In situ bilateral skeletonized internal thoracic arterial grafting for left-side myocardial revascularization using an off-pump technique

The aim of this study was to review the clinical and angiographic outcomes of in situ skeletonized bilateral internal thoracic artery (ITA) grafting for left coronary arterial revascularization using an off-pump technique in 144 consecutive patients. We also assessed the difference between left and right ITA grafting to the left anterior descending coronary artery (LAD). Arrangement of the bilateral ITAs (grafting of the left/right ITA to the LAD) was decided according to the coronary anatomy and quality of the grafts. Early postoperative angiograms were evaluated in 110 patients. The average numbers of anastomoses and bilateral ITA anastomoses per patient were 3.4 and 2.3, respectively. There were no surgical deaths or sternal infection. The left and right ITA were anastomosed to the LAD in 106 (73.6%) and 38 (26.4%) patients, respectively. There were no differences in preoperative conditions and postoperative complications between the left ITA and right ITA to LAD groups. The patencies of the left and right ITAs were 99.1 and 100%, respectively. In situ skeletonized bilateral ITA grafting for left-side revascularization using an off-pump technique was shown to be feasible, producing excellent early clinical and angiographic outcomes. Furthermore, arrangement of bilateral ITAs did not affect outcomes.     

Successful therapy of a malignant phyllodes tumor of the prostate after postoperative local failure

A 19-year-old student who had presented with acute urinary retention was referred to our hospital with biopsy diagnosis of proliferating mesenchymal tumor of the prostate. Magnetic resonance imaging showed enlarged prostatic masses. Suspecting prostate sarcoma, we performed a nerve-sparing radical prostatectomy. Histologic diagnosis of the tumor was prostatic malignant phyllodes tumor. Five months after the operation, bilateral obturator lymph node metastases appeared, which were treated with etoposide, ifosfamide, and cisplatin chemotherapy. After a good response was achieved with four cycles of the chemotherapy, pelvic irradiation was added. Since then, there has been no evidence of recurrence for more than 4 years.     

Hand assisted retroperitoneoscopic living donor nephrectomy in elderly donors

PURPOSE: We assessed the influence of HARDN on residual donor kidney and allograft function, invasiveness and morbidity in elderly living donors. MATERIALS AND METHODS: A total of 89 living donors underwent nephrectomy before September 2004 at our institution. The 18 donors who were 65 years or older included 4 of 27 with ODN and 14 of 62 with HARDN. RESULTS: In older (65 years or older) donors mean operative time, mean blood loss and warm ischemia time in the HARDN group did not differ from those in the ODN group. None of the donors had major complications. Older donors with HARDN had a tendency toward a shorter hospital stay than those with ODN. Postoperative serum creatinine in older donors with HARDN was higher than that in younger donors with HARDN, while there was no difference in postoperative serum creatinine between older donors with HARDN and those with ODN. The frequency of allograft losses tended to be higher in older than in younger kidneys (4 of 18 vs 5 of 71, p = 0.054). However, most allograft losses did not seem to be related to surgical technique. CONCLUSIONS: Although further studies, especially with long-term followup, are necessary, HARDN is suggested to be safe and minimally invasive surgery even in elderly donors and to be comparable to open surgery in terms of morbidity, the residual donor kidney and allograft function.     

Microsurgical anatomy around the origin of the ophthalmic artery with reference to contralateral pterional surgical approach to the carotid-ophthalmic aneurysm

The supraclinoid segments of the internal carotid artery (ICA) and their surrounding structures were examined under magnification in 25 adult cadavers. Attention was paid to anatomical variations and relationships concerning ipsilateral and contralateral pterional microsurgical approaches to these regions, especially to the origin of the ophthalmic artery. Eighty-four percent of the ophthalmic arteries arose from the supraclinoid segment of the ICA. In the ipsilateral pterional approach, mobilization of the ipsilateral optic nerve was required to see the origin of the ipsilateral ophthalmic artery and the medial aspect of the proximal portion of the supraclinoid segment of the ICA. In the contralateral pterional approach, on the other hand, these areas on the contralateral side could be identified under the optic nerve with minimal or without retraction of the contralateral optic nerve. This was because 71% of the ophthalmic arteries arose from the supero-medial aspect of the ICA, and because there was nothing to intercept the view of the medial aspect of the ICA under the optic nerve. This study supports the usefulness of the contralateral pterional approach to the origin of the ophthalmic artery and the medial aspect of the supraclinoid segment of the ICA. This approach could be useful in certain cases of carotid-ophthalmic aneurysm. The authors' experience with the contralateral pterional approach to carotid-ophthalmic aneurysms is also described.     

Increase by visual stimuli in turnover of 5-hydroxytryptamine in the superior colliculi of the rabbit.

1. Irregular light falshes were played on to one eye of dark adapted rabbits for periods of 20-80 min. The concentration of 5-hydroxyindol-3-ylacetic acid (5-HIAA) and of 5-hydroxytryptamine (5-HT) were estimated in left and right superior colliculi, thalami and hippocampi. 2. In rabbits exposed to such visual stimuli for 30-60 min, there was an increase in the 5-HIAA content of the colliculus contralateral to the stimulated retina which aberaged 17% (P = 0-02), but no rise was seen if the exposure was shortened to 20 or prolonged to 80 min. At no time was there a difference in 5-HIAA content between right and left thalamus or right and left hippocampus. 3. Stationary or strictly repetitive visual stimuli produced no difference between the 5-HIAA content of left and right superior colliculus. 4. No difference in 5-HT concentration between the two colliculi was found after any form of visual stimulation, nor did any changes occur in the other parts of the brain which were examined. 5. Irregular, prolonged visual stimualtion thus appears to activate tryptaminergic neurones terminating in the colliculi. The possibility is discussed that the 5-HT released at this site might act as a brake to neuronal activity under conditions when habituation to the stimuli is not yet complete.