Optimal revascularization of segmental pancreatic transplant.

Vascular anastomotic thrombosis is one of the most frequent complications after segmental transplantation of the pancreas (STP). We propose a new type of vascular anastomosis to reduce the rate of vascular thrombosis following STP. For this purpose we used double arterial-double venous anastomosis (DADVA). Four different types of vascular anastomosis used for STP were studied and compared. The rate of vascular anastomotic thrombosis was evaluated in correlation with the type of vascular anastomosis used. Traditional vascular anastomosis (TVA) was complicated by vascular thrombosis in 51.9% of cases. DADVA reduced rate of vascular thrombosis to 2.6% (P < 0.01).

Cyclic guanine monophosphate (cGMP) an intracellular mediator of cavernosal smooth muscle relaxation following penile vascular surgery.

BACKGROUND: We describe a new surgical method for treatment of male impotence. This procedure allows preservation of erectile tissues and avoids the need for implantable devices. It was demonstrated, that after this procedure sustained and reproducible erections were feasible. The role of cyclic guanine monophosphate (cGMP) in generation of erection following this procedure was studied. METHODS: Concentration of cGMP in erectile tissues was studied in the chronic canine experimental model. cGMP measurements were obtained using enzymeimmunoassay method. RESULTS: It was detected that the process of erection was accompanied with increased concentration of cGMP in the involved erectile structures (from 39.59 +/- 8.95 and 39.39 +/- 8.54 pm/g to 78.67 +/- 24.05 and 81.62 +/- 18.80 pm/g respectively with p = 0.0001). Concentration of cGMP did not change in the control (from 41.14 +/- 5.38 to 39.26 +/- 7.59 pm/g with p = 0.4568). CONCLUSION: It can be concluded, that proposed new surgical procedure causes erection not by simple distention of erectile tissue sinuses by arterial blood. Arterial blood inflow is accompanied by activation of intracellular mechanisms responsible for smooth muscle relaxation in erectile tissues. Normal values of cGMP concentration in canine erectile tissues are also reported.

Blood flow in the pancreatic segment before and after transplantation.

BACKGROUND: Blood flow in the pancreas before and after transplantation has not been studied sufficiently. Blood flow in the pancreatic transplant as a function of type vascular anastomosis used has not been explored. AIM: The objective of our study was to study blood flow in the intact pancreas prior to harvesting and at different time periods after transplantation. Two different types of vascular anastomosis were used for segmental transplantation of the pancreas. Blood flow in the transplanted pancreas was compared in this two experimental groups. METHODS: Study was conducted on 61 mongrel dogs. Autotransplantation of a pancreatic segment was performed to the left iliac vessels. There were two randomized experimental groups. In the first group (26 animals) traditional vascular anastomosis was used to revascularize pancreatic graft. Proximal end of splenic artery was anastomosed to iliac artery in "end to side" manner. Portal end of splenic vein was anastomosed to iliac vein in "end to side" manner as well. Splenic ends of splenic artery and vein were ligated. In the second group (35 animals) double arterial double venous anastomosis was used. For this purpose, after completing traditional vascular anastomosis, second arterial anastomosis was created distal to the first one between distal end of splenic artery and iliac artery in "end to side" fashion. Second venous anastomosis was performed distal to the first one between splenic end of splenic vein and iliac vein in "end to side" fashion. Blood flow in the pancreatic segment was measured using direct blood flow measurement method and electromagnetic flowmetry. After transplantation of pancreatic segment, blood flow was measured in the pancreatic graft 3 min, 1 h, 1 and 6 months following transplantation. RESULTS: Blood flow in the pancreas before harvesting was 0.69 +/- 0.01 ml/min/g. Blood flow in the pancreatic transplant in traditional vascular anastomosis group was higher than blood flow in the normal pancreas (1.13 +/- 0.05 ml/min/g after one month and 1.00 +/- 0.05 ml/min/g after six months (p < 0.01)). Blood flow in the double arterial double venous anastomosis group was not statistically significantly different from blood flow in the normal pancreas at 1 and 6 months after transplantation (0.70 +/- 0.02 and 0.67 +/- 0.02 ml/min/g accordingly). CONCLUSION: Double arterial double venous anastomosis provided more physiological blood flow to the graft, than traditional vascular anastomosis.