Changes in native coronary arteries after coronary bypass surgery: Role of graft patency,serum lipids and hypertension

Sixty-seven patients were studied by coronary angiography early (mean 3 weeks) and late (mean 13 months) after coronary bypass surgery to assess changes in the native coronary vessels. Among the 208 nongrafted arteries progression of disease was found in 2.9 percent. In arteries that were normal before operation, the rate was 0.7 percent; in those with luminal obstructions the rate was 7.6 percent (P < 0.05). Progression of disease occurred in 6 of the 67 patients (8.9 percent). In five bypassed arteries (5 percent), progression of disease occurred at or near the anastomotic site; in this subset the procedure was classified a technical failure. Progression of disease distal to graft insertion occurred in 2.4 percent of cases. The greatest incidence of progression took place proximal to graft insertion, in 24.2 percent of the grafted arteries. This rate differed significantly from the rate in nongrafted arteries (P < 0.001) and in distal segments of grafted arteries (P < 0.001). If the grafts were patent in the late control study, the progression of disease proximally occurred at a rate of 24 percent; if they were occluded, the rate was 25 percent. The data on timing of graft occlusion suggested that graft patency was related to the proximal progression. The prevalence of hyperlipidemia or hypertension did not correlate with progression of disease in any group.     

Tropical pyomyositis

A 22 year old male presented with symptoms of diffuse muscle pain and multiple abnormal laboratory findings that were eventually attributed to tropical myositis. Computed tomography scan was more reliable than ultrasound and served as a guide to needle aspiration and pathologic diagnosis.     

Role of the mesentericocaval shunt in the management of portal hypertension

A series of sixteen mesentericocaval shunts is presented. These mesentericocaval shunts were carried out only in occasional complicated cases in which standard shunts had previously become thrombosed or were no longer possible for other reasons. Eleven of the mesentericocaval shunts were performed as emergency procedures and four of the patients belonged to liver function group C.The operative mortality was 14 per cent. Two of the sixteen mesentericocaval shunts have become thrombosed (12 per cent). Both required reoperation, and the patients have well functioning shunts at follow-up examination.Eleven of the fourteen patients are still alive and none has had any bleeding episodes after the mesentericocaval shunt.On the basis of the results, it is suggested that the range of indications for the mesentericocaval shunt could be widened considerably.     

The geometry of triple-balloon dilation

Triple-balloon dilation (TBD) of a variety of luminal structures has been successfully, though infrequently, used. A mathematical model is presented for the selection of balloon sizes, and equations and tables are derived that allow the user to estimate more accurately the size of balloons needed for TBD of structures with large lumina. With TBD, an approximately circular lumen can be formed. Also, TBD allows smaller, higher-pressure balloons to be used instead of single, low-pressure, large balloons. However, multiple puncture sites may be required for TBD.     

Human umbilical cord vein as arterial substitute in the dog

The aim of this study was to compare human umbilical cord vein grafts (HUCV), treated in different ways, as arterial substitutes in the dog. A portion of the infrarenal abdominal aorta was replaced by a fresh HUCV in 18 dogs. Six HUCV grafts were covered with a vascular dacron prosthesis, 4 of them stayed open during a follow-up time of one year, 2 became occluded. Within an interval of 4 weeks, aneurysms developed in the uncovered 12 HUCV grafts. They also thrombosed within 3 months. The infrarenal abdominal aorta was replaced by HUCV grafts treated with glutaraldehyde in 39 dogs. Within a follow-up time of six months, all grafts were patent and no aneurysm formation could be observed. Eight biografts were compared with eight PTFE grafts ileofemoral positions. Six Biografts as well as six PTFE grafts were patent after six weeks.