The fate of human umbilical vein grafts as an infrarenal aortic substitute in monkeys

The literature contains conflicting reports about the potential value of the processed human umbilical vein graft as an arterial substitute. With a view to a better understanding of the ultimate fate of this device, a series of long-term implantation was undertaken with a nonhuman primate model. Dardik Biografts were implanted as an infrarenal aortic substitute in 13 monkeys. Nine were put to death following complications after post-operative periods ranging from 3 months to 3 years, while four animals remain alive. No calcification or lipid infiltration was found, presumably because the animals were healthy. The patency rate was poor because of complications associated with thrombotic deposits and thinning of the graft wall after implantation, which led to stenosis and fibrous hyperplasia along the anastomoses. The external polyester mesh was found to encourage external tissue proliferation, which could not prevent the graft from dilating since it contained neither elastin nor smooth muscle cells. Because the places where the graft had been damaged before or during processing were the sites of thrombotic accumulation and initial collagen degeneration, it is essential to use only defect-free material. As a consequence the long-term durability of this graft continues to be questioned.

Cholinergic REM induction response: separation of anxiety and depression

Five groups of subjects underwent EEG sleep recordings, arecoline rapid eye movement (REM) induction response testing, and Schedule for Affective Disorders and Schizophrenia (SADS) interview. Group I: 20 patients with primary major depressive disorder (MDD) (endogenous) without any coexisting anxiety disorder; Group II: 19 primary MDD (endogenous) patients with secondary panic, GAD, or phobic disorders; Group III: 18 patients with primary anxiety disorder without coexisting MDD; Group IV: 14 patients with primary anxiety plus secondary MDD; Group V: 26 normal controls. Modified Research Diagnostic Criteria (RDC) were used for diagnosis, based on the SADS interview. There was considerable overlap of SADS scaled scores between patient groups, which is consistent with a heterogeneous clinical presentation of depressive and anxiety states. REM latency was significantly shorter in patients with primary MDD (without anxiety) as compared with that in patients with primary anxiety (no MDD) and normals. Arecoline REM induction response time was significantly shorter in both primary affective groups (I and II) as compared with primary anxiety (no MDD) patients and normal controls. REM latency and arecoline REM induction time was not significantly different between the primary anxiety groups (III and IV) and normals. The study highlights the use of biological markers in differentiating between clinical syndromes confounded by mixed or overlapping phenomenology.

Propranolol in schizophrenia

1. 15 schizophrenic patients diagnosed according to criteria of I.C.D.-9 were treated with d1-propranolol in a 4 week open study. 2. A fixed dose schedule was followed and a maximum dose of 1920 mg/day was reached by day 17. 3. Results revealed a significant reduction in core schizophrenic symptoms of CPRS & BPRS starting between 1st and second weeks of therapy. Higher doses were well tolerated and serious bradycardia occurred only in 3 patients. 4. The implications of these results are discussed.

Hereditary pancreatitis: report of an affected Canadian kindred and review of the disease

Hereditary pancreatitis is an autosomal dominant disease with no other known cause. It usually begins in childhood and is characterized by recurrent attacks of abdominal pain of variable intensity and duration, followed by symptom-free periods. The diagnosis is usually made in early adult life, when pancreatic insufficiency and calcifications appear. Complications are less frequent than in nonhereditary chronic pancreatitis. There are also differences between the two forms of chronic pancreatitis in sex incidence, etiologic factors and life expectancy. In a Canadian kindred three generations are affected with hereditary pancreatitis; there are four definite and four suspected cases. More than 40 affected kindreds, including 195 proven cases and 190 suspected cases, have now been reported in the literature. Thus, hereditary pancreatitis should be considered in the differential diagnosis of chronic relapsing pancreatitis of unknown cause as well as recurrent abdominal pain in childhood.

Sacrococcygeal tumour in infancy

A newborn infant delivered after 33 1/2 weeks' gestation was operated on for sacrococcygeal teratoma. This tumour contained an unusual intra-abdominal cystic component that caused pulmonary problems. Amniography and echography were useful for diagnosing this lesion in utero.

Colorectal neoplasm: a rare complication of ureterosigmoidostomy

A 24-year-old woman had a rectal neoplasm which occurred 20 years after she had undergone ureterosigmoidostomy for exstrophy of the bladder. Only 41 cases of bening or malignant tumours of the large bowel developing after ureterosigmoidostomy have previously been reported in the literature. Adenocarcinoma of the colon is most frequently found and can develop even after urine has been diverted away from the colon. The presenting symptoms are either those of ureteral obstruction or of colorectal neoplasm. This rare complication remains intriguing and the possible pathogenetic mechanisms are discussed.

Computerized axial tomography and fine-needle biopsy in surgery of the pancreas

Notable advances have been made in the investigation of pancreatic disorders. However, many of the diagnostic tests required are still of an invasive nature and are attended by difficulty and risk. The authors have found that the noninvasive method of axial tomography is highly reliable for the evaluation of pancreatic lesions, especially in cases in which a pancreatic mass is present or the duct of Wirsung is dilated. This procedure can also be helpful in the follow-up of patients who have suffered from acute or chronic pancreatitis. The same diagnostic problem is present at operation. To obtain a quick and reliable diagnosis of pancreatic lesions, the authors performed fineneedle aspiration biopsies followed by immediate staining and examination of the specimen. Among 43 patients an accurate diagnosis was obtained in 41 instances and no complication was ascribed to this diagnostic procedure.