Three patients with subclavian artery obstruction caused by arteriosclerosis underwent surgical reconstruction based on their specific anatomic characteristics. Subclavian artery transposition was performed in a patient with a short segmental occlusion of the proximal subclavian artery. The patient with a long segmental occlusion, from the origin of the internal thoracic artery to the origin of the thoracoacrominal artery, underwent bypass-grafting between common carotid artery and axillary artery. The graft was passed lateral to the anatomical tract to prevent compression by the scalenus and subclavian muscles. Because the branchial plexus also can be compressed in the thoracic outlet, the scalenus muscles were detached at the first rib in both methods. It is important to consider the specific cause of subclavian artery occlusion when planning corrective surgery. Ischemic and neurologic symptoms improved using both techniques.

We performed several arterial reconstruction methods for five patients with buttock claudication due to ischemia of the hypogastric artery, and their symptoms improved remarkably. They had complained of severe buttock pain, although every patients' ankle brachial pressure index had almost been within the normal range. Angiography had showed not only hypogastric arterial stenosis but extensive sclerotic changes of pelvic arteries. Two cases had had contralateral iliac stenosis. We placed stress on reconstruction for the main trunks to supply the lower extremities with sufficient blood flow, and occasionally reconstructed the hypogastric artery in addition. Aorto-femoral bypass, ilio-femoral bypass, Y-graft replacement, atherectomy were performed, among other procedures. The buttock pain was eliminated. Buttock claudication, caused by critical hypogastric circulation, occurs only when blood flow through the pelvic collateral vessels is compromised. In particular, the principal etiology seems to be blood flow steal to the ischemic legs on exercise. In such cases, arterial reconstruction of the lower extremities is very effective.

Magnification of the surgical field is considered an essential technique for performing accurate surgery on small caliber arteries. For this reason, we use the transmicroscopic technique of vascular surgery on the tibial arteries. We obtained good results in long term patency. Our experience and results in bypass grafting to the tibial artery using a microscope are reported. Forty-four tibial artery bypasses using transmicroscopic techniques were performed in 38 consecutive patients between June 1984 and December 1992. Twenty-seven patients had arteriosclerosis obliterans, 5 had thromboangitis obliterans, 5 had acute arterial occlusion and 1 had traumatic vascular injury. Patient ages ranged from 37 to 78 years old. Thirty-five were men and 3 were women. Twenty-six surgeries were performed for limb threatening and 14 were for disabling claudication. All patients were examined with conventional aortic lower extremity angiography preoperatively. The reversed saphenous vein was used in 38, in-situ saphenous vein in 3 and composite vein to vein graft in 2. All distal anastomoses were performed by the transmicroscopic technique. Continuous sutures were used for recipient vessels larger than 1.0mm in diameter. However interrupted 8-0 sutures were chosen for smaller vessels. Distal anastomosis was made at the proximal portion of the tibial artery in 24 cases, while the distal portion of the tibial artery was used in 20 cases. On preoperative angiography, the condition of the tibial arteries affected the patency rate when runoff was poor or fair. Nine cases were judged to have “poor” runoff. Three of these became occluded during the early postoperative period, and 1 during the late phase. Eight cases were judged to have “fair” runoff. One of these became occluded during the early postoperative period, and 3 during the late phase. There were no graft failures identified throughout the follow-up period in patients with good runoff. Cumulative patency rates were 86.2% after 1 year, 79.0% after 5 years, and 67.7% after 8 years, respectively. The patency rate of the 24 grafts in which distal anastomosis was performed on the proximal tibial artery was 71. 4% after 5 years. The patency rate of the 20 grafts on the distal tibial artery was 93.3% after 5 years. There was no significant difference observed in the patency of these two groups. Hospital mortality was 2.6%. Femorotibial bypass using transmicroscopic technique could save severely ischemic limbs while maintaining hospital mortality at a low level and reducing limb loss. The advantage of microscopic surgery is achieving fine observation because the magnification level is changeable, depending on the field needed. In anastomosis of small caliber vessels like the tibial artery, magnification by 10 times is important to observe the characteristics of the intima of the recipient artery. Subsequently, the procedure is performed by transmicroscopic techniques under magnification by 5 times, which provides much higher accuracy for suture than surgical loupe. High magnification prevents intraoperative technical error and unexpected injury.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD).This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.

Dynamic X-ray (DXR) is a functional imaging technique that uses sequential images obtained by a flat-panel detector (FPD).This article aims to describe the mechanism of DXR and the analysis methods used as well as review the clinical evidence for its use. DXR analyzes dynamic changes on the basis of X-ray translucency and can be used for analysis of diaphragmatic kinetics, ventilation, and lung perfusion. It offers many advantages such as a high temporal resolution and flexibility in body positioning. Many clinical studies have reported the feasibility of DXR and its characteristic findings in pulmonary diseases. DXR may serve as an alternative to pulmonary function tests in patients requiring contact inhibition, including patients with suspected or confirmed coronavirus disease 2019 or other infectious diseases. Thus, DXR has a great potential to play an important role in the clinical setting. Further investigations are needed to utilize DXR more effectively and to establish it as a valuable diagnostic tool.

BACKGROUND: Pyrethroid (PYR) insecticides are widely used for controlling various pests. There are two types that differ in terms of usage: agricultural-purpose PYR (agriculture-PYR) and hygiene purpose PYR (hygiene-PYRs). Few studies exist on the exposure to these chemicals in small children. In this study, we conducted biomonitoring of urinary pyrethroid metabolites in 1.5-year-old children throughout the year. METHODS: Study subjects were 1075 children participating in an Aichi regional sub-cohort of the Japan Environment and Children's Study as of 18-month health check-up. The concentrations of four specific hygiene-PYR metabolites including 2,3,5,6-tetrafluoro-1,4-benzenedimethanol (HOCH₂-FB-Al), and five common metabolites of hygiene- and agriculture-PYRs including 3-phenoxybenzoic acid (3PBA) and cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (DCCA), were measured in urine samples extracted from soiled diapers using a triple quadrupole gas chromatograph-mass spectrometer. RESULTS: The highest detection frequencies were for 3PBA, followed by DCCA, 1R-trans-chrysanthemum dicarboxylic acid, and HOCH₂-FB-Al. Among the six metabolites, urinary concentrations were seasonally varied. However, this variation was not observed in the most studied PYR metabolite, 3PBA. Spearman's correlation analysis demonstrated a significant positive correlation between FB-Al and DCCA (r = 0.56) and HOCH₂-FB-Al and 4-methoxymethyl-2,3,5,6-tetrafluorobenzyl alcohol (r = 0.60). CONCLUSIONS This biomonitoring survey found widespread and seasonally specific exposure to multiple hygiene- and agriculture-PYRs in 1.5-year-old Japanese children.
Agriculture ; Child, Preschool ; Environmental Exposure/analysis* ; Humans ; Infant ; Insecticides ; Japan ; Mass Spectrometry ; Pyrethrins/urine*

BACKGROUND: Low-dose exposure to organophosphate (OP) insecticides during pregnancy may adversely affect neurodevelopment in children. To evaluate the OP exposure levels, single urine sampling is commonly adopted to measure the levels of dialkylphosphates (DAPs), common OP metabolites. However, the inter-day variations of urinary DAP concentrations within subjects are supposed to be large due to the short biological half-lives of the metabolites, and it is thus considered difficult to accurately assess OP exposure during pregnancy with single sampling. This study aimed to assess intra-individual variations of DAP concentrations and the reproducibility of the exposure dose categorization of OPs according to DAP concentration ranges in pregnant women in Japan. METHODS: Urine samples were collected from 62 non-smoking pregnant women (12-22 weeks of gestation) living in Aichi Prefecture, Japan. First morning void (FMV) and spot urine samples taken between lunch and dinner on the same day were collected on five different days during 2 weeks. The concentrations of DAP and creatinine in urine samples were measured using an ultra performance liquid chromatography with tandem mass spectrometry. Creatinine-adjusted and unadjusted concentrations were used for the intraclass correlation coefficient (ICC) calculations and surrogate category analyses. RESULTS: For all DAP metabolites, the creatinine-adjusted single ICCs exceeded 0.4, indicating moderate reliability. Overall, ICCs of spot urine samples taken in the afternoon were better than those taken as FMV. Surrogate category analyses showed that participants were categorized accurately into four exposure dose groups according to the quartile points. CONCLUSION This study indicated that a single urine sample taken in the afternoon may be useful in assessing OP exposure as long as the exposure is categorized into quartiles when conducting epidemiological studies in early to mid-pregnant women in Japan.
Adult ; Chromatography, Liquid ; Creatinine ; urine ; Environmental Exposure ; analysis ; Environmental Monitoring ; methods ; Environmental Pollutants ; urine ; Female ; Humans ; Japan ; Mass Spectrometry ; Organophosphates ; urine ; Pesticides ; urine ; Pregnancy ; Pregnant Women ; Young Adult