Faculty Bibliography

The accurate diagnosis of lung transplant rejection requires histologic examination of the grafted lung. Because transbronchial lung biopsy has been advocated as an effective diagnostic procedure for a variety of lung diseases, it was elected to assess this technique in rejecting transplanted lungs. Twenty-two dogs received allografts and underwent simultaneous lung biopsy by 3 techniques when signs of rejection occurred. Open lung biopsy was diagnostic of rejection in all instances. Transthoracic needle biopsy correlated with the open biopsy in 59 per cent of the cases. No specimen obtained by transbronchial lung biopsy provided sufficient material to permit fulfillment of the strict histologic criteria needed to diagnose allograft rejection. Although transbronchial lung biopsy is successful in many pulmonary infiltrative processes, it appears to be inadequate for the diagnosis of lung allograft rejection

The uptake of 131I-fibrinogen in canine pulmonary allografts was compared to that in lung autografts or lungs with papain-induced unilateral hemorrhagic pneumonia. In addition to serial lung scans and the postmortem measurement of tissue radioactivity, all dogs had serial chest roentgenograms and histologic study of their lungs. All four animals in the allografted group had increased radioactive uptake on the side of the allograft lung at the same time as or slightly before radiographic abnormalities were evident. However, increases in lung radioactivity also occurred in animals with pneumonia or autografts at the time infiltrates were present. Thus the presence of increased lung scan activity, which occurs in rejecting lung allografts after the injection of 131I-fibrinogen, is not a specific index of pulmonary rejection

Isotope angiography performed by intravenous injection of technetium 99m pertechnetate has been demonstrated to be of value in the diagnosis and management of a variety of disorders of the large arteries. An improved technique of isotope angiography is described and the technique validated (53 cases) in normal and diseased arteries by correlating it with conventional contrast arteriography and/or operative findings. Peripheral arteries as far distal as the wrist or mid-calf have been accurately visualized and quantitation of isotope arrival times and total isotope activity in different parts of the arterial tree has provided a means of evaluating the hemodynamic significance of stenosing lesions. Thirty-nine arterial reconstructions were studied by this technique. Seven of 27 (26%) clinically patent arterial reconstructions were found to be harboring significant and potentially dangerous imperfections which were clinically unsuspected. Nine of 12 (75%) arterial reconstructions thought clinically to be occluded were demonstrated to be patent, obviating the need for invasive contrast arteriography. Isotope angiography may be used with no risk for the immediate postoperative and long-term evaluation of arterial reconstructions. Only those patients with abnormalities identified on isotope angiography need have conventional contrast arteriography for further delineation of the abnormality so that it may be repaired before it causes failure of the reconstruction

Intravenous rupture of abdominal aortic aneurysms occurs infrequently but should be considered with the coexistence of severe congestive failure, anasarca, and abdominal bruits. Six patients are presented with four survivors. In only two patients was the diagnosis considered preoperatively without angiography. Two were variants in that thrombus occluded the fistula, thereby negating findings usually manifested clinically. Diagnosis of this type can be made only during operation when copious venous bleeding ensues with evacuation of the aortic thrombus. Careful fluid management and prompt surgery are prerequisites to obtaining a successful outcome. Repair is accomplished easily by suturing the fistula from the aortic aspect, but care is required to avoid dislodgement of thrombus and atherosclerotic debris resulting in pulmonary embolism

Arterial visualization using the gamma camera was achieved by peripheral intravenous injection of technetium pertechnetate Tc 99m 253 times in 200 patients. This technique, which successfully images the arterial tree to the level of the wrist and ankle, was validated by blind comparison of the scintiangiograms with contrast arteriograms or surgical findings or both in 93 studies. Although scintiangiography has less resolution than contrast arteriography, it provides quantitative and other important supplementary information in the diagnosis and management of patients with arterial disease. Scintiangiography has accurately diagnosed arterial occlusions (atherosclerotic, traumatic, and embolic), true and false aneurysms, and arterial stenoses. Patients sustaining trauma to the extremities may be evaluated by scintiangiography as a screening technique. Postoperatively, scintiangiography has replaced contrast arteriography for assessing patency of grafts and completeness of thromboembolectomy and for the long-term follow-up of these patients

A low-cost, portable isothermal transport system has been developed. It is based on a fundamental principle of physical chemistry, in which the equilibrium between the solid and liquid phases of a compound with a given freezing point determines an isothermal mixture at precisely the freezing point

Lung allograft rejection can usually be diagnosed by the appearance of infiltrates on plain chest roentgenograms when these are interpreted in the light of other clinical and bacteriologic information. Large pulsed intravenous doses of methylprednisolone were usually effective in reversing lung allograft rejection that occurred in immunosuppressed dogs. In 10 of 15 animals the presence of moderate to severe rejection and its effective reversal with treatment were documented with roentgenograms and histologic sections. This ability to reverse the manifestations of lung allograft rejection, when they occur, has helped in the management of human lung allograft recipients