Faculty Bibliography

Graft-vs-host disease (GVHD) and failure of donor stem cells to engraft permanently are two major obstacles to successful bone marrow transplantation. We evaluated the effect of a single large dose of anti-lymphocyte serum (ALS) on mice receiving various numbers of H-2 incompatible bone marrow cells. Most animals receiving lethal total body irradiation (TBI) and allogeneic marrow died within 45 days due to GVHD, A/J (H-2a), CBA/J (H-2k), and DBA/1J (H-2q) mice that were given ALS 6 to 24 hr before TBI and C57BL/6 (B6, H-2b) bone marrow 24 hr after irradiation survived in good health for more than 200 days. This result compared quite favorably with mice that received anti-Thy 1.2 and C-treated B6 bone marrow (90% survival at 100 days, 50% survival at 200 days). Engraftment of the allogeneic marrow was dose dependent. At 100 days after TBI, about 30% of the A/J mice given 2 x 10(6) bone marrow cells were complete chimeras, i.e., donor H-2 antigens could be detected on greater than 85% of the peripheral blood mononuclear leukocytes of these mice. However, at a dose of 1 x 10(7) B6 bone marrow cells, 95% of the A/J mice were complete chimeras. Spleen and bone marrow from B6 leads to A/J chimeras and B6 leads to CBA chimeras were unable to induce lethal GVHD in TBI-treated mice that were syngeneic to the recipient. However, these cell preparations caused lethal GVHD in third party mice indicating that the lack of alloreactivity was specific to the strain in which the unresponsiveness was originally induced

Twelve hypertensive patients underwent percutaneous transluminal dilation (PTD) for relief of arterial stenosis complicating renal allotransplantation. Two patients underwent repeat PTD for recurrent stenosis and hypertension. Six patients had end to end anastomosis of the donor renal artery to the recipient hypogastric artery; four of six PTDs were successful. Six patients had end to side anastomosis of the donor renal artery to the recipient external iliac artery; seven of eight PTDs, including one of two repeat PTDs, were successful. Prior to PTD, all patients were using several antihypertensive medications. Following successful PTD, the mean blood pressure dropped from 184 +/- 15/118 +/- 9 to 133 +/- 13/89 +/- 11 mm Hg (P < 0.001) and remained at that level for up to 15 months (average followup 9 months) with decreased or no antihypertensive medications. Since surgical correction of arterial stenosis occurring after renal transplantation is difficult and may endanger the graft, PTD should be the first interventional therapy

To determine the effects and effectiveness of small volume (50 ml) bronchoalveolar lavage, lavages were performed on healthy mongrel dogs under a number of protocols. The differential and total cell counts in small volume bronchoalveolar lavages were determined. These factors were compared to those obtained by large volume (500 to 600 ml) lavage of the same segment in a second experimental group. Small volume lavage yielded a greater total cell count per milliliter and a greater concentration of polymorphonuclear leukocytes (PMNs) than large volume lavage, in which there was a somewhat higher concentration of bronchial cells. We compared the cell populations from lobes lavaged at 48-hour intervals. No significant changes in these populations or in pulmonary histology were noted. Our results suggest that small volume bronchoalveolar lavage provides a representative sample of the total free cell yield from the lower respiratory tract. Furthermore, small volume bronchoalveolar lavage performed at 48-hour intervals does not influence the distribution of these cells or significantly damage the pulmonary parenchyma

Percutaneous transluminal angioplasty of the branches of the popliteal artery was performed in six patients, two of whom also had femoropopliteal angioplasty. Dilatation was performed with catheters ranging from 5.5 to 7 French. None of the popliteal branch dilatations was performed with an inflated balloon. Excellent dilatation, as documented by angiography and Doppler ultrasound pressure recordings, was obtained in four cases and moderate and slight improvement in one case each. Two of the four patients with excellent results had prompt healing of toe amputations and are doing well at 19 and 22 months after angioplasty. In the other two patients with excellent results, below-knee amputation was necessary despite patency of the dilated segment in one. In the other patient with initially excellent results, reocclusion occurred 4 months after angioplasty. In the patients who had moderate and slight improvement on angiography and in distal pressures, no significant clinical course change occurred. No patient had clinical deterioration after angioplasty and no significant complications occurred