Masafumi Hirai

Prevalence and risk factors of varicose veins in Japanese women.

The prevalence and risk factors of varicose veins in Japan were investigated in 541 Japanese women. Varicose veins were defined as any dilated, tortuous, and elongated veins of the lower extremity and classified into four types. The total prevalence rate was 45%. Saphenous type was observed in 22%, segment type in 35%, reticular type in 28%, and web type in 16%. Varicose veins in Japan seem to be less common than in the United States and Europe but more prevalent than in Africa. Concerning risk factors for varices, age, sex, heredity, and childbirth were related to the incidence of varicosities, as reported by others. However, these risk factors were shown to differ according to type of varicose veins.

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.

Combination gastric seromuscular patch and omental pedicle flap for bronchial fistula

We report the successful closure of a recurrent bronchial fistula using a combination gastric seromuscular patch and omental pedicle flap. This new method provided an immediate airtight closure of the bronchial fistula. This technique appears superior to closure by omentum alone.

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.

Hemodynamic Effects of Intravenous PGE1 on Patients with Arterial Occlusive Disease of the Leg

In 42 patients with arterial occlusive disease of the leg, the hemodynamic effects of prostaglandin E1 (PGE1) given intravenously were studied. Blood pres sure of the leg and crest time of the pulse wave did not change significantly, while increases in blood flow at the calf and foot, amplitude of the pulse wave, velocity, and skin temperature at the foot and toes were significant. Skin tem perature of the calf dropped significantly. The increase in blood flow, velocity, and skin temperature was significantly more dominant in the distal part of the leg than that in the proximal part. In separate observation of individuals, 12 of the 66 legs with arterial occlusive disease (18%) showed a decrease in skin tem perature at the toes. The steal phenomenon was observed most frequently in limbs with rest pain, gangrene, or both.

Clinical Significance of Doppler Velocity and Blood Pressure Measurements in Peripheral Arterial Occlusive Disease

In 20 normals and 50 limbs with arterial occlusive disease, Doppler flow velocity and blood pressure in different levels of the leg were determined at rest and during reactive hyperemia. While blood pressure measurement at the ankle and flow velocity analysis at the posterior tibial artery were of use in the diagnosis of arterial occlusion, recording the mean femoral flow velocity during reactive hyperemia showed less diagnostic value. Ankle blood pressure was determined after two different exercises — knee exercise and ankle exercise. A greater decrease of blood pressure was observed after ankle exercise than after knee exercise in limbs with isolated occlusion of the femoral artery, and a less decrease in limbs with isolated occlusion of the iliac artery. These findings indicate that comparison of ankle blood pressure after two exercises is useful as a screening test to detect the combined ilio-femoral diseases.

Cystic adventitial degeneration of the ilio-femoral artery and vein

A 48 year-old sales man was admitted to our hospital because of the swelling of the right lower extremity. The swelling with severe pain developed suddenly 8 days before admission. It was clarified that he had suffered from intermittent claudication in the right calf since 10 years. At that time he had noticed an index finger-size tumor in the right groin. During the first half a year he could not walk more than 100m because of a calf pain. After that the walking distance was unsteady from 100m to 1500m. The calf pain sometimes subsided by pushing or tapping the tumor in the groin. He was a smoker but

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.

Chronic Venous Insufficiency in Primary varicose Veins Evaluated by Plethysmographic Technique

Venous hemodynamics were evaluated by plethysmography in normal sub jects and patients with venous disorders of the lower extremity, to clarify the pathophysiology of chronic venous insufficiency (CVI) due to primary varicose veins. Expelled volume during five active dorsiflexions of the feet and venous recovery time were calculated to evaluate muscle pump efficiency and valvular competence. Limbs with CVI due to primary varicose veins showed a higher expelled volume and a more shortened refilling time than limbs with simple varicosities. With application of tourniquets, the refilling time normalized in limbs with CVI, as well as in limbs with simple varicosities. These results indicate that a high degree of venous congestion in the distal part of the calf and valvular incompetence of the superficial vein system might cause CVI due to primary varicose veins.

Segmental blood pressure of the leg and its clinical use

Systolic blood pressure at various levels of the leg was measured in 80 normal subjects by photoelectric plethysmography with a blood pressure cuff. Due to the higher pressure value at the tigh, calf, ankle, and foot and lower pressure value at the toe, the pressure gradient between each proximal site and the toe was significantly higher in the older (50–82) than in the younger age group (17–49). Therefore, normal values were determined separately in these two groups. In 64 limbs of 42 patients with arterial occlusive disease, a comparison between segmental blood pressure and arteriographic findings was made. Segmental blood pressure may be a rough indicator of the severity of arterial occlusion present and may refrect the status of the major conduits of the leg. An abnormal ankle-toe pressure gradient was found in only 52 per cent of limbs, although all 64 limbs had undergone an occlusive process distal to the ankle. In limbs with significantly low ankle blood pressure due to proximal lesions, less frequency and severity of an abnormal ankle-toe pressure gradient were seen than in limbs with normal ankle blood pressure. When pressure gradients between two different levels are used in clinical work, the blood pressure at the more proximal level should be always considered.