagnosis of aortic aneurysmal disease has diminished. Fewer than 25% of patients with aortic aneurysmal disease undergo aortic angiographic evaluation at our institution. A prospective clinical study was undertaken to assess the validity of this policy. One hundred patients with clinical or ultrasonographic evidence of aortic aneurysms were evaluated prospectively during the period July 1987 to December 1989. All patients underwent CT scanning as an initial evaluation. Patients were selected for angiography if they fulfilled any of the following criteria: radiographic evidence of thoracoabdominal or juxtarenal aneurysms, or horseshoe kidney; or clinical suggestion of renal artery stenosis, mesenteric arterial insufficiency, aortoiliac occlusive disease, or lower extremity aneurysmal disease. During this period 19 patients (19%) underwent both CT scanning and angiography. The indications for angiography were thoracoabdominal aneurysms (7), juxtarenal aneurysms (2), clinical evidence of mesenteric insufficiency (1) or renal insufficiency (2), evidence of lower extremity aneurysmal disease (3), or severe aortoiliac occlusive disease (4). Eighty-one patients (81%) underwent CT scanning as the only radiographic evaluation. No patient was adversely affected by elimination of angiographic evaluation. CT scanning revealed inflammatory aneurysms (4), retroaortic renal veins (2), and horseshoe kidney (1). This study suggests that most (81%) patients with aortic aneurysmal disease can be adequately evaluated by CT scanning, and that a very selective policy of angiographic evaluation is indicated.
- Published
- 1991
47. Comparison of gamma and ultraviolet irradiation on the migration patterns of rat dendritic cells and lymphocytes.
- Author
-
Oluwole SF, Engelstad K, De Rosa C, Fawwaz R, Reemtsma K, and Hardy MA
- Subjects
- Animals, Cell Movement radiation effects, Dendritic Cells physiology, Dendritic Cells transplantation, Gamma Rays, Kinetics, Lymphocyte Transfusion, Lymphocytes physiology, Male, Rats, Rats, Inbred Lew, Rats, Inbred WF, Dendritic Cells radiation effects, Lymphocytes radiation effects, Ultraviolet Rays
- Published
- 1991
48. Ethical aspects of xenotransplantation.
- Author
-
Reemtsma K
- Subjects
- Human Experimentation, Humans, Tissue and Organ Procurement legislation & jurisprudence, Animal Welfare legislation & jurisprudence, Ethics, Medical, Transplantation, Heterologous
- Published
- 1990
49. Incidence of preformed antibodies against potential xenodonors in human sera.
- Author
-
Edwards N, Ott G, Berger C, He X, Teppler I, Copey L, Smith C, Reemtsma K, and Rose E
- Subjects
- Animals, Antibody-Dependent Cell Cytotoxicity, Humans, Species Specificity, Antibodies immunology, Transplantation Immunology, Transplantation, Heterologous
- Published
- 1990
- Full Text
- View/download PDF
50. The importance of donor MHC compatibility in the allo- and autoimmune destruction of islet grafts in the BB rat.
- Author
-
Stegall MD, Chabot JA, Tezuka K, Reemtsma K, and Hardy MA
- Subjects
- Animals, Islets of Langerhans immunology, Rats, Rats, Inbred BB, Rats, Inbred Lew, Rats, Inbred Strains, Rats, Inbred WF, Transplantation, Homologous immunology, Graft Rejection, Graft Survival, Heart Transplantation immunology, Histocompatibility Testing, Islets of Langerhans Transplantation, Major Histocompatibility Complex
- Published
- 1990
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