Trends in reconstruction for atherosclerotic renal vascular disease

Twenty-eight patients underwent renal vascular reconstruction for atherosclerotic renal vascular stenosis. Ten patients had therapeutic renal artery reconstruction for isolated renal artery stenosis causing severe hypertension, nine patients had therapeutic renal artery reconstruction for severe hypertension combined with simultaneous aortic reconstruction, and nine patients had prophylactic renal artery reconstruction for renal artery stenosis combined with simultaneous aortic reconstruction. Ninety percent of patients undergoing therapeutic renal revascularization procedures for hypertension were cured or improved. The 10 patients undergoing prophylactic renal artery reconstruction combined with aortic reconstruction had an average 72 percent reduction in the diameter of the vessel. Dacron side grafts sutured to the aortic graft were used for revascularization in each of the patients with prophylactic revascularization and was found to be an expedient means of reconstruction with good patency rates. No increased morbidity or mortality rate was noted in the prophylactic group. We believe that prophylactic revascularization should be carried out in patients with atherosclerotic high-grade stenosis of the renal arteries to prevent hypertension and preserve renal function.     

Noninvasive measurement of femoral artery pressure for evaluating aortoiliac occlusive disease

Femoral systolic pressures measured by a compression technique (FSCP), were compared with proximal thigh systolic pressures (PTSP), for evaluation of aortoiliac occlusive disease. In phase I FSCP were measured by compressing the artery with a pressure cuff rolled into a cylinder and using disappearance of the profunda femoris Doppler signal (FSCP-D), or flattening of thigh plethysmographic waveforms (FSCP-P), as sensors. In normal extremities the compression techniques yielded false high values. The mean ratio of FSCP-D to brachial systolic pressure, FSCP-D/BSP, was 1.25 +/- 0.06 and the mean FSCP-P/BSP was 1.37 +/- 0.15, a value approximately equal to the mean PTSP/BSP, 1.38 +/- 0.20. In patients with aortoiliac occlusive disease linear regression analysis revealed a good correlation between FSCP-D/BSP and direct intraoperative measurements of femoral/aortic systolic pressure, FSP/ASP, (R = 0.79 and R2 = 0.63), a fair correlation between FSCP-P/BSP and FSP/ASP (R = 0.49, R2 = 0.24) but a poor correlation between PTSP/BSP and FSP/ASP (R = 0.35, R2 = 0.12). In phase II studies a soft bladder was used for arterial compression. In normal extremities the mean FSCP-D/BSP was 1.07 +/- 0.06, close to the predicted normal value of 1.00. In a second group of patients with occlusive disease a better correlation was observed between values of FSCP-D/BSP and FSP/ASP (R = 0.91, R2 = 0.82), than any of the correlations of noninvasive measurements with direct intraoperative values of FSP/ASP obtained in the first phase of the study.     

An enzyme immunoassay for the enumeration of peripheral human T-lymphocytes with OKT3.PAN monoclonal antibody

An enzyme immunoassay is described for the enumeration of peripheral human T-lymphocytes with a monoclonal antibody OKT3.PAN defining an antigenic determinant present on all mature T-lymphocytes. The method is compared with the indirect immunofluorescence technique and with an E-rosette test.     

Visual evaluation of hemoperitoneum in trauma

Evaluation of blood in the peritoneal cavity utilizing a fibro-optic scope inserted through a number 14 needle was carried out in twenty-two dogs. The amount of blood was unknown by the investigator and varied from 20 cc of normal saline to 150 cc of whole blood. A proper diagnosis was obtained 95.4 per cent of the time, there being one false-negative result at the level of 10 cc of blood.It is my opinion and that of other periodic observers that this is an accurate procedure for evaluation of hemoperitoneum.     

Incidence of recurrent stenosis after carotid endarterectomy determined by digital subtraction angiography

The results of recent reports of nonselected patients studied by noninvasive techniques suggest there is a 10 to 36 percent rate of restenosis within the first 1 to 2 years after carotid endarterectomy. In the present study of nonselected patients examined by intravenous digital subtraction angiography, only 6.7 percent of operated vessels had recurrent stenosis with a 50 percent or greater decrease in vessel diameter at a mean of 28.5 months postoperatively. These data, when compared with the results of most noninvasive studies, suggest that many of the early lesions regress after 1 to 2 years, as suggested by Zierler et al [8] or that there is a true difference in the rates of restenosis between centers, possibly due to subtle differences in surgical technique or patient risk factors, or both. A symptomatic recurrence rate of only 2.7 percen and a 6.7 percent overall rate of hemodynamically significant recurrent stenosis support the conclusions from earlier and larger series that carotid endarterectomy is a highly effective and durable operation. Although it is important that research centers continue to study the natural history of carotid artherosclerosis and serial changes after carotid endarterectomy, these results suggest that for routine clinical follow-up, frequent and expensive periodic tests to detect recurrent stenosis may not be warranted.     

An ultrastructural study of chromate-induced hyperplasia in the gill of rainbow trout (Salmo gairdneri)

Fingerling trout (Salmo gairdneri) were exposed to chromate at pH 6.5 to induce hyperplasia of the gill epithelium. Morphological and ultrastructural data indicate that the hyperplastic reaction starts locally in the primary and the secondary epithelium. Upon prolonged exposure to chromate, hyperplastic cells fill all interlamellar spaces and cover a number of clustered primary lamellae. The hyperplasia seems to result from direct chromate damage to the mucosal epithelium, triggering increased mitotic activity in underlying cells. Simultaneously, some of the newly formed epithelial cells differentiate into chloride and mucus cells. The balance between cell death and mitosis determines the degree of hyperplasia. Upon termination of the exposure to chromate, the hyperplasia disappears in gills of those fish that survive the respiratory and osmoregulatory dysfunction caused by the malformation of the gill lamellae.