Modified extraperitoneal approach to the abdominal aorta in exposure of the thoracoabdominal aorta.

A modified left transthoracic and retroperitoneal approach to the thoracoabdominal aorta without entering the peritoneal cavity is reported. The advantage of this modification is that the abdominal wall musculature is preserved intact except for the division of a small part of the transversus abdominis muscle.

Clinical results of femoropopliteal bypass using externally supported (EXS) Dacron grafts: with a comparison of above- and below-knee anastomosis.

As of the end of September 1989, 52 EXS Dacron grafts had been implanted for femoropopliteal bypass operations. The distal ends of 27 grafts were anastomosed to above-knee popliteal arteries and those of 25 grafts to below-knee popliteal arteries. The cumulative patency rate of above-knee grafts was 71.3% at 54 months, and that of below-knee grafts was 78.8% at 48 months (n.s.). Kinking and stenosis of the arteriosclerotic proximal and/or mid popliteal artery when the knee was bent were angiographically remarkable. These changes may explain why some femoropopliteal grafts occlude with time and why the late results of above-knee grafts are not much better than those of below-knee grafts.

Comparison of dihydrofolate reductase activities for folic acid in pigs and rats using in vivo and in vitro evaluation techniques.

The activity of dihydrofolate reductase (DHFR) for folic acid (PteGlu) was evaluated in pigs by in vivo and in vitro experiments. The results were compared with those of rats. Since bile secretion of reduced folates reflects the activity of DHFR for PteGlu in the body, the bile secretion rates of reduced folates including tetrahydrofolate (H4PteGlu), 5-methyltetrahydrofolate, 5,10-methylenetetrahydrofolate, and 10-formyltetrahydrofolate were determined by using high-performance liquid chromatography with electrochemical detection, after the intravenous injection of PteGlu at 1 mg/kg body weight to pigs and rats. Although the PteGlu injection raised the total secretion rate of reduced folates. the total increased amount of reduced folates secreted into bile from 0 h to 2.5 h after PteGlu injection in pigs was about one-tenth of that in rats. The enzyme kinetics of DHFR for PteGlu was examined at the physiological condition (pH 7.4 and 3 7 degrees C). Affinity chromatography was applied to liver homogenates of pigs and rats to obtain DHFR. The final product of the enzyme reaction, H4PteGlu, was measured. The Km for pig enzyme was similar to that for rat enzyme, whereas the Vmax for the pig enzyme was less than 1/5 of that for the rat's. The comparison of the ratio of Vmax to Km between pig and rat enzymes suggests that PteGlu is a much less efficient substrate for pig liver DHFR. In short, these results from in vivo and in vitro experiments suggest that the role of DHFR for PteGlu in pigs is physiologically much less important than that in rats.

[Effect of Oren-gedoku-to on changes in hexobarbital-induced sleeping time in chlorpromazine-treated mice].

The effects of Oren-gedoku-to on the hypnotic duration induced by hexobarbital, and on the change of this duration in chlorpromazine-treated mice were investigated. Single dose of Oren-gedoku-to (1.0 or 2.0 g/kg, p.o.) or chlorpromazine (10 mg/kg, p.o.) prolonged the hexobarbital hypnosis time. And the simultaneous dose of chlorpromazine (6.0 mg/kg, p.o.) and Orengedoku-to (1.0 g/kg, p.o.) indicated the equal effect for the administration of chlorpromazine (10.0 mg/kg, p.o.) alone. Although the mechanism of the action remains to be unknown, administration of Oren-gedoku-to in combination with chlorpromazine seems to be useful from the standpoint of alleviation of the side-effects caused by less dose.

[Isolated hypogastric artery aneurysm ruptured into urinary bladder: a case report].

An 81-year-old man was admitted to our hospital with a complaint of dysuria. He had had a right hypogastric aneurysm repaired three years earlier. Physical examination showed a distended soft abdomen and tender mass about the size of a child's head but no murmur was heard over the mass. An excretory urogram (DIP) showed left hydronephrosis and no excretion from the right kidney. Computerized tomography (CT) showed urinary bladder compressed by the mass on the upper right back side. Cystography showed that the large mass occupied the pelvic region with calcification and communicated with the bladder. After a few days, an operation for the aneurysm was undertaken by the surgical department. Although bilateral ureterolysis was possible, a resection of the aneurysm could not be done. The aneurysm was injected with fibrin adhesive and a bilateral nephrostomy was performed. The renal function has been stable and the size of the aneurysm has remained unchanged for 9 months after the surgery.

Bilateral ruptured isolated internal iliac artery aneurysms--report of a case and review of the literature.

We present herein, a rare case of a 78-year-old man who experienced rupture of an isolated internal iliac artery aneurysm on 2 separate occasions. He underwent successful embolization with ligation of the right aneurysm at our institution, where only 2 such cases have ever been seen. Embolization with ligation proved very effective in clotting the intraaneurysmal blood in this case and would appear to be the treatment of choice for very large aneurysms. A review of the English and Japanese literature follows this case report.

Aorto-caval fistula resulting from rupture of an abdominal aortic aneurysm--report and review of Japanese reported cases.

Rupture of an abdominal aortic aneurysm into the venous system such as the inferior vena cava, the iliac vein or the renal vein occurs rarely. Our own experience illustrating this uncommon lesion is presented, and 25 reported cases in Japan including our own were clinically analysed. The physician's awareness of this clinically rare entity is the most important factor for the early diagnosis and treatment of this disease.

Postocclusive Reactive Hyperemia During Vascular Reconstruction

The purpose of this basic investigation was to clarify the postocclusive reactive hyperemia during vascular reconstruction using laser Doppler flowmetry (LDF). For the fundamental experiment, thirty-nine limbs with arteriosclerosis obliterans (ASO) in Stage II according to Fontaine's classification and 33 limbs without arterial or venous disease were chosen. In the supine position, a thigh cuff was applied to the lower thigh of a subject. Systolic Doppler thigh pressure was obtained and thigh/arm pressure index (TPI) was calculated. A LDF probe was then fixed to the bottom of the first toe and cutaneous blood flow was measured continuously before, during, and after femoral artery occlusion by the thigh cuff. The occlusion time was 3 and 6 minutes. For the clinical study, thirty-three lower limbs with arterial occlusive disease were selected. During the vascular surgery, the LDF probe was attached to the bottom of the first toe and cutaneous blood flow was monitored continuously before, during, and after the vascular clamping. In the fundamental experiment, after the release of the occlusion, the maximum blood flow of the reactive hyperemia (peak flow) appeared. The period between the release of the occlusion and the peak flow was called the peak time. When the occlusion time was longer, the reactive hyperemia appeared later and was bigger. When TPI decreased, the peak time lengthened and the peak flow after a 6-minute occlusion decreased. In the clinical study, the more severe the degree of the preoperative limb ischemia was, the longer was the peak time. The longer the intraoperative clamping time, the longer the peak time. In conclusion, postocclusive reactive hyperemia during vascular surgery was influenced by the degree of the preoperative limb ischemia and the length of the vascular clamping time.