Faculty Bibliography

Cyclosporin, a potent new immunosuppressive agent, was used (alone or in combination with other drugs) in 28 canine single lung allograft recipients. Mean recipient survival with good allograft function was 155 days with cyclosporin and far exceeded that obtained in previous single lung allograft recipients treated with standard immunosuppression (15 to 22 days). The results of these experiments were as follows: (1) 20% of the recipient animals exhibited no evidence of rejection whatsoever; (2) four of 28 animals survived more than 350 days with good allograft function; (3) 79% of the animals exhibited some evidence of rejection that was easily reversed in 74% of instances with corticosteroids; (4) 10 of 28 animals exhibited good lung allograft function 5 months or more after operation; (5) in cyclosporin-treated lung allograft recipients, rejection was diagnosed by the presence of infiltrate on chest roentgenogram, analysis of the cellular content of bronchoalveolar lavage samples, and decreased perfusion on 99mtechnetium lung scan; (6) complete healing without stenosis of the bronchial anastomosis occurred in 82% of the animals studied. One of two patients treated with cyclosporin after undergoing single lung allografting survived 7 weeks after transplantation and 4 weeks after contralateral pneumonectomy. Episodes of rejection were reversible, and the bronchial anastomosis healed normally. This overall experience indicates that cyclosporin, although not a perfect immunosuppressive agent, increases the likelihood of success with therapeutic single lung transplantation

The association of severe peripheral arteriosclerotic occlusive disease and cancer is unusual. Review of 14 patients with both conditions treated by arterial reconstruction demonstrated excellent limb salvage without prejudice of survival or patency. Accordingly, we believe that limb salvage operations should be considered in patients with limb-threatening peripheral vascular disease and an associated cancer

Previous reports have suggested that renal allograft recipients have an increased mortality rate when returned to hemodialysis. We studied the survival of patients returned to hemodialysis after losing a renal allograft and compared it with the survival of patients undergoing maintenance hemodialysis during the same period as reported by individual centers in the United States and by the European Dialysis and Transplant Association. Six-year actuarial survival of 83 patients after loss of a first transplant and of 37 patients after loss of two or more transplants compared favorably with data on survival of patients undergoing maintenance dialysis. We conclude that a transplant recipient is not at increased risk when returned to hemodialysis

A retrospective study of 65 patients with unpalpable breast cancer revealed by microcalcifications on mammography showed that 18 had presented with infiltrating epithelioma. The contralateral epithelioma was revealed by mammography. Three deaths from metastases had occurred in this group. The 65 carcinomas discovered by mammography were treated by excision of the microcalcified area. This was followed by mammectomy in 34 cases and by irradiation in 25. Close surveillance only was suggested in 6 cases. Histological studies showed 6 lobular carcinomas in situ and 59 duct epitheliomas, 26 of which were infiltrating. The prognosis of isolated duct epitheliomas is highly favourable, and no dissemination was observed. The 2 local recurrences observed after secondary irradiation concerned infiltrating epitheliomas; these patients are now alive without sign of recurrence after mammectomy. After conservative treatment (tumorectomy followed by irradiation), no recurrence was observed among patients with non-infiltrating duct carcinomas

An airtight facemask/mouthpiece assembly has been devised to facilitate the performance of a wide range of pulmonary function tests during treadmill exercise in dogs. Using this appliance, data were obtained from 6 normal dogs and 3 of the same dogs after left lung autotransplantation. All measurements were made during awake, resting conditions and again after 5-7 minutes of moderate exercise. Resting values for pulmonary function tests, hemodynamic parameters, blood gases and pH from both pulmonary and systemic arterial blood samples did not differ significantly between normal dogs and those studied after left lung autotransplantation. During treadmill exercise, cardiac output doubled and pulmonary vascular resistance decreased comparably in both groups of dogs. Heart rates in both groups rose to approximately 22 b/min and blood gases and pH remained normal. These results indicate the facemask/mouthpiece assembly permits normal ventilation during treadmill exercise. In addition, these data support the view that pulmonary autotransplantation per se need not impose obligatory defects in ventilatory and hemodynamic function despite the increased demands of treadmill exercise