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BACKGROUND: A rise of the homocysteine plasma level--mild hyperhomocysteinaemia--is considered an independent risk factor for the development of vascular damage. It is due to hereditary deficiency of 5,10-methylene-tetrahydrofolate reductase with accentuation of vitamin deficiency (folic acid, vitamin B6 and B12). In previous studies the authors confirmed this fact in the population of patients with aortocoronary or peripheral arterial bypasses. The assumed autosomal recessive transmission of this deficiency should make it possible to detect carriers of this metabolic deviation already in childhood. By selective screening of the child population at risk it would thus be possible to detect affected subjects in time and prevent the development of vascular disease by preventive folate administration. METHODS AND RESULTS: In a group of 38 children and grandchildren from risk families where at least one of the parents or grandparents was operated on account of vascular obliterating disease the total homocysteine plasma level was examined by the chromatographic method. An increase of total homocystein (8.7 +/- 2.7 mumol/l) was found as compared with children from the non-risk population (5.4 +/- 1.8 mumol/l), (p < 0.001). The total homocysteine values however were dependent on the child's age and were more marked in children above 12 years of age. In the parental population mild hyperhomocysteinaemia was present in 38% of those with aortocoronary bypasses and in 43% of those with peripheral arterial bypasses. CONCLUSIONS: The authors found significantly elevated total homocysteine levels in the child population from risk families with obliterating vascular disease. The total homocysteine level depends on the child's age and is more markedly expressed in children above 12 years of age.

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A case report of a 45-year-old woman with Williams syndrome who was indicated, because of increasing problems, for surgery of a supravalvular stenosis of the ascending aorta. In addition to lesions on the aorta, examination revealed multiple stenoses of branches of the pulmonary artery. The patient showed no facial changes or signs of mental retardation. The operation was performed in extracorporeal circulation by suturing a Dacron flap into the stenotic segment of the aorta, and reimplantation and reconstruction of the stenosed aortic arch branches. The procedure was uneventful and, four months after surgery, the patient is completely free of problems.

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The authors submit a report on two patients with pseudoaneurysmatic bulging in the subrenal portion of the abdominal aorta. They present detailed histological findings in the two operated patients and discuss the aetiology of these formations. They draw attention on the failure of aortographic examinations in the diagnosis of these formations and the necessity of sonographic or CT examination. During surgery only partial resection of these formations is possible with subsequent reconstruction of the arterial circulation. The long-term results of these operations are favourable.

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The authors investigated, using optic and electron microscopy, the course of regressive changes in smooth muscle cells of the media in venous grafts, in relation to various physical and chemical factors. They recorded the influence of a temperature of 4 degrees C and 22 degrees C, the influence of various types of crystalloid and colloid solutions and some pharmaceutical preparations. In previous work they found that, as a result of ischaemia, regressive changes take place in the smooth muscle cells of the media, while plasmatic structures of these cells and fibrillar structures of the venous wall remain intact. They provided evidence of the adverse effect of crystalloids, where the regressive changes can be detected already after 30 minutes. A protective effect on the nuclear structure is exerted by colloids, in particular a 6% solution of detoxicated haemoglobin. More favourable results were achieved at 22 degrees C. Some pharmacological preparations have a favourable effect on the preservation of the structure of cellular nuclei. The authors draw attention to the importance of these changes for clinical practice.

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By means of light and electron microscopy the development of regressive changes in the media of vascular graft were studied. The authors found out that as a result of warm and cold ischaemia to which the vascular graft is exposed before implantation changes in nuclei of smooth muscle cells arise. The development of these changes can be postponed by keeping the graft in a suitable medium before implantation. Such medium may be e.g. the patient's blood cooled to 4 degrees C. On a group of their own patients the authors pointed out the significance of these changes in the development of early complications after vascular graft implantation.

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The authors investigated the intrahepatic lymphatic vessels of the human liver under a light and electron microscope. The histological material was obtained from 10 patients operated on account of simple cholecystolithiasis. The beginnings of the lymphatic capillaries are in the periphery of the perilobular connective tissue of the portobiliary space in the vicinity of openings of Mall's space. Communication between lymphatic capillaries and Mall's space was not proved. The fine structure of the openings in Mall's space with numerous microvilli of hepatocytes pointing towards the perilobular connective tissue were described. Mall's space communicates and is interconnected in a multiple way with intercellular spaces between neighbouring hepatocytes. Here also the plasmalemma of hepatocytes forms a system of microvilli which form the borderline of the interhepatocytic space. The ultrastructure of both systems of spaces corresponds to the pattern on the hepatocyte surface in Disse's perisinusoid space. The cell population of hepatocytes holds a special position because it lacks the lamina basalis as a selective barrier against the connective tissue interstitium. This structural specificity indicates the extensive and rapid transport of lymph via the perisinusoid Disse spaces into the blood stream of the hepatic sinusoids, also lacking lamina basalis. Mall's space and the system of interhepatocytic spaces form a continuous system which is in close but not direct contact with the incipient intrahepatic lymphatic capillaries.

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The authors investigated the importance of ankle pressure indices (aPi), peroperative blood flow and angiographic findings on peripheral arteries for the long-term patency of F-P venous bypasses. They found that neither the preoperative value of aPi nor the size of the peroperative flow through the bypass has an impact on the long-term patency of the reconstruction. As a result of general factors which lead to progression of the atherothrombosis in the arterial circulation in the implanted bypass, obstructions of the reconstruction occur even in patients with high preoperative aPi values and with a major preoperative flow, with patent peripheral arteries at the time of operation. To improve long-term results after implantation of F-P venous bypasses therefore above all prevention of the progression of atherosclerosis is essential.

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In 284 patients after angioplasty of the aortoiliac vessels postoperative angiography discovered complications in 63 cases (22%), most frequently in case of prostheses at the bifurcation. Late thrombosis was the prime complication. In 221 patients with reconstructions in the femoropopliteal region complications were found in 24.5% of the cases, most frequently in case of venous bypass (29%). As in the first group, late thrombosis prevailed.

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