[Injuries of peripheral blood vessels].
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Success in surgical intervention depends primarily on the general practicioner who makes the early diagnosis, who also makes the temporary bandages against clotting and who quickly transports the patient to the nearest surgical hospital. The arrival of patient in the shortest time period; within 6 hours after the injury, could give a guarantee for a successful surgical intervention. At a combined injury of veins and arteries, it is necessary to give, besides the minuteness surgical technic, an anti-coagulative (anti-clotting therapy during the post-operative period. We are of the opinion that every surgical department should be able to handle injuries on the outer blood vessels, which means they should have a good knowledge of basic principles on the vascular surgery.
Forty-two patients underwent endoluminal Doppler examination of blood flow velocity proximally, at the stenosis and distal to it by means of a 0.018 in. Doppler guide wire. The method was found to be an accurate tool for documentation of a wide spectrum of stenoses of different morphology. The changes induced by percutaneous transluminal angioplasty (PTA)-hemodynamic changes as well as vascular wall lesions-could be documented precisely. Remaining stenoses after PTA were precisely verified as compared to angiography. In multiple stenoses or in stenoses with pure run-off, the hemodynamic significance of the lesion was evaluated. Intravascular Doppler flow measurement is valuable in angiographically imprecise cases. The method fits well into the angiographic routine examination.
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The authors carried, out a test on the resistance of blood vessels to the flow of blood, (namely arteries), using an apparatus known by the name SONICAID EM 220. The SONICAID is a portable ultrasound generator and receiver weighing 3.5 kg. It consists of a transducer, and an ultra sound generator. The transducer, (which is about as large as a matchbox), receives the generated ultrasound signal, transforms it to an audible signal, and sends it to the main via a cable. The amplified signal can be monitored through a built-in speaker, or through headphones. The signal can also be recorded on tape, but th is feature was not included in the authors' unit. The SONICAID is based on the Doppler Principle; interference of reflected waves. If the generated ultrasound waves reach moving matter, (in this case a stream of blood), they are reflected back in such a way that they reach the transducer as interference waves. This signal is not unlike the sound produced by the heart during systolic contraction, or by stenotic blood vessels. The authors examined 21 ill patients with normal circulation using the SONICAID, and found it difficult to register the signals. The arteries of the forearm and lower leg could not be convincingly registered because it was difficult to determine the proper angle required to pick up the signals. In addition the area in which the signals could be picked up did not always concide with the anatomical position of the artery. These are the factors which the authors used to explain the rather inanccurate results. In 9 individuals (38%), the SONICAID indicated pathooligcal findings (false positive results). Later the authors examined 23 patients with previously confirmed vascular diseases, and obtained 15 pathological findings (65%). With 4 individuals, a false positive result was obtained, and wit the remaining 4, a false negative result, or a total of 8 false results (35%). Based on these results, the authors concluded that; the relatively large percentage of false results, the difficulty of demonstrating normal findings, and the relatively long examination time make this method of examination rather uncertain. The subjectivity of the person conducting the examination also influences the interpretation of the sounds emitted by the machine, which in turn influences the results. Objectivization, and documentation of such results is not certain. As a result, This method has no advantage over the oscillograph, and clinical examination. Such a conclusion however does not justify discontinuing the use of the more sophisticated diagnostic tools and methods used in vascular surgery.
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31 healthy volunteers at the age of 19 to 29 years underwent whole-body irradiations by either ultraviolet radiation (NARVA UVS 65-2; continuous sunshine-like emission, predominantly UVA plus 8% UVB; cumulative doses after 4 and 20 irradiations 8.8 J/cm2 and 51.0 J/cm2, respectively), or visible light (emission of a 3,500 Watt lamp HGMI 3500 DL, Tungsram CSSR, filtered through 6 mm window glass; cumulative dose 267.0 J/cm2 after 4 irradiations) or infrared radiation (250 Watt infrared lamps NARVA "Biotherm", emitting more than 70% infrared radiation; cumulative dose 159.0 J/cm2 after 4 irradiations). Before, during and after the irradiation series the following investigations were made: Arterial and venous oxygen pressure, oxygen utilization index; flow properties of peripheral blood (plasma viscosity, erythrocyte aggregation kinetics, apparent blood viscosity); hemodynamics (veineal plethysmography, 133Xenon clearance, functional diameter of small blood vessels, peripheral blood pressure), phagocytotic capacity of polymorphonuclear white blood cells; hematological parameters (blood sedimentation rate, polymorphonuclear and eosinophilic blood cells, red blood cells, hemoglobin, hematocrit), serum proteins (IgG, IgA, IgM, complement C3, alpha-1-glycoprotein, alpha-1-antitrypsin, haptoglobin, transferrin); calcium and phosphate in serum. As far as irradiance, dose and treatment frequencies are concerned, the experimental conditions were very similar to those in phototherapeutical practice. Under these circumstances there were no hints for unwanted early effects after application of all the three kinds of optical radiation used in that study. Considerable systemic responses exclusively were found by use of ultraviolet radiation. Under these experimental conditions according to dermatological phototherapy it has been proven the following biopositive systemic responses are due to happen: increase of serum calcium and phosphate, improvement of blood oxygen utilization, improvement of blood flow properties, and enhanced phagocytic capacity of polymorphonuclear white blood cells. Regarding the parameters taken in that study, no early unwanted side effects are to expect after therapeutical application of rather large doses of visible light or infrared radiation.
OBJECTIVE: Although many efforts have been made to generate small-diameter (< or =5mm) vascular grafts by means of tissue engineering, improvement in patency and functionality still remains a great challenge. It is our hypothesis that to achieve long-term functionality and patency, not only the complete lining with endothelial cells but also full biocompatibility is essential. DESIGN: The aim was the development of a conduit from a scaffold and endothelial progenitor cells (EPC) separated from peripheral blood of a single donor. MATERIALS AND METHODS: EPC and a fibrin preparation were separated from porcine peripheral blood. Fibrin segments were generated seeded with EPC and were perfused in a bioreactor in vitro. RESULTS: From 100ml blood 12-15 cm long fibrin tubes were successfully generated lined with endothelial-like cells. Seeded tubes showed a remarkable elasticity and burst strength up to 90 mm mercury. CONCLUSIONS: Stable fibrin tubes were successfully generated completely lined with an endothelium-like monolayer from fibrin and EPC, both isolated from the same volume of blood. Although their stability is not those needed for arterial grafting, our results raise the hope, that with distinct improvements in future studies functional autologous vascular grafts could be engineered from the patient's own blood.
The distribution and density of nerves containing vasoactive intestinal polypeptide, substance P, and neuropeptide Y around the cerebral and peripheral blood vessels of stroke-prone spontaneously hypertensive rats (SHRSP) and normotensive Wistar-Kyoto rats (WKY) were studied using an indirect immunofluorescence technique. Neonatal sympathectomy of SHRSP with anti-nerve growth factor and guanethidine was also carried out to study the effect of sympathectomy on the distribution of these nerves. Vasoactive intestinal polypeptide nerve density was higher in the veins and superior mesenteric artery of SHRSP than of WKY and lower in the cerebral arteries of SHRSP than of WKY, but no difference was found in the muscular mesenteric arteries. Sympathectomy reduced the density of these nerves in all the peripheral vessels but had little effect on the cerebral arteries. Density of substance P nerves was similar between SHRSP and WKY in the peripheral vessels but higher in the cerebral arteries of WKY than of SHRSP. Sympathectomy reduced the density of these nerves in the peripheral vessels but increased the density in some cerebral arteries of SHRSP. Neuropeptide Y nerve density was higher in the peripheral blood vessels of SHRSP than of WKY, and no difference was found in the cerebral arteries. Sympathectomy almost completely removed these nerves in the peripheral vessels but had no effect on the cerebral arteries. We suggest that some of the differences in nerve density between SHRSP and WKY, especially those in the peripheral blood vessels, may be related to the development of hypertension in the SHRSP.
A case of disseminated malignant melanoma with generalized melanosis of the skin and other tissues, melanuria, melanoptysis, and a dark brown blood serum is reported. The reticuloendothelial system contained large amounts of melanin pigment. Lysis of degenerating pigment-loaded melanoma cells in peripheral blood vessels seemed to be of considerable importance in the pigmentation of tissues. Focal pigmentation of capillary endothelium and perivascular deposition of melanin pigment in macrophages and, occasionally contained large amounts of melanin pigment. Lysis of degenerating pigment-loaded melanoma cells in peripheral blood vessels seemed to be of considerable importance in the pigmentation of tissues. Focal pigmentation of capillary endothelium and perivascular deposition of melanin pigment in macrophages and, occasionally contained large amounts of melanin pigment. Lysis of degenerating pigment-loaded melanoma cells in peripheral blood vessels seemed to be of considerable importance in the pigmentation of tissues. Focal pigmentation of capillary endothelium and perivascular deposition of melanin pigment in macrophages and, occasionally, in other cells, was noted. Single cell metastases contributed to melanin pigmentation of most organs, but were not found in sections of the skin. Melanoptysis (black sputum) was due to diffuse melanoma cell infiltration of the lungs, with secondary pigment deposition in macrophages and in bronchial epithelial cells. In this case the 'glomerular melanoma cell emboli' recorded by previous authors consisted of melanin pigment and cell debris. Focal damage of glomeruli affected by pigment emboli is described allowing access of melanoma cell debris (including melanin pigment granules) into glomerular tubules.