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To establish a model for 24 hours of hypothermic pulsatile perfusion-preservation, methylprednisolone, glucagon, and allopurinol were added to the perfusate of five groups of canine pancreaticoduodenal segments. Results after transplantation showed that neither allopurinol nor glucagon, when used alone, had any beneficial effect on the segments. The segments perfused with the additive combination of methylprednisolone and glucagon had the best results after transplant.

The effect of extracellular crystalloid (Ringer's) and colloid (silica gel fraction [SGF]) solutions, and intracellular crystalloid (Sacks) and colloid (modified silica gel fraction [MSGF]) solutions for canine heart preservation in a 24 to 48 hour model of hypothermic storage and zero to 30 minutes of warm ischemia was compared. Canine hearts flushed with an intracellular colloid solution (MSGF) had better survival rates after transplantation than did the hearts flushed with intracellular crystalloid solutions (Sacks). Better survival results also were observed in the group of hearts flushed with extracellular colloid (SGF) solutions than extracellular crystalloid (Ringer's) solutions. The most important theoretical factor in heart preservation appears to be hyperosmolarity and elevated concentration of potassium, proteins, and glucose.

Seven patients with primary osteomyelitis of the chest wall are described. All patients presented with pain at the site of infection, and four patients had a tumor-like mass that could easily be confused with a neoplastic process. All were heroin addicted and pseudomonas was the most common organism cultured. Conservative management with antibiotics for a minimum of 4 weeks is recommended with operation assuming a secondary role, namely, to assist in the initial diagnosis or in the form of limited resection of residual sinuses. Primary wide resection is discouraged.

Perfusion of cadaver kidneys up to 48 hours did not adversely affect the long-term renal allotransplant function and did not result in an increased rate of rejection. In fact, cadaver kidneys perfused for longer periods of time had a slightly better functional survival rate than did kidneys perfused for shorter periods. From 100 perfused cadaver kidneys, we can conclude that the length of perfusion had little if any effect on the immunogenicity of the renal allograft in the immunosuppressed transplant patient.

H2-histamine receptor antagonists may augment delayed hypersensitivity. The effect of cimetidine, a H2-histamine receptor antagonist, was assessed in renal allografts in dogs. The animals in the control group (I) (n = 5) received a renal transplant and moderate immunosuppression with azathioprine and prednisone. The dogs in the experimental group (II) (n = 8) were given cimetidine in two doses (300/150 mg, twice daily). Group III (n = 4) dogs were not operated upon and received all drugs in full dosage in order to test any direct toxic effect on normal kidneys. Biweekly gastric analysis, hemoglobin, white blood count, and daily serum creatinine were monitored. The dogs in group II that received the higher dose of cimetidine rejected the transplant earlier (mean survival, 20.4 days) than the dogs in the control group (mean survival, 37.8 days). No direct toxic effect from the drug was demonstrated in the control nontransplanted group. Cimetidine in high doses suppressed both basal and host stimulation secretion of gastric acid. In summary, the finding of increased rejection episodes and diminished survival after kidney transplantation in moderately immunosuppressed dogs that received cimetidine indicates that the use of this drug in transplantation is probably not safe until more is known about the immunological mechanisms involved in this situation.

Four cases of pulmonary actinomycosis are presented. Resection was necessary in three cases before the diagnosis was established. A high index of suspicion for this disease is advised for the thoracic surgeon involved in the treatment of lung masses.

The collapsed left lungs of dogs were subjected to 1 hour of normothermic ischemia in situ followed by immediate ligation of the contralateral pulmonary artery. Adenosine in a dose of 50 mg/kg prolonged the survival of the dogs significantly. In the survivors only transient changes in the chest x-ray were seen, and no changes in arterial oxygenation were observed. The pulmonary architecture was well preserved on histological studies 14 days after operation. Animals whose ischemic lungs were not protected by adenosine showed an immediate drop in arterial oxygenation and a massive infiltrate of the ischemic lung. Histological study of the lungs showed a complete breakdown of the capillary-alveolar barrier. Allopurinol alone was ineffective by itself and was not able to improve the survival achieved with adenosine further. We conclude that it is possible to prolong the tolerance of a deflated lung to normothermic ischemia by pretreatment with adenosine.

Survival of heart allografts flushed with antilymphoblast globulin (ALG) was significantly prolonged when the grafts were transplanted into minimally immunosuppressed recipients. When no immunosuppression was given, there was no prolongation of survival of ALG-flushed grafts. Donor pretreatment with cyclophosphamide, methylprednisolone, or ALG had no influence in the prolongation of survival of cardiac allografts. We do not have a clear explanation for the prolonged survival of ALG-flushed grafts transplanted into minimally immunosuppressed recipients.

We studied the effects of a colloid hypersomolar solution in perservation of lungs for transplantation in dogs. Fresh allografts were compared to lungs stored (4 to 7 degrees C), in Ringer's lactate for 3 hours and in modified silica gel function (MSGF) for 8, 16, and 24 hours before transplantation. Lungs preserved in Ringer's lactate for 3 hours were significantly damaged, and there were no long-term survivors in recipient dogs (1.2 +/- 0.4) (mean +/- S.E.). In contrast, the recipients of lungs preserved in MSGF for periods of up to 24 hours stored MSGF grafts = 10.5 +/- 3.1 days, survival, mean +/- S.E. Fresh Ringer's lactate grafts = 8.5 +/- 2.3 days, mean +/- S.E.; Fresh MSGF grafts = 13.6 +/- 3.8 days, mean +/- S.E.). Arterial blood gas measurements and chest roentgenograms were good methods of assessting the condition of preserved lung allografts. No significant differences were observed between the fresh and MSGF-preserved grafts. Pneumonia and rejection were the most frequent causes of death for both the fresh and MSGF-preserved allograft recipients. We demonstrate that a calloid hyperosmolar solution (MGSF) is a good method for 24 hours hypothermic storage of lung allografts for transplantation.

Eighty-nine patients with benign acid-peptic strictures of the esophagus were evaluated. Of these, 56 patients were treated by dilatation and medical therapy, whereas 33 underwent operative therapy because medical therapy failed. Three patients, all psychotic and having post-emetic strictures, required resection of the stricture and a colon interposition. Twenty-nine patients underwent a Belsey or Nissen fundoplication combined with esophageal dilatation. Fourteen of 29 had an associated vagotomy and 15 did not. Two patients of this 29 had a poor result, one of whom had a post-emetic stricture. Although the patients having a concurrent vagotomy and pyloroplasty had the more severe disease,there was no significant difference between the results in the two groups. It is concluded that most patients with such esophageal strictures may be adequately treated without resecting the stricture and that the routine addition of a vagotomy and drainage procedure is probably not indicated.

Methylprednisolone was given at different intervals before warm ischemia of the heart (37 degrees C. for 60 minutes), and viability of these hearts was evaluated after transplantation into the abdomen of another dog. Animals were divided into four groups: Group 1 received no methylprednisolone: Groups II, III, and IV received 30 mg. of methylprednisolone per kilogram 10 minutes, 60 minutes, and 120 minutes before warm ischemia. In all parameters measured, the animals of Group IV performed better than the other groups. It is concluded that methylprednisolone, when given 2 hours before warm ischemia, exerts a protective effect on the ischemic myocardium.