Résumé
Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after microarterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.
Sujets)
Collagène , Cellules endothéliales , Fibrine , Lambeaux tissulaires libres , Héparine , Microscopie électronique à balayage , Myocytes du muscle lisse , Spasme , Matériaux de suture , Thrombose , Activateur du plasminogène de type urokinase , Degré de perméabilité vasculaireRésumé
Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. Many studies has been published in microvascular anastomosis with histologic effect for irrigating solution. But local irrigation solution has been used clinically in microvascular anastomosis, the comparison with each solution, microhistological study for endothelial cell repair and vascular patency has not been reported. The heparin which is anti-thrombotic agent, and urokinase which is fibrinolytic agent are used for this study. Vascular patency and thrombus formation in experimental micro-arterial anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-arterial anastomosis, equal effects of good vascular patency were obtained in group of local irrigation with heparin and urokinase. 2. In thrombus formation in 7 days after micro-arterial anastomosis, equal effects of minimal thrombus formation were obtained in group of local irrigation with heparin and urokinase. 3. In toluidin blue staining in 7 days after micro-arterial anastomosis, local destruction of endothelial cell and inner elastic lamina were seen and endothelial repair was not seen. 4. In scanning electron microscope examination in 7 days after micro-arterial anastomosis, endothelial cell was not seen in peripheral to suture materials, thrombus associated fibrin network was observed. 5. In transmission electron microscope examination in 7 days after microarterial anastomosis, inflammatory cell was seen within smooth muscle cells in site of endothelial cell destruction, smooth muscle cell around suture material were arranged irregularly, some collagenous change were seen. From the results obtained in this study, same results of good vascular patency and anti-thrombotic effect of heparin and urokinase were obtained as a local irrigation solution, and repair of endothelial cell was not seen in 7 days after micro-arterial anastomosis.
Sujets)
Collagène , Cellules endothéliales , Fibrine , Lambeaux tissulaires libres , Héparine , Microscopie électronique à balayage , Myocytes du muscle lisse , Spasme , Matériaux de suture , Thrombose , Activateur du plasminogène de type urokinase , Degré de perméabilité vasculaireRésumé
The authors describe a rare case of inflammatory pseudotumor involving the clivus, where a soft tissue mass lesion, with extension into the prevertebral retropharyngeal space and the cavernous sinuses, was detected by CT and MRI. The mass resembled a malignant tumor or aggressive infectious lesion, and the final diagnosis of inflammatory pseudotumor was a diagnosis of exclusion, decided after histopathological examination.
Sujets)
Adulte , Humains , Mâle , Maladies osseuses/diagnostic , Fosse crânienne postérieure/anatomopathologie , Granulome à plasmocytes/diagnostic , Imagerie par résonance magnétique , TomodensitométrieRésumé
Regianal anesthesia applied by means of a gargle provides satisfactory analgesia for premedication of esophagogastroduodenoscopy (EGD). To access the influence of 2% lidocaine hydrochloride after regional anesthesia on oropharyngeal components of swal- lowing, we used the videofluorographic swallowing study for the evaluation of pharyngeal architecture, time of pharyngeal barium passage, and the submental surface EMG(S-EMG) for the evaluation of functional changes in skeletal muscle. Measurements were made in 10 healthy volunteers without any oropharyngeal problems. There was no liquid aspiration symptoms or signs before and after regional anesthesia application. Also, there were no structural changes in pharyngeal swallowing motion and no significant prolongation of pharyngeal barium transit time. But regional anesthesia affected the eletro-activities in swallowing skeletal muscle, i.e, the swallowing durations, peak amplitudes of peristaltic wave, and area under curves in S-EMG, which returned to pre-anesthesia levels in 60 minute's time. Therefore, it will be recommended to avoid meal within 60 minute's after regional anesthesia for EGD.