Biomedical subjects
Publications and source records attributed to D C Dunn.
A technique of orthotopic renal transplantation in rabbits is described. The technique has been evolved in an experience of over 400 grafts, and difficulties encountered in producing satisfactory anaesthesia and techniques of anastomosis and in obtaining reliable graft function postoperatively have been defined and overcome. These difficulties are discussed and detailed results of the last 100 grafts are given.
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This paper describes the behavior of orthotopically allografted hearts in the pig. Rejection between littermate pigs varied from under 7 days to more than 5 mo in unimmunosuppressed animals.
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A single passage, hypothermic, intermittent squirt perfusion of the pig's liver is described which has allowed preservation of porcine livers for up to 17 hours. After preservation, orthotopically allografted livers can maintain recipient animals in good health. If this technique can be applied to clinical liver transplantation it should be possible to move livers from one hospital to another in the same way that kidneys are transported. This should increase the availability of donor livers for transplantation and avoid the serious disadvantages of moving the sick recipient just before the operation to the hospital where the donor has died.
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Eleven patients who had islet cell tumours of the pancreas removed over a 20-year period were reviewed. Two had died, one in the postoperative period and one 10 years post-operatively. The remaining nine were traced and eight of them were personally interviewed and tested. All nine were well and free from recurrent symptoms. Five of the eight had evidence of subnormal insulin production in response to oral glucose. Glucose tolerance was impaired in three. Minor anomalies were found in the electroencephalograms of all these patients and major abnormalities in two.The results of this survey suggest that other patients who have had islet cell tumours removed may now have unsuspected diabetes.
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Seven patients on dialysis with renal failure received transplants from mismatched cadaver donors and were treated with cyclosporin A (CyA), initially as the sole immunosuppressive agent. CyA was effective in inhibiting rejection but there was clear evidence of both nephrotoxicity and hepatotoxicity. A cyclophosphamide analogue was added to the CyA treatment in six of the patients. Five patients are out of hospital with functioning allografts, and two of these have received no steroids. One patient required an allograft nephrectomy because of pyelonephritis in the graft. Another died of systemic aspergillus and candida infection. Further careful study of this potentially valuable drug will by required before it can be recommended in clinical practice.
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Dissection of the abdominal aorta without an associated thoracic dissection is uncommon. It is usually associated with blunt abdominal trauma and commonly presents early with aortic occlusion. A case is presented where abdominal aortic dissection presented two months after lower abdominal trauma. It is suggested that the initiating event in this case was injury to the iliac vessels.