Saphenous vein preparation for coronary artery bypass grafting using a cardioplegia delivery set.

Many techniques of saphenous vein preparation for coronary artery bypass grafting and their relation to endothelial preservation and graft patency have been published. We describe a method for final preparation of saphenous vein segments that uses the patient's undiluted heparinized blood infused at physiologic arterial pressure with a standard cardioplegia delivery apparatus. This method provides excellent demonstration of vein caliber and allows for quick identification and control of any previously undetected side branches or leaks. No additional equipment or instruments are required, and preparation can be performed before or after the institution of cardiopulmonary bypass.

Abdominoperineal resection in the octogenarian.

Traditionally, abdominoperineal resection has been the accepted surgical therapy for anorectal carcinoma. A review is presented of the experience with this procedure at the University of Iowa Hospitals, involving 52 patients (33 men, 19 women) over the age of 80 (median, 81 years). The most common symptoms were: rectal bleeding in 35 patients, change in character of stool in 35, weight loss in 13, and abdominal pain in 7. A rectal mass was palpable in 45 patients and visible by sigmoidoscopy in 3 others. Of the 52 patients, 23 percent (12/52) died before postoperative discharge from the hospital, and 32 percent of the survivors had significant postoperative complications. The most lethal complications were related to problems of surgical technique. The median survival time for patients discharged from the hospital was 22 months, with causes of death being equally distributed between recurrent carcinoma and other disorders. Abdominoperineal resection remains an acceptable method for treatment of anorectal carcinoma in the aged (80 or older) provided it is carried out with meticulous technique and careful selection of the patients.

Automatic quantitation of venous hemodynamics with an electrically calibrated strain gauge plethysmograph.

Strain gauge plethysmography has permitted noninvasive quantitation of altered venous hemodynamics in the legs of patients with venous disease. A new plethysmograph has been developed which avoids previous problems of mechanical calibration of gauges and the necessity for a recorder for calculating blood flows. This instrument permits accurate electrical calibration of mercury-in-Silastic gauges which are effectively at the corners of the Wheatstone bridge and are supplied by constant current for linear output. A timer and follow-and-hold circuit allow automatic calculation of rates of change in limb circumference and, thus, blood flow, from a panel meter. The accuracy of the automatic versus the graphic methods of quantitating venous outflow and reflux flow was determined in 20 normal subjects. Venous outflows were 15.1 +/- 0.5 (mean +/- 1 S.E.M.) and 15.9 +/- 0.4 cc/min/100 cc by automatic and graphic methods, respectively (r = 0.96, p less than 0.01). Reflux flows were 2.1 +/- 0.2 and 2.3 +/- 0.2 cc/min/100 cc by the automatic and graphic methods, respectively (r = 0.93, p less than 0.01). This plethysmograph may prove to be a simple, rapid, and accurate device for evaluating altered hemodynamics in venous disease.