Minimally invasive axillary-coronary artery bypass.

Axillary artery-to-coronary artery bypass using reversed saphenous vein provides a simple method of applying the minimally invasive coronary bypass grafting procedure when the internal thoracic artery is not an adequate conduit. Although this may allow extended use of the minimally invasive coronary bypass procedure, the long-term patency of this technique is unknown.

Sternal dehiscence. Early detection by radiography.

A study was conducted to look for radiographic indicators that might provide a clue to threatened separation of the median sternotomy closure. To evaluate this problem, we studied two groups of patients. In group A the postoperative plain chest roentgenograms of 50 consecutive patients having cardiac operations were reviewed until the time of their complete recovery from the operation. Sternal problems were not identified in these patients clinically. However, chest roentgenograms showed that one patient had a displaced sternal wire and another had a classic sternal separation as judged by the change in wire topography. In the second series of patients, group B, 10 patients with clinical separation of the sternum were similarly evaluated. In seven of the 10 an early subtle change in position of one or more sternal wires preceded clinical detection of separation by 1 to 8 days, and a gross change in the sternal wire positions preceded clinical diagnosis in five patients by 1 to 6 days. The appearances of the wires by roentgenogram showed four common patterns. These findings indicate that thoracic surgeons and radiologists alike do not always carefully examine the appearance of the sternal wires on the postoperative roentgenograms. Subtle changes or gross changes in the position of the wires is an indicator of sternal separation. Therefore, the topography of the sternal wires should be scrutinized along with the other postoperative changes seen on roentgenograms after median sternotomy.

Transmission of tuberculosis by kidney transplantation.

Tuberculosis occurred in two patients, each of whom received a kidney from the same cadaver donor whose cerebrospinal fluid cultures grew Mycobacteria following organ donation. Although the degree of immunosuppression and graft function were similar in the recipients, one died of disseminated tuberculosis. Kidneys contaminated with certain pathogens, including Mycobacteria, should not be transplanted. Transplant recipients with tuberculosis require prompt antituberculous therapy, and may require transplant nephrectomy for persistent evidence of urinary tract tuberculosis.