A 29-year-old man with high fever and chest pain was admitted to our hospital. He had undergone aortic valve replacement 1 month before admission to our hospital. Since computed tomography revealed a pseudoaneurysm in the ascending aorta, he underwent an emergency operation. An occlusion catheter was inserted into the ascending aorta via the left femoral artery, in preparation for pseudoaneurysm rupture. Cardiopulmonary bypass was established with inflow via the right femoral artery and the right axillary artery, and with vacuum-assisted venous drainage via the right femoral vein. After core cooling, we performed resternotomy. The pseudoaneurysm ruptured while we were exfoliating the adhesion around the aorta. We inflated the occlusion catheter in the ascending aorta and controlled the bleeding. We continued core cooling and ventricular fibrillation occurred at 30°C. Subsequently, we induced circulatory arrest, and selective cerebral perfusion was initiated. We inflated the occlusion catheter in the descending aorta and initiated systemic circulation with inflow via the right femoral artery. The origin of the pseudoaneurysm was the region of cannulation in the previous operation. Therefore, we replaced the ascending aorta and performed omentopexy. In this case we reported the use of a strategy involving cardiopulmonary bypass for a pseudoaneurysm in the ascending aorta.

A 52-year-old woman had undergone colectomy and adjuvant chemotherapy for stage IV cecal cancer with peritoneal dissemination and multiple metastases to the lung and liver. After two years of follow-up, she suddenly had right upper limb pain and was reffered to our hospital for treatment of acute upper limb ischemia. Enhanced CT revealed obstruction of the right brachial artery and metastatic lung cancer with pulmonary vein invasion. We performed emergency embolectomy with local anesthesia. The patient's perioperative course was uneventful. Pathological findings of the removed embolus revealed that it contained adenocarcinoma cells. We concluded that the embolus had originated from the metastatic lung cancer with pulmonary vein invasion.

After vascular surgical procedures, complications of the wounds in the groin region may sometimes lead to prosthetic graft infections or prolonged hospital stays. While some wounds heal completely during re-suture and VAC therapy, healing of other wounds that involve refractory graft infection, lymphorrhea, or a dead space, is extremely difficult. We performed tissue coverage using a Sartorius muscle flap for such difficult cases. The muscle is twisted onto itself to fill the dead space with some blood supply. Tissue coverage using a Sartorius muscle flap with adequate blood flow was effective in improving lymphorrhea and infection. We report four such cases where complications in the groin region were managed using a Sartorius muscle flap for wounded coverage.

We reviewed 632 cases which had undergone ultrasonograpy for thyroid disorders.(1) The sonographic examination found nodular lesions in 157 cases (including 52 solid tumor cases) and diffuse enlargement in 38 cases. No abnormalities were found in the remaining437 cases.(2) Further examination revealed that the cases of nodular lesions included 7 thyroid cancer cases (6 papillary carcinomas and 1 follicular carcinoma), 2 cases of hyperthyroidism, and 3 cases of hypothyroidism.(3) Diffuse enlargement cases included 5 cases of overactive thyroid (1 subacute thyroiditis and 5 Graves' diseases), 2 cases of underactive thyroid (chronic thyroiditis). Assays for antithyroid autoantibodies showed positive results even in the 31 cases of normal thyroid function.(4) Four in 7 cases diagnosed as thyroid cancer and 5 in 12 cases diagnosed as thyroid dysfunction (4 of 5 cases were elderly people 60 years of age or over) were screened by ultrasonography.
We concluded that ultrasonography is a valuable diagnostic procedure for early detection of not only thyroid malignancies but also disordered thyroid function. Abdominal sonography is often used for screening. The use of ultrasound for the thyroid gland is recommended as a standard procedure in the regular health screening program.

Complete revascularization of the coronary artery was performed in a 73-year-old man who had severe stenosis of the bilateral subclavian and left vertebral arteries and severe calcification of the ascending aorta. At first, we performed CABG (coronary artery bypass grafting) on the LAD (left anterior descending artery) and the RCA (right coronary artery) without cardiopulmonary bypass. In-situ GEA (gastroepiploic artery) was anastomosed to the LAD and SVG (saphenous vein graft) was anastomosed to 4 PD (4 posterior descending artery) of the RCA. The right brachiocephalic artery was selected as the site of the proximal anastomosis of the SVG. A Palmaz-Schatz stent was then held in place in the LCX (left circumflex artery) postoperatively. The combination of CABG without cardiopulmonary bypass and PTCA was a safe method for preventing cerebrovascular complications in a patient with a severely calcified artery.

Objective : Although an endoleak is the most common complication after endovascular abdominal aortic aneurysm repair (EVAR), the proper and noninvasive method for the detection of endoleaks is not established. The purpose of this study is to investigate whether plasma levels of D-dimer and fibrin degradation product (FDP) could be predictors of endoleaks after EVAR. Methods : Between June 2011 and January 2014, 65 consecutive patients underwent EVAR at our institution. We evaluated 55 patients excluding 10 patients pre-existing conditions such as aortic dissection, arterial or venous thrombosis, conversion to open surgery, and difficulties in making outpatient visits. Enhanced computed tomography (CT) examination was performed during 12 months after EVAR. Persistent endoleaks and maximum aneurysmal diameter were evaluated at each follow-up time. Patients were divided into groups according to CT findings at 12 months after EVAR. There were 26 patients with endoleaks vs. 29 non-endoleak patients, 34 with unchanged aneurysm findings vs. 21 with shrinkage. No patient showed aneurysmal enlargement. Plasma levels of D-dimer, FDP, counts of platelet, prothrombin time (PT), and activated partial thromboplastin time (APTT) were also measured at the time of CT examinations. Results : There was no operative death and no major complication. Endoleaks in all patients were identified as type II. None of them required re-intervention. In the endoleak group, plasma levels of D-dimer and FDP were significantly higher than in the non-endoleak group in each postoperative period. In addition, postoperative counts of platelet were significantly lower in the endoleak group. PT and APTT test results showed no significant difference in the two groups. In the unchanged aneurysm group, postoperative D-dimer and FDP tended to be higher compared with the shrinkage group. Postoperative counts of platelet also tended to be lower in the unchanged group. There were no differences in PT and APTT test results. Conclusion : Plasma levels of D-dimer and FDP are potentially useful predictors of endoleaks after EVAR.

A 14-year-old women who had a history of aortic root replacement at 7 years old admitted our hospital due to dilatation of aortic arch aneurysm. Loeys-Dietz syndrome was diagnosed when she was 10 years old. Computed tomography showed 70 mm proximal arch aneurysm. Operative findings revealed brachiocephalic artery and left common carotid artery branched from aneurysm. Partial arch replacement was performed and distal anastomosis was made between left common carotid artery and left subclavian artery. Close observation by CT regularly is necessary and undergo aortic repair not to miss the timing of surgery.

Purpose: Most studies have investigated the differences in postgastrectomy quality of life (QOL) based on the surgical procedure or reconstruction method adopted; only a few studies have compared QOL based on tumor location. This large-scale study aims to investigate the differences in QOL between patients with esophagogastric junction cancer (EGJC) and those with upper third gastric cancer (UGC) undergoing the same gastrectomy procedure to evaluate the impact of tumor location on postoperative QOL. Methods: The Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45) questionnaire was distributed in 70 institutions to 2,364 patients who underwent gastrectomy for EGJC or UGC.A total of 1,909 patients were eligible for the study, and 1,744 patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) were selected for the final analysis. These patients were divided into EGJC and UGC groups; thereafter, the PGSAS-45 main outcome measures (MOMs) were compared between the two groups for each type of gastrectomy. Results: Among the post-TG patients, only one MOM was significantly better in the UGC group than in the EGJC group. Conversely, among the post-PG patients, postoperative QOL was significantly better in 6 out of 19 MOMs in the UGC group than in the EGJC group. Conclusions Tumor location had a minimal effect on the postoperative QOL of post-TG patients, whereas among post-PG patients, there were definite differences in postoperative QOL between the two groups. It seems reasonable to conservatively estimate the benefits of PG in patients with EGJC compared to those in patients with UGC.

PURPOSE: Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC. MATERIALS AND METHODS: A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied. RESULTS: The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients. CONCLUSION: Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Aged ; Disseminated Intravascular Coagulation/complications/diagnosis/*drug therapy ; Female ; Fibrinolytic Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Sepsis/complications/diagnosis/*drug therapy ; Time Factors ; Treatment Outcome

Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41–79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire. Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4–833.1) and 484.8 mmol/L (95% CI, 381.1–588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6–7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3–6,817.9), respectively; however, the difference was not significant (p=0.72). Conclusions The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.