Journal of The Showa Medical Association
Online ISSN : 2185-0976
Print ISSN : 0037-4342
ISSN-L : 0037-4342
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Volume 70, Issue 2
Displaying 1-14 of 14 articles from this issue
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Feature Articles: Dietary Treatment in Kidney Disease
Original
  • EFFECT OF TOPICAL APPLICATION OF LIDOCAINE ON RAT SUPERFICIAL EPIGASTRIC ARTERY
    Satoshi KADOTA, Toshiya YOKOYAMA, Masatoshi HASHIKAWA, Kazunari HARAGU ...
    2010 Volume 70 Issue 2 Pages 136-142
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.136
    JOURNAL FREE ACCESS
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    Microvascular free tissue transfer has recently become a reliable procedure. However, hypoperfusion of the anastomotic site may occur due to vessel degeneration. In addition, vasospasm is a major problem during microvascular procedures that can contribute to ultimate failure of tissue transfer and replantation. Maintenance of sufficient blood flow and prevention and treatment of vasospasm are important in reconstructive surgery. Topical lidocaine has been widely used to treat vasospasm in microvascular surgery. The aim of this study was to evaluate the effect of topical application of 2% lidocaine in a rat experimental model. Using a laser Doppler flowmeter, the effect of lidocaine on the superficial epigastric artery of 35 male Sprague-Dawley rats was evaluated. In the first study, the change in blood flow following topical application of 2% lidocaine was investigated. Blood flow was measured for 15 minutes after topical application of saline (0.2 ml: Group I), saline (1.0 ml/hr: Group II), 2% lidocaine (0.2 ml: Group III), and 2% lidocaine (1.0 ml/hr: Group IV). In the second study, the effect of lidocaine on relief of vasospasm induced by application of 1:1000 epinephrine 0.03 ml was investigated. Blood flow was measured for 15 minutes after topical application of 1:1000 epinephrine (0.03 ml: Group V), 1:1000 epinephrine 0.03 ml + 2% lidocaine (0.2 ml: Group VI), and 1:1000 epinephrine + 2% lidocaine(1.0 ml/hr: Group VII). Topical application of 2% lidocaine increased blood flow of the rat superficial epigastric artery and relieved epinephrine-induced vasospasm. This method may be useful for improving the survival rate of microvascular free tissue transfer.
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  • A ANATOMIC EVALUATION OF THE LATERAL FEMORAL CIRCUMFLEX ARTERY SYSTEM BY USING MULTI DETECTOR-ROW CT
    Kazunari HARAGUCHI, Satoshi KADOTA, Yoshiaki HOSAKA
    2010 Volume 70 Issue 2 Pages 143-148
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.143
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    Flaps that are pedicled by perforators of the lateral femoral circumflex artery (LFCA) system have many advantages, including the transplantation of large and reliable skin with long pedicles and a large diameter, and little invasion of the donor sites. However, preoperative planning has been difficult because the perforators have many anatomic variations. We used multi detector-row CT for anatomical evaluation of the lateral femoral circumflex artery system. The patterns of LFCA from the main vessels were classified into three types and vessels coursing toward the lateral thigh region were classified into three groups. The distance from the anterior superior iliac spine to the lateral femoral circumflex artery showed no significant difference between men and women. We were able to evaluate vessels with a 2-mm diameter in the lateral femoral circumflex artery system, indicating that accurate evaluation and low invasive examination of the lateral femoral circumflex artery system, including the perforator area, can be achieved by adjusting the image conditions and the injection rate of the contrast dye.
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  • RADIOTHERAPY REGIMEN FOR POSTOPERATIVE ELECTRON BEAM IRRADIATION THERAPY FOR KELOIDS
    —Comparison of the effectiveness of 2 Gy and 3 Gy of radiation—
    Norihisa ABE, Toshiaki HASUMI, Yoshiaki HOSAKA
    2010 Volume 70 Issue 2 Pages 149-157
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.149
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    Patients with keloids experience sharp pains and itchiness. Radiotherapy after keloid excision is effective for preventing keloid recurrence; however, there is no consensus on the ideal dosage. We used time-dose fractionation (TDF) and biologically effective dose (BED) to compare different time doses and standardize the radioactivity dosage. Informed consent was obtained from all patients. From 1994 to 2005, we irradiated high tension sites with 2 Gy, using a 4-MeV electron beam for 5 weeks, a total of 10 times (total dose, 20 Gy; BED, 24 Gy; TDF, 32.2). From 1995, we irradiated these sites with 3 Gy, using a 4-MeV electron beam for 5 weeks, a total of 10 times (total dose, 15-24 Gy and average dose, 20.05 Gy; total BED, 19.5-31.2 Gy and average BED, 26.2 Gy; total TDF, 30.01-48.1 and average TDF, 40.20). For low tension sites, we changed the dosage from 2 Gy for 5 weeks with gross radioactivity, 16 Gy; BED, 19.2 Gy; and TDF, 25.8 for a total of 8 times to 3 Gy for 4 weeks with gross radioactivity, 12 Gy; BED, 15.6 Gy; and TDF, 24.1. We compared the recurrence rates between 27 sites receiving 2 Gy and 25 sites receiving 3 Gy of irradiation. The rates did not differ significantly at both the high and low tension sites. Therefore, 12 Gy of radiation is sufficient to prevent recurrence. However, TDF differed between the 2-Gy and 3-Gy groups. The irradiation dosage is important to prevent recurrence/complications. Longer follow-up of the outcome and late toxicity is required.
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  • EFFECT OF A BFGF SLOW-RELEASE PREPARATION ON VASCULAR ANASTOMOTIC SITES OF THE RAT FEMORAL ARTERY
    Masatoshi HASHIKAWA, Toshiya YOKOYAMA, Satoshi KADOTA, Yoshiaki HOSAKA
    2010 Volume 70 Issue 2 Pages 158-163
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.158
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    Basic fibroblast growth factor (bFGF)-containing agents are used at a number of institutions to aid in healing wounds. bFGF causes migration and proliferation of vascular endothelial cells and vascular smooth muscles; however, there have been no reports on the effects of bFGF on vascular anastomotic sites, as observed through histological presentations. For reconstruction of the extremities, in particular the fingers and palms, early rehabilitation is important for functional recovery; and early restoration of the vascular anastomotic sites plays an essential role. In the current study, a slow-release hydrogen gel preparation containing bFGF was used to determine the process of recovery at vascular anastomotic sites. Following sedation with ether, rats underwent intraperitoneal anesthesia using pentobarbital sodium (30 mg/kg). The femoral artery was exposed, transected and anastomosed using a 10-0 nylon suture. The animals were assigned to one of the following 3 groups: vascular anastomosis only (the control group) or either of the 2 groups with anastomotic sites treated with bFGF (50 or 100 μg) contained in 2 mg of a hydrogen gel (a slow-release preparation). For histological examination, tissue samples were obtained under the above-described anesthetic procedure 3, 5 and 7 days after application of the agent. To evaluate recovery at the vascular anastomotic sites, 2 types of immuno-staining (bFGF and VEGF) were conducted; the cells expressing bFGF and VEGF were counted at 3 locations (0.3 × 0.3 mm) around these anastomotic sites. A statistical analysis of these counts was conducted. The expressions of bFGF and VEGF were significant with significant differences between the groups treated with the bFGF slow release agent and the control group. The results of the current study suggest that the use of a bFGF slow release agent is effective for early recovery at vascular anastomotic sites.
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  • THE BEHAVIOR OF MACROPHAGES IN THE WOUND HEALING PROCESS IN HUMAN SKIN USING A NEW ARTIFICIAL SKIN MODEL WITH MACROPHAGES
    Shingo TSUKAHARA, Bunsho KAO, Kanae TERASE, Sachiyo FUJITA, Yoshiaki H ...
    2010 Volume 70 Issue 2 Pages 164-173
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.164
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    This study investigated the behavior of macrophages in the wound healing process in human skin using a new artificial skin model with macrophages. The experimental group (the artificial skin model with human monocytes) and control group 1 (without monocytes) were irradiated with a CO2 laser and compared with control group 2 (no laser irradiation with monocytes). Tissue samples were collected for 7 days after laser irradiation, and the degree of tissue damage and the process of regeneration were evaluated using hematoxylin-eosin and immunohistochemical staining. The monocytes changed to macrophages in the samples. The number of macrophages increased and their size was larger after laser irradiation in the experimental group from the day 3 and reached a peak on the day 5. The macrophages were activated both in the irradiated area and in the whole sample. MCP-1, a chemokine produced by inflammatory reactions, was identified in the epidermal layer from the keratinocytes and the dermal epidermal border region. These results suggest that MCP-1 from macrophages induces an acceleration of the re-epithelization in the epidermis, while also inducing wound healing. In conclusion, this new artificial skin model with macrophages demonstrated increased tissue interactions, especially in inflammatory reactions.
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  • ANALYSIS OF PROLIFERATION AND DIFFERENTIATION ACTIVITY OF LYMPHATIC ENDOTHELIAL CELLS IN LYMPHANGIOMA
    Mariko YAMAMOTO, Shoji WATANABE, Yayoi ABE, Yoshiaki HOSAKA
    2010 Volume 70 Issue 2 Pages 174-180
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.174
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    Lymphatic endothelial cell (LEC) proliferation or differentiation in lymphangioma was investigated by immnohistochemical study with D2-40, MIB1, and Prox1. Clinical types of 14 lymphangioma cases were classified into two groups, i.e. macrocystic type (Ma) and microcystic type (Mi); Ma was classified into two subgroups of large cysts (MLC) and small cysts (MSC). In Mi, the number of LECs stained with D2-40 was significantly higher than those of MLC and MSC. The MIB1 index that indicats proliferation activity showed a significantly lower score in MLC than in Mi and MSC. The Prox1 index score of MSC was significantly higher than in the other 2 groups. This study suggests that proliferating activity of LECs in Ma and MSC are higher than that of MLC, and differentiation to LEC in MSC might be higher than those of MLC and Mi. Prox1 is likely to participate more in local development of lymphatic vessels after surgical and/or radiological intervention in MSC than in Mi.
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Case Report
  • AN AUTOPSY CASE OF SUDDEN DEATH DUE TO CARDIAC SARCOIDOSIS IN A 45-YEAR-OLD FEMALE
    MikiYUI NYUI, Masafumi TAKIMOTO, Eiji MATSUBARA, Hidekazu OTA, Masayuk ...
    2010 Volume 70 Issue 2 Pages 181-186
    Published: April 28, 2010
    Released on J-STAGE: May 27, 2011
    DOIhttps://doi.org/10.14930/jsma.70.181
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    We report an autopsy revealing the cause of sudden death to be cardiac sarcoidosis. A 45-year-old woman with a permanent pacemaker, which had been implanted for complete atrioventricular (AV) block, visited the clinic for pneumonia. After determining that she should be admitted, she collapsed. Although she was immediately treated with emergency resuscitation, she died 12 hours later. On autopsy her heart weighed 705 g and severe fibrotic lesions were observed in the left ventricular wall and septum. Microscopic analysis revealed nodules of a sarcoid granuloma in the heart, particularly in the ventricular septum. Moreover, sarcoid granulomas were found in the bilateral lymph nodes of the pulmonary hilum, lung, liver and spleen. Therefore, we determined that cardiac sarcoidosis caused sudden death due to arrhythmia from conduction disorder. This case suggests that sudden cardiac death in a young to middle-aged patient, especially in a woman, might be caused by cardiac sarcoidosis.
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