Adenine nucleotide levels in preserved and ischemically injured canine kidneys.
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Biomedical subjects
Publications and source records attributed to N A Halasz.
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Sera obtained from kidney transplant recipients at various times after the graft were investigated for the presence of cytotoxic antibodies to B and T human lymphoid cells and for their ability to inhibit mixed lymphocyte reaction between allogeneic lymphocytes. More than 50% of sera from 35 such patients contained cytotoxic antibodies to B lymphocytes and 27 of 33 sera blocked and miced lymphocyte reaction by 25 to 75%. A statistically significant association between the presence of cytotoxic antibodies to B cells and the ability to block the mixed lymphocyte reaction was found in the group of patients with functioning grafts. However, the presence of cytotoxic antibodies to B lymphocytes did not correlate with the outcome of the graft.
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Cold nonperfusional (flushing and ice storage) with Collins or Sacks solution and perfusional preservation with cryoprecipitated plasma or albumin were compared in dog kidneys. All these methods were effective in achieving excellent 48-hour preservation of fresh kidneys. After exposure to 20 minutes of ischemia at 37 C, neither of the flushing solutions yielded kidneys that permitted survival of recipients after 48 hours of preservation, and flushed kidneys functioned poorly after 24 hours of preservation. In contrast, both plasma- and albumin-perfused kidneys exposed to ischemia supported life satisfactorily and with normal function. Therefore, simple and inexpensive flushing and ice storage techniques are entirely satisfactorily for the preservation of ideally harvested cadaver kidneys, while the more complex and expensive perfusional techniques must be employed in preserving ischemia-damaged organs.
The importance of the cation content of flush solutions used for simple hypothermic storage has been investigated in a 48 hour canine kidney preservation model. Uniformly successful 48 hour storage was achieved with solution C2. However, inclusion of procaine (0.1 Gm. per 100 ml.) in the flushing solution as in C3 produced significant kidney damage. Without procaine, Sacks solution was no better than was C2 and the latter proved significantly superior to a sodium-based solution having identical anion content and osmolarity. The magnesium content of the sodium appeared to favorably influence the outcome of the kidney storage experiments.
Canine left lower lobes which were subjected to 3 hours of warm ischemia in an atelectatic condition were compared to lobes which had not been stored. During short-term reimplantation studies, the injured lobes were characterized by marked weight gain, diminution in blood flow, increased vascular resistance, and peak airway pressure. The ventilation/perfusion ratios were high and considerable dead-space ventilation was present. Hypoxic vasoconstriction occurred in both control and stored lobes, and shunt determinations did not vary because of the low blood flows observed. Some or all of these physiological changes may serve to develop a simple screening method to evaluate techniques of pulmonary preservation.
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Of 238 patients hospitalized with a diagnosis of acute cholecystitis, 20 per cent were ultimately found to have other conditions, namely, renal/ureteral problems most often, followed by diseases of the liver, pancreas, appendix, and thorax. Discriminant factors are discussed. Operations based on misdiagnoses occurred only in the patients undergoing early operation. Painstaking preoperative study and interval cholecystectomy, whenever possible, are recommended.
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