In addition to the histological study of tendon blood circulation, high level of resting blood flows have been functionally observed in the in-vivo tendon tissue preparation. Interest has been directed to investigate the phenomenon from the measurement of tendon tissue Po2 changes which may indicate the activity of capillary blood flow. Simultaneous measurements were done in tendon synovial fluid, tendon and muscle tissues of the 15 rabbit hindlimbs, in conditions of hypoxia and hyperoxia. Continuous measurements of tissue Po₂ were performed by polarographic method using a pair of the wire platinum electrode (80μm in diameter) with polymer membrane to the indifferent silver electrode. Average Po₂ of tendon synovial fluid, tendon fiber and muscle tissues at rest (mean±SD, n) were 37.36±24.32 (10), 30.96±14.72 (10) and 19.54±8.05 (8), respectively. These data increased gradually to the maximal level of 45.46±27.46 (10), 39.23±16.23 (10) and 25.96±9.77 (8) after cutting of sciatic nerve. Reactive hyperemia-like Po₂ increase immediately after release of femoral arterial occlusion was observed neither in tendon synovial fluid nor in tendon tissue. There was no significant difference between each other of tissues in the process of Po₂ increase during oxygen intake and the decrease after cessation of oxygen flushing. During exercise, a marked decrease of Po2 was obtained in muscle, but not in tendon synovial fluid.
These data indicate that high level of Po₂ in tendon and the surrounding tissuse may have some oxygen supply channels including segmental blood supply system with a short length of and/or a large size of capillary.

A study was designed to determine the effect of cooling down and massage on lower leg volume after heel-raising exercise in men. The subjects were six healthy athletes ranging in age from 18 to 23 years. Lower leg volume was measured at rest and after heel-raising exercise using Lundvall's volumetric method with a water-filled“boot”. Ten minutes of rhythmic heel-raising, performed at 45 times per minute, was monitored continuously using a mech-anograph.
Immediately after the end of exercise, each subject lay in a relaxed supine position and the leg was raised to 45 degrees. A cuff was then attached around the thigh, and the cuff pressure was increased to occlude the leg circulation. The leg volume was then determined in a standing position. After the first measurement of the lower leg, three kinds of treatment were applied for each subject (no treatment, one minute walking : total seven minutes, one minute massage : total five minutes) .
The results obtained were as follows ;
1) The slopes of the recovery curve of lower leg volume were more gentle with no treatment than with cooling down and massage.
2) The time constant (min) obtained from the decreasing curve of lower leg volume after heel-raising exercise was 10.2 for no treatment, 9.4 for cooling down and 6.4 for massage.
3) The total fluid accumulation volume in the lower leg (ml/l lower leg) following heel-raising exercise was 450.9 for no treatment, 288.9 for cooling down and 198.6 for massage.
It is suggested that such a disappearance of fluid accumulation in exercising muscles of the lower leg following cooling down and massage is due to a mechanical pump action against the surrouding local skeletal muscle tissues.

Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

Evidence of an increased resting blood flow in the tendon against the adjacent muscle was confirmed in the in situ hindlimb preparation of a rabbit anesthetized with urethane. The tendon tissue blood flow was found to be modulated by nervous and mechanical factors. The effect of nervous control was demonstrated by the denervation of the sciatic nerve, which showed a gradual increase in the resting blood flow in the tendon and muscle after being severed. During local muscle exercise, the increase of tendon tissue blood flow observed was minimal in comparison with the adjacent muscle. The tendon surrounding tissue blood flow showed site-dependent characteristics along the longitudinal tendon bundles. Evidence of tendon vascular structure in the rabbit species was confirmed by observing capillaries in cross sectional fascicles and longitudinal and transversal vessels in the paratenon of the Achilles tendon. These results strongly suggest a physiological model of local tissue temperature regulation and fluid dynamics in the biological system.

We report the efficacy of catheter-directed thrombolysis (CDT) for acute deep vein thrombosis. Between January 2003 and August 2004, 20 patients were treated with CDT for occlusive femoral, ilio-femoral and vena caval thrombosis, for less than 2 weeks from onset. Average age was 56.4 years (range 30-78 years), 11 patients were male, and the duration of leg symptoms was 4.4 days (range 1-12 days). Routine temporary inferior vena caval filters were used, and a multi-lumen catheter was inserted from the popliteal vein. Urokinase was used via the catheter by the combination drip infusion method and pulse-spray method. All patients received heparin and stasis of venous flow was prevented with intermittent pneumatic compression. If thrombus remained, mechanical thrombolysis was necessary. Metallic stents were implanted for iliac vein compression syndrome and organized thrombus. Venographic severity score (VS score) and extremity circumference were used to evaluate the effects of treatment. The duration of the treatment was 5.0±0.28 days (range 2-9 days) and the total dosage of urokinase was 1, 025, 000±57, 000 units (range 360, 000-1, 680, 000 unit). One (5%) iliac vein compression syndrome and two (10%) organized thrombi were treated by implanted metallic stents. Giant thrombi was captured by temporary inferior vena caval filters in two patients, but there was no pulmonary embolism. Two patients had thrombophilia, one was antiphospholipid syndrome and one was protein S deficiency. There was an early recurrence in one patient and re-CDT was needed. The VS score deteriorated to 6.2±2.5 (post CDT) significantly (p<0.0001) from 26.2±6.3 (pre CDT). CDT for acute deep vein thrombosis was effective and its early outcome was acceptable.

A case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is reported. A 48-year-old man had undergone a total left hip arthroplasty 5 years previously. Acute arterial occlusion (AAO) of the left lower extremity occurred 3 times. AAO was due to pseudoaneurysm of the external iliac artery, which was detected by rotating digital subtraction angiography (DAS). Aneurysmectomy and reconstruction were carried out. Rotating DSA was useful for the diagnosis of this unusual case of pseudoaneurysm of the external iliac artery after a total hip arthroplasty is unusual.

We encountered a recurrent suprarenal abdominal aortic aneurysm (AAA) patient with coronary artery disease and hyperlipidemia after repair of infrareanal AAA. A 72-year-old woman complaining of an abdominal throbbing mass was admitted. Computed tomography (CT) and aortography revealed infrarenal AAA which was totally removed and Dacron graft was replaced. The patient was followed as an outpatient. At the time of initial graft replacement there was no remarkable aneurysmal change in suprarenal abdominal aorta. Five years after the initial operation, a suprarenal AAA 5cm in diameter was detected by ultra sonographic examination. CT scan and aortography confirmed suprarenal AAA involving the celiac trunk of the supramesenteric artery and renal artery. Redo AAA operation with reconstruction of these branches was performed under V-A bypass support in a thoracoabdominal approach. Slight renal and liver dysfunction occurred postoperatively. However, serum creatine GOT and GPT values normalized by the ninth postoperative day. Postoperative aortography revealed patency of all branches.

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.