Faculty Bibliography

We have used a simple reproducible method to measure total outflow resistance (OR) and its proximal and distal components in 101 bypasses (46 femoropopliteal [FP] and 55 femorodistal [FD]). All bypasses with a distal OR greater than 1.2 mm Hg/ml/min failed within 3 months and all with distal OR less than 1.2 mm Hg/ml/min remained patent for at least 3 months. To evaluate the contribution of vasospasm to OR and its role in graft failure, 60 bypasses (29 FP, 31 FD) had OR measurements before and after local infusion of papaverine hydrochloride (60 mg). Within 3 months, nine grafts (all FD) occluded and 51 remained patent. All nine failures had distal OR greater than 1.2 mm Hg/ml/min before papaverine infusion. After infusion, the mean percentage decrease in both total and distal OR for all grafts was 30% and 31%, respectively. However, there was no significant difference between these papaverine-induced decreases in OR and 3-month graft failure or success. Moreover, in three bypasses, even though papaverine lowered the distal OR from greater than 1.2 to less than 1.2 mm Hg/ml/min, early occlusion occurred. In six grafts (1 FP, 5 FD) when total and distal OR before and after papaverine was greater than 1.2 mm Hg/ml/min, the graft was extended to a second distal artery as a sequential bypass. These six grafts have remained patent over 3 months. Thus measurement of OR and particularly distal OR is a most accurate predictor of early graft success or failure. Pharmacologic manipulation does not enhance the predictive value of the OR measurement. OR measurements also help to select those FD bypass cases in which extension to a second distal artery as a sequential bypass improves patency

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

The application of microcomputers to vascular surgery has been limited because of the lack of software that allows collection and effective evaluation of a large amount of patient-related data. We have developed a microcomputer-based data handling system for evaluating vascular patients that is inexpensive ($6000 to $8000), easy to use, and flexible. Its simplicity for nonprogrammers is achieved through a natural interface with menu-driven operations and descriptive English language messages. With this system eight data entry forms were designed, and data on more than 1000 patients treated for peripheral vascular disease over the last 7 years were entered into the computer by clerical personnel with minimal training. A query language report generator allowed us to obtain reports of results in simple English on any set of selection criteria with all relevant statistical functions, including cumulative life-table patency rates. This system has the following advantages: rapid evaluation of data from several retrospective and prospective studies, such as comparison of graft material, effect of local and systemic risk factors, cost of limb-salvage surgery, and correlation of noninvasive laboratory tests with other parameters; more accurate patient follow-up, with elimination of many of the pitfalls involved in observing large groups of patients frequently; and quantitation of individual surgeon or service results for quality control and self-review, which guide the vascular surgeon to modify treatment protocols, patient selection, and/or surgical techniques. Wider use of this system for data collection and evaluation will help to standardize data reporting and thus allow accurate comparison of data from different centers

Subclavian artery compression by a cervical rib is an uncommon but potentially disabling condition. A series of 12 patients with 15 arterial lesions is reviewed and a staging system proposed to provide guidelines for managing patients with this condition. Stage I lesions have only arterial stenosis and minor poststenotic dilatation and are managed by thoracic outlet decompression, usually consisting of cervical rib resection. Stage II lesions have intrinsic arterial damage usually with subclavian aneurysm formation and require rib resection, aneurysmectomy, and arterial reconstruction. Stage III lesions present with distal thromboembolic complications and require thrombectomy or embolectomy in addition to thoracic outlet decompression and arterial reconstruction. The anatomic and pathophysiologic bases of the syndrome are reviewed and clinical and angiographic examples of each stage are presented

To determine femoropopliteal graft patency, the ankle-brachial pulse index and the ankle pulse volume recording amplitude were measured. Fourteen healthy volunteer subjects were tested on two occasions over 24 hours (ankle-brachial pressure index 1.14+:-0.16, change 0.03+:-0.05; ankle pulse volume recording amplitude 25+:-7 mm, change 5+:-4 mm). In the second control group, hemodynamic function in the unoperated limb was studied before and after surgery in 40 patients undergoing infrainguinal bypass on the contralateral side (preoperative ankle-brachial pressure index 0.66+:-0.3, change 0.02+:-0.12; preoperative ankle pulse volume recording amplitude 8+:-7 mm, change 1+:-3 mm). After 119 patent femoropopliteal bypasses ankle-brachial pressure index and ankle pulse volume recording amplitude increased by 0.41+:-0.26 and 11+:8 mm, respectively