Hagstrom Jw

Mycotic aneurysms of the pulmonary arteries in intravenous drug addicts: Report of three cases and review of the literature

During the postmortem study of pulmonary lesions in intravenous drug addicts, three patients were found to have bilateral multiple mycotic aneurysms of the peripheral pulmonary arteries in association with embolic pneumonia. Two of these patients had infective tricuspid endocarditis, and one had hemoptysis. This report draws attention to the occurrence of mycotic aneurysms in this unusual location and suggests that these pulmonary lesions may be more common than currently believed.

Arteriovenous fistula complicating percutaneous renal biopsy in polyarteritis nodosa

The occurrence of an arteriovenous fistula secondary to percutaneous renal biopsy in a patient with polyarteritis nodosa is recorded, and the literature reviewed. Although no specific cause for the development of such fistulas can be identified with certainty, advanced vascular disease and hypertension seem to be predisposing factors. Arteriovenous fistulas are probably relatively common consequences of renal biopsy and, in general, do not seem to have a marked effect upon the course or prognosis of the patient. The possibility of delayed hemorrhage in renal arteriovenous fistula is emphasized, and caution is urged in performing renal biopsy when polyarteritis nodosa is suspected.

Diagnosis and Reversal of Rejection in Experimental and Clinical Lung Allografts

Abstract Experience in our patients and dogs with lung transplants has provided reliable criteria for diagnosing rejection and distinguishing it from other pathological processes such as pneumonia and ischemic injury. These criteria include fever; dyspnea; malaise; increased sputum production; decreased arterial oxygen tension; and, most importantly, the rapid development (often within hours) of a roentgenographic alveolar infiltrate without any change in the sputum bacteriology. Using these criteria we have identified multiple rejection episodes in 2 patients and in comparably immunosuppressed dogs. In almost every instance all acute manifestations of rejection, including the roentgenographic infiltrates, have been completely reversed by three to seven large intravenous doses of methylprednisolone given at 12- to 24-hour intervals. In the dogs, reversal of rejection has also been confirmed by gross and microscopical examination of the allograft. These findings show that acute rejection in lung allografts can be reliably identified by noninvasive criteria and successfully reversed.

Long-term fate of lung autografts charged with providing total pulmonary function. I. Light and electron microscopic studies.

Two groups of dogs underwent light and electron microscopic examination of both lungs up to five years after left lung auto-transplantation. In one group of four dogs that had undergone ligation of the right pulmonary artery at the time of left lung autotransplantation, no generalized or consistent lesions were present in the transplant except for slight distension of net capillaries and slight capillary basement membrane thickening. Aside from these minor changes which were probably of no functional significance, most areas of lung examined up to five years after transplantation were normal. In the second group of four dogs that did not have contralateral pulmonary artery ligation at the time of left lung autotransplantation, no consistent abnormality was present in either the transplanted left or nontransplanted right lung. In three animals in this group, widespread normal areas were present bilaterally up to five years after transplantation. One animal in this group had focal changes consistent with chronic pulmonary disease in both of its lungs. Thus, transplanted lungs do not necessarily develop significant late pathologic lesions.

Radiological dissociation of alveolar and vascular phases of rejection in allografted lungs.

Abstract Twelve dogs with allografted lungs were treated with azathioprine and rabbit antidog thymocyte serum. Chest roentgenography, pulmonary angiography, and lung biopsy revealed a dissociation of the alveolar and vascular components of rejection in 7 of the animals. The vascular phase of rejection was more effectively suppressed than the alveolar phase. This dissociation may produce a functional disturbance with a decreased ventilation to perfusion ratio within the allograft such as has been observed in human lung transplant recipients. The results of this investigation suggest that rejection plays a more important role than previously recognized in the ventilation-perfusion imbalance that occurs with pulmonary allografts.

Pulmonary capillary permeability to sodium in unilateral transplanted canine lungs

Abstract Five dogs with autotransplanted left lungs, four with allotransplants and immunosuppression, and five with allotransplants but without immunosuppression were studied 4 to 5 days after surgery. The indicator dilution technique was used to measure the pulmonary capillary permeability to sodium from the left and right lungs separately. The permeability in each lung was evaluated with the blood flow (using carbonized microspheres), the steady-state albumin and sodium spaces and the lung morphology. In the allotransplanted lung there was an increase in capillary permeability to sodium, an increase in both water and solid content and a reduction in blood flow. These alterations were most marked in the allotransplants with immunosuppression, but were also present in the contralateral right nontransplanted lung in which pneumonia was frequently present.