Donor-derived transplant acceptance-inducing cells in composite tissue allotransplantation.

BACKGROUND: Composite tissue allotransplantation (CTA) is a newly emerging field of transplantation. Immunological research in CTA has been intensified due to the recent clinical success of hand and face transplantation. Establishing immunological tolerance by adoptive transfer of ex vivo cultured tolerance-inducing cell types is of growing interest. Transplant acceptance-inducing cells (TAICs) are a type of deactivated immunoregulatory macrophages. METHODS: A total of 36 allogeneic hind limb transplantations in the rat were performed in six groups. Group A (Lewis (LW) â†’ Brown-Norway (BN)) received Lewis-donor-derived TAICs locally (i.m.). Group B (LW â†’ BN) received Lewis-donor-derived TAICs systemically (i.v.) and group C (Sprague Dawley (Sp-D) â†’ BN) served as a control group receiving Lewis-donor-derived TAICs systemically (i.v.). Groups D (LW â†’ BN), E (LW â†’ BN), and F (BN â†’ BN) also served as control groups with group D receiving no immunosuppression, group E receiving FK506 and prednisolone and group F receiving no immunosuppression with isograft transplantations (BN â†’ BN). The timing of rejection was assessed by clinical observation and histological findings. RESULTS: Rejection of the allogeneic hind limb occurred on average 7.7 days after transplantation in group A and 7.4 days in group B. Rejection was significantly delayed (Log-rank test, p < 0.01) compared to groups C and D, where rejection of the allogeneic hind limb occurred on average 5.8 days and 5.6 days after transplantation. No rejection was seen in groups E and F. CONCLUSION: For the first time, TAICs have been applied in a CTA model and demonstrated a significant immunosuppressive effect. Even though the immunomodulatory effect is relatively modest, the results of this study justify subsequent research on TAIC therapy to improve experimental and clinical outcome after CTA.

[Solid-pseudo-papillary tumor of the pancreas (SPPT) as sonographic incidentaloma in the context of acute appendicitis]. / Solid-Pseudopapillärer Pankreastumor als sonographisches Inzidentalom bei akuter phlegmonöser Appendizitis.

OBJECTIVE: Review of the literature (Medline) based on a clinical case. CASE: A twenty one year old lady presented with a one day history of acute right sided lower abdominal pain associated with leucocytosis and the clinical signs of an acute abdomen. Sonography showed fluid coincident with cocardal formation in the right lower abdomen. Incidentally a cystic formation in projection to the caudal pancreas was seen. A CT scan confirmed a cystic mass, 5 cm in diameter. An appendectomy was performed immediately after admission. After an interval of ten days an upper laparotomy leading to a left sided resection of the pancreas was performed. Histological findings showed a solid-pseudo-papillary tumor of the pancreas without any signs of metastatic spreading. Four years after the operation the patient is subjectively well and shows no signs of diabetes or of insufficiency of the exocrine pancreas nor of any recurrence. -- Characteristic findings in solid-pseudo-papillary pancreatic tumors (SPPT) are remarkable size at the time of diagnosis, low risk of malignancy, predominance in young female (10 female symbol : 1 male symbol, M = 27 a), association with oral anticonceptive drugs and mostly incidentally detection. Usually the definitive diagnosis is only found after complete radical resection which in 95 % of cases is curative. CONCLUSION: Abdominal sonography should be performed very thoroughly in any diagnostic query even if, clinically, the diagnosis seems to be obvious.

[Scrotal abscess with inguinal lymph node swelling in an 86-year-old man]. / Skrotalabszess mit inguinaler Lymphknotenschwellung bei einem 86-jährigen Patienten.

HISTORY AND ADMISSION FINDINGS: An 86-year-old patient presented to our clinic with increasing redness and swelling of the right scrotum and inguinal lymphadenopathy. Five and a half years before admission carcinoma of the bladder (pT1,G2) had been diagnosed and was treated with several transurethral endoscopic resections as well as repeated instillations of Bacille Calmette-Guérin (BCG) into the bladder. INVESTIGATIONS: Orchiectomy on the right side was performed. Histological analysis revealed a granulomatous inflammation consistent with a mycobacteriosis. Mycobacterium bovis BCG could be isolated from several sputum and urine specimens of the patient. DIAGNOSIS, TREATMENT AND COURSE: Tuberculostatic therapy was started soon after surgery. After seven weeks of treatment no more mycobacteria could be detected in sputum and urine control specimens. At a follow up after twelve months there was no evidence of recurrent disease. CONCLUSION: We describe the late manifestation of a BCG infection including the lungs and the urogenital tract. This is a rare complication with potentially serious consequences and requires rapid diagnosis and urgent treatment by a multidisciplinary team.

[Diagnosis of a high-grade B-cell lymphoma of the small bowel by means of wireless capsule endoscopy]. / Diagnostik eines hochmalignen B-Zell-Lymphoms des Dünndarms mit der Kapselendoskopie.

Wireless capsule endoscopy is a new diagnostic procedure to detect diseases of the small bowel, in particular in patients with obscure gastrointestinal bleeding. We report on a 76-year-old patient who presented at our hospital with signs of gastrointestinal bleeding and hypochromic anaemia. Bidirectional endoscopy, push enteroscopy, angiography as well as small bowel barium enema rendered no pathologic findings. Wireless capsule endoscopy demonstrated a polypous space in the cantral area of the small bowel. Subsequent intraoperative endoscopy revealed a subtotal stenosing tumour of the upper jejunum which was resected. Based on the histology a high-grade B-Cell lymphoma was diagnosed. The postoperative staging examinations did not indicate any further extranodal involvement.

The effect of knee brace on coordination and neuronal leg muscle control: an early postoperative functional study in anterior cruciate ligament reconstructed patients.

Two studies were carried out after anterior cruciate ligament (ACL) reconstruction to determine the effect of a knee brace on coordination (test 1) and electromyographic muscle activity in drop jumps (test 2). Test 1 studied 25 patients with ACL reconstruction under three test conditions (one-leg static, two-legged static, two-legged dynamic) compared with a control (n=30). The results showed highly significant improvements in all braced conditions. In test 2 ten patients with ACL reconstruction and ten healthy subjects performed a two-legged drop-jump; this was repeated 15 times and again 15 times with a knee brace worn on the reconstructed limb. Changes in electromyographically determined muscle activity (vastus medialis, vastus lateralis, biceps femoris, gastrocnemius) were observed, but they were significant in only few cases because of high variability. Drop-jumps with knee brace improved jumping height, increased the maximum knee angle in the ground contact phase, and reduced the maximum knee angle in the landing phase. Patients thus develop an increased confidence in the stability of their knees. We conclude that the benefits of the knee brace are due to the mechanical action, an enhanced coordination, and a psychological effect.

[Effects of knee braces on sensorimotor capabilities of patients with ACL reconstruction]. / Auswirkungen einer Knieorthese auf die sensomotorischen Fähigkeiten bei Patienten mit einer VKB-Plastik.

In 25 test persons with Anterior-Cruciate-Ligament (ACL)-Operation the sensomotory capabilities of the affected and the unaffected side were examined by KAT 2000 (BREG Inc., Vista, C.A., USA) with and without knee-brace (Hypex knee-brace/Fa. Aircast-Europa GmbH). The results were compared with those of a control group. In all cases of test variations (both leg-static/both leg-dynamic/one leg-static) there were significant differences between testing with and without knee brace. In the one leg-static test there was an improvement of 30% (p < 0.01), in the both leg-static test an improvement of 24% (p < 0.01). The both leg-dynamic showed a similar result (23.8%; p < 0.01). These noticed adaptations may be mediated by improvements of proprioceptive and exteroceptive capabilities and a positive impact on the anticipative control of behavior. The results of the control group differ in only a few cases from the results in the group of patients. This may be judged as indicator for the variety of sensomotory capabilities in the general population.

Pseudotumor of the sigmoid mimicking carcinoma.

On colonoscopy, the macroscopic aspect of a lesion is an important criterion for the differential diagnosis. We present a case of an apparently malignant tumor in the sigmoid. Histological investigation failed to support the diagnosis made from the gross appearance seen on colonoscopy. After surgical resection, the lesion turned out to be a reactive pseudotumor caused by fibroepithelial hyperplasia related to a severe diverticulitis with perforation of the intestinal wall.

[Coordination training after anterior cruciate ligament surgery]. / Koordinatives training nach VKB-Operationen.

Many studies have shown that ACL-surgery leads to a decrease of proprioception abilities. In spite of the resulting high importance of coordinative exercise, there is nothing like a phase specific concept for coordinative training after ACL-operations going along with rehabilitation. Following a model, including all coordinative abilities, and a current after-care concept of ACL-surgery, the presented method is based on different categories of coordinative demands.

[Multiple pulmonary embolisms in nursing home patients recognizable by alertness to certain aspecific symptoms]. / Multipele longembolieën bij verpleeghuispatiënten herkenbaar door alertheid op bepaalde aspecifieke symptomen.

OBJECTIVE: To determine whether increased alertness regarding multiple pulmonary embolism in geriatric patients increases the number of cases diagnosed. DESIGN: Retrospective descriptive study. SETTING: Dutch nursing homes Mariënhaven (psychogeriatric) in Warmond and De Wilbert (somatic and psychogeriatric) in Katwijk aan den Rijn, the Netherlands. METHOD: In the period 1989-1991, the diagnosis of multiple pulmonary embolism was suspected in 15 patients with an 'unclear' or 'aspecific' complex of symptoms, who subsequently underwent ventilation perfusion scintigraphy. RESULTS: In 11/15 patients the diagnosis of multiple pulmonary embolism was confirmed. These patients were treated with anticoagulants resulting in complete recovery in 9 patients. Aspecific symptoms suggestive of pulmonary embolism include subfebrile temperature, respiratory and sensory disturbances and a clinical picture mimicking airway infection. If lung scintigraphy is only performed if a positive diagnosis will have the therapeutical consequences for the patients concerned, and assuming that refraining from treatment would lead to death, it was calculated that on a yearly basis mortality in subjects in nursing homes could be reduced by more than 2% when appropriate diagnosis is made and treatment given. Comparison of the data from SIG Health Information (Utrecht) with the present results suggests that the prevalence of (multiple) pulmonary embolism in the Dutch nursing homes is insufficiently recognized. CONCLUSION: More alertness regarding multiple pulmonary embolism in nursing home patients will establish the diagnosis more frequently and proper treatment of this condition will lead to a decrease in mortality.

Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: > 5000 cycles at one centre.

Cumulative pregnancy rates and pregnancy outcome analysis are useful methods for advising an infertile couple of the probability of in-vitro fertilization (IVF) success. All 5209 IVF cycles in 2391 couples at University Hospital, London, Ontario, Canada, over 10 years were studied. Cumulative pregnancy rates were estimated using life table analysis. The Cox proportional hazards model was used to estimate the influence of covariates. Oocyte retrieval and embryo transfer were achieved in 84 and 64% of cycles initiated respectively. There were 644 intra-uterine and 24 ectopic pregnancies (13%/cycle initiated, 15%/oocyte retrieval and 20%/embryo transfer). Cumulative pregnancy rates following six cycles were: tubal 55%, idiopathic 65%, endometriosis 60%, multifactorial 63% and male 40%. There were 68 spontaneous abortions (10.6%) and three induced abortions for congenital anomalies. The multiple gestation rate was 22%. Caesarean section and preterm delivery rates were 35 and 20% respectively, due in part to the high proportion of multiple gestations. Of 15 deliveries which resulted in stillbirths and/or neonatal deaths, 12 were multiple gestations; 18 pregnancies (3.3%) were complicated by congenital malformations. No increases in congenital malformations or spontaneous abortions were identified. Cumulative pregnancy rates were lower in cases of male infertility. Success rates did not decline with successive IVF cycles. IVF is an evolving infertility treatment.

Performance demand and sexual arousal in women.

Up to now, no experimental studies have inquired into the possible role of performance demand in female sexuality. The objective of this study is to investigate the effects of performance demand on sexual arousal in functional women, using explicit instructions. Forty-eight female subjects were asked to respond with maximum sexual arousal within 2 min, both during sexual fantasy and while watching an erotic film excerpt. Photoplethysmographic pulse amplitude was continuously recorded and self-report ratings of sexual arousal and affective reactions were collected after each erotic condition. Subjects were also instructed to continuously indicate their subjective sexual excitement during the conditions by means of a lever. Performance demand resulted in higher genital responses and was most effective in the fantasy condition. These results corroborate the findings for functional men. Although for both measures of subjective experience of sexual arousal performance demand yielded significantly higher ratings, this was conditioned by the order in which subjects were exposed to conditions. Women who masturbate with a mean frequency of 4 times a month reported higher subjective sexual arousal during performance demand conditions as compared with women who masturbate substantially more or who do not masturbate. Genital vasocogestion did not differ between masturbation-groups. Continuous subjective monitoring yielded lower correlations with vasocongestion than discrete ratings of sexual arousal and appears to be more sensitive to order effects.

The flora of renal haemodialysis shunt sites.

During investigations of the microbial flora of the skin over haemodialysis shunt sites it has not proved possible to predict clinical infection by a preceding colonization of the shunt site with a pathogenic organism. The normal non-pathogenic flora of the sites is not specifically related to the flora of other sites on the body though Staphylococcus aureus on a shunt site appeared to be acquired principally from the nose when the shunt was in the arm or from the perineum when the shunt was in the leg. Cimino shunt sites had a greater density of organisms than did Scribner shunt sites; this may be related to the disinfection procedures.