Arterial homografts in the management of infected axillofemoral prosthetic grafts.

Two lower limb amputees with infected contralateral axillofemoral prosthetic grafts received preserved human arteries after removal of the infected materials. Both grafts grew organisms (Enterococcus species, plus Staphylococcus species in one). Long length arterial conduits were fashioned from freshly harvested (in one patient) and cryopreserved (in another one) cadaveric iliac and femoral arteries. One arterial homograft had ABO-compatibility with the recipient. No immunosuppressive drugs were administered after repeat arterial reconstructions. After 12 and 15 months both grafts are still patent, without parietal changes at ultrasonography; the patients have a viable remaining lower extremity and are free of symptoms or re-infection.

[Hypocobaltemia in chronic obstructive arteriopathy. Physiopathologic and therapeutic importance]. / L'ipocobaltemia nelle arteriopatie croniche ostruttive. Suo significato fisiopatologico e terapeutico.

The role of some so-called primary and secondary (or oligo-elements) elements in the physiopathology of the cardiocirculatory system has been well known from a number of years and they have been regularly included in the treatment protocols. Some, including K, Ca, Mg and Zn, are extremely well known and widely used in clinical practice. Recently, however, a growing number of studies have focused on the biological importance of other oligo-elements in the pathogenetic mechanisms of atherogenesis and its clinical manifestations. This study aimed to verify the exact role of free cobalt in the physiopathology of the chronic obstructive arterial diseases (COAD). A total of 80 patients affected by 2nd stage COAD were examined and the levels of some oligo-elements, including Co, were assayed. Constantly low levels were found (85% of cases) in relation to other oligo-elements studied (Cu, Zn, Mg, Ca). This findings is particularly interesting since it confirms the biochemical hypothesis of atherosclerosis according to which parietal damage plays a central role in the pathogenetic mechanism. Some enzymatic deficiencies, which lead to changes in membrane stability at the level of the endothelial cells, are closely related to the presence of tissutal and humoral peroxidation products. These peroxides (lipid peroxides), which are formed following the interaction of fatty acids with oxygen free radicals, have been identified by a number of studies as being responsible for endothelial damage. Several authors have shown that lipid peroxidation is involved in the atherogenic process through several mechanisms entailing monocytic activity and reduced prostacyclin (PG2) synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudo velocity profiles in carotid artery through Doppler US signal processing.

In this paper a new method of obtaining hemodynamic information from spectral analysis of continuous wave Doppler ultrasound signals is presented. Some considerations of the evaluation of maximum and mean frequencies of the signal arising from scattering in the insonated volume are proposed. A new algorithm to compute the maximum frequency has been applied. Maximum and mean frequency are, respectively, proportional to the maximum and mean velocity in the insonated volume. Their application to mathematical models enables an estimate of velocity profiles into the vessels. The proposed method offers the possibility of matching an accurate evaluation of spectral broadening. In vitro tests and some clinical results involving healthy young people, arteriopathic and stenotic patients show the potential of the method in evaluating different hemodynamic conditions.

Our experience with spinal cord stimulation (SCS) in peripheral vascular disease.

Spinal cord stimulation (SCS) by epidural electrodes is being used more often in the treatment of patients with severe intractable ischemic pain. The promising clinical results and the objective increase in lower extremity blood flow (plethysmography, thelethermography, etc.), suggests that spinal cord stimulation may have an important role in the management of advanced arterial disease when other forms of treatment have failed. The selection criteria for implantation of SCS are very important. Our indications in patients with peripheral vascular disease are: 1. Peripheral vascular disease with severe, intractable symptoms that are untreatable by medical or surgical therapy. 2. Inflammatory or diabetic arterial disease resistant to medical treatment and/or sympathectomy. 3. Persistent and severe ischemic pain and/or ulcers in patients with patent grafts. 4. Patients for lumbar sympathectomy who have a high myocardial risk. Contraindications to implantation of SCS are claudication intermittent, large necrotic lesions (gangrene) and patients who have undergone prolonged narcotic therapy.

[Role of the lymphatic system in the etiology of edema in vascular surgery]. / La responsabilité du système lymphatique dans la genèse des oedèmes en chrirugie vasculaire.

The authors attempt to explain why oedema forms following operation, referring to an experiment of 900 cases of patients suffering from acute or chronic ischemia treated by surgery. They look for reasons for this oedema and suggest that the origin, in a large number of cases, is lymphatic.

[Different methods of demonstrating veno-lymphatic correlations at a clinical examination]. / Les différentes modalités de mise en évidence des corrélations veino-lymphatiques à l'examen clinique.

The authors have tried to show the close link between the lymphatic and venous systems. They describe the clinical aspects which cause us to note that one or other of these systems is the more affected, and they bring to mind aetiological theories on the origin, either congenital or acquired, of the affection. This leads to considerations clarifying the clinical and anatomo-pathological data.