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BACKGROUND: Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg-1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported. METHODS: Retrospective, observational study involving all patients treated with high-dose GIK after cardiac surgery during one year in a cardiovascular center at a University Hospital. RESULTS: Eighty-nine patients out of 854 adult patients undergoing cardiac surgery were treated with high-dose GIK. Mean age was 69 +/- 1 years, Higgins score 5.3 +/- 0.3. Preoperatively 31.4% had left ventricular function EF< or =0.35 and 32.5% had sustained a myocardial infarct during surgery. Mortality was 5.6% and the average ICU stay was 3.7 +/- 0.5 days. The main indication for GIK was intraoperative heart failure (69.7%). The average glucose infusion rate during the first 6 h was 4.22 +/- 0.15 and 4.91 +/- 0.14 mg kg-1 b.w.*min, respectively, in diabetic and non-diabetic patients (P = 0.023). Blood glucose and s-potassium control was acceptable. CONCLUSIONS: The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.

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At present more and more surgeons are using the radial artery as a graft for coronary bypass. The statistics until now show that the patency of radial grafts exceeds that of the venous grafts used up to the present. In our department we used radial artery for coronary bypass in 515 patients between January 1990 and December 2000. The radial artery harvesting with minimally invasive technique developed by us was applied in 50 of these patients while the rest were performed with the traditional method. No ischemic complications occurred in forearm or hand following either of the methods. One year after the operation we carried out control examinations on 197 consecutive patients. Our surveys showed that following the traditional technique of radial artery harvesting neurological complications (temporary dysaesthesia) occurred in 16.5% of the patients. After the minimally invasive procedure, temporary dysaesthesia occurred in one case (2%). These complaints ceased within 1-12 months (an average of 3.8 months). Definitive neurological complications did not occur in any of the patients. In summation, we experienced that both operating techniques can be safely applied. The proportion of temporary neurological complications is higher following the traditional procedure, therefore, further development and application of the minimally invasive procedure should be considered.

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Ten dogs underwent coronary artery bypass grafting through a right thoracotomy. Free internal mammary artery grafts (IMA) was used for aortocoronary bypass to right coronary artery (RCA) without temporary cardiopulmonary bypass. In upper median laparotomy approach, mobilization and lengthening of the omentum was performed through the retrosternal part of the diaphragm. An epiploic muff was effectuated surrounding the IMA graft. After three months the animals were sacrificed and the grafts folded by omentum were used for microscopical study. The histological evaluation has shown that the omentum has formed a new adventitia around the graft. In the new-formed adventitia, newly formed vessels can be found and these are grouped around the adventitia-media border zone, very rarely penetrating into the external layer of the media. This graft-omentoplasty offer a good experimental model which facilitates to investigate in vivo the blood supply needed by free IMA grafts through the adventitia in experimental conditions. The biological mechanism of angiogenesis in graft wall can be investigate as well.

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Authors give a brief description of a case of adult polycystic disease of the lung which was diagnosed by chest X-ray, real-time abdominal ultrasound and fluoroscopy.

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Corpus adiposum buccae (c.a.b.) was studied on 42 human subjects (fetuses and adults) using microdissection under magnifying glass after injection of the great vessels of the head with plastics, transparency technique of Spalteholtz and current histological methods. In fetuses, c.a.b. appeared as a well-developed mass located between Buccinator and inferior border of the Masseter. In adults, it emanated three prolongations among which the anteriorly directed molar prolongation was more conspicuous in edentulous old people. Externally, it was covered by a fine conjunctival wrap, which sent septa dividing the buccal fat pad in a series of minute fibroadipous compartments. C.a.b. contained a rich vascular network deriving from the branches of the facial and maxillary arteries. In this vascular net a more developed artery emanated branches to the prolongations of the c.a.b. The veins were tributaries of the pterygoid venous plexus. Beside the vessels, c.a.b. contained also lymphatics and myelinated nerves. The authors postulated that c.a.b. assumed the following functions: a) It filled up the masseter-zygomaticus-buccinator space forming an amortizing and a slipping platform for the masticatory muscles in action; b) in the baby, it resisted to the negative pressure which acted into the buccal cavity during sucking; c) its rich venous net, provided with valve-like structures, may be implicated in the exo-endocranial blood flow by means of the pterygoid plexus.

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Two cases with arteria lusoria were found at 278 routine dissections. These arteria arise as the last branches of the aortic arch and have a retroesophageal position. At the crossing point, the esophagus narrows due to the groove caused by the artery. The appearance of this malposition is the consequence of the perturbation in the organo-genesis of the right dorsal aorta and fourth branchial artery. The aberration can lead to disphagia lusoria.

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Two cases of ureteral endometriosis and 1 case of vesical endometriosis are reported and a short review of the literature is presented. The diagnostic problems, despite modern image procedures, and therapeutic modalities are discussed.

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The sublobular artery arises from the arcuate artery, as a constant vessel possessing its proper personality, giving 2 equal subdivisions, from which part the interlobular arteries. The sublobular arteries are characterized by a particular origin and branching type, having no or sporadically disposed glomeruli. Occasionally, arteriae interlobulares derive directly from the arcuate artery too. The authors suggest the acception of term "Arteria sublobularis " in the international nomenclature of the renal vessels. According our opinion the canine kidney is composed of a number of conical units, containing in their axis a sublobular artery of 2nd order. Certain theoretical and practical aspects of this new conception are briefly discussed.

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The pterygoid venous plexus (pt.v.pl.) was studied in 54 human heads (adults, children, fetuses) halved in the middle sagital plan, using microdissections and injections with PVC, coloured gelatin and roentgenopaque masses. In adults, the pt.v.pl. was closely related to the external pterygoid muscle. The superficial variant (more frequent) maintained connections with the facial vein through a venous network named by us "plexus pterygo-temporo-buccalis". The deep variant (less frequent) could be included in the system of venous plexuses placed at the basis cranii. Its tributaries, accompanying the lingual nerve, established connections with the veins of the sublingual compartment (a fact not yet mentioned in the literature). In children and old humans the pt.v.pl. was formed only by some large veins giving a radiate structure ("starfish-shaped" plexus) corresponding to the first and second portion of the maxillary artery. These results revealed that the pt.v.pl. is a unique formation which could be more developed laterally or medially in comparison with the external pterygoid muscle, in relation with the superficial or deep position of the maxillary artery. The practical importance of the pt.v.pl. is emphasized.

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The configuration and morphological features of the coronary sinus (c.s.) were studied on 54 human adult hearts. The c.s. has on an average 36 mm in length and 9 mm in diameter. The most frequent is the cylindrical configuration (67%), then follows the so-called "wafer" form (19%) and the funnel shaped c.s. (13%). The valve of Vieussens was present in 78%, but well developed only in 6% of the cases. The classical opening of the middle and small cardiac veins into c.s. was remarked in 28%; for the rest the particular forms described in this work make themselves obvious. The large tributaries of c.s. are provided with ostial valves in a percentage of 41%. The form and dimensions of the Thebesius valve are very variable; it is absent in 9% of the cases. The Marshall's vein appears as an obturated cord in a proportion of 20%. In each case there was found on the surface of the c.s. a myocardial coat, consisting of two layers, which form a device having probably a constrictive function during the atrial systole.

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The corrosion technique was used to demonstrate the presence of the "sublobular artery", a constant vessel with a special profile of the dog kidney, generating after two divisions the so-called interlobular arteries as a third generation of branches. More rarely arteriae interlobulares emerge also directly from the arcuate artery. The sublobular arteries (= parent vessels of the interlobular arteries) are characterized by their particular origin, branching type, and by having no or sporadically disposed glomeruli. For this reason, the authors suggest the acception of the term "arteria sublobularis" in the international nomenclature of renal vessels. According to authors' opinion the dog kidney is composed of a number of conical vascular-parenchymatous units, each containing in their axis a sublobular artery of the second order ("conical" architectonics of the renal cortex).

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Many authors described in detail the morphological features of human venous valves, but less their functional architecture. The present study provides additional information concerning the valvular anatomy, to enable its functional interpretation. The previously reported data and the author's results showed the regional distribution and characteristics of venous valves in different areas of the human body. Certain findings suggested a reorganization after birth of the venous valves which are frequently met in fetus. The close relation between hemodynamic mechanisms and the blood guiding structures may explain the changes (disappearance or persistence) of venous valves in some areas after birth. Significance of the rudimentary folds, resembling valves, is not yet elucidated. Based on his observations, the author attempted a new classification of the veins. The relations between density and morphological peculiarities of venous valves in different vein types showed that the constant valves were always involved in the local hemodynamics. Bardeleben's principles referring to the location and topographical arrangement of venous valves can be applied only to certain areas of the limbs, but not to other regions. In this paper there are described and functionally interpreted the venous valves of all territories of the human body.

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The regenerative morphogenesis of intrahepatic biliary ducts in subtotally hepatectomized rats was studied at 3, 7, 14 and 21 days after operation. Histological findings showed that during the postmitotic stage of hepatoregeneration, between the 1st and 2nd postoperatory week the regenerated biliary structures appeared in close connection with the newly formed vasculo-connective portal spaces. The poorly differentiated periportal cells generated through a gradual metamorphosis the bordering cells of the regenerating intrahepatic biliary ducts. These plead for the similarity of histogenetic mechanisms in regenerative and embryofetal cholangiogenesis.

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