Interposition grafting of the lower lobe pulmonary artery with a cuff of azygous vein, following its accidental ligation and division.

A patient with a mass lesion suggestive of a bronchial carcinoma in the right upper lobe was taken to theatre for a right upper lobectomy. The lower lobe artery, which was smaller than usual, was inadvertently divided. The arterial blood supply to the lower lobe was repaired with azygous vein as an interposition graft between the stump of the right apical segment arteries and the lower lobe artery. There were no signs of reperfusion injury post-operatively. We report a method that can be safely and relatively easily performed in these rare circumstances.

Transient limb ischemia induces remote ischemic preconditioning in vivo.

BACKGROUND: Ischemic preconditioning reduces local tissue injury caused by subsequent ischemia-reperfusion (IR), but may also have a salutary effect on IR injury of tissues remote from those undergoing preconditioning. We tested the hypothesis that limb ischemia induces remote preconditioning, reduces endothelial IR injury in humans, and reduces experimental myocardial infarct size. METHODS AND RESULTS: Endothelial IR injury of the human forearm was induced by 20 minutes of upper limb ischemia (inflation of a blood pressure cuff to 200 mm Hg) followed by reperfusion. Remote preconditioning was induced by three 5-minute cycles of ischemia of the contralateral limb. Venous occlusion plethysmography was used to assess forearm blood flow in response to acetylcholine at baseline and 15 minutes after reperfusion. Experimental myocardial infarction was achieved by 40 minutes of balloon occlusion of the left anterior descending artery in 15-kg pigs. Remote preconditioning was induced by four 5-minute cycles of lower limb ischemia. Triphenyltetrazolium staining was used to assess the extent of myocardial infarction. In the human study, the response to acetylcholine was significantly attenuated in the control group after 15 minutes' reperfusion, but remote preconditioning prevented this reduction. Limb ischemia caused a significant reduction in the extent of myocardial infarction relative to the area at risk compared with control (26+/-9% versus 53+/-8%, P<0.05). CONCLUSION: Remote ischemic preconditioning prevents IR-induced endothelial dysfunction in humans and reduces the extent of myocardial infarction in experimental animals. Transient limb ischemia is a simple preconditioning stimulus with important potential clinical applications.

In vitro biocompatibility of EPM and EPDM rubbers.

The in vitro toxicity of two EPDM rubbers (K 778 and K 4802) and one EPM rubber (K 740) was tested using human fibroblasts. The modulus of elasticity of each rubber was varied by exposure to different amounts of electron-beam radiation (0, 5 and 10 Mrad). The short-term in vitro toxicity was tested by culturing cells on polymer films. The long-term effect of ageing was simulated by growing fibroblasts in nutrient media prepared from extracts of heat-exposed materials. Cell cultures were studied both quantitatively and (ultra) structurally. Growth curves obtained in the toxicity test did not differ significantly from control values at any day of observation, and also showed that electron-beam radiation did not alter the biocompatibility. The same results were found for all but one material in the artificial ageing test. The number of cells in the K4802/10 Mrad extraction medium was decreased. Ultrastructurally no gross deviations from normal morphology were observed, either in the direct contact test or in the artificial ageing test. The most characteristic feature was a somewhat dilated endoplasmic reticulum. In summary, the in vitro biocompatibility of EPDM-rubbers as observed in this study is satisfactory and motivates further investigation of their biocompatibility in animal experiments.