Angioplasty of the deep femoral artery using a semirigid PTFE prosthesis. Experimental studies

Underlining the importance of Profundus Femoral Artery and its capacity to make up for lower limb's haemodynamics during obliterative arteriopathy, the Authors conceive a funnel-shaped intravascular prosthesis, Goretex constructed (PTFE), to introduce, in case of obstruction, in the artery lumen with a suitable instrument. The research is performed through ten oldster dogs whose average weight is twenty-four kilograms. Isolated the deep Femoral Artery and carried out an arteriotomy of about two centimetres on the Common Femoral Artery, we bring the prothesis in Profundis Femoral Artery and we fix it to the wall of the Common Femoral Artery with 8/O microsurgical dots. After thirty days, the arteriographic test shows the patency of the endoprosthesis with normal peripheral flow in nine animals out of ten. By virtue of this preliminary experiment, the Authors point out the semplicity of this intervention, also feasible in local anaesthesia, the good tolerability of the prosthesis and its perfect integration with the surrounding arterious wall, without shifts or dissecting laminar flows between the external prosthesis wall and the vessel lumen of the animal.     

Removal of forearm plates. A review of the complications

We studied 55 patients who had undergone elective removal of forearm plates between 1980 and 1986; 44 plates were removed from the radius and 37 from the ulna. Before removal only 20 patients (36%) had definite symptoms attributable to the plates, but 44 patients (80%) were advised by the surgeon to have the plates removed. In 22 cases (40%) the operation was followed by a significant complication. The complication rate was higher with junior surgeons and was permanent in 50% of cases. It is recommended that forearm plates should be removed only if they are causing significant symptoms, and that the operation should not be delegated to the most junior surgeon.     

Correction on congenital heart defects under conditions of hypothermia without perfusion and non-inhalation anesthesia

The clinical and pathophysiological indices were determined in the operative and immediate postoperative periods in 221 patients with various congenital heart diseases, with consideration for the degree of preoperative disorders of hemodynamics. The operations were conducted under conditions of non-inhalation anesthesia and various-level hypothermal protection without perfusion, with exclusion of the heart from circulation for up to 52 minutes. The main complications developing in the operative and postoperative periods were determined. It is proved that the processes of metabolism and blood oxygen-transport function are interlinked in operations conducted under these conditions. It is also proved that the operations are safe and effective.     

The effect of surgical intervention on the state of the immune system in brain tumors

In patients with benign and malignant brain tumors before the operation, the suppression of the immune system, in particular, proliferative response of lymphocytes to T- and B-mitogens was established. Preoperative preparation of the patients aggravated this process. At day 8-10 after the operation, normalization of the main indices of immunity in patients with benign tumors was noted. In malignant tumors after the operation, the increase in the contents of T- and B-lymphocytes against the background of decrease in their proliferative activity was observed.     

Transitional progressive multiple sclerosis: MRI and MTI findings

Transitional progressive multiple sclerosis (MS) is quite an unusual form of presentation and course of the disease. A case with this progressive form is presented and brain MRI and MTI findings are discussed in relation to the possible insight they may provide for understanding the mechanisms that determine progressive disability in MS.     

Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.

The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.