Polytetrafluoroethylene for microarterial prosthetic grafts.

Polytetrafluoroethylene (PTFE) grafts can successfully be used as a microvascular prosthetic grafting material in rats with patency results of 90%. There was not a significant difference between patency percentages obtained with the PTFE grafts in comparison with autologous vein grafts. Excellent patency was achieved at 40 days for all of the interposition grafts in this study. Aspirin and dipyridamole did not improve patency.

Rhinorrhea associated with intracranial cholesteatomas and an "empty sella.".

Three related disorders in the same patient, namely bilateral primary intracranial cholesteatomas, an "empty sella" syndrome, and a cerebrospinal rhinorrhea are reported. No previous report of bilateral symmetrical cholesteatomas has been made, though single intracranial cholesteatomas have frequently been recorded in medical literature. The "empty sella" syndrome is generally considered to be from a herniation of the subarachnoid into the sella through a deficient diaphragma sella, and was first defined by Ommaya in 1968. Non-traumatic (spontaneous) rhinorrhea remains an uncommon disease initially described in 1826. Experience of the individual otolaryngologist is limited in this region because of infrequent occurrence and because definitive treatment is directed to other specialties. On the other hand, the ear, nose and throat physician may be the first to interpret a drainage from the nose. With this in mind, the etiologic, clinical and management factors in the present case are discussed.

Microsurgical technique--fundamentals of the microsurgical laboratory.

It is imperative that the reconstructive surgeon master microsurgical technique prior to engaging in clinical microsurgery. The primary task of developing this expertise is most efficiently performed in the microsurgical laboratory. The immediate availability of the materials necessary to establish a laboratory, their low cost, and the numerous microsurgical exercises that can be performed in such a facility make the microsurgical laboratory a practical and necessary addition to surgical training centers. Postoperative examination of repaired vessels, including light and electron microscopic studies, is important in pointing out errors and weaknesses so that they can be, respectively, corrected and strengthened. The surgeon wishing to learn microsurgery must earnestly devote much time and energy to the pursuit of perfection. With the aid of a microsurgical laboratory, practice, and strict adherence to the established guidelines of microsurgical technique, the reconstructive surgeon can develop the skills necessary to master the art of microsurgery.

An intraluminal silastic stent for small vessel repair.

An intraluminal stent fashioned from medical grade Silastic was used for technical assistance in performing 23 microvascular anastomoses. Twenty control and 20 stent arterial anastomoses were completed. Patency rates of 100 per cent in both the stent and control anastomoses were found by radical pressure testing immediately postoperatively and after an interval of two weeks. Electron microscopic and light microscopic studies showed no increase in damage to the vessel wall or increase in connective tissue reaction. Under the conditions of this experiment the Silastic stent can be used safely for assistance in performing microarterial anastomoses. Preliminary studies in six microvenous anastomoses have also shown no significant difference postoperatively between the stent and control anastomoses, both having a 100 per cent patency rate.

[Morphogenesis of coronarosclerosis in rheumatism]. / K morfogenezu koronaroskleroza pri revmatizme

Post-mortem studies of 72 hearts of persons who when alive had suffered from rheumatism were carried out. A complex genesis of sclerotic processes in the vascular walls was noted. They were occurring as a result of the desorganization of the connective tissue, as well as of "wearing out" of hemodynamic adaptation structures and development of atherosclerosis. The dependence of the character of sclerotic changes in vessels upon the peculiar features of the clinical course of the disease is shown. In cases with a high activity of the rheumatic process and considerable increase in the vascular-tissue permeability the development of hyalinosis was noted, and in cases with a slow course of rheumatism an increased fibrillogenesis was observed. Simultaneously, lesion and perish of the smooth-muscle fibres of the media with outgrowth therein of the connective tissue occurred. The dependence of the extent of atherosclerosis in various branches of the coronary arteries upon a morphofunctional characteristics of this defect was established. The most extensive atherosclerotic lesions were found in those vessels which supplied with the blood the functionally burdened regions of the myocardium. A higher activity of lipolitic enzymes in the vessels and the cardiac muscle was observed in persons with rheumatism, as compared with that in persons free from cardiovascular diseases, and particularly in patients with atherosclerosis.