874

tion; Thal et al. found segmental blockage in only 2 oftheir patients, and consequently they believe that

endarterectomy is unlikely to succeed.Divergent opinions such as these are difficult to

reconcile; but from coronary arteriography, if it proves astrouble-free and informative in other hands, more canprobably be learnt about the lesions in ischaemic heart-disease. If observations elsewhere in the body are a

guide, it seems likely that both localised and diffusedisease will be found in individual patients, and call fordifferent operative approaches.While these questions are being settled the Beck

operation continues to give good results at Cleveland.9 9In 1954-58, 347 patients were operated on with a mor-tality of 6% overall, and of 2% in the last 200 cases.295 patients are still alive, and the result is described asexcellent or good in no less than 94%-a striking figure.But the follow-up period in many is still short, and thelongest is only four years, so the ultimate results in termsof increased survival are still unknown. If, as Blalock 10has suggested, the results are very similar after differentoperative procedures, perhaps the production of inter-coronary anastomoses is the factor common to each; andin this case there is much in favour of undertaking thesimplest and safest operation. The further outlook in thesurgery of ischxmic heart-disease is clearly unsettled.

9. Beck, C. S., Leighninger, D. S., Brofman, B. L., Bond, J. F. J. Amer.med. Ass. 1958, 168, 2110.

10. Blalock, A. Lancet, 1958, i, 1013.11. Murray, J. E., Merrill, J. P., Harrison, J. H. Ann. Surg. 1958, 148,

343; see Lancet, Jan. 3, 1959, p. 31.

SUCCESSFUL KIDNEY HOMOGRAFT

THE Peter Bent Brigham Hospital, Boston, Mass., hasannounced what appears to be the first successful kidneyhomograft in non-identical twins. A man, aged 23, hadchronic glomerulonephritis with severe uraemia and hyper-tension ; his life expectancy was thought to be a matter ofdays. He was given whole-body irradiation in two doses-250r followed eight days later by 200r. No corticoidswere given and no bone-marrow graft was attempted. Akidney from his twin brother was transplanted on Jan. 24,and both diseased kidneys were later removed. For amonth after the irradiation he was kept in a room sterilisedby detergent, with positive-inflow ventilation and an

ultraviolet-ray barrier. The patient is now in good health,and.the kidney seems to be functioning well; the blood-pressure is normal, and the blood and urine show noevidence of uraemia or bone-marrow damage.

Survival for three months does not prove completesuccess, for in the past kidney homografts from unrelatedpersons have functioned for as long as five months beforerejection; but none functioned as rapidly or efficiently asin the present case. The donor is thought to be closegenetically to the patient (his blood-groups are identical);but he is not an identical twin because his appearancediffers, and a skin-graft from the patient to him wasrejected. Three factors are thought to have contributedto the success: the genetic closeness (though not identity)of the brothers; the severe uraemia, which depressedimmune mechanisms; and the divided doses of radiation,which were enough to depress immune reactions withoutcompletely destroying the bone-marrow.

Successful kidney transplants in identical twins havepreviously been reported from the Peter Bent BrighamHospital 11; but this case, of a successful homograft to apatient not genetically identical with the donor, isapparently unique. ,

EXPANSION OF CANCER RESEARCH

IN about two years, when its new building in Lincoln’sInn Fields is ready, the Imperial Cancer Research Fundwill be able to expand its work greatly. Prof. G. F.

Marrian, F.R.S., who is to take up his full duties as directorof research next October, is already making plans for thisexpansion, in which the laboratories are to be organisedin divisions-though in practice, of course, most researchproblems will need an interdivisional approach.The division of experimental biology and virology has

already been established in the Fund’s laboratory at Mill Hill,headed for the past six months by Mr. R. J. C. Harris, PH.D.,who was formerly in charge of the Pollard’s Wood division ofthe Institute of Cancer Research. The division of pathologywill be temporarily housed at 48, Lincoln’s Inn Fields, whereDr. A. R. Currie, of Glasgow, will take up his appointment inOctober. The nucleus of a division of physiology and

endocrinology already exists at Mill Hill, and so far as spaceallows it will be encouraged to enlarge, under the leadership ofMr. P. C. Williams. The division of biochemistry and chemis-try, to be established in October under the leadership ofProfessor Marrian, has a nucleus at the Royal College ofSurgeons and will have further accommodation at 48, Lincoln’sInn Fields until it can move into the new building. Dr. C. C.Spicer, of the Public Health Laboratories at Colindale, is tohead a small division of statistics. Dr. James Craigie, F.R.s.,having given up his administrative work as director of theMill Hill laboratories, remains on the research staff of the Fund.The 56th annual report,! presented on Wednesday,

contains a brief account of the work of the clinico-

pathological research unit at Lincoln’s Inn Fields,written by Prof. Geoffrey Hadfield, its director, in termsreadily intelligible to the general reader. This report,illustrated by photographs, is again designed to attract

and maintain the interest of the Fund’s lay supporters.At E260,000 the income in the year ended last November,

from all sources except legacies of El 000 or more, was nearlyE40,000 higher than in the previous year; and about 138,000was from subscriptions and donations, including charityperformances. Legacies, at nearly E280,000, increased by someE50,000.

1. From the office of the Fund at the Royal College of Surgeons, Lincoln’sInn Fields, London, W.C.2.

CARDIAC SURGERY TEAM TO VISIT MOSCOW

Mr. W. P. Cleland, Dr. D. G. Melrose, Mr. H. H.Bentall, and four other members of the PostgraduateMedical School of London’s cardiac surgery team haveleft for Moscow where they are to demonstrate theclinical use of the Melrose heart/lung machine, the tech-nique of elective cessation of the heart-beat, and Britishmethods of open intracardiac surgery.The operations are being undertaken at the invitation of

Professor Bakulev, president of the Academy of MedicalSciences of the U.S.S.R., in the Institute of Thoracic Surgery.During their stay in Moscow the British team will be the guestsof the Soviet Government. Transport expenses are being metby grants from the British Council, the Nuffield Foundation,the Postgraduate Medical School, and the boards of governorsof Hammersmith, King’s College, and the Brompton Hospitals.A Melrose machine has been purchased by the Russian Govern-ment for use in Moscow, and will be used during the demon-strations. Anaesthetic equipment and drugs and surgicalinstruments have been supplied for the demonstrations byBritish firms. The team expects to spend two or three weeksin Moscow, and some 8 or 10 operations have been planned.

Dr. A. C. ALPORT, formerly professor of medicine in theUniversity of Cairo, died in London on April 17 at the ageof 79.