Donor-specific sensitization by cadaveric venous allografts used for arterial reconstruction in peripheral arterial occlusive vascular disease

The use of allogeneic venous grafts from postmortal organ donors allows for the reconstruction of critically affected arteries in patients with peripheral occlusive vascular disease. We were interested to determine the prevalence and specificity of anti-HLA antibodies in patients after allogeneic vein transplantation. Anti-HLA class I and II alloantibodies were analyzed by flowcytometric analysis using color-coded microbeads coated with HLA antigens including recombinant single antigens. Nine out of 10 patients involving 12 venous allografts were positive for anti-HLA alloantibodies. All antibody-positive patients carried both anti-HLA class I and II alloantibodies. Anti-donor HLA specificity of the anti-HLA alloantibodies was seen in seven out of nine patients for anti-class I antibodies and in eight out of nine patients for anti-HLA class II antibodies. A high rate of donor-specific allosensitization was seen after allogeneic venous transplantation. In conclusion, allosensitization not only includes a humoral response against the constitutively expressed class I antigens but also extends to class II antigens.     

Arterialization of the venous system of the brain

Department of Normal Physiology, N. I. Pirogov Second Moscow Medical Institute. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 105, No. 1, pp. 9–11, January, 1988.     

Vascular deposition of complement-split products in kidney allografts with cell-mediated rejection.

Complement activation in 73 renal transplant biopsies was investigated by indirect immunoperoxidase staining using MoAbs reactive with complement-split products. Intense deposition of complement fragments C4d and C3d in peritubular capillaries, indicating activation of the classical pathway, could be detected in the majority of transplanted kidneys with cell-mediated rejections. Abundant deposition of complement-split products was observed in 22 early biopsies from patients with high 'immunological risk' (i.e. previous, rejected transplants and/or circulating antibodies against HLA-antigens). Despite negative results in the crossmatch before transplantation and paucity of immunoglobulins in transplant biopsies, antibodies directed against endothelial cell antigens should be considered as a possible cause of classical complement activation.     

Biochemical and morphological changes in the myocardium of acute vascular surgical patients (early autopsy results)

Department of Pathological Anatomy, Faculty of Internal Medicine, Pirigov Second Moscow Medical Institute. Laboratory of Pathological Anatomy and Autopsy Department, A. N. Bakulev Institute of Cardiovascular Surgery, Moscow. (Presented by Academician of the Russian Academy of Medical Sciences V. S. Savel'ev.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 114, No. 8, pp. 214–216, August, 1992.     

Retransplantation of murine skin allografts: assessment of treatment effects on the allograft in the absence of effects on the host

In transplantation techniques previously described it was impossible to separate the effects of immunosuppressive treatments on the host from the effects directed at the allograft itself. The skin allograft retransplantation technique described here allows one to assess changes in the immunogenicity of the allograft generated in the primary recipient but assessed on a second untreated host. The skin allograft is parked on a primary recipient and then retransplanted with a thin margin of recipient tissue to a second host. Data obtained from this model shows that passenger leukocytes do not influence skin allograft survival times. Enhancing alloantisera used in the primary host was shown to cause prolonged graft survival in the untreated second recipient. Using this model the effects of immunosuppressive or immunostimulatory treatments directed at the graft itself can be assessed.     

Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery

 This retrospective study evaluated the influence of vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery. A total of 104 patients who underwent cardiac surgery via minimal access incision were included in this study. Cardiopulmonary bypass was initiated with gravity alone, and vacuum-assisted venous drainage was applied only when the bypass flow was 2.2 l/min/m² or less. We compared intraoperative variables of the patients to whom vacuum-assisted venous drainage (vacuum group) was applied with those who underwent gravity venous drainage alone (gravity group). In the 13 patients who most recently underwent isolated valve operations without maze procedures, free hemoglobin was measured to evaluate hemolysis. Vacuum-assisted venous drainage was required in 77 (72.6%) patients. Except for a smaller body surface area in the gravity group (P = 0.0118), patient characteristics did not differ significantly between the two groups. Free hemoglobin 60 mins after the beginning of cardiopulmonary bypass was higher in the vacuum group than in the gravity group (21.5 ± 7.3 vs 11.1 ± 7.1 mg/dl, P = 0.0284). Operative mortality and morbidity did not differ significantly between the groups. We found vacuum-assisted venous drainage to be a safe, simple, and effective technique in cases of minimally invasive cardiac surgery. However, there is a potential risk of hemolysis and air embolism, as shown in our findings and previous reports. Received: May 14, 2002 / Accepted: October 28, 2002 Present address: Department of Cardiovascular Surgery, Sayama Hospital, 1-33 Unoki, Sayama, Saitama 350-1323, Japan Tel. +81-42-953-6611; Fax +81-42-953-8040 e-mail: hykiyama@da2.so-net.ne.jp Correspondence to:H. Kiyama     

兔耳纯静脉皮瓣血流量和血管网面密度观测

目的:观测纯静脉皮瓣术后血流量和血管网面密度变化。方法:利用家兔耳背设计纯静脉皮瓣和动脉皮瓣模型①观测术后血流量;②墨汁灌注后软蜡厚蜡切片,图像分析血管网面密度。结果:①纯静脉皮瓣术后48h血流量最低,第14d恢复至术前65%。②纯静脉皮瓣术后第1～7d的血管网面密度高于动脉皮瓣(P<0.05)。结论:纯静脉皮瓣术后血流量及血管网密度变化与动脉皮瓣不同。     

Duration of increase in vascular volume during venous stasis

Duration of increase in vascular volume in the crus following application of venous stasis was studied in 3 healthy subjects placed in a supine position. Changes in calf volume during venous stasis was measured by plethysmography. In one series of experiments changes in vascular volume were studied by measurements of accumulation of ¹³³Xenon proximal to a depot located in the anterior tibial muscle. In another series of experiments changes in activity of ^99mTc-labelled erythrocytes were used as indicator for changes in vascular volume. Following application of venous stasis in the horizontal position the rate of increase in calf volume declined to a steady level after about 5 min. Both the studies with ¹³³Xenon and with ^99mTc-erythrocytes indicate that vascular volume continued to increase for 3, 3.5 and 5 min following venous stasis of 20, 30 and 40 mmHg, respectively. When the crus was lowered 50 cm below heart level the duration of increase in vascular volume following an additional increase in venous pressure induced by venous stasis was shorter than in the horizontal position. When the calf is placed at heart level the results indicate that for up to 5 min after application of venous stasis of 40 mmHg both increase in vascular volume and transcapillary fluid filtration contribute to the observed increase in calf volume. Using the rate of increase in calf volume within 5 min after induction of venous stasis thus leads to overestimation of CFC. After 5 min vascular volume appears to remain constant and the observed increase in calf volume seems to be solely due to a net increase in interstitial fluid volume.     

Pulmonary vascular disease in 57 necropsy cases of total anomalous pulmonary venous connection

In a semi-quantitative necropsy study, total anomalous pulmonary venous connection (TAPVC) was an isolated anomaly in 35 cases and was associated with asplenia and either pulmonary stenosis or pulmonary atresia in 22 cases. A comparison of the two groups showed pulmonary venous obstruction (26% vs. 4%), a small interatrial communication (51% vs. 4%), a patent ductus arteriosus or operative shunt (40% vs. 64%), medial hypertrophy of muscular pulmonary arteries (80 vs. 23%), muscularization of arterioles (80% vs. 23%), capillary engorgement (60% vs. 27%) alveolar wall thickening (29% vs. 0%), interlobular septal oedema (34% vs. 14%), dilated lymphatics (80% vs. 45%), arterialization of pulmonary veins (86% vs. 68%), medial hypertrophy of veins (26% vs. 0%), and venous dilatation (74% vs. 50%). Only one patient, a 5-year-old girl with isolated TAPVC, had severe plexogenic pulmonary arteriopathy. In the remainder, the pulmonary lesions were those generally associated with reversible pulmonary venous hypertension; they were most striking in patients with pulmonary venous obstruction, and were least prominent in patients with pulmonary stenosis or puimonary atresia.     

Anatomy of the presacral venous plexus: implications for rectal surgery

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.     

Vascular volume in B16 allografts and human melanoma xenografts estimated by means of Hoechst 33342

The vasculature of B16, a murine melanoma and Mel-mo, a human melanoma, was studied using intravital staining of patent capillaries by the fluorescent bisbenzamine dye Hoechst 33342. Capillaries were numerous at the edge of tumours in both the lines studied, but were scarcer within the nodules. Vascular volume as a proportion of total tumour volume was estimated by means of point counting. In both B16 and Mel-mo, the percentage vascular volume was inversely related to log tumour weight. Tumour necrosis, which increased with tumour size, was inversely correlated with percentage vascular volume, emphasizing the central under-perfusion of these experimental tumour nodules. This pattern of perfusion, with greater density of functioning capillaries at the periphery of tumour nodules, was seen in both the tumour lines examined despite differences in the degree and pattern of necrosis.     

老年患者中心静脉置管分析

目的总结对老年患者施行中心静脉置管的经验,寻找对老年患者施行中心静脉置管的最短时间和最佳部位。方法对三年来施行过中心静脉置管术的病例进行分析。结果总置管成功率为96.2%,失败率为3.8%。虽然经右颈内静脉置管的首次成功率与经右锁骨下静脉置管的首次成功率相比无显著性差异（P〉0.05）,但经右颈内静脉置管时间较经右锁骨下静脉置管时间短（P〈0.05）。结论老年患者施行中心静脉穿刺置管术条件复杂、情况多变,置管难度较大,经右颈内静脉置管较经右锁骨下静脉置管更为省时、安全、可行。     

Histopathological study of JNK in venous wall of patients with chronic venous insufficiency related to osteogenesis process

Chronic venous insufficiency (CVI) is one of the most common vascular pathologies worldwide. One of the risk factors for the development of CVI is aging, which is why it is related to senile changes. The main trigger of the changes that occur in the venous walls in CVI is blood flow reflux, which produces increased hydrostatic pressure, leading to valve incompetence. The cellular response is one of the fundamental processes in vascular diseases, causing the activation of cell signalling pathways such as c-Jun N-terminal kinase (JNK). Metabolic changes and calcifications occur in vascular pathology as a result of pathophysiological processes. The aim of this study was to determine the expression of JNK in venous disease and its relationship with the role played by the molecules involved in the osteogenic processes in venous tissue calcification. This was a cross-sectional study that analyzed the greater saphenous vein wall in 110 patients with (R) and without venous reflux (NR), classified according to age. Histopathological techniques were used and protein expression was analysed using immunohistochemistry techniques for JNK and markers of osteogenesis (RUNX2, osteocalcin (OCN), osteopontin (OPN)). Significantly increased JNK, RUNX2, OCN, OPN and pigment epithelium-derived factor (PEDF) protein expression and the presence of osseous metaplasia and amorphous calcification were observed in younger patients (<50 years) with venous reflux. This study shows for the first time the existence of an osteogenesis process related to the expression of JNK in the venous wall.     

Experimental anatomic modeling of venous dyshemocirculation in the scrotal organs

Disorders in venous outflow from the testis and epididymis lead to the formation of pathological compensatory hemodynamics, development of high intratesticular pressure with impairment of the integrity of the intra-organ vessels, up to extravasation (testicular venous infarction), to local arterial hypertension, inter-arterial shunting of stained solutions through the intersystem fusion of the testicular arteries (shunting of arterial blood under vital conditions), and hence, trigger the mechanism of secondary arterial ischemization of the testis and epididymis. The severity of circulatory disorders depends on the volume of venous collectors excluded from circulation: from pronounced disorders in case of testicular venous outflow blockade to extremely severe ones in case of combined testicular-cremasteric venous block (hemodynamic collapse). __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 143, No. 6, pp. 709–713, June, 2007     

Pulmonary vascular candidiasis and use of central venous catheters in neonates.

A retrospective study of infant deaths in this maternity hospital carried out from 1976-86 showed a recent increase in fatalities with systemic candidiasis. Ten of twenty five cases occurred between July 1985 and June 1986. Most of these infants had Candida plugging pulmonary vessels, often accompanied by vasculitis, thrombosis, and parenteral lipid embolism. The adoption of central venous catheters for prolonged parenteral feeding of very preterm infants may have accounted for this phenomenon. Over the same decade there was an increased incidence of Candida isolates from all admissions to the neonatal intensive care unit: the prolonged survival of very low birthweight infants and the use of multiple courses of antibiotics were also factors.     

A review of venous collaterals in inferior vena cava obstruction

The purpose of this study was to review venous collateralization resulting from inferior vena cava obstruction. The elements responsible for the extent and distribution of venous collaterals in inferior vena cava obstruction and whether or not the obstructive lesion involves tributaries of the inferior vena cava. Common etiologies of inferior vena cava obstruction include extensions of iliofemoral vein thrombi, thrombosis from intraluminal tumors or following trauma, and external compression. The anatomy of the venous collateral systems may be divided into deep and superficial networks, each of which is composed of systems of primary or secondary clinical significance, as defined by the degree of restoration of adequate venous return and the extent of visceral venous decompression. The most common obstructions of the inferior vena cava involve the lower third of the vessel. The azygos-hemiazygos and vertebral venous plexus systems play the most significant roles, while the superficial systems are less prominently involved. In upper level inferior vena cava obstruction, reestablishment of venous circulation is less developed, which usually leads to a poorer clinical outcome. © 1992 Wiley-Liss, Inc.     

Development and evaluation of new devices for use in the central venous catheter system

The central venous catheter (CVC) is considered the most reliable type of temporary blood access, and longer-term blood purification has become possible with its improvement. We report the clinical evaluation of a new CVC, the Tornado catheter, and discuss complications associated with the long-term use of the CVC (L-CVC). We placed Tornado catheters in the internal jugular vein for 1–2 weeks in 10 patients. L-CVC were employed in 14 patients undergoing maintenance hemodialysis (HD). In only 2 of 10 patients with a Tornado catheter, the blood flow was decreased during HD due to clot formation on the arterial side. No patients had other complications. In patients with L-CVC, poor blood flow often occurred. In two patients with cardiac dysfunction, we have been using CVC for more than 12 months. The development of a CVC that will serve as a permanent blood access is expected.     

髂腰韧带的形态及抗L5椎体滑脱的生物力学研究

目的:研究髂腰韧带(ILL)的形态学,探讨其在防止L5椎体前滑脱中的作用。方法:成人男性防腐标本26具,观察ILL起止点和走行,测量其长宽厚度。取10具标本制腰椎滑脱模型,等分为两组,A组为ILL保留组,B组为ILL切断组。测量在300、600、900和1200 N负荷时L5椎体在S1椎体上缘的位移。测量A组和B组在不同载荷下L5椎体的位移和移位程度,用Stata 7.0进行统计学分析。结果:ILL由上部和下部韧带组成。上部韧带主要起自L4横突,止于髂骨嵴的内缘和腰方肌在髂嵴的附丽部。厚(2.22±0.28)m m,宽(10.72±2.34)m m,长(69.80±5.02)m m。下部韧带不能再细分成束,主要起自L5横突,主要止于髂后粗隆,最长(82.20±4.02)m m,主束前缘长(36.64±2.30)m m,后缘长(8.54±1.78)m m,宽(12.22±2.18)m m,厚(4.30±0.96)m m。A组和B组在不同载荷下L5椎体的位移和移位程度,统计学分析结果P<0.05,为差别有显著性意义。结论:ILL具有特异的形态学结构特点,有阻止和减少L5椎体向前滑脱的作用。