Faculty Bibliography

Graft patency is thought to correlate with resistance in the runoff bed or outflow resistance. However, accurate measurement of this parameter has been difficult. A simple and reproducible method for direct measurement of outflow resistance following completion of the distal anastomosis of a bypass graft has been developed. This method employs injection of a fixed amount of normal saline through the proximal end of the graft and measurement of the resulting integrated pressure increment by an analog computer. Division of this pressure integral by the volume injected is a measure of the outflow resistance expressed in resistance units (mm Hg/ml/min). The median outflow resistance in 31 femoropopliteal bypasses was 0.29 units with a range of 0.08-1.38 units. The median outflow resistance in 33 femorodistal bypasses was 0.7 units with a range of 0.18-2.34 units. All bypasses with an outflow resistance of 1.1 units or less remained patent for 3 months. There were 51 grafts in this group (30 femoropopliteal; 21 femorodistal) and their outflow resistance ranged from 0.08 to 1.1 units. All bypasses with an outflow resistance of 1.2 units or higher thrombosed within the first postoperative month. There were 13 grafts in this group (1 femoropopliteal; 12 femorodistal) and their outflow resistance ranged from 1.2 to 2.38 units. Eight of the 13 grafts that failed originally were subjected to thrombectomy, which was uniformly unsuccessful. Although this method does not yet allow bypass surgery to be denied to any patient, it does define a group of patients in whom thrombectomy will not be effective and should not be attempted.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclosporin, a potent new immunosuppressive agent, was used (alone or in combination with other drugs) in 28 canine single lung allograft recipients. Mean recipient survival with good allograft function was 155 days with cyclosporin and far exceeded that obtained in previous single lung allograft recipients treated with standard immunosuppression (15 to 22 days). The results of these experiments were as follows: (1) 20% of the recipient animals exhibited no evidence of rejection whatsoever; (2) four of 28 animals survived more than 350 days with good allograft function; (3) 79% of the animals exhibited some evidence of rejection that was easily reversed in 74% of instances with corticosteroids; (4) 10 of 28 animals exhibited good lung allograft function 5 months or more after operation; (5) in cyclosporin-treated lung allograft recipients, rejection was diagnosed by the presence of infiltrate on chest roentgenogram, analysis of the cellular content of bronchoalveolar lavage samples, and decreased perfusion on 99mtechnetium lung scan; (6) complete healing without stenosis of the bronchial anastomosis occurred in 82% of the animals studied. One of two patients treated with cyclosporin after undergoing single lung allografting survived 7 weeks after transplantation and 4 weeks after contralateral pneumonectomy. Episodes of rejection were reversible, and the bronchial anastomosis healed normally. This overall experience indicates that cyclosporin, although not a perfect immunosuppressive agent, increases the likelihood of success with therapeutic single lung transplantation

Percutaneous transluminal angioplasty that was performed in five patients who had autogenous vein bypass graft stenosis using 6-French to 10-French teflon catheters was initially successful in all patients. One graft was patent at the time of death 15 months after angioplasty. In two patients grafts are patent 14 months and 13 months, respectively, after dilatation. One stenosis recurred at four months and again at eight months and was redilated on both occasions. Graft occlusion occurred at 11 months, and although it was redilated and lysed with streptokinase, the patient required an operation during which he died. One graft occluded at two months. No complications occurred from the angioplasties

A retrospective study of 65 patients with unpalpable breast cancer revealed by microcalcifications on mammography showed that 18 had presented with infiltrating epithelioma. The contralateral epithelioma was revealed by mammography. Three deaths from metastases had occurred in this group. The 65 carcinomas discovered by mammography were treated by excision of the microcalcified area. This was followed by mammectomy in 34 cases and by irradiation in 25. Close surveillance only was suggested in 6 cases. Histological studies showed 6 lobular carcinomas in situ and 59 duct epitheliomas, 26 of which were infiltrating. The prognosis of isolated duct epitheliomas is highly favourable, and no dissemination was observed. The 2 local recurrences observed after secondary irradiation concerned infiltrating epitheliomas; these patients are now alive without sign of recurrence after mammectomy. After conservative treatment (tumorectomy followed by irradiation), no recurrence was observed among patients with non-infiltrating duct carcinomas