W. Dock

Prospective clinical study with in vitro endothelial cell lining of expanded polytetrafluoroethylene grafts in crural repeat reconstruction

A nonrandomized prospective clinical study was undertaken to evaluate the technique and efficacy of in vitro endothelial cell lining of synthetic grafts. Twenty-six patients (10 men and 16 women with a mean age of 68.4 years; range, 49 to 80 years) with end stage chronic peripheral vascular disease requiring reoperation were entered into the study. In 13 patients venous endothelial cells were harvested 4 to 7 weeks before operation, grown to confluency in culture flasks, and seeded onto the inner surface of expanded polytetrafluoroethylene grafts. Thirteen patients received untreated expanded polytetrafluoroethylene grafts and served as a control. A scoring system with use of intraarterial angiography was used to assess disease severity. No statistically significant differences in angiographic score were seen between the two groups, indicating comparable severity of disease. Early secondary graft patency (0 to 30 days) was 92% for the in vitro endothelial cell lining group and 53% for control patients. The amputation rate after 18 months for the in vitro endothelial cell lining group was 15%, with a 31% rate in the control group. The functional performance of the in vitro endothelial cell lining bypasses was superior to that of untreated bypass grafts during the observed follow-up period. These early results suggest that in vitro endothelial cell lining is a method that can reduce the early occlusion rate now seen after repeat reconstruction of crural vessels.

Percutaneous extraction of centrally embolized foreign bodies: a report of 16 cases.

Sixteen cases of centrally embolized foreign bodies are reported (eight catheter fragments, two guide wires, four pacemaker electrodes, one ventriculo-atrial shunt, one Port-A-Cath catheter). In all patients only the Dormia basket was used. Foreign body extraction was successful in all patients except one, in which removal of a pacemaker electrode from the myocardium failed. Technical aspects as well as complications of percutaneous foreign body extraction are discussed.

Intraoperative and early postoperative colour Doppler sonography after carotid artery reconstruction: follow-up of technical defects

Abstract We studied 50 patients with intraoperative colour-coded Doppler sonography (CCDS) after carotid artery reconstruction. Technical defects could be detected in 19 cases (38 %): residual plaques in 9, flaps in 8 and strictures in 2. In 9 cases (18 %) the carotid endarterectomy was revised. One residual plaque and one residual stricture caused thrombosis at the operative site a few hours postoperatively. One of the patients with residual plaques developed a high-grade stenosis within the follow-up period. Of the patients with residual plaques two had a medium-grade stenosis at follow-up. Six flaps decreased in size or disappeared within 1 week after operation. No patient with a flap developed a stenosis within the follow-up period. Our findings seem to indicate that correction of intimal flaps less than 10 mm in size is not necessary.

An unusual cause of haemobilia.

Haemobilia, a communication between blood vessels and the biliary tract, is usually secondary to trauma, vascular disease, inflammatory disorders, gallstones or tumours (Hirsch et al, 1982). An extremely rare cause is presented, namely tuberculosis, presumably related to erosion of the hepatic artery and formation of a pseudoaneurysm. A 16-year-old girl was admitted with haematemesis and melaena. The patient had been well until the age of 14 years, when she experienced symptoms of fever, night sweats and fatigue and was diagnosed as having pneumonia.

Retrieval of Adherent, Centrally Embolized Foreign Bodies: Common and Advanced Methods

Percutaneous removal of centrally embolized foreign bodies left in situ is of utmost importance because of the high mortality. With the usual meth ods, however, removal is possible only if one end of the embolizate is freely accessible. In this report the authors present the common tech niques and a new method permitting the shifting of fixed foreign bodies into a position where they may be grasped and removed by snare or Dormia basket.

Primary malignant fibrous histiocytoma of a metacarpal bone: a new localization

Malignant fibrous histiocytoma (MFH) is a common tumour of the soft tissues (Ros et al, 1984); it is rare in bone but the predilection sites in bone are the distal metaphysis of the femur and the proximal metaphysis of the tibia. We present a patient with MFH of a metacarpal bone. A 72-year-old man presented with pain in his right second metacarpal region. Duration of symptoms was 5 months with increasing swelling in the past 4 weeks. There was no history of previous trauma or malignancy. Clinical examination revealed a tender second metacarpal of the right hand.

[The value of different clinical and imaging procedures for the postoperative follow-up of extra-anatomical bypasses].

In order to judge the patency of extra-anatomical by-passes in the lower extremities, 24 patients with 29 by-passes were examined clinically (palpation of the by-pass pulse, Fontaine staging, Doppler index) and by imaging methods (i-v DSA, Duplex sonography, colour-coded Doppler sonography). The value of these methods was compared. Sonography was found to be the ideal method for follow-up. Palpation was unreliable, particularly for femoro-femoral by-passes. The Doppler index and the Fontaine method provided no information about the actual state of the bypass. Angiography is indicated only if further vascular reconstruction is planned.

Chest Radiograph in the Acute Traumatic Rupture of the Aorta

The authors tried to determine the validity of sixteen well-known signs indicating an acute traumatic rup ture of the aorta on plain chest radio graphs of 22 patients. Angiograph ically 11 of the patients had a tear at the aortic isthmus. It turned out that seven of the sixteen signs (widened mediastinum, loss of the aortic knob contour, opacification of the aorto- pulmonary window, bulging of the vascular pedicle predominantly to the left, left apical cap, depression of the left main stem bronchus, and dis placement of the right paraspinous interspace) are of great diagnostic value.

Aussagekraft und Bedeutung der Genitourographie in der Diagnostik der Intersexualität und anderer Malformationen des Urogenitaltraktes

The accuracy of genito-urography in the diagnosis of intersex and for the demonstration of the internal genitalia has been studied in 16 patients. It was found that the radiological appearances agreed in all cases with the surgical findings. Advantages and disadvantages of various examination techniques are discussed

[Fibrinolytic therapy of thromboembolic vascular occlusions: primary success rates and long-term results].

A prospective study of the results of fibrinolytic therapy in 87 patients was carried out with particular reference to the type of fibrinolytic agent. The primary success rate using urokinase was 78%, which was markedly greater than the 44% success rate when using streptokinase. An attempt was also made to evaluate the effect of other factors, such as the extent and duration of the occlusion. Long term results, as might have been expected, were directly related to the primary success rate. If fibrinolytic therapy resulted in fairly normal vasculature, the long-term results were satisfactory in 79%, whereas unsatisfactory reconstruction of the vascular bed produced a satisfactory long-term result in only 30%.