Faculty Bibliography

In a series of limb salvage bypass to the popliteal and infrapopliteal arteries, the superficial femoral and popliteal arteries were used preferentially to provide inflow if these vessels were no more than minimally diseased proximal to the site of bypass origin. Cumulative life-table patency rate at 6 years for popliteal bypasses was 66% for 290 cases originating from the common femoral and 81% for 60 cases originating from the superficial femoral and popliteal arteries (P greater than 0.1). Infrapopliteal bypass patency rate at 5 years was 50% for 129 cases originating from the common femoral artery and 58% for 79 cases originating more distally (P greater than 0.25). When vein grafts alone were considered, patency rates were still not influenced by the site of origin of popliteal and infrapopliteal bypasses. Only 1 of 32 failures of a bypass with a distal origin could have been caused by proximal progression of disease. Because of these findings and multiple advantages that result from using arteries distal to the common femoral for bypass inflow, preferential use of the superficial femoral and popliteal arteries for this purpose is recommended in appropriately selected patients

Graft-vs-host disease (GVHD) and failure of donor stem cells to engraft permanently are two major obstacles to successful bone marrow transplantation. We evaluated the effect of a single large dose of anti-lymphocyte serum (ALS) on mice receiving various numbers of H-2 incompatible bone marrow cells. Most animals receiving lethal total body irradiation (TBI) and allogeneic marrow died within 45 days due to GVHD, A/J (H-2a), CBA/J (H-2k), and DBA/1J (H-2q) mice that were given ALS 6 to 24 hr before TBI and C57BL/6 (B6, H-2b) bone marrow 24 hr after irradiation survived in good health for more than 200 days. This result compared quite favorably with mice that received anti-Thy 1.2 and C-treated B6 bone marrow (90% survival at 100 days, 50% survival at 200 days). Engraftment of the allogeneic marrow was dose dependent. At 100 days after TBI, about 30% of the A/J mice given 2 x 10(6) bone marrow cells were complete chimeras, i.e., donor H-2 antigens could be detected on greater than 85% of the peripheral blood mononuclear leukocytes of these mice. However, at a dose of 1 x 10(7) B6 bone marrow cells, 95% of the A/J mice were complete chimeras. Spleen and bone marrow from B6 leads to A/J chimeras and B6 leads to CBA chimeras were unable to induce lethal GVHD in TBI-treated mice that were syngeneic to the recipient. However, these cell preparations caused lethal GVHD in third party mice indicating that the lack of alloreactivity was specific to the strain in which the unresponsiveness was originally induced

In a series of 148 polytetrafluoroethylene femoropopliteal bypasses performed for limb salvage, 33-month life-table cumulative patency rates for grafts inserted into an isolated popliteal artery segment (91% +/- 5%) were not significantly different from those inserted into a popliteal segment with angiographically better runoff (78% +/- 5%). Similarly, below-knee reconstructions had 3-year patency rates (86% +/- 6%) that were not significantly different from those for bypasses inserted into the popliteal artery above the knee (79% +/- 6%). One clear disadvantage of the isolated popliteal artery segment as a site for distal insertion of the bypass was the increased incidence of limb loss despite a patent reconstruction. This was particularly frequent in diabetics with extensive foot gangrene or infection and could be avoided by a secondary extension of the bypass to a patent distal leg or foot artery

To determine the effects and effectiveness of small volume (50 ml) bronchoalveolar lavage, lavages were performed on healthy mongrel dogs under a number of protocols. The differential and total cell counts in small volume bronchoalveolar lavages were determined. These factors were compared to those obtained by large volume (500 to 600 ml) lavage of the same segment in a second experimental group. Small volume lavage yielded a greater total cell count per milliliter and a greater concentration of polymorphonuclear leukocytes (PMNs) than large volume lavage, in which there was a somewhat higher concentration of bronchial cells. We compared the cell populations from lobes lavaged at 48-hour intervals. No significant changes in these populations or in pulmonary histology were noted. Our results suggest that small volume bronchoalveolar lavage provides a representative sample of the total free cell yield from the lower respiratory tract. Furthermore, small volume bronchoalveolar lavage performed at 48-hour intervals does not influence the distribution of these cells or significantly damage the pulmonary parenchyma

Percutaneous transluminal angioplasty of the branches of the popliteal artery was performed in six patients, two of whom also had femoropopliteal angioplasty. Dilatation was performed with catheters ranging from 5.5 to 7 French. None of the popliteal branch dilatations was performed with an inflated balloon. Excellent dilatation, as documented by angiography and Doppler ultrasound pressure recordings, was obtained in four cases and moderate and slight improvement in one case each. Two of the four patients with excellent results had prompt healing of toe amputations and are doing well at 19 and 22 months after angioplasty. In the other two patients with excellent results, below-knee amputation was necessary despite patency of the dilated segment in one. In the other patient with initially excellent results, reocclusion occurred 4 months after angioplasty. In the patients who had moderate and slight improvement on angiography and in distal pressures, no significant clinical course change occurred. No patient had clinical deterioration after angioplasty and no significant complications occurred