Analysis of time-dependent risks for infection, rejection, and death after pulmonary transplantation

Infection and rejection remain the greatest threats to the survival of pulmonary allograft recipients. Furthermore, a relationship may exist between these events, because the occurrence of one may predispose to the other. By using multivariate analysis for repeated events, we analyzed the risk factors for bacterial, fungal, and viral infection, grade II or greater acute rejection, and death among 239 lung transplant recipients who received 250 allografts between January 1988 and September 1993. A total of 90 deaths, 491 episodes of acute rejection, and 542 infectious episodes occurred during a follow-up of 6 to 71 months. The hazard or risk patterns of death, infection, and rejection each followed an extremely high risk during the first 100 days after transplantation, a second modest risk period at 800 to 1200 days, and a lower constant risk. Infection and graft failure manifested by diffuse alveolar damage were the major causes of early death (< 100 days), whereas infection and chronic rejection were primary causes of later death after pulmonary transplantation. By multivariate analysis, cytomegalovirus mismatching risk for primary infection was the most significant risk factor for death, rejection, and infection. Absence of cytomegalovirus prophylaxis was also a risk factor for early and late death and late infection. Survival of recipients who received cytomegalovirus prophylaxis was significantly improved. Immunosuppression based on cyclosporine versus FK 506 was a risk factor for late death and late infection. Graft failure manifested by diffuse alveolar damage/adult respiratory distress syndrome was a significant risk for death late after transplantation. These data suggest the following: (1) The hazard for death, infection, and rejection after pulmonary transplantation appears biphasic; (2) lower survival is associated with ischemia-reperfusion lung injury represented by diffuse alveolar damage/adult respiratory distress syndrome; (3) cytomegalovirus mismatch, absence of cytomegalovirus prophylaxis, and development of cytomegalovirus disease are significant threats for death, rejection, and infection after pulmonary transplantation; (4) prevention of cytomegalovirus disease should improve survival by decreasing the prevalence of infection and rejection.     

Complete duplication of the colon in assoication with urethral duplication

A case is presented in which complete colonic duplication is associated with genitourinary and bone abnormalities including a complete duplication of the urethra. The etiology, appearance, clinical course, and classification of various large bowel duplications are discussed.     

The role of immunopathological factors in severe forms of insulin-dependent diabetes mellitus

Immunogrammes of 31 patients with grave forms of insulindependent diabetes mellitus were reviewed. The illness has been characterized as a systemic immunopathologic process combining autoimmune and infectious-and-allergic components realized by organ and tissue abnormalities; it evolves against the manifest background of allergy of both delayed anl immediate types, impairement of the humoral and cell-mediated immunity function, pathogenetic activity of endogenous proteases, the complement system components and interferon.     

New design principles for visual acuity letter charts

This paper intoduces new principles for the design and use of letter charts for the measurement of visual acuity. It is advocated that the test task should be essentially the same at each size level on the chart. Such standardization of the test task requires the use of letters of equal legibility, the same number of letters on each row, and uniform between-letter and between-row spacing. It is also advocated that, combined with the test task standardization, there should be a logarithmic progression of letter size. Charts incorporating these design features have been made. These charts facilitate the use of nonstandard testing distances which might be used when there is low visual acuity, when examination room layout prevents testing at the standard distance, or when it is necessary to validate visual acuity scores or detect malingering. Adjusting the visual acuity score according to the chosen testing distance is simplified by the use of logarithmic scaling.     

Incorporation of 3H-thymidine into the cells of the heart conduction system (sinoatrial and atrioventricular nodes, bundle of His) during cardiogenesis in mice

The number of DNA synthesizing myocytes in the conductive system, as compared with the working myocardium, was determined by means of light autoradiography. At the same time the number of mitosing cells was counted. The indices of labelled nuclei in the sinoatrial and atrioventricular nodes of the embryos after the single and repeated 3H-thymidine injections were significantly lower than in the working ventricle and atrium. During the postnatal development (3-11 days) only in the sinoatrial node the index of labelled nuclei was significantly lower than in the working ventricle. The proliferative activity in all the myocardium parts fell markedly by the 13th day of development. Following 10 3H-thymidine injections with 12 hrs intervals, the indices of labelled nuclei varied from 0.03 to 0.67% in the working ventricle and atrium and from 0.13 to 1.0% in the conductive system of adult mice. During the embryogenesis the index of labelled nuclei in the sinoatrial node was significantly higher than in the atrioventricular one and during the postnatal development-vice versa.