Excisional surgery for chronic advanced lymphedema.

PURPOSE: We conducted a retrospective study to evaluate the efficacy of excisional surgery to treat chronic advanced lymphedema. Excisional surgery was performed to reduce the extremity size, improve limb function, and decrease the frequency of lymphangitis and prevent sepsis. METHODS: Between August 1997 and December 2001, we performed excisional surgery on one or two affected legs in 20 patients with chronic lymphedema (total 24 legs). The lymphedema was graded as stage III in 5 extremities and as stage IV in 19 extremities. Five patients had primary lymphedema and 15 had secondary lymphedema. The mean duration of follow-up was 17.8 months. RESULTS: Excisional surgery resulted in clinical improvement in 18 extremities, all of which received regular physiotherapy after surgery. However, lymphedema progressed to the preoperative status in six extremities, four of which did not receive regular physiotherapy after surgery. CONCLUSIONS: Excisional surgical therapy can be effective for chronic advanced lymphedema, but appropriate postoperative physiotherapy is essential to ensure that the effects last.

Surgical experience of carotid pseudoaneurysm.

An extracranial carotid artery pseudoaneurysm is a rare condition that is caused by various types of arteritis, trauma and infectious causes. Generally, a pseudoaneurysm may be difficult to treat surgically when dissecting the paraaneurysmal fibrotic dense inflammatory tissues. The surgical management of a peudoaneurysm of the carotid artery involves a risk of nerve and arterial injury. This paper reports the repair of a carotid artery pseudoaneurysm after the proximal and distal control of the internal carotid artery using a Pruitt-Inahara shunt (P-I shunt) and the distal control of the external carotid artery using a small sized occlusion balloon catheter.

Clinical and functional assessment after anticoagulant therapy of acute deep vein thrombosis involving the lower limb.

We assessed the clinical status after anticoagulant therapy in acute deep vein thrombosis (DVT) involving the lower limbs. Between 1994 and 2001, 139 patients suffering from acute DVT were treated with heparin therapy followed by oral anticoagulant therapy. The coagulation factor assay was done prior to any anticoagulation therapy. The duplex scan was checked serially. The mean follow-up periods was 32 +/- 19 months. There were 32 (23.0%)cases of protein C deficiency, 12 (8.6%) cases of protein S deficiency, 13 (9.4%) cases of AT-III deficiency and 11 (7.9%) cases of abnormal plasminogen level. Fourteen cases had coagulation factor abnormalities within the family. The initial lung scan showed 29 (20.9%) cases with high, 13 (9.4%) cases with intermediate and 70 (50.4%) cases with a low probability of pulmonary embolism (PE) developing. During the follow-up periods, there were 3 cases of non-fatal PE documented with chest CT scan. The patients were divided according to the extent of the thrombus; Group I (38 cases) was limited to the infrainguinal deep vein, Group II (70 cases) extended to the iliac vein and Group III (9 cases) extended to the vena cava. Partial lysis occurred in 20/35/3 (52.6/50.0/33.3%) cases and no change in 10/24/6 (26.3/ 34.3/ 66.7%) cases in Groups I/ II/ III, respectively. Deep vein valvular reflux occurred in 15/25/5 (39.5/35.7/55.6%) cases in Groups I/ II/ III, respectively. With anticoagulation therapy, most of the thrombi remained in unresolved states and there was a high rate of deep vein valvular reflux. However, there was no serious complications which affected the patients' quality of life.

Identification of differentially expressed mRNAs of the autologous vein graft after an arterial bypass in mongrel dogs.

PURPOSE: Intimal hyperplasia (IH) is characterized by vascular smooth muscle cell (VSMC) proliferation in the intima and subsequent accumulation of extracellular matrix. A variety of factors that might be considered as possible VSMC mitogens induce the specific gene expression of VSMC. This study was designed to identify differentially expressed mRNA by method using an mRNA differential display. METHODS: A bilateral femoropopliteal reverse saphenous vein bypass was performed on both hind limbs of mongrel dogs. At 4 and 8 weeks after the implantation, the vein bypass grafts were harvested. The total RNAs were extracted from each specimen and transcribed into the cDNAs. Amplified cDNAs using 16 sets of primers were separated on DNA sequencing gel. Differentially displayed bands were excised from the gel, cloned, and then sequenced. The sequences were compared with the National Center of Biotechnology Information nonredundant sequence database using the Basic Local Alignment Search Tool (BLAST) program. RESULTS: Forty-three bands were cloned and sequenced. A computer search revealed that 11 of them had similarities to known genes while 32 cDNAs had no similarities to any registered DNA sequence. CONCLUSIONS: We found several genes to be related to IH. Some of them had already had their function and sequence identified whereas some of them have yet to be identified. Further studies are necessary to determine the precise relationship between these genes and IH.

Coexisting aortocolic and aortovesical fistulae in an abdominal aortic aneurysm: report of a case.

Aortoenteric fistula is a rare complication in abdominal aortic aneurysms (AAA), and an aortovesical fistula is even more rare. This is a report of a case of aortocolic and aortovesical fistulae in a 64-year-old man with AAA who was treated with an aortobiiliac bypass, a primary repair of the fistulated bladder, and a sigmoid colostomy.

Vascular clips as a landmark for sites of anastomosis.

Vascular clips can be used in bypasses at risk of future occlusion, to assist with catheter placement for radiological intervention. We explain how vascular clips can be placed as a landmark for the sites of anastomosis. After completion of the vascular anastomosis, two or three bullets of medium-sized vascular clips are clipped to the tips of the vascular suture. The sites of the vascular anastomosis are checked by plain X-rays. Finding the inlet of the anastomosis in an occluded graft can be difficult, and the marker proved helpful for introducing the guide-wire through the inlet of the site of anastomosis. The vascular clips around the popliteal anastomosis enabled us to clearly differentiate above-knee from below-knee femoropopliteal bypasses using plain X-ray postoperatively. This is a simple yet effective method of identifying the site of vascular anastomosis. Thus, we recommend using vascular clips as a landmark to aid in postoperative intervention by allowing clear identification of the level of anastomosis.

Pseudoaneurysm of the abdominal aorta caused by acupuncture therapy.

Acupuncture is a major treatment modality used in Oriental medicine to control chronic pain. However, several complications have been reported, including spinal cord injury, pneumothorax, and subcutaneous pseudoaneurysm, according to the puncture sites. We report the case of a pseudoaneurysm of the abdominal aorta caused by acupuncture.