Localized aneurysm of the deep femoral artery is an extremely rare disease. A case of arteriosclerotic aneurysm of the bilateral deep femoral artery was reported. A 72-year-old man complained of pulsatile masses in his abdomen and left groin. Radiologic studies revealed an abdominal aortic aneurysm and one of the left deep femoral artery. Proximal and distal ligation of the left deep femoral artery aneurysm and partial excision of the aneurysmal sac were performed without revascularization 2 weeks after the resection of his abdominal aortic aneurysm. Three years later, ligation and division of the right deep femoral artery aneurysm and reconstruction of blood flow were performed using a 6mm EPTFE prosthetic graft. The postoperative course was uneventful and histological findings revealed arteriosclerosis. The literature of the deep femoral artery aneurysm was briefly reviewed.

A 42-year-old woman with antiphospholipid syndrome (APLS) secondary to systemic lupus erythematosus (SLE) complicated with thrombocytopenic purpura was successfully treated by mitral valve replacement with a mechanical prosthesis and tricuspid valve annuloplasty for mitral valve stenosis and regurgitation due to Libman-Sacks endocarditis. Intraoperative hemorrhagic oozing due to thrombocytopenia was effectively managed with platelet transfusion. Negative microbial culture and pathological examination of the resected mitral valve demonstrated an atypical sterile verrucose lesion, the findings of which were typically characteristic of Libman-Sacks endocarditis in SLE. She was successfully discharged 31 days after the operation without any hemorrhagic or thromboembolic events. However, 100 days after surgery, she suffered from fatal cerebral infarction caused by poor Coumadin compliance. Regarding the prosthetic valve selection, it is reasonable to select the mechanical valve because 1) anticoagulation therapy is necessary for APLS, 2) the risk of the dialysis induction due to the lupus-induced renal failure leading to a high calcium turnover, which results in accelerated bioprosthetic valve calcification. In case of SLE with APLS, in which anticoagulation and antiplatelet therapy is required to prevent the thromboembolic event and thrombocytopenic purpura, after valve replacement, strict management of anticoagulation plays an essential role to prevent thromboembolic complication.

We report a case of methicillin-resistant Staphylococcus aureus (MRSA) infectious endocarditis (IE) which was successfully treated with linezolid (LZD). The patient was a 44-year old woman. She was referred to our hospital because of fever of unknown origin. MRSA was detected from blood cultures and echocardiography revealed vegetation on the right coronary cusp of the aortic valve. She was diagnosed with MRSA endocarditis according to the Duke criteria, and was immediately give vancomycin (VCM) and isepamicin. Sixteen days after administration of VCM, she had a progressively increasing skin rash. It was considered a side effect of antibiotics and VCM was replaced with teicoplanin (TEIC). Eventually, LZD was given to her at 22 days after hospitalization because TEIC was not effective. LZD alleviated the fever and diminished the signs of vasculitis due to endocarditis within a week. LZD was continued for 4 weeks with cardiac failure medically controlled, and she underwent aortic valve replacement using a mechanical prosthetic valve. LZD was injected just before the operation and continued for 15 days postoperatively, followed by oral administration of levofloxacin. She was discharged 35 POD and no recurrence of the infection had been observed at 1 year after the surgery. LZD could be an alternative therapy for MRSA endocarditis, but further examinations are warranted to determine the most appropriate regimen.

When coronary artery bypass grafting (CABG) is to be done, we use the internal thoracic artery (ITA) as a graft conduit in order to obtain longer patency. When the ITA acts as a good collateral to the lower extremities, blood flow to the extremities may decrease after CABG with ITA. Simultaneous open heart surgery and laparotomy may cause pulmonary complication. We made an algorithm of treatment for patients with coronary artery disease (CAD) and aortoiliac occlusive disease including these problems. From July 1991 to March 1992, 6 patients were operated and reviewed. Four patients were operated on for CAD and AIOD simultaneously. Two patients were operated on for CAD or AIOD at first and for the other secondarily. All 6 cases were discharged without any complications and are now free from angina and intermittent claudication. When the therapeutic plan for the patients with CAD and AIOD is made, it is very important that coronary revascularization is planned at first with careful evaluation of the blood flow to the lower extremities in cases with AIOD.

Purpose: We report a case whose anal pain accompanied by rectal cancer was remarkably eliminated by subarachnoid phenol block and sacral nerve root thermocoagulation. Case Report: The subject was a sixty-one-year old male. His anal pain failed to respond to opioid whereas his pain was alleviated by subarachnoid phenol block, but was exacerbated a few weeks later. This relapsing pain was completely eradicated by sacral nerve root thermocoagulation. Conclusion: Anal pain associated with rectal cancer recurrence of pelvic space is sometimes hard to be controlled only by subarachnoid phenol block, but there is a possibility of pain control by combination use with sacral nerve root thermocoagulation. Palliat Care Res 2010; 5(2): 314-316

A 52-year-old man had a history that included aortic valve replacement due to infectious endocarditis in 1987. Chest X-ray showed slight enlargement of the superior mediastinum in 1998, but the enlargement was very mild and there had not been any significant change since 1998. However, chest X-ray demonstrated an extremely protruding mass on the right side of the superior mediastinum in May 2004 and a pseudoaneurysm located in the ascending aorta was demonstrated by computed tomography. We considered this aneurysm had been caused by ascending aortic cannulation for blood return from cardiopulmonary bypass (CPB) during the previous surgery. On re-operation, CPB was established by femoro-femoral bypass and median sternotomy was performed. The pseudoaneurysm measured 60mm in diameter and there was a felt-pledget on top of the aneurysm. Under deep hypothermic cardiac arrest, we incised the aneurysm and closed the orifice of the pseudoaneurysm using a patch (Hemashield Woven Fabrics). On pathological examination, the wall of the pseudoaneurysm showed a structural loss of the blood vessel and the felt-pledget had been exposed to the inferior of the aneurysm breaking through the wall. We considered this a non-mycotic pseudoaneurysm because of this patient's clinical course, surgical and pathological findings. We encountered a pseudoaneurysm in the ascending aorta that was detected and treated surgically about 20 years after aortic valve replacement.

Purpose  The effects of 10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions. Subjects and Methods  The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading. Results and Discussion  The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation.  After bathing, venous pO2 was significantly increased and pCO2 was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO2 was decreased and pCO2 was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO2 by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested.  As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running. Conclusion  Health promotion by bathing seems to be conducted through sufficient O2 supply and washout of CO2 by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.

Objective: This study aimed to clarify the details of inpatient cancer rehabilitation interventions provided by designated cancer hospitals in Japan. Methods: This questionnaire-based survey asked specialists regarding the outline of their facilities’ inpatient cancer rehabilitation, Dietz classification, disease, and intervention details. Results: Restorative interventions were the most common, and the most common cancer was lung cancer followed by colorectal cancer; hematologic malignancy; gastric cancer; and liver, gallbladder, and pancreatic cancer. Intervention proportions for colorectal and gastric cancer were significantly higher in general hospitals than in university hospitals and cancer centers; in contrast, those for hematological malignancy were significantly higher in university hospitals than in general hospitals. For bone and soft tissue sarcomas, intervention proportions in cancer centers were significantly higher than those in university and general hospitals; and for oral, pharyngeal, and laryngeal cancers, they were significantly higher in university hospitals and cancer centers than in general hospitals. The most common intervention was walking training, followed by resistance training, basic motor training, activities of daily living training, and respiratory rehabilitation. Respiratory rehabilitation was performed significantly more frequently in university and general hospitals than in cancer centers.Conclusion: The diseases had differed according to the characteristics of the facilities, and the interventions were considered accordingly. In future, it will be necessary to verify the effectiveness of inpatient cancer rehabilitation according to facility characteristics and to disseminate information on inpatient cancer rehabilitation.