Influence of HLA matching and blood transfusion on renal allograft survival.

One hundred and seven consecutive cadaver kidney transplants have been followed for up to 6 years. The beneficial effect of HLA matching, shown in previous studies, has been confirmed. The 2-year failure rate from rejection was 29% for grafts with less than two incompatibilities, in comparison with a figure of 52% where there were two or more incompatibilities. In contrast to some reports, the presence of HLA antibodies did not have an adverse effect on the survival of first grafts. Patients not transfused prior to transplantation had a much higher 1-year graft failure rate (72%) than those given either frozen-thawed red cells (29%) or whole blood (23%). This apparently beneficial effect of blood transfusion was no greater in patients transfused with more than five units compared with those given less than five units. We believe that blood transfusion has an important influence on the outcome of renal transplantation.

Histocompatibility types and antiviral antibodies in a diverse group of individuals.

A study was made of the possible relationship between histocompatibility (HLA) antigens of the A and B loci and antibodies to cytomegalovirus, influenza A (victoria strain), measles, rotavirus, vaccinia, and varicella/zoster. A large and diverse group of unselected individuals was studied. A possible relationship was detected between the presence of the antigen B15 and a lack of circulating measles antibodies. The study group was divided into three sections: (a) healthy individuals, (b) "renal disease" patients awaiting renal transplantation, and (c) patients with various types of "other disease," mainly of an immunological nature. Significantly elevated titers to cytomegalovirus and varicella/zoster were found in the two diseased groups, but these elevated titers could not be linked with the presence or absence of any particular HLA A or B antigen.

HLA antigens in haemophilic arthritis: a family study.

HLA typing for antigens of the A, B, C, and DR loci was carried out on lymphocytes from a haemophilic (Type A) family which included four siblings with arthritis. No single haplotype was found to relate to the presence of haemophilia or haemophilic arthritis.

Magnetic resonance grid analysis of soft tissue lesions.

Soft tissue tumors of seven patients were imaged with magnetic resonance imaging (MRI) prior to operative resection. In four cases, gross surgical specimen biopsy sites were broadly selected from areas of diverse signal intensity. A subsequently developed "grid analysis" technique, used in three additional patients, better localized differing zonal intensities within individual gross specimens. Further investigation of this technique is warranted, since MR images, when analyzed by means of a detailed grid technique, appear to enhance histologic diagnostic accuracy. Examination of larger segments of inhomogeneous soft tissue tumors is facilitated, while pathologists' sampling time is diminished.

Mycoplasmas and recurrent oral ulceration.

A controlled cultural and serological investigation of mycoplasmas in recurrent oral ulceration was undertaken. No evidence for an aetiological relationship between oral mycoplasmas and this condition was obtained.Mycoplasmas, principally M. orale, were frequently recovered from the oral cavities of individuals with natural teeth, but rarely from edentulous subjects.

Studies on the nature of autoimmunity in myasthenia gravis. Evidence for an immunodeficiency type.

Clinical and laboratory data continue to support the concept of a genetically determined breakdown of immunological tolerance in myasthenia gravis with immunological damage to the motor end plates. The demonstration of impaired function of thymus-derived lymphocytes and of IgA deficiency correlate well with the clinical data in which there is an increase incidence of autoimmune diseases associated with anergy. Whilst the exact pathogenesis of myasthenia gravis is unknown, the available data support the concept of an immune deficiency disorder.

Compressive stress-relaxation behavior of bovine growth plate may be described by the nonlinear biphasic theory.

The compressive behavior of the bovine distal femoral growth plate was studied in vitro. Strain-rate controlled, compression stress-relaxation experiments were performed on cylindrical bone-growth plate-bone specimens from the interior and periphery of the growth plate. The questions addressed in this study were (a) Can the nonlinear biphasic theory, one with strain-dependent permeability, be used to represent the compressive stress-relaxation behavior of bovine growth plate? (b) How do different assumptions concerning the permeabilities of the chondro-osseous interfaces influence the inferred material properties of the growth plate? and (c) Are there any differences in these properties between the periphery and the interior of the growth plate? Intrinsic biphasic material properties--aggregate modulus (HA), Poisson's ratio (v), and nonlinear strain-dependent permeability coefficients (ko and M)--were calculated from the compression stress-relaxation data with use of a finite element model and a least squares curve-fitting procedure. To verify this constitutive model for the growth plate, an independent set of finite element analyses was performed with use of the determined intrinsic biphasic properties, and comparisons were made between these finite element predictions and two additional sets of experimental data subsequently obtained for the same specimens with use of two slower rates of compression. Excellent agreement was achieved between these finite element predictions and the latter two sets of data. The aggregate modulus was found to be insensitive to the permeability of the chondro-osseous interface. The permeability coefficients were very sensitive to, and the Poisson's ratio was only slightly sensitive to the interface permeability condition. Therefore, the periphery of the growth plate is more compliant and permeable than the interior.

The microstructural tensile properties and biochemical composition of the bovine distal femoral growth plate.

The tensile properties of distal femoral growth plates from 12-month-old cows were determined on uniformly prepared straight bone-growth plate-bone specimens (7 x 7 mm2 in cross-section) from predetermined anatomical sites on the physis. Each specimen was distracted to failure using a computer-controlled servo-hydraulic testing machine at a strain rate of 0.004 s-1. It was found that the exponential constitutive law, using finite deformation formulation for strain, provides an excellent description of the stress-strain behavior of all the specimens up to the point of failure. The ultimate stress and both tangent moduli (i.e., the toe region tangent modulus and the tangent modulus calculated at 75% of ultimate strain) varied with anatomical site. The anterior region was the strongest, followed by the posterior/lateral. The anterior and posterior/lateral regions were also the stiffest, whereas the posterior/medial and center regions were the weakest and most compliant. The bone-growth plate-bone specimen exhibited a low ultimate strain (13.8% +/- 6%) that did not vary significantly throughout the growth plate. This result suggests that disruption of the physis may occur in vivo even at the lower distractions currently recommended for the clinical chondrodiatasis procedure for leg lengthening. The biochemical composition of the growth plate in the anatomical regions correlated well with the tensile properties. There was a greater collagen content in the regions that were the stiffest and strongest. The gross morphology of the growth plate of the bovine distal femur is also described in this study. There is a regular pattern to the undulations of the physis at several dimensional levels. Histologic findings showed that orientation of the hypertrophic cell columns and transphyseal septa are aligned nearly parallel to the longitudinal axis of the diaphyseal shaft. This column orientation is not affected by the undulation of the primary contour of the physis, which at certain locations may be inclined as much as 60 degrees relative to the diaphyseal axis. The orientation of the hypertrophic cell columns appears to be one of the dominant microstructural features influencing the tensile behavior of the bone-growth plate-bone specimens.

Histocompatibility antigens associated with motor neurone disease.

The distribution of histocompatibility antigens was studied in 44 patients with motor neurone disease (MND). An unusually high incidence of HLA antigens A2 and A28 was found, compared to a control population.

Heterogeneous in vivo MR images of soft tissue tumors: guide to gross specimen sampling.

Twelve soft tissue tumors preoperatively studied with magnetic resonance (MR) imaging contained areas of inhomogeneous intralesional signal intensity. The pathologist's selection of biopsy sites from gross specimens was based on specific MR images selected by a radiologist and depended on close cooperation between the radiologist and pathologist. The histopathology so sampled, further depended on the lesion's size, careful gross specimen orientation, discrete sampling, and a specially developed Grid Analysis technique. Our initial experience indicates that (1) histology may vary within different and often neighboring sites of a single soft tissue lesion; (2) that such variability is common in soft tissue tumors; (3) that histological variability within different sites of a single lesion influences signal heterogeneity; and (4) that although differing MR signal intensities per se are not tissue specific, MR may enhance the histopathological accuracy of pathologists who can be directed to particular gross specimen sites by magnetic resonance images. To our knowledge such a specific, detailed effort has not been made.

Synovial sarcoma of the hand.

Synovial sarcoma of the hand is a very rate tumor in an equally unusual location with a difficult histology of a fibrosarcoma combined with synovial-like areas that resemble joint endothelial lining. It has a poor prognosis prior to the current combined treatment of surgical ablation, radiation to the surgical field, and chemotherapy for microscopic metastases. It has an unexplained natural history of very late recurrence and distant spread, often 10 to 20 years following primary treatment.

Malignant fibrous histiocytoma of the hand.

Malignant fibrous histiocytoma of the hand is a unique tumor in a rare location with a characteristic histology of fibrous material in a storiform pattern that is diagnostic in appearance. It has a second type of tumor consisting of histiocytic appearance without fibrous tissue. It is most difficult to treat and often requires ablative surgery combined with postoperative radiotherapy and chemotherapy for long-term survival.

Malignant bone tumors of the hand.

Primary malignant tumors of the bone are among the most rare tissue type and more rare in the acral parts. The authors recommend the use of the Musculoskeletal Tumor Society Grading System for standardization of these rare tumors in the hand.

Cold lymphocytotoxins in connective tissue disorders.

Sixty-eight patients with various connective tissue disorders, 5 relatives of patients and 26 members of staff from the Centre for Rheumatic Diseases were studied for the presence in their sera of cold lymphocytotoxic antibodies. Antibodies were found in 71 percent of patients with systemic lupus erythematosus, 27 per cent of patients with rheumatoid arthritis, 0 per cent of the small group of relatives and 3.8 per cent of the controls. Absorption studies did not show T or B specificity of the antibodies. The control group, working in close proximity to the patients or their sera did not show any increased incidence of antibodies as compared to control groups of other studies. Red blood cell anti I or HI was found in the sera of 28 per cent of those with cold lymphocytotoxic antibodies. No correlation was found between the presence of the antibodies and number of blood transfusions or pregnancies, increasing age, R3 titre or antinuclear factor.

Benign chronic bullous disease of childhood in an Indian child.

An Indian atopic child presented with benign chronic bullous disease of childhood (BCBDC). HLA grouping did not show the typical finding of HLA B8 which questions the value of HLA typing in this condition.