In vitro and in vivo activity of 4-thio-uridylate against JY cells, a model for human acute lymphoid leukemia

We have previously reported the in vitro anti-proliferative effect of 4-thio-uridylate (s(4)UMP) on OCM-1 uveal melanoma cells. Here, we assessed the efficacy of s(4)UMP on JY cells. Treatment of JY cells with s(4)UMP suppressed their colony forming activity and induced apoptosis; healthy human bone marrow granulocyte-macrophage progenitor cells were 14-fold less sensitive to the nucleotide. In vivo effectiveness of s(4)UMP was determined using xenograft SCID mouse model. s(4)UMP decreased the cell number and colony forming activity of the total cell content of the femur of SCID mice transplanted with JY cells without affecting the bone marrow of healthy mice. These results suggest that s(4)UMP alone or in combination with other clinically approved anti-leukemic remedies should be further explored as a potential novel therapeutic agent.

High-resolution CT and angiographic evaluation of NexStent wall adaptation

Carotid stenting is a minimally invasive treatment for extracranial carotid artery stenosis. Stent design may affect technical success and complications in a certain subgroup of patients. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 +/- 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 +/- 8% before the procedure to 15.7 +/- 7% after stenting. Two patients experienced transient ischemic attack; one patient had bradycardia and hypotension. Stent induced kinking was observed in one case. Good plaque coverage and proper overlapping of the rolled sheet was achieved in all cases. There was weak correlation between the residual stenosis and the amount of calcification. The stent provides adequate expansion and adaptation to the tapering anatomy of the bifurcation.

Skin tube esophagus: present indications and late malignization

If there is no other possibility for the replacement of the whole esophagus, skin tube esophageal reconstruction gives a good result. Three successful cases treated with the antethoracal neoesophagus formed from musculocutaneous flaps are discussed. All patients recovered successfully. However, there exists the possibility of late malignization in the skin tube esophagus. Two such cases are also presented.

Complications following esophageal surgery

Chronologically, complications can be classified as intraoperative, early, and late. The authors analyze complications according to this classification on the basis of more than 400 esophageal operations and related literary data. As regards intraoperative complications, they deal only with those occurring at transhiatal esophagectomy (e.g., tracheal tear, bleeding, pneumothorax, laryngeal nerve injury). Among the early complications, they survey the incidence of transplant necrosis and related mortality, further sequelae ensuing from subacute ischemia of the replaced organ and analyze in detail the questions which arise regarding anastomotic leakage. Firstly, they deal with those causative factors that influence the frequency of anastomotic insufficiency, such as the technical "know-how" of anastomosis making (e.g., one layer vs two layers; stapling or manual suture; interrupted or running suture), the way of replacement using whole stomach or tube-stomach and the consequences originating from the route of replacement (e.g., anterior or posterior mediastinal route). Incidence and management of chylothorax are also dealt with. While dealing with late complications, the authors give a detailed comment on anastomotic strictures and also other factors facilitating the development of late dysphagia, such as peptic stricture and tumor of the organ remnant. Finally, some cases successfully treated by surgery are presented (skin-tube formation in cases following transplant necrosis; abolition of a pharyngogastric anastomosis stricture using a free jejunal transplant and surgical solution of an anastomotic stricture from median sternotomy approach).

[Using the radial artery in myocardial revascularization]

Between March 1996 and April 1998, 10 patients underwent myocardial revascularization using radial artery grafts. The age ranged between 59-81 (mean 67.7) years. The mean left ventricular ejection fraction was found to be 0.53 (range 0.45-0.62). A mean of 3.2 distal anastomoses per patient were performed. There was no operative mortality and no perioperative myocardial infraction was observed. No ischaemia of the hand was noticed. At a mean follow-up of 16.6 months (range 3-27) all patients are alive and free of symptoms. Only one patient had angina at bicycle ergometer test. The precise and atraumatic harvesting of radial artery and use of calcium antagonists prevent vasospasm and early graft occlusion on the short term. To assess the late results longer follow-up is necessary.

Reverse two-stage procedure in the surgical treatment of esophageal cancer

Authors have performed 266 one-stage resections and 6 reversed two-stage operations for the treatment of esophageal cancer during a 10-year-period. In six cases first a substernal bypass with colon or stomach was carried out while the tumourous esophagus was removed only 3-4 weeks later from a right thoracic approach. All six patients recovered. The reverse two-stage operation for esophageal cancer can be suggested with rare indications (pulmonary abscess, previous abdominal operations, severe malnutrition, etc.) and it is only justified when the advantage gained by increased operability and decreased morbidity and/or mortality is higher than the disadvantage ensuing from oncological, financial and patient demanding considerations.

[Use of an internal mammary artery graft in the revascularization of the myocardium. A ten-year follow up study]

Between September 1986 and August 1996, 233 patients (187 males, 46 females) ranging in age from 32 to 81 (mean 54.7) years received at least one internal mammary artery (IMA) graft for coronary artery bypass procedures. The mean left ventricular ejection fraction was 55.1% (range, 17 to 75%). An average of 3.1 distal anastomoses per patient was constructed. Hospital mortality was 2.1%. Perioperative myocardial infraction was seen in 2.1%. The mean follow-up of hospital survivors was 39.2 (range, 4 to 123) months. Ten-year actuarial survival for patients discharged from the hospital was 96%. Recurrence of angina occurred in 18 patients and reoperation or PTCA was performed in 3 patients in the late follow-up period. These results support the continuing use of IMA grafts for myocardial revascularization.

Lymphonodal response to sensitization with 2,4-dinitrochlorobenzene (DNCB) in laboratory rats

White laboratory rats were used for the experiments. Their popliteal lymph nodes were investigated after sensitization with DNCB (2,4-dinitrochlorobenzene) and i.c. injection of 3-H-thymidine and Patent Blue Violet at several intervals following the challenge with the hapten DNCB. Changes of weight of lymph nodes, further uptake of tritiated thymidine by the cells were investigated by auto -radiography, while the content of 3-H-DNA indicating an increased DNA metabolism due to blastic transformation of the small lymphocytes was determined by a liquid scintillation method. The authors found a significantly increased weight of lymph nodes and a higher percentage of labelled cells following antigenic stimulus of i.c. injected DNCB compared to non-sensitized lymph nodes of the control rats.

Aortico-left ventricular tunnel: late reoperations

Aortico-left ventricular tunnel is a rare congenital anomaly that presents as aortic regurgitation in infancy or childhood. Information on late results of surgery, especially with reoperations for progressive aortic regurgitation and recurrences are limited. The case histories of two patients with reoperations following correction of aortico-left ventricular tunnel are reported.

Surgical treatment of cardiac myxomas: a 20-year follow-up

Clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20-year period from 1974 to 1994 has been reviewed. There were 17 men and 33 women of mean age 55.2 (range 16-81) years. Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in three, right ventricular alone in one, left atrial+right atrial in two, left atrial+right atrial+right ventricular in one, and left atrial+left ventricular in one. Nineteen patients were operated on within 48 hours of the diagnosis. All tumours were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumour resulted in marked symptomatic improvement. There was one late death. The current survivors are symptom-free at a mean follow-up of 76.4 (range 1-241) months. Echocardiographic studies were performed in all survivors and no recurrences have been observed. It is concluded that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumour excision may prevent recurrences.

Surgical removal from the descending aorta of a floating thrombus caused by blunt chest trauma

A 44-year-old woman presented with a recurrent peripheral embolism. Her past history was remarkable for blunt chest trauma 7 years before presentation. Transoesophageal echocardiography showed a floating mass in the descending aorta. Operative and pathological findings revealed an aged thrombus. Reliable diagnostic methods and appropriate treatment can prevent further embolic events.

[Long-term results of surgical treatment of cardiac myxomas]

We have reviewed our clinical experience in the diagnosis and management of 50 cases of cardiac myxoma seen over a 20 year period, 1974 to 1994. There were 17 males and 33 females, their ages ranged from 16 to 81 years (mean 55.2 years). Echocardiography confirmed the diagnosis in all patients. The location of myxomas was as follows: left atrial alone in 42 patients, right atrial alone in 3, right ventricular alone in 1, left + right atrial in 2, left + right atrial + right ventricular in 1, and left atrial eft ventricular in 1. Nineteen patients were operated on within 48 hours following the diagnosis. All tumors were successfully removed with the aid of cardiopulmonary bypass. The hospital mortality rate was 10%. Excision of the tumor resulted in marked symptomatic improvement. There was one late death. The current survivors are asymptomatic at a mean follow-up of 76,4 months (range 1-241 months). Echocardiographic studies were performed in all survivors and no recurrences have been observed. We conclude that excision of cardiac myxomas is curative and long-term survival is excellent. Radical tumor excision may prevent recurrence.

Dissection of the atrial wall after mitral valve replacement

We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection.

Valve repair in infective endocarditis

From 1985 to 1995, 12 patients with native valve endocarditis underwent valve repair instead of replacement. Mean age was 41.9 years (range from 5 to 79 years). Eight patients had active and 4 patients inactive infection. The mitral valve was involved in 6 patients, the aortic valve in 1, both valves in 2, the tricuspid valve in 2, and the mitral and pulmonary valves in 1. The pathological findings were as follows: leaflet perforation in 2 patients, chordal rupture in 3, and vegetations in 10. Valve sparing procedures were carried out on the mitral valve in 8 patients, on the aortic valve in 1, on the tricuspid valve in 2, and on the pulmonary valve in 1. The following repair techniques were used: vegetectomy in 10 patients, leaflet patching in 2, posterior mitral leaflet resection in 3, mitral annuloplasty in 4, and pulmonary valve repair in 1. Uncontrolled sepsis, progressive heart failure, peripheral embolism, and echocardiographically demonstrated vegetations were the indications for surgery. There was no operative or late mortality and all infections were cured with no recurrences. One patient required valve replacement following aortic valve repair because of progressive aortic regurgitation. Postoperative Doppler echocardiography showed trivial to no regurgitation in 11 patients after valve repair. The overall outcome was favorable during the mean follow-up period of 39.3 months (range from 1 to 120 months). Reparative or reconstructive approaches for native valve endocarditis should be considered and can be successfully performed. Their advantages include (1) improved hemodynamics, (2) no recurrence, (3) no mortality, and (4) favorable long-term results.

[Surgical management of left cor triatriatum in adults]

Cor triatriatum sinistrum is a rare congenital cardiac anomaly in which a membrane divides the left atrium. Severity of the disease depends on the size of the opening on the membrane. The anomaly presents with severe pulmonary hypertension and prognosis is unfavourable without surgery. From 1976 through 1992, 5 adult patients were treated surgically in our institution. Cor triatriatum can be corrected surgically with a low mortality and excellent late results if an early preoperative diagnosis has been made. Clinical findings and cardiac catheterization do not provide sufficient data for the correct diagnosis. From a review of our experience it is concluded that echocardiography is superior to angiography for diagnosing cor triatriatum.

Total correction of tetralogy of Fallot in adolescents and adults

From 1976 to 1988, 23 adolescent and adult patients underwent total correction of tetralogy of Fallot. There were 13 males and 10 females, ranging in age from 16 to 47 years (mean 24.3 +/- 8.6 years). Eight patients were in New York Heart Association (NYHA) functional class II, 14 patients in class III, and one patient in class IV. Sixteen patients (69.6%) had undergone previous palliative operation. All shunts were patent at the time of repair. In 9 patients bovine pericardial monocusp patches were used for reconstruction of the right-ventricular outflow tract. Intraoperatively, the right-ventricular to left-ventricular systolic pressure ratio after repair ranged from 0.29 to 0.80 (mean 0.49 +/- 0.13). There were 2 early deaths (8.7%). Eight of 23 patients (34.8%) exhibited postoperative low cardiac output syndrome. One late death occurred: a 22-year-old male patient died of Staphylococcus sepsis 8 months postoperatively. All surviving patients were followed from 3 to 15 years (mean 8.3 +/- 2.7 years). No patient required reoperation in the follow-up period. The actuarial survival estimate for all 23 patients was 87% at the end of 15 years. At follow-up 17 patients were in NYHA class I, two were in class II, and one was judged to be in class III. We believe advanced age is no contraindication to surgery in tetralogy of Fallot. Adolescents and adults remain in need of total correction which can be performed with acceptable risk and long-term symptomatic improvement.

[Actinomycosis with abdominal manifestation]

During the last 4 years the authors observed 3 actinomycotic cases with abdominal localization. The disease was found in all the three cases to be localized to those parts of the intestinal tract where stasis of fecal contents may occur, i. e. to the appendix, to Meckel's diverticle and to the left colonic flexure. The relatively rare incidence and preoperative diagnostic difficulties make publication of these cases worthwhile. Based on own experience and literary data they describe natural history, clinical picture, histology and treatment of the disease, respectively.

Loco-regional renewal of malignant skin melanomas. II. Regional lymph node metastases and regional recurrence

The strategy of surgical therapy to treat regional disease in melanoma remains still controversial. The author analyzed 154 of 183 melanoma patients, who could be studied for the usefulness of surgery directed against regional tumour spread. Radical tumour excision combined with elective lymph node dissection (E+eRND) in medium or high risk tumour patients was found superior to therapeutic dissection (tRND) inasmuch 5-year-survival rates were significantly different (p < 0.001). Life expectancy seemed to be further impaired when postdissectional renewal appeared following tRND (5-year-survival rates 31.8 per cent --> 12.7 per cent) or tRND was incomplete.

Ruptured aneurysms of the sinus of Valsalva

From 1969 to 1989, 15 patients with an aneurysm of the sinus of Valsalva underwent operative correction. This represents 0.23% of 6515 cardiac operations with cardiopulmonary bypass during that time. There were 8 males and 7 females ranging in age from 15 to 54 years (mean 35.8 years). Symptoms of congestive heart failure, fatigue and palpitation were common. All patients underwent cardiac catheterization including aortography. Associated lesions included aortic valve regurgitation in 6 patients and a ventricular septal defect in 3 patients. The following connections occurred: right coronary sinus to right ventricle (8 patients), right coronary sinus to both right atrium and right ventricle (1 patient), and noncoronary sinus to right atrium (6 patients). The aneurysm was repaired via aortotomy or through the chamber into which it emptied. The aortic valve was replaced in 2 patients. There were no early or late postoperative deaths. Fourteen patients were in NYHA functional class I at late follow-up (range 0.5 to 20.5 years, mean 8.7 years). There have been no recurrences. Our experience supports the concept that early surgical intervention in patients with ruptured aneurysms of the sinus of Valsalva is justified.

Loco-regional renewal of malignant melanomas. I. Local recurrence satellites and in-transit nodes

183 patients with malignant melanoma treated during the period 1972-1987 were studied for the incidence of loco-regional metastasis. All cases were followed up for 5 years following initial treatment. In the "high risk" groups of patients--the setting being based on well-known prognosticators such as tumour invasion, thickness, clinicopathological type and anatomic site--there were significantly more recurrences (p < 0.01) than in the patients with thin lesions. About 91 per cent of the recurrences--except pure model ones to be discussed in an other paper--were discovered within 30 months following tumour excision. Wide excision in itself had no effect upon frequency and incidence of loco-regional renewal. While local recidivae were sufficiently controlled by simple re-excision, most of the "in-transit" metastases need an additional regional lymph node dissection because of the increased rate of micrometastases in the lymph nodes. Survival and treatment modalities are also discussed.

Bilateral congenital coronary artery-pulmonary artery fistulas. Report of two cases and review of the literature

Congenital coronary arteriovenous fistulas involving both coronary arteries are rare. Two cases are presented where the origin and termination of the fistulous communication have been visualized by selective coronary angiography. Both patients underwent successful surgical treatment. Our experience and the clinical features of 12 previously reported cases treated surgically are discussed.

The surgical management of all the mechanical complications of myocardial infarction in the same patient

A 48-year-old man sustained an inferior myocardial infarction resulting in a left ventricular aneurysm, ventricular septal defect and mitral regurgitation. Aneurysmectomy, closure of the ventricular septal defect, mitral valve replacement and coronary artery bypass were successfully performed.

[Surgical treatment of malignant melanomas of the skin]

The authors report on the most important problems of surgical treatment in primary melanomas. Great importance should be attributed to surgery especially in I. stage melanomas, just because it might influence further development of the disease--they accentuate. This argument will justify the performance of an elective lymphonodal dissection if there are some risk factors (e.g. depth of invasion, tumour thickness, exulceration, anatomic subsites, etc.) suggesting the possible presence of microscopic regional metastases. Within the frame of a clinical study a large number of literary data are also discussed.

High aortoiliac occlusion: treatment with thoracic aorta to femoral arterial bypass

Bifurcation bypass grafting from the thoracic aorta to femoral arteries provides excellent revascularization in the presence of high aortoiliac occlusive disease. Two such cases are described. There were no postoperative complications and the follow-up aortograms showed well-functioning grafts.

Passage through the lymph node. II. Functional dependence on the site of application of antigens

Following a previous comment on the compartmentalization of lymph nodes by lymphography performed through separate bundles of afferent lymphatics, the authors attempted to prove that sectoral arrangement has its functional equivalent, too. They found an elective uptake of tritiated thymidine and a rather circumscript response in cellular activity, if antigenic stimuli--such as VX-2 carcinoma cells and living BCG colonies--were transferred through the same bundle of afferent lymphatics which supply the lymph node part investigated.

Right aortic arch with contralateral congenital subclavian steal syndrome

Three cases of right aortic arch associated with contralateral congenital subclavian steal syndrome are presented. Diagnosis may be made if special attention is given to the blood pressures and amplitude of pulses in both arms. Retrograde aortography is necessary to establish a definitive diagnosis. If symptoms are present in the adolescent, a bypass graft procedure should be performed.

A unique malfunction of Cross-Jones mitral valve prosthesis

This case report is concern with the death of a patient 20 months following mitral valve replacement. The disc of a Cross-Jones prosthesis escaped into the left atrium causing severe mitral insufficiency. Disc variance represents a potentially lethal complication and patients with disc valve prostheses should be examined frequently. When signs and symptoms of mechanical malfunction develop, the valve prosthesis should be replaced immediately to prevent sudden death.

Histological and autoradiographic changes in locally irradiated lymph nodes (an experimental study on rabbits)

The authors studied the local effect of 3000 Rxl X-ray irradiation on the popliteal lymph nodes of rabbits. Beside the morpho-histological description autoradiography was performed after injection of H3-thymidine in the afferent lymphatic of the irradiated knee node. The main finding is the appearance of newly-formed germinal centers between the 6-10. days after irradiation.

Successful repair of left ventricular aneurysm due to blunt trauma. A case report

The authors report the successful surgical treatment of their patient with posttraumatic aneurysm of the left ventricle. On the basis of the data reported in the literature and on their own experience, the authors consider this lesion absolute indication for surgery.

Passage through the lymph node. Studies with watered and oiled contrast medium given into an afferent lymphatic

The authors investigated the passage of watered and oiled contrast media through the lymph node. Patent Blue dye diluted in saline has delineated as a rule only a circumscript area of the lymph node according to the supplying area of the afferent cannulated. Lipiodol Ultrafluid has been found suitable for filling up the whole node: at first only a small part of the node became filled primarily from the afferent, while other parts were filled secondarily from the hilus. The compartmentalisation of the lymph node has been proved by autoradiography (3H-thymidine), too.

Study of DNA metabolism of lymph-node cells by direct lymphatic administration of tritiated thymidine

A method for studying DNA metabolism in lymph-node cells by injecting tritiated thymidine intralymphatically is described. The administration of [3H]thymidine through a lymph vessel enabled a high concentration to be attained with only a small quantity of the precursor in close proximity to the cells. The significance of the method is that it may also be used in studies of metabolic processes in human lymph-nodes.

[Experimental treatment of the lesion of the flexor tendon, by means of tendon sheath substitution using a vein and diphasic flexor tendon plasty. A new method for the reconstruction of peritendinous slipping surfaces (author's transl)]

In dog experiments the surgical treatment of flexor tendons is discussed by the authors: the lesions of the tendons have been repaired according to the method of Paneva-Holevitch, with biphasic flexor tendon plasty; and for the substitution of the injured tendon sheath and the peritendinous slipping surfaces freely transplanted, autologous vein has been used. In the preparations removed after 8 weeks both the macroscopic and microscopic examinations showed satisfactory vascularity of the vein used as tendon sheath and of the tendinous tissue, as well as normal tissue structure. Between the vein and the tendon only small, ligamentous adhesions developed. On the basis of the good results obtained in experimental examinations the method is applied by the authors also in men with satisfactory result.