Biomedical subjects
Publications and source records attributed to A G Rose.
Intra-osseous synovial sarcoma is very rare and its mode of origin is conjectural. Our patient's tumour was situated within the lower femur. The sited of origin of the few intra-osseous synovial sarcomas so far documented may support the concept of intra-osseous synovial rests.
Eight-nine patients with heart tumours (76 metastatic and 13 primary) were studied. Metastatic tumours were usually clinically silent and most often came from lung carcinomas, lymphomas, malignant melanomas, and gastric and breast cancers. The primary tumours consisted of 11 myxomas, 1 fibrous histiocytoma and 1 haemangioma.
Explore the source record for details and available documents.
A review of 157 consecutive biopsies of donor endomyocardium in patients with heterotopic heart transplants is reported. The technique of percutaneous transvenous endomyocardial biopsy after this operation is described; manipulation of the catheter and bioptome into the junction of the donor superior vena cava and right atrium can be difficult when this anastomotic junction is small, as a result either of operative surgical technique or of subsequent contraction. The complication rate was 4%, but one patient may have died from infection resulting from biopsy when the bioptome had to be introduced at the groin. The histopathological changes seen in the biopsy specimens have been graded according to a scoring system to give the clinician a guide to the severity of rejection. Histopathological assessment was of clinical value in 96% of cases, but was inaccurate on two occasions, once because an opinion was given on what was in retrospect an inadequate sample. In patients undergoing persistent low-grade acute or chronic rejection there was difficulty in detecting or appreciating the true extent of myocardial fibrosis; this led to inadequate immunosuppressive treatment in two patients. Attention is drawn to the fact that ischaemic fibrosis resulting from the vascular changes of chronic rejection may spare the endomyocardium, which is kept viable by intracavitary blood, and that this may lead to a misleading histopathological report.
Explore the source record for details and available documents.
Baboon hearts were rapidly excised after being flushed with 500 ml of cardioplegic solution at 4 degrees C and then immersed in cold 4 degrees C saline or cardioplegic solution for 2 minutes. The hearts were then perfused at 8 to 10 cm H2O pressure for 20 to 24 hours under refrigeration with a hyperosmolar clear fluid maintain perfusate at 6 to 8 degrees C, through which 95% oxygen and 5% carbon dioxide were continually bubbled to maintain the perfusate pH between 7.2 and 7.4. Myocardial temperature remained at approximately 6 to 8 degrees C. The hearts were then orthotopically transplanted into recipient baboons matched for size and AB blood group. Two groups (A and B) were studied, differing significantly only with respect to the constitution of the cardioplegic solution and perfusate used. The cardioplegic agent used in Group B contained a higher concentration of magnesium than that used in Group A and included the calcium antagonist verapamil. Perfusate B had higher osmolality than perfusate A, largely due to the inclusion of sucrose. A preliminary group of 10 baboons in Group A received no immunosuppression. Five of the remaining six immunosuppressed baboons in this group survived more than 48 hours to rejection or until killed at 2 to 29 days. All six of the baboons in Group B survived to rejection between 6 and 33 days, with mean survival 19.5 days. Cardiac catheterization was performed in six surviving baboons (Group A, four; Group B, two) between postoperative days 6 and 10 and showed good hemodynamic function. Histologic examination of hearts after death has shown only minor ischemic changes in those hearts which functioned well.
A platelet derived growth factor released following platelet adhesion to the subendothelium of damaged arteries may promote the development of atherosclerotic lesions. Consequently patients with von Willebrand's disease in whom platelet adhesion is abnormal may be protected from atherosclerosis. This possibility was investigated by performing an autopsy study on an elderly patient who had suffered from severe von Willebrand's disease. Extensive atherosclerotic lesions were found at post mortem suggesting that platelets may not play a clinically significant role in the causation of atherosclerosis.
A 63-year-old man with sarcoidosis developed recurrent ventricular tachyarrhythmias, intermittent heart block and congestive cardiac failure. Transvenous endomyocardial biopsy demonstrated sarcoid infiltration of the myocardium. Ventricular tachyarrhythmias were abolished with amiodarone and prednisone.
A system has been developed for the ex vivo functional testing of isolated hearts. Three groups, each of 10 pig hearts, have been studied: group 1--freshly excised hearts; group 2--heart hypothermically perfused for 20 - 24 hours with Krebs-Henseleit solution; group 3--hearts similarly perfused with a clear fluid hyperosmolar solution. Group 2 hearts performed poorly on functional testing and would clearly have been unsuitable for transplantation. Haemodynamic observations on group 3 hearts showed little statistical difference from those of group 1, suggesting good preservation. The value of the ex vivo testing system as a reliable means of assessing myocardial function is discussed, and has been confirmed by subsequent successful orthotopic transplantation of baboon hearts stored under identical conditions.
Niridazole alone (at 50 mg/kg/day) and particularly in combination with azathioprine and prednisolone showed potent immunosuppressive activity, far surpassing that produced by conventional agents, in the rat heterotopic cardiac allograft model. Benzoylmetronidazole or metronidazole (at 50 mg/kg/day) either alone or in combination with azathioprine and prednisolone demonstrated little immunosuppressive activity. The potent immunosuppression obtained with niridazole in the rat could not be reproduced in the baboon heterotopic cardiac allograft model in the doses used; niridazole at 50 mg/kg/day seems to be toxic in this animal.
Explore the source record for details and available documents.
Fifty-one consecutively removed abdominal aortic atherosclerotic aneurysms were graded as mild, moderate, or severe, according to the amount of chronic inflammation and fibrosis present. Mild chronic inflammation and fibrosis were present in 72.5% of the aneurysms and moderate changes in 15.7%. The presence of the latter group indicated that there was no sharp distinction between the usual atherosclerotic aneurysm with mild chronic inflammation and those with severe changes (inflammatory aneurysms). Patients with the latter comprised about 12% of the total and showed no significant clinical difference from those with ordinary atherosclerotic aneurysms, apart from difficult operative dissection that led to a raised operative mortality. The clinical and pathological findings suggest that inflammatory aneurysms of the abdominal aorta are simply atherosclerotic aneurysms that show an unusual accentuation of the chronic inflammation and fibrosis that may be observed in relation to atherosclerotic aneurysms.
In a series of 568 patients with glutaraldehyde-preserved porcine xenografts followed for up to 3 1/2 years, calcification and stenosis of the xenograft has proved to be an important cause of valve failure. We have seen this complication only in children and adolescents. Seven of 54 patients under 16 years of age at the time of initial operation have required reoperation for calcification and prosthetic stenosis. Three patients who died had calcified, stenosed prosthesis at autopsy. The calcification has involved all of the cusps of the affected prostheses, and the calcified area often was enclosed by a superficial layer of noncalcified cuspidal tissue. We no longer insert xenograft valves in young patients.
Sixteen patients with Takayasu's (idiopathic) arteritis constituted 0.09% of the autopsy population during a 26-year-period. Systemic hypertension was present in 14 patients. All portions of the aorta as well as its major branches were involved in the 16 patients. Thrombi were scanty, but intimal fibrous plaques and multiple aneurysms were frequent. Three patients showed the unusual occurrence of segmental involvement of major epicardial coronary arteries with coronary aneurysm formation in two of these patients. Thirteen patients showed residual evidence of inflammation. Coexistent tuberculosis, distant from the arterial lesions, was present in 37.5% of our patients. One patient showed healed pulmonary arteritis. The cause of the disease remains obscure. Emphasis is laid on the application of strict criteria to differentiate specific forms of arteritis, eg, rheumatic mesoaortitis from Takayasu's arteritis.
A patient has an ECG on admission to the hospital that demonstrated acute transmural inferior and anterolateral infarction. Charges of additional transmural anteroseptal infarction were evident in ventricular extrasystoles but not in conducted sinus beats. The patient died five days after admission, and autopsy confirmed the presence of fresh anteroseptal infarction, in addition to inferolateral and right ventricular infarction.
The morhpological changes in 49 chacma baboons after cardiac transplantation were studied by light and electron microscopy. Non-immunosuppressed grafts were tolerated for an average of 10 days and immunosuppressed grafts for 18 days. Serial biopsy specimens of non-immunosuppressed grafts showed a progression in severity of rejection changes. Electron microscopy mirrored the light microscopic changes. Rejection changes in the baboon appear similar to those encountered in human and canine allografts. Heterotopic transplants showed more severe grades of rejection than would be compatible with life in orthotopic transplants.
Over a period of 11 years, commencing in December 1967, 31 cardiac transplants, 10 orthotopic and 21 heterotopic, were performed at Groote Schuur Hospital. Two patients with orthotopic transplants have a long survival, 1 for 7 1/2 and 1 for 9 1/2 years, and 1 with a heterotopic transplant for 4 years. Eighteen patients have died, and autopsy was performed from 13 to 623 days postoperatively. Rejection of the donor heart was found in 61,1% and was the cause of death in 44,4% of cases. Infection, attributable to immunosuppression, was a common finding and consisted of extensive pneumonia, usually due to Klebsiella aerogenes and Pseudomonas aeruginosa (38,8%), herpesvirus infection (38,8%), cytomegalic virus infection (37,5%), aspergillosis and other opportunistic infections. A combination of cardiac rejection and infection accounted for most of the deaths. The cardinal microscopic features of acute rejection were interstitial lymphocytic infiltration and myocytolysis, while chronic rejection was typified by obliterative myo-intimal proliferation of coronary arteries, with concurrent lipid deposition in the major coronary arteries. These lesions resembled atherosclerosis and caused graft failure due to myocardial ischaemia. Ultrastructurally, severe myofibre damage was reflected in extensive loss of cytoplasmic myofilaments. The advantages of heterotopic over orthotopic transplantation are discussed.