Extra-anatomic bypass graft for management of axillary artery occlusion in pitchers.

OBJECTIVE: Our goal was to evaluate the long-term results of vein bypass grafts for axillary artery occlusion, specifically those placed extra-anatomically to prevent arterial injury in pitchers. METHODS: With the greater saphenous veins used as the selected conduit, arterial bypass grafts were routed anterior to the pectoralis minor muscle in four baseball pitchers who had occlusion of the axillary artery. We performed a follow-up in excess of 10 years with evaluations of the bypass grafts by ultrasonic duplex scan and magnetic resonance angiography. RESULTS: All four pitchers treated in this manner returned to the game and played for several seasons without a recurrence of the arterial injury. Long-term evaluation of the bypass grafts did not reveal any structural or functional disorder. CONCLUSIONS: Axillary artery occlusion in an athlete can be effectively treated with a vein bypass graft placed extra-anatomically, anterior to the pectoralis minor muscle. The greater saphenous vein should be considered the conduit of choice.

A challenging treatment for an ischaemic ulcer in a patient with Buerger's disease: vascular reconstruction and local flap coverage.

An ischaemic heel ulcer in a patient with Buerger's disease was reconstructed using an in situ saphenous vein graft combined with a local flap. The bypass was sufficient to restore blood supply to the ischaemic limb but a flap was necessary to cover the persistent heel ulcer, which remained after revascularisation. One month after bypass surgery the ulcer was debrided and the resulting defect was covered with a lateral supramalleolar flap. The postoperative course was uneventful and the flap donor site healed well. When treating ischaemic ulcers in a patient with Buerger's disease, vascular reconstruction should be considered first in order to salvage the limb. After revascularisation, a local flap can be used to cover a persistent defect but very few local flaps have been reported. This report is the first published case of successful local flap transfer after bypass surgery in a patient with Buerger's disease. We think that a local flap is one possible treatment for a non-healing ulcer after revascularisation.

[Usefulness of hypoallergenic rice (AFT-R 1) and analysis of the salt insoluble rice allergen molecule].

An involvement of rice allergy in development and exacerbation of recalcitrant atopic dermatitis (AD) has been suggested in some cases, and it has been also known that elimination diet of rice results in improvement of AD and reduction of the doses of steroid ointment and anti-allergic drugs used for the treatment. We prepared the hypoallergenic rice grain, AFT-R 1 (Allergen-free Technology Lab. Inc.-Rice 1), with alkali treatment from the rice material, Koshihikari, which is popular in Japan. Its usefulness was evaluated clinically and serologically. The serological study with IgE-ELISA showed that the major allergic protein were remarkably reduced to less than 1/6400 of them in the AFT-R 1. Then it was applied to the clinical trial, and evaluated as useful by the clinical effect in 14 (93%) out of 15 patients, who were diagnosed to have rice allergy by the elimination (in 15 case) and ingestion (in 12 cases) of the regular rice. The serum taken from the patient, whom the AFT-R 1 was evaluated as unuseful in the clinical trial, was shown to have IgE antibodies reactive to the remaining protein in AFT-R 1 by IgE-ELISA, and the 60 kd protein band was detected as an IgE-binding component of AFT-R 1 by IgE-immunoblotting with the same serum. This 60 kd rice protein was identified as ADP (UDP)-glucose-starch glycosyl transferase (EC: 2.4.1.21) by N-terminal amino acid analysis. These results indicated that AFT-R 1 is very useful as a substitute of rice in many AD patients with rice allergy, although IgE-binding component such as the 60 kd protein is remaining in one.

Antioxidative properties of products from amino acids or peptides in the reaction with glucose.

The livers of rats fed with a brownish "soybean paste" (Miso) or peptides-glucose reaction mixture showed lower TBA and chemiluminescence values than those of the control. From these results, it was clear that Miso and peptide-glucose reaction products also exhibited antioxidative effect in vivo. In order to explain this mechanism, the scavenging activity against reactive oxygen species (ROS) of various Maillard reaction products (MRPs) were studied. It was confirmed that peptide-glucose reaction products. Amadori rearrangement products, melanoidins, modified protein and its hydrolysate, brown pigments isolated from Miso and other foodstuffs showed strong scavenging activity against hydroxyl radical and superoxide anion. Consequently, it was estimated that scavenging activity of MRPs against ROS played an important role in the antioxidative effect of MRPs in vivo.