Seiji Ogata

Impalement injury of the thorax: Report of a case

We report herein the case of a 33-year-old man who survived an impalement injury of the thorax involving the heart, esophagus, and spinal cord. The patient was transported to our hospital with the impalement object left in situ and it was extracted under cardiopulmonary bypass in an operating room. The important principles of surgical management contributing to the successful outcome of such patients are discussed following the presentation of this case.

Allograft rejection of small bowel transplantation in pigs.

n = 9): nonimmunosuppressed recipients; (2) group 2 (n = 8): FK506-immunosuppressed recipients; (3) group 3 (n = 2): autotransplant controls; and (4) donors (n = 17). Orthotopic small bowel transplantations were performed with Thiry-Vella loops for daily biopsies. The survival rate of group 2 was significantly longer than that of group 1 (P < 0.05). One best survivor in group 2 was killed at postoperative day (POD) 365. Treatment by FK506 prevented rejection, but most of the pigs died of pneumonia. In group 1, rejection began on POD 3 and progressed to severe rejection rapidly within 7 days. In group 2, rejection began from POD 6 to POD 8, but either remained mild or spontaneously improved. The differences in the routine laboratory data and the tumor necrosis factor-α level were not evident between the groups. Histological studies of repeated graft biopsies are thus considered to be essential for detecting signs of graft rejection.

Extended central bisegmentectomy—an en bloc resection of hepatic segments 4, 5, 8 and 7: Report of a case

We herein present an example of an extended central bisegmentectomy in a patient with a large hepatocellular carcinoma. According to a magnetic resonance imaging study, the right hepatic vein was displaced and narrowed at its origin and a large inferior right hepatic vein was revealed. In this case, owing to the only slightly functional remaining hepatic reserve, an extended central bisegmentectomy was selected as the optimum treatment. The postoperative course was uneventful except for some bile leakage. Twelve months after operation, the patient is still alive and no sign of recurrence has been detected.The extended central bisegmentectomy is an en bloc resection of hepatic segments 4, 5, 7, and 8. When the large inferior right hepatic vein is present, segment 6 can be preserved even when the right hepatic vein is sacrificed at its origin.

Portal Vein Replacement with Expanded Polytetrafluoroethylene (e-PTFE) Graft

This study was conducted to assess the efficacy of portal vein reconstruction with an expanded polytetrafluoroethylene (e-PTFE) graft. Five patients underwent interposition of the portal vein with e-PTFE graft following en bloc resection of the entire pancreas and the portal vein for advanced pancreatic cancer. The length of the excised vein ranged from 5 to 7 cm and that of the implanted graft (8 or 10 mm in diameter), 3 to 7.5 cm. In 4 of the 5 cases, the graft was patent at five to eighteen months following implantation. One patient died of respiratory failure two months after operation, and partial occlusion of the graft was noted at autopsy. Four patients died of recurrence of the original disease five to eighteen months after operation. The implanted graft taken at autopsy eighteen months after operation was covered uniformly with thin neointima on the internal surface. Microscopic examination showed endothelial cells covering the surface of the neointima, and capillary vessels had developed in the neointimal layer. Experimentally, five grafts, 0.8 cm in diameter and 2.5 cm in length with external ring support, were interposed in the portal vein in pigs. All grafts were patent during a four-month follow-up period. The authors conclude that the e-PTFE graft is a suitable prosthesis for replacement of the portal vein following its resection.

A New Experimental Model for Simultaneous Evaluation of Aortic and Pulmonary Allograft Performance in a Composite Graft

A model was developed in pigs for simultaneous evaluation of aortic and pulmonary allograft performance in a composite graft. The composite graft consisted of vascular prosthesis and aortic and pulmonary allografts. Following antibiotic preservation, it was anastomosed to the recipients thoracic descending aorta by an extrapleural approach without using cardiopulmonary bypass. Aortic blood flow was completely diverted into the composite graft. All 12 recipient pigs recovered well, 4 of which were assigned for the initial study to design the suitable experimental schedule. Calcification readily occurred in the aortic allografts and aneurysmal dilatation without calcification developed in the pulmonary allografts. These morphological findings were consistent with those of previous reports. This model has several benefits. First, aortic and pulmonary allograft conduits can be implanted and evaluated simultaneously under the same conditions by making a composite graft. Second, the magnitude of the operation is minimum, and postoperative circulatory and respiratory management is uncomplicated. Third, wound infection rarely occurs, because the skin incision is made on the back. These preliminary studies suggest that this model will allow future study concerning aortic and pulmonary allograft conduits under different conditions.