Aneurysms of extracranial carotid arteries.

Twenty-three extracranial carotid artery aneurysms were encountered in 19 patients. Arteriosclerosis was evident in 16 aneurysms. Severe arterial hypertension affected all patients with arteriosclerotic lesions. Trauma, penetrating neck injury once, and blunt neck injury three times caused four aneurysms. Three aneurysms resulted from earlier carotid artery operations. All 19 patients were symptomatic. Neurologic symptoms affected 13 individuals. Local symptoms referable to the aneurysmal mass troubled 15 patients. Twenty-one aneurysms were treated operatively. There was no operative mortality. Aneurysmectomy with arterial reconstruction was performed 16 times. Aneurysmorrhaphy was undertaken on four occasions and carotid ligation once. Two strokes and multiple cranial nerve injury accounted for three operative complications. No neurologic complications occurred during follow-up totaling 360 man-months. These lesions may be successfully treated by a carefully performed, properly selected operation.

Renal artery aneurysms. Significance of macroaneurysms exclusive of dissections and fibrodysplastic mural dilations.

Seventy-two patients (39 females and 33 males), 9 to 84 years in age, exhibited a total of 94 renal artery macroaneurysms. Solitary aneurysms affected 53 patients, and multiple aneurysms occurred in 19 patients. Arteriosclerotic changes, observed in nearly 30% of aneurysms, were considered secondary rather than primary processes in most instances. Renal artery fibrodysplasia was an associated finding among 27 patients. In 57 hypertensive patients, evidence supportive of renal artery aneurysms contributing to elevated blood pressure was meager. Two patients experienced frank aneurysmal rupture. Covert rupture into renal veins occurred twice. Aneurysmectomy was performed on 31 occasions. Nephrectomy, partial as well as total, was performed 17 times. No operative mortality occurred. Potential for rupture and an association with functionally important renal artery stenoses support surgical intervention in selected patients with renal artery macroaneurysms.

Polymorphonuclear and mononuclear leucocyte function in necrobiosis lipoidica and granuloma annulare.

Neutrophils and monocytes from patients with necrobiosis lipoidica (NL) and granuloma annulare (GA) were studied in vitro in order to detect functional abnormality. Phagocytosis of latex particles and zymosan-induced release of beta-glucuronidase were similar in patients and controls. Plasma from these patients did not enhance or inhibit phagocytosis or enzyme release from normal cells. Our studies suggest that peripheral blood leucocyte function in patients with GA and NL is normal, but this does not exclude a functional abnormality in the lesions.

In situ saphenous vein bypass for occlusive disease in the lower extremity.

In situ saphenous vein bypass, using the new valve incision techniques, has shown great promise in the early clinical trials to date. This procedure allows disruption of the venous valves without removal of the vein from its bed, thus allowing preservation of the vasa vasorum and maintenance of the endothelial integrity of the veins. This has allowed an overall improvement in the patency rates of the lower extremity bypasses, particularly in the bypasses to the infrapopliteal position. Also, and perhaps most important, it has permitted the use of smaller veins, with a minimum diameter of 2 mm. This greatly increases the number of patients who can benefit from such a vein bypass since reversed vein bypasses previously have required veins to have a minimum diameter of 3.5 to 4 mm. Long-term follow-up of in situ bypasses is not yet available. However, if the encouraging preliminary results of these bypasses are substantiated on long-term follow-up, in situ saphenous vein bypass may well become recognized as the procedure of choice for lower extremity bypass.

Biochemical differences in human glomerular basement membrane related to diabetes and age.

Preparations of glomerular basement membrane from diabetic and young and aged normal subjects have been isolated and purified and the component carbohydrates and amino acids quantitatively determined. Diabetic membrane preparations, compared with membranes from young normal subjects, show significant increases in total hexoses, mannose, and galactose and decreases in sialic acid and glucose; the component amino acids show increases in hydroxylysine, proline, and glycine and decreases in lysine, histidine, and leucine. Basement membrane preparations from aged normals show changes in component carbohydrates and amino acids similar to, but not as great as, those seen in the diabetics.

Diabetic serum stimulates the proliferation of endothelial cells in culture.

Pooled serum from insulin dependent or non-insulin dependent diabetics stimulated the proliferation of endothelial cells in culture. This potentiating effect was observed only during the growth phase, but not when confluency was reached. Both diabetic and control endothelial cells proliferated normally in control serum.

Photocontact urticaria from chlorpromazine.

Chlorpromazine is well recognized as a cause of delayed photosensitive eczema. A patient illustrated typical features of the phenomenon. Urticarial lesions were also elicited on photopatch testing.

The absorption of hexachlorophane from Ultralanum ointment.

The application of Ultralanum ointment to adult skin cases has produced levels of hexachlorophane in the plasma comparable with those found in infants who have undergone whole-body washing with hexachlorophane solutions. Clinical evidence of toxicity was not observed, but it is felt that the value of hexachlorophane in topical steroid preparations should be re-appraised, particularly for long-term treatment of large eczematous areas.

Cellular and circulating immunity to diabetic basement membrane, a negative finding.

A linear deposition of IgG was seen by immunofluorescence on the glomerular basement membrane of a diabetic kidney. However, when the remaining kidney was subjected to elution with acidic buffer the eluate had no affinity for glomerular basement membrane. The leucocytes from normal and diabetic subjects were also tested for an in vitro cell-mediated response to diabetic and normal basement membrane. No difference was found between the reaction of leucocytes from diabetics and those from normal age- and sex-matched controls.

The effect of transfer factor on the in vitro migration of tuberculin stimulated white cells from sarcoid and normal subjects.

In the mixed leukocyte migration test, white cells from Mantoux positive and Mantoux negative individuals and from patients with sarcoidosis responded similarly to tuberculin, there being no significant difference in the migration index of the three groups. The cells from patients with sarcoidosis, however, showed a depressed response to phytohaemagglutinin. Transfer factor prepared from an individual with a very positive Mantoux reaction did not have any significant effect on the migration index when added to the white cells from sarcoid patients either in the presence or absence of tuberculin.