Transection Of Vessels Research Articles

Nd:YAG laser bipolar dissector—preliminary results

We have developed a laser bipolar dissector (LBD) which uses the 1,064 nm Nd:YAG wavelength. The laser emits from the inner surface of the distal 7 mm of each probe made of synthetic sapphire. With low laser power (15-25 W), the bipolar provides hemostatic cutting of larger blood vessels. Animal experiments were carried out using New Zealand white rabbits. The LBD hemostatically cut through veins up to 5 mm and arteries up to 2 mm in diameter. Rebleeding did not occur. Transection of parenchymal organs such as liver and lung was easily performed with complete hemostasis. In chronic experiments a partial hepatectomy with splenectomy and left nephrectomy was performed using the LBD alone without any ligation. Up to 3 weeks postoperatively there were no direct complications related to using the LBD. In conclusion the LBD could perform a hemostatic transection of large vessels and might have clinical application in the dissection of vascular parenchymal organs.

Re-Orchiopexy: Advantages and Disadvantages

Re-orchiopexy was performed in 33 boys (42 testes) in order to place an undescended testis in the scrotum after failure of the initial operation. Success was achieved in 80.9%. Seven of the 10 testes, reported to have short spermatic vessels at the first surgery, had no elongation of the vessels and only 1 of these resulted in a high scrotal location of the testis. It appears that most orchiopexy failures are the result of technical failures of the initial procedure. Standard orchiopexy with extensive mobilization of the spermatic vessels and testis can successfully correct most of the undescended testes. However, the preferred management for the intra-abdominal testis with short vessels may be transection of the spermatic vessels rather than a planned two-stage technique.

Orchiopexy of the High Undescended Testis by Division of the Spermatic Vessels: A Critical Review of 38 Selected Transections

The technique used to perform 38 orchiopexies of high undescended testes by spermatic vessel transection in 26 patients is reviewed. Careful attention to detail and selection using the Fowler-Stephens test allowed for an 89 per cent success rate, confirming the efficacy of this procedure in cases selected in this manner.

Transection of varicose vessels in the nasal mucosa of patients with recurrent epistaxis. A 2-year follow-up.

Twenty-two patients with recurrent nose bleeds and varicose vessels on the nasal septum were subjected to transection of the vessels and followed-up for 2 years. One month after the operation, it was not possible to identify the original vessels. In other locations new varicose vessels began to appear after 1 month, and at the end of the follow-up period were observed on 9 out of 10 operated sides. The transection resulted in an immediate decrease in the frequency of nose bleeds and at the end of the control period 12 (55%) of the patients had had less than 4 bleeds during the previous year in spite of the observed rapid formation of new vessels. Mucosal atrophy with symptoms of increased nasal crusting occurred in 3 patients. Transection of varicose vessels in patients with nose bleeds leads to a decrease in the number of bleeds.

Age-related effects of transection of the testicular blood vessels on subsequent testicular development in the pig.

Pigs of different ages were studied to assess the effect of age on the development of the testes after intra-abdominal transection of the testicular artery and vein. Transection of the testicular artery and vein at different stages of sexual development had a variable effect on the growth and differentiation of the testes. Transection performed at a young age (2 months) had no effect on the development of the testes (previous study). The animals used in this study were between 3 and 12 months (adult) at the time of surgical intervention. Their testes appeared to be more sensitive to disturbance of the main blood supply. The alternative vascular pedicle (vasal artery) was unable to adapt sufficiently to the increased physiological requirements of the testis during development in more than 50% of the animals. The results obtained from adult males indicate that intra-abdominal transection of the testicular vessels invariably has a deleterious effect on the testis.

Transection of the spermatic vessels (Bevan's technique): an experimental study.

Intracanalicular or intra-abdominal undescended testicles often present a difficult surgical problem, due to a vascular pedicle shortening that prohibits scrotal placement with a 1 stage orchiopexy. The division of spermatic vessels to properly place the testis in the scrotum solves the problem of the shortening of the vessels, but raises the question of whether the endocrine function and the potential for fertility are preserved. In the present study transection of spermatic vessels before arterial branch-off was done intra-abdominally in rats. Angiographic, patho-anatomic and hormonal evaluations have been made. Revascularization of the testicular artery through the vasal artery has occurred in all cases. The anastomotic circuit, however, does not always have the same functional value. The spermatogenic alterations suggest that fertility can be impaired in a significant percentage of cases. Spermatogenesis was quantified taking into account the mean tubular diameter and the situation of seminiferous epithelium, expressed as the percentage of tubules containing well-developed spermatogenesis. Plasma testosterone levels are in a low range. However, Leydig cell functional response to human chorionic gonadotropin stimulation is maintained in every case and so are plasma and pituitary luteinizing hormone levels, suggesting that plasma testosterone levels are high enough to maintain an adequate hormonal activity.

A unifying theory of the delay phenomenon--recovery from the hyperadrenergic state.

Flap necrosis occurs from a combination of reduced blood supply--a result of transection of the feeding vessels--and vasoconstriction. The vasoconstriction is secondary to the hyperadrenergic state that follows transection of the sympathetic nerves accompanying the vascular supply to the flap. A flap that has undergone surgical delay has had its stored neurotransmitter, norepinephrine, released and cleared from the tissues. At the time of the flap transfer, therefore, the hyperadrenergic condition does not reappear and the vascular flow is greater than in an undelayed flap.

A simple method of pancreatic transplantation in the dog

Canine pancreatic organ transplantation can be performed without resection of adjacent structures or transection of major blood vessels. The graft consists of the entire gland except the distal tail and is based on the superior pancreaticoduodenal vessels. Devascularization of the duodenal loop does not result in ischemic necrosis. The duct-ligated graft is placed in the groin.

Effect of selective surgical interruption of the anterior pituitary's blood supply on ACTH release.

The acute effect of selective surgical interruption of the anterior pituitary’s blood supply on the release of ACTH has been investigated in surgically stressed rats. The corticosterone secretory rate was used to evaluate the release of ACTH. In intact, sham-operated animals, corticosterone secretion was near maximal throughout a 50-min observation period. Removal of the pituitary greatly suppressed the secretion of corticosterone. Posterior lobectomy or transection of the portal vessels in the upper stalk had no apparent effect on ACTH release. This finding was interpreted to mean that the posterior pituitary and post-chiasmatic eminence are not obligatory sources of CRF. Transection of the pituitary stalk greatly suppressed ACTH release. This finding supports the view that the caudal hypophysial arteries do not provide the anterior pituitary with a significant amount of blood via the short portal vessels. Transection of the peduncular arteries or the stalk portal vessels in the lower stalk suppressed AC...

Experimental Hemostasis in Normal Dogs and Dogs with Congenital Disorders of Blood Coagulation

Abstract Hemostasis was examined after transection of vessels, 50-200 microns in diameter, both in normal dogs and in dogs with congenital defects of either factor VII, factor IX, or factor VIII. The formation of the hemostatic platelet plugs was observed by direct microscopy in vivo, and sections of the plugs were prepared for both light and electron microscopy 10 to 30 minutes after transection. Furthermore, the reaction of platelets from normal and abnormal dogs with adenosine diphosphate, collagen and thrombin was tested in vitro by a turbidimetric technic. In normal and factor VII deficient dogs the initial arrest of bleeding took place about 3 minutes after transection, and rebleeding was infrequently observed. Their platelet plugs were composed of densely packed platelets, anchored to the vascular and perivascular tissue and surrounded by a cap of fibrin. In factor IX deficient dogs there was no definite prolongation of the initial bleeding time, but rebleedings were frequent. In factor VIII deficient dogs the initial bleeding time was prolonged and the intensity of the bleeding had a wave-like characteristic. The plugs in the hemophilic dogs were larger than normal, were rich in channels, and had areas of loosely packed platelets and an incomplete fibrin cap. Treatment of factor IX deficient dogs with Dicumarol did not further impair hemostatic plug formation in the doses used. Treatment of factor VII deficient dogs with heparin, or factor IX deficient dogs with phenylbutazone, prolonged the bleeding time markedly, delayed the building up of the plug, and gave fragile, loosely packed plugs. Treatment of normal dogs with phenylbutazone did not alter the hemostatic process at the dosage used. In the in vitro studies, platelets from the dogs with congenital coagulation defects reacted normally with the aggregating stimuli. It is concluded that the initial platelet interaction wih the vessel wall and surrounding tissue is not dependent upon blood coagulation. An intact intrinsic pathway of coagulation is necessary for the stabilization of the hemostatic plug after it is formed.

LYMPHOTOMA--SYMPTOMATIC LYMPH LEAKAGE AFTER SURGERY.

ALTERATION OF FLOW of lymphatic fluid in the pelvis and abdomen secondary to metastatic disease, 1 to trauma, 2 and to radiation 3 has been well documented; there are few reports, however, of the changes brought about by surgical transection of the lymphatic vessels of the abdomen. Dodd and his associates 4 demonstrated lymphangiographic evidence of pools of lymphatic fluid that had extravasated into the pelvis after transection of lymphatic vessels during pelvic surgery. The importance of the collections of lymph was emphasized by the occurrence of secondary urinarytract obstruction and sepsis. These collections of lymph were termed lymphocysts and lymphoceles. These terms we consider misnomers because of the absence of a limiting endothelial lining. Since the masses described represent free lymphatic fluid, we believe that the term lymphotoma, analogous to hematoma (a free collection of blood), is a more appropriate name. Despite the increased number of resections of aortic

The Ullrastructure of Platelet Participation in Hemostasis

SummaryThe ultrastructure of platelet aggregation in vivo in response to bleeding brought about by transection of small mesenteric vessels in rats and guinea pigs has been studied. Platelets aggregate, degranulate and separating membranes disappear in parallel with fibrin appearance which is first seen at several loci after 30 seconds of bleeding. About 40 per cent of the electron opaque granules, some of which contain platelet factor 3 have disappeared after one minute of bleeding while the electron lucent granules increase by 70 per cent suggesting that some of them may be empty vesicles. Most of the platelet aggregates of the random type disappear leaving clumped red blood cells entrapped by a network of fibrin fibers which emanate from the remains of platelet aggregates of the rosette type to maintain hemostasis.