A comparison of cyclosporine A and Nva2-cyclosporine (cyclosporine G) in a rat renal allograft model.

We compared CsG and CsA in the DA-to-Lewis rat renal allograft model. At equivalent oral doses, plasma radioimmunoassay (RIA) CsG levels were higher than CsA (P less than 0.02).

Sporadic hemorrhagic colitis associated with Escherichia coli, type O157:H7: unusual presentation mimicking ischemic colitis.

Hemorrhagic colitis is a bacterial infection of the colon, associated with a verotoxigenic strain of Escherichia coli, commonly serotype O157:H7. This recently described disease is usually self-limiting. Because fecal cultures are negative for the usual pathogens and the clinicopathologic features closely mimic ischemic colitis, the patient is exposed to the risk of unnecessary surgery.

Liver transplantation without venous bypass.

Fifty consecutive orthotopic liver transplants were performed without venous bypass in 41 recipients. Seven patients were transplanted twice and one patient received 3 transplants. The average age of the recipients was 37 years.

A simplified method for metabolic studies in conscious swine.

Reliable short-term blood access in conscious swine was provided by implanting multiple silastic catheters. Catheters were inserted into the aorta, hepatic vein, portal vein, and inferior vena cava through a midline laparotomy incision. Multiple catheters also were placed into the external jugular vein through a separate cervical incision.

Experience of a Canadian multi-organ transplant service.

Organ transplantation has become the treatment of choice for selected patients with end-stage failure of the heart, liver or kidneys. The expanding role for organ transplantation, however, has led to a corresponding increase in the complexity of patient management. In response to these changes, University Hospital, London, Ont.

Insulin decreases muscle protein loss after operative trauma in man.

Seventy-two hours after major operative trauma, nine patients receiving a constant infusion of calories (1460 kcal/m2/day) and protein (75 gm of amino acid/m2/day) showed a negative nitrogen balance, increased muscle catabolism, as measured by 3-methylhistidine excretion, increased amino acid efflux from muscle, and decreased circulating levels of insulin. When 5 U of insulin/hr were added to the infusate, arterial insulin levels rose significantly from 39.7 +/- 4.

Major operative trauma increases peripheral amino acid release during the steady-state infusion of total parenteral nutrition in man.

The effect of major operative trauma on skeletal muscle metabolism was examined in nine patients receiving a constant infusion of calories (1460 kcal/m2/day) and protein (75 gm of amino acids/m2/day) for 5 days before and 4 days after an operation. Compared with the preoperative state, 72 hours after the operation there was a significant rise in arterial levels of glucagon, cortisol, norepinephrine, and inactive triiodothyronine and a drop in concentrations of insulin, active triiodothyronine, and amino acids. Forearm blood flow increased, as well as the efflux from forearm muscle of lactate, taurine, serine, glycine, valine, methionine, isoleucine, leucine, phenylalanine, lysine, arginine, and total amino acid nitrogen (440%).

Renal function after nephrectomy for donor organs.

Thirty-three living related kidney donors were investigated at a mean of 5.8 years after donor nephrectomy (range 3-18 years) to detect late adverse effects. They were evaluated for hypertension, the presence of proteinuria and renal dysfunction as assessed by serum creatinine value and creatinine clearance.

Balloon therapy for obesity--when the balloon bursts.

Intragastric balloon placement is a non-invasive treatment for morbid obesity. We report a patient who illustrates incomplete bowel obstruction and pancreatitis following dislodgement of such a balloon. Percutaneous transabdominal puncture of the balloon is an effective method of decompression.

2,3-Dihydroxybenzoic acid. Effect on mortality rate in a septic rat model.

Neutrophil-derived oxygen-free radicals may play a role in organ dysfunction associated with generalized sepsis. A rat model was used to test the effects of two free radical scavengers, dimethyl sulfoxide (DMSO) and 2,3-dihydroxybenzoic acid (2,3-DHB), on mortality from intra-abdominal sepsis produced by cecal ligation and perforation. Being an iron-chelating agent, 2,3-DHB may have an additional bacteriostatic effect.

Liver transplantation: the initial experience of a Canadian centre.

At the University Hospital in London, Ont., 19 patients have received 24 liver transplants. The commonest indications for transplantation were primary biliary cirrhosis and cirrhosis from chronic active hepatitis.

Experimental low colorectal anastomosis.

The authors evaluated a side-to-end colorectal anastomosis carried out by the abdominoperineal approach, in which opening of the mucosal layer of the colon, and therefore the lumen, is delayed for 4 days. This technique was compared to transabdominal end-to-end anastomosis performed as low as possible, using the circular stapler and hand-sewing with a one-layer technique. Experimental end-to-end stapled and hand-sewn anastomoses were performed randomly in 24 female mongrel dogs.

Esophagogastrectomy without thoracotomy for carcinoma of the cardia and lower part of the esophagus.

Between 1 October 1979 and 1 September 1983, 34 patients with 25 adenocarcinomas and nine squamous cell carcinomas of the cardia and lower part of the esophagus have been treated with resection of the celiac lymph nodes (metastasis in 83 per cent of the patients), the lesser curvature of the stomach, cardia and total esophagus without thoracotomy. There was transmural spread of the cancer in 88 per cent of the patients. The esophagus was replaced by a tube made from the greater curvature of the stomach, which was brought through the mediastinum and anastomosed to the cervical esophagus.

Beam quality independent attenuation phantom for estimating patient exposure from x-ray automatic exposure controlled chest examinations.

The periodic assessment of exposures in diagnostic radiology is an important part of a comprehensive quality assurance program. The most frequent radiologic examination conducted in the United States is chest radiography. Automatic exposure controlled (AEC) techniques are often used for this exam, and a standard patient-equivalent chest phantom is useful when estimating patient exposures on such systems.

Metabolism of branched-chain amino acids in dogs with Escherichia coli endotoxin shock.

The arterial-femoral venous difference of phenylalanine concentration is proportional to net proteolysis in the leg. In ten fasting dogs receiving Escherichia coli endotoxin (2 mg/kg) intravenously, the mean systolic blood pressure decreased from 141.1 +/- 25 to 71.

Amino acid metabolism in patients with severe burns.

In this study we set out to determine, if relative to net catabolism of skeletal muscle protein as measured by phenylalanine release, the transamination of branched-chain amino acids (valine, isoleucine, and leucine) was greater in nonseptic burn patients than in controls. Arterial and femoral venous amino acid concentrations and circulating liver enzyme levels were measured. When the ratio of the arterial-femoral venous difference in concentration of each branched-chain amino acid to that of phenylalanine was determined, transamination of the branched chain amino acids, relative to net proteolysis, was not occurring at a greater rate in the burn patients.

Abdominal sepsis managed by leaving abdomen open.

Intra-abdominal sepsis and necrotizing infection of the abdominal wall are usually fatal unless adequate drainage and wide debridement are possible. To follow these principles, we managed 18 seriously ill patients with abdominal sepsis by leaving the abdomen completely open. All except two of the patients had severe intra-abdominal sepsis.

Necrotizing anaerobic infections.

Severe necrotizing anaerobic infections carry a high mortality. From a retrospective review of 17 cases of gas gangrene, necrotizing fasciitis and nonclostridial myonecrosis seen at the Victoria and University hospitals in London, Ontario, between Jan. 1, 1975 and Dec.

Acute and chronic benign ulcers of the rectum.

In managing 21 patients with benign ulcers of the rectum, there were seven patients with acute bleeding ulcers and two with acute rectal necrosis. Acute, bleeding ulcers of the rectum are associated with serious illness or injury, similar to those thought to cause stress ulcers of the stomach and duodenum. Rectal prolapse, complete or incomplete, is the condition most commonly associated with chronic, benign ulcers of the rectum.

Total exchangeable potassium in patients receiving total parenteral nutrition.

Total exchangeable potassium (Ke) measurements were done on 13 patients who received total parenteral nutrition (TPN) at 25% dextrose and 2.5% amino acids (AA) (a hypertonic dextrose solution) by central vein, and 12 patients who received TPN as 10% dextrose, 10% fat emulsion (Intralipid), and 2.5% AA with lipid supplying about 60% of the nonprotein calories.