The effect of hypertonic saline solution on vasodilatation of the superior sagittal sinus using magnetic resonance imaging in normovolemic dogs.

Several animal studies have demonstrated the beneficial effects of hypertonic saline (HSS) on cerebral blood flow, intracranial pressure and brain water content. This study aimed to investigate, using magnetic resonance imaging, whether a small volume of HSS is superior to dextran in vasodilatation of cerebral vessels and reduction of cerebrospinal fluids in dogs. HSS induced a significant expansion of the cross-section of the superior sagittal sinus in the axial transverse section of the pituitary and a decrease in cerebrospinal fluid area in the axial transverse section of the epencephalon more than dextran 40 did (p<0.001, respectively). However, the relative plasma volume in the dog which received dextran 40 was significantly higher after t=30min than in the HSS group (p<0.001). Therefore, it is suggested that HSS might be superior to colloid solutions in improving cerebral circulation, whereas dextran 40 is superior to HSS in enhancing systemic circulation in dogs.

MRI findings of haematomyelia in a dog with spontaneous systemic haemorrhage.

A 7-year-old female cross-breed dog was brought to Nihon University Animal Medical Center for investigation of tetraplegia. Lameness in the pelvic limbs, that had developed 2 weeks previously, had progressed to tetraplegia. On magnetic resonance imaging of the spinal cord, isointensity was detected from C2 to C4 and T12 to T13, isointensity and hyperintensity were intermingled from L3 to L4, and hyperintensity was detected from L5 to L7 by T1-weighted imaging. On T2-weighted imaging, hyperintensity was detected in all regions described above. The dog recovered from anaesthesia, but died during the day from systemic bleeding as the result of a coagulopathy of unknown aetiology. Histopathological examination revealed haematomyelia in these regions of the spinal cord. This is the first report of magnetic resonance imaging findings of haematomyelia in canine spontaneous systemic haemorrhage. It appeared that the differences in the findings of T1-weighted imaging along the spinal regions reflected time-lags in the occurrence of bleeding.

Surface coverage of vascular grafts with cultured human endothelial cells from subcutaneous fat tissue obtained with a biopsy needle.

Surface coverage with autogeneous endothelial cells is effective in reducing thrombogenicity of an artificial vascular graft, but procedure for obtaining the cells is invasive for patients. The purpose of this study was to establish cultures of human endothelial cells separated from a small piece of subcutaneous fat tissue. A piece of tissue weighing about 10 mg was obtained from subcutaneous fat using a biopsy needle, and treated with collagenase and dispase. Microvascular endothelial cells were selected and other types of cells contaminating the cultures were eliminated by scraping with a needle under a microscope. The yield of the cells was 8362 +/- 4264/10 mg of subcutaneous fat (n = 7). The cultures reached confluence in about 2 weeks. The cells were positive for von Willebrand factor, P-selectin, and uptake of acetylated low density lipoprotein. The cells produced 15.9 +/- 3.3 ng/mg cell protein/h of 6-ketoprostaglandin F1 alpha (n = 5) when stimulated with thrombin. Thrombin also stimulated the production of platelet-activating factor: 7653 +/- 4297 dpm/10(6) cells (n = 5). Endothelin-1 accumulation in the medium of unstimulated endothelial cells was 0.54 +/- 0.16 ng/mg cell protein/10 h (n = 8). As a preliminary experiment for graft seeding, the cells were also cultured on pieces of a gelatin-coated Dacron graft, and scanning electron microscopy revealed the surface coverage of the graft. We herein described about successful culture of human microvascular endothelial cells from subcutaneous fat tissue obtained using a biopsy needle. The cultured cells may be applicable to a seeded vascular graft.

Long-term results of aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect.

Long-term results in 64 patients who underwent aortic valvuloplasty for aortic regurgitation associated with ventricular septal defect are presented. The average age of the patients was 10.2 years and the average cardiothoracic ratio was 0.57 at the time of operation. The average degree of aortic regurgitation, as classified by Sellers, was 2.7. The type of ventricular septal defect was subpulmonic in 31 patients, perimembranous in 20, and was a total conal defect in five patients. Valvuloplasty was performed at one end of an aortic cusp in 23 patients, at two ends in 33, at three ends in six, and at four ends in two patients. There was one operative death (1.6%). The follow-up period was 447.7 patient-years, and there were no late deaths. The actuarial survival rate was 98.3% at 5, 10, and 15 years. Postoperative cardiac catheterization was performed in 40 patients. Valvuloplasty failure was defined as the presence of a cardiothoracic ratio greater than 0.6, a loud regurgitant murmur (Levine grade 3/6 or greater), moderate or severe aortic regurgitation (Sellers grade 3 or 4), or the necessity of reoperation. There were 17 patients whose valvuloplasty failed. The freedom from valvuloplasty failure was 74.2% at 5 and 10 years and 55.3% at 15 years. Eight patients underwent reoperation because of residual aortic regurgitation, and all survived. The freedom from reoperation was 90.1% at 5 years, 80.5% at 10 years, and 63.7% at 15 years. Multiple regression analysis revealed that older age, a greater cardiothoracic ratio, perimembranous ventricular septal defect, and multiple valvuloplasties were significant contributing factors for residual regurgitation after aortic valvuloplasty.

Seven-year follow-up study after the replacement of the esophagus with an artificial esophagus in the dog.

An artificial esophagus was made of silicone rubber (Phycon) tube covered with a Dacron mesh. A segment of thoracic esophagus of 16 dogs was replaced with this graft using three different types of anastomosis--overlayer end-to-end anastomosis with flanged tube, two-layer end-to-end anastomosis with flanged tube, and monolayer end-to-end anastomosis with no flange tube. Seven of 16 dogs (44%) survived more than 12 months without complications, four of them surviving more than 6 years. In six of seven of the prolonged survivors, extrusion of the graft was recognized in the 3 to 6 months after operation. Esophageal stricture increased slightly up to 6 months after extrusion of the graft, but it did not further advance until sacrifice. In these dogs, mucosal regeneration of the neoesophagus was complete with muscle layers and mucous glands in the submucosa recognized microscopically. Proximal esophagus from the replaced portion was apparently dilatated more than that of the distal portion. There was no definite difference between the anastomotic techniques with regard to complication or prognosis. These results suggest that this artificial esophagus should be considered as a possibility for clinical trials in the future.

A cooperative randomized controlled study of adjuvant chemoendocrine therapy for breast cancer in Japan.

A randomized trial was carried out in 55 Japanese institutions to examine the significance of postoperative adjuvant chemoendocrine therapy in Stages II and IIIA breast cancer patients after radical mastectomy. A total of 619 patients were entered from November 1982 to November 1984, of whom 554 were eligible. Patients were administered MMC (13 mg/m2) after surgery, and were randomized by the envelope method into either group A (ftorafur, 400 mg/m2/day; 275 patients), or group B (ftorafur, 400 mg/m2/day, and tamoxifen, 20 mg/day; 279 patients). Treatment was continued for 1 year from postoperative day 7. There were no significant differences between the two groups with regard to age, menopausal status, ER status, method of operation, stage, or number of positive lymph nodes. There was also no significant difference between the two groups in the 5-year survival and disease-free survival (DFS) rates (Kaplan-Meier method). Stratification by ER status, nodal status, or menopausal status produced no significant differences between the groups. However, postmenopausal patients and lymph node-positive patients who were also ER-positive showed a significantly higher DFS in group B. Furthermore, group B in ER-positive patients with four or more positive lymph nodes also had a higher survival rate.

Surgical treatment of mesenteric infarction, thoracoabdominal aortic aneurysm, and proper hepatic aneurysm in a middle-aged woman with Takayasu's arteritis.

Although Takayasu's arteritis may present a wide variety of signs and symptoms depending on the vessel affected, it is rarely associated with acute abdomen requiring emergency laparotomy. We report a case of Takayasu's arteritis that required several surgical interventions for mesenteric infarction, thoracoabdominal aneurysm, and proper hepatic artery aneurysm, all of which were noted in succession within a 1-year period. This is also the first report, to our knowledge, of a hepatic artery aneurysm caused by Takayasu's arteritis.

Four cases of lowered urethral pressure in canine ectopic ureter.

To evaluate the function of the constrictor urethrae of dogs that had urinary incontinence and were diagnosed as having ectopic ureter, the urethral pressure profile (UPP) was measured by means of a microchip catheter transducer. The UPPs (14.5 +/- 3.3 mmHg) of the four dogs suffering from ectopic ureter were much lower (p<0.001) than the UPPs of clinically healthy female dogs (35.3 +/- 5.7 mmHg). In the cases of ectopic ureter, it was shown that the UPP was lowered, and it was suggested that this would lead to the expression of urinary incontinence.

Evaluation of diagnostic availability of continuous ANP assay and LA/AO ratio in left heart insufficient dogs.

Left atrial/aorta ratio (LA/AO) by echocardiography and the plasma level of atrial natriuretic peptide (ANP) were measured in 32 dogs with left heart insufficiency. There was a significant correlation between plasma ANP concentration and LA/AO (r=0.66, p<0.001). The authors obtained the result that the degree of expansion of the left atrial diameter seemed to have a close relationship with plasma ANP concentration. Plasma ANP concentration decreased when the clinical signs of the patients improved. However, the LA/AO ratio after treatment did not decrease. From these findings, we concluded that plasma ANP concentration has the possibility to become a significant index in the diagnosis and prognosis of heart disease in dogs.

Double-chambered right ventricle in a dog.

A 32-month-old spayed female Pug was referred for an MRI study due to convulsions. The MRI examination indicated encephalitis. However, echocardiography and pathological examinations revealed that this case had a ventricular septal defect and double chambered right ventricle which is a rare congenital heart disease in the dog. An anomalous muscle bundle crossed the right ventricular outflow tract, dividing the right ventricle into 2 chambers.

MRI examination of the masticatory muscles in the gray wolf (Canis lupus), with special reference to the M. temporalis.

We examined the head of the gray wolf (Canis lupus) using MRI methods. Although the arising surface of the M. temporalis was not so enlarged in the frontal bone, the small frontal bone did not disturb the M. temporalis from occupying the lateral space of the frontal area in the gray wolf as in the domesticated dog. In the gray wolf, it is suggested that the M. temporalis may not be well-developed in terms of size of arising area, but in the thickness of running bundles. We suggest that the dog has changed the three-dimensional plan of the M. temporalis during the domestication and that the M. temporalis has developed a large arising surface in the frontal bone and lost the thickness of belly in the frontal area in accordance with the enlargement of the frontal bone and the increase in brain size.

CT examination of the guttural pouch (auditory tube diverticulum) in Przewalski's Horse (Equus przewalskii).

The domestic horse (Equus caballus) have the large symmetrical guttural pouches (the auditory tube diverticulum) formed by saccate bulge of the auditory tube. In this study, CT examination was carried out in the head of Przewalski's horse (Equus przewalskii), the only true wild horse living at present. As results of the examination, Przewalski's horse possessed the large symmetrical guttural pouches divided into medial and lateral compartments by the stylohyoid bone. Moreover, the right and left guttural pouches meet each other at the median part to form a thin septum. As CT sections get close to the part of the occipital condyle, the lateral compartment disappeared, and the medial compartment gradually became small toward the base of the skull. These results indicate that the nuchal-basal part of the medial compartment is not well-developed as compared with the domestic horse.

Cor triatriatum sinister in a cat.

A heart murmur was detected in a five-month-old Persian chinchilla cat. The animal was referred to Nihon University Animal Medical Center where radiographic examination revealed an enlarged heart with dilation of pulmonary arteries and veins and pulmonary oedema. Echocardiography revealed partition of the left atrium, with turbulent blood flow within the left atrium. The patient was placed under continuous care at the facility, but died at seven months of age. Postmortem examination revealed that the left atrium was partitioned by a fibromuscular septum, with a 1 mm diameter perforation, consistent with a diagnosis of cor triatriatum sinister.

Medulloblastoma in a cat: clinical and MRI findings.

A two-year-old, castrated crossbred cat presented with loss of balance and anorexia. A mass of the caudal aspect of the cerebellum was revealed by magnetic resonance imaging (MRI). The mass was hypointense on T1-weighted images, iso- and hyperintense on T2-weighted images and was enhanced by intravenous gadolinium contrast medium. The MRI characteristics of this case were similar to those of medulloblastoma of the cerebellar vermis in humans. The authors were able to remove almost all of the tumour. The cat was discharged from hospital on day 22 after surgery, but died on day 45. The excised tissue was histologically diagnosed as medulloblastoma.

[Coronary artery bypass with free arterial grafts].

Between October 1988 and October 1993, we experienced 15 cases of free arterial grafting for coronary artery bypass (11 men, 4 women: age range from 42 to 75 years). The bypass grafts were used 11 right internal thoracic artery (RITA), 4 right gastroepiploic artery (RGEA), and 1 left internal thoracic artery (LITA). There were no surgical complications by using free arterial graft. The patency rate at one month after operation was good (86.7%, 13/15 anastomoses). Sites of proximal anastomosis were ascending aorta in all patient. These results indicated that free arterial graft is usefull for multiple coronary artery bypass by arterial graft.

[Surgical management for atrial septal defect secundum in aged patients].

Between 1989 and 1992, atrial septal defect secundum (ASD) were closed in 8 patients aged 51 to 77 years with the use of cardiopulmonary bypass. The notable characteristics in our cases were; 1) All but one had slight or moderate left to right shunt ratios. Although pulmonary hypertension was present, the obstructive pulmonary vascular change had not progressed so far. 2) Atrial fibrillation was present in 6 patients (75%) and some other cardiac lesions (atrioventricular insufficiency, ischemic heart disease, intracardiac anomaly) coexisted with ASD in a high frequency. And surgical procedures other than ASD closure were required in 5 patients. 3) We must take care to prevent cardiac complications (i.e., arrhythmia) as well as extracardiac malfunctions in postoperative care, because aged patients had some organic dysfunctions of respiratory, renal and hepatic systems. 4) Post-operative courses were satisfactory and there was no operative mortality. All patients obtained improvements in their quality of life. Consequently, we concluded that surgical closure is recommended even for aged patients with ASD, except for Eisenmenger's syndrome.

[Bilateral coronary-pulmonary artery fistulas with a large saccular aneurysm: a case of cardiac tamponade following rupture of the coronary artery aneurysm].

A case of bilateral coronary-pulmonary artery fistulas with a large saccular aneurysm is reported as follows. The patient was a 72-year-old woman who was referred to our hospital with a complaint of abnormal shadow on chest X-ray and had the past history of cardiac tamponade. The fistula was ligated and the aneurysm was resected with the extracorporeal circulation. Her Postoperative course was uneventful. Coronary arteriography showed that bilateral coronary-pulmonary artery fistulas had completely disappeared.

[A case of ruptured left subclavian artery associated with von recklinghausen's disease].

Emergency operation was performed on a 38-year-old woman of von Recklinghausen's disease, who fell in shock due to massive hemorrhage in the left thoracic cavity following rupture of the left subclavian artery. The vascular wall was so fragile that hemostasis was difficult. She survived the operation. Vascular complications in von Recklinghausen disease were discussed.

[Bypass operation adaptable to stature increase in child with atypical coarctation of the aorta].

A 9-year-old girl was admitted with hypertension and severe congestive heart failure. Upon physical examination, a discrepancy of blood pressure between arm and leg was noted. Aortography revealed narrowing about 5 cm in length at the midportion of the descending thoracic aorta. Bypass operation of the narrow segment was performed under mild hypothermia with the diagnosis of atypical coarctation of the aorta. It was supposed that the patient might outgrow the graft and the graft would become too small for grown-up patient in diameter and length, then the haemodynamics would become less satisfactory and too much tension on the suture line would occur. A woven Dacron graft, 10 mm in diameter, 15 cm in length, was anastomosed proximally and distally to the coarcted segment at a distance of about 6 cm. So, the graft was disposed in a C-shaped configuration. It was expected that the arch of the graft would open more widely with increase of her stature, even if the graft does not increase in length. She has been followed for twelve years. Hypertension of upper extremity and arm-to-leg gradients of the systolic blood pressure were recognized from two years after the operation, particularly with exercise. However, cardiomegaly and left ventricular hypertrophy in ECG were improved. She appears to have been developing normally with no cardiac symptoms. Estimating from angiography, the distance between proximal and distal anastomoses stretched about 2 cm during the period of rapid growth, though calcification of the graft had been seen from four years after the operation, perhaps due to increased calcium turnover in childhood.

[Preoperative treatment of esophageal cancer with oral peplomycin jelly].

Pepleo-jelly, peplomycin (PEP) compounded with sodium polyacrylate (PANa), was used as a local preoperative chemotherapy for esophageal cancer. Thirty milligrams of PEP emulsified in 10 ml of jelly was orally administered for 17 patients on consecutive bed time, and the average total dose was 470 mg. Concentrations of PEP in blood and tissue were measured with a bioassay. PEP was not detected in the blood but was detected in esophageal tissue and regional lymphnodes. A significant difference (p less than 0.05) of tissue concentrations between normal esophageal mucosa (0.11 microgram/g) and malignant region (0.34 microgram/g) was noted. Furthermore, PEP was detected in many regional lymphnodes. Histological antitumor effect (Ef2) was noted in three of the eight metastatic lymphnodes. A side effect of this treatment was not recognized. It is believed that this treatment is safe and useful in combination with other adjuvant cancer therapy.