Transplantation of reproductive organs

A historical review of the literature concerning replantation and transplantation of reproductive organs has included studies from this laboratory, using rats, over the past 25 years. From the basic observation of ischemic and traumatic injury due to the transplantation, syngeneic testicle transplants, resulting in a partner's impregnation and histological restoration of the testicles, led to human testicular transplantation. As to the ovarian transplants, granulosa-theca cell tumors may transform into malignancies if followed for a prolonged period as intrasplenic ovaries, and high doses (15 to 20 mg/kg b.w.) of azathioprine can produce such malignant tumors in a shorter period. By caval-portal shunt, ovarian hormones enter directly into the portal blood stream and no typical granulosa-theca cell tumors were produced, owing to the fact that the liver cannot degrade all the hormones secreted by both ovaries. While en-bloc vagino-utero-ovarian transplantation in the rat is possible, no impregnation has been yet achieved. Finally, it is hypothesized that those who have acquired microsurgical techniques and have a full understanding of the anatomy of the reproductive system will not only be able to perform replantation of the penis, but also will be capable of allogeneic transplantation of genital organs, whether ethically approved or not, and sooner than one may think. In such cases a penile part may be obtained at a sex-change surgery or from a cadaveric donor, similar to other vital organ transplantation practices. © 1995 Wiley-Liss, Inc.     

Flexible technique for multiple organ procurement in rats: A training and research tool in transplantation

Multiple organ procurement techniques are increasingly popular in many transplant centers. This paper describes a technique for multiorgan unit(s) explantation in rats. The procedure involves in situ preliminary dissection, cold perfusion of the thoracic and abdominal organ units as separate procedures, explantation, and finally the ex situ isolation of various organ units as single and/or multiple organ combination units. The procedure is feasible, allows for flexibility in the separation of combination organ units, and is reproducible. The exercise is provided as a training and research tool for clinical and research transplant surgeons. The technique is also presented as an animal model for clinical organ sharing. © 1993 Wiley-Liss Inc.     

FK506和供体特异性输血在大鼠异位心脏移植中的作用

目的探讨FK506和供体特异性输血在大鼠异位心脏移植中的作用。方法利用大鼠异位心脏移植模型以了解在移植当天或移植术后第4日进行供者特异性输注（DST）的基础上,应用FK506能否延长移植物的存活。结果在移植当天行DST或单独用FK5061mg／kg连续10天,可将移植心中位存活时间从对照组的5天分别有效延长至7天和11天,而FK506与DST联合应用时并不产生增强效应。结论FK506和DST单独应用时虽均能延长大鼠同种移植心存活,但是它们没有协同作用。     

Variation in Cardiovascular Risk Related to Individual Antimuscarinic Drugs Used to Treat Overactive Bladder: A UK Cohort Study

Background

Blocking muscarinic receptors could have an effect on cardiac function, especially among elderly patients with overactive bladder (OAB).

Study Objective

To investigate the risk of cardiovascular (CV) events in users of antimuscarinic drugs to treat OAB.

Design, Setting, and Participants

Cohort study of new users of darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, 18 years or older, in the United Kingdom's Clinical Practice Research Datalink (CPRD), 2004–2012.

Outcome Measurements and Main Results

Using tolterodine as the reference, we estimated propensity‐score–stratified incidence rate ratios (IRRs) for acute myocardial infarction, stroke, CV mortality, major adverse cardiac events (MACE, a combined end point of the previous three), and all‐cause death for individual antimuscarinic drugs. The study cohort included 119,912 new users of OAB drugs. The mean age at cohort entry was 62 years, 70% were female, and the mean follow‐up was 3.3 years. The adjusted IRR for MACE and current use of oxybutynin compared with current use of tolterodine was 1.14 (95% confidence interval [CI] 1.01–1.30). In contrast, the IRR was 0.65 (CI 0.56–0.76) for current use of solifenacin compared with tolterodine. In this study, performed with health care data, the distribution of risk factors was relatively similar across users of different OAB drugs and, although our analyses controlled for a range of measured potential confounders, residual confounding cannot be ruled out.

Conclusions

In an observational comparative study of users of medications to treat OAB conducted in routine clinical practice, the risk for CV side effects was increased in users of oxybutynin and decreased in users of solifenacin compared with users of tolterodine.     

Rat heart-aorta cluster transplantation: a novel model to study transplant rejection

The purpose of this study was to develop a microsurgical cluster model of heart plus entire thoracic aorta transplantation and to compare it to the isolated model of heart transplantation as a tool to study transplant rejection. Thirty-six syngeneic (DAxDA and LewxLew) and allogeneic (DAxPVG and DAxLew) cluster heart-aorta transplants were compared to 43 syngeneic and allogeneic isolated heart grafts. Graft survival, recipient survival and histological data on myocardial and aortic tissues were assessed. There was no statistically significant difference in graft survival between the two models studied (P>0.05). In the cluster transplants, the aortic component was spared the severity of acute rejection noted for the myocardial counterpart. In conclusion, the results demonstrated that the cluster model was technically feasible and highly reproducible. Additionally, it was possible to apply this model to the study of experimental allograft rejection using novel immunosuppressants. The success of the cluster model in strongly mismatched transplant strain combinations underscores its potential for application in slower rejection combinations, making it particularly suited for chronic rejection studies. The inherent capacity for sampling a broader range of vessel sizes in one animal makes the cluster model more suitable than the isolated models of aorta or heart for application to experimental protocols.This paper was presented in part at the 6th ESOT Congress in Rhodes, Greece, in October 1993     

Amiodarone-induced thyrotoxicosis: Is there a place for surgery?

Amiodaroneinduced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, lifethreatening amiodaroneinduced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or neartotal thyroidectomy as a firstline therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a lifethreatening arrhythmia.

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Resumen El hipertiroidismo inducido por amiodarone ha sido descrito, en la mayoría de los casos, como una alteración leve de la función tiroidea que returna a sus niveles normales una vez que la droga es descontinuada. Sin embargo, también se han informado casos de tiroxicosis muy graves, capaces de poner en peligro la vida del paciente. Las modalidades convencionales de tratamiento, tales como las drogas antitiroideas (tionamide) y los corticosterides, generalmente no son efectivos o fallan en cuanto a modificar la evolución de la crisis hipertiroidea. Tal ineficacia de la terapia médica, especialmente en pacientes con enfermedad tiroidea previa desconocida o no tratada, nos ha llevado a intervenir quirúrgicamente. Informamos un grupo de nueve paciente que fueron sometidos a tiroidectomia total o casi total como la modalidad primaria de tratamiento en cinco de ellos. La operación dio como resultado la rápida resolución de la tiroxicosis con recuperación libre de complicaciones. Este aproche tiene la ventaja de un inmediato y eficaz resultado, un bajo riesgo de recurrencia y, por último, parece ser la única forma de tratamiento que permite continuar la terapia con amiodarone cuando esta droga es requerida para el control de una arritmia potencialmente letal.

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Résumé L'hyperthyroïdie induite par l'amiodarone est généralement modérée et disparaît lors de l'arrêt du médicament. Néanmoins, quelques cas de thyrotoxicose, menacant le pronostic vital, ont été décrits. Les traitements classiques, tels que les antithyroïdiens de synthèse ou les corticoïdes sont habituellement sans effet ou ne modifient en rien l'évolution dramatique de la crise toxique. C'est en raison de cette inefficiacité bien établie du traitement médical, surtout chez les patients ayant une maladie thyroïdienne négligée ou ignorée, que nous avons décidé de proposer une solution chirurgicale pour ces patients. Nous rapportons ici une séries de neuf patients qui ont eu une thyroïdectomie totale ou sub-totale comme traitement, et pour cinq d'entre eux, de première intention. La thyrotoxicose a diminué rapidement après la cure chirurgicale, et l'évolutionn postopératoire a été simple. La cure chirurgicale a l'avantage d'être immédiatement efficace, avec un risque de récidive quasi nul, et d'être la seule modalité thérapeutique qui permette de continuer le traitement par l'amiodarone lorsque celui-ci est indiqué pour contrôler une arythmie menacante.

     

Consecutive organ transplantation in inbred rats: Long‐term results—are organs recyclable?

Using 9-12-month-old Lewis rats, our laboratory performed consecutive organ transplantations to assess the technical feasibility and observe the histopathologies of prolonged transplants and implants over a rat's life span. This study includes a total of 688 cases of consecutive syngeneic organ transplantation, including pancreaticoduodenum (PD), en-bloc liver-pancreaticoduodenum-spleen-stomach (LPdSpSt), and spleen bearing ovary or testicle. A 52-month-old consecutively transplanted pancreas showed normal acini and islet cells. Consecutively transplanted LPdSpSt cases at 25-28 months preserved normal histology. After 26.5 months of ovarian follicle implantation into the spleen, the pathology of the organ exhibited typical dysgerminoma. However, 29.5-month-old infantile testicle implants in the spleen showed seminoma. Our studies suggest that transplanted organs can be reusable and retransplanted, and we hope this could be one of the clues to solve donor-organ shortages in the future.     

Pantoea ananatis as a cause of corneal infiltrate after rice husk injury

We report a case of an agricultural worker presenting with corneal infiltrate following ocular injury with a rice husk. On examination, a superficial corneal foreign body was removed and sent for culture, which grew Pantoea ananatis. This is, to our knowledge, the first clinical case report of Pantoea ananatis causing corneal infiltrate.     

Protecting health data privacy while using residence-based environment and demographic data

Spatial analyses of environment and health data are often made using point address data, despite the risk of identity disclosure. We describe how geospatial environment and non-spatial health data can be linked anonymously, thereby maintaining geoprivacy. High resolution environment data and population density were calculated specific to each residence. Population density and environment data were anonymously linked to individual-level demographic data using a split file method and residential anonymous linking fields. Access to the nearest park or playground was calculated for each residence; children in deprived areas have increased access compared to those in affluent areas. This method has the potential to be used to evaluate natural experiments and complex environmental health interventions.