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We describe the case of a 40-year-old man who presented with an ascending aortic aneurysm and aortic valve regurgitation. The patient underwent a Bentall surgical procedure. Pathologic findings were consistent with giant cell aortitis with synchronous cartilaginous and osseous metaplasia with bone marrow formation in the degenerated aortic valve. The coexistence of these findings has not been previously reported in the English language literature.

This is a report of a patient with renovascular hypertension associated with a suprarenal aortic aneurysm that was treated by nephrectomy, resection of the aneurysm and autotransplantation of the kidney. The autografted kidney was preserved on the Mox-100 perfusion-preservation apparatus for over four hours, during which time the aneurysm was resected and replaced with a Dacron bifurcated graft. The authors believe this is the safest method for the management of aneurysms of the suprarenal aorta, especially when associated with renovascular disease, and it deserves wider application in treating major renovascular disease.

The pathogenesis of aortoenteric fistulas was studied in the experimental laboratory. In 23 dogs patch of woven dacron was interposed in the anterior wall of the infrarenal abdominal aorta. In two groups (I and II), the serosa denuded duodenal wall was sutured to an opening of the proximal anastomosis--creating a pseudoaneurysm--, with induction of staphylococcal bacteremia, without (group I) and with simultaneous administration of methicillin (group II) pre and postoperatively. In the remaining two groups (III and IV), the serosa stripped duodenal wall, was simply attached to overlay the intact proximal anastomosis, with induction of staphylococcal bacteremia, without methicillin in group II and with administration of methicillin without bacteremia in group IV. Aortoduodenal fistulas developed in 100% of animals in group I, 80% in group II and 14% in group III. No aortoduodenal fistula was observed in group IV. We conclude that mechanical factors have the decisive role for the formation of aortoenteric fistulas, especially the development of a false aneurysm, which subsequently ruptures into the duodenum or the bowel.

Two ectopic pelvic kidneys were transplanted from living donors into well matched recipients. Both kidneys have good function at two and four years post transplantation and there has been no evidence of infection post transplantation. Such kidneys can be utilized when there is no evidence of obstruction or infection in the donor and when the contralateral kidney is normal.

Seven cases of infected aortic grafts or aorto-enteric fistulas following resection of an abdominal aortic aneurysm are reviewed. All cases were treated with axillo-femoral bypass and graft removal. Patients had recurrent fever, chills, and abdominal pain (5 patients), or massive gastrointestinal hemorrhage (2 patients). The two patients with massive gastrointestinal hemorrhage died. Three of the 5 long-term survivors had a recurrence of the retroperitoneal abscess after graft removal; one of these died. One axillo-femoral bypass graft required early thrombectomy. There have been no subsequent problems with any of the grafts in the 2.5 to 4 year followup period. Axillo-femoral bypass immediately before graft removal is the treatment of choice for infected or fistulous aortic grafts. Any delay in graft removal after the onset of symptoms should be avoided.

Miliary tuberculosis is the most lethal form of tubercular disease. If dissemination of tubercle bacilli occurs without therapy, death is almost certain. The importance of establishing an etiologic diagnosis as promptly as possible in patients receiving immunosuppressive therapy is self-explanatory. The presence of a life-threatening infection in these patients requires aggressive antimicrobial therapy and discontinuation of the immunosuppressive drugs until the infectious process is under control; the presence of an impaired immunologic response is responsible for the life-threatening infection and the lack of an acute rejection reaction.

The effect of the spontaneous occurrence of ventricular fibrillation during aortic valve replacement and coronary arterial perfusion was studied in a consecutive series of 361 such operations. All operations were performed in a standard manner before 1972. One fourth of the patients experienced ventricular fibrillation,and the early mortality rate of this group was significantly (p less than 0.005) higher 7.3 per cent) than in the nonfibrillating group (1.5 per cent). The total mortality rate was 3 per cent. However, late results among survivors of the operations showed no effect of fibrillation. These findings indicate that ventricular fibrillation should be avoided in these patients. Whether or not countershock is advisable if and when fibrillation occurs remains an unanswered question.

This report describes a case of complete occlusion of the right renal artery. Arteriography and intravenous pyelography demonstrated no kidney function. The occlusion was treated by endarterectomy, and eleven days later another intravenous pyelogram revealed that renal function had been restored. A review of the literature also suggests that acute occlusion (caused by embolism) or chronic occlusion (caused by atherosclerosis) should be treated surgically to perserve renal function, reserving nephrectomy only if that should fail.

The successful repair of associated atrioventricular canal anomaly and membranous subaortic stenosis is reported for the first time in two patients. Although subaortic stenosis associated with atrioventricular canal anomaly has been reported previously, it was caused by anomalous positioning of the atrioventricular valve, so that the discrete membranous type of stenosis in these two patients is the unique feature. Awareness of the possible association of these two deformities should enable accurate preoperative diagnosis and simultaneous correction at operation.

Total ureteropelvic necrosis of the transplanted kidney occurred more than one month after transplantation in 5 of 575 consecutive renal transplants performed at the University of Minnesota Hospital since 1963. Necrosis became evident long after normal renal function had been established. Histologic signs of rejection were minimal, but perinephric or periureteral hematomas were found in 3 of 5 patients: post-transplant acute tubular necorsis requiring hemodialysis occurred in all. The pathogenesis of this complication probably involves (1) a primary deficit of blood supply from the renal vessels to the pelvis and ureter, (2) a failure to develop a new ureteral blood supply because of surrounding hematoma, (3) early swelling of the ischemic ureter resulting in oliguria interpreted as acute tubular necrosis, (4) resolution of edema resulting in diuresis, and (5) late patchy ureteral necrosis and fistula formation due to ureteral ischemia.