Renal subcapsular islet cell transplantation.

Islet cell transplantation has been associated with ultimate graft rejection. This preliminary study investigates the use of the renal subcapsular region as a site for placement of canine islet cell allografts. A new noncollagenase mechanical technique was used for preparation of the allografts. Animals in group I (N = 6) died of hyperglycemia in 4.0 +/- 1.89 days (X +/- SD) after pancreatectomy without subsequent islet cell transplant. Normoglycemia and excellent survival (greater than 60 days) was obtained in pancreatectomized animals in group II (N = 6) and in group III (N = 6), who received an islet cell allograft to the renal subcapsular site. Group II recipients were given no immunosuppression, and animals in group III received minimal immunosuppression with azathioprine. Dependence on the islet cell allograft for maintenance of normoglycemia was confirmed in the majority of the recipients by nephrectomy, to remove the graft, with resulting hyperglycemia and death. One normoglycemic animal in group II died on day 6 from peritonitis. One recipient in group II was normoglycemic at greater than 1 mo after removal of the first graft by nephrectomy, followed by retransplantation of islet cells from a third-party donor. Two other recipients are being studied on a long-term basis, and have been normoglycemic for greater than 6 mo and greater than 4 mo after transplantation. These studies encourage further investigation in this area for application of islet cell transplantation in man, and elucidation of the possible mechanisms for prolongation of islet cell allograft survival at the renal subcapsular site.

Renal subcapsular islet cell transplantation.

This study was directed towards improving islet cell allotransplantation (ICTx) by testing the renal subcapsular region (RSC) as an alternative site for graft placement. In addition, a simplified, non-collagenase method was assessed for preparation of the allograft from the donor pancreas. Five groups of pancreatectomized mongrel dogs were followed. Group I (n = 10) were not transplanted and survived 5.0 +/- 2.92 days (M +/- SD). Five of six animals in Group II (n = 6) which received an ICTx prepared without collagenase in the RSC survived until allograft removal by nephrectomy at greater than 90 days (P less than .0005). No immunosuppression was given to this group. Recipients in Group III (n = 11) were transplanted as in Group II, but were given minimal immunosuppression with azathioprine. They also demonstrated excellent graft function until removal of the graft by nephrectomy at between 3 weeks and greater than 90 days. Animals in Group IV (n = 6) received an intrasplenic (IS) ICTx prepared without collagenase and survived only 4.16 +/- 1.16 days. In Group V (n = 6) poor survival was also noted (7.66 +/- 4.58 days) after IS-ICTx of a collagenase prepared allograft. All animals in Group IV and V received minimal immunosuppression as in Group III. These results indicate the potential for utilization of the RSC as an alternative site for ICTx. In addition, the collagenase-free method was satisfactory for ICTx preparation.

The paleopathology of an Aleutian mummy.

A multidisciplinary team examined an Aleutian mummy from the collection of the Peabody Museum of Archeology and Ethnology of Harvard University, Cambridge, Mass. The mummy, dating from the early 18th century, was of a middle-aged woman who had suffered from pulmonary and ear infections, atherosclerosis, pediculosis, and degenerative joint disease. Another finding was anthracosis, common in ancient bodies and related to indoor heating and cooking fires. Skeletal lead was not found, in contrast with the high levels seen in modern persons. No neoplasms were identified, again consistent with the results of previous studies of ancient human remains. Such comparisons of ancient and modern morbidity and mortality provide a historical perspective on the evolution and cause of human disease.

The effect of tenotomy and tendon transfers on muscle fiber types in the dog.

Different muscle groups have been shown to have variable muscle-fiber type patterns that may be, in part, due to function and use. In an attempt to identify any changes in fiber composition following surgical alteration of function, eleven beagle dogs had the fibularis longus tendon severed. Four dogs had the tendon reattached 6-24 weeks later. After 6-24 weeks, four dogs had the tendon surgically transferred to the tendon of the tibialis anterior, a functionally different muscle. Three dogs had the tendon immediately transferred to the tendon of the tibialis longus. Biopsies were performed after each procedure to assess fiber changes, and late biopsies were performed in one dog from each group at 27-29 months. Fiber characteristics in the biopsy specimens were identified using histochemical staining. In the first group (tenotomy-reattachment), variable atrophy occurred early but disappeared following reattachment. In the second group (tenotomy and tendon transfer), variable atrophy occurred along with an increased percentage of Type I and Type IIB fibers. Early biopsies performed in the third group (direct transfer) revealed mild Type II hypertrophy. In the late biopsy specimen, an increase of Type I and Type IIB fibers was noted and was similar to the fiber composition of the tibialis anterior to which it was transferred. These findings indicate that muscle-fiber remodeling does occur and that multiple operative procedures are not intrinsically harmful to the muscles. The best evidence from this and previous studies suggests that changes in muscle-fiber type are manifestations of functional adaptation.

Pathology of spastic muscle in cerebral palsy.

The histopathology of muscle in cerebral palsy has not been elucidated because correlated morphologic and biochemical data on normal pediatric muscles are insufficient to allow adequate correlation of pathologic findings. One hundred and eight muscle biopsies were taken during reconstructive operations on 85 patients. Normal values for pediatric muscles were obtained from a literature review and supplemented with our data on normal patients. Fiber sizes are normally different for children of different ages. Histochemical staining of enzyme systems demonstrate that adenosine triphosphatase staining, pre-incubated at pH 9.4, 4.6, AND 4.3 WAS USED FOR FIBer typing and fiber size. Depending on the muscle biopsied and the clinical status of the patient, there is a variety of patterns of type I and type II fiber atrophy, hypertrophy, and myopathy. In some cases, denervation changes are present to suggest nerve entrapment. Correlated clinical observations suggest type I fiber predominant muscles do not re-educate well when surgically transferred to perform a specified function.

Histologic findings in mummified skin.

Skin specimens from five mummies were examined histologically. The specimens ranged in age from 2,000 to 3,200 years. Material from two mummies had carbonized and showed only amorphous debris. The histology of the three remaining skin fragments retained surprising histologic architectural detail. One specimen obtained from the sole of the foot was compatible with a callus.

Total hip arthroplasty and polyostotic fibrous dysplasia: a case report.

Polyostotic fibrous dysplasia with Albright's syndrome causes progressive skeletal lesions which require orthopaedic surgical management. A case is presented of a 43-year-old woman with a history of multiple proximal femoral osteotomies with iliac bone grafting who developed a degenerative hip joint. A total hip arthroplasty was performed and a specially designed Charnley-Mueller type of prosthesis implanted. The patient is asymptomatic eight years postoperatively.

Autopsies on two native American Mummies.

An interdisciplinary team performed autopsies on an adult male and an infant male mummy from the American Southwest. Cause of death has not been determined for the infant. The presence of an unhealed skull fracture associated with an apparent hematoma in the adult male is suggestive of trauma as the cause of death in the adult. Evidence of disease is minimal. Analysis of powder thought to be dried blood from the thoracic cavity of the adult suggests the presence of human IgG. The instability of this protein may indicate the presence of proteolytic activity by enzymes that degrade immunoglobulins upon rehydration. The possibility of enzymatic degradation of proteins will be an important factor in future studies of such immunoglobulins in mummy remains and also indicates the importance of maintaining the desiccated condition of mummy tissues.