Twelve-hour and twenty four-hour preservation of small bowel allografts by simple hypothermia. Survival utilizing cyclosporine.

Canine small bowel was harvested and stored by simple hypothermic technique. After 12- and 24-hr storage, respectively, the small bowel graft was allotransplanted into recipients. All animals receiving 12-hr stored grafts (n = 9) survived beyond 5 days. In the 24-hr storage group, 67% of the animals (n = 9) survived beyond 5 days. Successful storage for such extended periods by simple hypothermia has not been achieved previously. Donor pretreatment with antibiotics as well as extensive intraluminal irrigation of the harvested small bowel are considered to be important technical features in this successful preservation.

Total orthotopic small bowel allotransplantation in the dog. Features of atypical rejection and graft-versus-host reaction.

The critical histologic review of our experience with small bowel allotransplantation in the dog is presented. While "classical" rejection with dense small cell infiltration and mucosal destruction does occur, more common is the "atypical" rejection reaction in which cellular infiltration is sparse. This "atypical" rejection was characterized by a significant decrease of mucosal epithelial structures with increased mitotic figures in crypt cells and frequent vascular changes, including segmental fibrinoid necrosis and thrombosis with or without overlying mucosal destruction. Substantial regenerating capacity of bowel mucosa tends to compensate for the destruction, complicating the histology. The host lymph nodes and spleen present a histologic picture highly suggestive of GVH reaction. The reduction in host lymphocytes in these organs from karyorrhexis with replacement by histiocytes and subsequently by plasma cells is described. It is emphasized that rejection and GVH are not mutually exclusive and occur simultaneously. The decrease of functional mucosal mass could well account for the nutritional malsequelae. Also, the weakening of immune structures on the host and the graft side may predispose to catastrophic enterogenous infections, perhaps explaining the large number of animals that die without overt signs of rejection following small bowel transplantation.

Osseous pseudotumor. The sole manifestation of sinus histiocytosis with massive lymphadenopathy.

Sinus histiocytosis with massive lymphadenopathy may involve extra-nodal tissue sites. Skeletal involvement is uncommon and has always been associated with disease in other nonosseous locations. The present case is the first to document sinus histiocytosis with massive lymphadenopathy arising primarily within bone and unaccompanied by disease elsewhere.

Nevus cells within lymph nodes. Possible metastases from a benign intradermal nevus.

Two axillary lymph nodes from a patient who underwent modified radical mastectomy for carcinoma of the breast showed benign nevus cells in the fibrous capsule and within afferent lymphatics. Subsequently, an intradermal nevus from the area of drainage of the axillary lymph nodes was excised, which showed groups of nevus cells lying within small lymphatic channels. It is postulated that the nevus cells in the lymph node capsule could represent benign metastases from the intradermal nevus.

Experimental paracetamol nephropathy and pyelonephritis in rats.

The nephrotoxicity of paracetamol (acetaminophen) administered to rats in doses of 300 mg/kg/day for periods up to 32 weeks was increased in the presence of experimentally induced pyelonephritis. The same dose of paracetamol failed to cause renal lesions in rats without pyelonephritis. Generally the pyelonephritic reactions were more severe in animals receiving paracetamol as compared to those in whom the drug was witheld. Thickened basement membranes of microvessels and tubules associated with papillary necrosis, and attempted healing of a necrotic papillary stump were unusual experimental findings which resemble pathology considered characteristic of clinical analgesic nephropathy.

Eosinophilic fasciitis in South Africa. A report of 2 cases.

Eosinophilic fasciitis was first described by Shulman in 1974 and is characterized by oedema of the extremities, peripheral eosinophilia, hypergammaglobulinaemia and inflammation of the deep fascia. The condition has not been previously reported in South Africa. We describe 2 cases seen at the Rheumatology Clinic of the Johannesburg Hospital recently. The most striking clinical features were the marked palmar fascial thickening and oedema of the hands and feet. The latter is said to be uncommon in this syndrome and mimicked the early changes of scleroderma. Furthermore, blood eosinophilia may also occur in scleroderma. Our patients illustrated the extremely variable laboratory features in this disorder. In accordance with previous findings in the literature, visceral involvement was absent in our cases. We suggest that in patients without Raynaud's phenomenon who present with scleroderma-like changes of the distal extremities, a diagnosis of eosinophilic fasciitis should be excluded by a full-thickness biopsy.

Femoral hernia with upward extension into abdominal wall: CT diagnosis.

The usefulness of computed tomography (CT) in identifying the nature of abdominal masses is well documented. A rare form of femoral hernia was observed extending upward within the abdominal wall. CT was helpful in determining that this was a hernia and not an intraabdominal mass.

Nephrotic syndrome during captopril therapy.

Captopril, an angiotensin-converting enzyme inhibitor, is being evaluated as an antihypertensive agent. We report on a patient who developed the nephrotic syndrome while on captopril 450 mg/d. Her urinary protein excretion was 5-7 g/24 h, plasma albumin concentration was 25 g/l, plasma cholesterol was 16,2 mmol/l, and she had oedema. Renal biopsy showed subepithelial deposits on the basement membrane.

Recurrent hypoglycemia associated with glutaric aciduria type II in an adult.

Repeated episodes of hypoglycemia accompanied by elevated serum concentrations of free fatty acid without ketosis, fatty infiltration of the liver, hepatic dysfunction, and proximal myopathy in a 19-year-old woman, prompted us to analyze her urine for organic acids. Greatly increased quantities of glutaric acid, ethylmalonic acid, dicarboxylic acids with six to 10 carbons, and isovalerylglycine were consistently found in her urine. The ability of cultured skin fibroblasts from the patient to oxidize [1(-14)C]butyrate and [2(-14)C]lysine was reduced. These urinary and in vitro findings indicated defective activity of several acyl coenzyme A dehydrogenases, including glutaryl, isovaleryl, and butyryl coenzyme A dehydrogenases -- establishing a diagnosis of glutaric aciduria Type II. Carnitine concentrations in the skeletal muscle and liver were moderately reduced, but carnitine deficiency was considered a secondary biochemical abnormality. Although glutaric aciduria Type II has previously been described only in a neonate, the disease must be considered in the differential diagnosis of hypoglycemia in adults.

Asymptomatic arsine nephrotoxicity. A case report.

A completely asymptomatic patient with arsine nephrotoxicity is described. The light and electron microscopic appearances of the kidney biopsy specimen are documented. The pathogenesis of the lesions, the usual manifestations of arsine exposure, and how these differed from those seen in our patient, are discussed.

Acral lentiginous melanoma or Hutchinson's melanotic freckle of the extremities. A case report.

An additional category of malignant melanoma of the skin, i.e. acral lentiginous melanoma, has been proposed by some authors. The lesion occurs on the extremities, particularly the soles of the feet, the palms of the hands and the digits, but otherwise has the clinical, histological and prognostic features of Hutchinson's melanotic freckle with melanoma. A case conforming to the description of Hutchinson's melanotic freckle of the sole of the foot occurring in a White patient is described. Reference is also made to previous studies of malignant melanoma of the extremities in Black patients. In 15% of these the histogenetic pattern of Hutchinson's melanotic freckle could be observed in the epidermis, adjacent to the invasive melanoma. This pattern was associated with a very much better prognosis than was the superficial spreading or nodular type. The advisability of introducing a new category of acral lentiginous melanoma is therefore questioned.