Normothermic acellular ex vivo liver perfusion reduces liver and bile duct injury of pig livers retrieved after cardiac death.

We compared cold static with acellular normothermic ex vivo liver perfusion (NEVLP) as a novel preservation technique in a pig model of DCD liver injury. DCD livers (60 min warm ischemia) were cold stored for 4 h, or treated with 4 h cold storage plus 8 h NEVLP. First, the livers were reperfused with diluted blood as a model of transplantation. Liver injury was determined by ALT, oxygen extraction, histology, bile content analysis and hepatic artery (HA) angiography. Second, AST levels and bile production were assessed after DCD liver transplantation. Cold stored versus NEVLP grafts had higher ALT levels (350 ± 125 vs. 55 ± 35 U/L; p < 0.0001), decreased oxygen extraction (250 ± 65 mmHg vs. 410 ± 58 mmHg, p < 0.01) and increased hepatocyte necrosis (45% vs. 10%, p = 0.01). Levels of bilirubin, phospholipids and bile salts were fivefold decreased, while LDH was sixfold higher in cold stored versus NEVLP grafts. HA perfusion was decreased (twofold), and bile duct necrosis was increased (100% vs. 5%, p < 0.0001) in cold stored versus NEVLP livers. Following transplantation, mean serum AST level was higher in the cold stored versus NEVLP group (1809 ± 205 U/L vs. 524 ± 187 U/L, p < 0.05), with similar bile production (2.5 ± 1.2 cc/h vs. 2.8 ± 1.4 cc/h; p = 0.2). NEVLP improved HA perfusion and decreased markers of liver duct injury in DCD grafts.

Rotavirus infection in adult small intestine allografts: a clinicopathological study of a cohort of 23 patients.

Rotavirus enteritis (RVE) is increasingly recognized as a cause of small bowel allograft dysfunction but its significance in adult patients is unknown. We have studied 23 adult small bowel transplant patients aged 19.8-59 years (mean = 38.2 years), who were presented with diarrhea and tested positive for rotavirus by enzyme-linked immunosorbent assay methods. Serial follow-up biopsies, as well as clinical data, are documented and analyzed. These patients were followed up for an average of 168 days (range 33-534 days). Mean time of rotavirus diagnosis from transplant day was 794 days (range 38-2907 days). Self-limited diarrhea lasting 6-13 days (mean = 9 days) was the main presentation. Sixteen (69.6%) patients developed acute cellular rejection either concurrently with (i.e. six patients) or after (10 patients) RVE, often characterized by prominent mucosal plasmacytosis at an average of 22 days (range 0-94 days) from the day RVE was diagnosed. One-third of patients with acute rejection (i.e. five out of 16) required muromonab-CD3 rescue therapy. Two patients experienced graft loss (one from chronic rejection, another from sepsis). Rotavirus infection is a cause of diarrhea in adult small bowel transplant patients. The infection appeared to trigger cellular rejection that was associated with mucosal plasmacytosis, and sometimes required aggressive rescue therapy.

Primary extranodal non-Hodgkin's lymphoma of the upper aerodigestive tract--a descriptive analysis of the pattern seen in the University College Hospital, Ibadan.

This retrospective review highlights primary extranodal non-Hodgkin's lymphoma (NHL), of the upper aerodigestive tract as seen in Ibadan over a ten-year period. There was a male preponderance (m:f ratio of 2:1), with a mean age of 42.5 years and a bimodal age presentation at the fourth and fifth decades. The Waldeyer's ring was the commonest affected site while the tonsil is the highest involved subsite. Sixty-eight percent of the patients had regional lymphadenopathy and thirty eight percent also 'B' symptom at presentation. The peculiar presentations of this NHL are the short duration (10 months) of symptoms, mainly intermediate/high grade diffuse large cell lymphoma especially in the Waldeyer's ring and sinonasal region with absence of low-grade small cell lymphoma. The majority of patients (64.3%) presented with Stage IV disease, which shows that the disease has an aggressive course with high mortality and generally poor outcome with 53.6% of the patients dead within one-year onset of symptoms. The overall mean survival period was 14 months. Comparison of the median survival of the patients that died when matched with the site, Ann Arbor staging, histological grade/subtype and treatment modality yielded no significant differences. These further confirm the aggressive nature of the disease in our environment.

Fibrillary glomerulonephritis: a report of 2 cases with extensive glomerular and tubular deposits.

Deposition of nonamyloid fibrillary material in glomeruli is well known. It is, however, unusual to find these fibrils in the tubular basement membranes and unprecedented to have fibrils of different sizes in the same patient. We present 2 cases with nephrotic range proteinuria with evidence of renal insufficiency. In both cases, strong, polyclonal immunoglobulin (Ig)G with C3 deposits were shown in the glomeruli and along tubular basement membranes. Ultrastructurally, the first case had 28-nm fibrils deposited extensively in the glomeruli and along tubular basement membranes. The second case had 30-nm fibrils in the glomeruli and 15-nm fibrils in the tubules. In both cases, the fibrils did not react with the regular amyloid stains. These findings are used to support the view that fibrillary glomerulopathy is not a disease, but rather the morphologic expression of an etiologically diverse group of diseases as yet incompletely defined.

A case of fibrillary glomerulonephritis with linear immunoglobulin G staining of the glomerular capillary walls.

We report a case of crescentic glomerulonephritis that presented with extensive crescent formation and fibrinoid necrosis in the glomeruli. Immunofluorescence staining was strongly positive for linear and pseudolinear staining of the capillary walls for immunoglobulin G (IgG) in the absence of significant mesangial staining. Histologic examination and immunofluorescence staining suggested a diagnosis of anti-glomerular basement membrane disease. However, electron microscopy showed the presence of numerous fibrillary deposits in the subepithelial areas of the glomerular capillary walls, supporting the diagnosis of fibrillary glomerulonephritis. Test results for circulating anti-glomerular basement membrane antibodies were negative. We report this interesting case to illustrate the point that fibrillary glomerulonephritis should be considered in the differential diagnosis of crescentic glomerulonephritis with linear and pseudolinear IgG deposits within the capillary walls. In such cases, electron microscopy is critical in differentiating the cause of crescentic glomerulonephritis.

Fine needle aspiration (FNA) in the management of palpable masses in Ibadan: impact on the cost of care.

Fine needle aspiration cytology is a relatively new technique in the management of palpable lesions in Ibadan. In the University College Hospital (UCH) Ibadan, as in most centres in Nigeria, inadequate facilities, a heavy patient load, financial constraints and an unreliable supply of basic necessities like water, often delay definitive diagnosis and management. In order to alleviate the patient's problems and provide prompt and accurate diagnosis, an FNA Cytology Clinic was set up in the Pathology Department, UCH, Ibadan, managed by the pathology team. This report represents the results of our experience. The cost effectiveness and impact on cost of care are highlighted. FNA costs N250.00 (pounds sterling 2.00), whilst cost of biopsy can vary from N5000.00 to N10000.00 (pounds sterling 35.00 to pounds sterling 70.00). A total of 752 satisfactory smears was reviewed during the 3-year period 1995-97 from various sites including breast (n = 295), lymph node (n = 183) and thyroid (n = 143). Diagnostic accuracy varied with different sites, the accuracy rate for breast, lymph node and thyroid malignancy being approximately 100%, 80% and 93%, respectively.

Fine needle aspiration cytology in the management of thyroid enlargement: Ibadan experience.

This report reviews our experience with fine needle aspiration (FNA) cytology in the assessment of thyroid enlargement in Ibadan between January 1995 and December 1997. The diagnostic accuracy of the procedure for malignancy was 80.6% with a sensitivity and specificity 83% and 80% respectively in this series. FNAC of thyroid enlargement is now a first line investigative procedure for thyroid enlargements in the University College Hospital, Ibadan.