Faculty Bibliography

Needle aspiration for cytological investigation has been used at the Foundation Curie since 1954. Until 1973, no less than 3,176 mammary tumours have been studied by this method and comparison made with the histological findings. In the whole group some relatively rare carcinomas have been encountered -- mucoid, medullary, adenoid cystic, squamous and apocrine. Each category is described from the cytologic viewpoint and illustrated with an appropriate cyto/histologic example to show what a high degree of precision may be attained by diagnostic cytology in mammary cancer

Alveolar lavages were performed repetitively on the normal and transplanted lungs of dogs that had recieved autografts or allografts without immunosuppression. One half of the lavage returns was fixed as a cytologic smear; the other half was subjected to semi-thin section or electron microscopic examination. Of the staining methods was used, the periodic acid-Schiff (PAS) and Giemsa techniques were best for differentiating and counting cells. The Ladewig technique was best for evaluating the presence and location of fibrin. After autotransplantation, the proportion of so-called alveolar marcophages increased, reached a peak in 4 to 7 days, and then returned to normal. Phagocytized fibrin increased for the first postoperative week, but not extracellular fibrin was ever observed. After allotransplantation, a progressive decrease in the proportion, size, and vacuolization of so-called alveolar macrophages was noted along with an increase in extracellular fibrin. Intracellular fibrin could be detected only up to the third day. These findings define adequate methods for preparing and staining material obtained from diagnostic alveolar lavages, and they suggest that the procedure may serve as an index of lung allograft rejection

Lung allograft rejection can usually be diagnosed by the appearance of infiltrates on plain chest roentgenograms when these are interpreted in the light of other clinical and bacteriologic information. Large pulsed intravenous doses of methylprednisolone were usually effective in reversing lung allograft rejection that occurred in immunosuppressed dogs. In 10 of 15 animals the presence of moderate to severe rejection and its effective reversal with treatment were documented with roentgenograms and histologic sections. This ability to reverse the manifestations of lung allograft rejection, when they occur, has helped in the management of human lung allograft recipients

Intraoperative angiography was performed during a variety of 155 arterial reconstructive procedures including bypass, endarterectomy, embolectomy, thrombectomy, primary reconstruction, and angioplasty. In 27 or 17% of these cases, defects were identified that could be corrected. These included technical errors at the suture line, accumulation of platelet thrombus and atherosclerotic debris, or unrecognized lesions in the runoff. The likelihood of identifying such lesions is greatest in patients undergoing bypass surgery, particularly when the distal anastomosis involves one of the leg arteries. Routine use of intraoperative angiography as an adjunct to vascular surgery is justified and will help to obviate many early graft failures

Thirty-two small-vessel bypasses were constructed as limb-salvage procedures. The one month patency rate was 72 percent and the one year cumulative patency rate was 55 percent. Preoperative, intraoperative, and postoperative angiography was performed in most cases and the results correlated with the ultimate fate of the graft. Preoperative angiography is critical in determining the location of a suitable small vessel, including the peroneal artery, and the quality of the runoff. Intraoperative angiography is required to delineate correctable intraoperative defects usually appearing at the distal anastomotic area. Additionally, failure to demonstrate runoff or a pedal arch can help support a decision not to re-explore a graft should early closure occur. Postoperative angiography is essential to validate clinical success with graft patency and function. It also serves to discover potential graft defects that might otherwise lead to closure and potential limb loss. Selected cases of failed small-vessel bypass grafts may be salvaged by thrombectomy with or without graft revision. Small-vessel bypass is generally contraindicated if there is extensive tissue necrosis and infection extending into the proximal foot. In cases where the necrotizing infection is localized, particularly to the forefoot, then open drainage, debridement, or amputation should be performed together with small-vessel bypass. Finally, the risks indigenous to small-vessel bypass procedures demand optimal patient selection and exquisite operative technique

The present study was undertaken to determine the mechanism of neointima formation in rabbit arteries subjected to extensive endothelial desquamation. Endothelial cells were selectively removed from the abdominal aorta by passing an inflated balloon catheter through the vessel. The healing response was then studied serially for up to a week, when neointima formation had provided a virtually complete cover. In en face preparations, the early neointimal cells appeared in random locations; they did not develop in apposition to residual, healthy endothelium. The possibility of blood cell colonization was explored by inserting killed aortic homografts. Since these homografts showed neointima formation only close to the site of junction with the normal aorta and as a direct extension of healthy endothelium, the likelihood of significant blood cell colonization was deemed small. Histologic and electron microscopic sections provided evidence that the early neointimal cells in the healing aorta were derived from medial smooth muscle cells. Healing of the injured arterial intima was accompanied by thickening instead of prompt restoration to normal, and the thickened intima resembled an arteriosclerotic plaque. The present study thus supports the concept that arteriosclerosis is a disease involving proliferation of medial smooth muscle cells