Itaru Ohara

Laser-Assisted Microvascular Anastomosis

A low power carbon dioxide laser was used to perform 110 end-to-end laser-assisted microvasuclar anastomoses of carotid arteries in ginea pigs and rabbits. In 56 of 72 cases which were irradiated with power output 20-40 mW, energy density 1.5-2.5 Joule/mm2, showed patency immediately after surgery with no wound distruption nor thrombus formation. From these results, the optimum condition for anastomosis seemed to be in this range of power output and energy density. The bursting strength of laser-assisted anastomosis (LA) was assessed and compared with conventional suture anastomosis (CA). LA arteries consistently demonstrated lower bursting strength than those of CA. Relatively low bursting strengths at 1 hour and 3 days in the LA with 3 stay sutures may explain the late aneurysm formation. Additional stay suture seemed to prevent such complication. The mean duration of each anastomosis was 13 minutes for the LA repairs compared to an average of 24 minutes for CA repairs. These findings suggest that a low power carbon dioxide laser has potential clinical application for anastomosis of small vessels.

Lymphaticovenous Anastomosis in a Case With Primary Lymphedema Tarda

cases showing lymphaticovenous anastomosis seems to be relatively few. Edwards and Kinmonthl reported on such communications and found it in 2.3% of 700 lymphangiographic studies. In this report, a 53 year old man with primary lymphedema tarda who showed such communications between the great saphenous and deep femoral veins and femoral lymphatics by lymphangiogram will be presented and the recent literature is reviewed.

Study On Peripheral Circulation Using Macroaggregated Serum Albumin Labelled With Radioactive Iodine

The existence of anatomical and functional arteriovenous shunts was demon strated in the limbs by injecting radioiodinated macro-aggregated serum albu min into the feeding main artery. The size of shunt included those with about 20-50 μ. Consequently, the degree of shunt could be analyzed. Scintiscanning after intraarterial injection of radioiodinated macroaggre gated serum albumin into the limb may be used as one of the ancillary methods for the diagnosis of peripheral vascular diseases. Especially, the study is useful when the findings are compared with that of peripheral arteriography. In order to detect occlusions of arterial trees of the limbs without resorting to arteriography in those with peripheral arterial occlusive lesions, scanning of a suspected area of the extremities with a scintillation detector after injection of 131I labelled macroaggregated serum albumin (abbr. 131I MAA) into the main feeding artery was carried out. Occasionally, the site of occlusion of the main artery which was demonstrated by arteriography was consistent with the find ings by scintiscanning. 1,2 However, the results were not highly successful. Jones et al3 in 1965 reported that when 131I MAA was injected into the femoral artery, normal and abnormal patterns of regional blood flow had been observed. In our study, it became obvious that regional blood flow was greatly influenced with the collaterals depending on the site, extent and period of occlusion. In this study, the anatomical and functional collateral blood flow in man with occlu sive vascular disease will be described.

Abnormally twisted cervical internal carotid artery, probably congenital.

* The Second Department of Surgery (Director: Prof. Dr. Morio Kasai), Tohoku University School of Medicine, Sendai, Japan. t Surgical Service, The Shinjo Prefectural Hospital (Director: Dr. Ichiro Okada), Shinjo, Yamagata, Japan. Recently, cerebral ischemia due to arteriosclerotic changes of the extracranial internal carotid arteries or vertebral arteries has become well recognized.l~ 2 These lesions cause stenosis or obstruction of the lumen of the blood vessel and impede blood flow to the brain. Tortuousity and elongation of arteries are also attributed to arteriosclerosis, which is frequently found in the internal carotid artery. Kinking or buckling of these stretched blood vessels are often severe enough to obstruct cerebral blood flow with certain positions of the neck and cause intermittent cerebral ischemia.3. 4 Vascular reconstruction of these tortuous arteries has been attempted to correct the retarded blood flow, with good results.5~ 6 This report is of a patient with a twisted cervical internal carotid artery unrelated to arteriosclerosis. The lesion was found during treatment for neurologic symptoms after a car accident. The abnormal appearance itself did not seem to be the cause of the symptoms. Because of its unusual anatomical structure, this anomaly and the pattern of its cerebral circulation will be described.

An experimental study on polyvinyl sponge grafts (ivalon and polyvinylformal) transplanted into arterial defect with a case of clinical application.

are showing undesirable complications, i.e., rupture, expansion, thrombosis and infection. Recently, the role of polyvinyl sponge has been studied by several investigators as substitutes for various organs, i.e., aortic or mitral valve, cardiac septum, vein, diaphragm, blood vessel shunt, esophagus, trachea, ureter and common bile duct;3, 5,8,16,18,31 and in plastic,!’ 7, 14, 33 neurosurgical ,11 chest2, 23 and orthopedic surgery.28, 35 Use of this material as an arterial substitute3, 12, 2s has arisen from its excellent

Light Irradiation And Response Of The Living Body - Effect Of Pain Relief And Promotion Of Wound Healing -

The first report of laser irradiation for wound healing was done by Mester, E., et al. in 1968. From their reports, we can get many knowledges and suggestions as for laser irradiation. At that time he used ruby laser (694.3 nm wave length) for surgical wounds and burns on the back skin of mice. The condition of irradiation was studied with energy density between 0.5-10 J/cm2 twice a week. As a result, they noticed 1 J/cm2 irradiation was effective for those wounds. After a few experimental reports, they published their clinical studies in 1975. Clinically, they used He-Ne laser (632.8 nm wave length) irradiation. Human leg ulcers due to peripheral circulatory disturbance were treated with energy density of 4 J/cm2 twice a week. And they got good results, obtaining complete healing in two-thirds of the cases. We became strongly stimulated by those reports. We have been studying the effect of light on experimental and clinical wound healing as well as on various kinds of biological phenomena since 1980. Particularly, its effect according to the difference of light has been studied. In October 1982, the first clinical case was tried by Argon laser (514.5 nm wave length) irradiation for therapeutic purpose. A man had a chronic ulcer of the left first toe due to Buergers disease for 5 months. Surprizingly, on the 14th day after 6 treatments of the light irradiation, his ulcer completely healed. During these treatments, the patient noticed that the pain completely disappeared after 2 treatments. Fifty Argon laser treatments were carried out on clinical cases after these experiences, we reached to a conclusion that light irradiation stimulated something in the injured tissues and lead to good clinical results. Several studies concerning mechanism for these effects i.e. peripheral circulation, histology of granulation, cell proliferation, chemistry and other studies were carried out. From these investigations, peripheral circulation was improved when in those who were suffering from vascular disorders but was not effective in normal subjects. From a study of cellular electrophoretic mobility, irradiated G0G1 cells increased their mobility, but irradiated G2M cells decreased. These results suggested light irradiation contributed to homeostasis of living cells, tissues, and body. Experiments concerning the light sources, i.e. wave length, energy density and polarization were done. As a result, linear polarization and right circular polarization improved wound healing, but incoherent light itself did not. ,According to our studies, no distinguished differences among various kinds of wave length were noticed. And light irradiation with energy density was very effective between 2 to 6 J/cm2. We strongly suggest the role of coherency is very important to do light irradiation on the living body. In conclusion, we like to propose our new viewpoint. That is, the light irradiation should be discussed with the structure of high molecular substances in the living body.

The Interaction of Kallikrein with Urokinase in Peripheral Circulatory Disorders. A Microcirculatory Observation

Kallikrein and urokinase were used successively in dogs and patients with peripheral vascular disturbance. It was found that kallikrein showed similar pattern of peripheral dye solution curve with that of urokinase. However, its action was slower than urokinase.