bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence of transmission of hepatitis D virus to spouses from sequence analysis of the viral genome
Authors: Wu Jaw-Ching , Chen Chuan-Mu , Sheen I-Jane , Lee Shou-Dong , Tzeng Huey-Miin , Choo Kong-Bung
Published: March 2007

To study sexual transmission of hepatitis D virus (HDV), 52 spouses of 56 index patients were observed and HDV genomes from antibody to HDV (anti-HDV)-positive couples were sequenced. Of the spouses, 11 (21%) were serum HBsAg positive, 3 (27%) of whom were also anti-HDV positive. The HDV sequences between spouses were found to be nearly identical (98% to 98.8%) in the region analyzed (nt 911 to nt 1260). Only one couple showed an identity >90% with the genotype I HDV strains. The HDV sequences of the remaining two couples showed >95% identity with each other and >91% homology with genotype II, but they shared only a 73.1% to 73.7% homology with those of the first couple. The regions corresponding to the autocatalytic cleavage sites, the junction between the middle and the carboxyl terminal one-third domains, and the middle domain of the open reading frame for delta antigen on the antigenomic HDV RNA were more conserved with <19% divergence among the three couples. Interestingly, there was a 56% divergence in the region corresponding to the carboxyl end of the open reading frame for the large delta antigen on the antigenomic HDV RNA. In summary, this study provides a direct nucleotide evidence of a common source of HDV infection in each couple. Despite divergence in the viral nucleotide sequence, both genotypes I and II were found in Taiwan and were transmitted from patients with a history of prostitute contact to spouses through sexual contact. (Hepatology 1995; 22:1656-1660).
Parvovirus B19 as a possible causative agent of fulminant liver failure and associated aplastic anemia
Authors: Langnas Alan N. , Markin Rodney S. , Cattral Mark S. , Naides Stanley J.
Published: March 2007

We recently observed that more than one third of pediatric patients who presented with non-A, non-B fulminant liver failure (FLF) also developed aplastic anemia (AA) either before or shortly after liver transplantation. Factors involved in the suppression of bone marrow could be the same as those causing hepatic failure. We considered parvovirus B19 a candidate etiologic agent because of the known tropism of B19 for erythroid precursors. Archived liver and serum from six patients undergoing liver transplantation for non-A, non-B, non-C FLF with associated AA were analyzed for the presence of B19 DNA and anti-B19 serology. An age- and gendermatched control group (N = 44) was analyzed in parallel. B19 DNA studies and anti-B19 serology were performed in a blinded fashion. B19 serologies were performed by antibody capture enzyme-linked immunosorbent assay (ELISA). B19 DNA was detected after polymerase chain reaction (PCR) amplification of target B19 DNA sequences in liver and serum. Liver tissue showed evidence of B19 DNA in four of six (66%) patients with FLF and associated AA. Two of 4 patients with cryptogenic FLF but without AA had B19 DNA detected in the liver tissue. Of the 34 remaining controls, only 5 (15%) showed evidence of B19 DNA in liver tissue (66% vs. 15%, P = .016). B19 DNA was not detected in any of the test or control sera. This study provides evidence to support the role of parvovirus B19 in the development of FLF and associated AA. (Hepatology 1995; 22:1661-1665).
Management of focal nodular hyperplasia and hepatocellular adenoma in young women: A series of 41 patients with clinical, radiological, and pathological correlations
Authors: Cherqui Daniel , Rahmouni Alain , Charlotte Frédéric , Boulahdour Hatem , Meignan Michel , Fagniez Pierre-Louis , Zafrani Elie-Serge , Mathieu Didier , Dhumeaux Daniel , Métreau Jean-Michel
Published: March 2007

Preoperative distinction between focal nodular hyperplasia (FNH) that should be managed conservatively and hepatocellular adenoma (HA) that should be resected remains difficult. The result is controversial management of these patients. The aims of this study were to report the value of modern imaging procedures for noninvasive diagnosis of these lesions, to assess the value of intraoperative frozen section studies, and to propose a management strategy in those patients. Fortyone consecutive women with FNH (35 cases) or HA (6 cases) treated at our institution between 1985 and 1992 were studied. New imaging techniques, including enhanced magnetic resonance imaging (MRI) and color Doppler ultrasonography (US), were prospectively appraised in addition to usual techniques. Histological examination of surgical specimens was obtained in all cases. A sixfold increase in the number of patients with FNH was observed during this study, whereas the number of patients with HA did not change. FNHs were incidental US findings in 74% of the cases. The best imaging procedure in the diagnosis of FNH was enhanced MRI with a sensitivity of 70% and a specificity of 98%. Color Doppler US was a useful adjunct. Intraoperative frozen section studies were performed in 16 patients with 19 tumors with a sensitivity of 89% and a specificity of 100%. From this study, we have come to the following conclusions: (1) in women, FNH is now much more often detected than HA; (2) using enhanced MRI, a preoperative diagnosis of FNH is possible in 70% of the cases, avoiding unnecessary surgery; (3) when clinical, biochemical, or imaging data are not typical of FNH, histological diagnosis is mandatory and can be safely and consistently made on large surgical biopsy specimens; (4) during surgery, a decision to resect or not resect a lesion can be efficiently assisted by frozen-section studies. (Hepatology 1995; 22:1674-1681).
The natural history of nonalcoholic fatty liver: A follow-up study
Authors: Teli Mohd R. , James Oliver F. W. , Burt Alastair D. , Bennett Mark K. , Day Christopher P.
Published: March 2007

Nonalcohol-induced fatty liver is widely believed to be a benign condition with little or no risk of disease progression. There have been occasional reports of progression to cirrhosis but none in the absence of preexisting fibrosis on the index biopsy specimen even when co-existing hepatitis was present (steatohepatitis). From our histological database (1978 to 1985), we identified 161 patients with fatty liver seen at our institution and traced the case notes of 156. One hundred five patients were initially excluded as having an alcohol-induced cause, and the remaining 51 either were seen in the clinic (37) or had died, in which cases copies of their death certificates were obtained (14). A further 7 patients were excluded after clinic attendance gave evidence of alcohol excess and another 4 after review of their initial biopsy showed the presence of fibrosis or steatohepatitis. The apparent cause of the steatosis in the 40 included patients with strictly nonalcohol-induced pure fatty liver was obesity in 12, diabetes in 4 (1 obese patient), and cachexia associated with extrahepatic malignancy in 6. Four of the remaining 19 had serological evidence of an autoimmune disorder, but none of these had any clinical or histological features of autoimmune liver disease. Nine patients had evidence of hyperlipidemia, 3 of whom were also obese. At a median follow-up of 11 years (7 to 16), 12 of 26 living patients had abnormal results of liver blood tests and had repeat liver biopsies performed. None had progressed to steatohepatitis or cirrhosis; 1 obese patient had developed mild fibrosis 9.8 years after her index biopsy. The remaining 14 living patients had normal blood tests and liver ultrasound and isotope scans. None of the 14 deceased patients died of a liver-related cause, and none had clinical evidence of liver disease before death. In the absence of preexisting fibrosis or steatohepatitis, fatty liver of nonalcohol-induced origin is an extremely benign condition. (Hepatology 1995; 22:1714-1719).
Deoxycholic acid influences cholesterol solubilization and microcrystal nucleation time in gallbladder bile
Authors: Hussaini Hyder S. , Pereira Stephen P. , Murphy Gerard M. , Dowling Hermon R.
Published: March 2007

Little is known about the effects of biliary deoxycholic acid on the partitioning of biliary cholesterol between vesicles and micelles and on the rate of nucleation of cholesterol microcrystals, key steps in gallstone formation. Therefore, 43 samples of fresh gallbladder bile were obtained from a heterogeneous group of patients with and without stones. Univariate and multivariate analyses were then applied to determine the inter-relationships between biliary cholesterol saturation, total lipid concentration, and bile acid species and (1) the distribution of biliary cholesterol between vesicles and micelles and (2) the cholesterol microcrystal nucleation time. The percentage of deoxycholic acid in bile was shown to be linearly related to the cholesterol saturation index (r = .54; P < .001), the vesicular cholesterol: phospholipid molar ratio (r = .53; P < .001), and the molar concentration of cholesterol in the vesicles (r = .59; P < .001). The mean proportion of biliary deoxycholic acid conjugates was also greater in patients with rapid nucleation times (23.4 ± SEM 1.1%) than in those with slow nucleation times (17.3 ± 1.9%; P < .05). As total bile lipid concentration increased, the proportion of total biliary cholesterol in vesicles decreased (r = .53; P < .001), whereas the molar concentration of vesicular cholesterol increased (r = .42, P < .01). The cholesterol saturation indices, total bile lipid concentration, and proportion of biliary deoxycholate were independent determinants of the molar concentration of cholesterol in vesicles. We conclude that relative increases in the percentage of deoxycholic acid and in bile lipid concentration, favor the partitioning of cholesterol into vesicles. In turn, this leads to an increase in the vesicular cholesterol: phospholipid molar ratio and thus to a decrease in the cholesterol microcrystal nucleation time. (Hepatology 1995; 22:1735-1744).
Blunted natriuretic response to low-dose brain natriuretic peptide infusion in nonazotemic cirrhotic patients with ascites and avid sodium retention
Authors: La Villa Giorgio , Riccardi Donato , Lazzeri Chiara , Raggi Vincenzo Casini , Sbarba Antonio Dello , Guerra Cristina Tosti , Fronzaroli Caterina , Foschi Marco , Laffi Giacomo , Gentilini Paolo
Published: March 2007

Patients with cirrhosis and ascites have high plasma levels of atrial (ANP) and brain (BNP) natriuretic peptides, two cardiac hormones released by the atria and ventricles, respectively. We evaluated renal hemodynamics, sodium excretion, and intrarenal sodium handling (lithium clearance method) in seven cirrhotic patients with ascites and avid sodium retention before, during, and after the infusion of synthetic human BNP, at the dose of 4 pmol/kg ± min for 1 hour, which has been shown to increase renal plasma flow, glomerular filtration rate (GFR), and sodium excretion in healthy subjects without affecting systemic hemodynamics. Plasma BNP levels were 7.31 ± 0.85 pmol/L in baseline conditions, and increased to 33.60 ± 2.96 pmol/L at the end of the infusion (P < .01 vs. baseline). Urinary excretion of guanosine 3′,5′-cyclic monophosphate (cGMP) also significantly increased during the infusion, indicating stimulation of natriuretic peptide receptors by BNP. BNP administration did not modify renal plasma flow, GFR, sodium excretion or tubular sodium reabsorption to any appreciable extent. Arterial pressure heart rate, plasma norepinephrine, and plasma renin activity (PRA) where also unchanged, whereas plasma aldosterone concentration showed a significant, 35% reduction at the end of the postinfusion period, ruling out the possibility that BNP-induced vasodilation might be responsible for failure of the peptide to induce a natriuretic response. Overactivity of antinatriuretic factors is probably the main determinant of the blunted natriuretic effect of BNP in these patients. (Hepatology 1995; 22:1745-1750).
Hepatobiliary transport of hepatic 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibitors conjugated with bile acids
Authors: Petzinger Ernst , Nickau Lutz , Horz Jurgen A. , Schulz Siegfried , Wess Gunther , Enhsen Alfons , Falk Eugen , Baringhaus Karl-Heinz , Glombik Heiner , Hoffmann Axel , Müllner Stefan , Neckermann Georg , Kramer Werner
Published: March 2007

To obtain prodrugs with affinity to liver parenchymal cells, the hepatic 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors HR 780 and lovastatin (syn. mevinolin) were conjugated with the bile acids cholic acid, taurocholic acid, and glycocholic acid. Hepatic uptake and biliary excretion of the coupled drugs were investigated and compared with the noncoupled drugs. Studies were performed with livers of normal Wistar rats, and TR−/GT− Wistar rats with deficient drug excretion. The experiments showed that the parent drug HR 780 was slowly excreted into bile. In contrast, the excretion of the bile acid-conjugated HR 780 derivatives S 3554 (conjugated with cholate), S 3898 (conjugated with glycocholate), and S 4193 (conjugated with taurocholate) was rapid and very efficient in both groups of rat strains. The bile acid-conjugated HMG-CoA reductase inhibitors showed a 10 to 20 times higher affinity for the uptake systems of bile acids than the noncoupled parent drug compounds, and even higher affinities than the bile acids themselves. The cholate conjugate of HR 780 (compound S 3554) was shown to be a noncompetitive inhibitor of taurocholate uptake and a competitive inhibitor of sodium-independent cholate uptake (Ki = 1 μmol/L). Uptake of radiolabeled S 3554 into isolated rat hepatocytes was observed to be rapid, cell specific, saturable, energy dependent, and carrier mediated. However, the carrier for S 3554 uptake was found not to be the cloned Na+-dependent taurocholate cotransporting polypeptide Ntcp. Expression of this carrier cRNA in Xenopus laevis oocytes did not stimulate S 3554 uptake. (Hepatology 1995; 22:1801-1811).
Microsurgical exposure of intracranial aneurysms
Authors: Fox John L.
Published: March 2007

The surgical anatomy of intracranial aneurysms as seen through the operating microscope is illustrated. The frontotemporal, or pterional, approach is used. The author demonstrates the teaching value of photographs of anatomic details as revealed in surgery.
Thrombogenesis in experimental microvascular anastomosis
Authors: Shimizu Yukio , Yasargil M. G. , Smith R. D.
Published: March 2007

A large number of microvascular anastomoses, involving both arteriovenous and artery‐artery end‐to‐side and end‐to‐end anastomoses, were carried out in the rat to develop a temporal and morphologic profile of thrombogenesis. While excellent patency rates were obtained in purely arterial preparations, significant thrombus formation occurred in the arteriovenous preparations, both at the suture line and more distally in the vein. Factors contributing to thrombogenesis in these microvascular anastomoses are discussed.
Microsurgical revascularization of the canine corpus cavernosum penis
Authors: Gross Peter L. , Geltzeiler Jules , Kwart Arnold M.
Published: March 2007

The concept of vasculogenic impotence in humans is addressed by attempting to surgically create and correct vasculogenic impotence in healthy dogs. Initial experience reveals that only by extensive pelvic vascular interruption can such impotence be created and that, at best, it is only temporary because of collateralization. Microsurgical revascularization using both direct femoral artery implantation and femoral vein interposition into the corpus cavernosum penis yielded low patency rates. Further studies on this technique are needed before it can be recommended for widespread use in human beings.
Microsurgery for tubal reconstruction following falope‐ring® sterilization in swine
Authors: Rock John A. , Rosenwaks Zev , Adashi Eli Y. , Jones Howard W. , King Theodore M.
Published: March 2007

Thirteen domestic swine underwent laparotomy and sterilization using the Falope‐Ring®. The silastic band was applied to the isthmus in 6 swine, and to the isthmic‐ampullary junction in 7 swine. Tubal reconstruction was performed using the OPMI–6 Zeiss operating microscope. Pregnancy was observed in 5 (83%) of 6 swine following isthmic‐isthmic anastomosis, and in 5 (71%) of 7 swine following isthmic‐ampullary anastomosis. Overall, 10 (77%) of 13 swine conceived following tubal anastomosis. An advantage to the placement of the Falope‐Ring® in the isthmus of the swine oviduct could not be demonstrated by chi‐square analysis.
Microsurgical replantation of an incompletely amputated penis
Authors: Franklin John D. , Kirchner Fred K.
Published: March 2007

The use of microvascular techniques in the replantation of one partially amputated penis is presented. The advantages of these techniques are discussed. A review of the literature is included; penis‐replantation results prior to the introduction of microvascular techniques are compared to results achieved since the advent of these techniques. The superior results associated with microsurgical techniques are demonstrated, and it is concluded that microsurgical replantation is the procedure of choice in the repair of penis amputations.
Microsurgery in otology and laryngology: A review of developments during the past thirty years
Authors: Smyth G. D. L.
Published: March 2007

The operating microscope was originally introduced to provide better visualization and illumination for otologic surgery. The successful use of this instrument in the fenestration operation for otosclerosis rapidly led to its application to reconstructive procedures in chronic suppurative otitis media. Later, it became evident that the operating microscope also provided advantages in the treatment of inner ear disorders and in the removal of acoustic Schwannomas; a considerable reduction in morbidity and an improved prognosis have resulted from application of microsurgery to these conditions. In addition, new photographic and television equipment, used in combination with microsurgery, has greatly improved the standards of teaching and the recording of pathologic information.
Microsurgical operations in the treatment of trigeminal neuralgia
Authors: Rand Robert W.
Published: March 2007

Three neurosurgical procedures to aid patients suffering from intractable, medically resistant tic douloureux are described: (1) the Sweet‐Nugent transcutaneous radiofrequency neurolysis of the gasserian ganglion, (2) the Gardner‐Rand suboccipital arterial decompression or rhizotomy of the trigeminal root, and (3) the Rand subtemporal transtentorial retrogasserian arterial decompression or rhizotomy of the trigeminal root. Each procedure has its indications, and the neurosurgeon should adjust his approach to the circumstances of the individual case. The clinical results with follow‐up evaluations over a 10‐year period for each of these operations are approximately the same. Ninety percent or more of patients suffering from intractable tic douloureux were completely relieved. Anesthesia dolorosa was not observed in more than 300 patients treated by these three operations, even though on rare occasions total anesthesia occurred following radiofrequency neurolysis. There was no operative mortality in the radiofrequency neurolysis series, and the operative morbidity and mortality rates were less than 4% for both the suboccipital and subtemporal craniotomy procedures.
Anatomic description of the free retroauricular flap
Authors: Wada Mitchitaka , Fujino Toyomi , Terashima Toshio
Published: March 2007

Twenty‐five human cadavers were examined to study the anatomy of the closed vascular system between the retroauricular artery and the retroauricular vein in the skin on the posterior aspect of the auricle and the mastoid process. The mean external diameters of the vessels supplying this region are 1.2 mm (artery) and 1.4 mm (vein). A flap averaging 5 × 7 cm may be taken from this area for use as facial cover.
Autogenous artery and vein grafts in common carotid‐supraclinoid carotid anastomoses
Authors: Shields Frcs(C) Christopher B.
Published: March 2007

Microsurgical techniques employing either autogenous saphenous arterial grafts or venous grafts were used for common carotid‐supraclinoid carotid anastomoses (CC‐SCAs) in dogs. The CC‐SCA provides a large volume of blood to a major vessel supplying the brain. Within 10 to 14 days postoperatively, angiography and postmortem examination showed arterial patency in 9 (69%) of 13 dogs and venous patency in 2 (25%) of 8 dogs. The discrepancy in patency between the arterial and venous grafts may be the result of the differences in construction of arteries and veins, technical failure, shear stress, turbulence, and/or boundary layer separation. The application of autogenous arterial grafts (i.e., radial, hypogastric) in humans seems justified.
Teaching microsurgery to gynecologists
Authors: Phillips Jordan M. , Winchester William J.
Published: March 2007

The gynecologist must master microsurgical techniques in the laboratory prior to engaging in clinical microsurgical work. This article describes an introductory microsurgical workshop program that is sponsored by the American Association of Gynecologic Laparoscopists in cooperation with the University of California at Irvine. The program encompasses films and lectures as well as laboratory experience that progresses from inanimate objects to small animals to fresh‐frozen human fallopian tubes. The goals, preliminary arrangements, and curriculum of the workshop are explained, and guidelines are offered for optimal workshop experience. The workshop can serve as a model for hospitals or educational institutions planning to create a microsurgical laboratory and for the physician who wishes to establish a small personal laboratory area.
Experiences in microsurgery in the People's Republic of China
Authors: Chang Ti‐sheng
Published: March 2007

In 1963, the successful replantation of an upper extremity amputated at the forearm provided the impetus for great interest in this surgical procedure in the People's Republic of China. In the 16 years since that time, much progress has been made, especially after the introduction of microsurgical techniques. Prior to 1973, replantation of digits was performed 443 times under the naked eye, with a digit survival rate of 51%. Since 1973, 92 replantations have been done under the microscope, with a digit survival rate of 91%. Experience is also recorded for free abdominal skin grafts, toe transplants for thumb and finger reconstruction, free dorsalis pedis flaps, free vascularized fibular transplants, free muscle transplants, jejunal transplants for esophageal defects, combined free grafts of the omentum and skin for repair of scalp, cranial, and extremity defects, and extracranial‐intracranial blood flow diversion.
Pars plana transvitreal carbon dioxide laser photocautery: A new surgical technique
Authors: Miller James B. , Smith Michael R. , Boyer David S.
Published: March 2007

Intraocular carbon dioxide laser photocautery has been used experimentally as well as clinically to surround and seal retinal tears and to treat fibrovascular fronds and blood vessels at the time of vitrectomy. All biologic tissue will absorb the 10.6‐μm infrared wavelength; thus the tissue does not have to be pigmented in order to absorb infrared energy. This technique involves no electrical hazard to the patient or surgeon. We have followed patients treated with the carbon dioxide laser, and they have retained improved vision for over 18 months. lntraocular carbon dioxide laser photocautery appears to be a safe, reliable, and effective means of performing intraocular photocautery at the time of vitrectomy.
Microvascular surgery in plastic surgery: Free‐tissue transfer
Authors: Harii Kiyonori
Published: March 2007

Progress in microvascular surgery has made possible important advances in reimplantation and transplantation. The author briefly reviews the success of early pioneers of these procedures and discusses the surgical equipment required and the techniques that he uses for microvascular anastomoses. A discussion of the clinical applications of free skin flap transfers, free transfer of omentum and muscle, toeto‐ hand transplantation, and vascularized bone grafts, with brief case reports from the author's experience, is included.
Free latissimus dorsi myocutaneous flaps in the dynamic reconstruction of cheek defects: A preliminary report
Authors: Maruyama Yu , Nakajima Hideo , Fossati Enrique , Fujino Toyomi
Published: March 2007

In the past, reconstruction of defects after cheek resection for such lesions as cancer or hemangioma was performed primarily by using local components. Two cases are reported in which free latissimus dorsi myocutaneous flaps with neurovascular microanastomoses were used to reconstruct cheek defects. Early follow‐up has shown that the results are satisfactory.
The creation of a scalp A‐V fistula followed by an STA‐MCA vein graft bypass: A case report
Authors: Feild James Rodney , Lee Ling
Published: March 2007

A thirty‐two‐year‐old male developed multiple neurologic symptoms. Medical evaluation disclosed hypertension, obesity, and a type IV hyperlipoprotein electrophoresis. A nuclear cerebral arteriogram showed reduced flow in the right middle cerebral artery. Arteriographic examination revealed an occlusion at the origin of this artery. The ipsilateral superficial temporal artery was too small to be used in an EC‐IC bypass procedure. To correct these conditions, a two‐stage procedure was performed. First, an arteriovenous fistula was created between the superficial temporal artery and its accompanying vein. Second, four and onehalf months later, the temporal vein, which had by then enlarged, was resected and grafted from the proximal superficial temporal artery to the right angular artery. Angiography three months after the latter procedure showed that the anastomosis was patent.
Brain tissue pO2 and pCO2 levels before and after cerebral revascularization
Authors: Shields Christopher B. , Roberts Esther , Numoto Mitsuo
Published: March 2007

Microvascular surgical techniques have made possible the improvement of cerebral blood flow, as demonstrated by angiography and by regional cerebral blood flow research. In this study, simultaneous mass spectrometer determinations of brain tissue and blood PO2, and pCO2, levels were used to evaluate the effectiveness of common carotid‐supraclinoid carotid anastomoses (CC‐SCA) in dogs. With blood pCO2 maintained at a constant level, the baseline brain tissue pO2 and pCO2 levels were recorded. During the CC‐SCA procedure, which involved brain retraction and temporary vascular occlusion, brain tissue pO2 levels fell to 40% of baseline and pCO2 levels rose by 35%. Following restoration of flow via the anastomosis, the brain tissue pO2 and pCO2 levels agina reached baseline.
Pituitary microadenomas in children: A cause of growth failure
Authors: Maira G. , Di Rocco C. , Borrelli P. , Belloni G.
Published: March 2007

Six children, originally regarded as being affected by prepubertal idiopathic growth failure, were found to have pituitary microadenomas. In all six patients, the growth failure (⩽ 2 cm/yr) was the primary clinical sign, and was accompanied by a growth hormone deficiency that was discovered during the laboratory evaluation. Prominent alteration of the sella turcica was not demonstrated in the skull x‐ray examinations of any of the children, even when the x‐ray examinations were supplemented by hypocycloidal tomography. CT scanning proved to be a very useful integrating diagnostic procedure, revealing the adenoma to be a nodular area of increased density within the sella turcica. In all of the children, resumption of normal growth was obtained following the surgical removal of the tumor through a transsphenoidal approach.
The history of the microscope in ocular surgery
Authors: Barraquer José I.
Published: March 2007

Microsurgery had its origins in ocular surgery. The development of the operating microscope and its accessories and complementary instruments, such as the surgical ophthalmometer, is reviewed from 1876 to the present.
The effect of portacaval shunt on hyperlipidemia in rats
Authors: Numata Minoru , Sutherland David E. R. , Hayashi Shiro , Najarian John S.
Published: March 2007

Hyperlipidemia was induced in rats by feeding them cheese mixed with high levels of cholesterol. Triglyceride levels more than doubled from 70.4 ± 25.8 mg/dl before the diet to 160.1 ± 50.5 mg/dl three weeks after initiation of the diet, and cholesterol levels were increased by approximately 25% from 72.5 ± 8.1 mg/dl to 98.9 ± 18.5 mg/dl after three weeks of the diet. The effects of microsurgically created side‐to‐side and end‐to‐side portacaval shunts were then studied. Triglyceride levels were lowered to normal after either type of shunt (68.4 ± 19.2 mg/dl in the side‐to‐side group and 58.1 ± 25.7 mg/dl in the end‐to‐side group) by four weeks after the creation of the shunt. Cholesterol levels tended to be slightly lower after either type of portacaval shunt, but did not return to normal. The mechanism by which the portacaval shunt reduced elevated triglyceride levels and, to a lesser extent, cholesterol levels is not clear, but hyperlipidemia induced by a high cholesterol diet in rats should be a useful model for further study of this question.
Microsurgical treatment of ten arteriovenous malformations in critical areas of the cerebrum
Authors: Da Pian Renato , Pasqualin Alberto , Scienza Renato , Vivenza Carlo
Published: March 2007

Ten cases of arteriovenous malformations located in critical areas of the cerebrum, i.e., motor and speech areas, the insular cortex, the corpus callosum, and the basal ganglia, were treated surgically by radical removal of the lesion. In four of the cases a neurologic examination before surgery was negative; five cases exhibited only mild hemiparesis or dysphasia; only one case exhibited hemiplegia and stupor. There were no postoperative deaths and a residual permanent deficit was noted in only one patient. Postoperative control angiograms failed to show any filling of the arteriovenous malformations in any of the cases. Recovery of the ability to work was achieved in all of the patients. The operating microscope and controlled hypotension made possible a precise resection at the edges of the lesion, and damage to surrounding important cerebral structures was thus avoided. Based on these results, microsurgery should be considered as an elective therapy for these kinds of arteriovenous malformations, even when preoperative symptoms are minimal.
Local cerebral blood flow after middle cerebral artery occlusion in rabbits following transposition of omentum to the brain
Authors: De Riu P. L. , Falzoi A. , Papavero L. , Rocca A. , Viale G. L.
Published: March 2007

Transposition of pedicled omental grafts to the brain has been shown to minimize the effects of cerebral infarction in dogs and monkeys. An experimental study in which pedicled omental grafts and free non‐revascularized omental grafts were placed on the brains of rabbits is reported. With the use of a modified inhaled hydrogen clearance technique to measure blood flow in the brain tissue, it was determined that the pedicled omental graft minimized the effects of middle cerebral artery occlusion by maintaining a collateral blood supply and limiting the decline of local cerebral flow. Superposition of free omental grafts on the brain had no effect on the threshold for infarction.
An improved microsurgical clamp and stay suture retractor for use in vascular surgery in rats
Authors: Lee Sun , Jay David , Orloff Marshall J.
Published: March 2007

Microsurgical procedures require the use of a variety of expensive precision instruments. This expense can be a problem for surgeons working in surgical research laboratories. To help combat rising expenses in our laboratory, we developed a new microsurgical vascular clamp and a new stay suture retractor for use in experimental surgery in rats. These instruments are inexpensive, can be manufactured in any medical machine shop, and have proved to be efficient and effective in surgical procedures.
New trends in carbon dioxide laser microsurgery
Authors: Smith Michael R. , Miller James B.
Published: March 2007

The carbon dioxide laser has been used for cutting and cauterizing tissue in a variety of surgical procedures by means of a dry‐field air/tissue interface approach. Recently, a new wet‐field CO2 laser technique has been developed and is being used successfully in humans to seal intraocular fibrovascular fronds and retinal tears at the time of vitrectomy, to close rubeotic vessels in the iris, and to excise fibrovascular fronds and epiretinal membranes in cases of severe diabetic retinopathy. Specialized wetfield CO2 laser photosurgical probes for use in gynecologic microsurgery have been developed and are being studied experimentally. Other potential applications include otolaryngologic microsurgery, neurosurgery, and gastrointestinal and urologic wet‐field surgery.
The operating microscope I. Optical principles, illumination systems, and support systems
Authors: Hoerenz Peter
Published: March 2007

The optical principles of the Zeiss OPMI 1, 6‐S, and 7 P/H operating microscopes are discussed, along with standard and fiberoptic illumination systems and the range of currently available support systems.
Microsurgery in andrologic urology I. Refertilization
Authors: Wagenknecht L. V. , Klosterhalfen H. , Schirren C.
Published: March 2007

Epididymovasostomies and vasovasostomies were used to treat infertility in aseries of 465 men from 1964 to the present. Of the cases availablefor follow‐up, duct patency was demonstrated in 42% receiving epididymovasostomies and in 77% receiving vasovasostomies. The specific techniques and the reasons for failures are also discussed.
A technical modification of heart‐lung transplantation in rats
Authors: Fox Umberto , Montorsi Marco
Published: March 2007

Hemodynamic studies were carried out on a series of rats undergoing heart‐lung transplantation according to the technique of Sun Lee. The results suggested a new hypothesis of blood circulation in the heart‐lung block by demonstrating the lack of necessity for the venovenous anastomosis. A new technique, with just one aortoaortic anastomosis, was therefore evaluated. Its value and reliability in a series of 30 rats are discussed.
Histopathologic findings in a human arterial anastomosis after free flap transfer
Authors: Karl Peter , Tilgner Anneliese , Heiner Harry
Published: March 2007

During the removal of subcutaneous fat 4 months after free groin flap transfer in a 25‐yearold male, the anastomosed artery was also removed for histologic examination. The removal of the artery did not impair flap viability. The considerable narrowing of the arterial lumen caused by extensive hyperplasia of the intima suggested a restriction of arterial function. In addition, the internal elastic membrane had disappeared or was partially intact, doubled, and fragmented. Where sutures were tight, necrosis of the media was found, with heavy scar formation. If the sutures were loose, the media remained intact. The tissue of the flap artery was more heavily altered than the tissue of the recipient artery. This was evidently the result of trauma incurred during preparation of the flap vessels. Functional restriction of the anastomosed artery and secondary flap revascularization apparently occurred in a temporally favorable relationship in this case.
Revascularization of isolated extracorporeal canine eyes by direct microsurgical anastomosis
Authors: Sher Herman , Cohen Ronald J.
Published: March 2007

Microsurgical techniques were used to anastomose the femoral artery and vein of anesthetized rats to the ciliary artery and internal ophthalmic vein of isolated extracorporeal canine eyes. Microscopic inspection and fluorescein angiography appeared to show early patency of the anastomoses. The applications of such an experimental model are discussed.
Microsurgery in andrologic urology. II. Alloplastic spermatocele
Authors: Wagenknecht L. V. , Weitze K. H. , Hoppe L. P. , Krause D. , Becker H. , Schirren C.
Published: March 2007

Experimental studies in rats and bulls demonstrated the feasibility of using a silicone‐Dacron prosthesis as a sperm reservoir in cases of excretory azoospermia. In the study in bulls, 50% of the cows inseminated with spermatozoa aspirated from the alloplastic spermatocele conceived and delivered healthy calves. The clinical results of a series of 14 humans suffering from excretory azoospermia not treatable by other means (e.g., epididymovasostomy or vasovasostomy) also are presented. The aspirations from these spermatoceles produced motile spermatozoa; however, none of the patients' spouses conceived after insemination.
Spontaneous cervical epidural hemorrhage, anterior cord syndrome, and familial vascular malformations: Case report
Authors: Foo Dominic , Chang Young C. , Rossier Alain B.
Published: March 2007

Complete motor tetraplegia with incomplete sensory loss was caused by spontaneous epidural bleeding from an arteriovenous malformation in the cervical region. There was a family and personal history of cutaneous hemangioma.
A new clamp for end‐to‐side microvascular anastomosis
Authors: Baek Se‐Min , Jacobson Julyus H.
Published: March 2007

A new clamp for use in microvascular end‐to‐side anastomosis is described. The advantages of the clamp are that the end of the donor vessel is placed precisely over the opening of the recipient vessel without tension, good exposure of the posterior wall is provided, and the tension on the stay sutures is easily adjusted.
Microvascular anastomoses: A comparison of the end‐to‐end and the telescoped techniques in rats
Authors: Krag Christen , Holck Susanne
Published: March 2007

The end‐to‐end anastomotic technique and the telescoped anastomotic technique were compared in a paired experimental study of 200 primarily patent anastomoses in the femoral arteries and veins of rats. It was found that the arterial telescoped anastomosis was faster and simpler to perform and had a significantly lower frequency of late thrombotic deposition (13%) than the arterial end‐to‐end anastomosis (41%), although the patency rates at 1 week were equal (88%). Aneurysms at the site of the anastomosis were not observed in the arterial telescoped anastomoses, while initial stages of probable aneurysms were observed in 24% of the arterial end‐to‐end anastomoses. The venous telescoped anastomoses were also less timeconsuming and simpler to construct. Although equal patency rates at 1 week were obtained (84%–88%), the venous telescoped anastomoses displayed a significantly more pronounced incidence of thrombotic deposition at the site of the anastomosis.
Microvascular anastomosis with absorbable and nonabsorbable sutures—A comparative study in rats
Authors: Mii Yoshio , Tamai Susumu , Hori Yoshihide , Shimizu Toyonobu , Fukui Akihiro
Published: March 2007

Polyglycolic acid, polypropylene, and nylon sutures were used to anastomose the aortas of 40 rats. Comparative studies of the healing process at the suture sites were performed. The long‐term observations, by means of light and scanning electron microscopy, revealed that the regeneration of endothelium was more rapid and the endothelium had a smoother surface in the aortas that received the polyglycolic acid sutures than in the aortas receiving polypropylene or nylon sutures because the polyglycolic acid sutures were absorbed after 6 weeks. It was concluded that polyglycolic acid suture material may be more desirable than nonabsorbable suture material in microvascular anastomoses.
Urologic microsurgery—Current perspectives: II. Orchiopexy and testicular homotransplantation
Authors: Belker Arnold M.
Published: March 2007

Reports of microsurgical testicular autotransplantation as a method of dealing with the high undescended testis have prompted this review. Results with various methods are compared. The increasing success being reported with division of the internal spermatic vessels (when certain principles as enumerated herein are followed) leads to the conclusion that the more technically complex method of microsurgical testicular autotransplantation will not come into general use. The opportunities for testicular homotransplantation are rare, and no definitive conclusions can be made concerning this rarely reported procedure.
A readily available background material for use in microsurgery
Authors: Hoehn James G.
Published: March 2007

The use of sterile Xeroform packaging is suggested as a background material for microsurgical procedures.
Reconstruction of esophageal defects with microsurgically revascularized jejunal segments: A report of 13 cases
Authors: Ti‐Sheng Chang , Oi‐Ling Hwang , Wang‐Wei
Published: March 2007

Experimental free transfer of a jejunal segment to a recipient bed in the neck was successfully performed in 5 mongrel dogs. This was followed by clinical application of 2 different microvascular procedures in 13 patients for repair of esophageal defects. In 7 of these patients a free jejunal transfer was used; in 6 of these patients a pedicled jejunal graft with revascularization of its distal end by microvascular anastomosis was used. The esophageal defects were located in the cervical portion in 7 cases, the cervicothoracic portion in 5 cases, and the thoracic portion in 1 case. Ten (77%) of the 13 procedures were successful.
The effects of short‐term preservation on microvascular free groin flaps in rats
Authors: Ballantyne Donald L. , Reid Carolyn A. , Harper Alice D. , Shaw William W.
Published: March 2007

Free groin flaps taken from rats were preserved by refrigeration at 4°C in either lactated Ringers solution or tissue culture medium for various periods of time. The results indicate that a high survival rate can be expected at periods up to 72 hours, but there was no success in preserving flaps longer than 72 hours. These preliminary experimental findings suggest that, clinically, a high survival rate can be achieved in free flaps following excision from donor sites even if the microvascular transfer must be postponed for a period up to but not exceeding 48 hours.
End‐to‐side anastomoses: A model and a technique with clinical application
Authors: Hall Elizabeth J.
Published: March 2007

Recently, the advantages of end‐to‐side anastomoses in reconstructive microvascular surgery have been emphasized. This article describes a practical laboratory model for practicing end‐to‐side anastomoses and a simplified technique for suturing the posterior wall in such anastomoses. The left common iliac artery of a rat is transected and an end‐to‐side anastomosis with the right common iliac artery is performed. A single clamp is manipulated to present the posterior wall for suturing.
Blood flow in small arteries after end‐to‐end and end‐in‐end anastomoses: An experimental quantitative comparison
Authors: Wieslander Jan B. , Åberg Magnus
Published: March 2007

Microvascular anastomoses were performed under standardized conditions on the central artery of the ear in 23 rabbits. Fifteen end‐to‐end and 13 end‐in‐end anastomoses were compared. No anticoagulants or vasodilating agents, other than the local application of lidocaine, were used. Blood flow was measured by electromagnetic flowmetry before anastomosis and after anastomosis at intervals of 30 minutes for 4 hours and at 1 and 3 days. The validity of the electromagnetic flowmetry method was established in a control group of 7 rabbits. The mean volume of blood flow after end‐to‐end anastomosis was 93% of the preoperative value (P < 0.05). The corresponding mean volume of blood flow after end‐in‐end anastomosis was 47% of the preoperative value (P > 0.001). The difference in flow between end‐to‐end and end‐in‐end anastomosis was highly significant (P < 0.001). Microangiography demonstrated marked stenosis in the end‐in‐end anastomoses but not in the end‐to‐end anastomoses.
The operating microscope. IV. Documentation
Authors: Hoerenz Peter
Published: March 2007

The methods of documenting microsurgical procedures with 35‐mm photography, Super 8 (8‐mm) and 16‐mm motion pictures, and television are discussed for the Zeiss OPMI 1, OPMI 6‐S and OPMI 7 P/H.
Vasography in rats
Authors: Lamesch Alfred J. , Schreiner Bernard
Published: March 2007

Vasovasostomy was performed in 20 rats. Vasography then was used to determine the patency of the vas. The scrotum was entered through a longitudinal incision and the scrotal contents were extruded extravaginally. The vas was divided near the epididymis and a 0.4/0.7‐mm cannula was inserted into the abdominal end of the vas and contrast medium was injected under fluoroscopic control. The results were documented by radiography. It is concluded that vasography is a reliable method for assessing the success of vasovasostomy in rats.
The microvascular technique of vein grafting in rats as a training and experimental model
Authors: Razaboni R. M. , Ballantyne Donald L. , Harper Alice D. , Shaw William W.
Published: March 2007

Techniques for obtaining and implanting vein grafts in the femoral arteries of rats are described. Grafts 5 mm in length can be removed from the femoral vein without ligating any side branches; a 15‐mm segment is the maximum graft that can be obtained from the femoral vein in a rat. This requires ligation and division of all the branches between the inguinal ligament and the great saphenous vein. The superficial epigastric vein also can be used as a source of grafts to be used in the femoral artery. In this study, neither the femoral nor the superficial epigastric vein appeared to have functioning valves. Therefore, reversing the vein graft before implantation was not necessary.
Hemodynamics after microsurgical anastomosis: The effects of topical lidocaine
Authors: Blair William F. , Greene E. R. , Eldridge Marlow , Cipoletti Robert
Published: March 2007

The hemodynamics in the femoral arteries of 30 rats were measured with a 20‐MHz pulsed Doppler velocity meter (PUDVM) in an attempt to define the changes resulting from anastomosis and to assess the effects of 1% lidocaine on those changes. Control values were obtained, the arteries were severed and anastomosed, and either physiologic saline or 1% lidocaine was applied topically to the vessels in a randomized blind study. Velocity measurements, derivations of vessel lumen diameters, and calculations of blood flow then were made with the velocity meter at intervals of 1, 2, 3, 5, and 10 minutes after the addition of the experimental fluid. The measurements obtained indicated that calculated blood flow through the anastomoses was reduced 36% at the 10‐minute interval in the group treated with physiologic saline but only 5% in the group treated with 1% lidocaine. These results demonstrate that microsurgical anastomosis adversely affects normal hemodynamic variables, but these effects are minimized by the application of a bolus of 1% lidocaine, a topical vasodilator. These results also suggest that the 20‐MHz PUDVM has sufficient resolution and sensitivity to provide the measurements of blood velocity necessary for reproducible calculations of blood flow distal to a microsurgical anastomosis in small vessels.