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Late failure of autologous vein grafts often results from excessive subendothelial fibromuscular hyperplasia. Varying factors have been implicated in this process, but the exact etiology remains unclear. In this study, three groups of animals were studied which had sections of common carotid artery replaced with autologous vein grafts. Group I had simple replacement, while Groups II and III had grafts supported by either tightly woven or loose mesh dacron prostheses. Thrombosis occurred only in the unsupported grafts. Unsupported grafts also had more subendothelial proliferation when compared to the loose mesh group. The combined thickness of the intima-media correlated inversely with the number of vasa present within the vein graft wall, i.e. significantly more vascularization was found in the mesh supported group when compared to the other groups. Grafts supported with the tightly woven prosthesis were relatively impervious to the ingrowth of vasa vasora. The data suggest that persistent distension of the graft wall by intra-arterial pressure influences the degree of subendothelial fibromuscular hyperplasia and may be interrelated to revascularization of the graft wall per se.

Several different forms of operative procedures for carcinoma of the breast have been advocated, but radical mastectomy remains the one most often recommended. Blood loss during this procedure is frequently high, often necessitating transfusion. Unfortunately, complications of the latter have been significant and justifiably have continued to receive attention in literature. In this study, blood loss and wound healing, with and without the use of electrocautery, in radical mastectomy were evaluated from both clinical and laboratory studies. Fifty patients who underwent radical mastectomy were studied for blood loss, transfusions received, and wound healing. Technique was identical except that one half of the patients had thin skin flap elevation via electrocautery rather than by sharp dissection. The average blood replacement was 160 ml per patient when cautery was used vs. 960 ml per patient when cautery was not used. The postoperative hemoglobin and hematocrit values were statistically similar for both groups. Wound healing was not affected. In addition, a laboratory study, utilizing skin incisions in dogs using scalpel and cautery, was performed. No appreciable difference in healing was noted either on gross or microscopic inspection. The use of electrocautery, therefore, for skin flap elevation during radical mastectomy is recommended.

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Techniques have undergone much change since the first successful repair of an acute traumatic rupture of the descending thoracic aorta was performed by Klassen at our hospital in 1959. It is interesting that we are returning to the techniques which worked so well in that case. Using this approach, which involves virtual elimination of the use of cardiopuimonary bypass, and evaluating each patient individually for the use of a shunt, we have reduced our mortality rate from 61% (8 deaths among 13 patients) during the period 1959--1974, to 6% (1 death among 17 patients) in the last 5 years. We believe that these data confirm the validity of this approach in the management of acute blunt descending thoracic aortic rupture. Prevention of spinal cord ischemia has become the primary concern for continuing clinical and laboratory investigation.