Joginder Bhayana

Preparation of venous allografts. A comparison of techniques.

In order to evaluate alternate techniques of preparing veins for use as homografts, 102 femoral veins were harvested from adult mongrel dogs. The veins were treated in four different ways, then transplanted into recipient animals bypassing their ligated femoral arteries. Group I--24 veins (6 cm each) were harvested and immediately transplanted. Group II--24 veins were stored in 15% dimethyl sulfoxide (DMSO) solution at -120 C for 21 days prior to transplantation. Group III--26 veins were stored for 21 days in plasminate solution at -60 C prior to use as allografts. Group IV--28 veins were stored in 0.5% gluteraldehyde solution for 21 days prior to implantation. Animals were randomly sacrificed at 1-month, 2-month, 6-month, and 12-month intervals. Patency of the transplant was determined weekly by ultrasound. Specimens were sent for light and scanning electron microscopy at the time of harvest, prior to implantation, and at sacrifice. Endothelial damage was graded on a scale of 0-16. Veins in Group II had a significantly higher patency rate (68% at 1 year) than Group III (35%) and Group IV (11%) (p less than 0.05). The intimal layer of all patent vessels was replaced by an organized mural thrombus. Partial endothelialization of the luminal surface was most prevalent in Group II. Intimal damage related to storage technique was significant in Group III (p less than 0.01). At sacrifice, severe endothelial damage was present in all groups (p less than 0.01). In conclusion, veins stored in 15% dimethylsulphoxide (DMSO) solution at -120 C have immunologic and physical characteristics that yield patency rates acceptable for clinical use when autogenous tissue is not available.

Long-Term Results of Internal Mammary Artery Implantation for Coronary Artery Disease: A Controlled Trial

Abstract One hundred forty-six adult men from sixteen Veterans Administration hospitals were entered in a controlled prospective clinical trial. Seventy-one patients were randomly allocated to receive implantation of the internal mammary artery into the left ventricular myocardium for chronic ischemic heart disease with angina pectoris, and 75 were assigned to the control group. The two treatment groups were similar at baseline with respect to sixteen clinical and angiographic factors thought to have prognostic importance. Most of the patients were operated on before 1970. Operative mortality was 12%, and implant patency in 52% of eligible patients studied 1 year after operation was 67%. At the end of follow-up extending up to 12 years (mean, 9.3 years), cumulative survival for both groups was similar. Over half of the patients (58%) had died at the end of 10 years (5% per year). While the hypothesis on which the operation was based appears to be valid, the degree of revascularization achievable in most patients did not affect longevity.

Adjuvant specific immunotherapy of resectable squamous cell lung carcinoma. Analysis at the eighth year.

SummaryFrom June 1976 to June 1981, 86 patients with resectable (Stage I and II) squamous cell lung carcinoma were entered into a randomized controlled study with three arms:I.Control Group — no treatment postoperatively.II.Specific Immunotherapy Group — three monthly doses of 500 μg of tumor associated antigen (TAA) emulsified with complete Freunds adjuvant (CFA).III.Nonspecific Immunotherapy Group — three monthly doses of CFA emulsified in saline. All the patients in the study received skin tests with PPD (5TU) and 100 μg of the same TAA used for the immunotherapy at 1, 4, 6, 9, and 12 months postoperatively.Patients in both immunotherapy groups showed a tendency for a better disease-free interval and overall survival compared to those of the control, but these interval and beneficial therapeutic effects were statistically significant only in the Group III patients who had no hilar lymph node metastasis (T1N0 and T2N0).Although Group III was originally designated as a nonspecific immunotherapy group, retrospectively, it should be called a lowdose specific immunotherapy group because these patients actually received a total of 500 μg of TAA (as skin tests) and three doses of CFA at separate sites.

Intraoperative myocardial protection by potassium arrest and local cardiac hypothermia.

Abstract The combined modalities of potassium arrest and local cardiac hypothermia were used for myocardial protection in 82 patients. The cardioplegic solution used was Ringers lactate to which potassium chloride and sodium bicarbonate were added so that the final solution had a pH of 7.5 and 30 meq/liter potassium. The myocardium was cooled externally by cold Ringers lactate at 4 °C and through coronary circulation by cold cardioplegic solution at 8 °C. The myocardial temperature was continuously monitored and kept between 12 and 18 °C. Moderate systemic hypothermia was used (26 to 30 °C). Eighty-two patients have been operated upon using this technique. Eighteen patients had single or double valve replacements, 4 had valve replacements with coronary bypass, and 60 had coronary bypass procedures. The operating conditions have been excellent and the myocardial protection offered by this technique has been good. Perioperative myocardial infarctions, as diagnosed by ECG and CPK (MB isoenzymes) and myocardial scans, were seen in 6 patients. In conclusion the combined modalities of potassium arrest and local cardiac hypothermia give excellent myocardial protection during cardiac surgery.