Polypropylene suture--is it safe?

Polypropylene suture has steadily gained popularity for use in vascular and cardiac surgical procedures because of its long-term tensile strength and minimal tissue trauma. However, recently some questions have arisen concerning its safety. We recently had two cases of polypropylene fracture, one occurring early and the other late after operation. Comparison and collation of these two cases with other reports leads to the conclusion that polypropylene suture is safe in most situations, but care must be taken to avoid instrumentation trauma and kinking stresses at knots, which probably explain most of the reported cases of polypropylene failure. In addition, polypropylene probably should not be used in graft-to-graft anastomoses in which the continual sawing stresses of two rigid structures appears to lead to an excessive incidence of late suture fracture with resultant false aneurysm formation.

Proximal shunt dissection: a potential problem in carotid endarterectomy.

The use of a shunt routinely, selectively, or not at all in performing carotid endarterectomy is a controversial and thus far unsettled dilemma. We have routinely used a shunt because it allows the operation to be done meticulously and without a sense of urgency. However, we recently encountered a case in which proximal subintimal dissection occurred secondary to shunt insertion, which resulted in a postoperative neurologic deficit. We present the case, with a discussion of the probable cause of dissection and its future prevention.

Sequential bypass grafting for salvage of lower extremities.

Since 1978, 12 patients at our institution have had distal sequential bypass grafting for limb salvage with either polytetrafluoroethylene (PTFE) or reversed saphenous vein and anastomoses to two different distal vessels. Seven patients had had previous vascular operations. One patient died of a stoke in the early postoperative period; a second patient, who was lost to follow-up several months after operation, was presumed to have died. Follow-up is otherwise complete (range seven to 48 months), without early or late limb loss. Results are encouraging and suggest that the sequential anastomotic technique may offer improved results in appropriate limb salvage cases with poor distal runoff.

Use of cardiopulmonary bypass for thrombectomy in acute superior vena cava syndrome.

An increasing incidence of nonmalignant, indwelling catheter cases has been reported in relation to superior vena cava syndrome. Such cases may be life-threatening, with rapid development of facial and neck edema and the production of respiratory distress. This is the first reported case of atrial and superior vena caval thrombectomy requiring cardiopulmonary bypass; it is only the second case reported in which operative thrombectomy has been used. Because of the problems associated with an increase in the use of indwelling venous catheters and the satisfactory results we obtained in this case, such an aggressive form of treatment for acute, benign superior vena cava syndrome may be used more frequently in the future.

The human tumor clonogenic assay in the treatment of patients with lung cancer.

The human tumor clonogenic assay has allowed the growth of human tumor cells and their testing to chemotherapeutic agents in vitro in a manner much like bacterial antibiotic sensitivities. This report deals with the in vitro test results compared with the in vivo therapeutic sensitivities of human lung cancer. Three hundred twenty-six lung tumor specimens from either primary or metastatic disease were plated using a two-layer technique. Of these, 68% (223) were grown and 41% (133) were applicable to chemosensitivity testing. Only 28 patients were considered for a retrospective analysis of in vitro tumor sensitivity versus in vivo tumor response to chemotherapeutic agents. Among them the percentage of true positives for the assay was 60%, while the percentage of true negatives was 91%. This technique has been encouraging in its initial stages and, with further development, may have an expanding role in the treatment of patients with lung cancer.

Coarctation of the abdominal aorta.

Coarctation of the abdominal aorta represents an unusual but surgically treatable form of hypertension. The cause is somewhat controversial but generally can be traced to congenital or acquired origins. A case is presented in which the anomaly appears to be congenital. The variability in anatomy and subsequent treatment are discussed along with appropriate evaluation of the problem.

Growth of lung cancer in a human tumor clonogenic system.

The human tumor clonogenic assay system has enabled human cancer cells to be grown in vitro and has the potential of providing chemosensitivity results in a manner much like bacterial antibiotic sensitivities. The in vitro growth of human lung cancer cells using this assay has not been previously reported. Over the past 2 years, 3,100 specimens have been plated by means of the two-layer agar technique as developed by Hamburger and Salmon, 302 of which were primary or metastatic lung tumors. Histologic, karyotypic, and nude mice studies confirmed that the colonies were composed of tumor cells. Growth rates (significant growth being greater than or equal to 5 colonies per plate) and plating efficiencies (the number of colonies grown per number of nucleated cells plated) were tabulated for each lung tumor cell type for primary, metastatic, and malignant pleural and pericardial fluids. The average overall growth rate was 199 of 302 (66%)--17 of 19 (90%) large cell carcinomas, 46 of 71 (65%) oat cell carcinomas, 57 of 91 (63%) adenocarcinomas, (* = p less than 0.05 when compared to large cell carcinomas) *40 of 68 (59%) squamous cell carcinomas, *and 39 of 53 (74%) of an undetermined cell type were grown. The average plating efficiency was 0.0236%. In primary tumors, large cell carcinomas had a plating efficiency of 0.0348%, adenocarcinoma 0.0247%, *oat cell 0.0224%, *and squamous cell 0.0113%.* It was concluded that lung tumor cells can be grown in vitro from 66% of lung tumor specimens. The highest growth rates and plating efficiencies were found in large cell carcinomas and the lowest rates in squamous cell carcinomas. This technique may provide a means of testing for the sensitivity of patients' lung tumor cells to various chemotherapeutic agents.