OBJECTIVETo investigate the effect of bone marrow derived endothelial cells implantation on healing of acute injured intima.

METHODSMononuclear cells derived from bone marrow were differentiated to endothelial cells. The cells were labeled with bromodeoxyuridine. Carotids injuring was induced by a balloon in 40 rabbits, endothelial cell suspension (2 x 10(6)/ml, n = 20) or PBS (2 ml, n = 20) was infused to injured arteries. The intima covered area was tested by Evan's Blue staining. The average intima thickness and media thickness were observed 7 and 14 days post procedure by histological assay. The immunofluorescent staining was performed for testing the BrdU labeled-cells, and these cells were detected under a fluorescent microscope.

RESULTSIntima covered area rate was significant higher (54.1% +/- 8.2% vs. 30.0% +/- 5.5% at day 7, and 81.8% +/- 6.0% vs. 63.6% +/- 8.4% at day 14, all P < 0.05) and the intima thickness and media thickness were significantly reduced in the endothelial cell suspension group.

CONCLUSIONThe bone marrow derived endothelial cell promoted healing post intima injury in this model compared to PBS group (all P < 0.05).

Animals ; Bone Marrow Cells ; cytology ; Bone Marrow Transplantation ; Carotid Arteries ; pathology ; Carotid Artery Injuries ; pathology ; surgery ; Endothelial Cells ; cytology ; pathology ; transplantation ; Female ; Male ; Rabbits ; Transplantation, Autologous

OBJECTIVETo employ reverse first dorsal metatarsal artery island flap to recover the donor site of great toe after free lateral pulp flap transfer, and decrease the morbidity of microsurgical donor site.

METHODSFrom February 2000 to June 2004, 12 cases of soft tissue defect in thumb and finger were treated by free lateral pulp flap of great toe transplantation, and that the secondary defect of great toes were repaired by reverse first dorsal metatarsal artery flap according to the anatomical communicating between first dorsal metatarsal artery and plantar metatarsal artery. The donor exposure of dorsal pedis were straightly sutured.

RESULTSAll the lateral pulp flaps of great toe and the reversed first dorsal metatarsal flaps survived uneventfully with desirable appearance and sensation. In thumb and finger defect reconstructed with lateral pulp flaps of the great toe, there was in mean static two-point discrimination of 6 mm at 10 month follow-up, that was 10 mm in reverse flaps.

CONCLUSIONSIt is an instructive and practical creation to adopt the reverse first dorsal metatarsal artery flap to recover the raw surface in the lateral aspect of the great toe, which minimizes the morbidity at the donor site and gains the twin-win results.

Adolescent ; Adult ; Arteries ; transplantation ; Female ; Finger Injuries ; surgery ; Humans ; Male ; Metatarsus ; blood supply ; Middle Aged ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; pathology ; Young Adult

Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.
Aneurysm, False/surgery ; Aneurysm, False/etiology* ; Aneurysm, False/diagnosis ; Angiography, Digital Subtraction ; Case Report ; Human ; Male ; Middle Age ; Temporal Arteries/surgery ; Temporal Arteries/pathology ; Temporal Arteries/injuries* ; Thrombosis/etiology ; Ultrasonography, Doppler ; Wounds, Penetrating/surgery ; Wounds, Penetrating/complications*

OBJECTIVETo investigate the application of the island flap based on the postfemur neurocutaneous nutrient vessel.

METHODSThe flap was designed and applied to repair the defects in the gluteal, popliteal fossa or the bilateral postfemur areas. A total of 11 cases (12 defects) were treated with this method. The size of the defects ranged from 4.0 cm x 7.8 cm to 8.3 cm x 16.6 cm.

RESULTSOf the 12 defects, 9 achieved complete success. Epidermal necrosis occurred in the distal part of the flap in 3 defects owing to venous stasis, which were cured with skin grafting. Postoperative follow-up for 8-19 months showed that the appearance, texture, and function of the flap were satisfactory.

CONCLUSIONSThe advantages of the flap lie in the reliable blood supply, constant anatomy, and without sacrificing a major artery. The key points for the flap survival are utilizing the "Superficial vein-nutrient vessel of the cutaneous nerve system" and retaining a comet tail-shaped soft-tissue pedicle in the flap creation.

Arteries ; Follow-Up Studies ; Humans ; Necrosis ; etiology ; surgery ; Skin ; injuries ; pathology ; Skin Transplantation ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing

OBJECTIVETo investigate the in vivo gene expression of adenovirus-mediated human tissue factor pathway inhibitor (hTFPI) and its inhibition effects on intimal proliferation in rabbit carotid arteries after balloon injury.

METHODSRabbits underwent carotid artery balloon injuries were treated with Ad-TFPI (n = 25), Ad-LacZ (n = 25) or PBS (n = 10), respectively. Sham operated rabbits (n = 10) serve as normal controls. The expressions of human TFPI at mRNA and protein levels were detected by RT-PCR and ELISA respectively on the 3rd, 7th, 10th, 14th, 28th day after operation. Intimal proliferation was detected by angiograms and morphometric analysis.

RESULTSTFPI mRNA and protein expressions were detected at 3 days and peaked at the 10th and 14th day after TFPI gene transfer. The expressions were still detectable on the 28th day. There was no TFPI expression in Ad-LacZ group. The carotid angiogram results indicated that the minimal lumen diameter in TFPI group was significantly larger and the lumina stenosis percentage was significantly lower in TFPI group compared those in Ad-LacZ and PBS groups (all P < 0.05). The morphometric analysis showed that the intimal area, the ratio of the intimal/media area, the lumina stenosis percentage in TFPI group were all significantly reduced compared with those in Ad-LacZ and PBS groups (all P < 0.01).

CONCLUSIONSThe TFPI gene could be effectively transferred by adenovirus vector to injured carotid arteries and transferred Ad-TFPI could significantly attenuate intimal proliferation in balloon injured carotid arteries in rabbits.

Adenoviridae ; genetics ; Animals ; Carotid Arteries ; metabolism ; Carotid Artery Injuries ; metabolism ; pathology ; Female ; Gene Transfer Techniques ; Genetic Vectors ; Humans ; Lipoproteins ; genetics ; Male ; Rabbits ; Transfection ; Tunica Intima ; pathology

Adolescent ; Adult ; Arteries ; injuries ; pathology ; surgery ; Child ; Child, Preschool ; Extremities ; blood supply ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Humans ; Male ; Microsurgery ; methods ; Middle Aged ; Recovery of Function

Traumatic thyroid hematoma is a rare problem in cases of blunt trauma, but it can be a life-threatening condition. We report here on a case of thyroid hematoma that was complicated with unexpected airway obstruction due to blunt trauma on the anterior neck. A 23-year-old man who developed neck painful swelling and dyspnea was admitted to the emergency room with a blunt neck injury after motor-bicycle accident, and he hit his anterior neck against the handle-bar. He had no previous thyroid pathology and other medical problems. On the initial examination, his vital signs were stable and the oxygen saturation was 97.8%. A computed tomography (CT) scan of the neck showed fragmentation and extensive hematoma within the right thyroid gland and dislocation of the trachea. No definite bleeding focus was identified on the angiography that was done through the carotid artery. Two hours later, the patient experienced sudden respiratory distress and the oxygen saturation dropped rapidly. The patient needed emerg encyendotracheal intubation and surgical intervention. He successfully underwent right lobectomy of the thyroid gland, and was discharged on the 6th hospital day without any complications. The thyroid function was normal after 3 months.
Airway Obstruction* ; Angiography ; Carotid Arteries ; Dislocations ; Dyspnea ; Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Intubation ; Neck ; Neck Injuries ; Neck Pain ; Oxygen ; Pathology ; Thyroid Gland* ; Trachea ; Vital Signs ; Young Adult

BACKGROUND/AIMS: Pseudoaneurysm is a life-threatening complication of chronic or acute pancreatitis. This study was undertaken to evaluate the clinical features of pseudoaneurysm complicating pancreatitis. METHODS: We reviewed the medical records of 7 patients diagnosed as pseudoaneurysms with chronic pancreatitis in Korea University Guro and Anam Hospital from January 1995 to March 2006 and analyzed their demographics, clinical courses and outcomes. RESULTS: All patients were men and mean age was 54.6 years (range, 43-67 years). All the cases occurred in the setting of chronic alcoholic pancreatitis complicated by pseudocyst. Abdominal pain was the unique initial clinical symptom in 5 cases, hematemesis in 1 case, and simultaneous abdominal pain with hematemesis in 1 case. Bleeding into pseudocyst developed in 5 cases, flowing into duodenum through pancreatic duct in 1 case and rupture into the descending colon in 1 case. Mean duration between onset of symptom and diagnosis of pseudoaneurysm was 7.8 days (range, 1-23 days). Six cases were diagnosed by abdominal computed tomography disclosing characteristic finding of focal high density area in the pseudocyst. Pulsed doppler abdominal sonography was performed before computed tomography in 3 cases and results were negative in 2 cases. Transcatheter arterial embolizations were initially performed in 6 cases, and there was no recurrent bleeding except one case of splenic infarction. Distal pancreatectomy was initially performed in 1 case. CONCLUSIONS: Pseudoaneurysms complicating chronic pancreatitis shows various clinical features. Transcatheter arterial embolization can be recommended as a primary therapeutic modality.
Adult ; Aged ; Aneurysm, False/*diagnosis/etiology/ultrasonography ; Arteries/injuries ; Demography ; Embolization, Therapeutic ; Hemorrhage/etiology/surgery ; Humans ; Korea ; Male ; Middle Aged ; Pancreatic Pseudocyst/etiology/surgery ; Pancreatitis, Alcoholic/*complications/pathology ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVETo investigate the role of small G-protein RhoA in neointimal formation following rat carotid artery balloon injury and related mechanisms.

METHODSMale 3-4-month-old Sprague-Dawley rats were used in the present study (10 rats per group). Group A: control; Group B: carotid artery balloon injury; Group C: injury + Ad-CMV-eGFP + Pluronic F-127; Group D: injury + Ad-CMV-N19RhoA-eGFP + Pluronic F-127; Group E: non injury + Ad-CMV-eGFP + Pluronic F-127. Perivascular gene transfer of an adenovirus co-expressing N19RhoA was performed to rat carotid artery following balloon injury and the effect on neointimal formation and the expressions of PCNA and α-SM-actin examined. Rats were killed after 14 days.

RESULTSThe protein expression of RhoA in group B was significantly higher than in group A (P = 0.001), and the positive cells rate of PCNA and α-SM-actin which were assessed by immunohistochemistry in group C (45.2% and 75.6%) was significantly higher than in group D (28.4% and 51.9%, all P < 0.01). The area of neointima was significantly smaller [(0.14 ± 0.08) mm(2) vs. (0.23 ± 0.10) mm(2), P < 0.01], the luminal area was significantly larger [(0.47 ± 0.11) mm(2) vs. (0.31 ± 0.06) mm(2), P < 0.01] in group D than in group C.

CONCLUSIONGene transfer of N19RhoA attenuates neointimal formation after balloon injury in rat carotid arteries possibly related to the modulating capacities of small G-protein RhoA on the proliferation, phenotypic differentiation and migration of vascular adventitial fibroblasts.

Adenoviridae ; genetics ; Animals ; Carotid Arteries ; metabolism ; Carotid Artery Injuries ; metabolism ; pathology ; Genetic Vectors ; Male ; Muscle, Smooth, Vascular ; metabolism ; Neointima ; Rats ; Rats, Sprague-Dawley ; Transfection ; rhoA GTP-Binding Protein ; genetics

We present the case of a 23-year-old man who suddenly collapsed during a physical altercation with his friends while in a drunken state. The post-mortem computed tomography (CT) with angiography revealed acute basal subarachnoid hemorrhage with rupture of the left middle cerebral artery. On autopsy, the head, face, mandible and neck showed multifocal hemorrhages with fracture of the hyoid bone, and the pathologic findings of the brain was consistent with CT findings. However, the vascular rupture site was not observed macroscopically. On histologic examination, a microscopic focal rupture was identified at the proximal portion of the middle cerebral artery, and possibility of arteriopathy was considered. This case illustrates that other parts of intracerebral arteries (other than the vertebral arteries) can be the culprit of rupture in the case of traumatic basal subarachnoid hemorrhage, and the post-mortem angiographic findings can be helpful in targeting the site of vascular injury. Furthermore, meticulous sampling of intracranial vessels could help find the vascular rupture site and identify any histologic findings suspicious of arteriopathy. Therefore, we suggest that post-mortem angiography can be an effective and adjunctive tool for a tailored approach in finding the vascular injury, and that histologic examination of both the intracranial and extracranial arteries be important to medicolegally ensure the death of traumatic basal subarachnoid hemorrhage and to examine presence of arteriopathy as a predisposing factor.
Angiography ; Arteries ; Autopsy ; Brain ; Causality ; Forensic Pathology ; Friends ; Head ; Hemorrhage ; Humans ; Hyoid Bone ; Mandible ; Middle Cerebral Artery ; Neck ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Hemorrhage, Traumatic ; Vascular System Injuries ; Young Adult