Infiltrating angiolipoma of the hand and wrist

Three cases of angiolipomas involving the wrist and hand are reported that emphasize the pathologic differences between infiltrating and noninfiltrating types. Although not previously reported in the hand, infiltrating angiolipomas are biologically aggressive and usually invade local tissues. Proper treatment requires wide excision, but the proximity to important neurovascular structures limits adequate surgical margin in the hand. Compromising surgical resection to preserve function should be undertaken only with the understanding that recurrence is more likely.     

Preliminary experience with intraoperative transluminal balloon-catheter dilation and coronary artery bypass grafting for the treatment of symptomatic diffuse coronary artery disease

Transluminal balloon-catheter dilation of coronary artery lesions has become increasingly common in the cardiac catheterization laboratory. We describe a method of intraoperative dilation that may improve surgical results when used in combination with coronary artery bypass graft (CABG) operations in patients with diffusely diseased coronary arteries. In 16 patients, long-segment intraoperative dilations were performed to enlarge luminal narrowings in 21 different regions. All of these patients had postoperative coronary angiography and left ventriculography so that we could objectively evaluate the coronary dilatations. There were no operative deaths or perioperative myocardial infarctions, and angina was relieved in all patients. Of the 21 dilated segments, 12 (57%) were unchanged, 2 (10%) became worse, and 7 (33%) were improved postoperatively. In addition, two new areas of intimal damage were detected in patients with unchanged postoperative liminal diameters. We conclude that further experience and longer follow-up are necessary before the efficacy of intraoperative coronary artery balloon-catheter dilation can be accurately determined.     

Effects of the pacing site in sinus node reentrant tachycardia.

His bundle recordings and premature atrial stimulation from coronary sinus, mid-right atrium and high-right atrium were performed in a patient with repetitive supraventricular tachycardias. Regardless of the paced site, there was a range of coupling intervals during which testing stimuli elicited short runs of premature beats. The corresponding P waves were positive in leads I, II and III and had a high-to-low right atrial activation sequence. Their morphology was similar to that of sinus beats. However, sustained tachycardia occurred only when pacing was performed from the coronary sinus. Therefore, it is postulated that the site of stimulation might be important in the genesis and (perhaps) perpetuation of this arrhythmia by changing the site and (or) mode of entry into the area where this type of tachycardia occurs. Though sinus node reentry was the most likely mechanism, it could not be determined whether the circuit involved the sinus node per se or the so called perinodal fibers.     

An electron microscopical study of the influence of different glycosaminoglycans on the fibrillogenesis of collagen type I and II in vitro

Summary Proteoglycans (PG) and glycosaminoglycans (GAG) bind to collagen, and thus influence fibril formation. Polysaccharides interfere with the aggregation of collagen molecules and affect pattern formation.The morphological structure of type I and type II collagen was studied after adding different GAG to collagen solutions in test tubes in vitro. Electron microscopical investigations suggest that sulfated GAG change the aggregation behaviour of collagen molecules. Thus, the cross-striation pattern is changed. This effect seems to be based on the degree of sulfatation and not on the molecular weight of the GAG. Furthermore, GAG appear to have a stabilizing influence on the in vitro fibril formation.     

Dislocation of Binkhorst four-loop lens implant.

A consecutive series of 1,093 Binkhorst four-loop lens implantations was used to examine the problem of dislocation of implants used in intracapsular cataract extractions; emphasis of the study was on the need for suture fixation. Transiridectomy suture fixation was used in 497 procedures, no suture was used in 403 procedures, and a simple iris suture technique was used in 193 procedures. Although the transiridectomy suture fixation procedure had the lowest percentage of dislocations, the iris suture technique is considered safer. Suture fixation is recommended for Binkhorst four-loop implants used in intracapsular cataract extractions.     

Adrenaline,DB-c-AMP and myocardial 45Ca exchange. Comparative studies in rat and guinea-pig auricles

Summary The positive inotropic effect of adrenaline has been assumed to result from an increase in the intracellular level of c-AMP which, in turn, might enhance the permeability of the cardiac cell membrane to Ca²⁺. In order to further test this hypothesis, the effects of cyclic N⁶-2-O-dibutyryl-adenosine-3,5-monophosphate (DB-c-AMP; 10^–3 M) on mechanical performance, ⁴⁵Ca uptake and total tissue calcium concentration were investigated in electrically stimulated (120 beats/min) left auricles isolated from female rats weighing 180–220 g. The experiments were performed in Tyrode solution containing 0.9 mM CaCl₂; the duration of ⁴⁵Ca exposure was 3–60 min. In this study, DB-c-AMP markedly enhanced contractile force but the drug failed to detectably increase ⁴⁵Ca exchange (Figs. 1 and 2). This finding seemed to indicate that the effects of DB-c-AMP on myocardial ⁴⁵Ca exchange were completely different from those of adrenaline which previously (and in this study; Fig. 4) has been shown to accelerate ⁴⁵Ca exchange in auricles obtained from guinea-pigs of normal size. However, under the conditions used, adrenaline (2.2–5.5×10^–6 M) also failed to significantly enhance ⁴⁵Ca exchange not only in rat auricles (Fig. 3) but also in small auricles isolated from very light guinea-pigs (body-weight 75–150 g; Fig. 4). From these findings it is concluded that druginduced changes in membrane calcium fluxes, which possibly occur, only might have escaped detection under the present experimental conditions. The pool saturation phenomenon previously described by Grossman and Furchgott (1964b; 1964c) is discussed to be the underlying mechanism. Thus, substantial conclusions on the effects of DB-c-AMP on myocardial Ca fluxes can as yet not be drawn. They must await experiments in which an adrenaline induced increase in cardiac ⁴⁵Ca exchange becomes detectable.     

Twelve-year experience with bilateral internal mammary artery grafts

A 12 1/2-year experience with 227 patients who underwent coronary revascularization with bilateral internal mammary artery (IMA) and supplemental saphenous vein grafts is presented. There were 725 coronary grafts performed (3.2 per patient). Forty-four IMA grafts were sequential. In 42 patients, the right IMA was placed through the transverse sinus to revascularize the circumflex artery. Operative mortality was 4% (9 of 227 patients). Postoperative complications included sternal infection (4 patients), reexploration for bleeding (5), and diaphragmatic dysfunction (10). Postoperative arteriography in 30 patients (mean interval, 4 1/4 years) revealed that 92% (34/37) of the left IMA and 87% (26/30) of the right IMA grafts were patent. Late follow-up was complete in 207 surviving patients. Eighteen late deaths (9 cardiac and 9 noncardiac) occurred. Actuarial survival was 83% at 10 years after operation. Of 68 patients followed from 8 to 12 1/2 years (mean interval, 10 1/2 years), 69% were asymptomatic, and 28% were in New York Heart Association Functional Class II. We conclude that bilateral IMA grafting can be accomplished with low operative risk and provides excellent long-term results.