Biomedical subjects
Publications and source records attributed to G Salem.
In hyperacute rejected lung allografts a significantly elevated fibrinolytic activity can be demonstrated which could explain why blood flow is only slightly impaired during this process.
In contrast with kidney, heart and liver transplantations, lung transplantation involves an organ which has contact with the environment and bears a special risk of infection. This circumstance and the diminished resistance during immunosuppressive therapy makes long-term treatment with an effective broad-spectrum antibiotic advisable for lung transplantations. Taking into consideration the different objectives and questions within the research project concerned the 182 lung allotransplantations carried out in dogs can be divided into two therapeutic groups in regard to postoperative treatment: lung allotransplantations with and without immunosuppressive therapy (methylprednisolone, azathioprine). Long-term doxycycline therapy was carried out in both groups. Those animals which were not treated with immunosuppressive drugs survived for an average of 9 days, those receiving immunosuppressive therapy survived for an average of 30 days. The longest survival period was 2.5 years. Clinically and histologically it could be demonstrated that doxycycline was successful both during the immediate postoperative period and in antibiotic long-term therapy after experimental lung transplantations.
A method to eluat donororganspecific antibodies enabling direct and specific access to the pattern of humoral rejection after lung allotransplantation is demonstrated. The antibodies were evaluated quantitatively and qualitatively by elution of lung-grafts immunoglobulins and by a consequent investigation of the eluates using the passive haemagglutination- and indirect immunflourescence- test against donors' lung-antigen. Humoral antidonorlung-antibodies could be proved in all rejected grafts belonging to sensitized as well as to unsensitized recipients. There can be seen a highly significant correlation when comparing the results of the passive haemagglutination and indirect immunfluorescence test (r = 0,93, p less than or equal 0,01). On the other hand negative results of the investigations of eluates by lungantigens of other dogs show the specifity of humoral graft rejection. The suprising fact that there does not exist an essential difference between the results of sensitized and nonsensitized animals reveals a humoral immunresponse in hyperacute as well as in acute rejection.
1250 protocols of heart-lung-machines, taken between 1962-1974, underwent a variance analysis. The results show that rollerpumps with high pumpvolumes (80 ccm) are not significantly lower hemolytic than rollerpumps with a pumpvolume of 40 ccm. The hemolysis stands in direct proportion to the blood flow. Membranoxygenators effect a less traumatisation than screen- and bubbleoxygenators. Furthermore the use of fresh ACD-blood shows a lower hemolysis than hemodilution and older ACD stored blood. Type and age of the vitium have no influence on the traumatic hemolysis. The use of the orthograde perfusion is significantly better than the retrograde perfusion; the use of blood-filters is no cause for traumatic hemolysis. The above mentioned results are in accordance to literature, but the facts cannot be objectivated that easily than in invitro experiments.
According to plain chest roentgenography correlated to needle biopsies the following grades in the course of rejection after single lungtransplantation could be evaluated. 1) Begin of rejection: perihilar alveolar infiltrate. 2) Increase of the infiltrates (positive Airbronchogram). 3) Almost total consolidation of the graft. 4) Complete consolidation of the graft, mediastinal hernia caused by the own lung.
In the present study 12 canine lungs perfused in a BELZER perfusion unit for 17 hours using Albumine solution were homotransplanted. Bronchospirometric evaluation up to the 21st postoperative day have shown sufficient function. There is no remarkable difference in minute ventilation, alveolar ventilation and oxygen uptake when compared with non-stored lung homografts.
Pulmonary function studies after single-lung homotransplantation in dogs with experimentally induced emphysema. Pulmonary emphysema was induced in 8 bastard dogs by intratracheal instillation of papain (dose 2 mg/kg 3 to 5 times in 6 to 10 weeks). Development of emphysema was documented by weekly pulmonary function studies. The emphysematous animals underwent single-lung homotransplantation. Postoperative studies of lung function were performed immediately after transplantation and 1 week postoperatively. Bronchospirometric measurement revealed that ventilatory function and oxygen consumption of the graft was at least equal to the animal's own emphysematous lung. Up to 1 week after transplantation there is no evidence of serious ventilation-perfusion imbalance.
On the 2nd Surgical Department of Vienna, only 2.61% of all resected oesophageal tumors are leiomyomas and fusiform neuromas Contrary to the opinion of the most other authors, fusiform neuromas are predominating in our cases. This fact could be explained by the exact histological evaluation which strictly follows the instructions published by Feyrter. The patients are young or middle-aged and suffer from dysphageal and pulmonal troubles. Indication for operation is not only founded on the clinical symptoms, but also on the possibility of a malign character of the tumour. Intramural tumours of the thoracical oesophagus should be ennucleated via a transpleural thoracotomy by preserving the mucoseal tube. Differential diagnosis and clinical experiences are resumed and discussed.
Experimental emphysema was induced by multiple intratracheal instillation of Papain in a dose of 2 mg/kg body weight in 4 bastard dogs. Development of emphysema was objectivated by pulmonary function tests. Increase of static lung compliance, decrease of lung elastance, and increase of air-way resistance were observed. In addition arterial pO2 decreased while pCO2 remained constant. Following single lung homotransplantation there was an increase of respiratory rate and minute ventilation, the transpulmonary pressure rose in the first postoperative days, static lung compliance was diminished. Four weeks after transplantation typical functional changes of emphysema could be demonstrated concerning the slope and appearance of the compliance loops. Arterial pO2 however remained within the normal range. This functional behaviour does not support the concept of a ventialtion perfusion imbalance after lung transplantation in emphysema patients. Respiratory insufficiency therefore is probably caused by an alveolar type of rejection.
Unilateral homotransplantation of the lung was performed in ten healthy mongrel dogs. Assessment of pulmonary function was obtained immediately after transplantation ten days and four weeks postoperatively. A conventional endotracheal tube was used for measurement of total lung function. A special tube was deviced for bronchospirometric measurements in dogs. A moderate increase of tidal volume and marked increase of respiratory rate and minute ventilation could be noted immediately after transplantation. Oxygen consumption was not changed significantly. There was a marked decrease in arterial pO2-level following transplantation, which was improved during the follow-up studies and found within normal limits at the tenth postoperative day. Bronchospirometry immediately following transplantation revealed equal ventilation values of both lungs, but oxygen consumption of the transplant was reduced 50% compared to the recipient's own lung. On the tenth postoperative day ventilatory function of the transplant was found close to that of the recipients own lung. Oxygen consumption in respiratory equivalent at this time averaged two thirds of the animal's own lung. Four weeks following transplantation no further significant change of respiratory function could be noted.
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Seven patients born with pyloro-duodenal atresia are reported, one had an additional atresia of the small and large bowel, and another had a pneumoperitoneum probably secondary to rupture of the stomach. All patients had the same radiological findings and had no air distal to the pylorus. Consanguinity was elicited in four and a familial incidence of an identical malformation in siblings in six. 6 of the 7 patients were operated on and 4 are living and well 6 months to 5 years later. This report raises the total number of published cases of pyloro-duodenal atresia to 46, and provides further evidence for an autosomal recessive mode of inheritance.
69 patients suffering from bronchiectasies underwent surgery at the II. Surgical Clinic of the University of Vienna from 1958 to 1972. Analysis of results revealed three groups: 1. 67% of the patients cured completely, 2. 23% significantly improved, 3. 10% no improvement. The evaluation of spirometric measurements of not improved patients showed extensive preoperative obstructive ventilation disturbance.
The effect of lumbar sympathectomy on regional blood-flow and on oxygen uptake of tissue has been investigated in animal experiments and in man. Lumbar sympathectomy did always result in increase of limb blood-flow, but did not significantly improve oxygen consumption of the observed extremity. This finding was manifested by marked narrowing of the arterial-venous oxyhemoglobin saturation difference suggesting that lumbar sympathectomy caused opening of arterial-venous shunts.
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Five mongrel dogs underwent a left side pulmonary homotransplantation and simultaneous contralateral pulmonary artery ligation using a standardized operative technique. The contralateral lung of the recipient was successfully removed on the first postoperative day. From the present study may be concluded that the transplanted lung is able to provide adequate respiratory function immediate postoperatively and is able to tolerate the total cardiac output in the presence of increased vascular resistence of the recipient contralateral lung.
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QUESTION: The function of alveolar macrophages in correlation with immunological stimulation, consequently also in pulmonary transplantation, are a subject of discussion. In this study the alveolar manifestations of rejection following pulmonary transplantation, are a subject of discussion. In this study the alveolar manifestations of rejection following pulmonary homotransplantation are investigated by electron microscopy. MATERIALS AND METHODS: In 20 healthy dogs (body weight between 7 and 19 kg) a left side pulmonary homotransplantation was performed using a standardized method. 2 randomized groups of 10 animals each were formed, one undergoing immunosuppressive therapy, the other none. Needle biopsies (Menghini needles) were taken in both groups at the onset of rejection daily until death of the animals (on the 5th to 12th postoperative day). At death of the animals always total rejection of the homograft was observed. The other animals were subjected to a scheduled immunosuppressive therapy (KREUZER et al. 1973, RADASZKIEWICZ et al. 1974). Needle biopsies were taken only at the stage of a clinically or roentgenologically ascertained crisis of rejection. Before implantation of the homograft and 20 mins after occlusion of anastomoses and onset of circulation in the transplant biopsies were taken, too, to exclude early changes or alterations in the donor. The lung specimens 2 mm in size) obtained by biopsy were fixed in phosphate buffered OSO4 and buffered phosphate solution by usual alcohol series. After embedding in epon the specimens were studied by electron microscopy. RESULTS: In the group not undergoing immunosuppressive therapy beginning with the 3rd post-operative day perivascular lymphocytic and plasmacellular infiltrates were seen which increased during the course of rejection. In both groups a swelling and vacuolization of endoplasmatic reticulum, cytoplasmic microvilli with bridge formation accompanied by an increase of alveolar macrophages and by augmentation of lamellar bodies in granular pneumocytes were noted following operation. A correlation between the increase of lamellar bodies and increase of surfactant has been shown previously.