Platelet adhesiveness related to long-term graft patency
1
880 BRIT. J. SURG., 1966, Vol. 53, No. 10, OCTOBER who implanted autografts of abdominal turnours beneath the skin of the thigh in the hope of stimulat- ing resistance, or the procedures of Gorodilova and others (1965) who have recently reported their 10-year figures for breast carcinoma in Muscovite women treated by vaccination. Assay of the patient’s R.E. functional state would allow assessment of, indication for, and rationalization of such procedures. Ross (1966), in a retrospective study of 200 cases of carcinoma of the breast, has shown a close correla- tion between 10-year survival and the axillary node content of silver-staining reticular cells, which he divided into four grades. It may well be that he was determining a measure of biological time, by which is meant a compounding of host resistance and tumour aggressiveness, and that an untreated patient would progress from one grade to another. If this is so, and if there is a critical point, as with the mouse model, then it would be of the utmost impor- tance, for it would modify therapy and indicate outcome. The experimental work described in this paper was started in the laboratories of the Surgical Clinic of Montreal General Hospital and continued in the Dunn Laboratories at St. Bartholomew’s Hospital. I would like to acknowledge my indebtedness to the heads of these departments, Dr. F. Gurd and Professor G. W. Taylor respectively, for their support, interest, and encouragement. REFERENCES ASCHOFF, L. (I924), Lectures in Pathology. New York: BERENBAUM, M. C. (1965), Br. med. Bull., 21, 140. BILLINGHAM, R. E., and BRENT, L. (1g57), Transplantn Hoeber. Bull., 4, 67. (I955),J. Path. Bact., 69, 299. FOLEY, E. J. (I953), Cancer Res., 13, 835. GLEDHILL, A. W., DICK,G. W., and NIVEN, J. S. F. GORODILOVA. V. V.. SILINA, I. G., and SARAEVA, Z. M. (1965), Vop. Onkol., 2, 22. GRAHAM, J. B., and GRAHAM, R. M. (I955), Cancer, N.Y., GROSS, L. (1943), Cancer Res., 3, 326. HADDOW, A. (1965), Br. med. Bull., 21, 133. ISHIBASHI, Y., HATTORI, T., FUJII, G., OKADA, K., SEKIGUCHI, M., ASHIKAWA, K., and MOTOYA, K. (1961),Jap.J. exp. Med., 31, 319. LOWRY, 0. H., ROSEBROUGH, N. J., FARR, A. L., and RANDALL, R. J. (I~sI), 3. biol. Chem., 193, 265. METCHNIKOFF, E. (1905), Immunity in Znfective Disease (trans. BINNIE, F. G.). Cambridge : University Press. OLD, L. J., and BOYES, E. A. (1964), A. Rev. Med., 15,167. Ross, H. B. (1966), personal communication. SOLOWEY, A. C., and RAPAPORT, F. T. (1965), Surgery STANSLY, P. G., RAMSAY, D. S., and NEILSON, C. F. 8, 409. Gynec. Obstet., I2 I, 756. (1962), Proc. SOC. exp. Biol. Med., 109, 264. PLATELET ADHESIVENESS RELATED TO LONG-TERM GRAFT PATENCY BY GEOFFREY EVANS ST. MARY’S HOSPITAL, LONDON [This is an abstract of the paper read at the meeting.*] THERE is considerable evidence to show that the adherence of platelets to the vessel wall and to each other is a fundamental step in the formation of the thrombi from flowing blood. Indeed thrombi will not form in flowing blood of animals rendered thrombo- cytopenic by immunological methods or in extra- corporeal shunts of pigs rendered thrombocytopenic. These platelet emboli on the vessel wall can be incorporated into the intima by being overgrown with endothelium. They can then give rise to thicken- ing of the intima, a condition so often seen in early stages of atheroma. Experimental evidence shows that the rapid adherence of platelets to the endothelium and sub- endothelial tissues at points of damage is due to the release of adenosine diphosphate. ADP is highly specific for causing platelet aggregation. Considering then that platelet aggregation may be an early stage in thrombosis, we undertook a retro- spective study on a group of patients who had had a femoro-popliteal graft inserted for superficial femoral * The full contents of the paper was published in The Lancet,(1g66), 2, 353. artery thrombisis. Platelet adhesiveness was measured using the Hellem technique. Owren and his associates have studied this for some years and found that the platelet adhesiveness is constant in a given patient over a period of years. The results of this study show a significant difference between the group under study and a control group of patients (0.005 <P<o.ooI). There is also a significant difference (0.005 >P> 0.001) between the patent grafts and the thrombosed grafts. We also consider that one can use this test to predict the duration of long-term patency. We have undertaken a forward-progressing study on a group of patients who have had femoro-popliteal grafts inserted and the results are very similar to those attained in the retrospective study. As platelet adhesiveness seemed to bear a direct relationship to late failure of a graft it was thought pertinent to study the effect of the reduction of platelet adhesiveness on the longevity of graft patency. Owren and his associates published in 1965 the use of linseed oil containing linolenic acid for this purpose. In a controlled blind trial, however, linseed oil was not found to have any significant effect on platelet adhesiveness.
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Transcript of Platelet adhesiveness related to long-term graft patency
880 BRIT. J. SURG., 1966, Vol. 53, No. 10, OCTOBER
who implanted autografts of abdominal turnours beneath the skin of the thigh in the hope of stimulat- ing resistance, or the procedures of Gorodilova and others (1965) who have recently reported their 10-year figures for breast carcinoma in Muscovite women treated by vaccination. Assay of the patient’s R.E. functional state would allow assessment of, indication for, and rationalization of such procedures.
Ross (1966), in a retrospective study of 200 cases of carcinoma of the breast, has shown a close correla- tion between 10-year survival and the axillary node content of silver-staining reticular cells, which he divided into four grades. I t may well be that he was determining a measure of biological time, by which is meant a compounding of host resistance and tumour aggressiveness, and that an untreated patient would progress from one grade to another. If this is so, and if there is a critical point, as with the mouse model, then it would be of the utmost impor- tance, for it would modify therapy and indicate outcome.
The experimental work described in this paper was started in the laboratories of the Surgical Clinic of Montreal General Hospital and continued in the Dunn Laboratories at St. Bartholomew’s Hospital. I would like to acknowledge my indebtedness to the heads of these departments, Dr. F. Gurd and
Professor G. W. Taylor respectively, for their support, interest, and encouragement.
REFERENCES ASCHOFF, L. (I924), Lectures in Pathology. New York:
BERENBAUM, M. C. (1965), Br. med. Bull., 21, 140. BILLINGHAM, R. E., and BRENT, L. (1g57), Transplantn
Hoeber.
Bull., 4, 67.
(I955),J. Path. Bact., 69, 299.
FOLEY, E. J. (I953), Cancer Res., 13, 835. GLEDHILL, A. W., DICK, G. W., and NIVEN, J. S. F.
GORODILOVA. V. V.. SILINA, I . G., and SARAEVA, Z. M. (1965), Vop. Onkol., 2, 22.
GRAHAM, J. B., and GRAHAM, R. M. (I955), Cancer, N.Y.,
GROSS, L. (1943), Cancer Res., 3, 326. HADDOW, A. (1965), Br. med. Bull., 21, 133. ISHIBASHI, Y., HATTORI, T., FUJII, G., OKADA, K.,
SEKIGUCHI, M., ASHIKAWA, K., and MOTOYA, K. (1961),Jap.J. exp. Med., 31, 319.
LOWRY, 0. H., ROSEBROUGH, N. J., FARR, A. L., and RANDALL, R. J. ( I ~ s I ) , 3. biol. Chem., 193, 265.
METCHNIKOFF, E. (1905), Immunity in Znfective Disease (trans. BINNIE, F. G.). Cambridge : University Press.
OLD, L. J., and BOYES, E. A. (1964), A . Rev. Med., 15,167. Ross, H. B. (1966), personal communication. SOLOWEY, A. C., and RAPAPORT, F. T. (1965), Surgery
STANSLY, P. G., RAMSAY, D. S., and NEILSON, C. F.
8, 409.
Gynec. Obstet., I 2 I, 756.
(1962), Proc. SOC. exp. Biol. Med., 109, 264.
PLATELET ADHESIVENESS RELATED TO LONG-TERM GRAFT PATENCY
BY GEOFFREY EVANS ST. MARY’S HOSPITAL, LONDON
[This is an abstract of the paper read at the meeting.*]
THERE is considerable evidence to show that the adherence of platelets to the vessel wall and to each other is a fundamental step in the formation of the thrombi from flowing blood. Indeed thrombi will not form in flowing blood of animals rendered thrombo- cytopenic by immunological methods or in extra- corporeal shunts of pigs rendered thrombocytopenic.
These platelet emboli on the vessel wall can be incorporated into the intima by being overgrown with endothelium. They can then give rise to thicken- ing of the intima, a condition so often seen in early stages of atheroma.
Experimental evidence shows that the rapid adherence of platelets to the endothelium and sub- endothelial tissues at points of damage is due to the release of adenosine diphosphate. ADP is highly specific for causing platelet aggregation.
Considering then that platelet aggregation may be an early stage in thrombosis, we undertook a retro- spective study on a group of patients who had had a femoro-popliteal graft inserted for superficial femoral
* The full contents of the paper was published in The Lancet,(1g66), 2, 353.
artery thrombisis. Platelet adhesiveness was measured using the Hellem technique. Owren and his associates have studied this for some years and found that the platelet adhesiveness is constant in a given patient over a period of years.
The results of this study show a significant difference between the group under study and a control group of patients (0.005 <P<o.ooI). There is also a significant difference (0.005 > P > 0.001) between the patent grafts and the thrombosed grafts.
We also consider that one can use this test to predict the duration of long-term patency. We have undertaken a forward-progressing study on a group of patients who have had femoro-popliteal grafts inserted and the results are very similar to those attained in the retrospective study.
As platelet adhesiveness seemed to bear a direct relationship to late failure of a graft it was thought pertinent to study the effect of the reduction of platelet adhesiveness on the longevity of graft patency. Owren and his associates published in 1965 the use of linseed oil containing linolenic acid for this purpose. In a controlled blind trial, however, linseed oil was not found to have any significant effect on platelet adhesiveness.
