Two Cases of the Blue Toe Syndrome Treated by Prostaglandin E1(PGE1) / 日本心臓血管外科学会雑誌

Two cases of blue toe syndrome were effectively treated by PGE1. Case 1 was an 80-year-old man who had an ulcer lesion of the 5th toe. Angiography indicated the symptoms were caused by microemboli from an extended lesion of the aorta and iliac artery. The wound was healed by lipo PGE1 (10μg×30 days). Case 2 was a 54-year-old man who had dull pain and skin color change of the 3rd and 4th fingers. A thrombus could not be detected by transthoracic echocardiography, but was found by transesophageal echocardiography. The symptoms improved by PGE1 (60μg×20days). Blue toe syndrome is induced by a microembolism in the peripheral arteries, and thus the conventional treatment has been the administration of fibrinolysins and anticoagulants. PGE1 was used in this study for the first time in consideration of its vasodilating effect on the collateral circulation and to prevent a secondary thrombus by inhibiting platelet aggregation.

Result of Bypass Surgery for Arteriosclerosis Obliterans of Lower Extremities. Comparative Study on the Aorto-Iliac and Femoro-Popliteal Occlusion / 日本心臓血管外科学会雑誌

Patients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.

Results of the Extra-anatomic Bypass Operation on Arterio Sclerosis Obliterans in Aorta and Iliac Artery / 日本心臓血管外科学会雑誌

Fifty-one cases which underwent surgery for arteriosclerosis obliterans in the aorta and iliac artery at the First Department of Surgery, Hiroshima University School of Medicine were divided into two groups. The EAB group (18 cases) underwent extra-anatomic bypass operation, and the AB group (33 cases) underwent anatomic bypass operation. A comparative study showed the mean age of the EAB group to be 10 years higher than that of the AB group, and the former group exhibited severer symptoms. Renal and pulmonary function declined in the EAB group, and the occurrence rate of complications such as cerebral infarction was also higher At operation, the following approaches were employed; long-term administration of PGE-1 before and after operation, operation with a better visual field under light general anesthesia, simultaneous reconstructive operation in peripheral lesions, artificial vessels of externally supported velour knitted Dacron. There was no case of obstruction in the past 5 years. Extra-anatomic bypass operation therefore provides as good postoperative patency as anatomic operation.

A Case of Budd-Chiari Syndrome Showing Severe Inspiratory Stenosis of the Diaphragmatic Portion of the Inferior Vena Cava / 日本心臓血管外科学会雑誌

A 74-year-old man presented with swelling in both lower limbs and fatigue. Venography indicated nozzle-like stenosis of the inferior <i>vena cava</i> that appeared during the inspiratory phase but disappeared during the expiratory phase. A large pressure gradient between the upper and lower portion of the stenosis was observed during the expiratory phase. Stenosis during the inspiratory phase was relieved by percutaneous transluminal angioplasty, and symptoms and signs disappeared. Although stenosis occurred only during the inspiratory phase, our patient exhibited symptoms characteristic of Budd-Chiari syndrome. We believe that this patient originally had stenosis of the diaphragmatic portion of the inferior <i>vena cava</i>, and that his symptoms derived from the formation of a parietal thrombus.

A Case of Abdominal Apoplexy / 日本心臓血管外科学会雑誌

This is a rare case of abdominal apoplexy encountered in a 50-year-old man who had aortic and mitral valve replacement due to dominant regurgitation resulting from infective eneocarditis. On the 4th day after the operation, retroperitoneal bleeding, probably due to rupture of the splenic artery aneurysm, occurred and he developed shock. On the 28th day, there was bleeding in the digestive tract and blood pressure was low, probably due to rupture of the microaneurysm of the small artery distributing to the ileum. Rupture of an abdominal vessel without a recognizable external cause is called abdominal apoplexy, and our case was caused by mycotic aneurysm caused by infective endocarditis. Angiography facilitated the accurate diagnosis.

A Case of Imflammatory Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

A 78-year-old man consulted our hospital with complaint of abdominal mass. Blood examination indicated a inflammatory reaction. An abdominal aortic aneurysm, 5.5cm in size, was found by CT scanning examination. Its wall quite thick (mantle sign), and enhanced by contrast medium. Y graft replacement was carried out. Microscopic hiatological examination of the aneurysmal wall indicated severe inflammation being assisted of chronic inflammatory cells, like lymphocytes and plasma cells at the adventitia. Ten cases of inflammatory abdominal aortic aneurysm reported in Japan so far are reviewed and features of this disease are discussed.