The role of extra-anatomic grafts for lower limb ischaemia

Aorto-bifemoral graft is the conventional treatment for ischaemic lower limbs due to severe aorto-iliac disease. However, some patients are not fit to withstand this major procedure, and for them extra-anatomic grafts provide a method of improving the blood supply to the legs where the alternative may be amputation. The role of these grafts has still not been established because of variable results. We have used the femoro-femoral and the axillo-femoral routes for ten years. The patients were unfit for major surgery and had an overall mortality of 20% in two years. They all presented with critical lower limb ischaemia. Forty-three extra-anatomic grafts have been inserted. Perioperative mortality was less than 2%. None of those undergoing femoro-femoral grafting required subsequent amputation: four amputations were performed in those with axillo-femoral grafts. We conclude that extra-anatomic grafts should be considered before resorting to amputation in patients with critical lower limb ischaemia.

Vascular trauma

Civilian vascular trauma is not uncommon. Prompt treatment with modern vascular surgical techniques produces good results.

Changes in the VIPergic, cholinergic and adrenergic innervation of human penile tissue in diabetic and non-diabetic impotent males

Penile tissue (consisting of corpus cavernosum and tunica albuginea) was obtained from 19 patients undergoing surgery for the implantation of penile prostheses. The tissue was examined for vasoactive intestinal polypeptide-like immunoreactivity in nerves, acetylcholinesterase-positive staining in nerves and noradrenaline content. Impotence was due to a variety of causes; 11 patients were classified as a 'non-neuropathic' group on the basis of their clinical history which included Peyronie's disease, vascular disease, hypertension and psychogenic impotence. Vasoactive intestinal polypeptide-like immunoreactive and acetylcholinesterase-positive nerves were present and the pattern and distribution were similar in each patient in this group. The noradrenaline content of the tunica albuginea was significantly lower than the corpus cavernosum (p less than 0.02), although there was a linear relationship between the noradrenaline contents of the two regions (r = 0.95, p less than 0.01). By comparison, a complete absence of vasoactive intestinal polypeptide-like immunoreactivity in nerves was observed in a patient with a cauda equina lesion. Five out of six diabetic patients studied revealed a marked reduction in vasoactive intestinal polypeptide-like immunoreactivity in nerves associated with the cavernous smooth muscle, while acetylcholinesterase-positive staining was reduced in three out of five diabetic patients studied. The noradrenaline content of the corpus cavernosum from diabetic patients was significantly lower (p less than 0.02) than that of the 'non-neuropathic' group. The noradrenaline content of the tunica albuginea, however, was similar in both groups. The results provide evidence that VIPergic, cholinergic and adrenergic nerves in the penis are affected in diabetes mellitus and thus may contribute to the development of impotence in diabetic patients.

Patterns of flap recurrence following mastectomy

Flap recurrence after mastectomy is divisible into three distinct entities: spot recurrence, multiple spot recurrence and field change. Spot recurrence and multiple spot recurrence are usually controlled by local measures and are not associated with any particular characteristics of the primary tumour. The field change type of flap recurrence is difficult to control and is associated with aggressive primary tumours (grade III, node positive, oestrogen receptor negative) and a very poor prognosis. The appearance of field change type of flap recurrence is an indication for systemic therapy.

A survey of registrars undertaking general surgical research in the United Kingdom on 1 October 1983

Data, concerning general surgical research, was obtained by means of a questionnaire from 103 junior surgeons undertaking full-time research. Most posts appeared to be adequately funded, though many respondents sustained a loss of salary on appointment. Less than half the posts were advertised in the national medical journals. All but one respondent were submitting their research for a higher degree. The majority felt that they were well supervised: a minority (24 per cent) were poorly supervised. The enjoyment of research and confidence of obtaining a higher degree were related to the standard of supervision.

Vasoactive intestinal polypeptide-like immunoreactive nerves in diabetic penis. A comparison between streptozotocin-treated rats and man

Vasoactive intestinal polypeptide (VIP) has been demonstrated by immunofluorescence histochemistry in nerves in human and rat penile tissue. A reduction in VIP-like immunoreactivity in nerves was revealed in tissue from streptozotocin-diabetic rats and a human diabetic with impotence. These results suggest that an impairment in the VIP-ergic innervation in penile tissue may be an important factor in the development of impotence in diabetes. They also support the view that the streptozotocin-treated rat is a useful experimental model for diabetic autonomic neuropathy.