Effect of altered blood flow on the caliber and morphology of the internal thoracic artery in the dog.

OBJECTIVE: The purpose of this study was to evaluate in dogs the effect of blood flow alteration on caliber and morphology of in situ internal thoracic arteries. METHODS: Six dogs underwent creation of a unilateral distal arteriovenous fistula between the internal thoracic artery and vein at the sixth rib to create high flow, and in six others the internal thoracic artery was unilaterally skeletonized and dissected. For both groups the contralateral internal thoracic artery served as the control; sides were alternated among cases. Blood flow was measured for shear stress calculation before and after surgical alteration. After 2 months, internal thoracic arteries were harvested with the entire anterior chest plate, which was dynamically inflated and fixed with 10% formalin at a controlled pressure of 120 mm Hg after angiography had been done at the same pressure. The luminal diameters were then measured at eight levels on the angiograms. Arterial tissue samples were taken at three levels and embedded, sectioned, and treated with hematoxylin-eosin and Verhoeff-van Gieson stains. Digital imaging analysis was used for quantitative morphometric studies. RESULTS: All fistulas remained patent. In comparison with control arteries, high-flow internal thoracic arteries dilated and low-flow internal thoracic arteries narrowed, which was associated with significant change in shear stress for both groups. There were no substantial structural changes in the walls of either group. CONCLUSION: In the dog, the luminal diameter of the internal thoracic artery responds to altered blood flow without intimal thickening or other undesirable wall changes.

Comparison of the effect of monopolar and bipolar cauterization on skeletonized, dissected internal thoracic arteries.

The internal thoracic artery is preferable to the saphenous vein for use as a conduit for coronary artery bypass. More extensive use is possible if this artery is mobilized in a skeletonized form to provide greater length. Internal thoracic arteries are usually mobilized with cauterization. This study compared the effectiveness and effects on neighboring areas of division of the branches of the canine internal thoracic artery with bipolar cauterization and monopolar cauterization. Branch closure was significantly more secure in the bipolar cauterization group, with bleeding in 25 (9%) of 279 branches of 15 internal thoracic arteries treated with monopolar cauterization, in contrast to bleeding in 4 (1.3%) of 306 branches in the 15 internal thoracic arteries treated with bipolar cauterization, which were paired with the group treated with monopolar cauterization. The group of internal thoracic arteries treated with monopolar cauterization had a significantly higher prevalence of leakage when luminal pressure was increased from 120 to 160 mm Hg. Scanning electron microscopy demonstrated partial loss of endothelial cells on the flow surface of internal thoracic arteries treated with bipolar cauterization, compared with almost complete loss of endothelial cells around the orificial areas after monopolar cauterization. Secondary bipolar cauterization treatment caused only slightly more damage than primary treatment, but secondary monopolar cauterization was much more severe and extensive than primary treatment. These data suggest that bipolar cauterization is preferable to monopolar cauterization for skeletonized dissection of the internal thoracic artery.

Location of Streptococcus mutans in the dentinal tubules of open infected root canals.

Seventy-six teeth from open canals were extracted to prepare serial longitudinal sections. The sections were made from apical portions of the teeth and stained. Ninety similar teeth were extracted to prepare dentinal splinters with files from the enlarged infected canal. The splinters were spread on a selected medium to grow S. mutans. S. mutans was detected in 48.7% of the 76 teeth examined. The distance of invasion of S. mutans in the dentinal tubules revealed by immunofluorescence averaged 509 micrometer from the canal wall and reached 1150 micrometer, depending on the serogroups of S. mutans. Unidentified germs in the sections which were demonstrated by Gram's stain invaded further than S. mutans. The frequency of appearance of the serogroups of S. mutans was 32.6% (d), 27.9% (c), 24.4% (a), and 15.5% (b).

[Antigenicity tests of tazobactam/piperacillin, tazobactam and piperacillin].

The antigenicity tests of Tazobactam/piperacillin (TAZ/PIPC), tazobactam (TAZ:beta-lactamase inhibitor) and piperacillin (PIPC:penicillin antibiotic) were performed in mice and guinea pigs. The following results were obtained. 1. TAZ/PIPC, TAZ or PIPC had no immunogenicity and allergenicity in either passive cutaneous anaphylaxis (PCA) test using BALB/c and C3H/He mice or in PCA test using guinea pigs. 2. Guinea pigs sensitized with TAZ/PIPC, TAZ or PIPC showed no anaphylactic symptoms in active systemic anaphylaxis (ASA) test. 3. Guinea pig PCA tests using protein conjugates as sensitizing and challenging antigens showed positive reactions. Immunological cross-reactivity tests were performed by using these conjugates in guinea pig PCA reaction. Results showed that TAZ/PIPC and PIPC cross-reacted with penicillin G (PCG) and ampicillin (ABPC), but not with cephalothin (CET) and cephmetazol (CMZ). TAZ did not cross-react with PCG, ABPC, CET or CMZ. 4. From the results of the passive hemagglutination (PHA) test, no antibody against TAZ/PIPC, TAZ or PIPC was detected. 5. In direct Coombs' test using human blood, TAZ/PIPC, TAZ, PCG and CET showed positive reactions at 20-80, 5-20, 80 and 10-20 mg/ml, respectively. 6. The results of a test on in vitro covalent binding activity with human serum albumin indicated that the order of binding potency was CET > CMZ > ABPC > PCG = PIPC > TAZ under the physiological condition (pH 7.2-7.4), and was CMZ > CET > ABPC > PIPC > TAZ > PCG under the alkaline condition (pH 10.0-10.5), respectively.

Antigenicity tests on propiverine hydrochloride in guinea pigs and mice.

Antigenicity of propiverine hydrochloride (P-4), a newly developed drug for pollakisuria, was investigated in guinea pigs and mice. 1. Two strains of mice (BALB/c and C3H/He) showed no production of antibodies against P-4 inoculated with aluminum hydroxide gel (alum) as an adjuvant, judged by the heterologous passive cutaneous anaphylaxis (PCA) test using rats. On the other hand, antibodies against P-4-ovalbumin (OVA) conjugate inoculated with alum was definitely detected. 2. In the studies with guinea pigs, both the inoculation of P-4 alone and of P-4 with Freund's complete adjuvant (FCA) as an adjuvant did not produce positive reactions in any of homologous passive cutaneous anaphylaxis (PCA), active systemic anaphylaxis (ASA) and passive hemagglutination (PHA) tests. On the other hand, the inoculation of P-4-OVA conjugate with FCA produced positive reaction in all of PCA, ASA and PHA tests. 3. In the active cutaneous anaphylaxis (ACA) test in guinea pigs inoculated with P-4-OVA conjugate with FCA, positive reaction was produced by eliciting injection of P-4-human serum albumin (HSA). 4. In the Schultz-Dale reaction test, any animals in any groups showed no positive reaction to both eliciting antigens, P-4 and P-4-HSA. 5. These findings showed that P-4 had no antigenicity in guinea pigs and mice.

[Mutagenicity study of a new antineoplastic agent S-1, and its components, CDHP, and Oxo].

S-1 is a new antineoplastic agent of a fluorinated pyrimidine derivative containing tegafur (FT), 5-chloro-2,4-dihydroxypyridine (CDHP) and potassium oxonate (Oxo) in a molar ratio of 1:0.4:1 with the aim of prolonging the effective plasma concentration of 5-fluorouracil (5-FU) and reducing its dose-limiting gastrointestinal toxicity. As a part of the safety evaluation of S-1, reverse mutation tests using bacteria and chromosomal aberration tests using cultured cells, CHL/IU, were conducted to test the in vitro mutagenicity of S-1, CDHP and Oxo. All S-1 doses are expressed as the content of FT. 1. The reverse mutation tests were carried out on S-1 at 1.02-520 micrograms/plate, on CDHP at 39.1-5000 micrograms/plate, and on Oxo at 78.1-5000 micrograms/plate using Salmonella typhimurium strains TA100, TA1535, TA98, and TA1537 and Escherichia coli WP2uvrA. None of the test compounds induced a significant increase over solvent controls in the number of mutant colonies in any tester strains in either system, with or without mammalian metabolic activation (S9 Mix). 2. For the in vitro chromosomal aberration tests, Chinese hamster lung cells (CHL/IU), were treated with S-1 at 27.5-220 micrograms/ml for 24 hr or at 6.88-27.5 micrograms/ml for 48 hr without S9 Mix, and at 110-880 micrograms/ml with S9 Mix, with CDHP at 365-1460 micrograms/ml (10 mM), and with Oxo at 122-1950 micrograms/ml (10 mM), with and without S9 Mix. S-1 with and without S9 Mix, and Oxo only for 48 h treatment without S9 Mix, induced chromosomal aberrations, while CDHP did not. 3. The present study indicates that S-1 was nonmutagenic in bacteria, but clastogenic in vitro. CDHP had no in vitro mutagenic or clastogenic activity. Oxo was positive in the in vitro chromosomal aberration test, but negative in the reverse mutation test.

[Immunotoxic effects of a new antineoplastic agent S-1 in mice--comparison with S-1, UFT and 5-FU].

The immunotoxicity of S-1, which is a new antineoplastic agent, was investigated in BALB/c mice. S-1 contains tegafur (FT), CDHP, and potassium oxonate (Oxo) in a molecular ratio of 1:0.4:1. 5-fluorouracil (5-FU) and UFT were used as reference drugs. S-1 and reference drugs were administered by oral gavage for 7 days. The high dose employed in this study was determined as the maximally tolerated dose of a 9-day repeated-dose study in sarcoma 180-bearing mice. Decreased body weight was observed in mice treated with 5-FU and UFT but not in those treated with S-1. A significant decrease in thymus and spleen weight was observed in S-1-, UFT- and 5-FU-treated mice, and the degree was same for the three drugs. Though the number of white blood cells decreased dose-dependently for the three drugs, S-1 had the weakest effect. The number of red blood cells also decreased, but the effect was not dose-dependent, and its magnitude was the same for the 3 drugs. S-1 induced a dose-dependent decrease in the IgM antibody PFC response to sheep erythrocytes. The delayed type hypersensitivity response used a footpad reaction method was significantly suppressed at the highest dose of S-1. 5-FU and UFT suppressed humoral and cell-mediated immunity in almost the same manner as S-1. The degree of suppressive effects was greater on the humoral immune response than on the cell-mediated immune response. The number of CFU-GM colonies was significantly decreased in the highest dose group of each drug and in a lower group as well in S-1-treated mice. This finding might reflect the fact that S-1 induced continuous high levels of 5-FU in the blood. Under these experimental conditions, S-1 induced immunosuppressive effects in BALB/c mice, and the degree of suppression was almost same as that induced by 5-FU and UFT.

Immunotoxic effect of low dose cisplatin in mice.

The immunosuppressive effects of cisplatin at relatively low doses were investigated in CD-1 mice. Mice were injected intraperitoneally with 8, 40 and 200 micrograms/kg cisplatin for 10 days. A decrease in body and thymus weights was observed at 200 micrograms/kg. Though there were no dose-related effects on the IgM antibody response to sheep erythrocytes, a statistically significant reduction of the contact hypersensitivity response (CHR) was seen at 200 micrograms/kg. In vivo and in vitro effects of cisplatin on T- and B-lymphocyte function were assessed by proliferative response to concanavalin A and lipopolysaccharide, respectively. Cisplatin inhibited splenic T-lymphocyte function more than splenic B-lymphocyte function. These data indicate that a relatively low dose of cisplatin induce immunosuppressive effects in mice with a greater effect on T-lymphocytes than the B-lymphocytes.

[Antigenicity tests of a new antineoplastic agent S-1].

The antigenicity was tested of a new antineoplastic agent S-1 (a combination of tegafur (FT), CDHP and potassium oxonate (Oxo)) in mice and guinea pigs. 1. Male BALB/c or C3H/He mice were sensitized with S-1, CDHP, Oxo, and conjugates of CDHP (or Oxo) and human serum albumin (HSA). S-1 was administered by oral gavage, and the other compounds were administered intraperitoneally with adjuvant (alum). In the heterologous passive cutaneous anaphylaxis (PCA) test, using Sprague-Dawley rats as recipients, no IgE antibodies against S-1, CDHP, or Oxo were detected to any serum obtained from the sensitized mice, and no eliciting antigenicities were seen for CDHP or Oxo. 2. Male Hartley guinea pigs were sensitized with S-1, CDHP, Oxo, and conjugates of CDHP (or Oxo) and HSA. S-1 was administered by oral gavage, and the other compounds were administered subcutaneously with Freund's complete adjuvant (FCA). The homologous PCA test, active systemic anaphylaxis test, and passive hemagglutination test showed no production of antibodies against S-1, CDHP, or Oxo in any sensitized guinea pig, and no eliciting antigenicities for CDHP or Oxo. 3. Female Hartley guinea pigs were sensitized with S-1 subcutaneously with FCA. The active cutaneous anaphylaxis test revealed that S-1 did not induce cell-mediated delayed type hypersensitivity. 4. These results indicated that S-1, Oxo, and CDHP were not antigenic in mice and guinea pigs.

[Peri- and postnatal study of cefodizime sodium in mice--intravenous administration from late gestation through period of lactation].

Peri- and postnatal study of cefodizime sodium (THR-221), a new developed cephem-type antibiotics, was carried out with ICR mice. THR-221 at dose levels of 0, 300, 1000 and 3000 mg/kg/day were administered intravenously to pregnant and delivered dams from day 15 of gestation through day 21 of lactation. No changes in body weights of dams in all treated groups but slight decrease in food consumptions of 3000 mg/kg/day group were observed. Treated sites, tails of a few dams in this group, were affected with inflammatory lesions because of repeated dosing. Neonates from dams treated with 3000 mg/kg/day were slightly decreased in body weight at birth. At term sacrifice of F 1 of 10 weeks age, absolute and relative spleen weights were decreased in male 3000 mg/kg/day group and in female 1000 and 3000 mg/kg/day group. No effects on other physical, behavioral or reproductive ability examinations of F 1 offspring were showed. It is suggested that no effect dose level of THR-221 is 1000 mg/kg/day and that of F 1 offspring is 300 mg/kg/day.

[Mutagenicity tests of tazobactam/piperacillin, tazobactam and piperacillin].

As a part of safety tests of tazobactam/piperacillin (TAZ/PIPC), the reverse mutation tests using bacteria, the chromosomal aberration tests using cultured cells and the micronucleus tests using male mice were conducted in order to evaluate the in vitro and in vivo mutagenicity of TAZ, PIPC, TAZ/PIPC. 1. The reverse mutation tests were carried out on TAZ, PIPC and TAZ/PIPC at dose ranges, where few antibacterial effects could be detected, using Salmonella typhimurium strains TA100, TA1535, TA98 and TA1537, and Escherichia coli WP2uvrA. All of three test articles showed that no significant increases were observed in the number of colonies in all tester strains in both systems, with and without mammalian metabolic activation (S9 Mix), as compared with solvent controls. 2. The chromosomal aberration tests were carried out on these test articles using cultured Chinese hamster lung cells (CHL). The cells were treated with TAZ, PIPC or TAZ/PIPC at the doses of 2.5, 5.0 and 10 mM with and without S9 Mix. In the test of PIPC with S9 Mix, the dose of 1.25 mM was set in addition to the three doses. The incidences of structural- and numeral-aberration were 0-3% in the absence or presence of mammalian metabolic activation system, and no significant increases were observed in the incidence of chromosomal aberrations as compared with solvent controls. 3. The micronucleus tests were carried out at doses of 625-5000 mg/kg of TAZ or TAZ/PIPC, or at 625-2500 mg/kg of PIPC. The femoral marrow cells were 48 h after administering intravenously to CD-1 male mice. The frequencies of polychromatic erythrocyte with micronuclei were 0.02-0.17%, 0.02-0.10% and 0.03-0.07% in the groups treated with TAZ, PIPC and TAZ/PIPC, respectively, and no significant increases were observed with dose dependence. The results indicated that these test articles were negative in the assessment standard using the background data. 4. The present study indicates that TAZ, PIPC and TAZ/PIPC have no in vitro and in vivo mutagenic potential.

[Antigenicity tests of suplatast tosilate (IPD-1151T)].

Antigenicity of suplatast tosilate (IPD-1151T) was investigated in guinea pigs and mice. The results were as follows: 1. Homologous passive cutaneous anaphylaxis (PCA), active systemic anaphylaxis (ASA), active cutaneous anaphylaxis (ACA) and Schultz-Dale reaction tests were carried out using guinea pigs which were immunized orally with IPD-1151T alone or subcutaneously with IPD-1151T and Freund's complete adjuvants (CFA). Positive reactions in these tests were not produced by eliciting injection of IPD-1151T or its metabolite, M-1. On the other hand, the sensitization of ovalbumin (OVA) with CFA produced positive reactions in all of PCA, ASA, ACA and Schultz-Dale tests. 2. Heterologous passive cutaneous anaphylaxis (PCA) test using rats was carried out using two strains of mice (C3H/He and BALB/c) which were immunized orally with IPD-1151T alone or intraperitoneally with IPD-1151T and aluminum hydroxide gel (Alum) as an adjuvant. No animals showed positive reaction to both eliciting antigens, IPD-1151T and M-1. On the other hand, a positive reaction in PCA test to eliciting antigen, OVA, was obtained in rats treated with sera of mice sensitized with OVA plus Alum. 3. These findings showed that IPD-1151T had no antigenicity in guinea pigs and mice.

[Comparison of mediansternotomy approach vs left thoracotomy approach for distal aortic arch aneurysm, and their postoperative complications].

We performed surgery for distal arch aneurysm in 22 patients; through a mediansternotomy in 11 patients (group M), and through a left thoracotomy approach in 11 patients (group L). If the distal position of an aneurysm was located at the pulmonary hilus without severe calcification of the ascending aorta, the mediansternotomy approach was chosen, whereas if we suspected that distal anastomosis would be difficult due to severe calcification of the descending aorta or aortic dissection type B, the left thoracotomy approach was selected. The mean cardiopulmonary bypass time (min.) was 229 +/- 56 in group M and 225 +/- 47 in group L, the mean circulation arrest time (min.) was 39 +/- 19 in group M and 31 +/- 5 in group L, and the mean lowest temperature (degree C) was 22 +/- 1 in group M and 20 +/- 2 in group L. No severe cerebral or cardiac complications developed in any patients. The hospital mortality was 9% (1/11) in group M and 9% (1/11) in group L. Following discharge, 8 (73%) patients from group M and 9 (92%) from group L resumed a normal lifestyle. There were no significant differences between the 2 groups and the operative results of both approaches proved satisfactory. Therefore our indications for each surgical approach to treat distal arch aneurysm seemed appropriate.

[Simultaneous surgery for unstable angina and gastric cancer: a case report].

This report describes a case in which an 81-year-old male underwent two operations simultaneously for unstable angina and gastric cancer. Successfully performed procedures were off pump CABG with bilateral IMA, and total gastrectomy. The post operative course was uneventful. Off pump CABG is an effective procedure in patient with malignant neoplasm.

[The removal of renal carcinoma thrombus extending to the right atrium by means of extracorporeal circulation: report of a case].

A case of renal cell carcinoma with a tumor thrombus extending to the right atrium was reported. A 70-year-old woman was admitted with a diagnosis of right renal tumor which had been detected on a routine abdominal ultrasonography. MRI revealed a tumor thrombus extending into the right atrium through the inferior vena cava. A transesophageal echocardiogram confirmed that the tumor extended into the right atrium, and was not adherent to the inferior vena cava and the atrium. Right nephrectomy and removal of the tumor thrombus were performed using extracorporeal circulation. Temporary occlusion of portal venous and hepatic arterial inflow was effective in reducing blood loss. She has been doing well, and there has been no evidence of recurrence during 18 month postoperatively.

Alpha 2-adrenergic receptors on canine platelet membranes characterized by [3H]-yohimbine binding.

Alpha 2-adrenoceptors on canine platelet membranes were characterized by [3H]-yohimbine binding. Binding of [3H]-yohimbine to the membranes was rapidly saturated, stable and reversible with high affinity. Dissociation constant (KD) calculated from Scatchard analysis of the equilibrium experiments was 1.89 +/- 0.20 nM which was in good agreement with KD (1.97 +/- 0.60 nM) obtained in the kinetic experiments. Maximal binding sites of the ligand (Bmax) was 249 +/- 20 fmoles/mg protein. Adrenergic antagonists inhibited the ligand binding in following rank order of potency; yohimbine greater than phentolamine greater than phenoxybenzamine greater than corynanthine greater than prazosin. This order was in good correlation with that for these drugs in the inhibition of platelet aggregation. Hill coefficients for the displacement curves of the ligand binding by adrenergic agonists were less than 1.0 which were converted into near unity in the presence of 5'-guanylyl-imidodiphosphate (100 microM). These results demonstrate that canine platelet membranes have alpha 2-adrenoceptors and suggest that the binding of these receptors to adrenergic agonists is regulated by guanine nucleotides.

Effect of prostaglandin I2 analogue TRK-100 on the suppression of intimal fibrous proliferation.

This study investigated the effect of prostaglandin I2 analogue (TRK-100) on the healing of arterial anastomoses. The infrarenal abdominal aorta was divided and reanastomosed immediately in rabbits. A control group of rabbits were fed commercial rabbit food (ORC 4); a cholesterol group of rabbits were fed a diet with 1% cholesterol added to ORC 4; and a TRK group of rabbits received the same diet as the cholesterol group, but TRK-100 was given subcutaneously at a dose of 0.3 mg (TRK-I group) or 1.0 mg (TRK-II group) every other day. After 3 months a blood sample was taken for biochemical analysis, and the abdominal aorta was harvested for histologic examination. The serum lipid and thromboxane B2 concentrations and the thromboxane B2/6-keto prostaglandin F1 alpha ratio in the TRK groups were significantly lower than in the cholesterol group. The proliferative connective tissue did not cover the anastomotic suture line in either the control or the TRK groups. However, the suture line was covered completely by connective tissue in the cholesterol group. Intimal thickness in the cholesterol group was greater than in either the control or the TRK-II group (p less than 0.01 and p less than 0.05, respectively). These data suggest that TRK-100 may suppress intimal fibrous proliferation at anastomotic suture lines by a mechanism affecting the thromboxane B2/6-keto prostaglandin F1 alpha ratio.

Early presence of endothelial-like cells on the flow surface of porous arterial prostheses implanted in the descending thoracic aorta of the dog.

The purpose of this study was to investigate early arterial graft healing and its sources in porous Dacron prostheses after very short implantation periods in the dog, using extensive histologic examination of serial sections. Preclotted Dacron prostheses 6 cm long and 8 mm in diameter were implanted in the descending thoracic aorta (DTA) of 14 dogs, and retrieved at 7 days (n = 6), 10 days (n = 4), and 14 days (n = 4). The flow surface was assessed for thrombus coverage, endothelial-like cell (ELC) coverage, and the number of microvessel ostia. Where an ELC island was identified under the stereomicroscope, full-wall longitudinal tissue samples were taken, and embedded in resin for light microscopy study of 6-microns, H&E-stained serial sections to determine general healing and interstitial tissue presence. If there was more than one ELC island, another full-wall sample was taken and embedded in paraffin for staining with laminin, collagen IV, and smooth muscle alpha-actin antibodies, and PTAH. All grafts were patent with very little thrombus. Islands of endothelial-like cells were found for each time period, and on all 14-day grafts. Endothelial-like cell coverage was highest at 14 days. On 7- and 10-day grafts, cells proved to be endothelium were found in the middle of the flow surface, unconnected to either pannus or perigraft tissue ingrowth. Healing occurs as early as 7 days in porous knitted Dacron grafts. The source at periods earlier than 10 days appears to be cells from the blood stream.

Histologic observation of continuity of transmural microvessels between the perigraft vessels and flow surface microostia in a porous vascular prosthesis.

To ascertain the histologic relationship between flow surface microostia and perigraft vessels in the healing of a porous vascular prosthesis, a series of careful histologic examinations were carried out on a preclotted, knitted Dacron graft, 8 mm in diameter and 7 cm long, after implantation in the canine infrarenal abdominal aorta for 3 months. Four adjacent longitudinal tissue blocks were taken from the middle for evaluation by means of light microscopy, scanning electron microscopy, transmission electron microscopy, and immunocytochemical staining, and the remainder of the specimen was stained with silver nitrate to allow visualization of microostia and cell borders on the flow surface. Following identification of two microostia adjacent to the area where samples had been taken for general healing evaluation, a 3 x 8 mm full-thickness block containing the microostia was embedded in glycol methacrylate and stained with hematoxylin and eosin. Of 240 serial sections cut from this block, 80 were prepared and examined. Silver staining revealed 42 microostia on the flow surface. Light, scanning, and transmission electron microscopy with endothelial factor VIII/von Willebrand factor stain confirmed a single layer of endothelial cells on the flow surface, and beneath was a well-organized neointima containing fusiform cells confirmed as smooth muscle by alpha-actin stain. Light microscopy of the serial sections revealed transmural microvessels, lined with endothelium, extending continuously between the flow surface ostia and the perigraft vessels in this porous vascular prosthesis.

Klippel-Trenaunay syndrome associated with splenomegaly: report of a case.

We report herein the case of a 19-year-old woman, diagnosed as having Klippel-Trenaunay syndrome at the age of 3 years, who presented to our hospital with severe abdominal pain. Abdominal computed tomography revealed splenomegaly, ascites, and paracentesis confirming an intraabdominal hemorrhage. Thus, an emergency laparatomy was performed for a suspected splenic rupture, and 2.5 L of blood was drained from the abdominal cavity. Splenomegaly was confirmed, and a splenectomy was performed. The patient's postoperative course was complicated by disseminated intravascular coagulation, but she recovered and was discharged 3 weeks following surgery. Pathological examination of the spleen suggested that the splenomegaly was caused by high venous pressure due to splenic vein stenosis. To our knowledge, this is the first reported case of Klippel-Trenaunay syndrome associated with marked splenomegaly.