Arteriovenous fistulas after replantation surgery

The delayed appearance of congenital arteriovenous fistula precipitated by local trauma is a rare event. However, these reports may provide some insight into pathogenetic mechanisms responsible for the opening of subclinical arteriovenous communications. This case of multiple arteriovenous fistulas in a previously "normal" hand followed a sharp, incomplete amputation at the wrist level with replantation.     

Thumb replantation after cardiac transplantation

Generally, severe medical illnesses, including chronic immunosuppression and heavy steroid use, have been deemed relative contraindications for replantation surgery. We report the successful replantation of an amputated thumb in a patient who had previously undergone heart transplantation and was on therapeutic immunosuppression. Despite extensive soft-tissue damage and joint involvement, thumb function and sensibility returned to acceptable levels. This case demonstrates that digital bony union, tendon repair healing, and nerve regeneration are not significantly altered by the standard immunosuppressive regimen following major organ transplant. The implications raised by this case for possible transplantation of allograft digits or limbs are discussed in detail.     

Survival after recurrence of breast cancer.

A series of 456 patients with cancer of the breast that was first diagnosed between 1961 and 1970 were studied to determine the effect of certain prognostic factors on survival after recurrence. The prognostic factors studied included those recorded at the time of initial diagnosis and at the time of recurrence. Life-table and log-rank methods were used to analyse the influence of individual prognostic factors, and the simultaneous effects of multiple factors were assessed with Cox''s proportional hazards model. The analysis indicated that, in addition to the strong effect of the length of the free interval and the nature and number of sites of recurrence, variables assessed at the time of initial diagnosis -- stage and histologic subtypes of the tumour -- also influenced survival after recurrence. This supports the contention that the presenting characteristics of breast cancer reflect the underlying biologic aggressiveness of the tumour as much as the length of time the tumour has been present.     

Lymphatic drainage in patients after replantation of extremities

Lymph drainage was studied by means of lymph scintigraphy in eight patients in whom successful replantation of a totally or subtotally amputated extremity had been performed. Scintigrams were made after subcutaneous injection of technetium-99m in the replanted part of the patient and the contralateral, normal extremity. In all scintigrams, axillary or inguinal lymph node activity is seen, implying drainage of lymph by means of the lymph vessels. Retention of colloid in the replanted part (79 to 94 percent) shows no significant difference with the contralateral, normal side (86 to 94 percent). Unquestionable evidence of regeneration of lymphatics in humans is delivered in the three patients, in whom lymph node activity and normal retention percentages are seen on the scintigrams after total amputation of an extremity followed by replantation without anastomosing of interrupted lymph vessels.     

Adjacent and spontaneous neurotization after distal digital replantation in children

In an exclusively pediatric population, this retrospective study examined the functional and aesthetic results after distal replantation without nerve suture. The aim was to demonstrate, in the child, the presence of spontaneous nervous regeneration resulting in a fingertip pulp with discriminatory sensation. Eight amputations in eight children with a mean age of 9 years and 2 months on the day of the accident were reviewed. The cases were managed by a single surgeon over a period of 8 years and were collected from two different hand centers. The patients were then examined by a different surgeon, and the data were collected. Sensibility was evaluated using the Weber, Semmes-Weinstein, and wrinkle tests. The results were excellent, with mean values of 4.6 mm for the Weber test, 3.3 for the Semmes-Weinstein test, and a positive wrinkle test in all subjects. All patients thus recovered discriminatory sensation with minimal aesthetic sequelae. The usual factors adversely affecting the results of the replantation (ischemic time, level and mechanism of the amputation, and quality of the venous return) were examined, but no statistical analysis was performed because of the small sample size. This study demonstrates the presence of the clinical phenomenon of adjacent neurotization in the absence of nerve repair. It thus confirms that children are excellent candidates for replantation of the distal extremities, even when nerve suture is not performed.     

Experimental replantation of canine forelimbs after 78.5 hours of anoxia

To assess the effect of ischemia on osteocyte survival and longitudinal growth in bone, one forelimb of eight puppies and seven dogs was amputated, perfused with iced Collins solution, maintained at 4 degrees C for 72 hours (78.5 hours total anoxia), and replanted. Five puppies were kept for 1 year to assess bone growth. Undergoing bone labeling on days 1, 8, and 15, the other animals were sacrificed at 22 days to assess osteocyte survival. Osteocytes survived replantation in all dogs and one puppy; most osteocytes died in two puppies. In five long-term puppies, central epiphyseal growth was disturbed, but the peripheral portions maintained nearly normal growth, with almost normal bone length being achieved at 1 year.     

Survival of human T and B lymphocytes after X-irradiation.

The survival of unstimulated human T and B lymphocytes after X-irradiation in vitro was measured by Trypan Blue dye exclusion over a period of four days. B cell numbers were observed to decline rapidly even after relatively low doses, but T cell numbers fell much more slowly. A comparison of the percentage survival 96 hours after irradiation shows that in this system T cells are between approximately 2 and 5 times more resistant than B cells. Data for interphase death after 48 hours are compared with cytogenetic data for interphase loss of PHA-stimulated human lymphocytes and are shown to be in broad agreement at radiation doses below 400 rad. It is suggested that at higher doses mitotic delay may be increasingly important leading to selection of non-irradiated cells at 48 hours.