Background and Purpose-Increased activation of excitatory amino acid (EAA) receptors is considered a major cause of neuronal damage. Possible sources and mechanisms of ischemia-induced EAA release were investigated pharmacologically with microdialysis probes placed bilaterally in rat striatum. Methods-Forebrain ischemia was induced by bilateral carotid artery occlusion and controlled hypotension in halothaneanesthetized rats. During 30 minutes of ischemia, microdialysate concentrations of glutamate and aspartate were measured in the presence of a nontransportable blocker of the astrocytic glutamate transporter GLT-1, dihydrokinate (DHK), or an anion channel blocker, 4,4Ј-dinitrostilben-2,2Ј-disulfonic acid (DNDS), administered separately or together through the dialysis probe. Results-In control striata during ischemia, glutamate and aspartate concentrations increased 44Ϯ13 (meanϮSEM) times and 19Ϯ5 times baseline, respectively, and returned to baseline values on reperfusion. DHK (1 mmol/L in perfusate; nϭ8) significantly attenuated EAA increases compared with control (glutamate peak, 9.6Ϯ1.7 versus control, 15.4Ϯ2.6 pmol/L). EAA levels were similarly decreased by 10 mmol/L DHK. DNDS (1 mmol/L; nϭ5) also suppressed EAA peak increases (glutamate peak, 5.8Ϯ1.1 versus control, 10.1Ϯ0.7 pmol/L). At a higher concentration, DNDS (10 mmol/L; nϭ7) further reduced glutamate and aspartate release and also inhibited ischemia-induced taurine release.

Background: Lymphaticovenular anastomosis (LVA) is a useful treatment for compression-refractory lymphedema with its effectiveness and minimal invasiveness. However, LVA requires supermicrosurgery, where lymphatic vessels with a diameter of 0.5 mm or smaller are anastomosed using 11-0 or 12-0 suture. To make LVA easier and safer, we adopted a modified side-to-end (S-E) anastomosis in LVA surgery. Methods: We performed modified S-E LVAs in 14 limbs of female patients with lower extremity lymphedema (LEL). In modified S-E LVA, lateral windows with a length of 1.0 mm or longer were created on a lymphatic vessel and a vein, respectively, and side-to-side (S-S) anastomosis was established with 10-0 continuous suture. After completion of S-S anastomosis, the vein distal to the anastomosis site was ligated to prevent venous backflow and subsequent thrombosis at the anastomosis site. Lymphedematous volume was evaluated preoperatively and at postoperative 6 months using LEL index. Results: All the 24 modified S-E anastomoses could be completed without difficulty or revision for anastomosis, and showed good patency after completion of anastomosis. Postoperatively, LEL indices significantly decreased compared with preoperative LEL index (255.9 6 14.1 vs. 274.9 6 22.2, P < 0.001). Conclusions: Modified S-E LVA can efficaciously divert lymph flows into venous circulation without performing supermicrosurgical anastomosis. V V C 2012 Wiley Periodicals, Inc. Microsurgery 33: 130-133, 2013.

Therapeutic, III.

Diagnostic, IV.