Ishikawa's Classification Research Articles

Limiting Levels of Fingertip Replantation Without Venous Anastomosis

This study aimed to compare the success rates of fingertip replantation with and without venous anastomosis. This retrospective study included 132 patients with 148 fingertip injuries who had undergone fingertip replantation (Ishikawa's classification I‒IV) between 2003 and 2020 at our hospital. Among them, 117 and 15 were men and women respectively, and their mean age was 43 years. There were 53, 44, and 51 fingertips with Ishikawa subzone II, III, and IV amputations respectively, and no cases were classified as Ishikawa subzone I. Venous anastomosis was performed on 64 fingertips (group A). This was not possible in the remaining 84 fingertips; thus, an external bleeding method was used (group B). Our external bleeding protocol consisted of 4-hourly skin pricks of the distal pulp with a 23-gauge needle for the first 5 days. The analyses included survival rates, hemoglobin levels (Hb), and blood transfusions administered. The overall survival rate was 90.5% (134 of 148). In group A, survival was achieved in 92.3%, 100%, and 94.3% of those with subzones II, III, and IV amputations, respectively. In group B, survival was achieved in 100%, 82.1%, and 62.5% of those with subzones II, III, and IV, respectively. Subzone IV in group B showed a significantly lower rate of replantation success. In groups A and B, the preoperative and 7-day postoperative Hb levels were 14.5 g/dL and 14.6 g/dL, and 11.3 g/dL, and 11.6 g/dL, respectively. In addition, blood transfusion was required for five patients (7.9%) in group A and six patients (7.9%) in group B. Thus, the Hb levels and blood transfusion administered were similar between the two groups. Subzone IV is an important threshold for artery-only replantation. Furthermore, our external bleeding protocol is a safe and effective method. Therapeutic IV.

Clinical manifestations, course variants and complications of Takayasu arteritis in Kyrgyz patients

Objective: to study clinical presentation, course variants and complications of Takayasu arteritis (AT) in Kyrgyz patients.Patients and methods. 75 Kyrgyz patients with a definite diagnosis of AT were included in the study, most of them were women (93.3%). The median age was 33 [23; 40] years, the median duration of the disease was 7 [3.0; 13.0] years. The anatomical type of vascular lesions was determined using the angiographic classification of R. Moriwaki et al., the AT activity – according to the BVAS index, the clinical stage of AT – using the R. Jefferson classification, the severity and prognosis of the disease – according to the K. Ishikawa classification. Highly sensitivity CRP (hsCRP) was assessed in 44 (58.67%) patients, interleukin 6 (IL6) – in 26 (34.7%). Instrumental procedures included duplex Doppler ultrasonography of peripheral arteries and contrast-enhanced computed pan aortography.Results and discussion. The mean age of AT onset was 24.4±9.4 years. The majority of patients had V anatomical type of vascular lesions (61.3%), vascular stage (89.3%), severe stenosis (54.7%) with predominant affection of the brachiocephalic trunk (68%), common carotid arteries (53.7 %) and renal (52%) arteries. Most patients (82.7%) at the time of inclusion in the study had a severe exacerbation of AT according to the BVAS index. An increase in hsCRP level was seen in 66% of cases, IL6 – in 31%. At the onset of AT, 20% of patients had fever, general weakness, weight loss, myalgia and/or arthralgia. 43% of patients had ≥2 complications. The clinical manifestations of AT were mainly characterized by cardiovascular pathology (77.3%) with the formation of relative aortic valve insufficiency (AVI) (93.1%) and kidney damage (57.3%) with the development of renovascular arterial hypertension (91%). At the first visit, more than one third of patients (37.3%) had irreversible damage, accompanied in half of them by AVI degree II or III.Conclusion. Young women predominated among Kyrgyz patients with AT. Most of the patients had anatomical type V AT (61.3%), vascular stage (89.3%), severe stenosis (54.7%), affection of the brachiocephalic trunk (68%), common carotid (57.3%) and renal (52%) arteries. Severe exacerbation of the disease was observed in 82.7% of patients. The presence of ≥2 complications worsened the prognosis of AT. The clinical manifestations of AT were characterized mainly by cardiovascular pathology (77.3%) and kidney damage (57.3%). In more than one third of patients (37.3%) AT was diagnosed late.

Evaluation of Neurotized Hypothenar Free Perforator Flaps Used for Fingertip Reconstruction

In reconstruction of digital amputations of the upper extremity, composite tissue alternatives with similar features are limited for finger tip reconstruction. Among these alternatives, free perforator flaps elevated from the hypothenar region (HFPFs) are defined, but reluctancy goes on for utilization of these flaps.In this study, we aimed to highlight the sensory results of HFPFs when a neural repair is incorporated to the flap and also to justify their usage by presenting functional and aesthetic outcomes of the reconstructions performed with HFPFs. This clinical study was conducted from June 2015 to June 2017. Twelve patients with acute finger tip amputations were examined. Distal amputation levels were subgrouped according to Ishikawa classification. Patient demographics and amputation etiology were listed. All fingertip defects were reconstructed with a neurotized HFPF. All perforator anastomoses were performed in an end-to-end fashion. During follow-up, 2-point discrimination and dynamometric test were conducted. In addition, the Michigan Hand Outcomes Questionnaire was carried out. Evaluation of the results from a cosmetic standpoint was also conducted, with 4 blinded, independent surgeons using the visual analog scale. Of 12 digital amputations reconstructed with neurotized HFPFs, 10 were totally viable during follow-up, whereas partial loss was observed in 2 flaps. The mean age was 38.8 ± 11.8 years. Most of the amputations were classified as Ishikawa subgroup 2 (50%). The mean dynamic 2-point discrimination was 3.2 ± 0.11 mm and slightly greater compared with contralateral digit (P = 0.003). Also minor decreases were measured in forced grip and pulp-to-pulp grip strengths (P = 0.003). Overall satisfaction was 92.7% in Michigan Hand Outcomes Questionnaire. Average visual analog scale score was 7.25 out of 10. Hypothenar free perforator flaps, with incorporation of neural repair, give promising results for reconstruction of the fingertip. In addition to superior sensorial outcomes, HFPFs yield satisfying results from aesthetic and functional perspectives.

The Utility of Preoperative Vascular Grading in Patients Undergoing Surgery First for Pancreatic Cancer: Does Radiologic Arterial or Venous Involvement Predict Pathologic Margin Status?

Controversy exists on accurately grading vascular involvement on preoperative imaging for pancreatic ductal adenocarcinoma. We reviewed the association between preoperative imaging and margin status in 137 patients. Radiologists graded venous involvement based on the Ishikawa classification system and arterial involvement based on preoperative imaging. For patients with both classifications recorded, we categorized vascular involvement as “None,” “Arterial only,” “Venous only,” or “Both” and examined the association of vascular involvement and pathologic margin status. Of 134 patients with Ishikawa classifications, 63%, 17%, 11%, and 9% were graded as I, II, III, and IV, respectively. Of 96 patients with arterial staging, 74%, 16%, and 10% were categorized as stages i, ii, and iii, respectively. Of 93 patients with both stagings, 61% had no vascular involvement, 7% had arterial only, 14% had venous only, and 17% had both involved. Ishikawa classification was strongly associated with a positive SMA and SMV margin (p<0.001). However, for arterial staging, there was no association with SMA or SMV margin. Overall, Ishikawa grading was more predicative of arterial involvement and remained significant on multivariate analysis. The use of diagnostic imaging in predicting positive margins is more accurate when using a venous grading system.

Which Classification of Cavernous Sinus Syndrome is Better - Ishikawa or Jefferson? A Prospective Study of 73 Patients.

Introduction:Ishikawa and Jefferson are the two most commonly used systems used for the classification of cavernous sinus syndrome (CSS). However, relative utilities of these two classification systems have not been evaluated in detail in developing countries. In this study, we compared relative utilities of these two classification schemes in the evaluation of CSS.Objective:To compare the utility of Jefferson and Ishikawa classifications in the evaluation of CSS.Patients and Methods:A total of 73 consecutive patients of CSS were prospectively classified using either Ishikawa or Jefferson classification and relative utility of these two classification schemes in determining etiology of CSS was compared.Results:While only 46.6% of patients could be classified using Jefferson classification, 95.5% of patients could be classified using Ishikawa scheme. CSS was classified as anterior, middle, and posterior in 17.8%, 21.9%, and 8.2% of patients, respectively, as per the Jefferson classification. As per the Ishikawa classification, 37% of patients each showed anterior and posterior CSS, 16.4% showed middle CSS, whereas 4.1% had whole CSS. Middle CSS was significantly associated with the presence of fungal infections (P = 0.045) as per Jefferson classifications, and anterior CSS was significantly associated with a vascular etiology (P = 0.005) as per Ishikawa classification. Overall, inflammatory causes were the most common cause for anterior CSS, while tumors accounted for maximum cases of posterior CSS.Conclusion:Although more number of patients could be classified using Ishikawa classification, there was no advantage of Ishikawa classification over Jefferson with regard to determination of etiology of CSS.

Fingertip replantation – obvious or debatable choice. Our experience

Introduction Fingertip injuries are one of the most frequent traumatic injury of the hand. Today fingertip replantation is an established surgical procedure but it is still a controversial surgical indication. Patients and methods From July 2007 to October 2014 17 patients (12 males, 5 females mean age 40.8) with fingertip amputation underwent to replantation surgery in our department. We classified fingertip amputation levels according to Ishikawa's classification. Results Eleven of the 17 fingertip replantations were successful. Four cases after venous stasis and two cases after arterial failure have been regularized. Patients were discharged 8 days after surgery (mean time). Active range of motion (ROM) at proximal interphalangeal joint (PIP) joint was 70°–90° (mean 82°) and for thumb reconstructions, Kapandji test was from 7 to 9 score. The Weber test was from 8 to 13 mm. Discussion Fingertip replantation represents a complex technical procedure for expert surgeons. Distal replantation is the most elegant and aesthetically satisfactory technique of tip reconstruction, superior to other alternative methods. However, surgical indications must to be personalized for each patient.

The clinical features and replantation strategies of Crushed amputations at the distal fingers in children

Objective To investigate the clinical features of crushed amputations at the distal fingers in children, summarize strategies for handling the vessels in replantation and assess its clinical outcomes. Methods From January 2005 to August 2009, 38 severed fingers in 28 patients of 11 months to 11.5 years old were replanted. The vessels were anastomosed under 12X to 15X magnification based on the vascular characteristics according to Ishikawa's classification. Results Tirty-five out of the 38 replanted fingers survived, while only 3 necrosed. The survival rate was 92.1%. Postoperative follow-up ranged from 3 months to 3 years. Satisfactory results in terms of the contours of finger nail and pulp, and finger length were achieved in all the survived cases except for mild lateral deviation deformity in three cases due to the crushing injury of epiphysis in zone Ⅳ. According to the functional evaluation criteria formulated by Chinese Hand Surgery Society, results were excellent in 18 cases, good in 14 cases, and poor in 3 cases. The overall excellent-good rate was 91.4%. Conclusion Blunt injury is the common cause of distal finger amputation in children, mostly manifested as crushed amputations. Satisfactory results can be obtained provided that the surgeon is familiar with the vascular anatomy of the distal finger, and that meticulous debridement and precise vascular anastomosis are done. Therefore, the crushed amputations at the distal fingers in children are also the candidates for replantation and should be replanted aggressively. Key words: Microsurgery; Replantation; Child

BIHARMONIC LAGRANGIAN SURFACES OF CONSTANT MEAN CURVATURE IN COMPLEX SPACE FORMS

AbstractBiharmonic Lagrangian surfaces of constant mean curvature in complex space forms are classified. A further important point is that new examples of marginally trapped biharmonic Lagrangian surfaces in an indefinite complex Euclidean plane are obtained. This fact suggests that Chen and Ishikawa's classification of marginally trapped biharmonic surfaces [6] is not complete.

The Ishikawa Classification of Cavernous Sinus Lesions by Clinico-anatomical Findings

Purpose: The Jefferson classification has been used to localize cavernous sinus lesions. However, this classification occasionally showed dissociation between identified localization and clinical findings. We investigated the clinical applicability of the newly proposed Ishikawa classification based on serial topographic sections of human cavernous sinus and the clinical findings. Methods: In the Ishikawa classification, the cavernous sinus is divided into three portions, that is, anterior, middle, and posterior, demarcated by the location of the intracranial orifice of the optic canal and the entry of the maxillary nerve into the cavernous sinus. A total of 162 patients with cavernous sinus lesions were classified using both the Jefferson and the Ishikawa classifications and the clinical applicability of these two classifications was studied. Characteristics of the localization of lesions were also examined in each etiological type. Results: By the Jefferson classification, 11% of the 162 patients had the anterior type of lesion, 12% the middle, 8% the posterior type, and 69% the unclassifiable type. However, by the Ishikawa classification, 35% had the anterior type, 10% the middle type, 22% the posterior type, 5% the whole type, and 28% the unclassifiable type of lesion. Furthermore, the Ishikawa classification revealed that the etiology of the anterior type was mainly inflammation, and that the etiology of the posterior and whole types was tumors. Conclusion: The Ishikawa classification is clinically useful to identify and classify the localization of cavernous sinus lesions.

エナメル上皮腫の臨床病理学的検討

Twenty-one ameloblastoma cases examined clinically, radiologically, and histopathologically were reported.1) The mean age was 33.1 years old and the highest incidence was recognized in the first and fifth decades. There were 11 males and 10 females.2) Twenty-one cases were found in the mandible, with the molar-ramus region being the most frequent site of involvement and none in the maxilla.3) In radiographycal observations, eleven cases were unilocular type, seven cases were multilocular type and three cases were honeycomb or soap-bubble type.4) In pathological observations using Ishikawa's classification, 1 case was Type I, 2 cases were Type II and eight-teen cases were Type III.5) Eigh-teen of the twenty-one cases were treated. Eight cases were operatedon by segmental resection, 5 cases were operated on by partial resection and 5 cases were operated on by the conservative surgical method.