Annals of surgery
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The IgG fraction of equine antithymocyte globulin administered by the intravenous and intramuscular route to two patients with severe thermal injury was associated with survival of the skin allografts to 19 and 42 days. In the second patient the IgG fraction was discontinued 28 days after skin grafting and rejection occurred 14 days later while the patient was receiving azathioprine and 1% topical hydrocortisone cream to the skin allografts. Although no comparison can be made between the immunosuppressive properties of antithymocyte globulin, azathioprine and topical steroids, skin allograft survival was prolonged temporarily until autograft skin from previous donor sites could be obtained. The use of skin allografts protected by immunosuppressive therapy in patients with severe thermal injury deserves further consideration.
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The effects of shock as a result of Escherichia coli endotoxin on certain hemodynamic and biochemical parameters and mortality were studied in the baboon. The ability of methylprednisolone succinate (MPS) in massive doses and/or rapid infusion of a buffered electrolyte solution to influence the results was then examined. ⋯ Likewise, MPS did not prevent the changes in oxygen metabolism or systemic hemodynamics, nor was it associated with any decrease in mortality associated with endotoxic shock. Buffered electrolyte solution therapy improved both hemodynamics and mortality, but did not significantly protect against changes in RBC 2,3-DPG.
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Morphological features of modified and unmodified bilateral lung allografts were studied in 87 dogs. Immunosuppressive treatment consisted of various combinations of azathioprine, methotrexate, prednisolone, methylprednisolone and antilymphocyte serum. The classic acute rejection was observed in the unmodified dogs, which died between 4 and 9 days. ⋯ The alveolar walls and perivascular area were thickened by fibrosis. Obliterative intimal thickening of pulmonary arteries was not observed. Although the immunologic and non-immunologic mechanisms responsible for the development of these lesions are difficult to separate, these cumulative changes apparently accompany the deterioration of the vital function of the graft until ultimate death.
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Sixty-four consecutive patients underwent renal homotransplantation 10 1/6 to 11(1/2) years ago, 46 from related and 18 from nonrelated living donors. Thirty-six of these recipients were alive when this series was presented to the American Surgical Assocation in 1965. Now, nine years later, 26 (72%) of the 36 still survive, in 22 instances with function of their original grafts. ⋯ Vascular lesions had a somewhat less serious import. Mononuclear cell infiltration, tubular atrophy, and interstitial fibrosis proved prognostically to be the least significant. Long-term followup of these early cases has shown the durability of chronic renal homografts, particularly if these are from related donors, and has demonstrated the very high degree of rehabilitation that could be achieved even in the early days of renal homotransplantation.
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One-hundred thirty-two renal transplant recipients were systematically screened for viral infections and the findings correlated with the clinical course. One-hundred ten patients showed evidence of infection with herpesviruses and 89 patients showed laboratory evidence of infection with cytomegalovirus (CMV) uncomplicated by bacterial infections or technical complications. Patients without viral infections were usually asymptomatic. ⋯ These patients could be distinguished from those who recovered by a decreased or absent antibody response to the virus, suppressed lymphocyte responses to mitogen in autochthonous blood, and absent histologic evidence of rejection in the renal allografts. Thus, two paradoxical responses to CMV infections are seen in transplant patients: In the relatively immunocompetent patient, the infection is associated with renal allograft rejection, a prompt antibody response to the virus, and recovery. The severely immunosuppressed patient cannot make an antibody response, does not exhibit allograft rejection as a cause of renal malfunction, he may be further immunosuppressed by the viral infection, and is susceptible to sequential opportunistic infections leading to death.