Faculty Bibliography

Routine use of axillobifemoral (ABF) bypass has been advocated because this operation is thought to achieve better patency than the axillounifemoral (AUF) procedure. In 5 years we performed 34 AUF and 22 ABF bypass operations for limb salvage in high-risk patients using 6 mm polytetrafluoroethylene grafts. Five-year cumulative life table patency rates for AUF bypasses were 71% with reoperation (secondary patency) and 44% without reoperation (primary patency). These values were not significantly different (p greater than 0.5) from those for ABF bypasses (77% and 50%, respectively). Five-year limb salvage results (AUF 73%; ABF 89%) were also not significantly different (p greater than 0.1). Correlation of arterial outflow characteristics with graft patency revealed that 78% of the patients who never had graft occlusion had occluded superficial femoral arteries (SFA) demonstrated at the first operation, while 79% of the patients who experienced graft closure had comparable SFA occlusions. Our aggressive approach to graft thrombosis included angiographic study of the inflow arterial system. This revealed that 16% of the failed grafts were associated with hemodynamically significant stenosis of the donor subclavian artery. Our results indicate that AUF bypass is the procedure of choice for unilateral limb ischemia in high-risk patients who require an axillary source and that patency of the SFA does not affect outcome. These results also emphasize the need to obtain angiographic evaluation of the inflow system

KIE: To help overcome the shortage of organs for transplantation, the authors propose a legislative change that would institute a policy of routine salvaging of organs from brain dead patients unless the family objected or the individual had previously registered an objection. They defend this approach as a good middle course between the current ineffective policy based on 'encouraged voluntarism' and a 'presumed consent' policy that would attempt to achieve effectiveness by transgressing established ethical and legal principles

We have studied effects of estradiol on primary cultures of nonmalignant human mammary tissue collected surgically from fibroadenomas or during reduction mammoplasties. After enzymatic digestion, 'organoids' made of epithelial cells organized in ductal or alveolar structure were grown in primary cultures (up to 12 days) on different substrata (glass, plastic, collagen-coated plastic, and floating collagen membranes). Transmission and scanning electron microscopy showed that these organoids were responsive to physiological concentrations of estradiol. Condensed chromatin of epithelial cells became dispersed following estrogen treatment. The plasma membrane of epithelial cells at the surface of the organoids was dramatically modified by estradiol, which increased the number and the length of the microvilli, as observed previously in the MCF7 breast cancer cell line (Vic et al., Cancer Res., 42: 667-673, 1982). This effect was not observed with the same concentrations of progesterone, dexamethasone, dihydrotestosterone, or 1 microM tamoxifen or in fibroblasts of the same tissue, demonstrating that epithelial mammary cells are specifically responsive to estradiol. By contrast, no effect of estradiol could be evidenced on the [35S]methionine-labeled proteins released into the medium by the organoids. The estrogen-regulated protein of Mr 52,000 was not found in the medium after purification by concanavalin A-sepharose or immunoprecipitation with specific antibodies to the Mr 52,000 protein from MCF7 cells. We conclude that nonmalignant mammary cells are responsive to estrogens in primary culture