Yoshio Mishima

Cystic Adventitial Disease of the Popliteal Artery

Four cases of cystic degeneration of the popliteal artery are presented together with a review of the literature. Cyst evacuation is supported as the recommended treatment.

Arterial involvement in Behçet's disease

For many years, the known vascular complications in Behçets disease have been attributed to thrombophlebitis, but considerable number of reports has been published in recent years relating to cases with aneurysm and arterial occlusion. We experienced arterial involvements in 6 cases with Behçets disease up to date. In five, the histological findings of the resected specimens suggested a presence of angiitis derived from the media. Of the vascular changes in Behçets disease, aneurysm develops relatively in early age of life and is extremely prone to rupture. Therefore, an aggressive surgical approach is mandatory for aneurysm, as soon as the diagnosis of this disease becomes definite. Histological changes of these arteries revealed derangements of the media, particularly of its elastic fibers. Although it is difficult to draw a conclusion at this stage that angiitis is one of the etiological factors of Behçets disease, etiologic relation of these angiitic changes of unknown origin is discussed from various standpoints of view.

Occlusive Arterial Disease in Extremities, with Special Reference to Buerger's Disease

extremities were caused by stenosis of the lumens due to arteriosclerosis and resulting thrombus formation. Weiss6 (1897) and Bunge7 (1900) were in favor of his opinion and commented that the so-called juvenile gangrene might have also been caused by arteriosclerosis, for this change had been found even in young people. On the other hand, Buerger’ (1908) examined 11 cases of the amputated lower extremities because of the so-called spontaneous gangrene, in which he observed occlusions of the main arteries and veins of the legs and the feet, and he revealed histologically inflammatory changes of the arterial walls and formation of thrombi. Thereafter,9-io he examined 19 amputated lower extremities and 6 resected veins from patients of the so-called spontaneous gangrene, and reported that migrating phlebitis of the superficial veins and thrombophlebitis of the main deep veins coexisted in the specimens. He insisted, therefore, that the spontaneous gangrene was not caused by endoarteritis obliterans nor by arteriosclerosis, but must be caused by arteritis and thrombus formation, and accordingly he

A Multiclinic Double-Blind Trial of Pyridinolcarbamate and Inositol Niacinate in Ischemic Ulcer Due To Chronic Arterial Occlusion

A double-blind multiclinic trial compared the efficacies of pyridinolcarba mate and inositol niacinate in the patients with the ischemic ulcer due to chronic arterial occlusion. A thrice-daily dose of 1.5 g of pyridinolcarba mate or 1.2 g of inositol niacinate was given at random to the patients during cold seasons, and the effectiveness of treatment was assessed mainly on the basis of the clinical course of the ischemic ulcer and the rest pain. The patients were classified into 4- and 6-week groups. Beneficial results were recorded in 16 of 32 cases (50.0%) of the 4-week pyridinol carbamate group, and in 24 of 42 cases (57.1%) of the 4-week inositol niacinate group. In the 6-week group favorable results were observed in 54 of 79 cases (68.4%) on pyridinolcarbamate, and in 36 of 74 cases (48.6%) on inositol niacinate. Although sympathectomy is currently indicated for these ischemic lesions, long-term treatment with pyridinolcarbamate is recommended on the basis of the finding that the 6-week treatment ap pears superior to the 4-week treatment and also to the 6-week treatment with inositol niacinate.

Accordion-like arterial shadows observed on the arteriogram.

Several authors in the past two decades have reported on peculiar arteriograms with regular, symmetrical corrugations of arterial contours. Involved arteries previously reported were mostly those of the lower extremities’ -20, and rarely those of the upper extremities2, 21, the necks and visceral organs7, 12, 17, 22-27. Fig. 1 shows a typical example observed in the femoral artery; regular symmetrical corrugations along a segment of artery are most characteristic. The shadows have been given various descriptions by different authors: Perlschnurarteriel, L’artere en collier de perles~s, stationary arterial waveS4, 12, corrugated artery’9, small circular constriction 27 , bead string artery3, 16, bamboo pattern, and so on. As the contour of the shadows was similar to that of the crimped arterial prosthesis, Morioka and Ishikawa called this &dquo;Accordion-like arterial shadows&dquo; in 1961.

Measurement of local blood flow of the intestine by hydrogen clearance method; Experimental study

Local blood flow of the bowel wall was measured by hydrogen clearance method both in the muscular and submucosal layers in the mongrel dog, separately and concurrently. A platinum wire electrode with a bare tip of 0.5 mm in length and 0.2 mm in diameter was inserted into each layer. About 10 per cent hydrogen gas was inhalated directly through the side hole attached to the endotracheal tube for 1–2 minutes and the obtained clearance curves were plotted on the semi-logarithmic scale, which was almost monoexponential.The results obtained were as follows:1)Mean basal perfusion rate of the muscular layer of the intestine was 0.81–0.92 ml/min/gm, whereas that of the submucosal layer was 1.29–1.31 ml/min/gm, respectively. There was little difference of perfusion rates between the small and the large intestine. The results showed good correlationship with those reported by other authors.2)The effect of vasoactive substances such as vasoconstrictor and vasodilator on the local blood flow in the bowel wall was confirmed.3)This method is repeatedly applicable for measurement and also renders the information on the distribution of blood flow in the splanchnic area.

Platelet aggregability in chronic arterial occlusive diseases of the extremities

Abstract Platelet aggregability in 120 male patients with either Buergers disease (TAO) or arteriosclerosis obliterans (ASO) was studied by optical density method. The results were compared with the clinical courses of the diseases. Hypoaggregability was observed with an addition of small amounts of ADP or collagen in TAO patients at the chronically aggravating and stationary stages. This hypoaggregability suggested to indicate some pathologic changes in vivo which may precede and promote thrombosis. Remarkably enhanced aggregability was noted in ASO patients at acute occlusive stage and in TAO patients at acute stage of thrombophlebitis migrans. Some differences in platelet aggregability between TAO and ASO were also discussed.

The dawn of surgery in Japan, with special reference to the german society for surgery

During Japans period of isolation, Philipp Franz von Siebold came to Nagasaki as a doctor with a Dutch trading company in 1823. He used many kinds of apparatus to examine patients and taught practices such as paracentesis and tumor resection. After the Meiji Restoration, the Japanese government elected to establish a medical educational system based on the German system, and to invite two prominent German dosctors to teach in 1869. In 1881, Julius Karl Scriba came to Japan as a teacher. He worked at the University of Tokyo for 25 years. He was the clinical coordinator and trained many surgeons who later became leaders in modern Japanese surgery. In 1898, Sankichi Sato and Tsugishige Kondo founded the Japan Surgical Society. The foundation of the Japan Surgical Society and the governments centralization of the University of Tokyo were major milestones, because from then on, graduates of the university led the way in surgery in Japan. The University of Tokyo has since contributed enormously not only to the development of surgery but to the foundation of surgery-related fields.

Current Status of Patients with Arteriosclerosis Obliterans in Japan, with Special Reference to its Prognosis

過去20年間に東大第1外科を受診した慢性動脈閉塞は1339例であり, 閉塞性動脈硬化症 (以下ASO) 449例, いわゆる Buerger 病 (以下TAO) 890例である. 今回, アンケートを中心に遠隔成績追跡調査を行い, 主としてASOの予後についてTAOと対比して考察を行った.ASOは最近増加の傾向にあり, 男性に多くみられ, 51歳以上の発症が約80%に及んでいる. TAOが20～30歳代の男性に多くみられるのと対照的である. 冷感, 疼痛や間歇性破行を初発症状とするものが多く, 閉塞部位は末梢側にもみられるが, TAOと異なり中枢側の限局的な閉塞例が約30%にみられ, 血行再建術の適応例が増加しつつある.臨床検査所見, 合併症, 併存症そして死因等からみると, 本症は高血圧症や高コレステロール血症, 糖尿病, 臓器血管合併症と密接な関係を有しているといえる.本症の死亡率もTAOに比し極めて高く, 症状初発より死亡までの期間は3年以内14.1%, 5年以内28.7%, 10年以内33.9%, 10年以上40.2%に及んでいる. 死因別にみると81死亡例中, 心疾患50.6%, 脳血管障害16.1%, 腎不全4.9%と脳・冠・腎等の重要臓器血管障害が70%をも占めている.全身性の動脈硬化性病変に対する治療法が確立されていない今日, 生命の予後の面からは薬物療法, 運動療法, 食事療法, 禁煙, そして冠動脈バイパスや高コレステロール血症に対する腸管バイパス等の外科療法などを行い, 直接死因とつながる臓器血管合併症の出現もしくは進展を抑える努力が必要といえる.患肢の予後という観点からは可能なら血行再建術を行い, 手術適応がない場合でも対症療法と併せて患肢の保護が必要である.本症は生活様式や食餌の変化, 平均寿命の延長などに伴い更に増加すると思われ, 全身の動脈硬化性病変に対する治療法, 患肢に対する外科療法の進歩が今後の課題である.