Yoshihiko Tsuchida

Emergency Endovascular Stent-Grafting for Infected Pseudoaneurysm of Brachial Artery

Abstract.The use of covered stents in an infected field is controversial. It is generally recommended that infected aneurysms be treated using autografts or allografts. We report a case of infected brachial pseudoaneurysms that developed after medical debridement of a methicillinresistant Staphylococcus aureus (MRSA)-infected wound of the right arm and emergency brachial artery bypass-grafting using the saphenous vein, which was successfully treated by endovascular stent-grafting followed by antibiotic administration. The present case suggests that endovascular stent-grafting prevents rupture and occlusion of infected aneurysms and enables the continued administration of antibiotics.

Combined gene therapy with adenovirus vectors containing CTLA4Ig and CD40Ig prolongs survival of composite tissue allografts in rat model.

Background. The blockade of costimulatory signal pathway by anti-CD40 ligand antibody or cytotoxic T lymphocyte antigen 4 immunoglobulin (CTLA4Ig) prolongs allograft survival in various vascularized organ transplantations. Because of the short half life of these agents, repeated administration of proteins is required to achieve significant graft survival. Furthermore, there is limited information regarding the effect of cosimulatory blockade on the survival of composite tissue allografts. Therefore, we examined the effect of adenovirus-mediated gene transfer of CTLA4Ig or CD40Ig gene or both in composite tissue allotransplantation. Methods. The hind limbs removed from male ACI rats (RT1a) were transplanted into female Lewis rats (RT11) heterotopically. The recombinant adenovirus carrying CTLA4Ig (AxCTLA4Ig) or CD40Ig (AxCD40Ig) was intravenously administered after limb transplantation. Results. Limb allograft survival was significantly prolonged by either AxCTLA4Ig or AxCD40Ig treatment at 1×109 plaque forming unit (mean survival time [MST] of 39.4±6.0 and 13.0±2.9, respectively) compared with the adenovirus vector containing &bgr;-galactosidase-treated group (MST of 4.8±0.8). Combination of AxCTLA4Ig and AxCD40Ig led to significant prolongation of graft survival (MST of 49.2±6.6). Serum levels of CD40Ig were higher in rats treated with combination therapy than those treated with AxCD40Ig alone, whereas the serum levels of CTLA4Ig in rats treated with AxCTLA4Ig alone and AxCTLA4Ig and AxCD40Ig combined were very similar. Conclusion. This study indicates that an adenovirus-mediated gene therapy of CTLA4Ig or CD40Ig has a therapeutic potential for preventing rejection in composite tissue transplantation. Furthermore, a combination therapy of AxCTLA4Ig and AxCD40Ig was even more effective in preventing acute rejection and prolonging the survival of allografted limbs without apparent complication.

Arthrodesis of knee joint by vascularized fibular graft

Knee arthrodesis has been performed in 17 patients using vascularized fibular graft (VFG); 15 of them could be followed more than 1 year. Twelve were bone defect following tumor resection, two were traumatic bone defect, and one was intractable traumatic non‐union. Three types of graft were performed; single VGF as supplement (Type I) in 5 cases, double VFG for femoral defect (Type II) in 8 cases, and double VFG for tibial defect (Type III) in 4 cases. Bone union was achieved in all cases except one. The average time to primary bone union was 4.7 months. Hypertrophy of the graft was observed significantly in some of Type II and in all of Type III. VGF is a useful method for knee fusion in patients with a large bone defect or with an intractable non‐union.

Vascularized bone marrow allotransplantation in rats prolongs a simultaneous skin allograft

Abstract Skin allotransplantation in rats were rejected even if they were treated with a suboptimal dose of FK506. However, skin allograft in rats which received vascularized limb allograft simultaneously were rejected more slowly. We hypothesized this prolongation phenomenon was due to a continuous supply of donor-derived progenitor cells from a vascularized bone marrow. In the present study, we compared the mean survival times (MSD) of skin allograft in rats that were simultaneously received nonirradiated rat limb, irradiated rat limb, or bone marrow cells.

Latissimus dorsi musculocutaneous free flap transplantation to salvage below-elbow amputation in an emergency operation: A case report

We used a free latissimus dorsi musculocutaneous flap (LD m‐c flap) to cover a large skin defect at the stump of a forearm in an emergency operation.