Functional analysis of cryopreserved veins. Preliminary report

Functional comparisons of cryopreserved and fresh canine vein endothelium, smooth muscle, and connective tissue were performed. Morphometric analysis of saphenous vein endothelium revealed no significant loss of endothelial integrity as a result of cryopreservation. Endothelial cell culture revealed similar numbers of clonogenic intimal cells from cryopreserved and fresh saphenous, cephalic, and jugular veins. Smooth muscle function was assessed by measurement of the isometric force generated by vein rings in response to norepinephrine, serotonin, and potassium chloride. There was no significant difference in the dose responses of cryopreserved and fresh saphenous veins to the reagents tested. Similar results were obtained for the cephalic and jugular vein experiments with norepinephrine. The maximum tensions generated in response to norepinephrine were 52% of fresh control segments. Connective tissue function was assessed by quantitation of 3H-proline incorporation. The results indicate that cryopreserved veins retained approximately 43.5% of values of fresh vein collagen synthesis. Finally, eight cryopreserved cephalic vein autografts were placed as femoral artery grafts and were removed electively after 1 to 8 weeks. All grafts were patent. Both light and electron microscopy demonstrated that the cryopreserved veins remained intact in vivo and that arteriolization occurred as described for fresh autografts in the literature. In conclusion, cryopreserved veins retain much of their cellular and tissue functions on thawing. Transplantation of cryopreserved veins suggests that cryopreservation does not change the sequence of histologic events associated with the use of autologous fresh vein as an arterial substitute.

Health literature for parents of children with cerebral palsy

This study examined the use of and need for written educational material by the parents of 41 children with cerebral palsy, aged between five and 63 months. After their initial counselling, the majority felt that they needed written information. The parents of 31 children attempted to find suitable books or pamphlets, but in 13 cases they failed to do so or found the material unsatisfactory. A significant association was found between reading material which the parents found satisfactory and their knowledge about the basic features of cerebral palsy.

Congenital dermoid cyst of the anterior tongue

Thirteen cases of “dermoid” cysts of the tongue have been reported in the literature, whereas only three of these have been histologically of the dermoid variety.1 We report the fourth known case of pathologically proven dermoid type cyst of the tongue. The embryology is reviewed.

Evaluation of endoscopic sclerotherapy of esophageal varices in children

Sixteen children (3.5-14.7 years) with portal hypertension and variceal hemorrhage were treated by direct endoscopic variceal sclerotherapy. Follow-up clinical and endoscopic evaluations have been carried out over a 1-6-year period (mean, 2.3 years). Prior to sclerotherapy, three patients had undergone unsuccessful surgical approaches, and the mean transfusional requirement from the time of the first hemorrhage was 12.3 units of blood per child per year for those with extrahepatic portal vein obstruction (n = 10) and 3.8 units for those with primary liver disease. Following sclerotherapy, transfusional requirements were significantly reduced in both groups, to 1.8 units and 2.2 units (85% and 43% reduction, respectively). Re-bleeding in four patients was due to the occurrence of gastric varices. One patient with extrahepatic portal hypertension has required subsequent shunt surgery for this complication, 5 years after sclerotherapy. Two patients have died, one with cystic fibrosis and hemorrhage from gastric varices and one from liver failure due to progressive biliary cirrhosis. Complications of sclerotherapy included transient retrosternal pain (eight occasions), esophageal ulceration with bleeding (n = 1) and esophageal stricture (n = 1). We conclude that sclerotherapy is an effective technique in obliterating esophageal varices and reducing the risk of hemorrhage in children with portal hypertension, with an acceptably low complication rate. We favor its use over more invasive surgical measures for control of acute and recurrent variceal hemorrhage, particularly for cases of extrahepatic portal hypertension in which a favorable natural history is likely.

Biologic fate of valves in reversed and nonreversed arterial vein grafts

The cusps of valve-bearing segments of canine cephalic, femoral, and jugular veins were completely divided and were used in interposition grafts in the femoral and carotid arteries in the nonreversed position. Three control grafts had intact valves in the reversed position, and one control graft in the reversed position had division of the leaflets. Nine grafts were studied up to 2 months postoperatively with gross and microscopic observations. The cusp tissue, which shrinks immediately after complete division, disappears very early in the postoperative period in the reversed and nonreversed positions. Two reversed intact valves were still grossly microscopically normal 5 and 7 weeks postoperatively. The complete disappearance of the divided valve with a nonreversed coronary graft 101/2 months postoperatively has been documented at autopsy for the first time in a human subject. The significance of these findings and the superiority of the valveless nonreversed autogenous vein graft in clinical cardiovascular surgery has been discussed.

Early experience with in situ saphenous vein grafts for severe ischemia of the lower extremity

Based upon this group of 35 patients with a variety of vascular lesions, it would appear that the in situ saphenous vein technique is certainly, at least, a viable alternative to standard bypass techniques. It has been applied with equally encouraging results by several surgeons in a variety of clinical settings, all using the procedure for the first time in a learning phase. This technique may become the procedure of choice for the treatment of occlusive disease of the lower extremity in this difficult and challenging group of patients.

Computed tomography of the normal larynx

A computed tomographic analysis of normal laryngeal anatomy was undertaken using cadaver larynxes. This was part of a larger project in which patients with laryngeal carcinoma were routinely evaluated in the computed tomographic (CT) body scanner. The appearance of normal laryngeal anatomy had to be delineated before disease processes of the larynx were evaluated, and this was accomplished using a computed tomographic technique with 5-mm slice thicknesses and a 3-mm overlap. The scan slices were then compared with anatomic sections taken at the same levels. The comparisons demonstrate an ideal level of accuracy that can be approached in the in-vivo larynx only with use of the latest-generation scanners. However, CT scanning is of immediate usefulness in the diagnosis of laryngeal pathology.

Myocardial perfusion and metabolism at normothermic and hypothermic levels

Changes in intramyocardial carbon dioxide tension (Pco2) and arterial oxygen tension (Po2) were recorded in dogs with a mass spectrometer after temporary occlusion of the aorta and the proximal part of the anterior descending coronary artery at normothermic and hypothermic levels. Patterns of hypoxic and hypercapnic changes and their recovery were favorably modified with moderate hypothermia. Deep levels of hypothermia seemed to enhance this protective effect and progressively slow the myocardial metabolism. Occlusion of the proximal part of the anterior descending coronary artery for 30 minutes had a regional effect similar to the general myocardial changes recorded after aortic clamping, while the posterior myocardial probe showed stable control values. These data support previous studies showing that moderate hypothermia halves the oxygen consumption and doubles the "safe" period of anoxic arrest.