Robert M. Sade

En face stripping of vascular endothelium

Abstract A technique for removing the endothelium from the intimal surface of a major vessel as a flat sheet is presented. The method is particularly suitable for autoradiography of endothelium.

DNA synthesis in endothelium of aortic segments in vitro.

Abstract This paper describes a method for the short-term preservation of rat aortic endothelium and presents evidence that such endothelium is capable of DNA synthesis in vitro. The method consists of relatively nontraumatic surgical removal of rat aorta and incubation of 2–5 mm segments in medium 199 with 10% fetal calf serum. DNA synthesis was assessed by autoradiography of en face preparations of endothelium after exposure to 3H-thymidine in vitro and endothelial structure was studied by electron microscopy. The percentage of labeled cells in uninjured aortic segments incubated with 3H-thymidine in vitro varied according to the age of the rat, being highest in younger rats and lowest in old retired breeders. The length of survival in culture was determined by ability of endothelium, that had been stimulated by in vivo crushing of the aorta, to incorporate 3H-thymidine at intervals after in vitro culture: labeled endothelial cells were readily identified 24–48 h after culture, when up to 90% of the endothelium appeared to be preserved in en face preparations. Subsequently there was progressive detachment of endothelial cells, but patches of endothelium and labeled cells were seen as late as 6 days after culture. Trauma to the aorta in vitro, after removal from the animal, also resulted in stimulation of DNA synthesis in endothelial cells of aortic segments in culture. Electron microscopic observations confirmed adequate preservation of endothelial structure after 24 and 48 h of culture. The relative simplicity of the method and the demonstration of the ability of cultured endothelial cells to incorporate 3H-thymidine after both in vivo and in vitro trauma make it suitable for studies on endothelial regeneration.

Repair of Tetralogy of Fallot after Aortopulmonary Anastomosis

Thirty-eight corrective operations have been performed in patients with tetralogy of Fallot and a functioning aortopulmonary shunt. There were 3 operative deaths (7.9%) and 1 late death (2.6%), and 3 patients have required reoperation for significant residual defects. Only 1 of 10 patients studied postoperatively by radionuclide scanning has a significant reduction in blood flow to the lung on the side of the closed shunt. We conclude that the presence of an aortopulmonary shunt does not add to the risk of repair in patients with tetralogy of Fallot and that mortality after such operations is related to the complex anatomy often present in patients of this group.

The management of Hemophilus influenzae, Type B, pericarditis.

The incidence of Hemophilus influenzae, type B, infections in children has been increasing recently, so the number of cases of pericarditis is likely to rise also. We describe the clinical manifestations and treatment of H. influenzae, type B, pericarditis based on 4 patients and a review of the literature. The most common complication is cardiac tamponade, which requires drainage. All patients should be treated with antibiotics (chloramphenicol, ampicillin) and a drainage procedure. Because of several recently reported cases of subsequent constrictive pericarditis, we recomment anterior interphrenic pericardiectomy both for drainage and to prevent constrictive pericarditis. With appropriate therapy the survival rate should be very high.

Ligation of Subclavian-to-Pulmonary Artery Shunt: Simplified Technique

Abstract Two methods are described which reduce the technical hazards attending the ligation of subclavian artery-to-pulmonary artery shunts at the time of definitive repair of cyanotic congenital heart lesions.