Faculty Bibliography

A randomized, prospective, controlled study comparing autogenous saphenous vein and polytetrafluoroethylene (PTFE) grafts in infrainguinal arterial reconstructions has been initiated in three different institutions. A total of 446 operative procedures were divided into six groups, depending on the site of distal bypass insertion into the popliteal or an infrapopliteal artery and on whether the patient received a randomized vein or PTFE graft or an obligatory PTFE graft. The randomized saphenous vein graft patency to infrapopliteal arteries was significantly better (P less than 0.005) at 2 1/2 years than the patency of randomized or obligatory PTFE grafts to the same level. No significant differences between randomized vein grafts and randomized or obligatory PTFE grafts in the femoropopliteal position could be demonstrated up to 2 1/2 years, either above or below the knee. The need for such a study and the limitations of this preliminary report are discussed. The requirement for longer observation of greater numbers of cases is stressed. A current plan for usage of the PTFE graft in the lower extremity is presented

Three cases of arterial-graft infection are presented. In all cases the gram stain obtained at surgery demonstrated white blood cells but no bacteria. Cultures obtained at operation subsequently grew Pseudomonas aeruginosa in two patients and Bacteroides fragilis in one patient. Failure to recognize the fallibility of the gram stain in the diagnosis of vascular infection may result in incorrect management decisions

Eleven female patients were treated conservatively by radical radiotherapy to the breast and ipsilateral lymphatics for metastatic adenocarcinoma in an axillary lymph node without clinical or mammographic evidence of a breast cancer. Ten of 11, four of five, and three of four were alive and free of disease 5, 10, and 15 years later, respectively. Of the 11 patients who were followed up for a minimum of five years, three (27%) had local recurrences: one at six, one at 11, and one at 14 years. The latter two recurrences were salvaged by secondary mastectomy. The cosmetic results were excellent and no serious irradiation complications were observed. Mastectomy may not be needed for patients with axillary adenopathy due to a probable subclinical breast cancer, since the long-term prognosis after radiotherapy is good and salvage surgery can be performed if recurrences develop