The survival and nature of the immune response to soft-tissue and composite-tissue allografts in rats treated with low-dose cyclosporine.

We studied a variety of soft-tissue and composite-tissue allografts (CTA) in a histoincompatible rat model to determine the outcome and the nature of the immunologic responses to these tissues using continuous low-dose cyclosporine (CsA) therapy. Brown-Norway (RT1n) rats served as donors of soft tissue and CTA to Lewis (RT1l) rat recipients given low-dose CsA immunosuppressive therapy by gavage. Nine groups were studied. Three control groups were not treated with CsA: group 1, skin grafts alone; group 2, skin flaps alone; and group 3, skin grafts and delayed vessel allotransplants. Six groups were treated with CsA: group 4, skin grafts alone; group 5, skin flaps alone; group 6, skin grafts and delayed vessel allotransplants; group 7, aortas alone; group 8, muscle flaps alone; and group 9, bone grafts alone. Isografts were performed in all groups as technical controls. The appearance posttransplant of donor-directed cytotoxic antibodies was determined in recipient serum using a complement-mediated cytotoxicity assay and was compared to control and pretransplant sera. In the absence of CsA therapy, recipients in groups 1, 2, and 3 rejected their allografts early (8.5-9.4 days) and developed profound antidonor cytotoxic antibody activity posttransplant by day 7. Groups 4, 5, 6, 7, and 9 had prolonged graft survival in the presence of low-dose CsA, despite the presence of antidonor antibody activity. By contrast, group 8 (muscle flaps) were all uniformly rejected in the presence of profound recipient cytotoxic antidonor antibody activity. These results suggest that long-term soft-tissue and CTA survival can be achieved in histoincompatible rat recipients using continuous low-dose CsA immunosuppressive therapy despite the presence of cytotoxic antidonor antibodies.

The natural history of carotid plaque development.

Fifty-seven carotid artery plaques in 54 patients were harvested at surgery and studied. Preoperative noninvasive findings, arteriograms, clinical symptoms, surgical findings, and light microscopic findings were compared. Thirty-four patients had symptoms, 28 with TIAs and six with a previous stroke. Thirty-three of the 34 had intraplaque hemorrhage, and 28 had a connection between the hemorrhage and the arterial lumen. Eleven of the 21 asymptomatic patients also had an intraplaque hemorrhage, and one had a connection. In eight of the 11, noninvasive studies showed progression of disease. The development of an intraplaque hemorrhage appears to be an important factor in an innocent plaque's becoming a clinically relevant one. If a connection develops between the intraplaque hemorrhage and the arterial lumen, the patient may have TIAs.

Consistent numerical chromosome aberrations in congenital fibrosarcoma.

Cytogenetic analysis of a congenital fibrosarcoma of the volar forearm from a 2.5-month-old boy revealed a mosaic karyotype 46,XY/49,XY,+11,+17,+20. This pattern of specific trisomies provides additional support to the cytogenetic findings in five cases of congenital fibrosarcoma reported previously. Trisomy 11 appears to be characteristic of congenital fibrosarcoma with additional trisomies 8, 17, and 20 as common findings.

Persistence of injectable collagen in human urethra: case report.

A polypoid lesion was found near the bladder neck during cystoscopy in a woman with urinary incontinence who had undergone periurethral collagen (Contigen) injections 3 years before. She had previously received radiation therapy in addition to a radical vulvectomy for vaginal cancer. On transurethral resection of the lesion, particles of unresorbed collagen material extruded from the capsulated suburothelial space. Histologic evaluation verified the material as the foreign collagen. The persistence of glutaraldehyde cross-linked collagen in our patient was much longer than previously reported and may have been due to effects of previous radiation treatment.

Burst therapy. A method of administering fibrinolytic agents.

The use of noninvasive studies to establish the diagnosis and to follow the clinical course of patients undergoing fibrinolytic therapy markedly reduces the amount of invasive alternatives and their attendant bleeding complications. Streptokinase administered by the burst therapy protocol is very effective. Streptokinase administered in this fashion is very cost effective and is in keeping with the current economic trends. Administering warfarin the evening before the last burst of streptokinase markedly reduces the time required to adequately anticoagulate the patient with warfarin. Administering acetaminophen before and during therapy decreases the incidence of febrile reactions. Although streptokinase therapy is not without significant complications, the benefits outweigh the attendant risks.

Adrenal cortical carcinoma with a liver metastasis in a child. Report of a case with fine needle aspiration findings and image analysis of nuclear DNA.

BACKGROUND: Adrenal cortical carcinoma is a rare and highly malignant neoplasm. Liver metastases from it may require special differential techniques in addition to cytologic findings. CASE: A 14-month-old child had adrenal cortical carcinoma and a liver metastasis confirmed by fine needle aspiration biopsy (FNAB). Histologic and clinical criteria of malignancy only partially applied to this tumor. Immunohistochemical analysis of both the primary tumor and metastasis supported an adrenal cortical origin. Other ancillary tests-DNA ploidy, proliferation index (proliferating cell nuclear antigen, Ki-67) and p53 protein immunolocalization-were utilized in a diagnostic sequence. Flow cytometric and image analysis of DNA ploidy of the primary tumor gave similar results. Assessment of DNA content of the adrenal cortical carcinoma and liver metastasis by image analysis showed identical patterns. CONCLUSION: The applicability of new diagnostic techniques to FNAB material may provide new objective measures of the biologic potential of adrenal cortical carcinoma. The validity of these tests is enhanced with the use of image-based quantitative approaches that provide greater reproducibility and objectivity of their results.

Prosopo-thoracopagus conjoined twins and other cephalopagus-thoracopagus intermediates: case report and review of the literature.

Prosopo-thoracopagus twins are united from the face down to the umbilicus, none with union in the brain but all with visceral anomalies intermediate between those of cephalopagus and thoracopagus. In a review of over 1200 cases of conjoined twins reported during the past 100 years, there were 14 that illustrate the continuum between cephalopagus and thoracopagus, including three that were united only from the cervical region to the umbilicus. Classic cephalopagus twins are joined from the top of the head to the umbilicus, sharing a single foregut as well as two relatively normal hearts, the "posterior" one often diminished. Typical thoracopagus, however, are conjoined only from the upper thorax to the umbilicus, each twin with a normal foregut but both sharing a single complex multiventricular heart. The intermediate cases shared either a single very abnormal heart or two hearts united by double aortic arches, and all except one had a single foregut. It is these cases intermediate between cephalopagus and thoracopagus which are the subject of this report.

Massive perinatal hepatic necrosis from maternal oxytocin overdose.

Review of clinical records regarding administration of oxytocin may provide clues to the etiology of hepatic infarction in the neonate. The authors present a case in which a large and rapid maternal overdose of oxytocin (17,300 mU over 20 min) during end-stage labor was associated with neonatal death and extensive hepatic infarction. These findings represent novel complications of oxytocin administration.

Abnormal vasculature of the liver in thoracopagus twins: case report.

Each of the two minimally united livers of thoracopagus conjoined twins occupied an epigastrium in opposite aspects of the conjoined abdomen, straddling the plane of conjunction, instead of being located beneath the domes of the diaphragm. Whereas the hepatic artery and portal vein of the right twin supplied only the larger "anterior" liver, the same vessels in the left twin divided to provide blood for both the "anterior" and the "posterior" liver. Thus the "posterior" liver had only one porta hepatis while the "anterior" liver had two. In addition, the hepatic veins of both ectopic livers were found to drain into the inferior vena cava of only the left twin. All of these anomalies have been reported, albeit rarely, among 477 cases of thoracopagus and omphalopagus twins recently reviewed. A theory explaining the abnormal embryology of the liver is proposed.

Unusual cardiac malformations in conjoined twins: thoracopagus twins with conjoined pentalogy of Cantrell and an omphalopagus twin with atretic ventricles.

Two unrelated cases of conjoined twins were found to have cardiac malformations that apparently have not been reported previously. In one case, thoracopagus twins had an extensive thoracoabdominal wall defect that resulted in ectopia cordis of a conjoined heart along with evisceration of the shared liver and intestine along with one spleen. These malformations, accompanied by defects in the sternum, diaphragm, and supraumbilical abdominal wall, constitute a conjoined pentalogy of Cantrell. In the second case, the heart of one of omphalopagus twins consisted of a solid ventricular mass with only a minute aortic cavity but no atrioventricular communication-an ineffective heart that could develop only in a conjoined or chorioangiopagus twin. In both cases, a common atrium lay in the primitive (embryologic) position caudal to the ventricles.