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Our preliminary experience with orthotopic liver transplantation in the pig has been reported (Calne et al., 1967). Out of 19 animals operated on 13 survived the procedure and six lived for a week or more. Focal necrosis of liver cells and round-cell infiltration in the portal triads of these six transplants was thought to represent evidence of a weak rejection process. One pig died after seven months from intestinal obstruction with minimal evidence of liver damage. Three pigs developed severe gastrointestinal haemorrhage due to mucosa erosions of the stomach and duodenum. We were impressed with the relatively mild rejection occurring in liver transplants in the pig, and it is the purpose of this paper to present our further experience in this field. We have added vagotomy and gastroenterostomy in an attempt to prevent the gastrointestinal haemorrhage and have related the rejection of liver transplants in the pig to transplants of kidneys and skin in this animal. Materials and MethodsOrthotopic Liver Transplantation, Vagotomy, and Gastroduodenostomy (36 Experiments)In the course of our experiments details of technique have been modified and the present technique, which has been used in the last 20 transplants, has had an operative mortality of *

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BRITISH certain of these changes occurred to a lesser degree in stress involution. The stress-involuted thymuses in our study showed the well-known change of cortical atrophy (Hammar, 1921), cystic Hassall's corpuscles, which have been observed in the involuted thymuses of guinea-pigs given cortisone or x-irradiation (Blau, 1965), and an increased percentage area of epithelial cell aggregates, these also being regarded by Lattes (1962) as associated with stress. The nature of these epithelial aggregates remains uncertain. Their appearances may be due simply to loss of lymphocytes with condensation of reticuloepithelial cells, or they may represent hyperplasia of reticuloepithelial cells, perhaps as a reaction to stress. The fact that these epithelial aggregates are seen to some degree in stressed thymuses makes it unlikely that they have any unique relation to systemic lupus erythematosus.The finding that certain of the thymic changes in systemic lupus erythematosus are an exaggeration, albeit gross, of those present in stress involution is in keeping with the prolonged and often debilitating course of the disease, the long terminal stages, and intense treatment with "thymolytic " drugs such as corticosteroids and mercaptopurines. However, we would emphasize that our series contained three surgically resected thymuses, two of which were from patients who had not received " thymolytic " drugs, yet both showed changes as pronounced as others in the series. On the other hand, the greatly increased numbers of plasma cells in the thymus in systemic lupus erythematosus and the presence of germinal centres in the medulla in two of the cases could not be accounted for by stress involution, and point rather to an immune (probably autoimmune) reaction within the thymus (Goldstein, 1966).C jr interpretation is that the thymus in systemic lupus erythematosus is a target organ. There is histological evidence of extreme stress involution and of an autoimmune reaction which could augment changes usually associated with stress involution. SummayStructural changes in the thymus were assessed by a quantitative method in 13 patients with systemic lupus erythematosus and in two groups of control cases representing minimal stress (94 cases) and stress involution (104 cases).The changes of stress involution included reduction of cortex, epithelial cell aggregates in the medulla, and cystic Hassall's corpuscles. In systemic lupus erythematosus there was pronounced lymphocytic depletion resulting in complete cortical atrophy and disorganization of the medulla. A large proportion of the medulla (mean 36%) was occupied by epithelial cell aggregates, and there was a high proportion (89%) of cystic Hassall's corpuscles; moreover, there were greatly increased numbers of plasma cells, and germinal centres were present in two cases.Our interpretation is that the thymus in systemic lupus erythematosus is a target organ. There is histological evidence of extreme stress involution and of an autoimmune reaction which could augment changes usually...

413with an anterior repair which, in turn, will reduce the risk of a direct recurrence.It is now 80 years since Bassini (1888) first described his operation and founded a principle of repair which, but for its ease of execution and the adaptability of nature, would have been abandoned years ago. If the problem of inguinal hernia is to be solved, we must seek a new principle of repair rather than yet another variant of the posterior repair operation. The operation I propose takes no longer to perform than the standard Bassini and gives uniformly good results with no complications-a finding by no means unique in the annals of the inguinal hernia. It is therefore my sincerest wish that the operation will be given as wide a trial as possible in the hope that it may one day be submitted to the acid test of impersonal statistical review, for no operation can be considered of value which cannot achieve success in the hands of all who wish to use it.