An Experimental Study of the Sleeve Technique in Graft Anastomosis

The effects of a sleeve anastomotic technique (SL), which was designed to avoid intimal injury, on the healing characteristics of a polytetrafluoro-ethylene (PTFE) graft were compared with the effects of the conventional end-to-end anastomotic technique (ETE). A segment of canine abdominal aorta was replaced with a PTFE graft. The grafts were explanted after 4 months and the anastomotic portion was examined macroscopically and by light microscopy. The animals were divided into 4 groups (A to D) according to the combination of the anastomotic methods (ETE or SL) used for the proximal and distal anastomosis. No substantial difference was found between the proximal and distal anastomosis for either ETE or SL. The pulling tests between the PTFE graft and the excised segment of the abdominal aorta revealed no significant difference in the breaking loads between ETE and SL. Macroscopic and microscopic examination revealed that SL resulted in better and more regular neointimal extension on the luminal surface of the PTFE graft. The results suggest that SL is less traumatic to the endothelium of the host artery and may be effective in preventing postoperative intimal hyperplasia

Experimental Assessment of Restoration of the Bronchial Artery in Sleeve Lobectomy Combined with Pulmonary Angioplasty

The restoration of the bronchial artery after bronchoplasty combined with pulmonary angioplasty was studied in relation to the degree of stenosis of the pulmonary artery by means of the microangiographic technique. Thirty-three dogs were used in this study. They were divided into Group A (15 dogs) with sleeve lobectomy alone, Group B (10 dogs) with sleeve lobectomy and a 50% stenosis of the left main pulmonary artery and Group C (8 dogs) with sleeve lobectomy and a 75% stenosis of the left main pulmonary artery. The restoration of the bronchial artery was assessed by microangiography. 1) The restoration of th bronchial artery after bronchoplasty was completed on day 14. The trend toward a ready regeneration of the bronchial artery becomes apparent if some degree of stenosis of the pulmonary artery exists after a duration of seven days. 2) The interrupted bronchial artery starts to restore at the adventitial face and extends throughout the whole wall of the bronchus after the 7th day. 3) From these results, an operative procedure of sleeve lobectomy with pulmonary angioplasty is applicable even though stenosis of the pulmonary artery remains to some degree

Changes in Esophageal Blood Flow by Esophageal Transection with Devascularization

Changes in the blood flow in the wall of the esophagus were experimentally measured with the use of the hydrogen clearance method to evaluate the influence of operative procedure by transectional esophago-esophagostomy with paraesophageal and perigastric devascularization in the treatment of esophageal varices. As a result of this study, an approximately 30% reduction in blood flow of the adventitia was confirmed according to the procedure of paraesophageal devascularization. When performing a further procedure of esophageal transection, total blood flow was reduced to 50%. It is logical to conclude that the marked decrease in blood flow in the wall of the esophagus offers a great opportunity for the development of postoperative anastomosis insufficiency. It is of interest to note that the incidence of postoperative complications in the performance of this operation for esophageal varices has become significant on the basis of blood flow changes in the wall of the esophagus

Surgical Treatment of Acquired Tricuspid Regurgitation with Carpentier\u27s Ring

Between 1976 and 1982, nine patients underwent tricuspid annuloplasty with use of CARPENTIER\u27s ring for acquired tricuspid regurgitation associated with mitral valvular diseases or ruptured aneurysm of the sinus VALSALVA. Of these, one patient died of low cardiac output and respiratory failure. Postoperative cardiac functions were evaluated on remaining eight patients by physical examinations, findings of roentgenogram and contrast echogram. No postoperative regurgitation of the tricuspid valve was detected by contrast echogram in any of the five patients who received this examination after operation. In six of the eight patients, postoperative physical activity improved to grade I of the classification of NYHA, whereas the improvement was limited to grade II in two other patients in whom some forms of the left side cardiac lesions (e. g. mitral regurgitation) still seemed to remain

Hyperbaric Lung Preservation with Hypothermia

The tolerable period of ischemia to canine lung were evaluated in preservation at hyperbaria of 3 atomospheres (absolute 3 at.) and 7 at. fed with oxygen or nitrogen gases. 1) Three atomospheres (absolute) protect lung transplant from ischemic damage up to 12 hours. 2) A 72 hour preservation lung at three atomospheres of nitrogen gas provided lung function after allografting in only one. This led us to know effectiveness of hyperbaria at three atomospheres

Ulceration of Leg Associated with Therapeutic Femoral Arteriovenous Fistula

We treated a rare case of stasis ulceration of the leg due to surgically induced femoral arteriovenous fistula. The patient is a 24-year-old Japanese man who had poliomyelitis in his infancy and had a sequela of short left lower limb. At ten years of age he underwent surgical creation of a femoral arteriovenous fistula at another hospital to accelerate the bone growth. Although the operation was effective on the growth of the impaired extremity, stasis signs progressed in the left leg and an ulceration developed 14 years after operation. We closed the fistula restoring the arterial and venous continuities, which was followed by a rapid healing of the ulcer

Long-Term Results of Open Mitral Commissurotomy : Effects of Pathologic Features and Surgical Techniques

Of the 174 patients with mitral stenosis (MS) who underwent open mitral commissurotomy (OMC) at Nagasaki University Hospital between 1971 and 1988, the cases of the 50 pure MS patients who underwent OMC alone as the first operation were retrospectively investigated, and the indications for OMC in these MS patients were evaluated. According to the pathological features of the mitral valve (Types I-III) and operative methods used (r: radical OMC, c : conservative OMC), the patients were classified into 4 groups, groups I, IIr, IIc, and III, and we compared the changes in the mitral valve area before and after the operation and the cardiac functions and clinical status in the late postoperative period in these groups. In all groups, the mitral valve area was significantly increased in the early postoperative period, then gradually decreased, but on average it remained larger in the late postoperative period than before the operation. However, significantly larger mitral valve areas were maintained in the late postoperative period than those before the operation only in groups I and IIr. Group IIr showed the highest % increase of the valve areas in the late postoperative period. Furthermore, group IIr maintained the best NYHA cardiac function classes and the highest percentage of normal sinus rhythm on electrocardiograms in the same period. These results suggested that OMC was effective in the Types I and II MS patients, and the complete removal of subvalvular fusions with debridement of calcified foci was considered to be particularly effective for Type II patients to maintain the favorable operative effects and high quality of life for a long period

A CASE OF REPLACEMENT OF THE ABDOMINAL AORTIC ANEURYSM

This is a report on a case of successful replacement of abdominal aortic aneurysm with a crimped Dacron graft. The prognosis of such a disease is said to be very poor, and it is generally accepted that a surgical replacment of the aneurysm is the only reliable treatment at present. Therefore the importance of early diagnosis and surgery must be stressed

Surgical Treatment for Pulmonary Metastases

This study is based on 29 patients undergoing resection for pulmonary metastases from 1960 to 1981 in our clinics. Factors concerning their prognosis are discussed in this study. 1) Prognosis following surgery is associated with the origin of the primary disease, the sizes and numbers of pulmonary metastases, and the disease-free period. 2) Pulmonary metastases arising from original tumors with slow growth rate, such as thyroid cancer, breast cancer, and some of osteogenic sarcomas, are favorable candidates for surgical treatment. 3) Operative methods of choice are not essential in anticipating better results. Complete removal of the tumor is required. We assume that improved chemotherapy may be contributary to a gain in a longer survival

Resuscitation from Cardiac Arrest, Occuring During Cardiac Catheterisation : A

This is the report of a case of successful cardiac resuscitation following cardiac arrest during cardiac catheterisation, treated with brain cooling, 12 minutes having elapsed between the arrest and initiation of cardiac massage