Faculty Bibliography

Two histological factors to be taken into consideration for prognosis in pretreatment schedules of breast cancer have been studied on a group of 352 cases treated by non-mutilating therapeutics at the Fondation Curie between 1960 and 1970. The tumour material the slides of which we have reexamined 'blindly', i.e. ignoring the evolution of the case had been obtained mostly by drill-biopsy. Histological groups and types have been determined following an analytical classification for computer purpose. The degree of malignancy was calculated with the method of Scarff-Bloom-Richardson. The analyzed data have been memorized on computer and then confronted with the elements of the T.N.M. classification and the survival of the patients involved. It appeared that if drill-biopsie have been performed correctly the histological type may be defined in eighty percent of cases. And it is likewise possible to calculate the histological grade of malignancy for each mammary cancer. With such a material the value for prognosis by means of the Scarff-Bloom-Richardson method still remains if applied only to adenocarcinoma of the 'common infiltrating type'

In a 52-year old woman, basal cell carcinoma of the back skin recurs after excision and the axillary lymph nodes are involved. This case is to be added to the list of basal cell carcinomas with metastatic evolution. The histologic study of a series of sections allows to show the migration of neoplastic cells in the vessels. Though exceptional, the ability of the basal cell carcinomas to yield metastases must be taken into account

The uptake of 131I-fibrinogen in canine pulmonary allografts was compared to that in lung autografts or lungs with papain-induced unilateral hemorrhagic pneumonia. In addition to serial lung scans and the postmortem measurement of tissue radioactivity, all dogs had serial chest roentgenograms and histologic study of their lungs. All four animals in the allografted group had increased radioactive uptake on the side of the allograft lung at the same time as or slightly before radiographic abnormalities were evident. However, increases in lung radioactivity also occurred in animals with pneumonia or autografts at the time infiltrates were present. Thus the presence of increased lung scan activity, which occurs in rejecting lung allografts after the injection of 131I-fibrinogen, is not a specific index of pulmonary rejection

Intravenous rupture of abdominal aortic aneurysms occurs infrequently but should be considered with the coexistence of severe congestive failure, anasarca, and abdominal bruits. Six patients are presented with four survivors. In only two patients was the diagnosis considered preoperatively without angiography. Two were variants in that thrombus occluded the fistula, thereby negating findings usually manifested clinically. Diagnosis of this type can be made only during operation when copious venous bleeding ensues with evacuation of the aortic thrombus. Careful fluid management and prompt surgery are prerequisites to obtaining a successful outcome. Repair is accomplished easily by suturing the fistula from the aortic aspect, but care is required to avoid dislodgement of thrombus and atherosclerotic debris resulting in pulmonary embolism

Arterial visualization using the gamma camera was achieved by peripheral intravenous injection of technetium pertechnetate Tc 99m 253 times in 200 patients. This technique, which successfully images the arterial tree to the level of the wrist and ankle, was validated by blind comparison of the scintiangiograms with contrast arteriograms or surgical findings or both in 93 studies. Although scintiangiography has less resolution than contrast arteriography, it provides quantitative and other important supplementary information in the diagnosis and management of patients with arterial disease. Scintiangiography has accurately diagnosed arterial occlusions (atherosclerotic, traumatic, and embolic), true and false aneurysms, and arterial stenoses. Patients sustaining trauma to the extremities may be evaluated by scintiangiography as a screening technique. Postoperatively, scintiangiography has replaced contrast arteriography for assessing patency of grafts and completeness of thromboembolectomy and for the long-term follow-up of these patients

The accurate diagnosis of lung transplant rejection requires histologic examination of the grafted lung. Because transbronchial lung biopsy has been advocated as an effective diagnostic procedure for a variety of lung diseases, it was elected to assess this technique in rejecting transplanted lungs. Twenty-two dogs received allografts and underwent simultaneous lung biopsy by 3 techniques when signs of rejection occurred. Open lung biopsy was diagnostic of rejection in all instances. Transthoracic needle biopsy correlated with the open biopsy in 59 per cent of the cases. No specimen obtained by transbronchial lung biopsy provided sufficient material to permit fulfillment of the strict histologic criteria needed to diagnose allograft rejection. Although transbronchial lung biopsy is successful in many pulmonary infiltrative processes, it appears to be inadequate for the diagnosis of lung allograft rejection

To evaluate a system for preserving and transporting lungs before transplantation, we removed the left lungs of 37 dogs, flushed them with a hypertonic solution having an electrolyte composition resembling intracellular fluid, and immersed them at 4 degrees C. for 7 to 24 hours. Some lungs were maintained at exactly 4 degrees C. during transport by means of a mixture of solid and liquid l-hexadecene. The lungs were allografted into immunosuppressed dogs whose right pulmonary artery was immediately ligated. Twelve recipients (32 per cent) survived 5 days or more solely on the function of the preserved lung. Four survived 10, 19, 40, and 40 days with lungs that had been preserved for 7 to 21 hours. Survival of recipients of preserved lungs (5 +/- 2 days) was equivalent to that of 75 comparably immunosuppressed recipients of nonpreserved allografts (6 +/- 1 days). One group of 10 dogs receiving lungs flushed against outflow resistance survived 12 +/- 5 days. In recipients of preserved allografts, arterial oxygen tensions remained in the normal range up to 5 weeks after transplantation, and radiographic infiltrates in the transplant were no greater than those present in recipients of nonpreserved transplants. Thus lungs transported and preserved up to 21 hours can provide total pulmonary function after transplantation and can function at least as well as nonpreserved transplants. The effectiveness and simplicity of this method are such that it might be considered for use in man

Isotope angiography performed by intravenous injection of technetium 99m pertechnetate has been demonstrated to be of value in the diagnosis and management of a variety of disorders of the large arteries. An improved technique of isotope angiography is described and the technique validated (53 cases) in normal and diseased arteries by correlating it with conventional contrast arteriography and/or operative findings. Peripheral arteries as far distal as the wrist or mid-calf have been accurately visualized and quantitation of isotope arrival times and total isotope activity in different parts of the arterial tree has provided a means of evaluating the hemodynamic significance of stenosing lesions. Thirty-nine arterial reconstructions were studied by this technique. Seven of 27 (26%) clinically patent arterial reconstructions were found to be harboring significant and potentially dangerous imperfections which were clinically unsuspected. Nine of 12 (75%) arterial reconstructions thought clinically to be occluded were demonstrated to be patent, obviating the need for invasive contrast arteriography. Isotope angiography may be used with no risk for the immediate postoperative and long-term evaluation of arterial reconstructions. Only those patients with abnormalities identified on isotope angiography need have conventional contrast arteriography for further delineation of the abnormality so that it may be repaired before it causes failure of the reconstruction