Enhanced neovascular formation in a novel hydrogel matrix consisting of citric Acid and collagen.

BACKGROUND: Three-dimensional regenerative tissue with large bulk generally requires blood perfusion through a vascular network to maintain its viability, and one promising approach is induction of neovascular growth from the recipient bed into the tissue. To induce ingrowth of a vascular network, it is necessary to furnish the regenerative tissue with a scaffold structure for neovasculature and a delivery system for an angiogenic growth factor. As such a scaffold structure, the present study created novel hydrogel materials by chemically cross-linking alkali-treated collagen (AlCol) with trisuccinimidyl citrate (TSC). MATERIALS AND METHODS: Many prototypes, consisting of several concentrations of TSC and AlCol, were implanted into the subfascial space of the rat rectus muscle, and 7 days later, the implanted materials were excised for histological analysis. Cross-sections were stained and neovascular development in the materials was evaluated by measuring vessel density, length and number of joints and branches. RESULTS: Significant ingrowth of vascularized granulation was observed in some materials, which surpassed the angiogenic ability of Matrigel(TM). Further, combination with basic fibroblast growth factor (bFGF) significantly increased the vascular formation in these gels. CONCLUSIONS: The TSC-AlCol gel functioned as a favorable scaffold for neovascular formation and also as a reservoir for controlled delivery of bFGF.

Gallbladder perforation associated with carcinoma of the duodenal papilla: a case report.

BACKGROUND: Gallbladder perforation is a rare clinical condition, which mostly occurs following acute cholecystitis associated with cholelithiasis. A tumor of the ampulla of Vater causes gradually progressive symptoms, and is rarely associated with perforation of the gallbladder. CASE PRESENTATION: A 56-year-old man with carcinoma of the ampulla of Vater presented with spontaneous gallbladder perforation and localized bile peritonitis. He complained of right upper abdominal pain, and laparotomy revealed perforation of the gallbladder with no gallstones. Postoperative upper gastrointestinal endoscopy demonstrated a slightly enlarged duodenal papilla, and biopsy revealed adenocarcinoma of the ampulla. Pylorus-preserving pancreaticoduodenectomy was performed subsequently. CONCLUSION: Ampullary carcinoma can be associated with gallbladder perforation and present with acute manifestations. Immediate surgical treatment is required for this condition.

Do inferior vena cava filters reduce the risk of acute pulmonary embolism in preoperative patients with venous thromboembolism?

PURPOSE: Although prophylactic anticoagulants reduce the risk of acute pulmonary embolism (PE), inferior vena cava filters (IVCF) remain elusive in prophylactic use. This study investigated whether IVCF in addition to anticoagulants augment the prophylactic effect on acute PE in the highest-risk patients. METHODS: This study included patients with existing venous thromboembolism (VTE) or a history of previous PE, who underwent subsequent surgery for the underlying disease. The hospital records of the patients were reviewed. RESULTS: Forty-nine consecutive patients treated from October 2001 to June 2007 were assessed, including 13 men and 36 women with a mean age of 58.1 years. The underlying diseases that required surgery included malignancy in 23, orthopedic disorder in 14, and others in 12. All patients received anticoagulants, with perioperative IVCF in 31 patients or without in 18. Neither group had any fatal complications. The no-filter group had no cases of recurrent PE, whereas the filter group had one case of recurrent PE just after placement of the filter. Moreover, 5 cases in the filter group had filter-related complications. CONCLUSION: This study suggested that the addition of IVCF to anticoagulants does not provide a substantial risk reduction for perioperative patients with VTE prior to surgery.

Long-term outcome after surgical treatment of arterial lesions in Behçet disease.

OBJECTIVE: Surgical treatment of arterial lesions associated with Behçet disease (BD) is often complicated by graft occlusion and recurrence of aneurysms. The purpose of this study was to clarify the long-term outcome of surgical intervention for arterial involvement in BD. METHODS: Ten patients with BD (9 men, 1 woman) who underwent surgical treatment for arterial aneurysms between 1980 and 2004 were included in the study. The age of patients at the first operation ranged from 36 to 69 years (mean, 50.4 +/- 9.0 years). The mean period between the onset of BD and that of arterial manifestations was 8.0 +/- 5.0 years. We retrospectively reviewed their postoperative courses, including survival, graft occlusion, formation of anastomotic false aneurysms, and the development of aneurysms at different sites. The Kaplan-Meier method was used to calculate the chronologic incidence of complications after surgery. RESULTS: The mean follow-up period was 133 +/- 92 months, ranging from 5 to 285 months. One patient died of rupture of a dissecting aortic aneurysm after undergoing several surgical interventions for multiple aneurysms. There were five graft occlusions among 21 grafts. The cumulative primary graft patency rate in the infrainguinal region was 83.9% at 3 years. Five anastomotic false aneurysms formed among 49 anastomoses between grafts and host arteries. The overall cumulative incidence of formation of anastomotic pseudoaneurysm was 12.9% at 5 and 10 years. All of them formed within 18 months after surgery. Development of new aneurysms in different arteries was observed in two patients. CONCLUSIONS: Early occurrence of anastomotic false aneurysm is characteristic of BD. Further investigation is necessary to establish effective postoperative treatment.