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Seven patients with heterotopic heart transplants have undergone further heart transplant procedures. In 5, the first heterotopically placed donor heart was excised and replaced with the second donor heart. In 2, the first heterotopic donor heart was left in situ and the patient's own heart (then nonfunctioning) was excised and replaced by the second donor heart; thus, these patients underwent orthotopic transplantation and were left with two donor hearts. The decision to perform retransplantation in a patient undergoing irreversible acute rejection is usually straightforward, but the timing of a further transplant procedure in a patient with advanced graft arteriosclerosis may present a difficult problem. Two of the 7 patients in this series died of infectious complications within the first 3 months after retransplantation. A third patient acutely rejected the second donor heart within 5 days, but survived an additional 17 months with the support of his own cardiomyopathic heart. Four patients remain alive and well between 5 and 36 months following the second transplant and between 17 and 54 months following the first transplant procedure.

During a 2-year interval 206 patients underwent renal transplantation at a single center, 38 of whom underwent bilateral nephrectomy and other adjuvant operations as part of the transplant procedure. The indications for this type of procedure were reviewed, with special emphasis on the control of hypertension. The morbidity and mortality (16 per cent) in this group were compared in detail to those in patients not undergoing a concomitant adjuvant operation. The results with regard to renal function were similar to the group as a whole and the indications for appropriate patient selection are discussed.

In 1979 two patients with Philadelphia (Ph1)-chromosome-positive chronic granulocytic leukaemia (CGL) were treated with chemoradiotherapy and transplantation of bone marrow from their respective identical twins. Subsequently twelve patients with Ph1-positive CGL in chronic phase were treated with chemoradiotherapy followed by transplantation of bone marrow from their HLA-identical sibs. Two of the fourteen patients have died of complications of the transplant procedure; twelve patients are alive and well. All the survivors have normal or nearly normal blood counts; there is no evidence of recurrent leukaemia or Ph1-positive cells in any patient after follow-up periods ranging from 97 to 1112 days. Bone-marrow transplantation should be considered in the management of any young patient with CGL who has a suitable marrow donor.

This article examines the function of play in the care of children who have undergone bone marrow transplantation. The serious nature of the children's illnesses, the rigors of treatment, and the restrictions posed by the environment make the provision of quality play a challenging endeavor. It is clear that the child's play behavior varies with the stage of the transplant procedure. Each phase of the process is a unique condition posing its own set of problems and solutions. Familiarity with these stage-related behaviors may assist health care professionals in working optimally with these patients.

From 1977 to December 1983 a total of 64 patients with posterior, anterior or extended urethral stricture have been treated by using free-foreskin grafts after the mesh transplant procedure. This operation is completed as a two-stage procedure. Of paramount importance for success is the open and dry treatment of the graft to assure an ideal situation for later reconstruction. Healing without the formation of fibrous tissue is the rule. In 63 patients this method was applied with an excellent anatomical and functional result. The most important indications are recurrent strictures after several operations, extended strictures of the whole length of the urethra, strictures with chronic inflammations, as well as problematic strictures in paraplegics.

— Twenty three out of 30 potential kidney donors were followed up after a period of 5–10 years. Fourteen were donors, and the other nine subjects who were refused from kidney donation on medical grounds constituted the control group (non-donors). Psychiatric morbidity was assessed by using the Present State Examination (PSE) Interview Schedule. CATEGO-ID Program identified one case in the donor group and one case in the non-donor group. The psychiatric problems of both the cases were unlikely to be related to the kidney transplantation. The majority of the donors, irrespective of the outcome of the transplant procedure, expressed positive feelings towards kidney donation. This study suggests that the kidney donation does not cause long term adverse psychological sequlae.

Breast cancers have been induced in female Fisher rats. This strain of animals was less susceptible to a development of tumours than the Sprague-Dawley and the Wistar rats previously studied. The induced breast cancers were originally hormone-responsive and could be transplanted to animals with intact ovarian function. Transplantation of hormone-responsive tumours may result in the development of hormone-unresponsive transplant tumours, whereas the opposite was not observed. It is argued that this change in hormone-response can be explained as a selection phenomenon rather than a transformation of the tumour during the transplant procedure. The observed change in hormone-response was paralleled by a change in tumour morphology.

The past few years have seen significant advancement in the clinical relevance of intraportal islet cell transplantation for treatment of type 1 diabetes mellitus. The implementation of novel protocols, such as the one developed by the group of Shapiro and collaborators in Edmonton, has revitalized the enthusiasm for cellular transplantation as a treatment for diabetes by improving the success rates and long-term function of islet grafts. Improved results in clinical islet transplantation reported by the groups in Edmonton, Miami, and Minneapolis have re-proposed the much simpler outpatient cell transplant procedure as an alternative to the more risky and technically challenging whole-organ pancreas transplantation.