Biomedical subjects
N Nishikimi
Publications and source records attributed to N Nishikimi.
[Chronic venous insufficiency].
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Comparison of laser vascular welding, interrupted sutures, and continuous sutures in growing vascular anastomoses.
BACKGROUND AND OBJECTIVES: The argon laser-assisted vascular anastomosis may solve the problems of conventional sutured anastomosis, such as vascular stenosis and arrest of growth owing to a foreign-body reaction to suture material. STUDY DESIGN/MATERIALS AND METHODS: Twelve argon laser-assisted vascular anastomoses, seven conventional anastomoses with interrupted sutures, and five conventional anastomoses with continuous sutures were performed in 12 young mongrel dogs. RESULTS: Five months later, the external diameter at the anastomosis had increased 70.5% in the laser group, 67.0% in the interrupted suture group, and 22.9% in the continuous suture group. Histological examination of the laser-assisted anastomoses showed almost complete healing, with no granulomatous response around the anastomotic site. In the interrupted suture group, marked scaring and foreign body reactions were observed on the vessel wall at the site of the anastomosis. The continuous suture group showed more remarkable disorientation of the vascular layer and intimal hyperplasia than the interrupted suture group. CONCLUSION: Vascular anastomosis using the argon laser offers advantages over the conventional procedure in growing vessels.
Thoracoscopic sympathectomy for Buerger's disease: a report on the successful treatment of four patients.
We describe herein the successful treatment of four patients with ischemic ulcers or gangrene of the fingers due to Buerger's disease by thoracoscopic sympathectomy, a new method of surgery which eliminates the difficulties associated with the traditional "open" approaches to the thoracic sympathetic chain, such as poor exposure, risk of damage to the adjacent structures, and postoperative pain. After the patients were placed in the lateral decubitus position with unilateral pulmonary ventilation, the thoracic sympathetic ganglia (T) from the lower third of T1 to T3 were resected endoscopically. The operative results were excellent, with improvement or complete resolution of the ulcer being achieved in all four patients. All of the patients were satisfied with the results in terms of ulcer healing, postoperative pain, and cosmetic appearance. Although a postoperative air leakage developed in one patient with a history of pulmonary tuberculosis, it was successfully treated with an adhesive agent. None of the patients developed Horner's syndrome. Thus, because thoracoscopic sympathectomy is easier to perform with a lower risk of complications than conventional thoracic sympathectomy, we recommend this operative approach as the procedure of choice for surgical thoracic sympathectomy.
Below-elbow joint arterial reconstruction for chronic ischaemia.
Ten below-elbow joint arterial bypass grafts performed in nine patients for chronic upper extremity ischaemia are reviewed. The cause of the ischaemia was thromboangiitis obliterans in four patients, iatrogenic trauma in four and unknown aetiology in one. Graft revision was required in two patients with thromboangiitis obliterans who underwent axillary-brachial bypass. Eight grafts, including one reoperation, have remained patent from 1 to 10 years (mean 54.3 months). Graft failure after 5 months did not occur, at which time the primary patency rate was 80%. In general, the long-term patency rates of autogenous vein bypass graft to the forearm were satisfactory. Aggressive arterial reconstruction is especially indicated in significant chronic upper extremity ischaemia resulting from iatrogenic trauma, as chances of success are excellent. Clinical and technical problems of in situ vein bypass in the upper extremity are discussed.
Microcirculatory characteristics in patients with Buerger's disease.
The most characteristic pathophysiologic change in Buerger's disease or thromboangiitis obliterans (TAO) is considered the breakdown of microcirculation in the extremity, but this has not yet been proven. The purpose of this study is to examine the damage of microcirculation in TAO objectively, by means of intra-arterial injection of two kinds of radioisotope. In 7 TAO and 4 infrainguinal arteriosclerosis obliterans (ASO) patients, thallium 201 chloride (201Tl) and 99mTc macroaggregated human serum albumin (99mTc-MAA) were administered through bilateral common femoral artery injections. In the planar image of the foot, rectangular regions of interest (ROIs) were placed on the foot muscles and toes. Normalized counts of 99mTc-MAA in each ROI were divided by that of 201Tl, and the result was defined as the microcirculation damage index, based on their different kinetics. The damage index of the foot muscle was not different between ASO and TAO, but that of the toe was lower in TAO than ASO patients. Lumbar sympathectomy was performed in 5 TAO patients, but it did not improve the damage index. It is concluded that there is breakdown of the microvascular defense system from the beginning of the disease, and critical ischemia make the regional cell function deteriorate as if a precursor to a trophic lesion. Lumbar sympathectomy did not immediately improve microcirculation.
[The treatment of choice in deep vein thrombosis of the lower extremity].
Of 67 patients with acute deep vein thrombosis of the lower extremity (DVT), 43 patients were treated by venous thrombectomy and 24 patients were managed by conservative treatment. The clinical effect of thrombectomy was evaluated by analyzing follow-up results in the 2 groups. The cumulative incidences of pigmentation and stasis ulcer at the 5th year were 2.7% and 0% respectively in the thrombectomy group, and 24.3% and 10% respectively in the conservative treatment group. Pigmentation and stasis ulcer were significantly more frequent in the conservative treatment group (p < 0.01). It is concluded that venous thrombectomy is superior to conservative treatment to prevent late postthrombotic sequelae. Protein C, protein S and plasminogen were assayed in 40 DVT patients to determine the incidence of hypercoagulable state in DVT. Congenital deficiency or abnormality were found in 15 patients (37.5%). In such DVT patients with thrombophilia anticoagulant prophylaxis should be continued to decrease a risk of rethrombosis.
Factors affecting the patency of small-caliber prostheses: Observations in a suitable canine model.
Lack of an endothelial surface is most often blamed for the relatively poor patency of polytetrafluoroethylene grafts used in infrageniculate bypass when compared to autogenous saphenous vein. Length, caliber, flow, and ability to withstand flexion are also acknowledged but have not been systematically examined. We report the results of our attempts to discriminate between the relative contributions of these factors and to develop a suitable canine model for evaluating small-caliber prostheses (4 mm x 10 cm thin-walled polytetrafluoroethylene). ASA/dipyridamole were given 1 week before and 4 weeks after operation. Patency was assessed by directional Doppler at frequent intervals (less than or equal to 3 days). The following were observed: (1) Iliac placement provided a useful patency reference point (40% to 50% patency at 60 days). (2) Carotid patency was not better than iliac patency. (3) Crossing a flexion crease decreased patency. (4) The low patencies were not technical but intrinsic to the graft. Iliofemoral vein grafts achieved 100% patency at 60 days. (5) External rings did not improve iliofemoral patency (equal in paired comparisons). (6) Neither baseline platelet aggregation nor platelet aggregation after ASA administration correlated with patency. This canine model is an excellent test for small caliber-low flow prostheses. It allows paired-site comparisons, which are essential, and meaningful patency data with reasonable numbers of subjects within 2 months' observation. Directional Doppler evaluation avoids need for angiography or serial postmortem analysis sacrifice.
Human seminal plasma Zn-alpha 2-glycoprotein: its purification and properties as compared with human plasma Zn-alpha 2-glycoprotein.
On the basis of the datum that the level of Zn-alpha 2-glycoprotein (Zn alpha 2gp) in human seminal plasma was about 6-times higher than that in adult serum, Zn alpha 2gp was purified from fresh human seminal plasma approx. 70-fold with 60% yield over seminal plasma by DEAE-Sephacel, Zn-chelate Sepharose 4B and DEAE-5PW column chromatographies. The molecular weight of seminal plasma Zn alpha 2gp was 50,000 on Superose column chromatography, and 40,500 and 41,500 on SDS-polyacrylamide gel electrophoresis in the absence and presence of beta-mercaptoethanol, respectively. Plasma Zn alpha 2gp is a glycoprotein, while the protein from seminal plasma does not contain carbohydrate. The amino acid sequence of the first 17 residues of seminal plasma Zn alpha 2gp was Glu-Asn-Gln-Asp-Gly-Asn-Tyr-Ser-Leu-Thr-Tyr-Ile-Tyr-Thr-Gly-Leu-Ser. This sequence was completely identical with the amino acid residues from Glu-2 to Ser-18 in the N-terminal amino acid sequence of plasma Zn alpha 2gp. These data suggest that both Zn alpha 2gps in plasma and seminal plasma may be expressed from one gene, but their posttranslational modifications are different.
Quantification of leg muscle perfusion using thallium-201 single photon emission computed tomography.
The purpose of this study is to quantify leg muscle perfusion with 201Tl single photon emission computed tomography (SPECT). Six normal controls and 21 patients with peripheral arterial disease underwent this examination. Thallium-201 leg SPECT of both stress and redistribution was performed using a dual-headed digital gamma camera. Each slice of transverse images was normalized with pixels and whole-body counts. In normal controls, the activity of posterior tibial muscle components was significantly higher than that of anterior tibial muscle components (p less than 0.001). In 14 components, where patients had insignificant lesions, profile curves were normal in 10 (71%). In 62 components, where patients had arteriographically significant lesions, stress profile curves were abnormal in 57 (92%) compared with normal controls. Approximately, in half (28/62) components which had significant lesions, profile curves showed redistribution after 3 hr compared with normal redistribution curves. In three patients who underwent successful bypass graftings, the activity of each muscle component returned to a normal range.
[Indication of femorotibial and femoroperoneal bypass for Buerger's disease].
Infrapopliteal bypass with autogenous vein graft was performed in twenty-three patients of thromboangiitis obliterans (Buerger's Disease) during the past 8 years. The outflow vessel of the graft had the direct connection with the pedal arch in 3 cases. In 20 cases the graft was anastomosed to the solitary tibial or peroneal segment, in which the occlusive lesion existed between the outflow vessel and pedal arch, or otherwise, the pedal arch was not opacified in the arteriogram. The length of the solitary tibial or peroneal segment of the successful cases ranged from 11.5 cm to 29.0 cm. The cumulative patency rates of the 23 bypass grafts at 3 months, 1 year, 3 years and 5 years were 86.7%, 77.3%, 77.3%, 77.3% respectively. This result is comparable to those of other authors. When the solitary tibial or peroneal artery is found out and is longer than 12 cm in the arteriogram of Buerger's Disease, we are going to perform bypass surgery to the vessel. If the foot is already necrotic, the amputation should be carried out several days or several weeks after the successful reconstructive surgery.
[Three cases of thoracic or thoracoabdominal aortic aneurysm successfully treated with cell saver].
During a three-month period from January to March 1986, reconstructive surgery was performed on three patients with thoracic or thoracoabdominal aortic aneurysm using a temporary bypass procedure. To reduce the amount of blood transfusion required during operation, an autologous blood recovery system, Cell Saver, was used in these three cases. The amount of blood loss, including the blood passing through the Cell Saver, was 7,020g in Case 1, 6,600g in Case 2 and 16,700g in Case 3. The amount of blood transfusion given to these three cases was 1,400g, 4,400g and 6,800g, respectively. The results indicated that the ratio of transfused blood amount to blood loss during operation was successfully reduced to a level of 20-67% of two other cases with thoracoabdominal aortic aneurysm, operated upon without using Cell Saver. Cell Saver was especially effective in Case 3 in which the blood for transfusion was restricted, for it was difficult to collect enough donors to complete operation because of rare blood type of Rh(-) in this case. That is, Cell Saver withdrew 15,000ml of blood through the sucker from the patient and returned it as concentrated and washed RBC during operation.
Chylous reflux with primary lymphoedema praecox.
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[Leg muscle perfusion study using T1-201 single photon emission computed tomography (SPECT)].
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