Bronchial circulation after experimental lung transplantation. The effect of long-term administration of prednisolone

The effect of corticosteroids on bronchial healing after modified left lung transplantation was investigated in pigs. In groups I (n = 6) and II (n = 6), animals received cyclosporine (15 mg/kg per day) and azathioprine (2 mg/kg per day). In group II, prednisolone (1 mg/kg per day) was also administered. Bronchial blood flow was estimated at the donor carina and donor second carina with laser Doppler velocimetry and radioisotopes 7 days postoperatively; macroscopic and microscopic assessments of graft airways were performed. Bronchial blood was calculated relative to the recipient carina. In group II, bronchial blood flow at the donor carina and donor second carina was significantly higher than that of group I. Macroscopic assessment revealed more pronounced ischemic changes in group I (5 of 6 animals) than in group II (2 of 6 animals, p = not significant). Microscopically, airway samples from the donor carina revealed marked destructive changes in five of six animals in group I. In group II, only mild ischemic changes, which were limited to the respiratory epithelium, were seen. We concluded that the administration of prednisolone results in improved bronchial blood flow and decreased bronchial ischemia after lung transplantation.

Effect of methylprednisolone and prostacyclin on bronchial perfusion in lung transplantation

In an experimental investigation using modified unilateral lung transplantation in pigs, the effects of systemic administration of methylprednisolone and prostacyclin on bronchial mucosal blood flow were assessed. Laser Doppler velocimetry (LDV) and radioisotope studies using radiolabeled erythrocytes (RI) were employed to measure blood flow at the donor main carina and upper lobe carina after 3 hours of reperfusion. The recipient carina was used as a reference point. Five groups of 6 animals each were studied. Group I served as control. In group II, methylprednisolone (20 mg/kg) was administered to the recipient. In group III, prostacyclin (4 ng.kg-1.min-1) was given to the recipient, and in group IV, prostacyclin (100 micrograms intravenously) was administered to the donor. In group V, prostacyclin was given to the recipient and the donor animals as in groups III and IV, respectively. In group I, bronchial blood flow at the donor main carina was 37.6% +/- 2.2% (LDV) and 44.1% +/- 14.8% (RI) of reference blood flow. No significant differences were found between the controls and groups II, III, and IV. In group V, bronchial blood flow was markedly increased both at the donor main carina (LDV, 39.8% +/- 6.2%, p = 0.12; RI, 55.7% +/- 11.4%, p < 0.2) and the donor upper lobe carina (LDV, 65.8% +/- 5.4%, p < 0.05; RI, 76.8% +/- 21.3%, p < 0.2). We conclude that systemic administration of prostacyclin to the donor and recipient results in marked improvement of bronchial blood flow and may reduce the incidence of bronchial complications after lung transplantation.

[Morphologic placenta findings in clinico-serologically verified and suspected rubella infection in the 2d half of pregnancy]

Rubeola is the congenital infection with the highest rate of embryonal damage. The hematogenous transplacental way of infection also causes morphological changes at the vessels of the placental villi. We examined 38 placentas from up to the 44th week of gestation and the fetus and children belonging to them. We regarded the clinical and serological findings. 6 out of 16 placentas from up to the 18th week of gestation (37.5%) showed endangitis obliterans. Two cases showed changes of the lenses. (Group I). In 10 out of 12 cases from the 19th to the 36th week of gestation (Group II) we found morphological changes in the vessels of the placental villi. The children belonging to them showed nonspecific malformations. From the 37th week of gestation (Group III) half of the placentas was histologically conspicuous. The children did not show malformations specific for rubeola. We refer to the possibilities and limitations of performing light microscopic diagnosis in placenta when there is the suspicion of rubeola infection, intrauterine death of the fetus and postnatal delay of the child's development.

Closing wedge osteotomy with transpedicular fixation in ankylosing spondylitis

The Smith-Petersen anterior opening wedge osteotomy of the lumbar spine is currently the accepted technique for the correction of spinal deformity in ankylosing spondylitis. It has a mortality of 10%, uses force, is uncontrolled, and fixation is often feeble. The authors have devised a posterior closing wedge with transpedicular fixation. This technique is controlled, comparatively safe, and provides secure fixation. The procedure is a relatively safe and reliable means of dealing with a dangerous operation.

Doppler flow measurements and histomorphology of the placental bed in uteroplacental insufficiency

For the first time histomorphological findings of the uteroplacental vessels were correlated with Doppler flow parameters of this vascular area in a combined study. The study group consisted of 58 women with a pregnancy-induced hypertension or an otherwise presumed uteroplacental perfusion impairment delivered by cesarean section. The control group included 50 healthy pregnancies, delivered by cesarean section due to presentation anomalies or failure to proceed. After removal of the placenta a placental bed biopsy containing the uteroplacental vessels of the decidual and inner myometrial layer was taken. The occurrence of accepted histological signs of low uteroplacental perfusion was compared to Doppler flow velocity wave forms in uteroplacental arteries. The accuracy of doppler-sonographic findings of uteroplacental circulatory impairment confirmed by the histomorphological results was high, even in cases not complicated by hypertension. The good accordance of Doppler flow parameters with morphological findings offers new perspectives for differentiated insights in pregnancy courses with and without signs of uteroplacental insufficiency.

Groove pancreatitis

Groove pancreatitis is characterized by the formation of a scar plate between the head of the pancreas and the duodenum, and is by no means a rare entity. In our material comprising surgical specimens, it was found to be present in 19.5% of the cases. This form of pancreatitis is "special" only on account of the topography of the scar tissue. Scarring of the groove leads to complications that are also determined by the topography: disturbance of the motility of the duodenum, stenosis of the duodenum, and tubular stenosis of the common bile duct, which occasionally extends to obstructive jaundice. In the "pure" forms of groove pancreatitis the main pancreatic duct is not involved, and this fact has a certain significance in the differential diagnosis vis-à-vis carcinoma of the head of the pancreas, since signs of stenosis with no involvement of the rest of the pancreas are, in the first instance, suspicious for carcinoma and provide the indication for surgery. A knowledge of the existence of groove pancreatitis suggests a differential-diagnostic alternative. In terms of etiology, pathogenesis, and the pathological/anatomical picture, groove pancreatitis is "special" only on account of its topographic aspects.

[Anatomic variants in the peripheral conduction system of the heart. Are there electrocardiography correlates?]

Anatomical variations of the peripheral conduction system are a very common finding. One of these variations are the so-called aberrant tendons, which are found in about 67% of the hearts. In this paper the possible correlation between these anatomical variations and disturbances of conduction in the electrocardiogram is discussed.

Interlocking nailing for the treatment of femoral fractures due to gunshot wounds

Fifty-six patients who had a fracture of the femur due to a low-velocity gunshot injury were treated with interlocking nailing with the Grosse-Kempf nail. Patients who had an isolated fracture were treated by intravenous administration of antibiotics followed by delayed interlocking nailing. Ninety-three per cent of the fractures had Grade-III or IV comminution. At an average duration of follow-up of sixteen months (range, twelve to twenty-nine months), the results of closed interlocking nailing were excellent. All of the fractures united an average of twenty-three weeks (range, fourteen to forty weeks) after the nailing. There were no apparent infections in the entire series. There were two delayed unions and seven malunions. Five patients had a serious associated vascular injury; four of these five had interlocking nailing immediately after vascular repair. The fractures united without any residual vascular insufficiency.

Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus

Twenty-one adults who had a fracture of the middle of the humeral shaft and an injury of the ipsilateral brachial plexus were followed for an average of twenty-eight months. Only two of these patients showed evidence of neurological improvement. Of the eleven patients who had an associated traumatic injury to the brain, eight were treated non-operatively and three, operatively. The presence of a fracture of the humerus in a flail extremity has been found to delay rehabilitation markedly and to result in prolonged hospitalization. Eleven fractures were treated non-operatively with a brace or cast, and there were five non-unions, two delayed unions, and two malunions. Of the ten fractures that were treated operatively, three that were treated by compression-plating all united. Two fractures were treated by external fixation; one had a delayed union and one, a malunion. In the remaining five patients, who were treated with an intramedullary rod, there were two non-unions, one delayed union, and one malunion.

Physiological and pathological morphology of the umbilical and placental circulation

Closure mechanisms of fetal vessels are essential after birth. They are physiological. The speedy and characteristic constriction is made possible by the special construction of the fetal vessels. The so-called "folds of Hoboken" in the umbilical artery initially form tapered constrictions which quickly extend to longer sections of the vessel. The contractions continue to include the chorion plate and the villi. Due to a lack of lamina elastica interna, a protrusion of pear shaped, expanded mediamyocytes and myofibroblasts is possible which reduces the cross-sectional area of these vessels. Similar, but lasting reductions in the cross-section of the villous arteries due to a fibrous-muscular media occur in the second half of pregnancy (IVth sign of maturity). Closure of the fetal vessels during intrauterine life leads to placental insufficiency of fetal death in utero. The endarteritis obliterans closes villous vessels by means of a connective tissue plug which starts on one side of the vessel and continues across the whole width of the lumen. The periphery dependent of these villi remains avascular, as the placenta is limited in its resorptive capabilities. In the case of intrauterine asphyxia, intravasal fibrinthrombi form as a sign of subacute insufficiency in the utero-placental circulation. A decompression collapse occurs in the fetal circulation, when fetal death occurs with continuing maternal circulation.

[Granuloma of the pancreas]

1. Granulomas in the pancreas are not equivalent to granulomatous pancreatitis. 2. Apart from foreign body granulomas on the pseudocyst margin (endogenous foreign body), and around the past operation stitch rests (exogenous foreign body), we have found thirty-six cases of granulomas in 1000 cases of chronic pancreatitis. Occasionally one could find granulomas around Ethibloc residues. The frequency could not be exactly determined, because most of Ethibloc reacted parts of the glands were not operated (removed). 3. We could not clarify the etiology in 20 cases (so-called cryptogenous granulomas). There were 7 cases of vessel granulomas, partly with complete obliteration of the arteries: arteriitic granulomas. The granulomas were always found in many arteries of the same caliber, never in solitary vessels. These findings were always preceded by arteriography. 4. Granulomatous pancreatitis was organ manifestation in primary Syphilis (2 cases) and primary M. Boeck (2 cases). We found fungal granulomas in AIDS. 5. Granulomatous pancreatitis plays a subordinate role in the complete picture of the basic disease; but it can cause an obstructive icterus and show a tumoral symptom.

The Hamburg Stroke Data Bank: goals, design and preliminary results

A stroke data bank has been developed which consists of 1500 items, including clinical and laboratory findings, past medical history, treatment and outcome. In addition to previously published registries, the Hamburg Stroke Data Bank allows storage of time-dependent data: multiple findings can be entered at different times after stroke onset. The data bank runs on any MS-DOS microcomputer and can be operated without computer knowledge. The stroke registry is conceived to support a prospective, local, multicentre study of stroke. This paper describes objectives, data bank structure and preliminary results of the pilot phase, which includes data of 441 patients with completed stroke and reversible ischaemic deficits. Demographic characteristics, incidence of stroke types, associated risk factors and outcome are evaluated.