The endothelial damage of pulsatile renal preservation and its relationship to perfusion pressure and colloid osmotic pressure.

To evaluate the effects of pulsatile preservation, 34 heterotopic renal autografts with immediate contralateral nephrectomy were divided into four groups with either the pulsatile preservation or cold storage technique. Group I had pulsatile preservation with plasma-albumin perfusate at a mean pressure of 60 mm. Hg and a colloid osmotic pressure (COP) of 20 to 50 cm. H2O. Group II had pusatile preservation with the same plasma-albumin perfusates as in Group I, but at a mean pressure of 30 mm. Hg. Group III had pulsatile preservation with albumin-phosphate buffer solution at a mean pressure of 30 mm. Hg. Group IV used cold storage technique. Group I demonstrated severe endothelial destruction and denuding of basement membrane. The changes were inversely related to COP. None of these kidneys functioned and, following transplantation, had persistent severe tubular damage and plugging of glomerular capillary loops with platelets, fibrinogen, and white cells. In Groups II and III, there were minimal changes, consisting of widening of the endothelial pores and focal endothelial damage. All of these kidneys functioned following reimplantation with minimal ultrastructural alterations. Group IV had no glomerular changes following preservation or following transplantation. All preservation techniques produced proximal tubular damage. There is a definite mechanical lesion associated with pulsatile preservation, which can be minimized by utilizing low perfusion pressures and solutions of high colloid osmotic pressure and which has the potential of producing a picture resembling hyperacute rejection following transplantation.     

Dacron patch enlargement of anterior wall of left ventricle after aneurysmectomy with concomitant infarctectomy.

The basis for left ventricular aneurysmectomy with cardiopulmonary bypass was established 20 years ago. There is a higher risk in patients who undergo operation within 2 months of myocardial infarction. In these patients there may be no clear demarcation between devitalized tissue and residual healthy myocardium. A case is reported in which anterolateral aneurysmectomy with concomitant infarctectomy so compromised left ventricular size that the anterolateral wall of the left ventricle had to be reconstructed with a Dacron patch graft.     

Cyclic AMP-induced changes in the electroencephalogram and in behavior during morphine dependence and abstinence in the rat.

Rats were prepared with permanent electrodes for recording activities of the electroencephalogram (EEG) and electromyogram (EMG) and made morphine dependent by the subcutaneous implantation of two morphine pellets. Abstinence was then precipitated by removal of the pellets 72 hr later. During the first 2 days after pellet implantation, high voltage slow activity appeared in the EEG during behavioral wakefulness and stupor, and sleep and REM sleep were greatly reduced. By the third day, tolerance to these effects developed. After pellet removal, REM sleep time during the first day was reduced. Wet dog shake activity reached a maximum during the second day of abstinence. Treatment of rats with cyclic adenosine 3',5'-monophosphate (cAMP), 50 mg/kg intraperitoneally once daily prior to and during induction of morphine dependence and during withdrawal, markedly reduced the appearance of morphine-induced high voltage EEG slow activity after implantation of the morphine pellets. Behavioral arousal during the first 2 days after pellet implantation, on the other hand, was increased. After removal of the morphine pellets, sleep episodes occurred less frequently during the first day than in the control rats. The incidence of wet shakes at this time was also elevated. These results provide direct evidence for an involvement of brain cAMP in the mediation of the central effects of morphine.     

Erythrokinetic Studies in Thalassaemia

Erythrocyte survival studies were performed in a group of thalassaemic patients. The survival and sites of destruction of autologous and normal donor cells were determined. These studies were repeated in patients who had undergone splenectomy. The life span of the autologous red cells was found to be invariably shortened with some evidence of splenic sequestration. On the other hand, the life span of the donor cells was normal or decreased after repeated blood transfusions.
Following surgery, there was no noticeable improvement in the survival of the patient's abnormal cells, while transfused red cells now survived normally.     

Adenoid cystic carcinoma of larynx

This case report presents the clinical picture, diagnostic methodology, and surgical treatment of a 30 years old female patient, who presented with hoarseness of voice and difficulty in breathing. Direct laryngoscopy showed mass in right side of subglottic region, and biopsy-proven adenoid cystic carcinoma. Total laryngectomy was performed and patient was discharged three weeks postoperatively and doing well.     

Progressive symmetrical erythrokeratoderma with perioral involvement

Erythrokeratodermas are inherited or sporadic disorders of keratinization, with many variants. Progressive symmetrical erythrokeratoderma presents as large, erythematous or hyperpigmented, hyperkeratotic, fixed symmetrical plaques over various parts of the body along with many other inconsistent features. Periorificial keratotic lesions have very rarely been reported in progressive symmetrical erythrokeratodermas. We report a 9 years old boy with progressive symmetrical erythrokeratoderma having perioral involvement besides fixed hyperpigmented, keratotic plaques. He was started with oral etretinate but he stopped the treatment due to no-response after two weeks and is presently using topical keratolytics without marked improvement.