Arthur L. Humphries

Transmission of human immunodeficiency virus (HIV) by transplantation: clinical aspects and time course analysis of viral antigenemia and antibody production.

The human immunodeficiency virus (HIV) was transmitted to a patient who received a cadaveric renal transplant from a donor who had received massive blood component replacement. A negative HIV antibody test was obtained on serum drawn immediately after transfusion. After transplantation, pretransfusion sera and sera obtained several hours after transfusion tested positive for HIV antibody, suggesting that transfusions had transiently diluted the patients serum and resulted in a false-negative HIV antibody test. Immediately after transplantation, the recipient showed a transient increase in HIV antigen levels followed by a more sustained increase representing de-novo antigen synthesis. Antibodies to HIV were detected 51 days after transplant. The recipient has shown no signs or symptoms of HIV infection after 1 year. In potential cadaveric organ donors, HIV antibody testing should be performed on pretransfusion sera or on sera obtained several hours after massive transfusion of blood products.

Elevated basilic vein arteriovenous fistula

BACKGROUND Many surgeons continue to use prosthetic arteriovenous grafts for dialysis access despite the clear superiority of native arteriovenous fistulas. This study was undertaken to review our experience with elevated brachial-basilic fistulas as an alternative to prosthetic grafts in patients lacking veins suitable for more conventional arteriovenous fistulas. METHODS We retrospectively reviewed the outcomes of 67 patients receiving elevated brachial-basilic arteriovenous fistulas over a 10-year period. Operative complications and causes of failure were identified and actuarial fistula patency determined. RESULTS No patients suffered wound infections, and only 1 developed a steal syndrome in the late postoperative period. Actuarial fistula patency was 84% at 1 year, 73% at 3 and 5 years, and 52% at 10 years. CONCLUSIONS The elevated brachial-basilic arteriovenous fistula is a superb alternative to prosthetic arteriovenous grafts in patients lacking suitable cephalic veins for native arteriovenous fistulas. Operative complications are uncommon, vascular steal is rare, and long-term patency is excellent.

Survival of dog kidneys subjected to high pressures: Necrosis of kidneys after freezing☆

Abstract Dog kidneys were perfused to ensure cooling and then subjected to high pressures before being reimplanted into the autologous donor and tested by an immediate contralateral nephrectomy. Such kidneys exposed to pressures as high as 15,000 psi for 5 min regained excellent function quickly and maintained the life of the dog. Lower pressures were tolerated for longer periods of time. All kidneys that were frozen became necrotic after reimplantation. Thus we were unable to demonstrate that high pressures, to facilitate rapid, uniform thawing, were of any value.

ZOLLINGER-ELLISON SYNDROME IN A NINE YEAR OLD BOY.

Abstract The Zollinger-Ellison syndrome was seen in a nine year old Negro boy. This is the youngest case recorded. He was treated by total gastrectomy seventeen months ago, even after a liver metastasis was proved by biopsy. He now appears to be well in all respects.

Ureteroneocystostomy in Renal Transplantation: A Simple Transvesical Technique

A simple transvesical technique for transplant ureteroneocystostomy is described. The method has been used in 245 transplants during a 6-year period. Only 4 significant complications (1.6 per cent) were recognized and no kidney was lost owing to a complication of ureteroneocystostomy.