An attempt to create spleno-systemic anastomosis in the rat

A selective diversion of the splenic venous flow into the systemic circulation was attempted in the rat. A combination of the subcutaneous splenic transposition and the ligation of the splenic vein as a two stage operation was carried out in 15 rats. A rich collateral system developed rapidly from the transposed spleen to the systemic circulation. Angiography, performed four weeks after the ligation, revealed that almost all of the injected contrast medium was diverted into the systemic circulation via those newly developed collaterals. The described method as an experimental model could be of value in the search for a spleno-hepatic axis.     

An attempt to create spleno-systemic anastomosis in the rat.

A selective diversion of the splenic venous flow into the systemic circulation was attempted in the rat. A combination of the subcutaneous splenic transposition and the ligation of the splenic vein as a two stage operation was carried out in 15 rats. A rich collateral system developed rapidly from the transposed spleen to the systemic circulation. Angiography, performed four weeks after the ligation, revealed that almost all of the injected contrast medium was diverted into the systemic circulation via those newly developed collaterals. The described method as an experimental model could be of value in the search for a spleno-hepatic axis.     

An attempt to develop a model to study the effects of intrathecal steroids

An attempt has been made to develop a chronic inflammatory arachnoiditis model in the rat to study the influence of subarachnoid or epidural steroids. Through chronically implanted catheters in Wistar rats (250-350 g), either triamcinolone (3.5-350 micrograms) or methylprednisolone (3.5-350 micrograms) was injected intrathecally, daily for 7 days or weekly for 7 weeks. Some rats also received 100 mg kg-1 cefoxitin and 0.5 mg deoxycortone by intramuscular injection. Equivalent control groups were included. High doses of intrathecal steroids caused marked weight loss and infection and many rats died. These effects were mitigated at a lower dosage especially by the addition of cefoxitin and deoxycortone. The effects of triamcinolone were more marked than those of methylprednisolone. No systematic histological evidence of neurotoxicity was observed after either steroid. Injections of talc failed to cause arachnoiditis or meningitis probably because sufficient particulate talc could not be injected through the narrow catheter.     

An attempt at a percutaneous retroperitoneoscopic approach to ureterolithotomy

Summary The extensive laparoscopic tubectomy programs organized by the Indian government during 1978–1981 as a measure to curb the population explosion brought some unanticipated problems for the authors. One of these, surgical emphysema, gave the authors the opportunity to explore laparoscopically extraperitoneal appearances. So deliberate retroperitoneal surgical emphysema was created, to isolate the ureter so as to locate the stone in it, and to study the feasibility of its removal via laparoscopy itself. The procedure entails minimal trauma and gives the considerable advantage of clear vision for total removal of stone(s). This procedure offers an alternative to the conventional method and to other, newer methods. The conventional method involves wide exposure with attendant morbidity and prolonged hospital stay. Other newer methods require high-tech multimode prerequisites, such as a extracorporeal shock-wave lithotriptor, ultrasound, screening, software, endourological instruments (including lithotriptor), necessarily supplemented by technical experts in each field. Hence such methods require an institutional arrangement at an exorbitant cost to the patient.     

An attempt to classify the malformations of the hand based on morphogenetic criteria

Summary At the present time there exist two internationally accepted classifications for the grouping of malformations of extremities: The anatomically and clinically orientated classification by Swanson (1976) and the anatomically and genetically founded classification by Temtamy (1966) and Temtamy and McKusick (1969 and 1978). In the introduction, the phylogeny and ontogeny of the extremities are considered. Under the aspect of phylogeny and ontogeny the groups I Failure of formation of parts, II Failure of differentiation (separation) of parts, III Duplication and VI Congenital constriction band syndrome of Swanson's (1976) classification are discussed. It is found that this anatomically founded classification is largely confirmed in the use of latest morphogenetic criteria and that only few modifications may be called for. In the light of present-day genetic knowledge the use of new classifications published in the literature, for example that of the cleft hand, appear doubtful, as they are based on mere by clinical criteria.     

An attempt to analyze the relation between hospital surgical volume and clinical outcome

Objectives The aim of this study was to investigate the relation between hospital volume and clinical surgical outcome for 10 cardiac, lung, and esophageal surgical procedures. Methods The Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery collected the pooled data on cardiac, lung, and esophageal surgical procedures between 2000 and 2004 from the annual reports. The relation between operative mortality (30-day or in-hospital mortality) and hospital volume was analyzed using a logistic regression model. The surgical procedures studied were surgery for acquired cardiac diseases [coronary artery bypass grafting (CABG), valve procedures, acute type A dissection surgery], total CABG (elective + emergency), elective CABG, emergency CABG, single-valve surgery, acute type A dissection surgery, open heart surgery for the newborn, open heart surgery for the infants, lung cancer surgery, and esophageal cancer surgery. The data used in this study were not risk-adjusted. Results The data on the relation between hospital volume and operative mortality generally tended to show an inverse correlation for all 10 cardiac, lung, and esophageal surgical procedures; that is, the higher was the volume the lower was the mortality. However, wide variations in operative mortality were noted among the very-low-volume hospital groups. Conclusion An inverse correlation was noted between hospital volume and operative mortality in the present study, although wide variations in clinical outcome were noted among the very low-volume hospitals. Further analysis is warranted using risk-adjusted data. This report was prepared by the Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery