The authors encountered 2 rare cases of adventitial cystic disease of the popliteal artery. Case 1 was a 51-year-old woman with dull pain in the lower limbs during walking. Case 2 was a 34-year-old man with numbness in the lower limbs on bending his knees. In both cases, angiography showed crescent stenosis, and computed tomography (CT) showed cyst-like lesions about the artery. Magnetic resonance imaging (MRI) indicated the lesions to have high density at T 2 imaging. With a diagnosis of adventitial cystic disease, cystectomy was conducted with satisfactory results. Adventitial cystic disease is rare and only 43 cases have so far been reported in this country. All of these were reviewed to clarify the characteristics of this disease. Its clinical symptoms often resemble those of arteriosclerosis obliterans (ASO) as intermittent claudication, but it differs from ASO in that it is usually achieved cure by cystectomy alone and seldomly required bypass operation. In the case of intermittent claudication in young patients, adventitial cystic disease should be diferrentiated from ASO.

Patients who underwent the bypass operation during 5 years from 1987 to 1992 in the 1st Department of Surgery, Hiroshima University School of Medicine, were divided into 2 groups; AIOD group (51 cases) had lesions in the aorta and iliac artery, and FPOD group (46 cases) had lesions in the femoral artery and popliteal artery. A comparative study of these two groups was made. There was no significant difference in age, sex, symptom severity, smoking history, serum cholesterol level, serum triglyceride level. The complication rate of peripheral lesions of the AIOD group was 24% and of the FPOD group was 57%. The cumulative patency rate for 5 years of the AIDO group was 100% and of the FPOD group was 61%. The AIOD group exhibited better patency. In addition to the lower complication rate of peripheral lesions, all the AIOD group had underwent reconstruction operation for peripheral lesions simultaneously. The run-off state of the peripheral region may thus possibly be related to patency.

Fifty-one cases which underwent surgery for arteriosclerosis obliterans in the aorta and iliac artery at the First Department of Surgery, Hiroshima University School of Medicine were divided into two groups. The EAB group (18 cases) underwent extra-anatomic bypass operation, and the AB group (33 cases) underwent anatomic bypass operation. A comparative study showed the mean age of the EAB group to be 10 years higher than that of the AB group, and the former group exhibited severer symptoms. Renal and pulmonary function declined in the EAB group, and the occurrence rate of complications such as cerebral infarction was also higher At operation, the following approaches were employed; long-term administration of PGE-1 before and after operation, operation with a better visual field under light general anesthesia, simultaneous reconstructive operation in peripheral lesions, artificial vessels of externally supported velour knitted Dacron. There was no case of obstruction in the past 5 years. Extra-anatomic bypass operation therefore provides as good postoperative patency as anatomic operation.

A 74-year-old man presented with swelling in both lower limbs and fatigue. Venography indicated nozzle-like stenosis of the inferior vena cava that appeared during the inspiratory phase but disappeared during the expiratory phase. A large pressure gradient between the upper and lower portion of the stenosis was observed during the expiratory phase. Stenosis during the inspiratory phase was relieved by percutaneous transluminal angioplasty, and symptoms and signs disappeared. Although stenosis occurred only during the inspiratory phase, our patient exhibited symptoms characteristic of Budd-Chiari syndrome. We believe that this patient originally had stenosis of the diaphragmatic portion of the inferior vena cava, and that his symptoms derived from the formation of a parietal thrombus.

OBJECTIVESystemic and myelotoxic effects of 2,3,7,8-tetrabromodibenzo-p-dioxin (TBDD) were examined by the single administration of TBDD by gavage to rats.

METHODSFifteen Wistar rats of both sexes per group received 0, 10, 30, 100 or 300 μg TBDD/kg body weight. Rats surviving to the scheduled necropsy on Days 2, 7 and 36 after TBDD administration were examined for growth rate, organ weight, hematology, histopathology and adipose tissue levels of TBDD.

RESULTSThree 300 μg/kg-dosed females died on Days 21, 23 and 27, and exhibited a marked decrease in body weight, severe thymic atrophy, decreased bone marrow hematopoiesis and hemorrhage in the subarachnoid space of brain and spinal cord. TBDD-dosed surviving rats exhibited growth retardation, decreased bone marrow hematopoiesis, decreases in red blood cell counts, hemoglobin concentrations, and hematocrit values, an increase in reticulocytes and decreases in platelet counts, white blood cell counts and eosinophils. These signs suggested TBDD myelotoxicity. Splenic extramedullary hematopoiesis was increased in both sexes given TBDD, whereas atrophy of the splenic white pulp occurred only in TBDD-dosed females. Marked decreases in body weights and the size and weight of the thymus, severe thymic atrophy and death in TBDD-dosed females suggested a wasting syndrome. The adipose tissue level of TBDD culminated on Day 7 and decreased to 20-30% of the Day 7 level on Day 36.

CONCLUSIONSThe TBDD-induced effects were characterized by a wasting syndrome and myelotoxicity that appeared at the dose levels of 30 μg/kg and higher and caused death in 300 μg/kg-dosed females.