Xia Sui-sheng

Segmental pancreas allograft: A report of one case surviving more than one year with functioning graft

Since December 22, 1982, we have per formed 3 cadave r i c segmental pan creas t r ansp l an t a t i ons w i t h duct ob literated in 3 pat ierds who suffered f rom in su l in -dependen t diabetes. The f i rs t two pat ients su f fe red f rom superacute rejection and acute reject ion respective ly t~l. One of t hem is a l ive and has resumed r ece iv ing exogenous insul in . C u r r e n t l y , one case s u r v i v e d more than 2 years and h a d f u n c t i o n i n g graf t and became i n s u l i n i n d e p e n d e n t more than erie year . The pa t ien t is the f i rs t case s u r v i v i n g more t h a n 1 year w i th f u n c t ion ing graf t in China.

Spleen transplantation: IV. Vascularized heterotopic hemispleen autotransplantation in humans

SummaryTwo cases of vascularized heterotopic hemisplenic autotransplantation of the traumatized spleen in adults are reported, and the operative technique and clinical course are described. These two patients have been followed up for 27 and 20 months respectively, and the immunologic parameters, splenic functions, sonarography and99mTc scan studies all indicate that the grafts are in good condition.

Chirurgische Anatomie des Leberhilus

ZusammenfassungAnhand von 100 frischen Ganzleberpräparaten wird hier zum erstenmal in China die chirurgische Anatomie des Leberhilus eingehend beschrieben. Verschiedene Varianten der Aufteilung der A. hepatica am Haupthilus werden erörtert mit besonderer Berücksichtigung der den linken paramedianen Lappen versorgenden A. hepatica media, die manchmal aus der linken, manchmal aus der rechten Leberarterie entspringt. Infolgedessen gehört der linke paramediane Lappen (Lobus quadratus) vom Stand der arteriellen Blutversorgung aus nicht immer zur linken Leberhälfte. Die linke Lebervene vereinigt sich in den meisten Fällen vor dem Eintritt in die Cava intrahepatisch mit der mittleren Lebervene, und die Vereinigungsstelle liegt im Leberinneren regelmäßig auf der geradeaus verlaufenden Verlängerungslinie des Lig. falciforme-Ansatzes. Eine Freipräparierung der linken Lebervene, welche sehr leicht zerreißt, kann eine lebensbedrohende Blutung verursachen, und die Blutungsgefahr wird durch das Vorhandensein der V. hepatica superficialis, deren topographische Lage den meisten Chirurgen leider noch nicht bekannt ist, noch erhöht. Am Hilus hepatis renalis ist die erste Reihe der kurzen Lebervenen zu finden, und die kaliberstärkste, und zugleich die oberflächlichste kurze Vene liegt gerade der rechten Nebenniere gegenüber. Wegen der extrahepatischen Lage ist eine Freilegung des Ductus hepaticus mit seinen beiden Hauptästen ohne Inzision des Leberparenchyms möglich.

Free—draining intraperitoneal pancreatic segmental autografting in canine

SummaryIn this study we attempt to define the result of pancreas transplantation with the duct left open to drain freely into the peritoneal cavity. Twenty dogs underwent total pancreatectomy, splenectomy, and segmental pancreas transplantation with this technique. Eighteen of the twenty animals recovered normal blood sugar and serum insulin levels 24 hrs after operation. Up to date, the longest survival time is 5 months with excellent pancreatic function. Pancreatic biopsies obtained from animals 45 days after transplantation showed that the islet cells were normal, the acinar tissue was normal on the whole and interlobular connective tissue showed slight proliferation.In this report we advocate creation of an arteriovenous fistula between the splenic artery and vein at the tail of the graft in order to markedly reduce the incidences of thrombosis in the graft vessels and hemorrhagic pancreatitis.Our study concludes that segmental pancreas transplantation with unligated duct is a better approach to transplantation of pancreas. This technique is recommended for clinical application.

Orthotopic homotransplantation of vascularized composite mandibular tissue in rabbits immunosuppressed with cyclosporine A

SummaryTo develop the surgical model, composite mandibular tissue was transplanted at the same site. Revascularization was accomplished by end-to-end anastomosis of the facial vessels using standard microvascular techniques. A total of 33 vascularized composite mandibular tissue allografts were similarly performed between two incompatible strains of rabbit. In a control group of 9 animals, no immunosuppression was administered. All of these allografts were rejected acutely within 10 days after surgery. 7 allograft recipients were immunosuppressed with azathioprine and prednisone at 5 mg/kg.d and 2 mg/ kg.d, respectively. Their allografts were also rejected acutely within 10 days. 17 allograft recipients were immunosuppressed with cyclosporine A (CsA). All allografts showed primary wound healing and hair growth and took on normal appearance. 8 of these recipients were given CsA at 5 mg/kg.d i.v. and their allografts were rejected at a mean time of 17.9 days. The remaining 9 recipients given CsA at 10 mg/kg.d i.v. rejected their allografts at a mean time of 36.1 days. In 3 of them, the rejection was reversed with CsA (20 mg/kg.d) injection for five days successfully, and one allograft survived more than 100 days. This pilot study suggests that the surgical model is reliable and that CsA will be useful as an immunosuppressive agent in the study of vascularized composite mandibular tissue allografts.

Clinical significance of hemorrheological parameters in patients with renal transplantation

SummaryHemorrheological studies carried out on 14 recipients of cadaveric kidney transplant regularly before and after transplantation showed very significant differences in plasma viscosity in the period of stable function after successfully transplanted kidney, dialysis before transplantation, and renal rejection (P<0.00l). Significant difference was observed in fibrinogen level in cases with stable normal function and rejection (P<0.05,). Significant positive correlation was found between plasma viscosity and fibrinogen level in patients on dialysis as well as after transplantation. The results in this series showed that abnormal changes in hemorrheology respond to the development of rejection episode and deterioration of renal function in patients after receiving cadaveric renal allografts.

Spleen transplantation: III. Autotransplantation of splenic slices into omental pouches in adults after trauma

SummaryRecently preservation of traumatized spleen has been advocated. Splenic autotransplantation has been proposed as a method for preserving splenic function. This paper reports our experience with autotransplantation of splenic tissue in adults. During a 5-year period from 1981–1985, 102 patients with injured spleen underwent conservative surgery at our institute, 54 of whom received autotransplantation of splenic slices into omental pouches. One patient died of multiple organ failure 2 days after operation,. and another one developed adhesive intestinal obstruction and, therefore, required reoperation 5 months after the first surgical intervention. Histologic studies of this patient’s transplants revealed extensive fibrosis. 42 of the 54 patients were followed up, only 10 maintained a regular follow-up schedule. It was found that the neutrophil leukocyte to lymphocyte ratio was reversed in 7 cases, andα-naphthyl-acetate esterase assay showed the excessive peripheral lymphocytes to be mainly B lymphocytes. The size, volume, function and fibrosis of the transplants are also discussed.

Spleen transplantation: I. Vascularized heterotopic autotransplantation of hemispleen in dog

SummaryPresented in this paper is a new kind of splenic salvage operationvascularized heterotopic hemisplenic autotransplantation in dogs. All the experimental operations on 10 dogs met with success. The technique of surgery, operative complications and maintenance of splenic function of grafts are discussed. The authors believe that the operation is safe and clinically employable.

The technique of heterotopic heart-lung transplantation in the rat.

SummaryA simple technique of heterotopic heart-lung transplantation in the rat has been established. The preparation of donor heart-lung and surgical procedures used on the recipient are those originally described by Lee, with minor modifications. The donor’s ascending aorta is anastomosed to the recipient’s abdominal aorta and all the other vessels are permanently ligated. Except the right inferior lobe of the lung which is left attached to the heart all the rest of the pulmonary lobes is removed. The direction of blood flow through the transplanted heart and lung is as follows: aorta, coronary arteries, coronary sinus, pulmonary lobe, left atrium and left ventricle and then to the aorta (with blood exiting from donor aorta to host aorta during contraction of the donor heart). In inbred Wistar rats, the one month survival rate was 90 %. The model is used for experimental selection of immunosuppressive drugs to prolong the survival time of allografts in the rat.

Erfahrungen über die orthotope Lebertransplantation

ZusammenfassungNach 5 Jahren intensiver experimenteller Vorarbeit wurden von Dezember 1977 bis Januar 1981 9 orthotope Lebertransplantationen durchgeführt. Die Hauptindikation stellt das nicht resezierbare primäre Hepatom dar. Zur Gewinnung einer vitalen Spenderleber wird die einfache hypotherme Konservierung mit Sacks’ Lösung als vorzüglich bewertet; die warme Ischämiezeit schwankte zwischen 0–8 Min., und die kalte Aufbewahrung darf nicht länger als 4 1/2 Std. dauern. Die wesentlichen Punkte der Operationstechnik bei der Empfänger-Hepatektomie und Einpflanzung der Spenderleber werden erörtert. Alle Gefäße werden mit fortlaufender Naht einschichtig End-zu-End anastomosiert; die direkte End-zu-End-Choledocho-Choledochostomie ist jetzt bevorzugt zu verwenden. Es gibt keinen sicheren Parameter für die Beurteilung der Abstoßung, deren Diagnose hauptsächlich auf der klinischen Beobachtung von einer Reihe von Symptomen beruht. Eine Kombination von Azathioprin und Prednison, eventuell mit Zusatz von ALG hat sich als immunosuppressiv wirkend erwiesen. Das Prinzip ist, niedrigere Steroiddosen zu verwenden, und die Dosis rascher zu reduzieren. Bis jetzt hatten wir keinen Exitus in tabula, aber die Perioperationsletalität war ziemlich hoch. Von 9 Fällen lebt noch einer, jetzt über 5 Monate, in gutem Allgemeinzustand und mit genügender Leberfunktion und mäßigem Ikterus. Unser am längsten Überlebender, bis jetzt auch der nach Lebertransplantation am längsten Überlebende in ganz China, lebte nahezu 9 Monate (264 Tage) und starb dann an allgemeiner Metastasierung