軸索鞘接合による神経軸索即時再建のためのイカ巨大軸索in vivo実験モデルの確立

学位の種別: 論文博士審査委員会委員 : （主査）東京大学教授 高戸 毅, 東京大学教授 大友 邦, 東京大学教授 牛田 多加志, 東京大学准教授 星 和人, 東京大学講師 吉村 浩太郎University of Tokyo(東京大学

Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs

BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI

イカ巨大軸索・マウス軸索を用いた即時軸索機能回復のための軸索融合法に関する研究

application/pdfイカを用いて、巨大軸索クランプおよびクランプ解除・再疎通後の神経再結合を模した機能回復過程と軸索輸送変化を直視下に電気生理学的手法・蛍光イメージングを用いて形態学的・電気生理学的に軸索機能観察実験を行った。 活イカを新たな神経ブロック半身麻酔の開発と巨大軸索clamp解除時間と機能回復までの時間とを計測し、機能回復のための最適時間を得た。Clamp時に軸索内へカルシウムの流入が示唆され、流入コントロールすることも軸索融合を行う上で重要であることが分かった。またGFPマウスを用いて、ミトコンドリアの軸索内輸送の観察を行い、コントロールデータを得た。With using squid, function recovery process of a nerve re-connection was observed after claming and unclamping. Changes in axonal transport were directly observed using fluorescence imaging and electro-physiological techniques. We developed a new nerve block hemi-anesthesia for squid in vivo and measured the time to release the giant axon clamp and the time to recover function. The influx of calcium into the axons was suggested during clamp. Controlling influx is also important for an axonal fusion. In addition, GFP mice were used to observe the transport of mitochondria into axons, and control date were obtained.2016年度～2019年度科学研究費補助金(基盤研究(C))研究成果報告書16K1136

Hemi-Intravascular Stenting for Supermicrosurgical Anastomosis

Background:. Although supermicrosurgical anastomosis is a widely known reconstructive microsurgical technique, it is difficult to perform. To expand the clinical use of supermicrosurgery, we used hemi-intravascular stenting (hemi-IVaS), which is performed by inserting an intravascular stent into one side of the vessel. We conducted lymphaticovenular anastomosis, free perforator flap transfer, and fingertip replantation with supermicrosurgical anastomosis using hemi-IVaS technique and examined its usefulness. Methods:. Between January 2013 and February 2015, 11 anastomoses in 11 cases of lymphaticovenular anastomosis for lymphedema patients, 14 anastomoses in 7 cases of free perforator flap transfer with supermicrosurgical perforator-to-perforator anastomosis, and 9 anastomoses in 5 cases of fingertip replantation were performed using hemi-IVaS. Time required for anastomosis and complications were examined. Flap survival rate was also examined in free perforator flap transfer cases and fingertip replantation cases. Results:. In all cases, anastomoses were performed without complications such as inadvertent catching of the back wall of the vessel during the procedure or the need for reanastomoses. The average time required to complete the anastomosis was 16.4 ± 3.20 minutes using the hemi IVaS technique. All flaps survived in the supermicrosurgical perforator-to-perforator anastomosis as well as fingertip replantation cases. Conclusions:. Hemi-IVaS could be a useful alternative to conventional intravascular stenting techniques and is also effective for supermicrosurgical perforator-to-perforator anastomosis. Further studies are needed to improve the success rate and to explore its other possible utilizations in supermicrosurgery

Local Flaps with Negative Pressure Wound Therapy in Secondary Reconstruction of Myelomeningocele Wound Necrosis

Summary:. Major wound necrosis is an uncommon yet critical complication of meningomyelocele surgical repair with few reports available. Management is demanding and often requires further reconstructive surgery. We report a case of a neonate who developed extensive wound necrosis with dehiscence following primary repair of myelomeningocele. The large defect was reconstructed using transposition fasciocutaneous flaps and negative pressure wound therapy applied over the flap donor sites resulting in wound closure, alleviating the need for further surgery. We report this case to highlight the importance of local flap design in reconstruction of the complex wounds seen following meningomyelocele repair wound necrosis. Additionally, we report the unique utilization of negative pressure wound therapy in the management of myelomeningocele

Side-to-End Lymphaticovenular Anastomosis through Temporary Lymphatic Expansion

<div><p>Objective</p><p>The number of bypasses is the most important factor in lymphaticovenular anastomosis (LVA) for lymphedema treatment. Side-to-end (S-E) LVA, which can bypass bidirectional lymph flows via one anastomosis, is considered to be the most efficient bypass, but creation of lateral window to a small lymphatic vessel is technically demanding. To overcome the difficulty, we introduced S-E anastomosis through temporary lymphatic expansion (SEATTLE) procedure in S-E LVA.</p><p>Methods</p><p>This was a retrospective observational study set in a teaching hospital. Forty eight lower extremity lymphedema (LEL) patients underwent LVA. S-E LVAs were performed with (SEATTLE group) or without (non-SEATTLE group) temporary lymphatic expansion. S-E LVAs were evaluated to compare anastomosis result in SEATTLE and non-SEATTLE groups.</p><p>Results</p><p>S-E LVAs resulted in 44 anastomoses in SEATTLE group (n = 25) and 37 anastomoses in non-SEATTLE group (n = 23). LEL index reduction in SEATTLE group was significantly greater than that in non-SEATTLE group (16.5±14.5 vs. 10.9±11.8, <i>P</i> = 0.041). Success rate of S-E LVA in SEATTLE group was significantly higher than that in non-SEATTLE group (95.5% vs 81.1%, <i>P</i> = 0.040). Thirty seven of 44 (84.1%) lymph vessels in SEATTLE group were successfully dilated by temporary lymphatic expansion maneuver. All of 9 failed S-E LVAs used a lymphatic vessel with diameter of 0.35 mm or smaller.</p><p>Conclusions</p><p>The SEATTLE procedure facilitates S-E LVA by a simple and easy maneuver. When the diameter of the lymphatic vessel is 0.35 mm or smaller even after the temporary lymphatic expansion maneuver, S-E LVA is not recommended due to relatively high failure rate.</p></div