[Optimization of multiple abdominal organ procurement]

Multiple abdominal organ procurement should enable the kidneys, the liver and the whole pancreas to be removed. Simultaneous removal of the liver and pancreas depends on arterial variations. In subjects with one single hepatic artery simultaneous removal of the liver and the whole pancreas is always possible. In subjects with right hepatic artery, the whole pancreas can only be removed if the right hepatic artery and the median hepatic artery can be left to the liver transplanter and if the coeliac trunk, the common hepatic artery, the gastroduodenal artery and the splenic artery can be preserved to feed the pancreas.

Value of antegrade ureteral dilation for late ureter obstruction in renal transplants

We report on eight kidney-allografted patients treated for delayed ureteral obstruction between January 1986 and January 1987. In all cases, standard endourological dilation was performed using a balloon catheter, and this was followed by insertion of a pigtail stent. All eight cases showed improvement 1 month after dilation (decrease in creatinine and caliceal dilation). At 6 months, renal function had deteriorated in six patients but remained good in two. One of the six patients was redilated with apparently good results. The remaining five were operated on using their own ureter. We conclude that while internal drainage helps in distinguishing between obstruction and other causes of creatinine increase, antegrade dilation is the treatment of choice for delayed ureteral obstruction.

Presence of papilloma virus type 11 in condyloma acuminatum of bladder in female renal transplant recipient

A case is reported of a female renal transplant recipient in whom, after two years of immunosuppression, condylomata acuminata of the genital tract with urethral and bladder extension developed. The condyloma of the bladder was resected endoscopically with no relapse. Virologic examination revealed a human papilloma virus type 11.

Multiple drug combinations with "low-dose" cyclosporin for renal transplantation. Multivariate analysis of risk factors determining short-term graft survival within one renal transplant center

The factors affecting graft survival in transplant recipients receiving cyclosporin (CsA) are still being debated. Our report is based on an analysis of 202 successive transplantations performed in our institution from May 1984 to December 1986, using low-dose CsA as the basic means of immunosuppression. A total of 142 patients received the triple combination CsA, azathioprine (AZA), and corticosteroids. Sixty patients received a prophylactic combination of CsA, corticosteroids, and antilymphocyte globulins (ALG). From January to December 1986, both regimens were compared in a prospective randomized trial. The factors that affect graft survival were analyzed using the Cox multivariate hazard analysis. The relative risks were calculated for pretransplant baseline risk factors and for outcome-dependent post-transplant risk factors for surviving grafts at 1 month. Transplants performed with a prolonged ischemia time and patients whose graft did not function immediately were statistically at higher risk of graft loss. Adding prophylactic ALG to CsA was associated with better graft survival. Patients who experienced more than 1 rejection crisis and patients whose 1-month CsA dose was lower than or equal to 5 mg/kg per day were also at significantly higher risk of further graft loss. Neither HLA matching, peak panel reactivity, age of the recipient, occurrence of post-transplant renal dysfunction nor 1-month renal function affected the short-term graft outcome.

Enhancement of adriamycin antitumor activity by its binding with an intracellular sustained-release form, polymethacrylate nanospheres, in U-937 cells

We investigated the antitumor activity of Adriamycin on a monocytic-like cancer cell line U-937 after its binding on polymethacrylate nanospheres (diameter, 270-350 nm). Compared to free Adramycin (F-ADR), nanosphere-bound Adriamycin (B-ADR) exhibits a 3-fold enhancement of cytotoxicity, as determined by cell growth inhibition and DNA synthesis, after continuous exposure to 0.02 and 0.04 microgram/ml. The 90% growth inhibition concentration was 0.051 microgram/ml for F-ADR and was 0.018 microgram/ml for B-ADR (P less than 0.001). Furthermore, the nanosphere densities per cell play an important role since for the same drug concentration the higher the density increases, the better the activity is. Indeed, after 4 days of incubation in a medium containing 160 nanospheres at 0.5 fg/cell, the cell counts were 62.8 +/- 12.8% (SD) of the initial inoculum and they were only 16.1 +/- 0.1% after incubation in a medium containing 800 nanospheres at 0.1 fg/cell (P less than 0.001). A comparable enhancement of activity regarding the nanosphere densities was observed after a 24-h exposure to 0.02 and 0.05 microgram/ml. Short-term uptake studies showed that B-ADR accumulation was higher with B-ADR than with F-ADR. In addition, the efflux kinetics was modified. For cells exposed to F-ADR for 4 h, the efflux half-life was 23.7 +/- 7.7 h and the area to infinity under the efflux curve was 8.6 +/- 2.8 micrograms/mg protein x h-1. For cells exposed to B-ADR, the efflux half-life increased to 85.9 +/- 19.2 h and the area to infinity under the efflux curve to 29.6 +/- 6.6 micrograms/mg protein x h-1 (P less than 0.001). Electron transmission microscopy and previous findings have revealed that B-ADR was well internalized into cells. Our data support the hypothesis that B-ADR acts as an intracellular drug release complex after endocytosis. The findings regarding the number of nanospheres per cell and dose-effect relationships are consistent with mechanisms of drug actions extending to membrane domains.

Anatomical study of the infra-montanal urethra in man

Five samples infra-montanal prostatic urethra fixed in formalin and stored in liquid nitrogen at -30C were examined histologically. The results of this study demonstrated that muscle fibres of the striated sphincter extend as far as the level of the verumontanum. The proportion of rapid and slow striated fibres was identical. These striated fibres were mixed with smooth muscle fibres of the urethra. The density of innervation of this muscular tunic was found to increase closer to the striated sphincter; it is composed of equal numbers of adrenergic and cholinergic fibres.

Mycotic aneurysm and renal transplantation

A case of mycotic aneurysm secondary to suppuration of a renal transplant is reported. This aneurysm was responsible for ischemia of the leg and was treated successfully by ligation and venous bypass grafting.

The anatomy of erection

Erection is due to a neurovascular mechanism: an inflow of arterial blood and an obstruction of venous return. The direction of this mechanism is of neurologic origin: (1) control of the smooth muscle tissue of the corpora cavernosa by the autonomic system controlled by reflex centers in the cord or cortical centers accessible to multiple (visual) stimuli (2) control of the perineal muscles by the somatic system. Tumescence is due to a reduction in the alpha-sympathetic tonus of the cavernous tissue permitting influx of arterial blood, and to decreased venous flow from compression of the subalbugineal venous network against the tunica albuginea of the corpus cavernosum. Once this obstruction to the venous return has been achieved, the arterial flow in the corpora cavernosa decreases but persists; the arterial blood in the corpora cavernosa is renewed and not shut off. Rigidity is due to an increase in intracavernous arterial pressure simultaneous with contraction of the perineal muscles (ischiocavernosus) under the somatic control of the pudendal nerve.