• Journal of Trauma and Injury
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• v.36 no.1
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• pp.60-64
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• 2023

Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.256-263
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• 2007

Background: Intimal hyperpiasia is characterized by a proliferation of vascular smooth muscle cells in the intimal layer Epigallocatechin-3-gallate (EGCG) is known to suppress smooth muscle cell proliferation. We propose that EGCG may have a protective effect against the development of intimal hyperplasia through the suppression of smooth muscle cell proliferation. Material and Method: Human umbilical vein endothelial cells (HUVEC) and rat aortic smooth muscle cells (RASMC) were cultured with different concentrations of EGCG, and proliferation and migration speed were measured. In 20 dogs, the autologous jugular veins were interposed into the carotid arteries. For the study group (n=10), the graft was stored for 30 minutes in EGCG solution and 300mM EGCG was applied to the perivascular space after grafting. After 6 weeks, the intimal and medial thickness was measured. Result: The proliferation of RASMC and HUVEC was suppressed with EGCG. The migration of RASMC was suppressed with EGCG, but that of HUVEC was not affected. In the in vivo study, the intimal thickness was thinner in EGCG group than in the control group (p<0.05), but the medial thickness did not show any difference. The intimal/medial thickness ratio was lower in the EGCG group (p<0.05). Conclusion: EGCG suppresses intimal hyperplasia after vascular grafting, and this may be mediated by prevention of migration and proliferation of vascular smooth muscle cells. The use of EGCG may offer new therapeutic modality to prevent intimal hyperplasia.

• Journal of Chest Surgery
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• v.47 no.5
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• pp.468-472
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• 2014

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.

• Mycobiology
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• v.44 no.3
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• pp.180-186
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• 2016

Trichoderma species are able to persist on living sapwood and leaves of cacao (Theobroma cacao) in an endophytic relationship. In this research, we evaluated the ability of Trichodema asperellum introduced at the incision site in the bark for side grafting with the concentration of 4 g/10 mL, 4 g/100 mL, and 4 g/1,000 mL (suspended in water) in suppressing vascular streak dieback (VSD) incidence and promoting growth of side grafts in the field. The incidence of VSD in two local clones of cacao, MCC1 and M04, without application of T. asperellum was 71.2% and 70.1% at 21 wk after grafting, respectively. However, when the two clones were treated with a concentration of 4 g/10 mL T. asperellum, the incidence was 20.6% and 21.7%, respectively, compared to 29.1% and 20.9% at 4 g/100 mL and 18.2% and 15.6% at 4 g/1,000 mL. By comparing to the control, the treatment with the same concentrations of T. asperellum listed above, the total number of stomata in MCC1 decreased by 41.9%, 30.2%, and 14.0% and in M04 by 30.5%, 21.9%, and -2.5% (exception), respectively. Otherwise, the total area of stomata opening increased by 91.4%, 99.7%, and 28.6% in MCC1 and by 203.8%, 253.5%, and 35.9% in M04, respectively. Furthermore, the number of buds and branches treated with a mixture concentration on the the two clones increased by 90.7% and 21.7%, respectively. These data showed that the application of T. asperellum to cacao scions while grafting can decrease VSD incidence in side grafts and increase growth of grafts in addition to decreasing total number of stomata, increasing total area of opened stomata, and increasing number of buds and branches.

• Archives of Plastic Surgery
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• v.39 no.5
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• pp.534-539
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• 2012

Background Autologous fat grafting evolved over the twentieth century to become a quick, safe, and reliable method for restoring volume. However, autologous fat grafts have some problems including uncertain viability of the grafted fat and a low rate of graft survival. To overcome the problems associated with autologous fat grafts, we used uncultured adipose tissue-derived stromal cell (stromal vascular fraction, SVF) assisted autologous fat grafting. Thus, the purpose of this study was to evaluate the effect of SVF in a clinical trial. Methods SVF cells were freshly isolated from half of the aspirated fat and were used in combination with the other half of the aspirated fat during the procedure. Between March 2007 and February 2008, a total of 9 SVF-assisted fat grafts were performed in 9 patients. The patients were followed for 12 weeks after treatment. Data collected at each follow-up visit included clinical examination of the graft site(s), photographs for historical comparison, and information from a patient questionnaire that measured the outcomes from the patient perspective. The photographs were evaluated by medical professionals. Results Scores of the left facial area grafted with adipose tissue mixed with SVF cells were significantly higher compared with those of the right facial area grafted with adipose tissue without SVF cells. There was no significant adverse effect. Conclusions The subjective patient satisfaction survey and surgeon survey showed that SVF-assisted fat grafting was a surgical procedure with superior results.

• Journal of Periodontal and Implant Science
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• v.28 no.2
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• pp.263-273
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• 1998

For histologic observation of the regenerated bone following guided tissue regeneration (GTR) using ePTFE membranes with calcium carbonate implant and autogenous bone graft, biopsies were collected from 2 patients during 5-year-postoperative surgical reentry. In both combined cases with guided tissue regeneration in conjunction with calcium carbonate implant and autogenous bone graft, significant bone fill and gain in probing attachment level was observed. In histologic examination, specimen in GTR case with calcium carbonate grafting was composed of a dense bone containing vascular channel with lamellar structure and viable bone cells in lacunae, however considerable calcium carbonate particles remained unresorbed and isolated from regenerated bone by the dense cellular and fibrous connective tissue. No formative cells could be seen in contact with remained calcium carbonate particles. In GTR case with autogenous bone grafting, specimen show was composed of a dense lamellar bone containing vascular channel, which showed normal alveolar bone architectures. The present observation indicate that guided tissue regeneration in conjunction with grafting, especially autogenous bone graft, has highly osteogenic potential, however resorbable calcium carbonate granules were not completely resorbed at 5 year postimplantation.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
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• v.46 no.1
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• pp.84-87
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• 2013

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.383-386
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• 2016

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare, potentially fatal, congenital anomaly with a high mortality rate in the first year of life. It occurs rarely in adulthood and may appear with malignant ventricular arrhythmia or sudden death. We report a case of a 49-year-old woman with ALCAPA who presented with dyspnea on exertion. Management was coronary artery bypass grafting to the left anterior descending artery and obtuse marginal arteries, closure of the left main coronary artery ostium, and reestablishment of the dual coronary artery system.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.150-153
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• 2021

Moyamoya disease (MMD) is characterized by progressive steno-occlusive lesions of the distal or proximal branch of the internal carotid arteries, and cerebrovascular symptoms are its major complications. Extracranial vascular involvement including the coronary artery has been reported, and some case reports have described variant angina or myocardial infarction. However, no report has yet described a case of myocardial infarction after coronary artery bypass grafting (CABG). Here, we present a patient with MMD who suffered cardiac arrest caused by myocardial infarction due to a coronary spasm after offpump CABG and who was discharged successfully after treatment with a veno-arterial extracorporeal membrane oxygenator and percutaneous coronary intervention.