Renal artery stenosis. a clinical-pathologic study in normotensive and hypertensive patients.

Esophageal atresia: Primary results of 500 consecutively treated patients

Neither asymmetric septal hypertrophy (ASH), marked cell disorganization in the ventricular septum nor systolic anterior motion of the anterior mitral leaflet (SAM) is pathognomonic of hypertrophic Cardiomyopathy. However, each is uncommonly found in patients with other cardiac disorders and is therefore a highly specific hallmark of hypertrophic cardiomyopathy. Disproportionate septal thickening does occur in about 10 percent of older children and adults with various acquired or congenital heart diseases. In these patients it usually appears to be secondary to the underlying hemodynamic state. However, disproportionate septal thickening is the usual finding in the developing embryonic and fetal heart and it is relatively common (prevalence rate about 25 percent) in normal neonates and infants with congenital heart disease. Likewise, although cell disorganization in the ventricular septum may occur with other cardiac malformations, extensive disorganization is present in about 90 percent of patients with hypertrophic cardiomyopathy and in only about 5 percent of patients with other cardiac diseases. Finally, systolic anterior motion of the anterior mitral leaflet is characteristic of those patients with hypertrophic cardiomyopathy who have obstruction to left ventricular outflow, and it rarely appears (prevalence rate about 3 percent) under basal conditions in other hemodynamic states or cardiac diseases. Hence, in analyses comprising over 1,600 patients the specificity of asymmetric septal hypertrophy, marked septal disorganization and systolic anterior motion of the anterior mitral leaflet was at least 90 percent (90, 93 and 97 percent, respectively). Furthermore, the sensitivity of extensive septal disorganization for hypertrophic cardiomyopathy was 90 percent. The data currently available therefore suggest that the vast majority of patients fulfilling the basic anatomic criteria for hypertrophic cardiomyopathy (that is, a hypertrophied nondilated left ventricle in the absence of a cardiac or systemic disease that itself could produce left ventricular hypertrophy) have a distinct disease entity with diverse clinical manifestations. The majority of such patients appear to have a genetically transmitted disease, but it is not known precisely what proportion of these patients have phenotypically similar but etiologically separate disease entities.

Hypertrophic cardiomyopathy: Recent observations regarding the specificity of three hallmarks of the disease: Asymmetric septal hypertrophy, septal disorganization and systolic anterior motion of the anterior mitral leaflet

The number and distribution of lymphocytes in man has not yet been determined quantitatively. But there is limited information available on the cell number or the size of single compartments of the human lymphoid cell system. The problem is to derive knowledge about the quantitatively unknown compartments from other data. This is done by extrapolation of data on rats to man after having confirmed that lymphocyte numbers in rat and man are comparable under certain conditions.

Number and distribution of lymphocytes in man. A critical analysis.

Blood concentrations of alemtuzumab and antiglobulin responses in patients with chronic lymphocytic leukemia following intravenous or subcutaneous routes of administration.

Fourteen patients with uremia received 17 cadaveric renal allografts following lymphocyte depletion by means of thoracic duct cannulation. As depletion progressed, marked lymphocytopenia appeared, large lymphocytes appeared in the lymph, peripheral lymphoid tissues became depleted in the thymus-dependent areas, immunoglobulin levels remained constant, and delayed hypersensitivity skin responses disappeared. Renal allografting was performed following the removal of as few as 10 x 109and as many as 331 x 109lymphocytes. Immunosuppressive drugs were not administered unless allograft rejection occurred or the patient was discharged from the hospital. Little evidence of rejection was noted for as long as 78 days following transplantation. Excellent renal function is maintained in all but one of the nine survivors. The depletion of circulating lymphocytes prior to renal allotransplantation appears to selectively suppress cellular immune defenses and enhance graft survival without seriously depressing humoral defenses.

Depletion of lymphocytes for the protection of renal allografts.

Three cases of hypertension associated with vascular insufficiency of aberrant renal arteries are presented Two patients were subjected to revascularization procedures The types of pathologic processes associated with aberrant renal arteries in production of segmental renal ischemia are discussed Considerations of diagnosis and therapy of such lesions are reviewed

The surgical significance of aberrant renal arteries in relation to systemic hypertension.

Primary Repair of Esophageal Atresia Without Staging or Preliminary Gastrostomy

The Blalock-Taussig Shunt in the First Two Years of Life: A Safe and Effective Procedure

Summary Three cases of segmental coarctation of the abdominal aorta with involvement of the renal arteries treated by prosthetic revascularization are presented. Two of the patients are normotensive one and seven years postoperatively. The third is asymptomatic although moderately hypertensive without antihypertensive therapy. Histologic examination of involved vessels in two of the cases show no indication of an inflammatory origin for the lesions. It is suggested that most abdominal coarctations seen in children and young adults in the United States are of a developmental origin and may be treated successfully by revascularization.

Kenneth R.T. Tyson

Papers

Depletion of lymphocytes for the protection of renal allografts.

The surgical significance of aberrant renal arteries in relation to systemic hypertension.

Primary Repair of Esophageal Atresia Without Staging or Preliminary Gastrostomy

The Blalock-Taussig Shunt in the First Two Years of Life: A Safe and Effective Procedure

Coarctation of the abdominal aorta. Etiologic considerations in surgical management.