Faculty Bibliography

Over the past 20 years, many advances in surgical methods, transplantation immunology, donor organ procurement and preservation techniques, and postsurgical care regimens have influenced greatly the field of lung transplantation. The single remaining obstacle to widespread clinical success is donor lung availability. Improved methods of ex vivo lung preservation, organ donor maintenance, and donor lung retrieval after the completion of cardiac donation should help to ameliorate this problem

Of the 355 consecutive infrapopliteal bypasses for limb salvage performed over a 5 year period at our institution, 116 (Group I) were to noncalcified vessels, 203 (Group II) were to vessels of varying degrees of calcification (mild to moderate), and 36 (Group III) were to heavily and circumferentially calcified arteries. A new intraoperative fracture technique was used to overcome the rigidity of the arterial wall in the latter group. Three year cumulative patency rates for Groups I, II, and III were 45 percent, 58 percent, and 47 percent, respectively. Comparable limb salvage rates for Groups I, II, and III were 66 percent, 73 percent, and 75 percent. No significant difference in patency or limb salvage results could be elicited between the three groups by the log-rank test. These findings suggest that arterial calcification is an invalid predictor of failure in small vessel bypasses. Even circumferentially calcified arteries, which are generally thought to be surgically unapproachable, should not be a deterrent to limb salvage attempts

Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were compared. Recipient age for all groups was similar (34-36 years). Life table analysis revealed no difference in graft survival in recipients of kidneys from donors aged 2, 3, 4, 5-10, and 11-15 when compared with adult donors. Graft survival in these groups improved over time with current 1-year survival over 75%. Recipients from donors less than 24 months of age demonstrated significantly poorer results, with no kidney surviving greater than 2 months. Serum creatinine of grafts functioning greater than 6 months was similar in all groups. It is concluded that single pediatric kidneys from donors greater than 2 years of age can be successfully transplanted to adults with good long-term results

Fourteen patients with severely ischemic extremities but relatively minor degrees of pedal gangrene or ulceration were managed without surgery. Contraindications to direct arterial reconstruction included significant intercurrent illness or generally poor surgical risk, the need for reoperative or difficult distal reconstruction, or the favorable characteristics of the actual lesion. Management consisted of bed rest, simple saline soaks, occasional gentle debridement, and antibiotics when indicated. Seven patients had complete resolution of their lesions for 3 to 48 months, and seven had improvement or stabilization for 3 to 18 months. Only three of the 14 patients have eventually required surgery with limb salvage in one. Revascularization remains the method of choice for managing most severely ischemic extremities. However, the conservative approach described represents an alternative to early amputation, attempts at revascularization, or lumbar sympathectomy in some patients with advanced ischemia. Studies of sympathectomy and pharmacologic agents as effective treatment for ischemic ulcers or gangrene should include control groups treated with the conservative measures outlined herein

The photoplethysmograph (PPG) was utilized to evaluate the role of external compression in the treatment of chronic venous insufficiency with ulceration (CVIU). Thirty patients with long standing CVIU were evaluated using a PPG probe placed just above the medial malleolus. Venous recovery time (VRT) was calculated after 5 active dorsiflexions. Patients were then retested after an Unna boot had been applied and again, after this had been supplemented by a tight elastoplast wrap. VRT in 10 normal control subjects was greater than 12 seconds (12-30 seconds, mean 19+/-5 seconds). VRT was less than 12 seconds in all tested patients (0-11 seconds, mean 5+/-2 seconds). When an Unna boot was applied, VRT increased to 7+/-2 seconds in 20 patients. An Unna boot and elastoplast wrap increased VRT to 10+/-3 in 25 patients (p less than 0.01)