The effect of peri-transplant plasmapheresis in the prevention of recurrent FSGS.

Many pediatric centers utilize a variety of protocols including preemptive plasmapheresis to prevent the recurrence of FSGS post-transplant. But the effectiveness of this expensive, time-consuming process of plasmapheresis in the prevention of FSGS recurrence is still unclear. We retrospectively reviewed all pediatric cases of FSGS in our center that received a kidney transplant and compared the transplant and patient outcomes of those transplanted after 2006 who received pretransplant plasmapheresis to those prior to 2006 who did not. Of the 57 children with FSGS, 31 and 26 were transplanted before and after 2006, respectively. The cohorts differed significantly in keeping with the center immunosuppression protocol changes, and prior to 2006, the recipients were significantly younger. All children with FSGS transplanted after 2006 underwent three and one sessions of 1.0 plasma volume/exchange plasmapheresis with fresh frozen plasma replacement prior to the transplant in living and deceased donors, respectively, in addition to five sessions of every other day post-transplant pheresis. The incidence (27% vs 26%, P = 1.0) and time to recurrence of FSGS in the kidney allograft (P = .22) were not significantly different in patients that did and did not undergo prophylactic plasmapheresis. We need to re-evaluate the role of preemptive plasmapheresis in the prevention of FSGS recurrence in a prospective multicenter study.

Tetraethylammonium and nicotine transport by the Malpighian tubules of insects.

We examined transepithelial transport of the prototypical type I organic cation (OC) tetraethylammonium (TEA) and the plant alkaloid nicotine by the isolated Malpighian tubules (MTs) of nine insect species from six orders. Isolated tubules were exposed to radiolabelled forms of either TEA or nicotine in the bathing (basal) fluid. Luminal (apical) secreted fluid was collected and TEA or nicotine concentration was determined. Active net transport of nicotine from bath to lumen was observed by the MTs of all the insects studied. TEA was also transported from bath to lumen in MTs of all species except Rhodnius prolixus and Aedes aegypti. MTs of both of these blood feeders did not show active transport of TEA under normal physiological conditions. Transport of TEA but not nicotine increased during the moult in the MTs of Rhodnius, but the concentrations of TEA in the secreted fluid were still consistent with passive accumulation in response to the lumen-negative transepithelial potential. Nicotine transport by Rhodnius MTs was inhibited by the type II OC quinidine, a known p-glycoprotein inhibitor, but not by the type I OCs N-methylnicotinamide or cimetidine. Taken together, the results suggest that active transport of OCs by the MTs is common among species from different orders and that transepithelial TEA and nicotine transport occur through separate pathways.

Analysis of epithelial K(+) transport in Malpighian tubules of Drosophila melanogaster: evidence for spatial and temporal heterogeneity.

Transport of K(+) by the lower, main and distal segments of the Malpighian tubules of Drosophila melanogaster was analyzed using self-referencing K(+)-selective microelectrodes. Transport properties of the Malpighian tubules of Drosophila melanogaster change along their length. Self-referencing ion-selective (SeRIS) microelectrode measurements (relative to the bath concentration of 20 mmoll(-1)) showed a 1% reduction (P<0.05) of [K(+)] in the unstirred layer adjacent to the main segment of the Malpighian tubules, confirming secretion of K(+) from the bath to the tubule lumen. Conversely, SeRIS measurements showed a 0.7% increase (P<0.05) in [K(+)] in the unstirred layer adjacent to the lower segment of Malpighian tubules, confirming reabsorption of K(+) from the luminal fluid to the bath. Measurements using SeRIS also showed that the distal segment neither secreted nor reabsorbed K(+). There was pronounced spatial heterogeneity in K(+) transport by the lower segment and the main segment; not all morphologically similar cells participated equally in K(+) transport, nor did all main segment cells respond equally to stimulation of K(+) transport by cyclic AMP. Pronounced temporal heterogeneity in K(+) reabsorption by the lower Malpighian tubules was also observed. We suggest that this reflects periodic reduction in K(+) reabsorption due to retention of fluid within the lower segment when the ureter contracts.

Hormonally controlled chloride movement across Drosophila tubules is via ion channels in stellate cells.

Anion conductance across the Drosophila melanogaster Malpighian (renal) tubule was investigated by a combination of physiological and transgenic techniques. Patch-clamp recordings identified clusters of 4, 4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS)-sensitive "maxi-chloride" channels in a small domain of the apical membrane. Fluid secretion assays demonstrated sensitivity to the chloride channel blockers 5-nitro-2-(3-phenylpropylamino)benzoic acid, diphenylamine-2-carboxylate, anthracene-9-carboxylic acid, and niflumic acid. Electrophysiological analysis showed that the calcium-mediated increase in anion conductance was blocked by the same agents. Vibrating probe analysis revealed a small number of current density hot spots, coincident with "stellate" cells, that were abolished by low-chloride saline or the same chloride channel blockers. GAL-4-targeted expression of an aequorin transgene revealed that the neurohormone leucokinin elicits a rapid increase in intracellular calcium levels in stellate cells that precedes the fastest demonstrable physiological effect. Taken together, these data show that leucokinins act on stellate cells through intracellular calcium to increase transcellular chloride conductance through channels. As electrogenic cation conductance is confined to principal cells, the two pathways are spatially segregated in this tissue.

Total gastrectomy in a patient with an in situ right gastroepiploic artery graft.

A 60-year-old man in whom coronary artery bypass grafting was performed with an in situ right gastroepiploic artery presented with a gastric adenocarcinoma 22 months after myocardial revascularization. He underwent a total gastrectomy with preservation of the patent right gastroepiploic artery graft to the right coronary artery. Because of the difficulty of abdominal reoperations in patients with in situ right gastroepiploic artery grafts, surgeons must consider right gastroepiploic artery free graft or alternative conduits.

[Pierre Masson: the father of histopathology teaching in Canada]. / Pierre Masson: pilier de l'enseignement de l'histopathologie au Canada.

Pierre Masson's influence on teaching of pathology in Canada has been unique. One of the most eminent pathologist, director of the Institute of anatomopathology of Strasbourg, he accepts, in 1926, to be the ambassador of the french science in North America. He is named professor and Chairman of the Department of pathology of the University of Montreal. Very soon, his "school" is world renowned and contributes to the excellent reputation of his new country of adoption. During his career, Pierre Masson has published more than 131 original scientific papers and written his masterpiece "Les tumeurs humaines" which has been translated in English. Masson died in 1959, but his influence is prolonged be his collaborators and students who still cherish his memory.

[Geriatric digestive surgery. An analysis of 163 cases]. / Chirurgie digestive gériatrique. Une analyse de 163 cas.

The aim of our study is to analyze the clinical features and outcome of digestive surgery in the aged. From Jan. 1979 to Dec. 1981, 1,389 operations under general anesthesia were performed on patients 75 years old and more. From this group, 163 patients (111 females and 52 males, mean age: 79 +/- 0.7 years) underwent surgery of the alimentary tract. The procedures were divided in: colorectal (48%), biliary (32%), gastric (10%), small bowel (6%), esophagus (1%) and others (3%). An operation for cancer was performed in 63 patients: palliative (69%), curative (31%). The mean length of hospital stay is 23 days (pre-op 7 days, post-op 16 days). Only 16% of the patients needed intensive care. Postoperative complications occurred in 43 patients (26%); cardiovascular (47%), psychiatric (26%), pulmonary (23%) and others (4%). The overall mortality rate is 10%: 6% for elective cases and 24% for urgent cases (49 patients). The mortality is related to: sepsis and peritonitis (53%), cardiopulmonary disease (23%), hemorrhage (12%), cachexia (12%). At discharge, 62% of the patients returned home directly, 18% to convalescent homes, 10% to unknown places and 10% in nursing homes. Our data supports the benefit of surgery in the aged.

Physiologic response to cricopharyngeal myotomy and diverticulum suspension.

Ten patients who had a cricopharyngeal myotomy and diverticulum suspension for pharyngoesophageal diverticulum have been studied clinically, radiologically, and manometrically. There were no deaths or morbidity and all patients have achieved marked improvement of their symptoms. Before operation all patients but one had low resting tone in the upper esophageal sphincter and all patients had normal relaxation of the sphincter upon swallowing. The coordination of pharyngeal contraction and sphincter relaxation was normal in six patients and abnormal in four patients. After operations the only change was an increase in resting tone in seven patients, and there was no change in three patients. We conclude that cricopharyngeal myotomy and diverticulum suspension constitute an effective form of treatment for pharyngoesophageal diverticulum.

The gastric antisecretory effects of clofibrate in the rat.

The object of this study was to explore the effect of clofibrate on gastric secretion. The volume and the total acid output of Shay-treated rats (pyloric ligation) was studied after intragastric, intraduodenal, intramuscular and intraperitoneal administration of clofibrate. The experimental model was a factorial (3 X 4) random block design. The treatment factor had 3 levels: water, oil and clofibrate. The route of administration factor had 4 levels: intragastric, intraduodenal, intraperitoneal and intramuscular. The data were analyzed by analysis of variance. Compared to the control group (water and oil) the intraduodenally and intraperitoneally administered clofibrate produced a statistically significant (p less than 0.001) reduction in the volume and total acid output. The intragastric and intramuscular groups did not show a statistically significant reduction on the gastric secretion. It is concluded that clofibrate acts systemically rather than locally to reduce gastric secretion.

Early gastric cancer at the Hôtel-Dieu de Montréal: a 30-year review.

Early gastric cancer is usually defined as a lesion involving the mucosa alone or the mucosa and submucosa, regardless of whether lymph-node metastases are present. Between 1948 and 1978, 1295 gastric cancers were diagnosed at the Hôtel-Dieu de Montréal. Of these, 65 (5%) were early gastric cancers. Sixty of the 64 patients underwent gastric resection for cure. The other four cancers were found incidentally at autopsy. One patient (1.7%) died following operation. Ten patients were followed up for less than 5 years and therefore were excluded from survival analysis, as were 6 patients who died of unrelated causes. Forty-one of 43 patients survived, free of disease, for more than 5 years following operation, a survival rate of 95.3%. The annual yield of early gastric cancers has remained relatively constants since 1948, even with a decreasing number of gastric cancers treated at the hospital. The advent of fiberoptic endoscopy significantly (P less than 0.005) increased the number of early gastric cancers detected. Further improvements will depend on a more vigorous approach to endoscopy, especially in high-risk patients. A refined radiologic technique, including double-contrast roentgenography after a barium meal, was diagnostic in all patients who underwent operation in this study.

[Mortality in the emergency surgical management of upper gastrointestinal hemorrhage due to ulcers and gastritis]. / Mortalité dans le traitement chirurgical d'urgence des hémorragies digestives hautes par ulcères et gastrites.

A retrospective study of 68 patients with acute upper gastrointestinal bleeding (excluding bleeding from esophageal varices) revealed that all patients had emergency surgery. The factors influencing the mortality and the recurrent bleeding have been sought. The overall mortality was 29.5%. Age of patients and type of surgical procedure did not affect the mortality raate, while chronicity of lesions and their duodenal location had a favourable influence. Most deaths were due to hypovolemic shock and its complications. Gastric resection with vagotomy is the operation of choice for control of bleeding. The authors present a brief review of the literature and stress the importance of early diagnosis and resuscitative measures, as well as the need for aggressive surgical intervention.