{"created":"2023-06-19T07:19:20.977464+00:00","id":5394,"links":{},"metadata":{"_buckets":{"deposit":"556a3e9a-9b04-47d6-a5e5-a9055639886b"},"_deposit":{"created_by":17,"id":"5394","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"5394"},"status":"published"},"_oai":{"id":"oai:az.repo.nii.ac.jp:00005394","sets":["370:15:392"]},"author_link":["17233"],"item_10006_date_granted_11":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2020-07-27"}]},"item_10006_degree_grantor_9":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_name":"麻布大学"}],"subitem_degreegrantor_identifier":[{"subitem_degreegrantor_identifier_name":"32701","subitem_degreegrantor_identifier_scheme":"kakenhi"}]}]},"item_10006_degree_name_8":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士(獣医学)"}]},"item_10006_description_22":{"attribute_name":"Abstract","attribute_value_mlt":[{"subitem_description":"Chylothorax is a disease of the lymphatic system in dogs and cats. Surgical procedures are often considered as treatment because medical treatments are unable to achieve complete resolution. Even though surgical procedure involves ligation of the thoracic duct, but recurrence frequently occurs. This is due to a failure to tie all tributaries of the thoracic duct, which then leads to persistent effusion, or occurring co-lateral duct after ligation. Therefore, a precise recognition of the lymphatics is required to determine the optimal ligation site during surgery and planning for chylothorax each case. The degree of visualization of lymph vessels using indocyanine green (ICG) by laparotomy are investigated, and the difference between dogs and cats were evaluated in chapter 1. The visualizations of lymph vessels by CT lymphography and thoracoscopy in dogs were investigated in chapter 2. The visualization of lymph vessels by CT lymphography and near infrared fluorescent thoracoscopy in cats were investigated in chapter 3. \nIn chapter 1, to investigate differences in the degree of visualization among individual animals and between dogs and cats, two clinically healthy beagle dogs and four clinically healthy cats were subcutaneously injected with ICG (1.2 ml/kg) in the peri-anal tissue, and the lymph vessels stained by ICG in the abdominal cavity were observed by laparotomy. In dogs, the colic lymph nodes, mesenteric lymph, the lumbar lymphatic trunk and the cisterna chili were observed but with individual variation in visualization of these structures. In cats, the colic lymph nodes, mesenteric lymph, the lumbar lymphatic trunk, and the cisterna chili were observed as well. However, the degree of visualization in cats was lower than that seen in dogs with wide variation among individual cats. These results of the visualization of lymphatics using ICG suggest the presence of the difference both individual- and species in dogs and cats in. \nIn chapter 2, the visualization of lymph vessels on CT lymphography and visualization of the thoracic duct by thoracoscopy were investigated in dogs. Three clinically healthy beagle dogs were used for CT lymphography, and two clinically healthy dogs were used for thoracoscopy. Iodine contrast agent (iopamidol, 370 mgI/ml), at a dose of 1.2 ml/kg, was injected into rectal tissue, perianal tissue, or vaginal tissue, respectively, and the injection site was massaged for 5 minutes. In all 3 dogs, the cisterna chili, and the thoracic duct were on CT lymphography. Visualization was superior after injection in to rectal or perianal tissue, compared to vaginal tissue. This is because vaginal tissue is distanced from the rectal lymph nodes than rectal or perianal tissue, thereby limiting contrast agent uptake. The cisterna chili and the tributaries of the thoracic duct divisions were clearly seen in three-dimensional CT images. No significant adverse effect was noted in any animals. In thoracoscopy, ICG (1.2 ml/kg) was injected into perianal tissue under anesthesia, and the injection site was massaged for 5 minutes. The thoracic cavity was monitored continuously, and in all dogs, the thoracic duct running along right of the aorta could be gradually visualized. Our observations show that, for CT lymphography in dogs, contrast material administered in the perianal tissue provides superior visualization of the lymphatic vessels easily, and thoracoscopy enables easy and direct observation of the thoracic duct. Thus, combined CT lymphography and thoracoscopy can be a reliable tool for successful ligation of thoracic duct in dogs.\nIn chapter 3, the visualization of lymph vessels on CT lymphography and visualization of the thoracic duct by near infrared fluorescent thoracoscopy were investigated in cats. Three clinically healthy cats were used for CT lymphography, and two clinically healthy cats were used for near infrared fluorescent thoracoscopy. For CT lymphography, iohexol (300 mgI/ml) or iopamidol (300 mgI/ml), at a dose of 1.2 or 1.8 ml/kg, was subcutaneously injected into the peri-anal region, the injection site massaged for five minutes. In all three cats administered iohexol, abdominal lymphatics, cisterna chili, and the thoracic duct were visible after injection. Conversely, visualization after iopamidol varied widely among cats and was not reproducible. It is considered that contrast effect of iohexol was superior to that of iopamidol in CT lymphography. The observed differences in visualization between iohexol and iopamidol may be due the fact that the molecular weight of iohexol is slightly greater than that of iopamidol. The cisterna chili and the tributaries of the thoracic duct divisions were clearly seen in three-dimensional images. No significant adverse effect was noted in any animals. For near infrared fluorescent thoracoscopy, ICG, at a dose of 1.8 ml/kg, was peri-anally injected into the rectal submucosa under anesthesia, the injection site massaged for 5 minutes. The thoracic duct stained by ICG could be clearly observed under near infrared fluorescence thoracoscopy; conversely, it was difficult to visualize under visible light. Thus, near infrared fluorescent thoracoscopy enables direct and easy observation of the thoracic duct. Taken together, these observations suggest that combined CT lymphography and near infrared fluorescent thoracoscopy can be a reliable tool for successful ligation of the thoracic duct in cats. \nIn summary, both CT lymphography and thoracoscopy are useful for evaluating lymphatics in dogs and cats. The easy visualize techniques described in this study would contribute towards better for the surgical procedure of chylothorax in a small animal practice.\nThe contents of the chapter 3 is published in scientific journal.\nKamijo K, Kanai E, Oishi M, Ichihara N, Asari M, Yamada K (2019): Perirectal injection of imaging materials for computed tomographic lymphography and near infrared fluorescent thoracoscopy in cats. Veterinarni Medicina 64, 342-347."}]},"item_10006_description_7":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"乳び胸は、犬や猫に発症するリンパ流路の疾患である。乳び胸に対する内科治療は功を奏さないことが多く、根治的治療として胸管結紮術が実施される。しかし、胸管を完全に結紮したにもかかわらず、乳びの漏出が再発することがある。その理由は、結紮した胸管に分岐があり、結紮されていないリンパ流路から乳びが漏出、あるいは結紮後に側副路が形成されるためと考えられている。このことから、乳び胸の外科治療には、症例毎のリンパ流路の把握が重要である。本研究では、乳び胸の胸管結紮術を想定し、犬および猫のリンパ流路を簡便に可視化する方法を検討した。まず、肛門周囲の皮下組織に色素を投与し、開腹下で染色性の個体差と、犬と猫の違いを調べた（第1章）。次に、犬のリンパ管造影および胸腔鏡による胸管可視化法を検討した（第2章）。さらに、猫のリンパ管造影および蛍光光源を用いた胸腔鏡による胸管可視化法を検討した（第3章）。 \n　第1章では、臨床上健康なビーグル犬2頭と猫4頭の肛門周囲の皮下組織に、インドシアニングリーン（ICG）1.2 ml/kgを投与し、開腹下でリンパ流路の染色性の個体差と、犬と猫の違いを調べた。その結果、肛門周囲の皮下組織にICGを投与した場合において、犬の結腸リンパ節、空腸リンパ節、腰リンパ本幹、乳び槽が染色された。猫も犬と同様に、結腸リンパ節、空腸リンパ節、腰リンパ本幹、乳び槽が造影された。猫は犬に比べて染色の程度は弱く、個体による染色のばらつきも大きかった。このことから、リンパ流路のICGの染色性には個体差と犬と猫の間の差があることが示唆された。\n　第2章では、犬におけるリンパ管造影CTと胸腔鏡を用いてICGで胸管を描出する方法を検討した。また、リンパ管造影CTは、造影剤の投与部位についても検討を加えた。リンパ管造影CTには臨床上健康なビーグル犬3頭を、胸腔鏡には臨床上健康なビーグル犬2頭を使用した。リンパ管造影CTは、全身麻酔下でヨード造影剤1.2 ml/kgを、個体別に直腸粘膜、膣粘膜または肛門周囲の皮下組織にそれぞれ投与し、5分間マッサージを行った。投与後3頭全てで、乳び槽および胸管が造影された。視覚的な造影効果は、直腸粘膜、肛門周囲の皮下組織に投与した個体が優れ、膣粘膜に投与した個体は造影効果が乏しかった。膣粘膜は直腸から離れていたため、消化管のリンパ節に取り込まれる程度が低かったと考えられた。肛門周囲の皮下組織に投与する手技は、直腸粘膜に投与する手技よりも簡便であるため、臨床での実施しやすさは、肛門周囲の皮下組織に投与する方法が優位と考えられた。三次元像では、乳び槽および胸管の分岐が立体的に描出された。実験終了後に、供試動物の一般状態に著変はなく、副反応は観察されなかった。胸腔鏡は、全身麻酔下で、ICG（1.2 ml/kg）を肛門周囲の皮下組織に投与し、5分間マッサージを行った。その結果、2頭ともに、胸管は段階的に染色され、胸大動脈右側を併走する胸管が観察された。リンパ管造影CTは簡便にリンパ流路の全体像を把握することができ、胸腔鏡では胸管の観察が可能であることが明らかとなった。リンパ管造影CTと胸腔鏡を組み合わせることで、犬の胸管結紮手術の確実な実施が期待できると考えられた。 \n　第3章では、猫におけるリンパ管造影CTと蛍光胸腔鏡で胸管を可視化する方法を検討した。また、リンパ管造影CTでは、造影剤の種類および投与量についても検討を加えた。リンパ管造影CTには、臨床上健康な猫3頭を、胸腔鏡には臨床上健康な猫２頭を使用した。リンパ管造影CTは、全身麻酔下でヨード造影剤イオヘキソール（300 mgI/ml）またはイオパミドール（300 mgI/ml）1.2 ml/kgまたは1.8 ml/kgを、肛門周囲の皮下組織に投与し、5分間マッサージを行った。その結果、イオヘキソールの投与では全ての個体でリンパ流路の造影効果が確認された。一方、イオパミドールの投与では造影効果にばらつきがあり、猫のリンパ流路の造影にはイオパミドールよりもイオヘキソールの方が優れることが判明した。わずかではあるがイオヘキソールの分子量がイオパミドールよりも大きいことから、猫のリンパ流路への造影剤の取り込みの差には、イオパミドールとイオヘキソールの分子量の差が影響していると考えられた。また、三次元像では、乳び槽および胸管の分岐が立体的に描出された。実験終了後に、供試動物の一般状態に著変はなく、副反応は観察されなかった。胸腔鏡は、全身麻酔下で、ICG 1.8 ml/kgを肛門周囲の皮下組織に投与し、5分間マッサージを行った。胸腔鏡下の可視光では、胸管内へのICGの流入は視認が困難であったが、蛍光胸腔鏡を用いてICGを発光させることにより、胸管の観察が可能であった。リンパ管造影CTは簡便にリンパ流路の全体像の把握が可能であり、リンパ管造影CTと蛍光胸腔鏡を組み合わせることで、猫の胸管結紮手術の確実な実施が期待できると考えられた。\n　以上の研究から、今回開発したリンパ管造影CTと胸腔鏡の組み合わせによるリンパ流路を可視化する方法は、小動物の乳び胸の外科治療に貢献すると考えられた。"}]},"item_10006_dissertation_number_12":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"乙第437号"}]},"item_10006_textarea_23":{"attribute_name":"Rights","attribute_value_mlt":[{"subitem_textarea_value":"本論文の一部は以下のとおり公表されている。(Part of this dissertation has been published as follows.) \nKamijo K, Kanai E, Oishi M, Ichihara N, Asari M, Yamada K (2019): Perirectal\ninjection of imaging materials for computed tomographic lymphography and near\ninfrared fluorescent thoracoscopy in cats. Veterinarni Medicina 64, 342-347."}]},"item_10006_version_type_18":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"上條, 圭司"},{"creatorName":"Kamijo, Keiji","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2020-11-23"}],"displaytype":"detail","filename":"diss_dv_otsu0437.pdf","filesize":[{"value":"2.6 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"diss_dv_otsu0437","url":"https://az.repo.nii.ac.jp/record/5394/files/diss_dv_otsu0437.pdf"},"version_id":"c48bed36-985a-427b-83b7-5611178747ad"},{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2020-11-23"}],"displaytype":"detail","filename":"diss_dv_otsu0437_jab&rev.pdf","filesize":[{"value":"159.1 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"diss_dv_otsu0437_jab&rev","url":"https://az.repo.nii.ac.jp/record/5394/files/diss_dv_otsu0437_jab&rev.pdf"},"version_id":"82a6ec44-3128-443e-8098-0b11f0fef52f"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"doctoral thesis"}]},"item_title":"⼩動物のリンパ管造影および胸腔鏡による胸管可視化法の研究","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"⼩動物のリンパ管造影および胸腔鏡による胸管可視化法の研究"},{"subitem_title":"Study for visualization of the thoracic duct by computed tomographic lymphography and thoracoscopy in small animals","subitem_title_language":"en"}]},"item_type_id":"10006","owner":"17","path":["392"],"pubdate":{"attribute_name":"公開日","attribute_value":"2020-08-28"},"publish_date":"2020-08-28","publish_status":"0","recid":"5394","relation_version_is_last":true,"title":["⼩動物のリンパ管造影および胸腔鏡による胸管可視化法の研究"],"weko_creator_id":"17","weko_shared_id":-1},"updated":"2023-06-19T07:39:33.286465+00:00"}