Ichiro Ban

False aneurysm of the superficial temporal artery

Abstract A case of false aneurysm with fistula of the superficial temporal artery is reported, and the English literature is reviewed.

Pattern of Arterial Occlusion in Buerger's Disease

The pattern of arterial occlusion in Buergers disease was analyzed by simultaneous bilateral femoral arteriography in 210 limbs of 105 patients with Buergers disease. In 55 limbs of 42 patients, the femoropopliteal segment was affected in addition to the infrapopliteal arterial obstructive lesion. The pattern of crural arterial occlusion was similar in about 40% of both the patients with femoropopliteal occlusion and the patients with crural occlusion. Toes were ulcerated in 4 of 58 limbs with continuous arterial flow, and ulceration occurred in 86 of 152 limbs with a discontinuous flow. The rate of occurrence of bilateral trophic lesion in the group with an arterio graphically similar occlusion pattern was not significantly higher than that in the group with a different pattern. The pattern of arterial occlusion in Buergers disease seemed to be fixed mainly within 1 year after the onset of symptoms, and the skip-lesion in the main artery was favorable to proximal progression of the disease.

Onset and Clinicopathological Course in Buerger's Disease:

From clinicopathological study, vasculitis of Buergers disease seemed to start at small branch arteries and veins and progress to the trunk artery with thrombus. Progress of vascular lesions in trunk artery was gradual in general; the pathogenesis was briefly discussed.

Measurement of Blood Pressure, Blood Flow and Flow Velocity in Arterial Reconstruction of the Lower Extremity

Seventy-five limbs of 66 patients undergoing arterial reconstruction of the lower extremity were studied. In 41 of 64 limbs that were not involved in early failure, API returned to normal immediately and the increased API was main tained as long as grafts remained patent. The limbs exhibiting a rise in API of 0.1 or more following proximal reconstruction in the cases with combined iliac and femoral arterial occlusion or bypass grafting to an isolated segment ob tained marked improvement of symptoms. Postoperative increase in TPI was not so marked as in API, and TPI remained very low in the limbs with arterial obstructive lesions below the ankle after successful reconstruction. Early or late failure could not be predicted on the basis of preoperative or postoperative API, TPI or A-T gradient. In the limbs with no recovery of TPI, blood flow or flow velocity in the foot was of value predicting which limbs would be sal vaged.

Arterio-venous fistula formation after hand replantation

Replantation of a completely severed finger, hand or arm is now performed with wide success. We now report an extremely rare complication of this replantation, an arterio-venous (A-V) shunt formation. Pathogenesis of the new A-V fistual formation is discussed.

Lont-term prognosis for reconstruction of arterial lesions due to arteriosclerosis

Out of 769 patients with arterial diseases, reconstructive surgery was performed on 100 limbs of 79 patients for arteriosclerosis. The overall patency rate was 59 per cent over a period of 3 to 8 years. Longterm patency was influenced by the condition of the run-off arteries, the site of the operation, and the method of surgery. No relation was found between patency rate and hypertension, cardiac insufficiency, total serum cholesterol, diabetes mellitus, or age. The survival rate was 62 per cent at 5 years and 48 per cent at 7 years. These rates were significantly poor (p<0.001), compared with those in the normal population. Mortality was related to the degree of hypertension, with cardiac and renal failure being responsible for 72 per cent of deaths. Aggressive reconstruction may be indicated in cases with hypertension of stage 2 or below based on the WHO classification. However, especially in patients with associated diabetes mellitus close long-term observation of the cardiovascular system is necessary.

Recurrence of the Nephrotic Syndrome in the Renal Isograft: A Preliminary Report

The fifth case of kidney transplantation between monozygotic twins in Japan is presented. Immediately after the transplanation the original disease, nephrotic syndrome, recurred but it was treated with steroids successfully. There have been few cases reported in which recurrence of the original disease in the isograft was treated successfully.

Chirurgische Therapie und Pathologie der Takayasu-Arteriitis

SummaryThe pathology of so-called Takayasus disease is an allergic-hyperergic granulomatous arteriitis affecting predominantly the aortic arch and its major branches in young women. The arteriitis seems to begin in the adventitia, i.d. in the vasa vasorum, with extension to the media. The restoration of the carotid artery and surgical therapy of hypertension caused by atypical coarctation of theaorta or renovascular lesions are needed, for the occlusive process of the carotid artery causes not infrequently blindness and the patients die mostly of cardiac or cerebrovascular insufficiency due to hypertension.Although the prosthetic bypass graft from the ascending aorta to the internal carotid artery is effective for the carotid-insufficiency, the problems of operative indication remain to be resolved.ZusammenfassungBei der Takayasu-Arteriitis handelt es sich um eine allergischhyperergische granulomatöse Entzündung, die meistens den Aortenbogen und dessen große Äste bei jungen Frauen befällt. Die Arteriitis scheint in der Adventitia, nämlich in den Vasa vasorum, zu beginnen.Da die ophthalmologische Komplikation sehr gravierend ist und die Patienten meistens an Herzversagen oder cerebralen Durchblutungsstörungen wegen einer Hypertonie sterben, ist die rechtzeitige Wiederherstellung der Carotiden und die Korrektur der Koarktation oder der renovasculären Hypertonie entscheidend.Für die Carotisinsuftizienz ist der Aorta ascendens-A. carotis int.-By-pass zwar erfolgreich, aber die Beurteilung über die rekonstruktive Operation der Carotiden steht noch immer im Brennpunkt des Interesses.

Indirect Blood Pressure Measurement at the Common Femoral Artery

In the present study the technique and the reliability of indirect blood pres sure measurement at the common femoral level was described. The blood pres sure was measured by using a long cuff, which encircled the hips at the level of the groin, and determining the flow signals by Doppler technique applied at the ankle. In order to transmit the cuff pressure to the artery, a slender bag with air, which was a blood pressure cuff used in children, was placed over the common femoral artery under the cuff. A 14 cm. wide cuff-bladder was usually used, but in obese subjects with the size of hips more than 90 cm, a 16 cm. wide cuff-bladder was applied. In patients with collateral vessels around the groin due to the iliac disease, the blood pressure could be measured by placing the Doppler flat probe over the common femoral artery or the collateral vessel. In observation of 24 subjects, a close correlation was obtained between the femoral cuff pressures and common femoral intra-arterial pressures. Furthermore, blood pressure values at the common femoral level measured indirectly showed similar reproducibility as those at the ankle and toe levels.