Metabolic and membrane aspects of gastric H+ transport.

Metabolic properties of dog gastric mucosa, investigated by substrate level measurements, implicate the Krebs cycle as the major energy-yielding metabolic pathway but are equivocal in terms of an ATP-based H+ secretion. Purification of gastric membranes by centrifugation and free flow electrophoresis results in a class of membrane vesicles enriched in K+-ATPase and capable of ATP-energized H+ uptake. Immunohistochemistry shows these to be derived from the parietal cell. H+ uptake by the vesicles is accompanied by K+ efflux, and movement of either ion is not potential-coupled. The simplest interpretation of these transport studies is uptake of KCl by the vesicles by passive diffusion followed by active H+:K+ exchange. In some respects, however, this model fails to conform to the expectations from in vitro studies. It may be, therefore, that another pump (i.e., redox) or another membrane component (i.e., Cl- conductance) is lost during purification. The properties of the vesicles are such, however, as to establish their role in H+ secretion by the stomach.

Ileal urinary diversion in patients with Renal transplants.

Ileal urinary diversion has been carried out on 8 occasions in 7/215 kidney transplant patients. In six instances the diversion was required either because the bladder had previously been removed or there was gross abnormality of the outflow tract: in 2 it was successfully employed to deal with difficult post-transplantation urinary fistulae. 4 patients died: 3 within 2 months and 1 at 9 months after the operation. Infection with organisms indistinguishable from those cultured from the ileal loop, was a common complication and, although there were other significant factors which contributed to the mortality, retrospective consideration suggests that energetic prophylactic antibacterial therapy should be instituted when kidney transplantation with ileal urinary diversion is undertaken.

Prelusive skin grafts in live-donor kidney transplantation.

In recipients receiving oral azathioprine (50 mg. a day) the fate of skin grafts taken from live human prospective kidney donors correlates well with the outcome of kidney transplantation from the same donors. Correlation between the fate of skin grafts and HL-A serotyping is not nearly as good except in the case of complete HL-A identity. There is little or no correlation between the mixed-lymphocyte-culture test and the fate of skin grafts and the outcome of kidney transplantation. When the degree of compatibility does not exceed one haplotype the results of live human-kidney transplantation can be significantly improved if the fate of a preliminary skin graft from the prospective kidney donor is used as an index.

Response to influenza vaccine by renal transplant patients.

Twenty-five renal transplant patients and 17 controls were vaccinated with influenza vaccine. Antibody titres were estimated before and one, three, and 12 months after vaccination. On the basis of antibody titre measurements the transplant group showed a similar qualitative and quantitative response to that of the controls. No rejection episodes occurred among the transplant patients as a result of vaccination and nobody in the trial developed influenza. We conclude that it is safe to vaccinate transplant patients with an inactivated influenza vaccine and that protection (haemagglutination-inhibiting antibody) can be induced.

The dip-slide in urology.

To assess the value of the Uricult dip-slide in a hospital urological unit, bacteriological examination of 1,033 urine specimens was compared by this technique and by conventional methods. In 87% of cases identical results were obtained using the dip-slides and the standard laboratory culture plates. Insignificant differences occurred in 10%, and a serious discrepancy between the two methods was found in only 3%. The Uricult dip-slide technique is valuable as a bacteriological screening procedure in urological practice but subculturing from the slide is not recommended except in special circumstances.

Clinical evaluation of the urinary sediment after renal allotransplantation.

The detection of lymphoid cells by routine examination of the urine after renal allotransplantation has proved to be a useful early indication of rejection. In a study of 36 rejection episodes, 20 (56%) were associated with a significant number of lymphocytes in the urine. The incidence was much higher when rejection occurred during the first month after operation (76%); lymphocytes were rarely found when rejection occurred after three months. The appearance of lymphocytes in the urine was of particular value for detecting rejection in patients with prolonged oliguria after transplantation.