Use of Dacron velour in choledochoplasty. An experimental study.

Patch choledochoplasty for experimentally produced defect and annular stricture and replacement choledochoplasty with Dacron velour was carried out in 20 healthy mongrel dogs with a maximum follow-up of 485 days. There was no derangement of liver functions after patch choledochoplasty for defect and replacement choledochoplasty. Elevated levels of serum bilirubin and alkaline phosphatase observed after stricture production returned toward normal following choledochoplasty. Flat diameter of the common bile duct could be increased significantly after patch choledochoplasty for defect and annular stricture. There was no change in the flat diameter of the common bile duct at the anastomotic sites after replacement choledochoplasty. The graft became completely incorporated in the common bile duct. Neobiliary and glandular regeneration occurred over the graft, which persisted without shrinkage or fibrosis.

Treatment of patients with thromboangiitis obliterans with cyclophosphamide.

This report describes a small, nonrandomized trial of cyclophosphamide in the treatment of patients with advanced thromboangiitis obliterans (TAO) with modest results. The rationale of the treatment was based on the immunopathogenesis of the disease, ie, autoimmune vasculitis of peripheral arteries. Twelve male patient volunteers with TAO were included for the trial. Diagnosis was based on the history of chronic smoking or tobacco chewing, clinical features of ischemia of peripheral vessels, radioarteriography showing arterial block, and characteristic histopathologic changes of affected arteries. Cyclophosphamide (400 mg) was given intravenously daily to the patients for 7 days followed by daily oral administration of 100 mg cyclophosphamide for another 7 weeks. Clinical conditions of the patients started to improve during the third week of the treatment and maximum benefit was noticed at the end of the treatment. There was significant decrease of intermittent claudication and twentyfold increase of claudication distance as well as relief of rest pain. Before starting treatment 6 patients had developed ulcers on their affected limbs; these healed completely in 2, partially healed in another 2, and showed no improvement in the remaining 2, who never stopped smoking. However, immunosuppressive therapy failed to show any improvement of arterial block, as evidenced by radioarteriography and any significant increase of skin temperature over the affected limbs. Nevertheless, histopathologic studies of biopsies taken from the diseased arteries after completion of therapy showed decreased influx of lymphocytes and plasma cells in the thrombi as well as in the arterial walls in comparison to the biopsies taken before the start of treatment. During the treatment the degree of immunosuppression was monitored by blood leukocyte and lymphocyte counts, which were kept between 4,000/mm3 and above 3,000/mm3 and not less than 500/mm3, respectively, indicating modest immunosuppression and no serious complications. All patients were followed up for 1 year. Only 2 patients, who resumed smoking, had relapse.

Significance of circulatory immune complexes in thromboangiitis obliterans (Buerger's disease).

Circulatory immune complexes were estimated in the sera of 25 patients and 20 age and sex matched controls by precipitation with 8% polyethylene glycol (PEG). Characterization of the immune complexes, thus obtained, was performed by the double immuno-diffusion method. The mean protein content of the PEG precipitates was significantly higher in the patients of thromboangiitis obliterans than in the controls. The immunoglobulins in the immune complexes were predominantly of mixed type in contrast to mainly single class immunoglobulins in the controls. C3 complement distribution in immune complexes of patients and control sera was 64% and 45% respectively. The immune complexes in patients were found to be biologically active. The mechanism of formation of circulatory immune complexes and their role in the pathogenesis of arteritis in relation to smoking of tobacco has been postulated.

Autoantibodies in thromboangiitis obliterans (Buerger's disease).

Autoantibodies, organ and non-organ specific, were studied in 10 patients of thromboangiitis obliterans by immunofluorescence technique and compared with age matched controls without peripheral vascular disease and patients of other peripheral vascular diseases. Organ specific autoantibodies (various classes of immunoglobulins IgM, IgG, IgA) and C3 component were observed in the diseased vessels of thromboangiitis obliterans. Antibodies, antiarterial, were present in the sera of these patients. Among the non-organ specific antibodies (ANA and AMA), only ANA were found in the sera of patients. Presence of autoantibodies in patients of thromboangiitis obliterans strongly point out of that probably this disease entity is an autoimmune disorder.

Colloid carcinoma of the breast with concomitant metastasis and a tuberculous lesion in the axillary lymph nodes. A case report.

A 30-year-old woman presented with a lump in the left breast and left axillary lymphadenopathy that, on fine needle aspiration cytology (FNAC), proved to be duct cell carcinoma with metastasis. Histology of the radical mastectomy specimen showed a mixed colloid carcinoma. Axillary lymph nodes revealed a variety of pathologic changes consisting of reactive hyperplasia, tuberculosis and metastasis. A combination of a tuberculous lesion and metastasis in the same lymph nodes was also found. During follow-up, after radiotherapy, the patient developed left supraclavicular and right cervical lymphadenopathy that, on FNAC, revealed a tuberculous lesion and metastasis, respectively. The rarity of this condition with double pathology is highlighted, and the reason behind the limitations of FNA in subtyping the primary malignancy and its failure to detect the tuberculous lesion in the axillary lymph node are discussed.

The role of percutaneous transluminal angioplasty for atherosclerotic disease of the lower extremities.

A consecutive series of 62 patients (74 symptomatic limbs) were admitted with atherosclerotic disease of the legs in a 6-month period from 1st July 1982. All patients had an arteriogram under local anaesthetic the day after admission and if possible a transluminal balloon dilatation was performed. If dilatation failed an operation was performed the following day. Dilatation was successful in 13 of 23 lesions above the inguinal ligament and significantly improved the Doppler foot pressures from 84 to 120 mmHg. Dilatation was only successful in 17 of 51 lesions below the inguinal ligament and 40% of these had re-occluded within 6 months. Transluminal dilatation is an important advance for stenotic lesions of the distal aorta and iliacs but its place is limited for the more common lesions in the superficial femoral artery.

Multiple primary visceral malignancy--a review with report of two cases.

Multiple primary cancers are being reported with increasing frequency in recent years, the frequency varying from 0.3 to 4.3% in different studies. A combination of primary cancer of larynx and lung is the most common followed by malignant neoplasm involving lip-larynx, skin-larynx, skin-lung, breast-ovary and breast-endometrium. Two interesting cases of rare combinations of primary cancers are being presented. In the first case primary adenocarcinoma of the gall bladder was associated with appendiceal adenocarcinoma. In the second case primary malignant papillary serous cystadenocarcinoma of right ovary and squamous cell carcinoma of cervix uteri were found.