Jack A. Cannon

Primary intraluminal tumor of the aorta producing malignant hypertension: successful surgical removal.

PRIMARY intraluminal tumors of the aorta must be exceedingly rare. There is, to our knowledge, only 1 other case in the literature that resembles to any degree the case reported below.1 Our patient...

Studies of Successful Skin Homografts in the Chicken: Description of a method of Grafting and Its Application as a Technic of Investigation

SUMMARY AND CONCLUSIONSFrom the method of Danforth a simple technic of obtaining a significant number of healthy, growing chicken skin homografts was derived, which provides a delicate method of testing the influence of various factors on homografted tissue.The technic is useful for comparing the sk

A clinical survey of aortobifemoral bypass using two inherently different graft types.

The performance of knitted Dacron and polytetrafluoroethylenc (PTFE) bifurcated grafts are compared in this study of 312 patients at a single institution. Patients of the two graft groups were statistically well-matched in risk factors and degree of distal obstructive disease. Operating time needed to implant either graft was approximately equal. For patients with abdominal aortic aneurysms, mean volume of blood transfused was 2.2 units for Dacron grafts and 0.2 units for PTFE grafts; for patients with aortoiliac occlusive disease, the comparable figures were 1.1 units and 0.1 units, respectively. Four-year cumulative patency for Dacron (90%) and PTFE (97%) grafts were not significantly different (p > 0.01). Complications affected 13% of the patients of the Dacron group and 4% of the PTFE group. AH six graft infections and all seven graft double-limb thromboses occurred in Dacron grafts. Anastomotic aneurysms, amputations, and late graft revisions occurred with greater frequency in patients with Dacron grafts.

Experience with the surgical management of 100 consecutive cases of abdominal aortic aneurysm

Abstract A series of 100 consecutive cases of aneurysm of the abdominal aorta is reported. The results are analyzed and observations on the development of the operation, pathologic changes of the lesion, indications for operation, problems in operative technic, prosthesis of choice and venous anomalies encountered are made. There were sixty-six nonruptured and thirty-four ruptured aneurysms in our series with an operative mortality of 15 per cent in the former and 59 per cent in the latter, with a combined figure of 30 per cent. Seven patients have died since operation, and an additional seven have been lost to follow-up study. Fifty-six patients are living and enjoying normal lives seven years following surgery.

Routine use of a shunt for carotid endarterectomy

A temporary inlying shunt used during carotid endarterectomy is the ideal method of cerebral protection. The data presented suggest that if meticulous technique is used, the potential complications of a shunt may be avoided and excellent clinical results expected. When a shunt is used properly, carotid endarterectomy may be performed in a teaching situation with a high degree of safety.

Antibody Response to Homografts. I. Technic of Lymphoagglutination and Detection of Lymphoagglutinins upon Spleen Injection.

Summary An agglutination method for detecting antibodies against blood lymphocytes is described. By this method non-specific clumping of polymorphonuclear leucocytes and/or monocytes usually encountered in leucoagglutination tests is avoided. The humoral response following homografting in chickens was reinvestigated using this lymphoagglutination reaction. In 82 combinations of normal sera or sera from autografted chickens, and lymphocytes, lymphoagglutination was found in only 5 instances. On the other hand, 103 cases of positive agglutination were obtained in tests with 107 combinations of immune sera and normal lymphocytes. These immune sera, including one with titer of 1:1024, were from animals previously injected with pooled homologous spleens. Sera from animals injected with splenic cells or grafted with skin from one donor, also contained lymphoagglutinins against lymphocytes of spleen or skin donor chicken. These lymphoagglutinins also reacted in some instances with lymphocytes of chickens other than spleen or skin donor.

Renal damage produced in vivo by homologous mouse antisera.

The argument that humoral antibodies play a key role in the destruction of homografts hinges strongly on whether immunity can be passively transferred by serum. The demonstration that antibodies directed against homografts can destroy donor cells in vitro (see references in Terasaki et dl) indicates that they can kill, but does not indicate that they do in fact destroy homografts in vivo. Numerous earlier attempts to influence graft survival by “immune” serum have been negative; however, in recent years Stetson and Demopoulous,2 Chutna? and Kretschmer and Per6z-Tamayo4 have reported successful passive transfer of immunity against skin homografts. Aside from the fact that this result could not be repeated by Brent,6 three important objections have been raised against the design of these experiments (in which a skin graft from Animal A was placed on Animal B, and the antiserum against Animal A was administered several days after grafting). First, since the grafts were in the process of healing-in, various nonspecific factors might be thought capable of influencing their survival. Second, since the host is also simultaneously beginning to react immunologically against the graft, dissociation of this effect and the activity of antisera is difficult. Third, skin homograft survival time is extremely difficult to determine accurately; thus a difference in survival time of a few days may not be highly significant. The present experiments were designed to produce damage in vivo by antisera in a system which is free of the above three difficulties. The essential experiment consisted of preparing antisera against C57 kidney in A strain mice and injecting it into C57 mice in an attempt to destroy their kidneys; thus the test tissue (C57 kidney) was under no stress other than that of the administered serum (such as attempting to heal-in or counteracting the immunological response of a foreign host). Moreover, injury in the kidneys could easily be determined by several objective criteria. The tests employed here to assess the effect of antisera were as follows: I13’-hippuran clearance, proteinuria, blood levels of urea, and histological study of the kidney.

Experience with ligation of the pancreatic ducts in the treatment of chronic relapsing pancreatitis.

I T is the purpose of this paper to present experience with six patients suffering from chronic reIapsing pancreatitis who were treated by Iigation of the pancreatic duct or ducts. Experience at Wadsworth HospitaI in the past has indicated that for the most part none of the surgica1 procedures advocated for the relief of symptoms of chronic reIapsing pancreatitis in the absence of biliary tract disease, short of actuaI excision of the pancreas, has been invariabIy effective. Procedures most commonty advocated alone or in combination incIude: vagotomy, sympathectomy, sphincterotomy, gastroenterostomy with or without gastric resection, transpIantation of the common biIe duct, and caudaI pancreatico-dochojejunostomy. The fact that so many procedures are advocated for the reIief of this disease wouId seem to indicate that none is particuIarIy effective. AI1 of the surgica1 measures so far devised, short of excision, have had as their aims relief of assumed major duct obstruction, suppression of exocrine activity, or interruption of nerve fibers bearing pain impuIses. Neither the actua1 cause nor the pathoIogic physioIogy of chronic reIapsing pancreatitis is well understood. It is probably safe to say, however, that breakdown of the ductal system with the consequent reIease of activated enzymes into the pancreatic stroma is essentia1 to the production of the disease. In chronic reIapsing pancreatitis it is the presence of episodes of severe pain which make the disease subject to surgica1 intervention. It wouId appear that the pain is the resuIt of stroma digestion and irritation by activated enzymes which have escaped from the ducta system. Rich and Duff’ have reported the most

Antibody response to homografts. VI. In vitro cytotoxins produced by skin homografts in rabbits.

Summary The sera of rabbits which were homografted with skin are shown to be toxic to lymph node cells of the skin donor rabbit. Cytotoxicity was demonstrated upon incubation in vitro for 2 hours at 37°C. Sera of grafted rabbits became toxic after graft breakdown had commenced (11 days), and reached a peak after the rejection (20-30 days). The sera were in all instances more toxic to lymph node cells of the skin donor than to cells of other rabbits. The authors wish to acknowledge the technical assistance of C. C. Chamberlain and J. D. McClelland.

A Technic for Cross-Transfusion of Blood in Embryonic Chicks and Its Effect upon Hatchability.∗

Summary A method is described by which .04-0.4 ml of blood may be cross-transfused in 9-18-day-old chick embryos with almost no increase in mortality over untreated control eggs. Of the 567 eggs tested, 82% hatched, as compared to 87% of the control eggs.