M. Auriol

Human cardiac transplants diagnosis of rejection by endomyocardial biopsy causes of death (about 30 autopsies)

1,000 endomyocardial biopsies performed in 110 patients treated by cardiac graft were reviewed. These biopsies permitted early detection of acute rejection after cyclosporin treatment and a good appreciation of its intensity. By this method, almost all rejection episodes were resolved after adequate treatment. Chronic rejection was diagnosed by arteriography used in vivo or in cardiac transplants removed by surgery or necropsy. Rejection provoked an obliterative fibrous endarteritis often complicated by atherosclerosis and its ischaemic consequences. 34 autopsies were performed in patients dead at a variable time after cardiac or cardio-pulmonary transplantation. In early death (14 cases), graft failure and systemic disorders were observed. Acute and chronic rejection was noted less frequently (9 cases). Systemic infections (10 cases) occured either early (post-surgical complications) or late (bacterial, fungal and parasitic lesions). In one case, death was due to a contemporaneous bladder carcinoma. The complications of cyclosporin treatment are briefly discussed.

A pathologic analysis of the outcome following heart-lung transplantation: an autopsy study of 22 recipients

SummaryBetween 1987 and 1989, twenty-two patients who received combined heart-lung transplantation were autopsied at La Pitie Salpetriere Hospital in Paris. With the exception of two recipients who survived for 2 months and 4 months, respectively, the majority of the patients died in the early post-operative period (the mean survival was 20.1 days). At autopsy, five patients showed acute cardiac rejection of a minor grade. Perivascular and peribronchiolar mononuclear cell infiltrates suggesting acute pulmonary rejection were seen in three patients. Obliterating bronchiolitis, which might be indicative of chronic rejection, was observed in four patients who had longer survival rates, and one of these four had died of obliterating bronchiolitis. Rather than allograft rejection, the major causes of death were (1) perioperative hemorrhage, (2) infections (mainly respiratory infections and occasionally mediastinitis), (3) diffuse alveolar damage (the so-called adult respiratory distress syndrome and/or pulmonary organizing edema), and (4) multiple organ failure.The present study suggested some of the reasons why the survival rate following heart-lung transplantation is much poorer than after isolated heart transplantation. Hemodynamic or respiratory problems causing perioperative multiple organ failure as well as pre-existing complications of the recipients, such as “cardiac cirrhosis,” may play an important role in the prognosis of heart-lung transplantation.

Granulomatose lymphomatoïde buccale

Summary A 57 year old man was referred to us with multiple long-standing, recurring and refractory mouth ulcers involving the palate, the intermaxillary folds, the inner side of the cheeks, the frenum of the tongue, a tonsil, the pharynx, the gums and a lower lip. Multiple biopsies had excluded a lymphoma, a carcinoma and infection. A new biopsy showed a polymorphous granuloma with up to 40% of atypical lymphoid cells. No angiitis was present, but an angiocentric pattern was present in the granuloma. The atypical cells stained positively with OKT3 and OKT4 antisera. The patient also had cardiac rhytm disturbances with defects on the myocardial scan and a proteinuria. Thus, we suspected the diagnosis of lymphomatoid granulomatosis, although there were no pulmonary nodules. Cyclophosphamide and prednisone were given with immediate success. As the doses were gradually decreased, a small relapse occured. It was controlled by increasing the cyclophosphamide dosage for six months. The patient is now in complete remission more than four years after having discontinued the treatment. Thus, lymphomatoid granulomatosis can be diagnosed on the basis of a biopsy of buccal ulcers and in the absence of the classical pulmonary nodules. We found no evidence that the atypical cells were lymphomatous; rather, the very good response to the treatment points to a curable granulomatosis.

Les réactions de la paroi aortique au cours de l'athérosclérose induite chez le lapin par l'administration d'adrénaline-thyroxine et régime hyperlipidique

An initial parenteral injection of adrenalin-thyroxin (1 injection daily for 5 days) followed by a high lipid diet induces an unusual, rapidly occuring atheroma in the rabbit aorta. Previous ultrastructural and histoenzymologic studies of the same model have shown obvious intimal and medial changes, apparently due to the hormonal treatment alone. Repair occurs quickly. The mechanism of atherogenesis is uncertain. The present study reports the occurence of obvious atherosclerosis at later stages in this model, when studied by the same methods. The changes are compared with those induced by hormonal treatment alone, allowing some insight into the additional effects of adrenalin and cholesterol on rabbit aorta: — two sets of 6 experimental animals were killed after one month. In the first group, receiving hormonal treatment alone, the vascular wall is not completely repaired and a change in the histochemical perfusion gradient (elevated level of hydrolase activities of the outer layers of the vessel) remains. In the second group, receiving hormonal treatment and the lipid diet, atheromatous plaques containing lipid containing cells appear at intimal level. These cells develop by migration of myocytes from the medial layer. Cholesterol seems to be the main factor inducing the smooth muscle cell migration and lipid deposition and its proliferative effect is increased by the elevated vascular permeability. — after adrenalin-thyroxin, 6 animals received the lipid diet for one month and were sacrificed after a further month. Atheromatous plaques were still present and contained higher lipid levels. Medial scarring may disturb the parietal gradient and increase the intimal lipid accumulation found. — two sets of 6 experimental animals were killed after one month. In the first group, receiving hormonal treatment alone, the vascular wall is not completely repaired and a change in the histochemical perfusion gradient (elevated level of hydrolase activities of the outer layers of the vessel) remains. In the second group, receiving hormonal treatment and the lipid diet, atheromatous plaques containing lipid containing cells appear at intimal level. These cells develop by migration of myocytes from the medial layer. Cholesterol seems to be the main factor inducing the smooth muscle cell migration and lipid deposition and its proliferative effect is increased by the elevated vascular permeability. — after adrenalin-thyroxin, 6 animals received the lipid diet for one month and were sacrificed after a further month. Atheromatous plaques were still present and contained higher lipid levels. Medial scarring may disturb the parietal gradient and increase the intimal lipid accumulation found.

Contribution à l'étude des liquides de lavage alvéolaire

Light cytology, enzymology, immunofluorescence and scanning electron microscopy have been performed on 49 bronchoalveolar fluids recovered by bronchoscopic lavage. The patients had the following lung diseases: infectious pneumonitis (19 cases), pulmonary fibrosis (13 cases) including 5 sarcoïdosis, 3 idiopathic pulmonary fibrosis and 5 silicosis, hypersensitivity pneumonitis (5 cases) and miscellaneous lung tumors (12 cases). Cytologic studies in comparison with clinical aspects show 4 groups: Group I (chronic bronchopneumopathy and inactive fibrosis) presents numerous cells but few lymphocytes (less than 5%); in Group II (evolutive fibrosis) have an increase percentage of lymphocytes (20%); in Group III (hypersensitivity pneumonitis) is observed a very high percentage of lymphocytes (45%); and in Group IV (cancerous lung diseases) values are not far from normal percentage except for lymphomas. Small macrophages (diameter: 10 microns) with a central monocytoïde nucleus and few cytoplasma, are abundant in groups II and III where lymphocytosis is higher. Scanning electron microscopy shows irregular and rough surface, and numerous spontaneous adherences with erythrocytes, lymphocytes, or bacterias. Enzymatic activity (acid hydrolase, esterase, oxydase) increases in these cells. Lymphocytes have a smooth surface evocative of T origin which is confirmed by granular acid phosphatase positivity and rosette forming test. Immunofluorescence shows positive granules with IgG, C1Q and C3 in macrophages only for Groups II and III while free immunoglobulins were present in the recovered lavage fluid.Light cytology, enzymology, immunofluorescence and scanning electron microscopy have been performed on 49 bronchoalveolar fluids recovered by bronchoscopic lavage. The patients had the following lung diseases: infectious pneumonitis (19 cases), pulmonary fibrosis (13 cases) including 5 sarcoïdosis, 3 idiopathic pulmonary fibrosis and 5 silicosis, hypersensitivity pneumonitis (5 cases) and miscellaneous lung tumors (12 cases). Cytologic studies in comparison with clinical aspects show 4 groups: Group I (chronic bronchopneumopathy and inactive fibrosis) presents numerous cells but few lymphocytes (less than 5%); in Group II (evolutive fibrosis) have an increase percentage of lymphocytes (20%); in Group III (hypersensitivity pneumonitis) is observed a very high percentage of lymphocytes (45%); and in Group IV (cancerous lung diseases) values are not far from normal percentage except for lymphomas. Small macrophages (diameter: 10 microns) with a central monocytoïde nucleus and few cytoplasma, are abundant in groups II and III where lymphocytosis is higher. Scanning electron microscopy shows irregular and rough surface, and numerous spontaneous adherences with erythrocytes, lymphocytes, or bacterias. Enzymatic activity (acid hydrolase, esterase, oxydase) increases in these cells. Lymphocytes have a smooth surface ovocative of T origin which is confirmed by granular acid phosphatase positivity and rosette forming test. Immunofluorescence shows positive granules with IgG, C1Q and C3 in macrophages only for Groups II and III while free immunoglobulins were present in the recovered lavage fluid.