Shyunichi Mori

Blood vessel repair utilizing a new plastic adhesive: Experimental and clinical studies

Summary Compared with Eastman 910 (90% alphamethyl-cyanoacrylate monomer), Aron Alpha S-2 (98% alpha-ethyl-cyanoacrylate monomer) elicited less tissue reaction on adventitia and less thrombus formation on intima and maintained its tensile strength in vivo over a much longer period of time. Aron Alpha A-2 was able to repair longitudinal vessel incisions without a single suture, resulting in 100 per cent patency in 24 vessels. This adhesive yielded a patency rate of 88.2 per cent (53/68) in end-to-end carotid artery anastomoses when used with three stay sutures without stent. This patency rate is as good as that of routine meticulous continuous suture. Wrapping, invagination and stay suture, all with stent, failed to surpass routine continuous suture in terms of resulting patency rate. Use of Aron Alpha S-2 made possible a speedy and yet bloodless operation in end-to-side anastomoses of 5 carotid arteries, end-to-end anastomoses of 18 external jugular veins and anchoring of 6 peeled intima. They were all patent at sacrifice 14 to 180 days after surgery, except 3 jugular veins complicated by bacterial contamination. Twenty-one patients underwent vascular surgery using plastic adhesives, Eastman 910 for one patient and Aron Alpha S-2 for 20 patients. More extensively described are six patients who required repair of diseased vessels. Aron Alpha S-2 was unable to restore the blood flow in a patient with bilateral occlusion of femoral arteries. In 20 other patients, vessel repairs with plastic adhesives were successful in reestablishing and maintaining blood flow.

Allotransplantation of the pancrease in dogs

Abstract En block transplantation of the pancreas and duodenum was performed in 30 pancreatectomized dogs, 10 of which served as a control group and the remaining 20 as the azathioprine group. The latter were orally administered (6 mg. per kilogram) azathioprine every day. The former group lived an average of 10 days; and the latter, 22 days. Rejection was a cause of death in 6 of the control group and in 6 of the azathioprine group. In 5 of these 12, however, the last fasting blood glucose level was over 150 mg. per deciliter, suggesting that hyperglycemia is not an initial sign of rejection but rather its terminal sign. Histological study revealed that acute rejection resembling acute pancreatitis was a phenomenon observed in the control group, while chronic rejection manifested by interstitial fibrosis was characteristic of the azathioprine group. Azathioprine is effective in suppressing the acute rejection process but is unable to prevent fibrotic process.

Manifestations of rejection of pancreaticoduodenal allografts.

Transplantation of pancreaticoduodenal allografts was done in 30 totally pancreatectomized dogs. Ten hosts served as a control group and the remaining 20 were treated with azathioprine for immuno-suppression. Excepting two hosts (one in each group) which died of anastomotic complications, the control hosts lived for 3–20 days (averaging 10 days) and the azathioprine-treated hosts for 7–63 days (averaging 22 days). In both groups, hyperglycemia occurred rarely and only after a preponderance of islets were destroyed by rejection; it was therefore considered a terminal event. Serum amylase increased sharply at the start of rejection in control hosts and decreased rapidly to the preoperative level once the initial phase of rejection had passed. In azathioprine-treated hosts, small retarded rises in serum amylase were observed. Histologically the rejection patterns in the allografts were either acute or chronic. A chronic rejection pattern was found only in such allografts as stayed for more than 3 weeks in azathioprine-treated hosts. In the transplanted pancreas, there was no difference between the resistance of acinar cells and that of islet cells against the hosts immunological attack. Different parts of the allograft showed different susceptibilities to the host reaction. The parenchyma of the pancreas and of the duodenum, as organs, succumbed readily to the immunological attack. Some lymph nodes were relatively resistant. Nerves and blood vessels maintained their histologic integrity longer than other tissues of the allograft.

Nonsuture Anastomosis of Vascular Prothesis Utilizing Plastic Adhesives

During the past 5 years a considerable amount of research work has been reported on the application of adhesives to vascular surgery. The investigations have been directed mainly to the nonsuture repair of arteries and veins,1-8 to the reinforcement of aortic suture line6~ 8-lo and to small vessel anastomosis,.5, 6 This paper describes an experimental nonsuture anastomosis of Dacron prothesis to canine thoracic aorta in an attempt to evaluate the efficacy of plastic adhesives on the implantation of synthetic prothesis.