Detection of recurrent bladder tumours by transrectal and abdominal ultrasound compared with cystoscopy

Transrectal and transabdominal ultrasound was used to detect the recurrence of bladder tumours and compared with conventional cystoscopy. Forty patients with a previous history of bladder tumour were examined by these methods; 50% had a recurrence. Transabdominal and transrectal ultrasound together identified 95% of recurrences; 1 tumour (diameter 1 mm) was missed. The false positive rate was 5% and these areas, identified wrongly by ultrasound as tumour, were shown to be scars on cystoscopy. Combination ultrasound may be used as an alternative to check cystoscopy in certain categories of bladder tumour.

The effect of hyperglycaemia on pancreatic islets transplanted into rats beneath the kidney capsule

The effect of hyperglycaemia on islet transplantation in the rat has been examined in two ways, using syngeneic transplantation of 400 islets to the kidney capsule and subsequent measurement of kidney insulin content as a measurement of B-cell survival. Firstly, islets were transplanted into either diabetic or normal rats, then 6 months later the composite kidney/islet graft was transplanted into a normal rat. The insulin content was measured after a further 6 months and was found to be significantly reduced in islets exposed to hyperglycaemia in the primary recipient. These findings are interpreted as showing that long-term exposure of islets to hyperglycaemia results in B-cell loss. In the second experiment 400 islets were transplanted into either a long-term (6 months) diabetic or a normal rat. Two weeks later the composite kidney/islet graft was transplanted into a normal rat. The insulin content was measured after a further 6 months and no significant difference was found, whether the primary recipient was diabetic or not. These results are interpreted as showing that islet graft implantation is not impaired in long-term diabetic rats.

Dietary fibre and gastrointestinal disease

This review examines the evidence linking dietary fibre to gastrointestinal disease. Fibre increases stool weight, decreases whole gut transit time and lowers colonic intraluminal pressure. While it may be of benefit in the treatment of constipation, the irritable bowel syndrome and diverticular disease, its role in the prevention or treatment of other gastrointestinal disease has yet to be established.

Splenectomy and renal allograft survival in the rat

The effect of splenectomy on renal allograft survival is not clear. In the rat, spleens isolated from recipients with functioning grafts have been shown to be a major source of cells that are capable of suppressing the rejection response (suppressor T lymphocytes). Thus the removal of the spleen in these allograft recipients could be detrimental to renal allograft survival. This study investigates this hypothesis, and looks for the presence of suppressor cells in other lymphoid organs apart from the spleen. In the rat renal allograft model, donor Lewis spleen cells given to DA recipients intravenously 1 week before transplantation of a Lewis kidney leads to indefinite allograft survival (median survival time (MST) greater than 100 days). Splenectomy before or after pretreatment with donor spleen cells failed to abrogate this effect (MST greater than 100 days). Experiments were performed in which cells or serum were prepared from long-term surviving splenectomized animals which had already been pretreated and transplanted, and then were injected into untreated recipients (adoptive transfer experiments). This was done to determine if cells capable of suppressing graft rejection were present in lymphoid organs outside the spleen in these splenectomized recipients. Thus the IV transfer of 10(8) lymph node cells harvested from splenectomized DA recipients with a long-term surviving LEW graft (LTS), into untreated but lightly irradiated (200 rad) DA recipients resulted in indefinite survival of a fresh Lewis kidney (MST greater than 100 days). In contrast, adoptive transfer of normal DA lymph node cells was ineffective (MST 13 days). Thus splenectomy is not necessarily detrimental to graft survival, as cells capable of preventing graft rejection are found in other lymphoid organs, such as lymph nodes, in splenectomized recipients.

Pretreatment with lymphocyte subpopulations and renal allograft survival in the rat

The induction of antigen-induced immunosuppression by highly purified lymphocyte populations of different phenotypes was investigated in a rat renal allograft model (LEW-to-DA). Lymphocyte populations were prepared from Lewis spleen cells by rosette depletion and flow cytometric separation. Rosette depletion was performed using appropriate monoclonal reagents. B cells were prepared from spleen lymphocytes by rosette depletion of T cells, using three monoclonal antibodies: MRC OX19 (anti-T-cell), MRC OX8 (anti-T-cytotoxic/suppressor) and MRC W3/25 (anti-T-helper). T cells were purified by rosette depletion of B cells with MRC OX12 (anti-rat-K-chain). After depletion the lymphocyte populations were analyzed by flow cytometry and the purity of each preparation determined. B cells were 93.6% pure and T cells were 92.4% pure. Intravenous injection of 5 X 10(6) of these LEW B or T cells one week before transplantation of a LEW kidney into a DA recipient resulted in was indefinite renal allograft survival (median survival time [MST] greater than 100 days). Purification of the enriched B and T cell preparations by flow sorting resulted in highly purified populations of spleen B cells (99.3%) and T cells (98.2%). Further fractionation of the T cells into cells of T helper (99.6%) (i.e., W3/25-positive) and T cytotoxic/suppressor phenotype (99.4%) (i.e., MRC OX8-positive) was performed. While purified B cells, T cells, and T helper cells, given at a dose of 10(6) cells intravenously one week before transplantation resulted in long-term renal allograft survival (MST greater than 100 days), cells of the T cytotoxic/suppressor phenotype did not prevent graft rejection at this dose (MST 10 days).

Abrogation of the immunosuppressive effect of donor spleen cells on renal allografts in the rat by irradiation or heat treatment

In the donor-recipient strain combination Lewis (RT1l) to Dark Agouti (RT1a), indefinite renal allograft survival (MST greater than 100 days) was induced by pretreating recipient animals i.v. with 10(6) to 10(8) viable spleen lymphocytes, seven days before transplantation. Pretreatment with 10(4) or 10(5) cells was ineffective (MST 10 days). However when 10(7) live, but heat-treated (55 degrees C for 10 min) or irradiated (1000 rads) cells were used, all the animals rejected the allograft in a normal fashion (MST 10 and 11 days, respectively). Median survival time of third-party controls was 10 days. The relative amount of cell surface major histocompatibility antigens (class I and class II) expressed by the three spleen cell preparations was investigated using monoclonal antibodies and fluorescence activated cell sorter analysis and found to be similar. After 24 hr in culture, only 1% of heat-treated and 10% of irradiated cells were viable, in contrast to 75% of untreated splenocytes. Trafficking of these lymphocytes in recipient animals was investigated by 51chromium labeling of the cells: 30% of lymphocytes had localized in the liver within 3 hr with little difference in localization among the different cell preparations. But, although 20% of normal and irradiated cells localized in the spleen within 3 hr, at no stage were more than 5% of the heat-treated cells found in the spleen. It is suggested that the length of time viable donor lymphocytes remain in the recipient circulation is important in the induction of specific immunosuppression by spleen lymphocytes.

Hyperparathyroidism--patterns of presentation, symptoms and response to operation

Forty-three patients operated upon for hyperparathyroidism over a 7-year period are reviewed with reference to modes of presentation, symptoms and symptomatic response following operation (76% of symptoms cured or improved). The patterns of presentation are discussed in relation to the increasing use of routine biochemical screening; emphasis is given to the symptoms admitted by 17 so-called 'asymptomatic' patients diagnosed in this way and to their improvement following surgery (75% of symptoms). Symptomatic improvement among a similar group of seventeen 'asymptomatic' patients undergoing operations for thyroid swellings was observed in only 9% of symptoms. In the light of such subjective improvement following parathyroidectomy, the theoretical prophylactic benefit of operation and its lack of morbidity, an aggressive surgical approach to the disease is considered justified.

Aorto-duodenal and subsequent aorto-colonic fistula following operation for ruptured aortic aneurysm

Direct communication between aorta and intestinal lumen, whether spontaneous (primary) or postoperative (secondary), is a rate and frequently lethal cause of gastrointestinal haemorrhage. This paper records what is believed to be a unique occurrence in the survival of a patient who following surgery for ruptured aortic aneurysm, not only developed an aorto-duodenal but subsequently an aorto-colonic fistula over a span of 5 years.