Human genome meeting 2016 : Houston, TX, USA. 28 February - 2 March 2016

O1 The metabolomics approach to autism: identification of biomarkers for early detection of autism spectrum disorder A. K. Srivastava, Y. Wang, R. Huang, C. Skinner, T. Thompson, L. Pollard, T. Wood, F. Luo, R. Stevenson O2 Phenome-wide association study for smoking- and drinking-associated genes in 26,394 American women with African, Asian, European, and Hispanic descents R. Polimanti, J. Gelernter O3 Effects of prenatal environment, genotype and DNA methylation on birth weight and subsequent postnatal outcomes: findings from GUSTO, an Asian birth cohort X. Lin, I. Y. Lim, Y. Wu, A. L. Teh, L. Chen, I. M. Aris, S. E. Soh, M. T. Tint, J. L. MacIsaac, F. Yap, K. Kwek, S. M. Saw, M. S. Kobor, M. J. Meaney, K. M. Godfrey, Y. S. Chong, J. D. Holbrook, Y. S. Lee, P. D. Gluckman, N. Karnani, GUSTO study group O4 High-throughput identification of specific qt interval modulating enhancers at the SCN5A locus A. Kapoor, D. Lee, A. Chakravarti O5 Identification of extracellular matrix components inducing cancer cell migration in the supernatant of cultivated mesenchymal stem cells C. Maercker, F. Graf, M. Boutros O6 Single cell allele specific expression (ASE) IN T21 and common trisomies: a novel approach to understand DOWN syndrome and other aneuploidies G. Stamoulis, F. Santoni, P. Makrythanasis, A. Letourneau, M. Guipponi, N. Panousis, M. Garieri, P. Ribaux, E. Falconnet, C. Borel, S. E. Antonarakis O7 Role of microRNA in LCL to IPSC reprogramming S. Kumar, J. Curran, J. Blangero O8 Multiple enhancer variants disrupt gene regulatory network in Hirschsprung disease S. Chatterjee, A. Kapoor, J. Akiyama, D. Auer, C. Berrios, L. Pennacchio, A. Chakravarti O9 Metabolomic profiling for the diagnosis of neurometabolic disorders T. R. Donti, G. Cappuccio, M. Miller, P. Atwal, A. Kennedy, A. Cardon, C. Bacino, L. Emrick, J. Hertecant, F. Baumer, B. Porter, M. Bainbridge, P. Bonnen, B. Graham, R. Sutton, Q. Sun, S. Elsea O10 A novel causal methylation network approach to Alzheimer’s disease Z. Hu, P. Wang, Y. Zhu, J. Zhao, M. Xiong, David A Bennett O11 A microRNA signature identifies subtypes of triple-negative breast cancer and reveals MIR-342-3P as regulator of a lactate metabolic pathway A. Hidalgo-Miranda, S. Romero-Cordoba, S. Rodriguez-Cuevas, R. Rebollar-Vega, E. Tagliabue, M. Iorio, E. D’Ippolito, S. Baroni O12 Transcriptome analysis identifies genes, enhancer RNAs and repetitive elements that are recurrently deregulated across multiple cancer types B. Kaczkowski, Y. Tanaka, H. Kawaji, A. Sandelin, R. Andersson, M. Itoh, T. Lassmann, the FANTOM5 consortium, Y. Hayashizaki, P. Carninci, A. R. R. Forrest O13 Elevated mutation and widespread loss of constraint at regulatory and architectural binding sites across 11 tumour types C. A. Semple O14 Exome sequencing provides evidence of pathogenicity for genes implicated in colorectal cancer E. A. Rosenthal, B. Shirts, L. Amendola, C. Gallego, M. Horike-Pyne, A. Burt, P. Robertson, P. Beyers, C. Nefcy, D. Veenstra, F. Hisama, R. Bennett, M. Dorschner, D. Nickerson, J. Smith, K. Patterson, D. Crosslin, R. Nassir, N. Zubair, T. Harrison, U. Peters, G. Jarvik, NHLBI GO Exome Sequencing Project O15 The tandem duplicator phenotype as a distinct genomic configuration in cancer F. Menghi, K. Inaki, X. Woo, P. Kumar, K. Grzeda, A. Malhotra, H. Kim, D. Ucar, P. Shreckengast, K. Karuturi, J. Keck, J. Chuang, E. T. Liu O16 Modeling genetic interactions associated with molecular subtypes of breast cancer B. Ji, A. Tyler, G. Ananda, G. Carter O17 Recurrent somatic mutation in the MYC associated factor X in brain tumors H. Nikbakht, M. Montagne, M. Zeinieh, A. Harutyunyan, M. Mcconechy, N. Jabado, P. Lavigne, J. Majewski O18 Predictive biomarkers to metastatic pancreatic cancer treatment J. B. Goldstein, M. Overman, G. Varadhachary, R. Shroff, R. Wolff, M. Javle, A. Futreal, D. Fogelman O19 DDIT4 gene expression as a prognostic marker in several malignant tumors L. Bravo, W. Fajardo, H. Gomez, C. Castaneda, C. Rolfo, J. A. Pinto O20 Spatial organization of the genome and genomic alterations in human cancers K. C. Akdemir, L. Chin, A. Futreal, ICGC PCAWG Structural Alterations Group O21 Landscape of targeted therapies in solid tumors S. Patterson, C. Statz, S. Mockus O22 Genomic analysis reveals novel drivers and progression pathways in skin basal cell carcinoma S. N. Nikolaev, X. I. Bonilla, L. Parmentier, B. King, F. Bezrukov, G. Kaya, V. Zoete, V. Seplyarskiy, H. Sharpe, T. McKee, A. Letourneau, P. Ribaux, K. Popadin, N. Basset-Seguin, R. Ben Chaabene, F. Santoni, M. Andrianova, M. Guipponi, M. Garieri, C. Verdan, K. Grosdemange, O. Sumara, M. Eilers, I. Aifantis, O. Michielin, F. de Sauvage, S. Antonarakis O23 Identification of differential biomarkers of hepatocellular carcinoma and cholangiocarcinoma via transcriptome microarray meta-analysis S. Likhitrattanapisal O24 Clinical validity and actionability of multigene tests for hereditary cancers in a large multi-center study S. Lincoln, A. Kurian, A. Desmond, S. Yang, Y. Kobayashi, J. Ford, L. Ellisen O25 Correlation with tumor ploidy status is essential for correct determination of genome-wide copy number changes by SNP array T. L. Peters, K. R. Alvarez, E. F. Hollingsworth, D. H. Lopez-Terrada O26 Nanochannel based next-generation mapping for interrogation of clinically relevant structural variation A. Hastie, Z. Dzakula, A. W. Pang, E. T. Lam, T. Anantharaman, M. Saghbini, H. Cao, BioNano Genomics O27 Mutation spectrum in a pulmonary arterial hypertension (PAH) cohort and identification of associated truncating mutations in TBX4 C. Gonzaga-Jauregui, L. Ma, A. King, E. Berman Rosenzweig, U. Krishnan, J. G. Reid, J. D. Overton, F. Dewey, W. K. Chung O28 NORTH CAROLINA macular dystrophy (MCDR1): mutations found affecting PRDM13 K. Small, A. DeLuca, F. Cremers, R. A. Lewis, V. Puech, B. Bakall, R. Silva-Garcia, K. Rohrschneider, M. Leys, F. S. Shaya, E. Stone O29 PhenoDB and genematcher, solving unsolved whole exome sequencing data N. L. Sobreira, F. Schiettecatte, H. Ling, E. Pugh, D. Witmer, K. Hetrick, P. Zhang, K. Doheny, D. Valle, A. Hamosh O30 Baylor-Johns Hopkins Center for Mendelian genomics: a four year review S. N. Jhangiani, Z. Coban Akdemir, M. N. Bainbridge, W. Charng, W. Wiszniewski, T. Gambin, E. Karaca, Y. Bayram, M. K. Eldomery, J. Posey, H. Doddapaneni, J. Hu, V. R. Sutton, D. M. Muzny, E. A. Boerwinkle, D. Valle, J. R. Lupski, R. A. Gibbs O31 Using read overlap assembly to accurately identify structural genetic differences in an ashkenazi jewish trio S. Shekar, W. Salerno, A. English, A. Mangubat, J. Bruestle O32 Legal interoperability: a sine qua non for international data sharing A. Thorogood, B. M. Knoppers, Global Alliance for Genomics and Health - Regulatory and Ethics Working Group O33 High throughput screening platform of competent sineups: that can enhance translation activities of therapeutic target H. Takahashi, K. R. Nitta, A. Kozhuharova, A. M. Suzuki, H. Sharma, D. Cotella, C. Santoro, S. Zucchelli, S. Gustincich, P. Carninci O34 The undiagnosed diseases network international (UDNI): clinical and laboratory research to meet patient needs J. J. Mulvihill, G. Baynam, W. Gahl, S. C. Groft, K. Kosaki, P. Lasko, B. Melegh, D. Taruscio O36 Performance of computational algorithms in pathogenicity predictions for activating variants in oncogenes versus loss of function mutations in tumor suppressor genes R. Ghosh, S. Plon O37 Identification and electronic health record incorporation of clinically actionable pharmacogenomic variants using prospective targeted sequencing S. Scherer, X. Qin, R. Sanghvi, K. Walker, T. Chiang, D. Muzny, L. Wang, J. Black, E. Boerwinkle, R. Weinshilboum, R. Gibbs O38 Melanoma reprogramming state correlates with response to CTLA-4 blockade in metastatic melanoma T. Karpinets, T. Calderone, K. Wani, X. Yu, C. Creasy, C. Haymaker, M. Forget, V. Nanda, J. Roszik, J. Wargo, L. Haydu, X. Song, A. Lazar, J. Gershenwald, M. Davies, C. Bernatchez, J. Zhang, A. Futreal, S. Woodman O39 Data-driven refinement of complex disease classification from integration of heterogeneous functional genomics data in GeneWeaver E. J. Chesler, T. Reynolds, J. A. Bubier, C. Phillips, M. A. Langston, E. J. Baker O40 A general statistic framework for genome-based disease risk prediction M. Xiong, L. Ma, N. Lin, C. Amos O41 Integrative large-scale causal network analysis of imaging and genomic data and its application in schizophrenia studies N. Lin, P. Wang, Y. Zhu, J. Zhao, V. Calhoun, M. Xiong O42 Big data and NGS data analysis: the cloud to the rescue O. Dobretsberger, M. Egger, F. Leimgruber O43 Cpipe: a convergent clinical exome pipeline specialised for targeted sequencing S. Sadedin, A. Oshlack, Melbourne Genomics Health Alliance O44 A Bayesian classification of biomedical images using feature extraction from deep neural networks implemented on lung cancer data V. A. A. Antonio, N. Ono, Clark Kendrick C. Go O45 MAV-SEQ: an interactive platform for the Management, Analysis, and Visualization of sequence data Z. Ahmed, M. Bolisetty, S. Zeeshan, E. Anguiano, D. Ucar O47 Allele specific enhancer in EPAS1 intronic regions may contribute to high altitude adaptation of Tibetans C. Zeng, J. Shao O48 Nanochannel based next-generation mapping for structural variation detection and comparison in trios and populations H. Cao, A. Hastie, A. W. Pang, E. T. Lam, T. Liang, K. Pham, M. Saghbini, Z. Dzakula O49 Archaic introgression in indigenous populations of Malaysia revealed by whole genome sequencing Y. Chee-Wei, L. Dongsheng, W. Lai-Ping, D. Lian, R. O. Twee Hee, Y. Yunus, F. Aghakhanian, S. S. Mokhtar, C. V. Lok-Yung, J. Bhak, M. Phipps, X. Shuhua, T. Yik-Ying, V. Kumar, H. Boon-Peng O50 Breast and ovarian cancer prevention: is it time for population-based mutation screening of high risk genes? I. Campbell, M.-A. Young, P. James, Lifepool O53 Comprehensive coverage from low DNA input using novel NGS library preparation methods for WGS and WGBS C. Schumacher, S. Sandhu, T. Harkins, V. Makarov O54 Methods for large scale construction of robust PCR-free libraries for sequencing on Illumina HiSeqX platform H. DoddapaneniR. Glenn, Z. Momin, B. Dilrukshi, H. Chao, Q. Meng, B. Gudenkauf, R. Kshitij, J. Jayaseelan, C. Nessner, S. Lee, K. Blankenberg, L. Lewis, J. Hu, Y. Han, H. Dinh, S. Jireh, K. Walker, E. Boerwinkle, D. Muzny, R. Gibbs O55 Rapid capture methods for clinical sequencing J. Hu, K. Walker, C. Buhay, X. Liu, Q. Wang, R. Sanghvi, H. Doddapaneni, Y. Ding, N. Veeraraghavan, Y. Yang, E. Boerwinkle, A. L. Beaudet, C. M. Eng, D. M. Muzny, R. A. Gibbs O56 A diploid personal human genome model for better genomes from diverse sequence data K. C. C. Worley, Y. Liu, D. S. T. Hughes, S. C. Murali, R. A. Harris, A. C. English, X. Qin, O. A. Hampton, P. Larsen, C. Beck, Y. Han, M. Wang, H. Doddapaneni, C. L. Kovar, W. J. Salerno, A. Yoder, S. Richards, J. Rogers, J. R. Lupski, D. M. Muzny, R. A. Gibbs O57 Development of PacBio long range capture for detection of pathogenic structural variants Q. Meng, M. Bainbridge, M. Wang, H. Doddapaneni, Y. Han, D. Muzny, R. Gibbs O58 Rhesus macaques exhibit more non-synonymous variation but greater impact of purifying selection than humans R. A. Harris, M. Raveenedran, C. Xue, M. Dahdouli, L. Cox, G. Fan, B. Ferguson, J. Hovarth, Z. Johnson, S. Kanthaswamy, M. Kubisch, M. Platt, D. Smith, E. Vallender, R. Wiseman, X. Liu, J. Below, D. Muzny, R. Gibbs, F. Yu, J. Rogers O59 Assessing RNA structure disruption induced by single-nucleotide variation J. Lin, Y. Zhang, Z. Ouyang P1 A meta-analysis of genome-wide association studies of mitochondrial dna copy number A. Moore, Z. Wang, J. Hofmann, M. Purdue, R. Stolzenberg-Solomon, S. Weinstein, D. Albanes, C.-S. Liu, W.-L. Cheng, T.-T. Lin, Q. Lan, N. Rothman, S. Berndt P2 Missense polymorphic genetic combinations underlying down syndrome susceptibility E. S. Chen P4 The evaluation of alteration of ELAM-1 expression in the endometriosis patients H. Bahrami, A. Khoshzaban, S. Heidari Keshal P5 Obesity and the incidence of apolipoprotein E polymorphisms in an assorted population from Saudi Arabia population K. K. R. Alharbi P6 Genome-associated personalized antithrombotical therapy for patients with high risk of thrombosis and bleeding M. Zhalbinova, A. Akilzhanova, S. Rakhimova, M. Bekbosynova, S. Myrzakhmetova P7 Frequency of Xmn1 polymorphism among sickle cell carrier cases in UAE population M. Matar P8 Differentiating inflammatory bowel diseases by using genomic data: dimension of the problem and network organization N. Mili, R. Molinari, Y. Ma, S. Guerrier P9 Vulnerability of genetic variants to the risk of autism among Saudi children N. Elhawary, M. Tayeb, N. Bogari, N. Qotb P10 Chromatin profiles from ex vivo purified dopaminergic neurons establish a promising model to support studies of neurological function and dysfunction S. A. McClymont, P. W. Hook, L. A. Goff, A. McCallion P11 Utilization of a sensitized chemical mutagenesis screen to identify genetic modifiers of retinal dysplasia in homozygous Nr2e3^rd7 mice Y. Kong, J. R. Charette, W. L. Hicks, J. K. Naggert, L. Zhao, P. M. Nishina P12 Ion torrent next generation sequencing of recessive polycystic kidney disease in Saudi patients B. M. Edrees, M. Athar, F. A. Al-Allaf, M. M. Taher, W. Khan, A. Bouazzaoui, N. A. Harbi, R. Safar, H. Al-Edressi, A. Anazi, N. Altayeb, M. A. Ahmed, K. Alansary, Z. Abduljaleel P13 Digital expression profiling of Purkinje neurons and dendrites in different subcellular compartments A. Kratz, P. Beguin, S. Poulain, M. Kaneko, C. Takahiko, A. Matsunaga, S. Kato, A. M. Suzuki, N. Bertin, T. Lassmann, R. Vigot, P. Carninci, C. Plessy, T. Launey P14 The evolution of imperfection and imperfection of evolution: the functional and functionless fractions of the human genome D. Graur P16 Species-independent identification of known and novel recurrent genomic entities in multiple cancer patients J. Friis-Nielsen, J. M. Izarzugaza, S. Brunak P18 Discovery of active gene modules which are densely conserved across multiple cancer types reveal their prognostic power and mutually exclusive mutation patterns B. S. Soibam P19 Whole exome sequencing of dysplastic leukoplakia tissue indicates sequential accumulation of somatic mutations from oral precancer to cancer D. Das, N. Biswas, S. Das, S. Sarkar, A. Maitra, C. Panda, P. Majumder P21 Epigenetic mechanisms of carcinogensis by hereditary breast cancer genes J. J. Gruber, N. Jaeger, M. Snyder P22 RNA direct: a novel RNA enrichment strategy applied to transcripts associated with solid tumors K. Patel, S. Bowman, T. Davis, D. Kraushaar, A. Emerman, S. Russello, N. Henig, C. Hendrickson P23 RNA sequencing identifies gene mutations for neuroblastoma K. Zhang P24 Participation of SFRP1 in the modulation of TMPRSS2-ERG fusion gene in prostate cancer cell lines M. Rodriguez-Dorantes, C. D. Cruz-Hernandez, C. D. P. Garcia-Tobilla, S. Solorzano-Rosales P25 Targeted Methylation Sequencing of Prostate Cancer N. Jäger, J. Chen, R. Haile, M. Hitchins, J. D. Brooks, M. Snyder P26 Mutant TPMT alleles in children with acute lymphoblastic leukemia from México City and Yucatán, Mexico S. Jiménez-Morales, M. Ramírez, J. Nuñez, V. Bekker, Y. Leal, E. Jiménez, A. Medina, A. Hidalgo, J. Mejía P28 Genetic modifiers of Alström syndrome J. Naggert, G. B. Collin, K. DeMauro, R. Hanusek, P. M. Nishina P31 Association of genomic variants with the occurrence of angiotensin-converting-enzyme inhibitor (ACEI)-induced coughing among Filipinos E. M. Cutiongco De La Paz, R. Sy, J. Nevado, P. Reganit, L. Santos, J. D. Magno, F. E. Punzalan , D. Ona , E. Llanes, R. L. Santos-Cortes , R. Tiongco, J. Aherrera, L. Abrahan, P. Pagauitan-Alan; Philippine Cardiogenomics Study Group P32 The use of “humanized” mouse models to validate disease association of a de novo GARS variant and to test a novel gene therapy strategy for Charcot-Marie-Tooth disease type 2D K. H. Morelli, J. S. Domire, N. Pyne, S. Harper, R. Burgess P34 Molecular regulation of chondrogenic human induced pluripotent stem cells M. A. Gari, A. Dallol, H. Alsehli, A. Gari, M. Gari, A. Abuzenadah P35 Molecular profiling of hematologic malignancies: implementation of a variant assessment algorithm for next generation sequencing data analysis and clinical reporting M. Thomas, M. Sukhai, S. Garg, M. Misyura, T. Zhang, A. Schuh, T. Stockley, S. Kamel-Reid P36 Accessing genomic evidence for clinical variants at NCBI S. Sherry, C. Xiao, D. Slotta, K. Rodarmer, M. Feolo, M. Kimelman, G. Godynskiy, C. O’Sullivan, E. Yaschenko P37 NGS-SWIFT: a cloud-based variant analysis framework using control-accessed sequencing data from DBGAP/SRA C. Xiao, E. Yaschenko, S. Sherry P38 Computational assessment of drug induced hepatotoxicity through gene expression profiling C. Rangel-Escareño, H. Rueda-Zarate P40 Flowr: robust and efficient pipelines using a simple language-agnostic approach;ultraseq; fast modular pipeline for somatic variation calling using flowr S. Seth, S. Amin, X. Song, X. Mao, H. Sun, R. G. Verhaak, A. Futreal, J. Zhang P41 Applying “Big data” technologies to the rapid analysis of heterogenous large cohort data S. J. Whiite, T. Chiang, A. English, J. Farek, Z. Kahn, W. Salerno, N. Veeraraghavan, E. Boerwinkle, R. Gibbs P42 FANTOM5 web resource for the large-scale genome-wide transcription start site activity profiles of wide-range of mammalian cells T. Kasukawa, M. Lizio, J. Harshbarger, S. Hisashi, J. Severin, A. Imad, S. Sahin, T. C. Freeman, K. Baillie, A. Sandelin, P. Carninci, A. R. R. Forrest, H. Kawaji, The FANTOM Consortium P43 Rapid and scalable typing of structural variants for disease cohorts W. Salerno, A. English, S. N. Shekar, A. Mangubat, J. Bruestle, E. Boerwinkle, R. A. Gibbs P44 Polymorphism of glutathione S-transferases and sulphotransferases genes in an Arab population A. H. Salem, M. Ali, A. Ibrahim, M. Ibrahim P46 Genetic divergence of CYP3A5*3 pharmacogenomic marker for native and admixed Mexican populations J. C. Fernandez-Lopez, V. Bonifaz-Peña, C. Rangel-Escareño, A. Hidalgo-Miranda, A. V. Contreras P47 Whole exome sequence meta-analysis of 13 white blood cell, red blood cell, and platelet traits L. Polfus, CHARGE and NHLBI Exome Sequence Project Working Groups P48 Association of adipoq gene with type 2 diabetes and related phenotypes in african american men and women: The jackson heart study S. Davis, R. Xu, S. Gebeab, P Riestra, A Gaye, R. Khan, J. Wilson, A. Bidulescu P49 Common variants in casr gene are associated with serum calcium levels in koreans S. H. Jung, N. Vinayagamoorthy, S. H. Yim, Y. J. Chung P50 Inference of multiple-wave population admixture by modeling decay of linkage disequilibrium with multiple exponential functions Y. Zhou, S. Xu P51 A Bayesian framework for generalized linear mixed models in genome-wide association studies X. Wang, V. Philip, G. Carter P52 Targeted sequencing approach for the identification of the genetic causes of hereditary hearing impairment A. A. Abuzenadah, M. Gari, R. Turki, A. Dallol P53 Identification of enhancer sequences by ATAC-seq open chromatin profiling A. Uyar, A. Kaygun, S. Zaman, E. Marquez, J. George, D. Ucar P54 Direct enrichment for the rapid preparation of targeted NGS libraries C. L. Hendrickson, A. Emerman, D. Kraushaar, S. Bowman, N. Henig, T. Davis, S. Russello, K. Patel P56 Performance of the Agilent D5000 and High Sensitivity D5000 ScreenTape assays for the Agilent 4200 Tapestation System R. Nitsche, L. Prieto-Lafuente P57 ClinVar: a multi-source archive for variant interpretation M. Landrum, J. Lee, W. Rubinstein, D. Maglott P59 Association of functional variants and protein physical interactions of human MUTY homolog linked with familial adenomatous polyposis and colorectal cancer syndrome Z. Abduljaleel, W. Khan, F. A. Al-Allaf, M. Athar , M. M. Taher, N. Shahzad P60 Modification of the microbiom constitution in the gut using chicken IgY antibodies resulted in a reduction of acute graft-versus-host disease after experimental bone marrow transplantation A. Bouazzaoui, E. Huber, A. Dan, F. A. Al-Allaf, W. Herr, G. Sprotte, J. Köstler, A. Hiergeist, A. Gessner, R. Andreesen, E. Holler P61 Compound heterozygous mutation in the LDLR gene in Saudi patients suffering severe hypercholesterolemia F. Al-Allaf, A. Alashwal, Z. Abduljaleel, M. Taher, A. Bouazzaoui, H. Abalkhail, A. Al-Allaf, R. Bamardadh, M. Athar

Cerebral oxygen saturation is improved by xenon anaesthesia during carotid clamping

INTRODUCTION

The cerebral protective effect of xenon anesthesia could be of interest during carotid surgery. The purpose of this study was to compare the effects of xenon on cerebral oxygen saturation with those of propofol during carotid clamping.

METHODS

After approval of Research Ethics Board and patient informed consent, 74 patients scheduled for carotid endarterectomy were enrolled. Patients were not randomized but were well matched by preoperative characteristics. Patients in the Xenon group were the ones scheduled for surgery in the operative theater equipped with the xenon anesthesia system. Anesthesia was started with a target control infusion of propofol and remifentanil. Patients were then divided into the control group (37 patients) with anesthesia maintained with target control infusion propofol and remifentanil and the Xenon group with anesthesia maintained with xenon (target inspired concentration of 60%) and target control infusion remifentanil. Remifentanil and xenon or propofol were stopped at the end of skin closure.

RESULTS

A cerebral oxygen saturation decrease below 55% was less frequently observed in the Xenon group during carotid cross-clamping (7/37 patients vs 15/37; p=0.01). Compared with values observed before clamping, the decrease in cerebral oxygen saturation during clamping was significantly less important in the Xenon group (12±11% vs 17±14%, p=0.04). Blood pressure and heart rate were not different between groups during carotid clamping.

CONCLUSIONS

This pilot study suggests that xenon anesthesia may be associated to higher cerebral oxygen saturation values when compared to propofol anesthesia during cross-clamping for carotid endarterectomy.

Laparoscopic aorto-iliac surgery: present status and future perspectives

Over the past few years, the concept of "minimally invasive surgery" has generated a significant interest in the field of cardiovascular surgery. Congenital heart diseases such as patent ductus arteriosus, vascular ring or atrial septal defect have been treated using video-assisted technology. Although patients have undergone mitral valve replacement and repair, the focus of interest in the development of video-assisted cardiac surgery is in the treatment of coronary artery disease.

Coronary subclavian steal syndrome after left internal mammary bypass in a patient with Takayasu's disease

We report the case of a 56-year-old symptomatic woman who underwent 2 coronary bypasses (left internal mammary artery on the left anterior artery and saphenous venous bypass on the circumflex) for a tight stenosis of the left main coronary. An inflammatory syndrome had been explored for 1 year without specific diagnosis. Eight months later, coronary angiography was performed for recurrence of angina: both bypasses were patent without stenosis and the left main stenosis was unchanged, but significant stenosis of the subclavian artery was found just before the LIMA. The diagnosis of Takayasu's disease was suspected in accordance with the ARC criteria and corticosteroids were started. One year later, because of recurrent angina, the patient was surgically treated with subclavian, vertebral and internal mammary endofibrectomy and an inverted saphenous vein graft from the subclavian to the axillary artery for extensive supra-aortic lesions. The patient remains symptom free at 1 year follow-up.

[Endarteriectomy of the femoral tripod: long-term results and analysis of failure factors]

STUDY AIM

The aim of this retrospective study was to report immediate and long term results of endarteriectomies of the common femoral artery (CFA) and/or femoral tripod and to analyse predictive factors of failure.

PATIENTS AND METHODS

Between 1982 and 1995, 110 endarteriectomies were performed in 101 patients, 52% of them in limb salvage situation. The arteriogram showed a thrombosis or stenosis of the common femoral artery in 100% of cases. There was a stenosis of the deep femoral artery (DFA) in 79% of cases. The superficial femoral artery (SFA) was thrombosed in 40% of cases. One artery only of the lower leg was permeable in 43.3% of cases. Run off was judged bad in 38% of patients.

RESULTS

The endarteriectomy could be realised in 93 patients (84.5%). It concerned the only common femoral artery in 20% of cases (patch angioplasty in 55% of cases), common and deep femoral arteries in 50.5% of cases (82% of patch), CFA, DFA and SFA at its origin in 29.1% of cases (93% of patch). Perioperative mortality rate was 1%. Local morbidity rate was 21.6% with 18% of minor complications and 3.6% of complications requiring a second operation. There were 2% of vascular complications (1 thrombosis and 1 false-aneurysm). Mean follow-up was 43 months in 90 patients. There were restenosis or thrombosis (5.5%), false-aneurysms (2.2%) and amputations (6.6%). Femoro-popliteal (10%) and iliac complementary bypasses (6.6%) were necessary. Permeability was 94.9% at 3 years and 88.8% at 5 years. Clinical results were considered good in 80.7% of the cases at 3 years and in 71.7% at 5 years. With univariate analysis, the predictive factors for failure were: limb salvage (P < 0.01), altered popliteal run off (P < 0.03) and extended distortion of the deep femoral artery (P < 0.05).

CONCLUSION

Isolated endarteriectomy of the femoral tripod is a low risk and effective technique. A femoropopliteal revascularisation should be associated in case of a major alteration of the deep femoral artery.

Influence of preoperative high-dose radiotherapy on postoperative outcome and colonic anastomotic healing: experimental study in the rat

PURPOSE

Surgical treatment of rectal cancer is followed by local recurrence in up to 30 percent of cases. Recently, preoperative low-dose radiotherapy has been shown to improve both local recurrence rate and overall survival. Down-staging of locally advanced tumors, however, requires preoperative doses of at least 50 to 60 Gy. Most experimental studies investigating the effect of preoperative radiotherapy have made use of a single dose or a limited number of fractionated doses. Moreover, in most studies, both limbs of the anastomosis were irradiated, in contrast to clinical practice, in which one limb of the anastomosis consists of nonirradiated bowel. We studied the effect of a fractionated, clinically relevant scheme of high-dose preoperative radiotherapy on colonic anastomotic healing in the rat.

METHODS

Male Wistar rats randomly received 0, 40, 60, or 80 Gy of preoperative radiotherapy on one limb of the anastomosis only. Radiotherapy doses were validated with implanted dosimeters; before the start of radiotherapy, the cecum was fixed outside the radiation field. A clinically used fractionation scheme of 2 Gy per day, 5 days per week for 4 to 8 weeks was used. The day after radiotherapy completion, a side-to-side colorectal anastomosis was performed. Rats were killed 10 days after surgery. The following parameters were determined: presence of abscess or peritonitis, anastomotic complications (stenosis, leak, or dehiscence), intestinal obstruction, anastomotic bursting pressure, and anastomotic hydroxyproline content.

RESULTS

No significant differences were found in peritonitis rate, anastomotic complications, anastomotic bursting pressure, or hydroxyproline content. Irradiated animals gained weight more slowly than the control group.

CONCLUSION

In this rat model, preoperative high-dose radiotherapy using a clinically relevant fractionation scheme does not affect outcome or anastomotic healing when only one limb of the anastomosis is irradiated.

Pseudo-aneurysm of the popliteal artery by femoral exostosis in a young child

Exostosis is a solitary benign bone tumor frequently observed in children. It may be totally quiescent or provoke complications. We report a case of pseudo-aneurysm of the popliteal artery caused by an exostosis on the lower metaphysis of the femur in a 12-year-old boy. This unusual complication mostly reported in young males (mean age 19 years) occurs in the context of an initial trauma in half the cases. Surgical treatment is a semi-emergency requiring both bone and arterial repair. Preventive surgery should be discussed for all cases of exostosis with a risk of arterial damage due to the gravity of the potential vascular complications.

[Adjustable silicone gastric banding (ASGB, Bioenterics) and the Swedish adjustable gastric banding (SAGB, Obtech) in treatment of morbid obesity]

INTRODUCTION

Two different adjustable silicone gastric bandings were laparoscopically applied and compared regarding per- and postoperative complications and successful weight loss.

PATIENTS AND METHODS

A total of 120 consecutive patients received a laparoscopic adjustable gastric banding and were prospectively documented. In the learning phase (LP) 50 patients were treated with an Adjustable Silicone Gastric Banding (ASGB, Bioenterics) using an intragastric balloon calibration technique according to Belachew. Group I (n = 29) received the same band using a surgical technique with tunneling behind the oesophagus towards His' angle, while the second group (n = 41) received a Swedish Adjustable Gastric Banding (SAGB), using the same technique as in group I. A BMI of > 35, complications secondary to obesity and failed diets were the indication for the operation. Thirty patients were male, 90 female, with a mean age of 37 years (18-60).

RESULTS

In the LP 8 patients had to be reoperated (16%) for band slippage and/or pouch dilatation, in group I 6 (19%) and in group II 1 (3%) (P = 0.02, II vs I). The mean hospital stay was 3.7 +/- 0.5, 3.4 +/- 0.8 and 3.3 +/- 0.4 days in LP, I und II, respectively. LONG-TERM RESULTS: After a mean of 24 months (19-42) the loss of body weight was 8.4 kg after 3, 13.9 kg after 6, 22.1 kg after 12 and 27.8 kg after 18 months in the LP. In group I after a mean of 14 months (12-19) 10.3 kg after 3, 18.7 kg after 6, 24.8 kg after 12 months. In group II after a mean of 10 months (6-16) the loss of body weight was 7.9 kg after 3 and 19.4 kg after 6 months.

CONCLUSION

In our experience it appears that the SAGB is easy to handle and less prone to complications such as dysphagia and slipping, probably due to good fixation of the band due to its width. A prospective randomized trial is warranted.

Sealing of polyester prostheses with autologous fibrin glue and bone marrow

The purpose of this study was to develop a sealing technique for polyester prosthetic grafts able to promote healing and reduce intimal hyperplasia. The porcine experimental model was aortoiliac bypass with a 6-mm diameter knitted polyester prosthetic graft implanted for 14 and 90 days. Animals were divided into three groups according to sealing technique as follows: pre-clotting with blood (group I, n = 12), sealing with autologous fibrin glue (group II, n = 14), and sealing with autologous fibrin glue and bone marrow cells (group III, n = 16). Feasibility and quality of sealing were evaluated by scanning electron microscopy prior to implantation and by assessment of blood loss. After removal, prostheses were cut into three segments comprising the proximal anastomosis, midsection, and distal anastomosis. Pieces were fixed, embedded in paraffin, and serially sectioned for histologic study. Histological study focused on the degree of stenosis and hyperplasia of the neointima of each prosthesis. The results of this short-term study indicate that sealing of polyester vascular prosthetic grafts with autologous fibrin glue and bone marrow cells is effective in reducing intimal hyperplasia. However further study will be needed to assess long-term healing.

[Isolated popliteal arteries: results of surgical treatment and causes of failure]

Isolated popliteal artery is defined as an obstruction of a superficial femoral artery with a patent popliteal segment followed by an obstructed distal popliteal artery or a patent leg artery less than 5 cm long.

PURPOSE

The aim of this retrospective study was to report the results of surgical treatment and the causes of failures.

PATIENTS AND METHODS

From 1988 to 1996, 31 patients with isolated popliteal artery were operated on with femoropopliteal bypass. The age of the patients ranged from 45 to 92 years, (mean: 79 years); all had critical ischemia that threatened limb viability. All underwent preoperative arteriography and diagnosis was confirmed by intraoperative arteriography.

RESULTS

In the postoperative course, there were 22 patent bypasses (68%) with minor amputation in five patients, and nine thromboses that required a major amputation in seven patients, a trans-metatarsal amputation in one, and a medical treatment in one. With a mean 37-month follow-up, seven thromboses required a major amputation in five patients, a new bypass in one and a medical treatment in one. The death rate was 34% at two years. The actuarial patency rates of the bypasses were 51% at one year, 38% at two years and 25% at five years. The limb salvage rate was identical. The patency rates were 65% at one, two and five years for venous bypasses and 38%, 13% and 0% respectively for PTFE bypasses. Statistical analysis showed two causes of failure: the absence of a run-off branch and the use of PTFE prostheses. No other statistically significant cause of failure was demonstrated among those analysed. Favourable anatomic conditions for a bypass to a leg artery were not predictive of failure of a femoro-popliteal bypass on the isolated arterial segment.

CONCLUSION

Bypass to isolated popliteal artery is indicated in patients whose limb viability is jeopardized. Results may be considered as satisfactory especially if there is a run-off branch and if a venous graft is available for the bypass.

Fat- and bone marrow-impregnated small diameter PTFE grafts

OBJECTIVES

to evaluate an alternative and simple technique which consists in impregnation of a synthetic prosthesis with either autogenic omental fat or bone marrow. These tissues have been selected based on previous works and because they contain multiple cellular and extracellular compounds with biological healing properties (i.e. angiogenesis, endothelialisation, etc.).

DESIGN

PTFE grafts of Group 1 were impregnated with fatty tissue, those of Group 2 with bone marrow and those of Group 3 served as controls.

MATERIALS

nine mongrel dogs divided among these three groups. PTFE grafts are 3 mm in diameter.

METHODS

in each animal, both iliac arteries were submitted to an end-to-side ilio-iliac bypass. At 3 months, pathology assessment was performed.

RESULTS

group 1: all grafts were thrombosed and intimal hyperplasia was found occluding the anastomotic sites. Group 2: 4/6 grafts were patent and their mid-portion presented a thin neointima which did not totally cover the anastomotic sites. Group 3: 2/5 grafts were patent and their mid-portion as well as the anastomotic sites were covered with neointima which was hyperplastic in some areas.

CONCLUSIONS

addition of bone marrow cells may contribute to improve the quality of the healing process.

Impregnated polyester arterial prostheses: performance and prospects

Impregnated polyester arterial prostheses have gained wide acceptance by most vascular surgery teams, probably because these prostheses are easy to use, without any preclotting. We offer here a synthesis of the main studies that have appraised the experimental and clinical performance of these prostheses, and we delineate their major prospects.

Alternative technique for creation of a proximal gastric pouch in laparoscopic adjustable silicone gastric banding

BACKGROUND

Laparoscopic adjustable silicone gastric banding (LASGB) has become a widely used procedure for the treatment of morbid obesity. The original operation, as described by Kuzmak, has been subjected to modifications. Construction of a proximal gastric pouch is an important part of the operation. Until now, we used the technique of Niville. Since this was often complicated by gastric bleeding and/or serosal tears, we developed a new technique to construct a pouch.

SURGICAL TECHNIQUE

A new technique, using a thread previously fixed to that portion of the fundus that will be used to construct the pouch, is described.

CONCLUSION

A safe and easy adaptation of the LASGB technique is proposed to create the gastric pouch.

A model for laparoscopic aortic aneurysm resection

BACKGROUND

The laparoscopic treatment of abdominal aortic aneurysm (AAA) could improve the perioperative course of patients suffering from this disease. The goal of the current experiment was to develop an animal model that could simulate many of the difficulties encountered in the treatment of human AAA.

METHODS

Twelve piglets were submitted to a laparotomy. An AAA was created by suturing a 12- by 5-cm piece of knitted dacron to an aortotomy. Four to 15 days later, the piglets underwent the laparoscopic treatment of their AAA.

RESULTS

All procedures were completed successfully. The average duration of the laparoscopic intervention was 210 min (range, 150-300 min). Aortic cross-clamping took 55 min (range, 38-72 min). Blood loss averaged 150 ml (range, 80-250 ml). During each procedure, four to six lumbar arteries were treated by intraluminal aortic clip application. Intraoperative complications consisted of one splenic trauma, one anastomotic stenosis, and one case of bleeding from a lumbar vein.

CONCLUSION

Laparoscopic AAA resection is feasible in this animal model, which presents similarities to human AAA.

Retrospective analysis of laparoscopic gastric banding technique: short-term and mid-term follow-up

BACKGROUND

Although adjustable gastric banding shows good results concerning weight loss, several complications such as excessive vomiting, total dysphagia, and slipping of the stomach through the band with pouch dilatation may occur rather frequently. Different types of adjustable bands are available to prevent these short- and mid-term complications.

METHODS

In this retrospective study, 120 consecutive laparoscopic adjustable gastric bandings were performed. In group I, 50 patients were treated with adjustable silicone gastric banding (ASGB) by an intragastric balloon calibration technique. Group II (n = 29) received the same band by a surgical technique with tunneling behind the esophagus toward the angle of His. Group III (n = 41) received Swedish adjustable gastric banding (SAGB) by the same technique as in Group II.

RESULTS

Weight loss was approximately 15% of the excess weight after 3 months, 30% after 6 months, and 45% after 12 months in all groups. Total dysphagia was significantly more frequent in Groups I and II. The incidence of slipping of the band and pouch dilatation was more frequent in Group II.

CONCLUSION

The diameter of the ASGB band is rather small and can cause total dysphagia independently of surgical technique. The SAGB is easy to perform and seems less vulnerable to complications like dysphagia and slipping of the band, probably because of the individual adjustment of the stoma diameter during surgery and good fixation of both band and ventral pouch with separate posterolateral sutures.

Use of ipsilateral greater saphenous vein as a valved transplant in management of post-thrombotic deep venous insufficiency: long-term results

Incompetence of the deep venous valve is a common feature of post-thrombotic deep venous insufficiency. Various surgical techniques have been proposed to treat reflux. In this study we describe long-term results of a novel transposition technique using the ipsilateral greater saphenous vein. From 1984 to 1994 we used this procedure to treat 16 patients including 10 men and 6 women with a mean age of 56 years (range: 25 to 76 years). In all 16 cases the indication for surgery was incapacitating pain associated with recurring ulceration in 9 patients. From the results of using this technique we conclude that transposition using the ipsilateral greater saphenous vein is safe and effective with good mid-term results, especially for pain. For ulcers the primary success rate was 55% but this increased to 84% with proper surveillance and treatment of secondary insufficiency of the superficial venous system.

[Biomechanical study of the vasomotor system of the arterial smooth muscle after long-term cryopreservation of a human arterial graft at two different temperatures -80 and -150C]

We conducted two parallel studies on cryopreserved arterial homografts: a biomechanical study based on traction tests and a functional study coupled with a histology examination. Twenty-four arterial segments from 6 donors (2 iliac and 2 superficial femoral segments per donor) were cryopreserved at -150 degrees C and -80 degrees C. Cryopreservation lasted at least 6 months. Lengthening at rupture, the Young elasticity module, and rupture stress were calculated from the traction test. Results were significantly different depending on the preservation temperature. The functional properties of the cryopreserved arterial grafts were evaluated by studying the vasomotricity capacity of the vascular smooth muscle (VSM) and the endothelium. The expected results (direct contracture of VSM induced by PHE and endothelial dependent relaxation of VSM induced by ACH) were measured on fresh arteries. Cryopreserved arteries showed no response to physiological doses of PHE and ACH, whatever the preservation temperature. In one-third of the cases, a lower amplitude vasoconstriction was obtained using nonphysiological doses of PHE; there was no relaxation with ACH.

Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases

AIMS

A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions.

METHODS

Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9-22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied.

RESULTS

Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases.

CONCLUSION

These results demonstrate that peribulbar anaesthesia offers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.

Results of isolated carotid surgery in patients with vertebrobasilar insufficiency

The purpose of this study was to establish whether carotid-revascularized patients who had preoperative vertebrobasilar insufficiency (VBI) displayed distinctive characteristics and whether a particular prognosis would ensure. From January 1985 to December 1993, 1022 carotid revascularizations were performed, of which 114 (11%) were for high-grade stenosis associated with VBI. The group with VBI and the group without VBI were compared according to a set of 121 prospectively collected variables. Of all the demographic and risk-factor variables, only female prevalence (42% vs. 27%) and hypertension (77% vs. 27%) distinguished the group with VBI, who also exhibited a significantly higher proportion of significant contralateral carotid lesions (27.2% vs. 8.9%) and vertebrosubclavian lesions (38.6% vs. 24.8%). Following isolated carotid surgery, there was no statistically significant difference between the two groups as to their cumulative rate of permanent neurological mortality and morbidity (2.6% in the group with VBI vs. 3.4% in the group without it). With an average follow-up of 60 months, VBI was cured in 82.4% and improved condition shown in 6.5% of patients. However, the proportion of good results fell to 65% in patients with a nonfunctional circle of Willis. Out of 13 cases of failure to control VBI, cure was finally effected by means of contralateral revascularization in 3 cases and by means of vertebrosubclavian revascularization in 5 cases out of 6. At 5 years, the actuarial rates of neurological event-free intervals and survival were not different from one group to another. In most cases, isolated carotid surgery is sufficient to bring vertebrobasilar insufficiency under control, except when significant vertebrosubclavian lesions and a nonpatent circle of Willis call for simultaneous carotid and vertebral artery surgery.

Results of carotid surgery in elderly patients

METHODS

We have evaluated the results of carotid surgery in 252 patients of 75 years and over age (A group) including 281 interventions between June 1st 1985 and December 31st 1993.

RESULTS

These results have been compared to those obtained in 660 patients of less 75 years (B group), operated on over the same period of time (741 interventions). In the A group, the mean age was 78.2 (from 75 to 89) and 37.3% were women. Nicotinism, obesity and dyslipaemia was significantly more frequent in A group. An angor was shown in 48% in A group (versus 38.8% in B group). In A group, 34.5% (n = 97) of patients were neurologically asymptomatic against 41.7% (n = 309) in B group. Four patients aged over 75 died (1.42% per intervention), one from myocardial infarction, the other from postoperative stroke. Three other patients showed a non regressive postoperative neurological deficiency. The Cumulated Rate of Mortality Morbidity (CRMM) in A group is then 2.49% per intervention. It does not significantly differ from B group results: mortality = 1.48% (n = 11, 10 of neurological origin), CRMM = 3.23% per intervention. We counted 4 myocardial infarctions (1.58%) in A group and 5 (0.75%) in B group. The mean time after the interventions was 58 months. The five years actuarial survival is 73% of A group patients and 85% for B group patients. In A group patients, 44% of deaths are of coronary origin and 35% in B group patients. The actuarial rate of people free from neurological deficiency, after 5 years, is 90.9% in A group and 92.4% in B group.

CONCLUSIONS

In this study, age does not seem to be a risk factor in carotid surgery. The elderly patients must be selected according to the same criteria as the under 75, save the estimation of intellectual faculties and autonomy.

Endovascular repair of iliac artery aneurysm with Endoprosystem I: a multicentric French study

Due to their position deep in the pelvis, the classical surgical treatment of iliac artery aneurysm leads to a high morbidity and mortality rate. The transfemoral percutaneous repair of these aneurysms is now possible thanks to a new device the endoprosystem I from "Mintech". We began in 1994 a study including radiological, cardiac and vascular centers all of them skilled in endovascular procedures. 27 patients entered the study: 1 patient died, 2 attempt failed and 2 presented leakage: the immediate failure rate was then 18.5%. For the late result (min 6, Max 19, mean 12 months) we had 1 thrombosis treated by surgery, 1 restenosis treated by PTA. We did not see any polyester dilatation or reactivation of aneurysm at the scan control at one year. We conclude that the percutaneous treatment of iliac aneurysm is possible and safe but we need long term result to validate the method.

Transluminal recanalization of occluded iliac arteries: a surgical experience

The purpose of this study was to evaluate the feasibility of transluminal techniques in an unselected group of patients and to assess long-term outcome in successful procedures. All patients in whom iliac artery recanalization was attempted were included in this study. Patients with an occluded prosthesis or recent embolism were excluded. A total of 37 patients were studied. Assessment of the success or failure of the procedure was based on the results of control arteriography. Recanalization was deemed successful in 31 patients. This study demonstrates that transluminal recanalization of occluded iliac arteries by a surgeon is indeed feasible. Primary patency was 66% at 24 months. The potential risk, however, is long-term restenosis. Thus follow-up examination every 6 months is recommended including pressure index measurements after exercise and color Doppler ultrasonography of the recanalized zone.

Iliac aneurysm in a child complicating umbilical artery catheterization

We report a case of an iliac artery aneurysm in a 9-year-old girl due to Staphylococcus aureus infection of an umbilical arterial catheter inserted at birth. After resection-anastomosis of the iliac artery the postoperative course was uneventful and hemodynamic data remain normal at 2 years. A review of the literature indicates that the prognosis of infective aortoiliac aneurysm is poor in children, except when the aneurysm is located solely in the iliac artery. Arterial continuity should be restored as late as possible after infection using a technique consistent with normal growth of the artery in the child.

[Role of surgery in the treatment of dissections of the extracranial internal carotid artery. Apropos of a case, review of the literature]

The authors report about one operated case of spontaneous dissection of the extracranial internal carotid artery close to the bifurcation. The persistence of a floating thrombus in a 60% stenosis after a six-week treatment with heparin led to establishing the indication for surgery. The surgical indication remains exceptional, considering the natural history of dissections and the frequency of repatency of the arterial lumen. This type of surgery is mainly for sequellae such as stenosis, thrombi or saccular aneurysms, whose emboligenic potential leads to operating (exeresis and graft on the internal carotid artery) if the anatomical location of the lesion makes it possible.

[Crossed ilio- and femoro-femoral revascularizations. Apropos of 50 cases]

Results are reported after a mean follow up of 3 years (max: 8 years) of cross-over ilio- and femoro-femoral revascularizations performed in 50 patients for severe arterial disease of lower limbs. Mean age of the patients was 62 years. Operative mortality was nil and immediate permeability 98%. Five year actuarial curves showed a survival rate of 76%, and a permeability of 71% globally and of 85% in patients under 55 years of age. Limb conservation rate was 90% (amputations). Tolerance and reliability of these cross-over revascularizations are discussed, and precise details given of the anatomic and functional conditions of the donor limb that allow use of the method, the technique involved and the associated procedures on the donor arterial axis and the place of this cross-over type of surgery. It is concluded from analysis of the literature and the author's personal experience that ilio- or femoro-femoral bypass surgery is a well tolerated rational procedure. Its indication of choice is for iliac thromboses (arterial or prosthetic) in elderly patients exposed to the risk of an anatomic repair, but its use is also justified in young patients for aortic sparing by avoiding immediate performance of an aortofemoral revascularization.

Interactions of cytostatic unsaturated ketonucleosides with sulfhydryl containing cell constituents

The cytostatic unsaturated ketonucleosides, 1, 2, 3 and 4 are highly reactive sulfhydryl blocking agents. Kinetics of their reactions with reduced glutathione (GSH) were measured and their reactivity was compared to that of N-ethylmaleimide (NEM), acrylonitrile and chloroacetamide. Their reaction products with N-acetyl-L-cysteine (AcCys) were prepared and characterized by chemical analysis and nuclear magnetic resonance (NMR) spectroscopy. Compounds 1, 2 and 3 gave Michael type 1:1 addition products. Compound 4 reacted with AcCys by a three step mechanism; the primary addition product 8 underwent an unusual elimination reaction giving the unsaturated compound 9, which yielded the addition product 10 with AcCys. In the reaction with GSH, compound 4 behaved like a bifunctional SH alkylating agent. Compounds 1, 2, 3 and 4 also reacted with protein thiols as shown by their ability to inhibit lactate dehydrogenase (LDH). Unsaturated ketonucleosides had diversified effect on L1210 leukemia cells. While the most potent cytostatics, compounds 1 and 3, reduced considerably the membrane surface SH level, they were without effect on soluble intracellular protein thiols. In contrast, nucleosides 2 and 4, less active than the former, only slightly affected the membrane surface sulfhydryls and considerably depleted the intracellular soluble protein thiols. Only slight differences were found between the reactions of the four nucleosides with non-protein SH (NPSH). The correlation found between in vivo biological activity and cell membrane impairment suggests that selective alkylation of certain key membrane thiols by unsaturated ketonucleosides might be an important event in their biological effect.

The clinical activity of oxazepam

Over the years, oxazepam has distinguished itself clinically from other benzodiazepines by virtue of its excellent tolerance. Recent research suggests that this is due to metabolic and pharmacokinetic differences rather than an intrinsically more favourable toxic-to-therapeutic dosage ratio. Because of its excellent tolerance, dosage is very flexible, and it is, therefore, possible to utilize oxazepam in a wide spectrum of anxiety-related disorders including the psychoses. The use of oxazepam in anxiety neurosis, depressive neurosis, psychotic disorders, alcoholism, and insomnia is discussed.