Plasma metabolite concentrations and hepatic enzyme activities in pregnant Romney ewes with restricted feeding.

Plasma metabolite concentrations and activities of enzymes related to energy metabolism in plasma, peripheral leukocytes and liver of pregnant Romney ewes with restricted feeding were measured to assess those metabolites and enzymes as indicators for evaluating metabolic conditions in the ewes. The body weights and plasma lactate concentrations of the low-feeding ewes (about 1.0 times maintenance) were significantly lower than those of the high-feeding ewes (about 1.5 times maintenance). There were no significant differences in plasma protein, glucose, triglyceride, cholesterol, pyruvate and immunoreactive insulin concentrations and plasma and leukocyte enzyme activities between both groups. Hepatic malate dehydrogenase activities were significantly higher and hexokinase activities were significantly lower in the low-feeding ewes than in the high-feeding ewes. Restricted feeding could maintain pregnancy and some plasma metabolites and peripheral leukocyte enzymes may be useful indicators for evaluating metabolic changes in ewes.

Changes in peripheral leukocytes enzymes activity and plasma metabolite concentrations in growing Holstein calves.

Plasma metabolite and immunoreactive insulin concentrations and activities of enzymes related to energy metabolism in peripheral leukocytes were measured in growing Holstein calves. A ratio of girth of abdomen divided by girth of thorax (A/T ratio) of calves was significantly elevated after weaning, and the A/T ratio maybe a good indicator to evaluate rumen development. Plasma glucose and free fatty acid concentrations were changed in calves accompanying change in feeding. Activities of lactate dehydrogenase with pyruvate as substrate (LDH-P) and hexokinase (HK) in cytosolic fractions of peripheral leukocytes decreased significantly after weaning the calves reflecting the change of energy source from milk replacer with high percentages of fat and glucose and lactose as absorbable carbohydrate to pelleted feed containing starch as less absorbable carbohydrate and roughage. Some peripheral leukocyte enzymes such as LDH and HK may be good indicators to evaluate changes in energy metabolism of growing calves.

Epidermoid cyst of the spleen with CA19-9 or carcinoembryonic antigen productions: report of three cases.

True splenic cyst is a relatively rare disease, and the majority of the cases are classified as epidermoid cysts. Three cases of epidermoid cysts in the spleen or accessory spleen were studied using an immunohistochemical technique and staining for mucin. In case 1, serum carcinoembryonic antigen (CEA) and CA19-9, and in cases 2 and 3, serum CA19-9, before surgery were markedly elevated, and these levels decreased postoperatively. This strongly indicates the relationship between the increase of tumor marker levels and the presence of the epidermoid cyst. In addition, stratified squamous epithelium in the resected tissues of cases 1 and 2 was positive for anti-CEA antibody and anti-CA19-9 antibody, and that of case 3 was positive for anti-CA19-9 antibody. This strongly supports CEA or CA19-9 production in the squamous epithelium.

Tissue and cellular distribution of alpha-L-iduronidase in the pig.

We investigated the alpha-L-iduronidase activity of various pig tissues. Furthermore, we examined the tissues using antibody, enzyme immunoassay (EIA), and immunohistochemical methods. The amounts of enzyme measured by the EIA method in the various tissues were proportional to their enzyme activities and also to their immunohistochemical characteristics. The tissues could thus be classified into three groups: a high enzyme activity group composed of the liver, kidney, and spleen; a moderate activity group comprising the lung, lymph nodes, stomach, ileum, colon, and pancreas; and a low activity group consisting of the heart, diaphragm, iliopsoas muscle, cerebrum, cerebellum, and skin. The molecular weight of the enzyme in each tissue did not reveal any heterogeneity, having two components of 70 KD and 62 KD by Western blot analysis. Immunohistochemically, alpha-L-iduronidase was strongly detected in the lysosomal membranes of cells of the mononuclear phagocyte system, epithelial cells of the proximal tubules in the kidney, and some blastic cells, whereas hepatocytes revealed weak positive reactions. The tissue and cellular distribution of the enzyme appeared to have a close relation to tissues that manifest or are affected by alpha-L-iduronidase deficiency.

Intraluminal velocity profile analyzed from flow waveforms.

Normal and abnormal flow waveforms, electromagnetically measured in the reconstructed arteries of patients with peripheral occlusive diseases of the lower extremity, were analyzed in terms of luminal velocity profile, using a newly designed flow wave simulation pump. The blood flow with normal flow wave was characterized by a large fluctuation in the velocity profile in the limited layer adjacent to the wall, where a reversal stream was characteristically noted during the phase of cardiac diastole. In contrast, in the abnormal flow wave, the velocity profile in the limited layer adjacent to the wall was always stagnant with little change in the velocity during each phase of a cardiac cycle. These observations clearly explain why an artery with a normal flow waveform remains patent, while an artery with an abnormal waveform tends to occlude. It was also found that the electromagnetically determined flow waveforms do provide the required information on the luminal velocity distribution.

Venous reconstruction for iliofemoral venous occlusion facilitated by temporary arteriovenous shunt. Long-term results in nine patients.

In nine patients with iliofemoral venous occlusion, venous reconstructions using a temporary arteriovenous shunt were performed by open thromboendvenectomy with autogenous vein patch angioplasty in four, expanded polytetrafluoroethylene (ePTFE) bypass grafts (including two with external ring-supported ePTFE) in four, and Palma's procedure in one patient. There was an adequate function in the reconstructed venous segments in two of four who underwent thromboendvenectomy and in all four with ePTFE bypass grafting for nine months to 13 years after surgery. In those with a temporary arteriovenous shunt, prepared to maintain patency of the reconstructed venous segments, blood flow through the shunt exceeded 100 mL/min, determined by an electromagnetic flowmeter. Postoperative shunt closure was readily facilitated, using a looping technique and a 2-0 nylon. The increased blood flow through the graft made feasible by the temporary arteriovenous shunt enhanced the patency of the reconstructed venous graft and hence there was an improvement in the affected limb.

Relationship between tooth loss and electrocardiographic abnormalities in octogenarians.

Recent reports have suggested that periodontal disease is a risk factor for coronary heart disease (CHD). However, little is known about the relationship between periodontal disease and CHD in the very elderly. Therefore, we evaluated the association between tooth loss and abnormal ECG findings in octogenarians. Of the 1,282 octogenarians in Fukuoka Prefecture, Japan, 697 participated. Oral examinations--including a tooth count and an assessment of the Community Periodontal Index--and a 12-lead ECG were performed. Logistic regression analysis revealed that individuals with < 20 teeth had increased prevalence of ST segment depression, and T-wave abnormalities, after we adjusted for gender, smoking, serum cholesterol and glucose, blood pressure, and body mass index. Compared with individuals with > or = 20 teeth, edentulous individuals had an increased prevalence of T-wave abnormalities and arrhythmias after adjustment for coronary risk factors. We conclude that tooth loss may be an independent predictor of abnormal ECG findings in octogenarians.

Hepatocellular carcinoma with sarcomatous change.

We studied clinicopathological and immunohistochemical features of hepatocellular carcinoma (HCC) with sarcomatous change among surgically resected HCC cases. Among 308 HCC cases, 6 (1.9%) showed partial (5 cases) or entire (1 case) sarcomatous change. Only 1 case received preoperative anti-cancer therapy among the 6 cases, suggesting that sarcomatous change is not always related to anti-cancer therapy. Immunohistochemically, the sarcomatous components were positive for albumin and alpha 1-antichymotrypsin and negative for alpha-fetoprotein in all cases. Expressions of intermediate filament-related proteins (e.g., cytokeratin and vimentin) in the sarcomatous components were heterogeneous. The sarcomatous components showed stronger expressions of p53 protein and/or mouse double minute-2 protein, and higher proliferating cell nuclear antigen labeling index, suggesting their high proliferative activity and high malignant potential.

Flow wave form analysis in vascular surgery.

An analysis of 82 limbs subjected to femoropopliteal bypass grafting demonstrated that electromagnetic flow wave forms of the reconstructed vessel are a reliable indicator in predicting the outcome of surgery. On the basis of this knowledge, postoperative follow-up study of patients who had undergone reconstructive surgery was carried out. Early occult occlusive lesions were detected in 5 of 56 limbs examined, and 3 of these patients underwent successful reoperation with satisfactory restoration of blood flow. Follow-up study using flow wave form analysis is a useful method of detecting occult changes in arteries and leads to early treatment.

A new human hepatocellular carcinoma cell line (HAK-2) forms various structures in collagen gel matrices.

We established a new human hepatocellular carcinoma (HCC) cell line, designated HAK-2, from a surgically resected HCC of a 57-yr-old Japanese man. The patient's tumor consisted of 5 different histological features in a single nodule: well-differentiated HCC with trabecular pattern; and moderately differentiated HCC with 4 different patterns (i.e., trabecular, pseudoglandular, solid, and scirrhous). Morphologically, HAK-2 cells on a plastic dish showed oval-shaped nuclei and large flat, polygonal eosinophilic cytoplasm and proliferated in a monolayered sheet with a population doubling time of 36.8 hours. Meanwhile, various structures, such as compact, trabecular, and tubular arrangements, were induced in HAK-2 cells cultured in type I collagen gel matrix. Also, HAK-2 cells in vitro underwent spontaneous apoptosis more frequently than other HCC cell lines examined. HAK-2 cells secreted various plasma proteins including albumin into the culture medium. Chromosome and flow cytometric analyses revealed that HAK-2 had many structural abnormalities with human karyotype and a single aneuploid cell population with a DNA index of 3.7, respectively. These findings suggest that HAK-2 is a new human HCC cell line representing two morphological characteristics; (1) formation of various structures in the presence of extracellular matrix and (2) frequent spontaneous apoptosis in vitro.

Experimental study of the influence of porosity on development of neointima in Gore-Tex grafts: a method to increase long-term patency rate.

The objective of this study was to evaluate the controlled microscopic development and fate of the neointima of Gore-Tex graft pretreated with multiple regular perforations, compared to nonperforated controls. Gore-Tex grafts (each 7 cm x 8 mm), perforated at regular 2 mm intervals with a special needle (0.8 mm internal diameter) for one half the length, with the remaining half kept intact, were implanted in 37 canine abdominal aortas in an end-to-end fashion. Standard untreated Gore-Tex grafts, of identical size, were similarly implanted in ten as controls. The perforated portion of the artificially treated Gore-Tex grafts demonstrated early neointimization at one week, the presence of fibroblasts and developing vasovasorum at 4 weeks, and complete endothelialization at 12 weeks. In contrast, the unperforated portion of implanted grafts demonstrated delayed endothelialization, requiring 24 weeks for complete development. Untreated controls demonstrated incomplete healing of the central luminal portion of the graft, with reddish thrombi still present at 24 weeks. Our study demonstrated that the poor development of neointima persists in the central portion of standard Gore-Tex controls in the last postoperative period, while pretreatment with multiple small perforations significantly hastens the development of a smooth neointima.

Absorbable suture materials for vascular anastomoses. Tensile strength and axial pressure studies using polyglycolic acid sutures.

This study attempted to evaluate how vascular healing itself is sufficient enough to provide adequate strength to autogenous vein grafts in small arteries without the use of nonabsorbable sutures. The absorbable suture, Dexon, was used in small canine femoral vein graft anastomoses over a two-month trial period with nonabsorbable Prolene as a control. Tensile strength and resistance to axial leak were measured. Results show that Dexon had 93 per cent of the tensile strength of Prolene immediately; 76 per cent at 14 days, 111 per cent at 21 days, and 110 per cent at 30 days, and 124 per cent at 60 days as an average for all suture lines. The per cent mean resistance to leakage that Dexon had compared to Prolene for all suture lines was 102 per cent at seven days, 97 per cent at 14 days, 107 per cent at 21 days, and 97 per cent at 30 days. There is no evidence of aneurysms, suture line disruptions, dilations, or infections of any anastomoses. Our ultimate conclusion is that the integrity of small autogenous vein graft is dependent on healing rather than on the permanent strength of the suture material and that Dexon maintains vascular integrity long enough to permit this healing to occur.

Femoral component wear in retrieved hip prostheses.

We retrieved 159 femoral heads at revision surgery to determine changes in surface configuration. Macroscopic wear of the head was observed in three bipolar hip prostheses as a result of three-body wear. There was a considerable change in surface roughness in the internal articulation of bipolar hip prostheses. Roughness in alumina heads was almost the same as that in new cobalt-chromium heads. The annual linear wear rate of polyethylene cups with alumina heads was less than that of cups with cobalt-chromium alloy heads. Polyethylene wear was increased in the prostheses which had increased roughness of the head.

Wrapping technique for prevention of anastomotic false aneurysm in synthetic prostheses: clinical and experimental.

A clinical review of late anastomotic false aneurysm in 293 prosthetic reconstructions including 694 anastomoses for larger arteries at the Department of Surgery II, Kyushu University, from 1965 to 1979, revealed the incidence of anastomotic false aneurysm to be 3.9% of 204 abdominal aortic anastomoses and 12.9% of 209 common femoral anastomoses, respectively. A major contributing factor to development of the anastomotic false aneurysm was deterioration of the parent artery. In order to prevent this complication, we successfully applied a dacron felt wrapping to 45 abdominal aortic, 44 iliac arterial and 27 common femoral arterial anastomoses and there have been no postoperative complications at 5 years. The reliability of the dacron felt wrapping technique was also evaluated by an experimental study using dogs. Furthermore, we devised a double wall anastomosis technique for application in cases with severely sclerotic abdominal aortic aneurysms. Five patients in whom this technique was used are well after 3 years.

Tibial artery autogenous in situ vein bypass with adjunctive arteriovenous fistula.

A man suffering from severe intermittent claudication of the right calf and foot was successfully treated by femoro-tibio-peroneal trunk autogenous vein bypass with adjunctive arteriovenous fistula. Prior to operation, he was unable to walk more than 50 meters without resting. Preoperative arteriography revealed extensive occlusion of the popliteotibial arteries, except for indistinct visualization of the tibio-peroneal trunk, in which conventional reconstructive surgery seemed not to be feasible because of poor distal run-off. An autogenous vein bypass graft between the distal superficial femoral artery and tibio-peroneal trunk was successfully made "in-situ", creating an adjunctive arteriovenous fistula. Postoperatively, the ankle pressure index of the posterior tibial artery was considerably increased from 0 to 0.65, and Doppler flow wave could be recorded. The patient can now walk more than 1,500 meters without resting.

A new revascularization procedure for extensive arterial occlusions of lower extremity. A.V shunt procedure.

A revascularization procedure for extensive arterial occlusive lesions of the lower extremity, namely "A-V shunt procedure" was devised. The occluded popliteal artery is recanalized by open endarterectomy in association with E-PTFE bypass for occlusion of the superficial femoral artery, and the patency of reconstructed arterial segments is ensured by an arterio-venous shunt created at the distal end of the recanalized tibio-peroneal trunk. The branches of the genicular arterial network are also reopened by a technique of thrombectomy. Numerous collaterals develop through the reopened genicular network increasing blood flow to the ischemic distal areas. From 1967 to 1980, 63 extremities in 57 patients, which had extensive arterial occlusions of lower extremities with impending ulcer and/or severe rest pain in their feet or toes, underwent this procedure. Remarkable improvement of ischemic symptoms resulted in 76.2% of extremities at the time of the hospital discharge and 57.1% in follow-up.

Crural artery bypass with adjunctive arteriovenous fistula. A modification in distal anastomosis.

We carried out crural artery bypass with an adjunctive arteriovenous fistula in 8 lower extremities of 7 patients with severe ischemic symptoms and poor distal run-off. Mean blood flow rates in the implanted grafts ranged from 43 to 340 ml/min and those of the reconstructed crural arteries from 20 to 100 ml/min. A stenotic lesion was noted on postoperative angiogram in one patient and stasis symptoms caused by downward blood flow into the distal veins in another. The other patients have remained well with good function of the grafts 1-5 years after surgery. We modified the distal corner of the anastomosis as follows: three additional interrupted simple sutures were made on the anterior wall of the concomitant arteriotomy and venotomy incisions after making the common posterior wall of the vessel incisions. A vascular pocket formed at the distal corner of the anastomosis prevents stricture at the anastomosis. The vein is finally ligated just distal to the fistula to intercept downward blood flow into the distal veins. This modification in technique is recommended to prevent stricture of the distal anastomosis and postoperative stasis symptoms.

Popliteal artery entrapment syndrome. Report of two cases.

We treated two patients with popliteal artery entrapment syndrome. In one, the popliteal artery was entrapped and obstructed in its abnormal course around the medial head of the gastrocnemius muscle, which was inserted into the femur laterally and cephalad (type II in Delaney's classification). In the other patient, the popliteal artery followed a normal course but was compressed laterally by the medial head of the gastrocnemius muscle, which was aberrantly inserted into the femur considerably higher and more lateral than usual, and was occluded. This could not be fitted into Delaney's or Insua's classification. Arterial reconstruction was successful with an autovein graft in the former case and an in situ bypass graft in the latter. We suggest a modification of type IV in Delaney's classification, so that when the popliteal artery is compressed by an aberrant muscular or tendinous structure in the popliteal fossa it can be included.

Failure of dacron arterial prostheses caused by structural defects.

We have observed unusual aneurysmal complications associated with structural defects of Dacron fabrics in three patients. The first patient had beadshape aneurysms along the course of the bilateral axillo-femoral prosthetic bypasses 4 or 5 years after surgery. Round defects or longitudinal rents in the lower third of the prostheses (Vascular-D knitted Dacron graft of high porosity, USCI) were the source of the aneurysmal complications. In the second patient, the transverse diameter of the aorto-femoral Dacron graft (Vascular-D, USCI) was increased to twice that of the original graft with formation of an anastomotic false aneurysm in the groin 3 1/2 years after surgery. The defective prostheses in these two cases were successfully replaced by Cooley double velour knitted Dacron grafts. The third patient developed an arterio-ureteral fistula originating from a round defect of the aorto-femoral prosthesis (Tetoron that is woven Dacron graft with a low porosity, Nakao-Filter, Japan) 8 years postoperatively and died from massive hematuria and subsequent disseminated intravascular coagulopathy. Microscopic examination of the removed prostheses revealed a complete loss of the conformation of the weave with fragmentation and disruption of the graft fibers. Therefore, patients with Dacron arterial prostheses should be followed up regularly and with great care.

Occluded persistent sciatic artery.

The case of a patient with ischemic symptoms due to occlusion of a persistent left sciatic artery is presented. Femoral arteriography revealed a tapering hypoplastic superficial femoral artery terminating as small branches in the distal thigh and a hyperplastic profunda femoris artery. Also, translumbar aortography demonstrated an abrupt occlusion of a hyperplastic left hypogastric artery just distal to the inferior gluteal artery. The popliteal artery was found to be patent and perfused by collaterals. A bypass graft using a composite E-PTFE prosthesis and an autogenous vein graft was successfully performed.