Joseph A. Buda

Factors influencing patency of femoropopliteal artery bypass grafts

An analysis of 276 femoropopliteal bypass procedures performed in 264 patients at the Columbia-Presbyterian Medical Center over the past two decades showed a direct relationship of graft patency to preoperative popliteal artery runoff. Fuctional results were better than patency results. Sympathectomy and anticoagulation did not improve graft patency. The risk of amputation is outweighed by the benefits of restoration of blood flow to the ischemic extremity by a byass procedure.

Management of peripheral vascular problems in recipients of cardiac allografts

Five hundred and twenty consecutive heart transplant cases (458 adult, 62 pediatric) were reviewed to assess the impact of peripheral vascular problems. Peritransplant interventions requiring vascular cannulation (e.g., intraaortic balloon pump procedures, catheterization of the right and left sides of the heart, femoral bypass) resulted in 10 complications that necessitated nine surgical procedures. Five aortic aneurysms (three infrarenal and two suprarenal) were resected. There was one death unrelated to the aneurysm resection. Sixteen patients had evidence of peripheral vascular disease (PVD). There were three deaths in this group, none directly related to the PVD. Three patients required vascular reconstruction (axillobifemoral, bilateral femoral distal and popliteal endarterectomy) in the posttransplant period, all for advanced ischemic symptoms. Except for one patient in whom ischemia-related ulcers developed on the heels, all patients had improved or stable symptoms that did not require intervention. There were no limb losses or vascular infections. We conclude that despite the rigors of posttransplant immunosuppression, patients with stable manifestations of PVD may successfully undergo heart transplantation and subsequent vascular reconstruction, when indicated, without prohibitive risk.

Surgical treatment of renovascular hypertension

Abstract Sixty-two operative cases of renovascular hypertension are presented. Nephrectomy was performed in thirty patients and renal artery reconstruction was carried out in thirty-two. Follow-up period in these patients has been from six months to six years. The overall cure rate was 50 per cent. Twenty-four per cent of patients were improved by operation and 26 per cent were not improved.

Serum Inhibitory Factors in Cancer

The cellular response and serum blocking factors of 70 cancer patients were assessed by micro-MLC and PHA-stimulation techniques. Serum level of carcinoembryonic antigen (CEA) was determined by radioi

Evaluation of the immune status of transplant recipients by mixed lymphocyte culture

Abstract Modifications of MLC responses to donor antigens were followed in 12 recipients of living related kidney allografts. The patients sera were tested for MLC inhibitory factors and for anti-HL-A antibodies. Attempts to correlate the MLC results with the functional outcome of the transplant led to the identification of the following groups: 1. Seven patients showed excellent renal function, negative MLC response to the donor, and no cytotoxic antibodies or MLC inhibitory serum factors. 2. Three recipients undergoing chronic rejection showed strong MLC reactivity to the donor, multispecific cytotoxic antibodies, and serum inhibitory factors. 3. Two recipients displayed enhanced responsiveness in temporal proximity to infections, discontinuation of immunosuppressive treatment, and allograft rejection. Their sera showed cytotoxic antibodies and MLC inhibitory factors. Our data suggest that induction of immunologic tolerance or, alternatively, of allograft immunity as well as sensitization to bacterial and viral antigens are reflected in changes of MLC reactivity.

Comparison of Lymphocyte Reactivity in Patients with Cancer, Systemic Lupus Erythematosus and Renal Allografts

The PHA and MLC reactivity of lymphocytes from patients with cancer, SLE or renal allografts was comparatively tested in the presence of autologous and of normal homologous serum. Sera from patients with advanced cancer, active SLE or chronic allograft rejection strongly inhibited the MLC reactivity of autologous lymphocytes. It is suggested that serum inhibitory factors might be antibodies which are directed against modified antigenic determinants of the major histocompatibility complex, and are capable of blocking T lymphocyte receptors.

The effect of portacaval transposition and renal artery stenosis on the rejection of renal allografts in dogs

Abstract Hypertension during acute renal allograft rejection was prevented in five animals by subcutaneous injection of reserpine, and in 11 animals by prior performance of portacaval transposition and renal artery stenosis. Whereas 14 control animals with normal circulation dissolved their kidneys over a 2-week period with a rapid exudative response, the two groups of animals kept normotensive dissolved their graft kidneys over a 6-week period, and with less necrosis. It is suggested that hypertension alone accelerated graft dissolution by increasing tissue ischemia.