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PLATES LXXIII-LXXVII)ALTHOUGH the arterial lesions in amputated gangrenous lower limbs have been frequently studied, there are very few accounts available of arterial disease in lower limbs free frbm gangrene or other clinical manifestations of ischzemia. Most references (Bell, 1933) are confined t o incidental allusions or general statements. This paper outlines the findings in a pathological study of the arteries in the lower limbs in a group of subjects none of whom had presented clinical evidence .of ischzmia. XATERULLS AND METHODThe lower limbs were examined in 50 unselected routine post-mortem subjects. In every case the left leg was investigated, but in ten casea in which the arteries showed interesting features the right leg was also examined to observe the degree of symmetry of the lesions. The ages ranged from 24 to 82 years, mean 63.8 years. There was one case in the third decade and there were 4 cases in the fifth decade, 9 in the sixth, 20 in the seventh, 13 in the eighth and 3 in the ninth ( fig. 6). Twenty-eight of the subjects were males with ages ranging from 24 to 82 years, mean 62.2 years, and 22 were females, age range 43-75 years, mean 65.7 years.In order to obtain radiographs in which the injected vessels were clearly visible throughout, a highly radiopaque medium was necessary because of the density of the bone shadow. After preliminary trials of a number of substances, a 75 per cent. by weight suspension of finely divided lead in liquid parafi was used. The most satisfactory results were obtained with what is known in the paint industry as " flaked lead ", in which there is a small amount (less than 10 per cent.) of turpentine and stearic acid. A syringe is unsuitable for injection of this material owing to the piston jamming in the barrel and an air-piston apparatus wm used. Pressure waa supplied by a bicycle pump and controlled by a simple pressure gauge.Injections of 40-60 ml. of this medium were made through a cannula in the femoral artery a t a pressure of 700 mm. of mercury maintained for 15 minutes. Antero-posterior and lateral X-ray photographs were then taken below the middle of the thigh. The wet films were used &B a guide to the dissection of the limb arteries and the popliteal, both tibial, peroneal, dorsalis pedis and plantar arteries were removed in one piece. After fixation in formol-saline, more thorough dissection wm undertaken and the findings recorded as transverse sections of each vessel made every few mm. As a routine, blocks were made from 23 standrtrd sites throughout the series ( figs. 1 and 4) and the paraffin sections stained by Verhoeff-Van Gieson elastic-connective tissue stain. Where required, hemalum and eosin, Masson's trichrome stain, reticulin-fibre stain J. PATH. BACT.-VOL. LXV (18.53) 315 x 2
PLATES LXXIII-LXXVII)ALTHOUGH the arterial lesions in amputated gangrenous lower limbs have been frequently studied, there are very few accounts available of arterial disease in lower limbs free frbm gangrene or other clinical manifestations of ischzemia. Most references (Bell, 1933) are confined t o incidental allusions or general statements. This paper outlines the findings in a pathological study of the arteries in the lower limbs in a group of subjects none of whom had presented clinical evidence .of ischzmia. XATERULLS AND METHODThe lower limbs were examined in 50 unselected routine post-mortem subjects. In every case the left leg was investigated, but in ten casea in which the arteries showed interesting features the right leg was also examined to observe the degree of symmetry of the lesions. The ages ranged from 24 to 82 years, mean 63.8 years. There was one case in the third decade and there were 4 cases in the fifth decade, 9 in the sixth, 20 in the seventh, 13 in the eighth and 3 in the ninth ( fig. 6). Twenty-eight of the subjects were males with ages ranging from 24 to 82 years, mean 62.2 years, and 22 were females, age range 43-75 years, mean 65.7 years.In order to obtain radiographs in which the injected vessels were clearly visible throughout, a highly radiopaque medium was necessary because of the density of the bone shadow. After preliminary trials of a number of substances, a 75 per cent. by weight suspension of finely divided lead in liquid parafi was used. The most satisfactory results were obtained with what is known in the paint industry as " flaked lead ", in which there is a small amount (less than 10 per cent.) of turpentine and stearic acid. A syringe is unsuitable for injection of this material owing to the piston jamming in the barrel and an air-piston apparatus wm used. Pressure waa supplied by a bicycle pump and controlled by a simple pressure gauge.Injections of 40-60 ml. of this medium were made through a cannula in the femoral artery a t a pressure of 700 mm. of mercury maintained for 15 minutes. Antero-posterior and lateral X-ray photographs were then taken below the middle of the thigh. The wet films were used &B a guide to the dissection of the limb arteries and the popliteal, both tibial, peroneal, dorsalis pedis and plantar arteries were removed in one piece. After fixation in formol-saline, more thorough dissection wm undertaken and the findings recorded as transverse sections of each vessel made every few mm. As a routine, blocks were made from 23 standrtrd sites throughout the series ( figs. 1 and 4) and the paraffin sections stained by Verhoeff-Van Gieson elastic-connective tissue stain. Where required, hemalum and eosin, Masson's trichrome stain, reticulin-fibre stain J. PATH. BACT.-VOL. LXV (18.53) 315 x 2
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