Based on two patients suffering from chronic visceral ischemia, the anatomic and pathophysiologic principles prior to surgery are discussed. Antegrade revascularization is supposed to be better hemodynamically. Complete revascularization of multiple arteries seems to be theoretically superior to one-vessel procedures. Within the bypass procedures the aortic-celiac-mesenteric patch bypass could be an excellent surgical possibility combining antegrade with simultaneous revascularization of celiac and superior mesenteric artery.

The histomorphology of carotid plaques with necrotic core and fibrous cap, basic for understanding the concept of unstable high-risk plaques, is presented on MRI in vitro and in vivo. Further clinical studies should follow.

The concentration of biliary IgA is greatly reduced after scald burn injury in the rat, thereby contributing to a deficiency in upper intestinal immune defense. This reduction in biliary IgA might have several explanations, including failure of the transhepatic transport of polymeric IgA (pIgA) from the circulation, decreased delivery of pIgA to the hepatocyte, or decreased local synthesis of IgA in the liver. The authors examined whether burn injury reduces circulating pIgA available for delivery to the hepatocyte. In initial studies, they demonstrated that burn injury induces a decrease in circulating pIgA in bile-duct-ligated rats. They then sought to determine whether this decrease in pIgA was due to increased loss from the circulation or to a decreased supply of pIgA to the circulation through the thoracic duct. After injection of purified 125I-pIgA into bile duct-ligated rats, radioactivity was removed more rapidly from the circulation of burn-injured compared with control rats. The radioactivity localized in the skin and muscle at the site of burn injury. In another group of rats with patent bile ducts, the thoracic duct was cannulated and lymph collected for 12 hours. The total amount of IgA protein in lymph was found to be reduced in burn-injured compared with control animals. Thus, burn injury is accompanied by reduced circulating pIgA, which may be attributed to its enhanced loss from the circulation and to decreased delivery of pIgA from the intestinal mucosa to the systemic circulation via the thoracic duct.

The continuous wave Doppler is a major diagnostic contribution because of its ability to register hemodynamic changes. Additionally, CCDS with its combination of sonomorphology and hemodynamics enables a distinction between HHS and other causes of digital ischemia. The CCDS more precisely refines the indications for preinterventional angiography in acute ischemia syndromes of the hand.