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

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

It has been claimed that the level of amputation is rendered higher by unsuccessful limb salvage bypass procedures. To evaluate this premise, we analyzed 242 major amputations performed for atherosclerotic vascular disease. One hundred and sixty-one amputations were performed as primary operations--50 per cent being below knee and 50 per cent, above knee amputations. Eighty-one amputations followed failure of an arterial revascularization. Twenty-three amputations, 13 below knee and ten above knee, followed late closure of such bypass procedures. Early failure of the bypass in 58 patients resulted in 46 below knee and 12 above knee amputations. After failure of 45 bypasses to arteries distal to the popliteal, 14 of the patients required above knee amputation. Following 28 unsuccessful femoropopliteal bypasses, only two patients needed above knee amputation. Thus, the risk of jeopardizing the knee joint should not be considered a major contraindication to limb salvage procedures, especially if a femoropopliteal bypass is contemplated

Little is known about the traffic of lymphocytes within the lung and hilar lymph nodes and even less is known about the alterations in such traffic after immunization of animals via the trachea. To explore these phenomena, we developed an intrapulmonary immune response to alloantigens in mice by depositing semiallogeneic spleen cells into their tracheas. We studied lymphocyte traffic in this model by two assays. In one, we assessed the recruitment of nonspecific 51Cr-labeled resting lymphocytes to the lungs and hilar node and in the other, a dual-antigen, dual-isotope assay, we measured the recruitment of both allospecific and nonspecific labeled blast cells to the lungs and hilar nodes. The results indicated: (1) that circulating T lymphocytes that have recently synthesized DNA (blast cells) are retained in lungs and hilar lymph nodes of challenged mice far more readily than a circulating resting T lymphocytes, and (2) that there is at least some preferential retention of lymphocytes with specific reactivity to the alloantigen used for immunization. Although lymphocyte recruitment to the lungs and hilar nodes was observed during the entire 5-day postchallenge interval, most of the allospecific recruitment occurred during the first 48 hours