Roy Cohn

Successful homotransplantation of the canine heart after anoxic preservation for seven hours

Abstract Experiments are described in which successful homotransplantation of the dog heart was carried out after seven hours of cardiac anoxia. During the period of extracorporeal preservation, the arrested heart was maintained at 2 to 4 °C. by immersion in cold saline solution. Two animals recovered after transplantation and lived for seven and eleven days, respectively, at which time death was caused by homograft rejection.

EARLY RENAL TRANSPLANT FAILURE ASSOCIATED WITH SUBLIMINAL SENSITIZATION

SUMMARY A sensitive assay, based on the inhibition of binding of radioiodine-labeled anti-HL-A IgG, was used to measure antibodies against transplantation antigens on donor cells. Low levels of antibodies, not detectable by cytotoxicity assays, are rapidly destructive to renal grafts. The titer of antibody correlated with the severity of early renal failure. High levels of antibody caused immediate anuria (hyperacute rejection). Intermediate titers were associated with immediate diuresis and with graft failure within 24–96 hr (accelerated rejection). Low levels were associated with mild impairment of renal function suggestive of ischemic damage (high output failure). These findings indicate that a substantial number of early failures previously attributed to obscure causes may have been attributable to antibodies not detected by routine tests used for cross matches.

Rupture of the thoracic trachea and major bronchi following closed injury to the chest

Abstract Three cases of closed injury to the trachea or bronchus have been reported. These cases emphasize the importance of early recognition of the injury and again illustrate the difficulties of late repair of tracheal stenosis. Uncontrollable emphysema or tension pneumothorax after a closed injury to the chest warrant bronchoscopy and immediate thoracotomy with a tentative diagnosis of traumatic rupture of the trachea or bronchus. Progressive dyspnea occurring within ten days after closed chest injury demands bronchoscopy. Granulation tissue projecting into the lumen should be recognized as unmistakable evidence of injury to the trachea or bronchus, and thoracotomy with repair of the injury should be accomplished. Otherwise tracheal stenosis will occur later, and the difficulties of late repair are often insurmountable.

ALTERNATE-DAY PREDNISONE THERAPY AFTER RENAL TRANSPLANTATION

Abstract In 17 renal-transplant patients receiving daily azathioprine, supplementary prednisone was given on alternate days instead of daily. The side-effects of prednisone diminished, and all but two patients maintained stable renal function.

An experimental method for the closure of interauricular septal defects in dogs.

Abstract A method is described whereby a defect in the interauricular septum in dogs can be closed.

Gastric stapling for morbid obesity

Summary Medical therapies for morbid obesity offer very little hope for controlling excess body fat and its sequelae. Of the surgical therapies available, gastric stapling has emerged as a safe, effective adjunctive measure in a broad-based program to rehabilitate obese patients. Seventy-seven patients lost an average 20 percent of their preoperative weight.

Nonpenetrating Wounds of the Lungs and Bronchi

While many deaths are inevitable owing to extent of injury, in some cases death can be ascribed to delays of therapy, errors, and impropriety in the handling of the thoracic component of a patient’s injury. Various aspects of injuries to the lung itself and to the major bronchi are emphasized.

SERIAL ANGIOGRAPHY IN CANINE RENAL ALLOGRAFTS

Serial studies of the vascular tree of canine renal autografts, unmodified first-set allografts, and a second-set allograft were performed. Thorotrast was utilized so as to allow visualization of both the arterial and venous beds. Serial determination of scrum creatinine, BUN and effective renal plasma, flow were obtained. Histologic correlation of radiographic abnormalities in the venous tree was made. Attenuation, truncation and separation characterized changes in the arterial tree of the first-set allografts. Similar, less striking changes occurred in the veins. Intraluminal venous filling defects occurred prior to other radiographic and laboratory abnormalities. Subintimal round cell infiltrates, possibly related to the venous vasa vasorum or perivenous lymphatics, appear to be the basis for these defects.

CHANGES IN PULSATILE BLOOD FLOW IN AUTOGRAFT AND HOMOGRAFT KIDNEYS DURING REJECTION

It is now established that a decrease in the blood flow of the homograft is an early sign of homograft rejection. In order to examine this decrease in blood flow carefully, a model was designed to permit daily serial measurements of pulsatile renal artery blood flow in unanesthetized animals having both an autograft and a homograft kidney. It was demonstrated that blood flow to a homograft kidney progressively decreases as rejection occurs, while blood flow to an autograft kidney in the same animal is unchanged. This decrease in homograft blood flow was accompanied by a change in the pulsatile pattern of the homo-graft renal artery blood flow, which was noted as early as the 2nd post-transplant day. The altered pulsatile flow pattern can be temporarily converted to a normal pattern by the intraarterial injection of vasodilating agents, provided that the injection is given before the late stage of rejection.

Renal allotransplantation in man: II. Transplantation in cystinosis, a metabolic disease

Abstract Two patients with cystinosis in end stage renal failure received renal transplants from parental (heterozygous) donors. Although initial renal function was excellent, rapid glomerular insufficiency ensued between the third and sixth post-transplant months, without the reappearance of the Fanconi syndrome. Biopsies disclosed nephron loss, interstitial edema and fibrosis, and moderate infiltration with lymphocytes, plasma cells, and blast cells. The glomeruli showed mild to marked membranous and proliferative changes. One biopsy specimen demonstrated intracellular deposits of cystine crystals. These changes do not permit an assessment of the relative roles of systemic cytinosis, cell-mediated immune rejection, or antibody-mediated damage. The implications of these findings for future transplants in cystinotic children are discussed.