Alterations of the immune system following splenectomy in childhood

After splenectomy due to blunt abdominal trauma, splenectomized children showed a restricted pattern of T-cell immunodeficiency compared to age and sex-matched normal children. Peripheral blood total (CD3) T-cell counts of 11 splenectomized children of 43%, double positive helper (CD4) inducer subpopulation (CD29) cell counts of nine splenectomized children of 7%, and phytohemagglutinin (PHA)-induced T-cell proliferation of 11 splenectomized children of 53,206 c.p.m. were significantly (p less than 0.05) lower than values of normal children (61% CD3 cells, n = 12; 13% CD4CD29 cells, n = 11; 107,832 c.p.m. PHA-induced proliferation, n = 12). The deficit of CD4CD29 cell numbers may be due to impaired maturation of these particular CD4 lymphocytes and may explain diminished PHA-induced proliferation in small children. The significantly higher B-lymphocyte counts of splenectomized children (21%, n = 11; 558 cells/mm3, n = 10) compared with 12 normal children (14%; 329 cells/mm3) may be due to loss of the reservoir function of the spleen.     

A new technique for reconstruction of the common bile duct after severe injury by laparoscopic cholecystectomy

Zusammenfassung Schwere Gallengangsverletzungen sind nach laparoskopischen häufiger als nach konventionellen Cholezystektomien zu beklagen. Sie resultieren meist aus technischen Problemen oder unzureichender Identifikation der entsprechenden Strukturen. Das sofortige Erkennen der Gallengangsverletzung ist fur eine entsprechende Therapie ebenso wichtig wie die ädequate chirurgische Technik, die angewendet wird. Hier wird eine neue Methode der Gallenwegrekonstruktion unter Verwendung eines Jejunalkonduits vorgestellt. Das Verfahren wurde bislang bei 5 Patienten mit schweren Gallengangsverletzungen (Typ 3 and 4 nach Bismuth) [2] nach laparoskopischer Cholezystektomie erfolgreich angewendet. Der Verlauf nach nunmehr 9 Monaten bis zu mehr als 2 Jahren war ohne Probleme and vielversprechend. Die Methode der Anwendung des Jejunalkonduits erscheint uns zur Rekonstruktion bei schweren Gallengangverletzungen sehr empfehlenswert.

---

A new technique for reconstruction of the common bile duct after severe injury by laparoscopic cholecystectomy

Laparoscopic cholecystectomy involves a higher incidence of severe common bile duct injury than did open cholecystectomy. The severe injuries most often result from technical problems and inadequate exposure. Reconstruction of the bile duct is then possible provided that an immediate diagnosis is made and an appropriate surgical technique is applied. The report focuses on a new method of reconstruction of the common bile duct by interposition of a small jejunal conduit. The procedure was performed in five patients with severe bile duct injury (Bismuth class 3–4) that occurred during laparoscopic cholecystectomy. The outcome after follow-up periods of 9 months to more than 2 years is promising. This method of reconstruction is therefore recommended for severe forms of bile duct injury.

     

Tizolemide-induced changes of passive transport components across the basolateral membrane of isolated frog skin

The effect on transepithelial Na transport of tizolemide was investigated in isolated frog skin (Rana temporaria). It was found that tizolemide (2–5 mM, serosal side) decreased transepithelial Na transport (measured as short circuit current and as net sodium flux) within 60 min to 25–40% of the control level resulting from reduction of the unidirectional sodium influx. Intracellular recording with microelectrodes revealed that these changes were associated with depolarization of the intracellular space to less than 40% of the control values (averaging –71.7±5.1 mV) which is a consequence of a decrease in conductance of the basolateral border to about 25% of the control values. The conductance of the apical border was only slightly reduced. It is suggested that tizolemde blocks the partial conductance of potassium at the basolateral border which secondarily diminishes trans-epithelial Na transport due to a decrease of the driving force for apical border Na entry. A certain degree of inhibition of the Na-K-ATPase by tizolemide cannot be excluded. When vasopressin (ADH) was added to frog skin after treatment with tizolemide, the response was markedly reduced compared to that of untreated control preparations. Under these conditions, the conductance of the basolateral border increased while the apical border remained little influenced by the hormone — opposite to the response of frog skins under control conditions. It is concluded that the mode of action of ADH is more complex than has been recognized hitherto and includes effects at the basolateral border.Dedicated to Professor H. Schwiegk on the occassion of his 75th birthday.Some of these results have been presented at the 8. Int. Congr. Néphrology, Athens 1981.     

Damaged chromatin does not prevent the exit from metaphase I in fused mouse oocytes

The presence of checkpoint mechanisms which are able to recognize damaged chromatin and thereafter to prevent exit from metaphase I has been investigated in giant mouse oocytes produced by fusion of a normal metaphase I oocyte with an equivalent oocyte with damaged chromatin. The presence of damaged chromatin did not prevent the onset of anaphase I in both sets of chromatin in the fused cells. Interestingly, fused or unfused cells containing only damaged chromatin failed to enter anaphase and persisted instead in a metaphase-like state. These results demonstrate the fragility of checkpoint controls in mammalian female germ cells.