A Successful surgical repair of a ruptured ventricular septum concomitant with a left ventricular free wall rupture secondary to myocardial infarction was performed on a 81-year-old woman. Anterior myocardial infarction was accompanied with a ventricular septal rupture, 7mm in size, and hemorrhagic dissection type left ventricular free wall rupture. Acute ventricular aneurysm formation of the left ventricle was also noticed. A review of the literature reveals that in surgical cases, the hemorrhagic dissection type ventricular rupture in left ventricle was usually concomitant with ventricular septal rupture.

Cystic adventitial disease of the popliteal artery is a rare cause of lower extremity occlusive disease. We report 2 cases of this disease. Two male patients aged 27 and 59 year old complaining of intermittent claudication visited our vascular service. Angiography showed a smooth sharp defect of the popliteal artery. Postcontrast computed tomography (CT) scanning and magnetic resonance image (MRI) showed a cystic lesion around the popliteal artery. One patient underwent resection of the cyst, which in the other patient endscopic surgery was performed with the aid of intravascular ultrasonograpy and intravascular endscope. Fifty three cases of this disease have been reported in Japan so far. These patients included 45 men and 8 women with a mean age of 47.7, ranging from 19 to 76 years old. Chief complaints were commonly intermittent claudication and sensory disturbance. In all cases, angiography revealed a smooth sharp defect. Recently 3D-CT scan, ultrasonography and magnetic resonance angiography (MRA) also are accurate for cystic lesions around the popliteal artery and these new technologies easily distinguish such cases from arteriosclerosis obliterans, Buerger disease and popliteal entrapment syndrome. Treatment consist resection of the cyst, in 27 cases reconstruction of the popliteal artery using a saphenous vein graft or artificial graft in 19 cases, percutaneus aspiration under the guide of CT and endscopy in 2 cases and 1 with spontaneous resolution, was seen in 1 case. In conclusion, we encountered 2 cases of cystic adventitial disease of the popliteal artery. 3D-CT scan, ultrasonography and MRA were useful for preoperative diagnosis and evaluation of postoperative condition.

Many institutions have applied a tutorial system to medical education since Tokyo Women's Medical College started doing so in 1990. Chiba University School of Medicine started a clinical tutorial system in April 1997 and has continued it for 4 years. Our system has employed problem-based learning using cases, with the goal of students' acquiring self-learning and problem-solving skills. This tutorial system has been positively evaluated by both students and instructors and is likely to be useful for clinical medical education.

We encountered a recurrent suprarenal abdominal aortic aneurysm (AAA) patient with coronary artery disease and hyperlipidemia after repair of infrareanal AAA. A 72-year-old woman complaining of an abdominal throbbing mass was admitted. Computed tomography (CT) and aortography revealed infrarenal AAA which was totally removed and Dacron graft was replaced. The patient was followed as an outpatient. At the time of initial graft replacement there was no remarkable aneurysmal change in suprarenal abdominal aorta. Five years after the initial operation, a suprarenal AAA 5cm in diameter was detected by ultra sonographic examination. CT scan and aortography confirmed suprarenal AAA involving the celiac trunk of the supramesenteric artery and renal artery. Redo AAA operation with reconstruction of these branches was performed under V-A bypass support in a thoracoabdominal approach. Slight renal and liver dysfunction occurred postoperatively. However, serum creatine GOT and GPT values normalized by the ninth postoperative day. Postoperative aortography revealed patency of all branches.

Reperfusion injury occasionally occurred after revasculization of acute arterial occlusion (AAO). The most common reason of death is myonephropatic metabolic syndrome due to reperfusion injury. This paper focusses on the criterion of systemic inflammatory response syndrome (SIRS). From January 1987 to April 1996, we treated 89 patients (male 59/female 30) with lower limb AAO. The mean age was 68.5 (ranging from 16 to 94) years old. There were 59 cases of thrombosis, 25 of embolism, 2 trauma and 3 dissecting aneurysm of the aorta. These patients were divided into two groups according to whether or not they fulfilled the criterion of SIRS. Of these patients, 46 cases met the criterion of SIRS (SIRS group) but the other 43 did not (non-SIRS group). We compared the two groups. The mortality of the SIRS group (23.9%) was higher than the non-SIRS group (2.3%). The ischemic time of the SIRS group (83.1±113.3 hours) was longer than the non-SIRS group (37.5±38.2 hours). Complications of MNMS were more common in the SIRS group (15.3%) than in the non-SIRS group (2.3%). The ischemic area in the SIRS group was remarkably less than in the non-SIRS group. Conclusion: The criterion of SIRS as indicated by the measurement of interleukin 8 (IL-8) was a useful prognostic parameter for limb salvage rate and mortality of AAO patients.

In general the incidence of peripheral arterial aneurysm is said to be low. We focussed on popliteal aneurysm and enrolled 18 legs in 14 patients with popliteal aneurysm who visited us during the period from 1974 to January 1998 in our study. Acute arterial occlusion was observed as a complication in 6 of the 14 patients (42.9%) and rupture developed in 4 patients (28.6%), and on those occasions this disease was frequently detected and treated for the first time. Although this disease is said to scarcely affect prognosis, we encountered patients for whom amputation of the leg was unfortunately required. This disease was thus considered to require sufficient care. Popliteal arterial aneurysm is frequently palpable from the body surface and increased recognition of this disease should enable more appropriate treatment.

In order to investigate an effects of the hot spring within a short period on immune system of human, the leukocyte, monocytes, lymphocyte and lymphocyte surface markers: CD2, CD4, CD8, CD16, CD19 and CD57 were tested in the human peripheral blood of twenty-three healthy volunteers by hot spring bathing. The results were as follows: Total number of leukocytes and lymphocytes in the peripheral blood significantly increased in an older group after hot spring bathing (p<0.01). However, we obtained a clear decrease in the number of granulocyte after hot spring bathing in the younger group (p<0.01). In addition, we found greater increase of the CD16⁺ cell counts and a clear decrease of the CD19⁺ cell counts in older group. But in younger group, we also obtained an increase of CD8⁺, CD16⁺ cells after hot spring bathing. These results indicated that hot spring bathing can regulate the physical immune system.
According to the percentage of lymphocytes or granulocytes in the total leukocytes, volunteers were divided into two types, more than 70% of granulocyte were recognized as G type and more than 40% of lymphocyte were divided in the L type. We found an increase of lymphocyte and lymphocyte subsets as well as a decrease in granulocyte in G group by hot spring bathing. But in L group, especially, indicated a greater increase in granulocyte and a decrease in lymphocyte subsets. We suggest that hot sping bathing can regulate by an autonomic nerve system, making it suitable.

We have simultaneously proved that cell populations taking charge of immunity in human peripheral blood can be regulated quantitatively by hot spring bathing. Now, we investigated the effect of hot spring bathing qualitatively on cytokine production by lymphocyte cell in human peripheral blood estimating by cytokine containing cell by FACScan. We found a significant increase in IFN-γ containing cells after hot spring bathing and an increase in IL-4 with no statistical significance after hot spring bathing. In addition, we found significant negative relationship between the level of IFN-γ, IL-4 and IL-1β before hot spring bathing and the ratio of cytokine that increased in variation after hot spring bathing. Namely, after hot spring bathing, there was a decrease of cytokine producing cells in subjects who had higher level before hot spring bathing. But an increase in subjects who had lower level before hot spring bathing, the trend was concentrated toward average levels in the cytokine production by lymphocyte in peripheral blood. So we suggest that hot spring bathing can promote acquired immunity to make it possible more suitable as immune reaction.

BACKGROUND: There have been several reports on neonates with milk allergy in a neonatal ward. This type of allergy is mostly categorized as a non-IgE-mediated food allergy. Although most cases of milk allergy occur in the first few months of life, the differences in clinical characteristics between premature and full-term neonates are still unclear. OBJECTIVE: This study aimed to clarify the differences in clinical characteristics of milk allergy between premature and full-term neonates. METHODS: We retrospectively evaluated 2,116 neonates admitted to the Department of Neonatology, Chiba Kaihin Municipal Hospital, between 2001 and 2007. RESULTS: We identified 24 neonates strongly suspected of having milk allergy because of symptoms, such as bloody stools, repeated vomiting, diminished sucking and abdominal distension, as well as objective laboratory findings of eosinophilia in stool cytology and/or positive results for a rectal milk challenge test. Twelve of these 24 neonates were premature (median gestational age, 31 ± 3 weeks; median birth weight, 1,656 ± 592 g) and the other 12 were full-term (median gestational age, 38 ± 1 weeks; median birth weight, 2,760 ± 560 g). There were no differences in symptoms and time to start of feeding between premature and full-term neonates, but there was a significant difference in the median postnatal age at onset (premature neonates: 23 days; vs. full-term neonates: 3.5 days; p < 0.01). CONCLUSION: All premature neonates developed a milk allergy after 32 weeks of corrected gestational age, suggesting that the development of milk allergy requires a certain degree of immunological maturation.
Age of Onset ; Birth Weight ; Eosinophilia ; Food Hypersensitivity ; Gestational Age ; Hospitals, Municipal ; Humans ; Hypersensitivity ; Infant, Newborn ; Infant, Newborn ; Intensive Care, Neonatal ; Milk Hypersensitivity ; Milk ; Neonatology ; Retrospective Studies ; Vomiting