Indefinite survival of human skin allografts in patients with long-term immunosuppression.

The transplantation of a sufficient quantity of good quality skin is of great clinical importance. Severe burn patients lack adequate skin donor sites to cover their wounds with autografts. Patients with severe injuries and burns of areas such as the entire face are presently reconstructed with multiple full- or split-thickness skin grafts. The final result is a patchwork appearance of skin with inferior qualities to normal full-thickness facial skin. Before structures such as hands should be transplanted, each individual tissue component should be evaluated to determine whether the tissue will survive and function with immunosuppression. Skin is obviously an important part of the hand. One hypothesis tested is the ability of transplanted human skin to survive indefinitely with long-term immunosuppression. The early detection of rejection of transplanted organs is paramount in reversing the rejection phenomena and hence saving the transplanted organ. Another hypothesis tested is the ability of a synchronously placed, same-donor, same-recipient skin graft to be used to detect rejection of a transplanted organ. As the skin and kidney from the same donor have similar antigens and the transplantation of both these tissues is to the same recipient and immunological system, it is hypothesized that there will be a correlation of rejection between the transplanted skin and the transplanted organ. To test the above hypotheses a small skin graft was placed on renal transplant patients synchronously with renal transplantation. The skin allografts were followed by direct observation and biopsy at regular intervals and at the time of suspected rejection. The patients were treated with the usual renal transplant immunosuppressant drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for childhood homicides in Ohio: a birth certificate-based case-control study.

Death certificate of children less than 8 years of age who were killed between 1979 and 1986 were linked to their Ohio birth certificates and compared with those of Ohio children born in 1983 (controls). Having an unmarried mother increased risk of homicide almost fivefold (odds ratio 4.87). Having a teenage mother, a mother who had not graduated from high-school, and being of Black race or low birthweight each increased the risk by approximately threefold. Increases in the proportion of children born to unmarried mothers may contribute to increases in childhood homicide rates.

Response of isolated rat heart cells to hypoxia, re-oxygenation, and acidosis.

Responses of isolated adult rat heart cells to conditions that emphasize various aspects of ischemia have been evaluated. Cells maintained in hypoxic media with limited substrate deteriorate more rapidly than aerobic controls supplemented with glucose. Two distinct irreversible pathways for cell alteration can be distinguished as follows: (1) continued anaerobic aging in the absence of glucose results in the production of large numbers of cells which retain the rod-shaped morphology of heart cells in situ, but which have lost sarcolemmal integrity, and (2) after a period of anaerobic aging, reaeration of the cells produces large numbers of rounded cells in irreversible contracture. These cells maintain an intact sarcolemma and are indistinguishable from those produced by addition of 1 mM Ca2+ to Na+-loaded, aerobic cells. Contracture of isolated cells on re-aeration is at least superficially analogous to the oxygen paradox in situ, but since the isolated cells maintain an intact sarcolemma, there is no loss of creatine phosphokinase or other components of the cytosol. Incubation of isolated heart cells at acid pH (pH 6.8 to 6.2) largely prevents both Ca2+-dependent contracture and a Ca2+- dependent loss of respiratory capacity. The acidic conditions virtually eliminate the net influx of 45Ca2+ into isolated cells that occurs at neutral pH, and the inhibition appears to be localized at the sarcolemma.

Time course of diet-exacerbated carotid artery atherogenesis in the White Carneau pigeon.

The carotid arteries of White Carneau pigeons fed an atherogenic diet developed fatty streaks, proliferative and atheromatous lesions. The carotid bifurcation had accelerated lesion development when compared to either the proximal internal carotid or the dorsal carotid artery. After 4 weeks of being fed an atherogenic diet, the bifurcation region of all birds showed some lesion involvement. Lesions at the bifurcation initially involved the medial and lateral walls; flow dividers became involved slightly later, with the anterior flow divider consistently developing thicker lesions than the posterior flow divider. Lesions progressed in terms of length of circumference, mean thickness, cross-sectional area, and percent lumen stenosis as the time fed the atherogenic diet increased.20

Late failure in vein grafts: mediating factors in subendothelial fibromuscular hyperplasia.

Late failure of autologous vein grafts often results from excessive subendothelial fibromuscular hyperplasia. Varying factors have been implicated in this process, but the exact etiology remains unclear. In this study, three groups of animals were studied which had sections of common carotid artery replaced with autologous vein grafts. Group I had simple replacement, while Groups II and III had grafts supported by either tightly woven or loose mesh dacron prostheses. Thrombosis occurred only in the unsupported grafts. Unsupported grafts also had more subendothelial proliferation when compared to the loose mesh group. The combined thickness of the intima-media correlated inversely with the number of vasa present within the vein graft wall, i.e. significantly more vascularization was found in the mesh supported group when compared to the other groups. Grafts supported with the tightly woven prosthesis were relatively impervious to the ingrowth of vasa vasora. The data suggest that persistent distension of the graft wall by intra-arterial pressure influences the degree of subendothelial fibromuscular hyperplasia and may be interrelated to revascularization of the graft wall per se.

Crystalloid configuration in the adrenal cortex of the Siamese tree shrew (Tupaia glis).

Crystalloids of what appear to be smooth reticulum have been observed in the zona fasciculata and zona reticularis in both the stressed and nonstressed adrenal gland of the Siamese tree shrew (Tupaia glis). No crystalloids are observed in the zona glomerulosa. Similar crystalloids have been described in other steroid-secreting organs, including the antebrachial organ of the lemur (Lemur catta), the parotoid gland of Bufo alvarius and in sebaceous gland cells of the Galagos and Macaques. Moreover, the crystalloids in the present investigation resemble the paracrystalline arrays of smooth reticulum present in the adrenal cortex of the fetal guinea pig. The crystalloids show much variation in degree of organization, sometimes appearing as wavy tubules parallel with one another or as fused tubules having a "donut" configuration. In addition, the crystalloids are nearly identical to configurations which have been described in mitochondrial cristae of the protozoan, Pelomyxa carolinensis.

Intimal changes in arteriovenous bypass grafts. Effects of varying the angle of implantation at the proximal anastomosis and of producing stenosis in the distal runoff artery.

Autologous arteriovenous bypass grafts were constructed between external iliac arteries in 20 mongrel dogs to determine the development of intimal fibromuscular hyperplasia. Animals received grafts at 55, 90 or 120 degree angles relative to the proximal anastomosis. Five animals with 90 degree angle grafts were also subjected to 80% stenosis in the runoff artery. All grafts showed the development of a fibromuscular tunica intima. Qualitative or quantitative intimal differences were not observed among grafts placed at 90 degree angles, 90 degree angles with runoff artery stenosis, or 120 degree angles. Grafts placed at 55 degree angles relative to the proximal anastomosis developed a consistently thicker fibromuscular layer in the tunica intima when compared to the other groups. These changes which were segmental in nature, occurred in the proximal and distal grafts and over the distal anastomosis.

The anatomy of the parotoid gland in Bufonidae with some histochemical findings. II. Bufo alvarius.

The gross and microscopic anatomy of the venom producing parotoid glands of Bufo alvarius has been studied by light and electron microscopy. Histochemical reactions for the presence of venom constituents and of components in biochemical pathways in the synthesis and release of venom were performed. The gland is composed of numerous lobules. Each lobule is an individual unit with a lumen surrounded by a double cell layer. Microvilli of the outer layer interdigitate with microvilli of the inner layer. Cells of the outer layer resemble smooth muscle cells, are rich in adenosine triphosphatase and glucose-6-phosphatase, and contain numerous pinocytotic vesicles, glycogen granules and various organelles. These organelles include "crystalloids" of what seem to be highly organized agranular reticulum. These outer layer cells probably function in some aspects of venom synthesis, active cellular transport and contraction in the discharge of the secretory product. The inner cell layer demonstrates a positive chromaffin reaction, contains steroid material, various organelles, some pinocytotic vesicles and glycogen granules, and appears devoid of a plasmalemma on its inner surface. This layer is probably involved in venom formation and release via an apocrine type of secretion. Bufo alvarius parotid gland shows significant morphological and histochemical differences from that of B. marinus and more nearly resembles a typical steroid producing organ.