A new method of vascular anastomosis by CO2 laser: experimental and clinical study

It is difficult to maintain the long-term patency after conventional anastomosis especially for the small caliber vessels. Since 15 years we have performed aortocoronary bypass with suture materials for the patients with ischemic heart disease. There are some problems in maintaining the long-term patency of the bypass grafts. Low energy CO2 laser was utilized to make vascular anastomosis with a few stay sutures. Vascular anastomoses (side-to-side, end-to-end, end-to-side) were carefully made by CO2 laser in the regions of the femoral arteries and veins, the carotid arteries and jugular veins in dog. A-C bypass was also successfully carried out between the internal mammary artery and the left anterior descending artery under the beating heart in experiment. Outputs of 20-40 mW and irradiation times of 6-12 sec/mm were optimal conditions for anastomosis of the small caliber vessels. There were no problems in the intensity and the healing of the anastomotic sites in comparison with the conventional suture method. On the basis of these excellent experimental results a low energy CO2 laser was employed clinically for vascular anastomosis of the peripheral vessels in 28 patients with angina pectoris or chronic renal failure and cardiac failure. There were no complications such as bleeding and suture line aneurysm after surgery. In conclusion, vascular anastomosis by laser might be recommended in performing with safety and rapidity for small caliber vessels.     

A new operation for the prevention and treatment of amputation neuromas

A stump neuroma is caused by the disorganised growth of axon cylinders into proliferating granulation tissue, but this is stopped by an undamaged epineural sleeve. We report experiments in the rat in which the epineural sleeve of the stump of the sciatic nerve was freed from nerve fascicles for about 5 mm and then sealed with a synthetic tissue adhesive. Neuroma formation was largely prevented in comparison with the results of other methods. This new technique has been used to treat 68 painful neuromas in 36 patients. All but three of the patients were cured or improved and none were made worse.     

A new method for microvascular anastomosis: report of experimental and clinical research.

Principles of microvascular anastomotic surgery are uncertain in contrast to the standardized suture methods for the repair of large arteries. Complications of early thromboses or late stricture at the microvascular anastomotic line can be related to the inherent biologic response of these delicate tissues to penetrating needle and suture. A new method for microvascular reconstruction based on the principle of flanged, nonpenetrated, intimal approximation by an arcuate-legged clip has proven biologically and technically superior to the penetrating microsuture. These conclusions are based on extensive testing in multiple surgical laboratories of the following parameters: long- and short-term patency, morphology of wound repair, and burst and tensile strength. Details of the new surgical system and experimental studies are described.     

A new treatment of painful amputation neuroma: a preliminary report

Two cases of painful amputation neuroma treated by a new method are described. A vascularized island transfer from a less important finger was used, but the accompanying nerve was divided and its distal end sutured to the proximal end of the nerve in the recipient finger, after excision of the neuroma. Four years and two years later, no clinical evidence of neuroma was present at either amputation stump or donor site.     

平阳霉素治疗瘢痕疙瘩的效果及组织学观察

目的探索局部注射平阳霉素治疗瘢痕疙瘩的最适合浓度、治疗效果及细胞组织变化。方法48例患者随机分为4组,分别注射不同浓度的平阳霉素（1．000、0．500、0．250、0．125mg／m1）,每两周注射1次,5次后按温哥华瘢痕评分与治疗前评分相比,配对t检验;HE染色观察瘢痕组织形态学的改变。结果4组中注射0．5mg／ml浓度组治疗效果最佳（P=0．0026）,与其他组的治疗效果比较差异有统计学意义（SNK检验P〈0．05）;1年复发率为12．00％。组织学显示治疗后的瘢痕疙瘩表皮增厚,大量炎性细胞浸润,胶原纤维束粗细不一。结论0．5mg／ml平阳霉素是每两周注射1次治疗瘢痕疙瘩的适合浓度,0．25mg／ml为有效浓度;此方法简单易行,安全可靠,效果良好,复发率低,并发症少。     

切取耳软骨的新方法

目的 探讨切取耳软骨而又不使耳郭变形的方法 .方法 根据造船过程中的"龙骨-龙筋-肋骨"支架原理,保留耳甲轮廓、耳轮脚及轮脚的侧向延伸部,使耳郭供区不发生明显变形.结果 本组56例鼻成形术患者,切取耳郭软骨进行移植,30例获随访6～12个月,并对耳郭形态进行测量,无供区耳外形变化.结论 本方法 可以获得大量耳软骨而不致使供区耳外形发生改变,值得临床推广应用.     

A new method to induce topical cooling of the right atrium for treatment of supraventricular tachyarrhythmia: an experimental study

Supraventricular tachyarrhythmia (SVT) such as sinus tachycardia and atrial dysrhythmia is a life-threatening problem in the period immediately following an open-heart operation. Because of their negative inotropic effects, antiarrhythmic agents are not recommended for patients with low cardiac output syndrome. A device was developed that topically cools the right atrial surface for antiarrhythmic treatment. In experiments, this device lowered right atrial temperature and did not affect the temperature of the right ventricle or the whole body. When right atrial temperature decreased from 37 degrees to 28 degrees C, heart rate was reduced from 146.3 to 109.7 beats per minute (p less than .001). Meanwhile, cardiac output and blood pressure remained within control levels. In the treatment of experimental SVT induced by the intravenous infusion of isoproterenol hydrochloride and by direct application of aconitine, this method worked effectively and was reproducible. The results demonstrated the beneficial effects of this method in the treatment of SVT in experimental studies and suggested its future clinical application following open-heart operations.     

A new method for conservative renal surgery — experimental and first clinical results

Summary So far two methods for prolonging the tolerance of renal ischemia are available: 1) surface cooling with crushed ice and 2) perfusion cooling with an extracellular-like solution. Both methods use only the principle of reducing metabolism through cooling. While rewarming during surgery the ischemic protection is lost, or the kidney must be cooled once again. Therefore, a new preservation solution should reduce energy consumption due to its composition in addition to cooling. For open heart surgery, the HTK solution by Bretschneider is already used clinically. In 71 dog kidney experiments, the ischemic time kidneys could tolerate was prolonged by this solution from 15 to 120 min at 35°C and from 45 to 360 min at 25°C. After 2h of ischemia at 30°C glomerular filtration rate was about 20 ml/min · 100 g_ww within 3 h of reperfusion. After six postoperative days the filtration rate was 40 ml/min · 100 g_ww. No ischemic damage could be recognized by histological investigations. The clinical effectiveness of this method was shown in 7 clinical applications. Ischemic duration lasted up to 113 min, and blood creatinine was between 0.8 and 2.4 mg% at the 6^th postoperative day. Use of this preservation technique thus leads to improved kidney function immediately following operation. Longer ischemia can be tolerated by a kidney thus protected, and using this technique excellent visibility can be achieved during intrarenal surgery, simplifying, for example, tumor extirpation.

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Eine neue methode der konservativen nierenchirurgie —experimentelle und erste klinische ergehnisse

Zusammenfassung Zur Verlängerung der renalen Ischämie stehen bisher zwei Verfahren zur Verfügung: 1) eine Oberflächenkilhlüng mit Eis and 2) eine Perfusionskühlung mit einer extrazellulären Losung. Beide Methoden nutzen nur das Prinzip der Stoffwechselsenkung durch Kühlung. Während der Wiedererwärmung bei der Operation geht der Ischämieschutz verloren oder die Niere muß erneut gekiihlt werden. Deshalb sollte eine neue Protektionslösung den Energieverbrauch zusätzlich zur Kühlung auch durch ihre Zusammensetzung senken. Bei offenen Herzoperationen wird die HTK-Lösung nach Bretschneider bereits klinisch angewendet. In 71 Experimenten an Hundenieren wurde die Ischämiezeit durch diese Lösung von 15 auf 120 min bei 35°C and von 45 auf 360 min bei 25°C. verlängert. Nach 120 min Ischämie bei 30°C betrug die glomeruläre Filtrationsrate ca. 20 ml/min 100g_FG innerhalb von 3 h Reperfusion. Nach 6 Tagen postoperativ war die GFR wieder 40 ml/min 100g_FG. Es konnte kein ischämischer Schaden durch histologische Untersuchungen mehr festgestellt werden. Der klinische Nutzen dieser Methode konnte in 7 klinischen Anwendungen gezeigt werden. Die Ischamiezeit betrug bis zu 113 min and das Kreatinin lag zwischen 0,8 and 2,4 mg% am 6. postoperativen Tag. Dieses Protektionsverfahren führt also zu einer verbesserten Nierenfunktion in der postoperativen Phase. Eine längere Ischämiezeit wird von der Niere vertragen, and unter Anwendung dieser Technik wird eine ausgezeichnete Übersichtlichkeit während der Nierenoperation erreicht, was eine radikale Tumorexzision erleichtert.

Supported by the Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 330 — Organprotektion — Göttingen     

A new method for correction of Stahl's ear.

Stahl's ear is characterized by a third crus, a flat helix, hypoplasia or total absence of the superior crus, and deformity of the scaphoid fossa. There are various methods for the correction of Stahl's ear, but the surgical correction of this deformity is more difficult than it appears. We recently devised a new surgical method of our own. During the past 4 years, we treated 5 patients with Stahl's ear with this procedure. Our procedure can be used in every kind of deformity of Stahl's ear and can get satisfactory results.     

Chondritis of the ear: a method of treatment.

Chrondritis may develop as a secondary complication of trauma to the ear. Its onset is often insidious and may be delayed until after apparent healing has occurred. Treatment is difficult, but if postponed, the result may be complete destruction of the external ear. A method of aggressive surgical therapy combined with antibiotics is presented which, when utilized early, results in good healing with minimal residual otic deformity.     

NOTES新术式:经气管内镜甲状腺切除术动物实验研究

目的：探讨一种全新的经自然腔道内镜手术（NOTES）——经气管内镜下甲状腺切除术的可行性、安全性和优越性。方法：采用3只巴马香猪和6只比格犬,利用自制带双通道的气管插管全身麻醉,置入内镜及器械,纵行切开甲状腺上方气管前壁软骨环。在内镜监视下行甲状腺部分或次全切除术。术毕连续或间断缝合气管前壁。结果：3只猪行经气管内镜下甲状腺部分切除术,6只狗行经气管内镜下甲状腺次全切除术,所有实验动物均顺利完成手术,无术中缺氧、窒息、气管梗阻及死亡。拔管后实验动物均自然苏醒,分别于2、4h后处死,观察气管切口缝合严密,无皮下气肿及血肿形成。结论：实验证实,经气管内镜甲状腺切除术是安全可行的。利用自然管腔（气管）作为甲状腺手术入路,保持了皮肤及颈前肌群的完整性,美观无疤痕,开拓了NOTES新领域。     

An alternative method of vascular anastomosis by laser: experimental and clinical study

In vascular surgery, it is now very difficult to maintain the long-term patency after a conventional vascular anastomosis, especially for small-caliber vessels. A low-energy CO2 laser was experimentally employed to make a vascular anastomosis with only a few sutures. Subsequently, it could be confirmed that optimal conditions for vascular anastomosis by laser were 20-40 mW in output and 6-12 sec/mm in irradiation time. On the other hand, pressure tolerance test as well as tensile strength test and microscopic examinations at the sites of anastomoses by laser were compared with the conventional suture method. There were no significant differences between laser and suture methods. On the basis of the excellent results of this study, the laser was clinically applied for anastomoses of the peripheral vessels in 35 patients. The first clinical laser application in the world was successful in a 44-year-old female patient with chronic renal failure in 1985. All patients are doing well without any complications from vascular anastomosis by laser. From these experimental and clinical studies, it can be concluded that anastomosis by laser should be recommended for small-caliber vessels such as aortocoronary bypass surgery.