Pressures were measured in the cervical portion of the thoracic duct during a surgical procedure performed to drain lymph in 8 male patients. Cyclic variations depending on respiration were observed. Smaller oscillations in pressure were synchronous with the pulse‐rate and result from rhythmic compression of the thoracic duct by the aorta in the thorax. In 2 patients the recordings showed superimposed pressure waves which were independent of breathing and the heart‐rate and which are thought to be due to spontaneous contractile activity of the duct.

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Data were collected concerning 314 internal arteriovenous fistulas created in 242 adult patients (92 women and 150 men). The immediate failure rate for the various techniques used ranged from 7-7 to 12-0 per cent, except for ulnar fistulas which had a rate of immediate thrombosis of 20-7 per cent. Survival rates were significantly lower for patients submitted to a combined therapy of dialysis and kidney transplantation when compared with patients treated with dialysis alone. The probability of survival of an arteriovenous fistula was lower in women than in men but the difference was significant only in patients undergoing transplantation. Survival rates at 2 years in dialysed patients were 87-6 per cent for distal radial-cephalic side-to-side fistulas, 100 per cent for radial-cephalic end-to-side fistulas located in the mid-forearm, 78-5 per cent for radial-cephalic end-to-side fistulas created near the wrist, 53-1 per cent for distal radial-cephalic end-to-end fistulas and 60-9 per cent for ulnar fistulas. Thrombosis was responsible for 87-2 per cent of 109 late failures. The incidence of infection was 1 case/11 patient years of haemodialysis.

The aim of the present retrospective study was to uncover the factor(s) responsible for the poor outcome of cadaver kidney grafts from female donors in male recipients. The 741 transplantations performed at our center from August 1983 to September 1997 were distributed into four groups according to recipient and donor gender: female donor to female recipient (F to F: n = 117), male donor to female recipient (M to F: n = 172), female donor to male recipient (F to M: n = 170), and male donor to male recipient (M to M: n = 282). All the patients received immunosuppressive therapy based on corticosteroids and cyclosporine, associated or not with either azathioprine or prophylactic anti-lymphocyte globulin. Overall graft survival was lower in the F to M group than in the three other groups (p = 0.009). Failures due to rejection were more frequent during the 1st post-transplant trimester in female than in male donor grafts, irrespective of recipient gender (p = 0.025). All failures due to technical problems occurred during the first 3 months post-transplantation: they were more frequent in the F to M group than in the three other groups (p = 0.040): this could be related to the older age of the donors in the former group. After the first post-transplant year, failures due to causes other than rejection remained low in the F to F group but increased steadily in the three other groups (p = 0.007). Specific survival rates were not correlated with the time-evolution of mean serum creatinine values, daily doses and trough levels of cyclosporine in the four groups of grafts. In conclusion, the poor outcome of F to M grafts results from combined immunologic and technical factors exerting their effects early in the course of transplantation.