A Technique to Harvest the Inferior Epigastric Arteries for Coronary Bypass Procedures

The demonstrated superior long-term patency of the internal mammary artery (IMA) over the saphenous vein (SV) has prompted the use of other arterial grafts, particularly for younger patients and patients without a suitable SV. We have used the single or bilateral inferior epigastric arteries (IEA) as a detached arterial conduit in 27 patients undergoing coronary artery bypass operations (CABG). In this report we describe the surgical anatomy of the IEA, preoperative noninvasive evaluation by duplex scan, our harvesting technique, and early surgical experience.     

The Use of Signal-Averaged Electrocardiography in Predicting Patients at High Risk for Sudden Death

Delayed and inhomogeneous ventricular depolarization is found in patients with ventricular tachycardia. This abnormal activity may be discerned as a ventricular late potential (LP) by applying special signal-averaging techniques to the surface electrocardiogram. The presence of LPs after acute myocardial infarction (AMI) is associated with an increased risk of serious ventricular arrhythmias and sudden cardiac death during the subsequent year. Thus the signal-averaged ECG (SAECG) can identify a high risk subset of patients following AMI for whom more intensive diagnostic and/or therapeutic measures are indicated. Patients with findings ordinarily indicative of a relatively poor prognosis, such as reduced left ventricular ejection fraction, may be more precisely classified into high or low risk based on the presence or absence of LPs. The SAECG may be helpful in selecting patients with other types of presentations, such as syncope, who are likely to benefit from electrophysiological testing.     

The plastic cap—an improved technique for impression taking

An improved impression technique is described using a plastic, transparent, flexible cap in combination with silicone impression materials. The technique can easily be applied at the chairside by the clinician and provides a solution to some of the present problems in impression with minimal trauma to the surrounding tissues.     

Multigenetic lesions in infant acute leukaemias: correlations with ALL-1 gene status

The large majority of childhood B-precursor cell acute lymphoblastic leukaemia cases present IgH and TCRδ gene rearrangements. These rearrangements have been widely used as specific markers for monitoring minimal residual disease. However, their prognostic value still remains unclear. In order to determine whether IgH and TCRδ gene rearrangements have any influence on relapse and event-free survival (EFS), we analysed the clinical impact of these genetic characteristics in 51 B-precursor acute lymphoblastic leukaemia patients. 46/51 patients (90.2%) showed IgH gene rearrangements by Southern blot and/or polymerase chain reaction (PCR) analysis. No statistically significant associations were found between IgH gene rearrangement pattern and age, sex, WBC count, immunophenotype, risk factor, relapse or EFS. 27/41 patients (66%) showed Vδ₂Dδ₃ recombination by Southern blot and/or PCR analysis. At a median follow-up of 53 months the estimated 5-year EFS probability was 78 ± 3% for the whole group. The EFS probability among patients with a Vδ₂Dδ₃ recombination pattern in the TCRδ locus was 90 ± 3%, whereas for patients without Vδ₂Dδ₃ recombination was 39 ± 13% ( P  < 0.005).
IgH rearrangement patterns do not appear to influence relapse or EFS probability. However, TCRδ gene rearrangement patterns have a relevant impact on the relapse rate and the EFS probability. Patients with Vδ₂Dδ₃ recombination have better clinical outcome than patients without this recombination, independent of any other prognostic factors.