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Advances in antenatal imaging over the past 10 years have completely changed diagnosis and management of congenital lung disease, especially for congenital cystic adenomatoid malformations and sequestrations that are the two lesions most commonly detected. If early surgical excision is required for symptomatic cases, management of asymptomatic malformations is still discussed. The natural evolution and consequences of later complications of congenital lung malformations need to be compared with the benefits of elective resection and surgical morbidity. Complete regression of sequestrations or clinical and morphological improvement in congenital lobar emphysema pleads for clinical watching. On the other hand, resection is advocated for cystic malformations, because of an increased risk of acute respiratory distress, later infections and the possibility of malignant transformation. Even though the proportion of asymptomatic patients that go on to develop symptoms is hard to evaluate, an argument for elective surgery is a better outcome than emergency surgery. Further studies and long term follow-up are still needed to understand the natural history of congenital lung malformations precisely and help to define the optimal way in which to manage them.

Intestinal occlusion occurs in approximately 1 in 3000 births. Its diagnosis can be made in utero with ultrasound however, determination of its precise location is difficult to achieve. We report herein the feasibility of diagnosing and locating a fetal small-intestine occlusion with the use of magnetic resonance imaging.

Background—In a previous study, it was shown that a spontaneously tolerated DA (RT1a) liver allograft in a PVG (RT1c) recipient was able to induce tolerance of a DA small bowel graft performed 17 days later in spite of infiltration of the intestinal grafts by mononuclear cells.Aims—To compare the phenotype of graft infiltrating cells in rejecting and tolerated small bowel grafts in order to elucidate the mechanism(s) which block the graft infiltrating cells from mediating rejection.Methods—Multiparameter immunofluorescence was used to compare the phenotype and state of activation of donor and recipient cells isolated from intestinal grafts rejected or tolerated after liver transplantation.Results—Three differences were found. Firstly, there was a more rapid replacement of lamina propria (LP) cells by recipient lymphocytes in tolerated than in rejected grafts. Secondly, the proportion of LP recipient CD8αβ+ lymphocytes bearing the high affinity receptor for interleukin 2 was significantly less in tolerated grafts (1.1%, range 0–2%) than in rejected grafts (21.3%, range 9–26%). Finally, tolerated grafts contained significantly less NK lymphocytes (NKR-P1+) and macrophages than rejected intestinal allografts.Conclusions—These observations make it possible to delineate clear cut differences in the phenotype of cells infiltrating rejecting versus tolerated grafts. Furthermore, the data suggest that liver transplantation induces tolerance of intestinal grafts by hampering the activation of recipient TcRαβ+ CD8αβ+ T cells and subsequently the recruitment of non-specific effector cells.

The intestinal mucosal barrier plays a major role in the body’s local and general defense systems. Any alteration of the immune barrier can be responsible for severe diseases. This mucosal barrier consists of a large population of different cells, mainly lymphocytes, plasmocytes, macrophages, polynuclear cells, and mast cells (Arnaud- Battandier 1984), a fact which distinguishes small intestinal (SI) transplantation from that involving other organs. Surgical improvements and drug developments now enable long-term survival of animals that undergo SI transplantation, including large animals such as pigs (Ricour et al. 1983) or dogs (Cohen et al. 1983; Raju et al. 1984) and rodents (Thiede and Deltz 1978; Schraut et al. 1983; see review by Kirxman 1984). Before the use of immunosuppressive drugs, rejection of small- bowel allografts in experimental animals occurred within 10 days.