Traumatic aneurysm of the extracranial internal carotid artery due to hyperextension of the neck.

Aneurysms of the extracranial internal carotid artery (ICA) are rare. The majority arise iatrogenically after surgery, but a few follow trauma. Traumatic aneurysms of the ICA may follow penetrating injury, direct "blunt trauma" injury or hyperextension of the neck. We report a case of traumatic ICA aneurysm which probably followed a hyperextension injury to the cervical spine in a young woman.

Vacuum drainage of groin wounds after vascular surgery: a controlled trial.

A pilot study of 100 consecutive groin wounds after vascular surgery demonstrated lymph leaks in 12 per cent. Lymph leak was significantly associated with wound infection and with prolongation of in-patient stay. A controlled trial was therefore instituted to assess the influence of vacuum drainage in groin wound healing. One hundred and twenty-seven wounds were randomized to drainage (n = 65) or no drainage (n = 62) and the wounds were examined 'blind' by independent observers. No difference in the incidence of lymph leakage or wound infection was noted between the two groups. The routine use of suction drainage for groin wounds in vascular surgery is unnecessary.

Place of transmetatarsal amputations: a 5-year experience and review of the literature.

A series of 30 patients who underwent transmetatarsal amputation over a 5-year period was analysed. The indications for amputation were gangrene, rest pain and ulceration. The mean age was 75 years and the male to female ratio was 3:2. A higher level of amputation was required in 50% of patients. Of a series of factors analysed for their influence upon outcome (age, diabetes, peripheral pulse status, pre-existing infection, smoking habits, previous digital amputation, prior sympathectomy and/or vascular reconstruction), none had any predictive value in terms of wound healing.

Bacteriology of aortic aneurysm sac contents.

Aerobic and anaerobic cultures from the intraluminal thrombus of infrarenal aortic aneurysms were obtained from 239 patients. Culture results were related to the mode of presentation and the incidence of graft infection. Positive cultures were obtained from 27 patients (11.3%). No statistical correlation between the result of thrombus culture and the mode of presentation was found.

Ten-year review of non-ruptured aortic aneurysms.

Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2.9 per cent. The mortality in patients undergoing elective surgery was 1.9 per cent (1.1 per cent in asymptomatic and 3.6 per cent in symptomatic patients) and 4.0 per cent for patients undergoing emergency surgery.

Morbidity and mortality in acute lower limb ischaemia: a 5-year review.

A series of 204 consecutive patients with acute lower limb ischaemia was treated over a 5-year period in a Regional Vascular Unit. The mean age was 70 years, with a range of 41-98 and a female to male ratio of 1:0.94. Eighty-eight percent were treated by operation. Twenty-one had simultaneous vascular reconstructive procedures. Fifty-three patients died within 30 days (mortality rate 26%), and 12 required major amputation. Of these, four died resulting in a limb salvage rate of 95% in the survivors. An analysis of factors affecting outcome has shown increasing age, level of occlusion, recent myocardial infarction, pre-existing peripheral arterial disease and cardiopulmonary functional class to be major determinants of morbidity and mortality.

Acute ischaemia of the lower limb: the effect of centralizing vascular surgical services on morbidity and mortality.

Surgical audit data for two 5-year periods (1974-78 and 1983-87) have been compared in a Health Board Area to assess the impact of centralization of emergency vascular services on the treatment of the acutely ischaemic lower limb. Patient populations in each period were comparable. Mortality rates remained constant in both periods at approximately 30 per cent. A significant improvement in overall limb salvage was observed (from 54 to 67 per cent, P less than 0.05). Limb salvage in survivors was improved from 80 to 95 per cent (P less than 0.001) and was paralleled by an increase in the number of reconstructive vascular procedures performed. We concluded that the centralization of emergency vascular services has not led to a reduced risk of mortality but has been associated with improved limb salvage.

Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review.

A series of 61 patients with acute upper limb ischaemia treated over a 5-year period is analysed and compared with patients presenting with acute lower limb ischaemia during the same period. The mean age was 74 years with a female to male ratio of 2.2:1. Eighty-two per cent were treated by operation. Three patients died and no survivors required a major or minor limb amputation, in contrast to a 5 per cent major limb amputation rate in patients with acute lower limb ischaemia. Mortality for upper limb ischaemia was 5 per cent compared with a 30 per cent mortality rate in patients with acute lower limb ischaemia in whom cardiopulmonary debility (New York Heart Association score 3-4) was significantly greater.

Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage.

Data collected prospectively from 326 admissions for acute upper gastrointestinal haemorrhage were examined to identify factors predicting further haemorrhage or mortality. Seven predictive factors were identified by univariate analysis for both further haemorrhage and/or mortality, but only age over 60 years, an admission haemoglobin less than 8 g/dl and the presence of endoscopic stigmata of recent haemorrhage were shown by stepwise logistic regression to have independent significance for further haemorrhage. An age over 60 years, the presence of clinical shock on admission and an episode of further haemorrhage following admission emerged as independently significant in the prediction of mortality.

Restoration of allograft responsiveness in B rats by interleukin 2 and/or adherent cells.

LEW X BN)F1 cardiac allografts survive 1 wk in unmodified LEW recipients (MST +/- SD = 8.3 +/- 1.2 days) but indefinitely (greater than 100 days) in B rats, produced by 750 R sublethal x-radiation 3 to 4 wk after adult thymectomy and reconstitution with syngeneic bone marrow cells from thymectomized thoracic duct-drained donors. Graft survival appears independent of blocking antibodies and is not mediated by suppressor cells or loss of graft immunogenicity. The unresponsive state is eventually reversed by adoptive transfer of 10(8) spleen cells from nonimmune (MST +/- SD = 27.5 +/- 4.7 days) or alloimmune (MST +/- SD = 21.5 +/- 1.9 days) syngeneic animals. In contrast, concomitant administration of 2 X 10(7) thioglycollate-stimulated peritoneal exudate adherent cells plus 10(8) alloimmune syngeneic spleen cells produced acute allograft rejection in 50% of B recipients within 10 to 12 days, while in every instance grafts underwent acute rejection (MST +/- SD = 10.0 +/- 1.4 days) in B recipients treated with interleukin 2 (IL 2) rich conditioned supernatant plus sensitized cells. In vitro studies revealed that adherent cells from B rats possessed less than 50% the capacity of adherent cells from normal animals either to support the Con A-stimulated uptake of 3H-thymidine by splenic T cells or to promote production of IL 2 by spleen cells depleted of adherent cells. Altered lymphocyte migration patterns in B recipients may also contribute to prolonged allograft survival secondary to adherent cell dysfunction.

Migration patterns of lymphocytes in untreated and immunologically manipulated recipients of organ allografts.

We have investigated the migration patterns of normal LEW rat splenic lymphocytes (SLs) radiolabeled in vitro with [2-3H]adenosine and adoptively transferred i.v. into LEW hosts bearing LBNF1 heterotopic cardiac allografts. Twenty-four hours after cell transfer, the animals were killed and the radioactivity of all lymphoid and nonlymphoid tissues measured in a beta counter. The following experimental groups were studied: group 1, untreated recipients acutely rejecting their grafts at 7 days after transplantation; group 2, actively and passively enhanced recipients bearing long-term surviving grafts, at 7, 14 to 18, and 25 days; group 3, cyclosporin A-treated recipients; and group 4, B rats, each bearing indefinitely surviving grafts, at 7 and 20 to 30 days. In group 1, 28% of recoverable activity was found in spleen and 22% in mesenteric and peripheral lymph nodes. In animals with well functioning grafts of groups 2 and 3, SLs accumulated in both organs equally (25 to 27%). In animals in group 4, SLs migrated primarily to lymph nodes (30%) and away from spleen (20%). Sequestration in nonlymphoid tissues of animals experiencing graft rejection was higher than those with prolonged or indefinitely surviving hearts. By using mouse anti-rat monoclonal antibodies, the quantitative relationship between T cell subpopulations in transferred cell suspensions and in lymphoid organs of grafted hosts was also assessed. Lymphocyte migration patterns are influenced dramatically by the immunological status of recipients of vascularized organ allografts.