Faculty Bibliography

In the past nine years, 1196 patients whose lower extremity was threatened because of infrainguinal arteriosclerosis have been treated at Montefiore Hospital. In the last six years, limb salvage was attempted in 679 or 90% of 755 patients. Femoropopliteal (318), small vessel (204) and axillopopliteal (29) bypasses were used along with transluminal angioplasty (128) and aggressive local operations to obtain a healed foot. Immediate (one month) limb salvage was achieved in 583 or 86% of the 679 patients in whom revascularization was possible. The 30-day mortality rate was 3%. The cumulative life table (LT) survival rate of all the patients undergoing reconstructive arterial operations was 48% at five years. The cumulative LT limb salvage rate after all reconstructive arterial operations was 66% at five years. The cumulative LT patency rate of femoropopliteal bypasses was not influenced by angiographic outflow characteristics of the popliteal artery but was increased 15% by appropriate reoperations to 67% at five years. Cumulative LT patency and limb salvage rates of small vessel and axillopopliteal bypasses were more than 50% at two years. Of patients undergoing arterial reconstruction, 88% of those who died within five years did so without losing their limbs. Of all the patients in whom limb salvage was attempted, 68% lived more than one year with a viable, useable extremity, and 54% lived over two years with an intact limb. We believe this aggressive approach to limb salvage is justified, and can be undertaken with a low cost in mortality, knee loss and morbidity

Spontaneous resolution of thrombosis of the systemic arteries is a rarely documented phenomenon. Two patients are described in whom thrombus within the popliteal artery was noted to lyse spontaneously. This resulted in a decrease in ischemic symptoms and was documented by angiography. The spontaneous improvement that occurs in some patients with atherosclerotic femoropopliteal disease may be due to this mechanism as well as to increased flow via collateral vessels

The hormone dependence and the prognosis of human breast cancers are currently based on assays of the estrogen receptor (RE) and progesterone receptor (RP) in the tumor. However, such prediction can not be fully accurate: RE may be non functional in some tumors and the estrogenic regulation of RP is not directly correlated with the effects of estrogens on cell growth. Here we described other estrogen induced intracellular, secreted or membrane proteins. Investigations of these proteins should allow a better understanding of the mechanisms by which estrogens stimulate the growth and spreading of breast cancer. Some secreted proteins could even be useful as circulatory markers of hormone dependence

The technical feasibility and rejection characteristics of intrafamilial fox-to-dog xenografts were studied. The results indicate that (1) both lungs of a smaller donor can be successfully transplanted into a single hemithorax of a larger recipient, (2) fox-to-dog lung xenografts are capable of providing total pulmonary function at tolerable right ventricular pressures, and (3) the rejection process of unmodified intrafamilial lung xenografts, was similar to and not more vigorous or more rapid than that of canine lung allografts in untreated recipients