Anatomy of the saphenous nerve: relevance to saphenous vein stripping.

Sensory impairment in the saphenous nerve distribution after stripping of the long saphenous vein was studied in 14 patients undergoing bilateral vein stripping for symptomatic varicose veins. The vein was stripped upward in one leg and downward in the other to determine whether the direction in which the vein is stripped contributes to the incidence of such sensory impairment. Sensory evaluations at 12 weeks postoperatively revealed that ten of the 14 legs in the group that had the veins stripped upward demonstrated significant objective sensory deficits (P less than 0.001) compared with those that had the veins stripped downward (zero of 14). At 6 months the results were similar. To obtain anatomic correlation with the clinical findings, ten fresh cadaver dissections were carried out. In four of five legs in which the vein was stripped in an upward direction, the pretibial branch was avulsed off the main trunk and in two of five, the infrapatellar branch was avulsed. Such nerve avulsions did not occur on downward stripping. We recommend that the long saphenous vein be stripped downward to avoid sensory impairment in the saphenous nerve distribution.

Breast reconstruction using modified tissue expansion.

Inadequate chest-wall skin following mastectomy for carcinoma continues to be a problem in many breast reconstructions. To avoid extensive surgery, serial tissue expansion has been advocated. Since 1977, one of the authors has used a simple method of tissue expansion that we have termed "modified tissue expansion", defined as the creation of an adequate breast mound in one or two stages using a permanent prosthesis. Ninety percent of patients undergoing breast reconstruction between 1978 and 1983 were reconstructed using this method. A retrospective analysis of these 208 patients is presented. There were no mortalities, and only a 6.3 percent complication rate. Skin necroses related directly to the prosthesis occurred once, and there were no prosthetic deflations. Eighteen percent had first-step reconstruction only. The initial prosthesis averaged 400 cc in size. Selected Halsted radical mastectomy and postradiotherapy patients were successfully reconstructed. Seventy-eight percent felt their results were excellent at 1 year. Two percent were dissatisfied. Multiple office visits and the potential problems of serial expansion were avoided. Modified tissue expansion is a simple and viable method and should be considered among the options for breast reconstruction following mastectomy.

Cardiovascular peripheric effects of a new tricyclic antidepressant, cianopramine (Ro 11-2465) in dogs.

In acute experiments in dogs anesthetized with pentobarbital, pressor responses produced by the i.v. injection of serotonin, noradrenaline and electric stimulation of the sympathetic nerves of the spleen, were registered before the i.v. injection of cianopramine (Ro 11-2465), a potent inhibitor of the uptake of serotonin into 5-HT neurones. Doses of 0.1 to 0.5 mg/kg of the antidepressant did not modify the blood pressure, while these produced a more intensive and prolonged pressor response during the i.v. injection of serotonin (p less than 0.05), noradrenaline (p less than 0.001) and stimulation of the splenic nerves (p less than 0.005). These effects resulted from the inhibition of the presynaptic reuptake of monoamines. The i.v. injection of 1-2 mg/kg of cianopramine produced significant hypotension (p less than 0.001) with baroreceptor and serotoninergic responses blockade. An induced strong hypertensive dose-dependent effect was observed after the i.v. administration of noradrenaline (+82%) and stimulation of splenic nerves (+80%). Cianopramine did not affect the hypotension produced by carbachol and histamine. The peripheric action of cianopramine showed a higher inhibitory effect on the presynaptic reuptake of noradrenaline than on serotonin.