Pharmacodynamics of intracavernously injected drugs and cavernous wall resistance

The volumetric flow rates, mean and pulsatile, in the aorta and its major branches were measured in nonfed, anesthetized rabbits, using a transit time Doppler ultrasonic flowmeter. Anesthesia was maintained with isoflurane, and a vasodilator was applied topically during the measurements to avoid introducing additional flow resistance due to vasoconstriction. The cranial mesenteric and celiac arteries received the bulk of the aortic flow, (mean +/- SD) 29.5 +/- 6.6% and 23.3 +/- 5.8%, respectively, for mean flow. The brachiocephalic artery received as much as 14.7 +/- 3.2%, while each of the other branches received a considerably smaller fraction: 7.1 +/- 2.5% for the left subclavian artery, 6.2 +/- 2.6% and 5.1 +/- 2.2%, respectively, for the right and left renal arteries, and 6.0 +/- 2.5% for each of the two iliac arteries. Flow divisions were nearly the same in paired vessels. Peak pulsatile flow divisions were similar to their steady flow counterparts in the brachiocephalic, left subclavian, celiac, and cranial mesenteric arteries, but were smaller in the renal and iliac arteries, although the difference was not statistically significant. Reverse flow from one or more of the branches back into the aorta occurred in diastole in seven of eight rabbits studied.     

Angiokeratoma circumscriptum]

A case of superior mesenteric artery branch aneurysm is described. A 43-year-old female patient was hospitalized after the incidental discovery of a low echogenic mass next to the superior mesenteric artery trunk. A selective superior mesenteric arteriography confirmed aneurysms of the inferior pancreaticoduodenal artery and an aortogram demonstrated occlusion of the celiac trunk. Bypass between the abdominal aorta and the common hepatic artery and resection of aneurysms were performed. The possible etiology and operative procedure are discussed.     

Perfluoroctyl bromide as a blood pool contrast agent for computed tomographic angiography

RATIONALE AND OBJECTIVES: We determined whether perfluoroctyl bromide (perflubron) could be used as a computed tomography (CT) angiographic agent by studying vessel visibility (celiac artery, superior mesenteric artery [SMA], and renal arteries) with spiral CT and three-dimensional (3D) reconstructions. METHODS: Five rhesus monkeys were examined with a perflubron emulsion (90% [w/v] perfluorochemical; administered intravenously at a dose of 1.5 ml/kg and at a rate of 0.5 ml/sec. Spiral CT was performed immediately and at 5 hr after injection. Three dimensional images of the aorta at the level of the celiac artery, SMA, and renal arteries were reconstructed and blindly rated 0-4 (0 = not seen; 4 = excellent visualization) by two observers. RESULTS: All the vessels had the best ratings immediately after injection: celiac artery, 2.8 +/- 0.42; SMA, 2.7 +/- 0.48; left renal artery, 2.1 +/- 0.99; and right renal artery, 1.2 +/- 1.03. The ratings after the 5-hr delay were as follows: celiac artery, 1.3 +/- 1.34; SMA, 1.5 +/- 1.08; left renal artery, 1.5 +/- 0.97; and right renal artery, 1.2 +/- 0.79. CONCLUSIONS: Spiral CT angiography with a perflubron emulsion successfully demonstrated all vessels immediately and at 5 hr after contrast agent infusion. Further refinements of the dose, rate, and reconstruction technique are expected to increase vessel visibility over this wide imaging window.     

The significance of the morphology of the dorsal pancreatic artery in determining the presence of the accessory right hepatic artery passing behind the portal vein

The dorsal pancreatic artery (DP) and an accessory right hepatic artery (AcRH) passing behind the portal vein were investigated in 98 Japanese specimens. The dorsal pancreatic artery was identified in 87 specimens (88.8%). This artery has been found to yield the following 6 branches: (1) an inferior pancreatic artery (left branch, 83.9%); (2) a right branch-1 that serves as the prepancreatic arcade in front of the pancreas (77.0%); (3) an uncinate branch that distributes to the uncinate process (60.9%); (4) a head branch that distributes from the dorsal side of the pancreas to the head of the pancreas (newly defined in the present study, 60.9%); (5) a right branch-4 that distributes superior to the dorsal part of the pancreatic neck (39.1%); and (6) a right branch-5 that communicates with the posterior pancreaticoduodenal arcade (21.8%). In some cases, the above six branches are formed separately, i.e., two (18.4%) or three (5.7%) dorsal pancreatic arteries are present. The parent artery of the DP was the superior mesenteric artery (SM; 55.0%), accounting for 45.0% of the entire celiac trunk. An accessory right hepatic artery was identified in 18 specimens (18.4%). In cases where the AcRH originated from the entire celiac trunk (5 specimens, 27.8%), it always formed a common trunk with the DP. On the other hand, when the AcRH derived from the SM (13 specimens, 72.2%), it formed a common trunk with the DP 6 of the specimens (33.3%), independent branching was observed in 6 specimens (33.3%). And a common trunk with the inferior pancreaticoduodenal artery was observed in one specimen (5.6%). The dorsal pancreatic artery was considered to supply not only the AcRH but also other pathways that form more complicated variations such as an accessory middle colic artery.     

Effects of heredity, age, weight, puberty, activity, and calcium intake on bone mineral density in children

Anastomotic dehiscence after colon resection is the most frequent complication in colon surgery and the main cause of post-operative death. In the light of anatomical peculiarities of the blood supply to the rectum, it would appear that in atherosclerotic patients with impairment of hypogastric arteries (80% in authors' series out of 200 atherosclerotic subjects) inferior mesenteric artery ligature, determining vascularization of the rectal ampulla by the distal vessels alone, results in an insufficient supply in case of colo-rectal anastomosis. A series of 15 cases of cancer of the left and sigmoid colon, treated with left hemicolectomy, preservation and peeling of the inferior mesenteric artery, is reported. In the follow-up ranging from 6 months to 5 years, no anastomotic dehiscence was observed and only one case (7.5%) presented hepatic recurrence after two years. The other patients are all alive and disease free.     

Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia

The purpose of this study was to evaluate accuracy of dynamic gadolinium-enhanced MR angiography (MRA) of the celiac, superior, and inferior mesenteric arteries in patients with suspected mesenteric ischemia compared with catheter angiography or surgery. Sixty-five patients with suspected mesenteric ischemia underwent three-dimensional spoiled gradient-recalled acquisition in the steady state (GRASS) gadolinium-enhanced MRA. Correlative studies were performed on 14 patients, catheter angiography alone was performed on 12 patients, and surgery alone was performed on two patients. Six patients had mesenteric ischemia. In all patients, the celiac artery (CA) and superior mesenteric artery (SMA) were seen well enough to evaluate; however, the inferior mesenteric artery (IMA) could be evaluated in only 9 of the 14 patients. MRA showed severe stenosis (> 75%) or occlusion of the celiac axis in seven patients, of the SMA in six patients, and of the IMA in four patients. The overall sensitivity and specificity were 100% and 95%, respectively, compared with catheter angiography and surgery. The two errors were caused by overgrading the severity of IMA disease. Three-dimensional gadolinium-enhanced MRA can accurately demonstrate the origins of the CA and SMA and is useful in evaluation of patients with suspected mesenteric ischemia.     

Characterization of alpha1-adrenoceptor subtypes mediating contractions to phenylephrine in rat thoracic aorta, mesenteric artery and pulmonary artery

1. The subtype of alpha1-adrenoceptor mediating contractions to phenylephrine of the rat thoracic aorta, mesenteric artery and pulmonary artery were investigated by use of antagonists which show selectivity between the cloned alpha1-adrenoceptor subtypes in binding studies. 2. Cumulative concentration-contraction curves for phenylephrine were competitively antagonized in the rat thoracic aorta by prazosin (pA2 9.9), WB4101 (pA2 9.6), 5-methylurapidil (pA2 8.1), benoxathian (pA2 9.2) and indoramin (pA2 7.4). These compounds were also competitive antagonists in the mesenteric and pulmonary arteries (except for 5-methylurapidil in the pulmonary artery), (prazosin pA2 9.9 and 9.7; WB4101 pA2 9.8 and 9.6; 5-methylurapidil pA2 7.9 and pK(B) estimate 8.0; benoxathian pA2 8.8 and 9.3; indoramin pA2 7.2 and 7.5, respectively). 3. RS 17053 was not a competitive antagonist in any blood vessel as Schild plot slopes were greater than unity. The pK(B) estimates for RS 17053 were 7.1 in aorta, 7.0 in the mesenteric artery and 7.7 in the pulmonary artery. 4. The alpha1D-subtype selective antagonist BMY 7378 appeared to be non-competitive with shallow Schild plot slopes. The data were better fitted with two lines in all tissues, with Schild plot slopes that were no longer different from unity, except in the pulmonary artery. The higher affinity site for BMY 7378 in the aorta had a pA2 of 9.0, while it was 8.8 and 8.9 in the mesenteric and pulmonary arteries, respectively. 5. MDL73005EF acted in a non-competitive manner in all three blood vessels, with shallow Schild plot slopes. The pK(B) estimates for MDL73005EF were 8.4 in aorta, 7.5 in the mesenteric artery and 8.0 in the pulmonary artery. 6. In all three blood vessels the functionally determined antagonist affinity estimates correlated best with published pKi values for their displacement of [3H]-prazosin binding on membranes expressing cloned alpha1d-adrenoceptors compared with alpha1a- or alpha1b-adrenoceptors. The antagonist affinity estimates in the aorta, mesenteric and pulmonary arteries correlated highly with their previously published pA2 values in rat aorta (alpha1D) and less well with those for alpha1A- and alpha1B-adrenoceptors mediating contraction of the rat epididymal vas deferens and rat spleen, respectively. 7. The results of this study suggest that the contraction to phenylephrine of the rat thoracic aorta, mesenteric artery and pulmonary artery are mediated in part via the alpha1D-subtype of adrenoceptor. The data for both BMY 7378 and MDL73005EF in all three blood vessels are consistent with receptor heterogeneity. However, the identity of the second site is unclear.     

Hepatic embolization through extrahepatic collateral pathways after hepatic arterial embolization for the hepatocellular carcinoma

Extrahepatic collateral pathways developing after repeated transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) make therapeutic arterial embolization for recurrent lesions extremely difficult. TAE was performed through the collateral pathways using a sophisticated micro-catheter with good trackability and pushability and a coaxial system. Twenty-three TAEs were undertaken through the collateral pathways in 13 patients with recurrent HCC who had extrahepatic collateral pathways after the previous hepatic arterial TAE. There were 69 extrahepatic collateral pathways, with partially obstructed hepatic arteries. On the average, three feeding arteries were seen in the liver. The main extrahepatic collateral pathways were the inferior phrenic artery and epicholedocal artery, 18 vessels and 29 vessels, respectively, accounting for about 80% of the total collateral pathways. TAEs were successful in all cases and the number of embolized vessels was 2.1 on average. The average time of the first collateral TAE after the initial conventional hepatic arterial TAE was 2.3 years. Excellent prognosis was observed with a one-year survival rate of 77% and 3-year survival rate of 38% after the collateral TAE. We consider that collateral TAE for recurrent HCC with obstruction of the hepatic artery is the procedure of choice, is technically feasible, and provides better prognosis for the patients.     

Coronary arterial hyperreactivity and mesenteric arterial hyporeactivity after myocardial infarction in the rat

After myocardial infarction, several neurohumoral systems become activated to maintain systemic perfusion pressure. We evaluated whether this leads to alterations of wall structure and contractile reactivity in the thoracic aorta, coronary septal artery, and mesenteric resistance arteries. In male Wistar rats, myocardial infarction (MI) was induced by permanent ligation of the left coronary artery. At 5 weeks after MI or sham operation, vessel segments were isolated, chemically sympathectomized, and mounted in a myograph for recording of isometric force development. Contractile reactivity to high potassium, norepinephrine, phenylephrine, serotonin, and Arg-vasopressin was determined. At the end of the experiments, vessels were fixed for morphometric analysis (cross-sectional area, media thickness, radius, and wall-to-lumen ratio). At 5 weeks after myocardial infarction, no alterations of contractile reactivity or wall structure were observed in the thoracic aorta of MI rats. In mesenteric resistance arteries, a nonselective reduction of maximal active wall tension and of active wall stress in response to vasoconstrictors was observed, whereas vessel wall structure and sensitivity to stimuli were not modified. On the other hand, coronary septal arteries displayed hyperreactivity to all strong contractile stimuli. These observations demonstrate a heterogeneity of arterial reactivity changes at 5 weeks after MI in the rat: (a) no alterations in thoracic aorta, (b) hyporeactivity of mesenteric resistance arteries despite maintenance of media mass, and (c) hyperreactivity of coronary vessels obtained from the hypertrophic remnant myocardium. This could result from the complex regional hemodynamic and neurohumoral changes associated with heart failure and may contribute to the further deterioration of cardiovascular function in this setting.     

The arterial blood supply of the pancreas: a review. IV. The anterior inferior and posterior pancreaticoduodenal aa., and minor sources of blood supply for the head of the pancreas. An anatomical review and radiologic study

The present article is the fourth part of a comprehensive review of the arterial blood supply of the pancreas and completes the study of the arterial vascularization of the pancreatic head dealing with the anterior inferior and posterior inferior pancreaticoduodenal aa. and with some minor sources of blood supply not involving the classical system of the pancreaticoduodenal arches. The aim of this review is to summarise the anatomical studies, starting from Haller's reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomical concepts. For this purpose, 1015 selective angiographs (celiac trunk and its branches, superior mesenteric a.) were taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. These demonstrated the anterior inferior pancreaticoduodenal a., present in most instances, as arising from the inferior pancreaticoduodenal a., from a common trunk with the posterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the 1st jejunal a. or from the superior mesenteric a.; on the other hand, the posterior inferior pancreaticoduodenal a. was more variable, originating from the inferior pancreaticoduodenal a., from a common trunk with the anterior inferior pancreaticoduodenal a. and the 1st jejunal a., from the superior mesenteric a., from the dorsal pancreatic a., or from a right accessory hepatic a. coming from the superior mesenteric a. In addition, minor branches to the head of the pancreas arose from the gastroduodenal a., the dorsal pancreatic a., the common hepatic a. and the inferior right phrenic a. Other origins of the inferior pancreaticoduodenal aa. previously reported, but not angiographically detectable with certainty, as well as further minor sources of blood supply to the head of the pancreas, have been listed. The differing opinions regarding the incidence of the various ways the inferior pancreaticoduodenal aa. arise are discussed and an attempt is made to explain the variability of the vascular anatomy of the pancreatic head on embryologic grounds.     

Effects of lorazepam on the distribution of spatial attention

A left persistent primitive sciatic artery was observed in a Japanese male cadaver. The sciatic artery arose from the internal iliac artery and perforated the ventral division of the sacral plexus. The sciatic artery did not anastomose with the perforating arteries nor the popliteal artery. The left femoral artery was incompletely developed, attenuating and terminating as the saphenous artery. Instead of the femoral artery, direct continuation of the profunda femoris artery, which probably corresponded to the fourth perforating artery, became the popliteal artery. Other vessel anomalies were observed in various regions. They included; (1) the retroesophageal right subclavian artery; (2) the left vertebral artery entering the transverse foramen of the 4th cervical vertebra; (3) bilateral occurrence of the superficial brachial artery; (4) the left gastric artery independently arising from the abdominal aorta; (5) a hepatolienomesenteric trunk; (6) three accessory renal arteries; (7) double testicular arteries; (8) the arteria intermesenterica; (9) a venous ring termed the 'renal collar', and (10) paired thoracic ducts. The present cadaver was considered to be a very rare case in which many primitive vascular systems had extensively persisted in various parts of the body.     

pH sensitive properties of Tc(V)-DMS: analytical and in vitro cellular studies

Coronary arteries anomalies may be part of complex congenital malformations of the heart or be an isolated defect. In our anatomic collection of congenital heart disease, an isolated anomalous origin of coronary arteries was observed in 27 of 1,200 specimens (2.2%): left coronary artery from pulmonary trunk in five, origin from the wrong aortic sinus in 12 (both right and left coronary artery from the right sinus in four and from the left sinus in seven, left coronary artery from the posterior sinus in one), left circumflex branch from right aortic sinus or from very proximal right coronary artery in three, high takeoff of right coronary artery in three, stenosis of the coronary ostia attributable to valvelike ridge in four. In 16 (59%) patients (12 males and 4 females, age ranging from 2 months to 53 years; median, 14), the final outcome was sudden death; it occurred in all cases of left coronary artery origin from right aortic sinus, in 43% of right coronary artery origin from left aortic sinus, and in 40% of the left coronary artery from the pulmonary trunk. Sudden death was precipitated by effort in eight (50%) and was the first manifestation of the disease in eight (50%); previous symptoms consisted of recurrent syncope in four, palpitations in three, and chest pain in one. Five patients who died suddenly during effort were athletes. In conclusion, (1) more than half of our postmortem cases with anomalous origin of coronary arteries died suddenly, (2) all but two patients with sudden death had anomalous coronary artery origin from the aorta itself, (3) the fatal event was frequently precipitated by effort, (4) palpitations, syncope, and ventricular arrhythmias were the only prodromic symptoms and signs. Recognition during life of these coronary anomalies, by the use of noninvasive procedures, is mandatory to prevent the risk of sudden death and to plan surgical correction if clinically indicated.     

A comparative study of velocity measurements in major blood vessels using magnetic resonance imaging and Doppler ultrasound

Velocity measurements in major blood vessels were obtained in studies of volunteers using magnetic resonance imaging (MRI) and compared with Doppler ultrasound (US). The vessels studied were the abdominal aorta, superior mesenteric artery, common carotid artery, superficial femoral artery and middle cerebral artery. Using a paired t-test, no significant difference was found between velocity values estimated by MRI and US (p > 0.08). The relative advantages of each technique in radiological practice are discussed.     

Mesenteric vascular problems. A 26-year experience

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.     

Contrast-enhanced endoscopic ultrasonography with galactose microparticles: SHU508 A (Levovist)

BACKGROUND AND STUDY AIMS: To evaluate the utility of a suspension of galactose microparticles available as SHU508 A (Levovist) as a contrast agent during endoscopic ultrasonography (EUS). MATERIALS AND METHODS: Three sets of experiments were performed on three 20-25 kg swine (Sus scrofa) under general anesthesia. Upper EUS was performed with an echo endoscope with color Doppler capability (Pentax FG-32 UA). The celiac artery, superior mesenteric artery, aorta, portal vein, pancreas, and gastrointestinal wall were imaged by EUS. Multiple intravenous bolus injections of 400 mg/ml of SHU508 A were made, and their effect on color Doppler and gray-scale imaging during EUS was studied. RESULTS: After contrast injection there was a significant, visually noticeable enhancement of the color Doppler signals from the celiac artery, superior mesenteric artery, and portal vein. Vessels with weak to no color Doppler signals before injection of SHU508 A--for example, the celiac artery and superior mesenteric artery--were observed to have strong color signals after injection. The effect of SHU508 A on color Doppler imaging was easily appreciated subjectively without the need for complex quantitative measurements. No visually noticeable color Doppler enhancement was seen in vessels such as the aorta that had a very pronounced color Doppler signal even prior to the injection of contrast. Movement of particulate matter was seen in the portal vein on the gray scale. CONCLUSION: Intravenous SHU508 A as a contrast agent significantly enhances color Doppler signals during EUS. Vascualar contrast of this sort could potentially have a significant role in improving the accuracy of EUS in diagnosing malignant vascular invasion, the detection of occult pancreatic neoplasms, and the diagnosis of vascular thrombosis.     

Surgical standards in primary colon cancer

The surgical standards in the treatment of primary cancer of the colon include the radical resection of the tumor-bearing colon with truncal ligation of its vessels. Eradication of the tumor with complete dissection of the lymphatic drainage area increases the chance for cure (R0). The lymphatic dissection determines the extent of colonic resection: right hemicolectomy (ileo-transversostomy) with truncal ligation of the iliocolic and right colonic arteries for carcinomas of the cecum and ascending colon; transverse colectomy (ascendo-descendostomy) with ligation of the middle colic artery for carcinomas in the middle of the transverse colon; left hemicolectomy (transverso-rectostomy) with ligation of the inferior mesenteric artery at the aorta for cancer of the descending and sigmoid colon; extended sigmoid resection (descendo-rectostomy) with central lymphadenectomy and ligation of the inferior mesenteric artery distal to the left colic artery for cancer of the distal sigmoid colon. Carcinomas located in between two drainage areas (lateral transverse colon, hepatic or splenic flexure) are treated by extended hemicolectomies or subtotal colectomies with dissection of two lymphatic drainage areas. The monobloc no-touch isolation technique requires the ligation of vessels prior to the mobilisation of the colon. Exceptions from these standard operations (limited resections) are necessary for metastatic disease or in the acute emergency situation of perforation or obstruction. Application of these surgical principles will ensure the best possible treatment results in primary colonic cancer.     

Distribution of the perivascular nerve Ca2+ receptor in rat arteries

We recently showed that perivascular sensory nerves of mesenteric branch arteries express a receptor for extracellular Ca2+ (CaR), and reported data indicating that this CaR mediates relaxation induced by physiologic levels of Ca2+. We have now tested whether the perivascular sensory nerve CaR-linked dilator system is a local phenomenon restricted to the mesentery, or is present in other circulations. Vessels from the mesenteric, renal, coronary, and cerebral circulations were studied. Immunocytochemical analysis was performed using anti-CaR and anti-neural cell adhesion molecule (NCAM) antibodies. Wire myography was used to assess contraction and relaxation. Although perivascular nerves of all arteries stained for CaR protein, there were regional differences. A morphometric method used to estimate CaR positive nerve density revealed the following rank order: mesenteric branch artery > basilar artery = renal interlobar artery > main renal trunk artery > left anterior descending coronary artery. Vessels from the mesentery, renal, coronary, and cerebral circulations showed nerve-dependent relaxation in response to electrical field stimulation (EFS) when precontracted with serotonin in the presence of guanethidine. The degree of Ca2+-induced relaxation of mesenteric, renal, and cerebral arteries positively correlated with the magnitude of EFS-induced relaxation. In contrast, coronary arteries contracted at Ca2+ levels between 1.5 and 3 mmol L(-1), and relaxed to a small degree to 5 mmol L(-1) Ca2+. Thus, a functional perivascular sensory nerve CaR-linked dilator system is present to varying degrees in the mesenteric, renal, and cerebral circulations, but only to a very limited extent in the coronary circulation.     

Successful revascularization of mesenteric infarction following aortography

Two cases of bowel infarction following abdominal aortography are presented. In both patients, two of the three major arteries supplying the bowel were occluded before the study. The superior mesenteric artery in one and the inferior mesenteric artery in the other were the only arteries supplying the bowel and their lumens were reduced. After the aortogram, the residual lumen clotted, leading to bowel necrosis. Survival was made possible in these two cases by revascularizing the superior mesenteric artery and resecting the necrotic bowel.     

A simplified technique for selective and superselective abdominal angiography

A simplified technique for selective abdominal angiography utilizing the Simmons Femoral-Cerebral catheter is described. The technique affords a rapid simple approach to selective and superselective catheterization of the celiac, superior mesenteric and inferior mesenteric arteries.