Vena cava replacement with a peritoneum-lined vascular graft.

The use of the peritoneum as a venous conduit was analyzed because of the inherent fibrinolytic properties of the mesothelium. A canine model in which the infrarenal inferior vena cava was replaced with interposition grafts (2 cm) of either a peritoneal tube, polytetrafluoroethylene (PTFE), or PTFE lined with peritoneum (lined graft) was studied. Venograms were performed 1 and 6 weeks after graft implantation for the percent area reduction of the lumen. Grafts were explanted at 6 weeks for light and scanning electron microscopy. The percent area reduction at 1 week for all grafts was found to be predictive of graft clotting by 6 weeks. At 6 weeks, one of three peritoneal tube grafts (33%), six of seven PTFE grafts (86%), and four of seven lined grafts (57%) were patent. Histologic studies demonstrated that stenosis of PTFE grafts was due to intraluminal thrombus formation, whereas lined grafts stenosed due to granulation tissue growth between the mesothelium and PTFE. A cellular circumferential intraluminal lining was found in four of four lined grafts, but in none of six PTFE grafts (p < 0.01). Furthermore, none of four lined grafts had intraluminal thrombus, but all of six PTFE grafts did (p < 0.01). Peritoneum-lined PTFE grafts maintain a continuous circumferential cellular lining, but have no improvement in short-term patency compared to PTFE alone.

Effect of vitamin E on adhesion formation.

This study investigated the effects of vitamin E on adhesion formation and fibrosis. Forty-eight adult, virgin, female Sprague-Dawley rats were divided equally into two groups, one of which received 300 mIU/kg vitamin E orally in their daily diet in comparison with the control group, which received the vehicle only. Laparotomy was performed and the uterine horns identified. Denuding of the serosa was performed over a segment of the right horn; bipolar coagulation over a similar area on the left horn was performed. Following the procedure the animals continued on the same diet for three weeks. They were then killed, the adhesions were graded, and microscopic evaluation for fibrosis was accomplished. Although there was a trend of less fibrosis with vitamin E, there was no statistically significant difference, nor was there a difference with respect to a reduction in adhesion formation.

A follow-up study of 33 subdiagnostic eating disordered women.

Thirty-three female subjects with subdiagnostic DSM-III-R anorexia nervosa (SAN) and/or subdiagnostic bulimia nervosa (SBN) were reinterviewed 24 to 52 months (mean 41 months) after seeking treatment for an eating disorder. Subjects were administered a semistructured interview by telephone and assessed for level of functioning, eating disorder symptoms, course of illness, and treatment sought. During the course of the follow-up, 15 (46%) subjects went on to meet full DSM-III-R criteria for AN and/or BN. At follow-up, 4 (12%) met full DSM-III-R criteria for AN and/or BN, 22 (67%) were subdiagnostic, and 6 (18%) had recovered. The high percentage of subdiagnostic women that eventually develop full DSM-III-R criteria for AN and/or BN and the low rates of recovery at 2 to 4 years suggest that the current diagnostic criteria may be too restrictive.

Cholangiocarcinoma in association with multiple biliary microhamartomas.

The rarity of cholangiocarcinoma occurring in von Meyenburg complexes is well appreciated. We describe the case of a 35-year-old man found to have cholangiocarcinoma in association with multiple biliary microhamartomas of the liver. Areas of ductal proliferation and atypia within the bile duct hamartomas suggest malignant transformation to cholangiocarcinoma.