Oxygen free radicals in abdominal aortic surgery. An experimental study.

BACKGROUND: In aortic reconstruction, intestinal and muscular ischaemia in the lower limbs occurs during cross-clamping of the aorta. After restoration of blood flow, reactive oxygen intermediates may lead to systemic injury to local or remote organs. In this study we investigated the usefulness of a shunt and vitamin E administration against the oxidant load generated in ischaemia-reperfusion phases. METHODS: In three groups of pigs (n=16) aortic reconstruction was simulated. In Group A (n=5) clamping of the infrarenal aorta was performed for 2 hours. In Group B (n=6), during aortic cross-clamping, a shunt was used to give flow to the inferior mesenteric and internal iliac arteries. In Group C (n=5) vitamin E was administered before aortic cross-clamping. In all groups we evaluated sigmoid histology after reperfusion, while the oxidant load was estimated by measuring superoxide dismutase (SOD) activity in blood samples from portal and jugular vein. RESULTS: Histology of the sigmoid revealed increased postischaemic injuries in Group A, while the protective effect of shunt and vitamin E was apparent in Group B and C, respectively. SOD activity was minimized in Group C. CONCLUSIONS: Vitamin E protected the sigmoid from postischaemic injury and is responsible for the decreased levels of SOD activity.

Therapeutic tactics and late results in predominant truncal congenital malformation.

BACKGROUND: Congenital vascular malformations are rare vascular lesions of unknown etiology, non-degenerative or of inflammatory nature, which begin during embryological development; they are characterized by anomalies of the vascular system, apparently due to hemodynamic and metabolic disturbances. METHODS: Our diagnostic and therapeutic management in addition to the late results in 60, mainly truncal cases, out of 265 congenital vascular malformations, are analyzed in the present study. In a 20-year period 25,000 vascular examinations were carried out, among which 265 (1.06%) congenital vascular malformations (CVMs) were discovered, that is 77% (205/265) extra-truncal venous angiomata and 22.7% (60/265) truncal diffuse or localized types. The distribution of the above types was: 22 (36.6%) arteriovenous, 30 (50%) venous and 8 (13.4%) lymphatic. RESULTS: Surgery was carried out in 48.3% (29/60) of the truncal types of which 37.9% of the cases, on average, recurred 8 years later. Of the 22 arteriovenous malformations 20 patients were operated on (90%), of whom 35% (7/20) had a recurrence; of the 30 venous defects 30% (9/30) were operated on and 44.5% (4/9) of these had a recurrence. The recurrence rate rose to 50% (5/10) in cases of operative therapy of arteriovenous defects and to 20% (2/10) with combined surgical and non surgical methods. The recurrence incidence of venous defects with surgical treatment and sclerotherapy was 54.1% (6/11). CONCLUSIONS: Timely diagnosis, microsurgical techniques and highly specialized surgical and interventional experience are expected to improve these results significantly.

E. Kondoleon: the man behind the procedure.

UNLABELLED: Historical events and their in-depth analysis have much to teach us about medicine today. Moreover, the lives of those who have made their mark in medical history can be a source of inspiration to future generations of medical scientists. A case in point is the career of E. Kondoleon, originator of the surgical procedure that bears his name. METHODS: Retrieval in the archives of the "Areteion" and "Hippocration" hospitals, where E. Kondoleon had worked and passed away, together with information obtained from the Chair of History of Medicine of the University of Athens, as well as information taken from the Hellenic Surgical Society relative to his life and the motives which led him to the Kondoleon surgical procedure namely: Wide excision of the fascia and concomitant partial excision of the hypertrophic tissue in the treatment of lymphoedema. RESULTS: The Kondoleon operative procedure was not a simple applicable idea of a surgical technique but the result of a long-term systematical study of the anatomy and pathophysiology of the lymphovascular system as well as the continuation of their experimental application. Thus in the beginning of our century, Kondoleon took the lead of carrying out his own technique on the human which for more than 50 years was the object of discussion and application in the treatment of lymphoedema. CONCLUSIONS: Although "the microworld" of the electronic microscope and the conventional microscope of surgery have illuminated many sections of pathophysiology and has led to newer evolutionary tactics (vascular anastomoses, transplantation of lymph-vessels) in the management of lymphoedema, the Kondoleon operative procedure has given the necessary stimuli for these developments. As with other prominent, celebrated men in the history of investigation, Kondoleon had a dramatic end.

Effect of balloon angioplasty and stenting following clips vs suture arterial stenosis: an experimental study.

BACKGROUND: Comparative evaluation of balloon angioplasty following intravascular stenting after experimental stenoses caused by arterial reconstruction with vascular clips and conventional sutures. MATERIALS AND METHODS: A total of 24 arteriotomies were carried out at the carotid and common iliac arteries of pigs following a 10 mm longitudinal arteriotomy and provocation of stenosis. Twelve of the arteries were reconstructed with vascular clips and 12 with conventional suture. Ultrasonography revealed stenosis fluctuating from 60-95% (PSV: 1.8-3.5 m/sec EDV: 1.3-1.47 m/sec PSV ratio > 3.5). After 8 weeks, following digital subtraction angiography, which revealed > 50% stenosis in all of the cases, balloon angioplasty followed by placement of intravascular stent was carried out. RESULTS: All the angioplasties remained angiographically and macroscopically patent two months after without thrombus formation. Rupture during dilatation occurred in one of the sutured cases. Histologically no degenerative changes, necrosis or remarkable intimal thickness were observed in either method. Focal inflammatory reaction was seen in 2 sutured and in 1 clipped cases while intimal ulceration was observed in 2 sutured cases. All cases with clips presented an intact endothelial surface. CONCLUSION: Early experimental results suggested that arterial stenosis provoked by clipped reconstruction could be managed successfully by balloon angioplasty followed by placement of intravascular stent.

Comparative results of staged and simultaneous bilateral carotid endarterectomy: a clinical study and surgical treatment.

OBJECTIVE: Bilateral carotid stenoses are actually managed by staged endarterectomy. The present study compares the results of the above surgical procedure with simultaneous bilateral carotid endarterectomy. METHODS: Sixty-four carotid endarterectomies were carried out on two groups of thirty-two patients with bilateral carotid stenoses. Fifteen patients (group A) were subjected to staged and 17 patients (group B) who were subjected to simultaneous bilateral carotid endarterectomies. RESULTS: The mortality rate was zero in both groups; no statistically significant difference was found concerning complications related to the heart, neurological deficit and postoperative hypertension. CONCLUSIONS: Simultaneous carotid endarterectomy is a challenging and technically demanding operation but with limited indications in strictly selected patients. The development of methods of more effective monitoring and protection of the cerebral cells might broaden the indications of such a surgical tactic in the future. Staged carotid endarterectomy, however, remains the method of choice for the management of bilateral carotid occlusive disease.

The physician B. Adamantiades and his contribution to the disease Adamantiades-Behçet.

Adamantiades-Behçet disease is a multifocal entity which was first described by Hippocrates 500 years BC. The disease is characterised by relapsing oral aphthae, genital ulcers and iritis, while 24-40% of cases present with arterial or venous thromboses, arterial aneurysms or varices. In rare cases, due to invasion of different systems, the clinical picture varies, making timely diagnosis difficult. The disease is common all over the world but is more frequent in Japan, Korea, China and the Middle East. The first description in contemporary times was made by the Greek ophthalmologist Benedict Adamantiades in 1931, and the disease was described for the second time, independently, by the Turkish dermatologist Hulusi Behçet in 1937.