Vascular outflow resistance and angiographic assessment of lower limb arterial reconstructive procedures.

In an attempt to predict early graft occlusion secondary to poor distal run-off, the outflow resistance was measured intra-operatively and compared with the intra-operative angiogram in 50 patients undergoing lower limb bypass procedures. With arterial inflow occluded, 60 mL of plasmalyte was infused via a catheter and the resultant pressure generated in the graft was measured through a second catheter connected to a pressure transducer and recorder. Using the infusion rate and integrated pressure value, outflow resistance was calculated. High resistance measurements were defined as grafts with outflow resistance greater than 1.1 mmHg/mL per min, low measurements were defined as values less than 0.5 mmHg/mL per min and intermediate measurements were those in the range 0.5-1.1 mmHg/mL per min. Angiograms were classified independently of resistance measurements by scoring the numbers of run-off vessels crossing the ankle and stenoses, with subsequent assignment of the patient to one of three groups with either low, intermediate, or high probability of graft failure. Early graft failure was defined as cessation of graft function within 3 months of surgery. Early graft failure occurred in both cases with high outflow resistance and in seven of 44 with low outflow resistance. Of these nine occluded bypasses, six had been placed in the high probability of occlusion category on angiographic appearance and three in the intermediate category. Assessment of angiographic appearance and prediction of patency on a prospective basis had a sensitivity rate of 67% and a specificity rate of 78%. The corresponding sensitivity and specificity rates with resistance measurements were 22% and 100%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Transluminal balloon angioplasty in diabetic peripheral vascular disease.

Transluminal (balloon) angioplasty of iliac or superficial femoral stenoses in 18 diabetic patients resulted in a significant improvement in ankle/brachial systolic pressure index with marked symptomatic improvement in 16, little change in one and deterioration requiring arterial bypass surgery in one patient. Follow-up for 12 months or more showed that the initial good results were sustained despite a downward drift in ankle pressures. These findings indicate that transluminal angioplasty has a useful place in the management of proximal atherosclerotic stenotic lesions in diabetic patients with symptomatic peripheral vascular disease.

Plasmacytoma of the stomach: diagnosis with the aid of immunoperoxidase technique.

A gastric tumor, originally diagnosed as a plamacytoma in 1953, but in which the diagnosis was disputed, has been re-examined by the immunoperoxidase staining technique. The demonstration of a single type of immunoglobulin in the tumor cells is considered conclusive evidence of its neoplastic nature. Two further cases of gastrict plasmacytoma encountered in recent months have also been examined by this technique and similar results obtained. The pathology of plasma cell tumors is discussed and a brief review of the literature is added with regard to the management and the overall poor prognosis.

The relationship of plasma fibrinogen, erythrocyte flexibility and blood viscosity.

Measurements have been made of plasma fibrinogen concentration, erythrocyte flexibility and blood viscosity at shear rates from 5.75 to 230 sec-1 during and following surgery. In the post-operative period the plasma fibrinogen level in the patient rose to over 1,000 mg/dl and because there were subsequent complications, only returned to normal after 4 weeks. There was an associated change of erythrocyte flexibility, with a correlation coefficient of 0.98. The blood viscosity also varied with the plasma fibrinogen level, the effect being more pronounced at low shear rates. The internal viscosity of the red blood cell, calculated from the plasma viscosity and whole blood viscosity at 230 sec-1, decreases with increasing plasma fibrinogen concentration, in agreement with the direct measurements made of erythrocyte flexibility. It is proposed that at high shear rates an increase in plasma viscosity due to an elevation of fibrinogen concentration, is offset by a decrease in the rigidity of the erythrocytes, and these 2 effects counter-balance.

The Mobin-Uddin umbrella filter in the management of proven and threatened pulmonary embolism.

An umbrella filter was inserted into the inferior vena cava in 8 patients with proven or threatened pulmonary embolism. The technique was found to be simple and without major complication in this small series. Two patients died of their primary disease and a further 2 died of lung complications secondary to their initial embolism. The remaining 4 patients have been followed up for periods ranging from 2 to 11 months.

Chylothorax after high translumbar aortography.

Two patients who had high translumbar aortograms for suspected arterial disease developed shortness of breath 48 hours after aortography and were found to have chylothoraces. Conservative management was initially adopted for both, but surgery had to be resorted to, although the first patient died before arriving in the operating theatre. The literature and the management of this condition are reviewed.