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1. Experiments were performed in anaesthetized rabbits to examine the effects of calcitonin gene-related peptide (CGRP) and the CGRP antagonist CGRP8-37 on blood flow to the medial collateral ligament of the knee joint. 2. Topical application of CGRP (10(-13) to 10(-9) mol) to the exposed external surface of eight knee joints resulted in dose-dependent dilatation of vessels in both the ligament and the joint capsule. The magnitude of this response varied significantly in different regions of the medial collateral ligament, with the 10(-9) mol dose of CGRP giving the maximum response (101.5 +/- 25.3% increase) at the femoral insertion site of the medial collateral ligament and lowest (23.1 +/- 8.8%) at the tibial insertion site. 3. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) produced dose-dependent constriction of vessels in the ligament and the joint capsule in five knees, with a trend towards the greatest effect occurring at the femoral insertion site (45.8 +/- 8.1% reduction in blood flow). With the 10 nmol dose, the vasoconstrictor response at the femoral insertion site differed significantly (P<0.05) from the responses obtained at the tibial insertion and joint capsule sites. 4. Topical application of CGRP8-37 (0.1, 1 and 10 nmol) to four chronically denervated knees produced substantially smaller vasoconstrictor responses at all sites. At the femoral insertion site, where 10 nmol CGRP8-37 normally produces a 45.8 +/- 8.1% reduction in blood flow (n=8), ten days following denervation this response was reduced to 6.5 +/- 6.1%, this difference being significant (P=0.01). 5. Adrenaline was applied topically to augment blood vessel tone, in order to establish how effectively co-administration of CGRP would offset this increase in tone. Adrenaline (10(-10) mol) produced vasoconstriction at all sites (n=6). In the capsule this vasoconstriction was virtually abolished when CGRP (10(-9) mol) was co-administered with adrenaline but in the ligament vasodilatation occurred at all sites. This vasodilatation was significantly greater at the femoral insertion site compared to the tibial insertion and mid ligament sites (P<0.05 for both) and the capsule (P<0.01). 6. Topical application of substance P (10(-10) or 10(-9) mol) failed to elicit dilatation of ligament blood vessels. 7. These results suggest that endogenous CGRP may play an important role in regulating blood flow to different structures in and around the knee joint.

We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis.

The suggested methods of the formation of intubation granuloma as well as carcinoma invasion in the area of posterior vocal ligament insertion have been controversial. One reason for divergent opinions is possibly based on different judgements of morphology in this region. The present study analyzed structures of the vocal ligament and vocalis muscle insertion at the vocal process by means of histological, immunohistochemical and electron microscopic methods. Investigations were performed in three planes on the vocal cords of 22 men and 19 women (aged 21-97 years). Inside the insertion zone of the vocal ligament at the vocal process three structures could be distinguished: hyaline cartilage at the base of arytenoid cartilage, elastic cartilage at its apex and the posterior elastic nodule in front of them. No perichondrium could be seen around the elastic nodule. In elastic nodules type I and type III collagen fibrils as well as elastic fibers formed a scissor-like meshwork around large fibroblasts. The vocalis muscle inserted at the perichondrium in the lateral part of the arytenoid skeleton by short tendons. At the insertion zone blood vessels of the vocalis muscle penetrated the perichondrium and reached the cartilaginous matrix. At the beginning of osteogenesis, the blood vessels connected with intraosseous blood vessels of the arytenoid. Connective tissue cells of the insertion zone and extracellular matrix components formed by these cells fulfilled a biomechanical function by equalizing the different elastic moduli of tendon, cartilage or bone. The lack of perichondrium around the lengthened posterior elastic nodule made formation of intubation granulomas caused by perichondritis in this area impossible. Loosened perichondrium or periosteum in the area of the insertion of the vocalis muscle at the vocal process, ossification and associated vascularization of the arytenoid skeleton permitted invasion of carcinomas into the arytenoid.

The hepatic ligamentum teres was investigated in 30 adult specimens. The ligament represents a fibrous remnant of the umbilical v. and a small irregular lumen still exists in the ligament in adult life. The ligament is supplied by one set of independent round ligament a. and paraumbilical vv. Since the proximal segment of the ligament is easily mobilised and since the ligamentous a. originates from the right hepatic a. near the hilum, a proximal vascularized pedicle flap of the ligamentum teres has been recommended. Surgical repair of the extrahepatic bile duct using a vascularized pedicle flap of the ligamentum teres has been carried out successfully in 12 patients.

Coloured microspheres were used to determine standardized blood flow in an established model of medial collateral ligament injury in the adult rabbit knee. Resting blood flow in the ligament was ascertained to be on the order of 0.68 +/- 0.08 ml/min/100 g (mean +/- SEM) in normal rabbit knees, although errors in flow estimates of this magnitude may be quite high. In healing medial collateral ligament, however, flow had increased markedly 3 weeks after injury (21.45 +/- 5.48 ml/min/100 g). Flows in sham-operated control medial collateral ligaments were not significantly increased compared with those in control normal ligaments. Six weeks after injury, blood flow in the ligament remained elevated (16.90 +/- 3.20 ml/min/100 g) and was similarly elevated in other neighbouring joint tissues (i.e., ipsilateral synovial fat pad). The increase in flow to ipsilateral noninjured articular tissues did not persist beyond 6 weeks, but flow in the healing medial collateral ligament scar tended to remain elevated after 17 weeks (4.20 +/- 1.79 ml/min/100 g), although this did not achieve statistical significance. We conclude from these data that it is possible to measure the increase in blood flow in injured and healing articular tissues using the coloured microspheres technique and that ligament injury is a potent stimulus for increasing blood flow. Coloured microsphere measurements of blood flow to joint connective tissues may offer a valuable approach to future investigations of joint injury and arthritis.

We present the operative technique of laparoscopic proctocolectomy along with the clinical course of the first four patients to undergo this procedure. The operation was conducted through five 12-mm ports. In total laparoscopic proctocolectomy, the dissection began with the sigmoid, left colon, and rectum. The gastrocolic ligament was opened at the level of the midtransverse colon and dissected along with the transverse mesocolon toward the splenic flexure. The attachments and vessels of the right side of the gastrocolic ligament and the right colon were taken last. This sequence was followed because gradual mobilization of the colon displaced all structures in the middle of the abdomen and obscured vision. The specimen was extracted through the anus. In laparoscopy-assisted proctocolectomy, it was necessary to incise only the white line of Toldt of the ascending and descending colon, mobilize the hepatic and splenic flexures, and ligate the vessels of the gastrocolic ligament. Then the vessels of the mesentery were ligated near the bowel wall through a 6.5-cm midline subumbilical incision from which the abdominal colon was also extracted. The rectum was then completely dissected and sectioned at 10-15 cm from the anus, everted, and resected at the dentate line. Mean operative time was 7 h, 18 min, and average blood loss was 493 ml. One patient had urinary retention. Return to liquid diet took a mean of 4 days. Average postoperative stay, which depended on full return of bladder function and teaching of stoma care, was 10 days.

The vascular and microvascular anatomy of the equine deep digital flexor tendon (DDFT) within the digital sheath was studied by injecting the vasculature with either colored latex or barium sulphate for radiographic, microangiographic, histologic, and computed tomographic (CT) evaluation. Consecutive 4-mm thick two-dimensional CT slice data were reconstructed to 3-dimensional volumetric images to enhance spatial evaluation of the blood supply. Gross dissection and angiographic studies identified three major vascular sources. Above the fetlock, the DDFT was supplied by either a branch of the medial palmar artery (Arteriae digitalis palmaris communis II) or a branch of the medial palmar digital artery (A. digitalis [palmaris propria III] medialis). Below the fetlock, the DDFT was supplied by branches from the lateral and medial palmar branches to the proximal phalanx (Ramus palmaris phalangis proximalis). The most distal aspect of the tendon received small branches from the medial and lateral palmar digital arteries. Using histology and microangigraphy we observed an extensive and uniform intratendinous vascular network above and below the fetlock, with a relatively avascular region of tendon palmar to the fetlock. The most distal 2.0 to 2.5 cm of the tendon within the sheath was heavily infiltrated with fibrocartilage along its dorsal aspect.

Eighty rabbits receiving the square resection (4 x 4 mm) of both patellar ligaments in full thickness at their center were divided into 4 groups, and each group (20 rabbits) were electromagnetically stimulated with different magnetic intensities, 0 (control group), 2, 10, or 50 gauss (G), for 6 hr daily. Pulse frequency and pulse width were 10 Hz and 25 microseconds, respectively. Five animals of each group were sacrificed weekly from 1st to 4th week after operation and the defect tissue was collected for biochemical and ultrastructural evaluations. Before sacrificing, the blood flow of the central portion of patellar defects were measured. Significant increases in blood flow at the defect were observed in 50 G group compared to those of other groups from 2 to 4 weeks after operation. The collagen content in PEMFs groups showed a significant increase compared to that of control group. Furthermore, those increases were higher according to the increase in magnetic intensity. Electronmicroscopically, massive developmental rough endoplasmic reticulum was seen in the fibroblasts at 2 weeks after operation in 50 G group compared to other groups, which suggests the more active collagen production in this group. These results suggest that PEMFs enhanced the blood flow and increased the fibroblasts at the defect. At the same time, PEMFs directly stimulated the collagen production from the fibroblasts, thus accelerate the healing process of the ligament.

On the basis of the results of specially performed investigations on 47 complexes of the liver with extrahepatic bile ducts and gallbladder, a new method of cholecystectomy has been developed. In the clinic, 132 patients were operated on for cholelithiasis, acute and chronic cholecystitis. In performance of subserous cholecystectomy, a danger of injuring the vessels of the hepatoduodenal ligament is excluded, its adequate blood supply and that of hepatic parenchyma adjacent to the gallbladder is preserved.

Detailed dissections were performed on 83 pelvic halves from 45 cadavers in order to obtain more accurate data on the composition of the lateral ligament of the rectum and the rectosacral fascia. The middle rectal artery was observed in only 18 out of 81 spcimens (22.2%). The lateral ligament of the rectum was divided into lateral and medial portions, according to the positional relationship to the pelvic plexus. The lateral part consisted of a superoanterior and an inferoposterior subdivision. The main component of the former was the middle rectal artery, while the pelvic splanchnic nerves were contained in the latter. Both compoents can be considered to contribute to the formation of the medial part, although the middle rectal vessels were not always present. The medial part consisted of the rectal branches from the pelvic plexus and their connective tissue. The rectosacral fascia was formed by dense connective tissue between the posterior wall of the rectum and the third and fourth sacral vertebrae. The main components of the fascia were branches of the lateral and median sacral vessels and the sacral splanchnic nerves which arose directly from the sacral sympathetic ganglia.

The aim of this study was to establish a precise architecture of the retinacular ligaments of human digits. Sixty selected digits from human cadavers aged 40-70 years were used in this study. We were able to identify, under the dissecting microscope, two distinct ligamentous complexes: one proximal of greater importance and the other distal of lesser importance. Both structures extend from the periosteum as well as from the fibrous part of the digital sheath to the skin. There are many variations in size and in shape of these structures but they are not related to a particular digit. The role of these ligaments is to prevent the 'effet de doigt de gant', to stabilize and to maintain the neurovascular bundle of the digit at the moment of the digital flexion.

This study evaluates the dose-dependent accuracy of the radionuclide-labeled microsphere technique for blood flow evaluation in nerve, tendon, and ligament. In eight dogs, blood flows were determined for nerve, nerve graft, tendon, and ligament tissue by simultaneous injection of high- and low-dose microspheres with different radiolabels. The results demonstrated no significant differences in blood flow as measured from the small number of microspheres (less than 400) and the high number (more than 400) for nerve and tendon tissue. For nerve tissue, microsphere counts of 50 to 100, 100 to 200, 200 to 300, and more than 300 produced mean percentage errors of 12.74% (n = 5, SEM = 4.52), 5.45% (n = 13, SEM = 1.22), 10.22% (n = 6, SEM = 4.37), and 17.08% (n = 12, SEM = 3.30), respectively. For tendon tissue, the same microsphere subdivisions had mean percentage errors of 7.47% (n = 4, SEM = 2.66), 3.63% (n = 6, SEM = 1.34), 15.54% (n = 4, SEM = 4.43), and 12.91% (n = 1), respectively. For ligament tissue, percentage errors were consistently higher; microsphere counts of 30 to 100, 100 to 200, and 200 to 300 produced mean errors of 20.14% (n = 4, SEM = 6.38), 18.66% (n = 4, SEM = 6.24), and 25.78% (n = 2, SEM = 1.97), respectively. Although there was no direct relationship between percentage error and number of microspheres retrieved, we suggest that microsphere counts in the range of 100 to 200 should be considered acceptable for nerve and tendon in the canine. Ligament tissue seems to be less well suited to the microsphere technique; however, further study is warranted.

In order to determine whether an allogeneic tendon could be used to replace an extra-articular ligament, the right medial collateral ligament from 11 adult dogs was replaced with a fresh-frozen allogeneic patellar tendon. At each of 3, 6, 15, 30 and 52 weeks postoperatively, one dog was killed for micro-angiographical and histological studies; at 52 weeks the remaining six dogs were killed for tensile testing. Micro-angiograms showed that the allogeneic tendon was revascularised with infiltration of the mesenchymal cells from the surrounding tissues and both ends of the graft. Histologically, the alignment of the fibroblasts and collagen bundles became more regular over time, without any immunological rejection. A biomechanical study performed at 52 weeks found no significant difference in stiffness or ultimate load between normal and reconstructed ligaments. Fresh-frozen allogeneic tendons are therefore considered useful for extra-articular ligament reconstruction.

The structure of blood vessels in five points of the uterine ligamentum latum was to examined. Histological and histochemical methods were used as well as examining the internal structure of endothelium in the scanning electron microscope (SEM). The greatest changes occurred in the walls of the ovarian artery and vein, as well as in the branches of the uterine artery which torms arcuate anastomosis near the uterine horns. Differences concerned alkaline phosphatase (FZ) content, the presence of acid mucosaccharides, occurrence of laminae consisting of elastic fibres, changes of thickness of central membrane of vessels. Furthermore, occurrence of specific structures regulating blood circulation was seen. Observations in the SEM showed the occurrence ot differences in endothelium picture during the cycle.

In order to examine the significance of the blood flow through the ligamentum teres in Perthes' disease, intraosseous venography was performed on 81 hips. During the initial stages of the disease, the FCV was visualized in 40% of the hips examined, decreasing to 15% during the reparative stage. Moreover, the size of the FCV tended to decrease as the disease progressed. In venograms obtained in the early stage, several abnormalities were found in the morphology and course of the vein. Based on these findings, it appears that the blood vessels within the ligamentum teres play a compensatory role in reestablishing blood flow to the femoral head following the pronounced disturbance in blood circulation that is characteristic of the initial stages of Perthes' disease.

Traditionally, ligaments and tendons (L and T) have been regarded as metabolically inert structures. However, sufficient biochemical evidence on the metabolism of collagen has indicated that such a concept is no longer tenable. To determine whether L and T respond to increased or decreased levels of chronic exercise, studies were undertaken to measure their aerobic capacities. For comparative purposes, similar measurements were obtained from liver and skeletal muscles secured from normal and hypophysectomized male rats. Oxygen consumption and cytochrome oxidase (CO) activity was recorded from cell suspensions that had been prepared with the inclusion of collagenase and with elastase added to the medium. The O2 results showed that L and T had values that were approximately 10 times lower than liver tissue and 7.5 times less than the means from skeletal muscles. Hypophysectomy caused marked reductions in O2 uptake of liver and muscle tissues; but had no impact on L and T. When CO activity of these connective tissues were evaluated, immobilization and hypophysectomy caused significant reductions that ranged from -36% to -59% respectively. Training, on the other hand, resulted in increases of less than 10% in the activity of this enzyme within L and T while being elevated in muscle tissue by 58%. It was concluded that the metabolic activity of L and T was lowered with decreased levels of physical activity but it was unclear why chronic exercise did not produce the opposite effect.

Abdominal pain radiating to the right upper quadrant, producing peritoneal signs, developed in a 30-year-old pregnant woman. At surgery, she was found to have an infarction of the falciform ligament that was excised.

By means of perfusion studies, an analysis was made of the arterial supply to the proximal end of the femur in 150 specimens from autopsied fetuses and children, aged from twenty-six weeks of gestation to fourteen years and eight months old. All died of diseases which did not involve the hip joint. Two anastomotic rings were found: an extracapsular one formed by the medial and lateral femoral circumflex arteries, and a subsynovial intra-articular ring at the articular cartilage-neck junction. The intra-articular rings in males were discontinuous more often than in females. A three-plane analysis of totally-cleared specimens demonstrated that the epiphyseal plate constituted an absolute barrier to blood flow between the epiphysis and metaphysis in all but two of the 124 barium sulphate-perfused specimens examined. A smaller number of ascending cervical arteries crossed the anterior and medial surfaces of the mid-neck in the specimens from three to ten-year-old white children than in those from newborn to two-year-old white and black children. This finding may be important for the etiology of Legg-Perthes disease. No differences with respect to age, sex, or race were found in the arteries of the ligamentum teres.

The aim of this study was to determine if the addition of pulsed Doppler imaging to conventional sonography allows discrimination between true paraumbilical veins of portal hypertension and the apparent vein sometimes seen in the ligamentum teres in normal subjects. Conventional sonography and Doppler sonography of the ligamentum teres were performed in 33 normal subjects and in 39 patients with portal hypertension due to chronic liver disease. An apparent ligamentum teres vessel (i.e., hypoechoic channel) was identified on sonograms in 32 (97%) normal subjects (diameter 0.6-1.9 mm) and in 35 (90%) patients with portal hypertension (diameter 1.1-22 mm). In the portal hypertension group, the apparent vessel had a diameter of greater than 3 mm in only 20 patients (51%), but in 32 patients (82%) it was shown on Doppler examination to be a patent paraumbilical vein (i.e., hepatofugal venous signal). A patent paraumbilical vein on duplex Doppler sonography is therefore a specific sign of portal hypertension. The addition of Doppler imaging to conventional sonographic examination significantly increases the sensitivity for the diagnosis of portal hypertension by demonstration of a paraumbilical vein.

The present work is a fragment of the author's complex study of replantation of an extremity in experiment. Experiments on reproduction of the model of traumatic shock with acute loss of blood under conditions of muscle relaxation proposed by Yu. V. Kiprenski were performed in 15 dogs and 10 cats. It was established that in animals dead as a result of shock there appeared severe disorders of microcirculation in tissues and organs. They were characterized by a pronounced spasm of the vessels of the arteriolar link and dilatation of the venular and lymph collectors of the microcirculation bed. Simultaneously a great number of arterio-venular anastomoses were opened through which the arterial blood was shunted partly to avoid constricted capillaries. In the vessels of the venular link of the microcirculatory bed there appeared aggregations of formed elements of blood and microemboles. In absence of specific complex therapy, as it was in our experiments, the animals die of shock within the period from 17 min to 5 hour 20 min.

Structural adaptation of the vascular bed in the broad ligament of the dog uterus has been studied at various time of the experimental phlebohypertension. Restitution of the circulation after the posterior vena cava occulsion occurs phasically. The venous collateralies are not formed at one time and it is connected with the venous pressure level in the inferiocaval system and with some changes in the construction of the microcirculatory bed. Basing on the morphometry data, a general equation has been derived which reflects dynamics of the microangiological parameters and demonstrates unidirectionness of the adaptive reactions in the vascular bed at the disturbed venous circulation. Using principles of the system-structural analysis and the mathematical graph theory, we consider the microcirculatory system of the broad ligament of the uterus as a graph-system and study the reorganization of the microcirculatory network at a venous congestion. Realization of the compensatory possibilities is reached in the microcirculatory bed by a changed relationships in the number of the intervascular connections. The latter are estimated according to the graph-schemes of the microvascular bed. Morphokinetics of the connections between the vessels is characterized by widening or narrowing the borders of the "adaptive norm" and by changing the microangioarchitectonics. At the same time, there is noted formation of specialized microhemoangioconstructions. Morphofunctional state of the lymphatic system is connected with reorganization of the angioarchitectonics. This is certain manifestation of the law of the lymphatic and blood beds "synergism". Thus, the structural changes of the vascular bed are aimed to support a certain hemodynamic level.

Various methods for reconstruction of the anterior cruciate ligament have been described in the literature. In 1968 Broström et al. described a reconstruction using the medial third of the patellar ligament as a substitute for the cruciate ligament. (The operative procedure is described elsewhere in this book by Eriksson and has also been described by Alm and Gillquist.) The aim of the present investigation was to study the long term clinical results after reconstruction of the anterior cruciate ligament using the medial third of the patellar ligament. The clinical and morphological findings were correlated at various intervals after reconstruction of the ligament. The influence of the rotatory movement of the tibia on the tensile strength and on the elongation of the anterior cruciate ligament was studied experimentally. To clarify the vascular anatomy and morphology of the cruciate ligaments and to study the vascularization and fate of the transposed part of the patellar ligament, experimental surgery was performed in dogs.

The investigations were carried out on the material taken from four pigs, weight about 35 kg. Ovary ligaments and hilus were taken for these experiments. To trace cholinergic nerves situated in the collected material, Koelle and Friedenwald's thiocholine method in Gomori's modification and Gienc's adaptation was used. To eliminate the possibility of pseudocholinesterase staining in the preparation, Iso-OMPE in dilution 1 X 10(-6) was added to the control material. In the mesovarium of the pig cholinergic nerves have been observed. They can be divided into three groups according to their course and position: 1) paravascular bundles, 2) perivascular plexi and 3) nerve bundles not connected with the vessels.

From dissection of thirty dead bodies, the authors describe accessory hepatic arteries and show that many arteries reach the left liver; while, the right accessory arteries are essentially posterior and very peripheral.