Recently, eosinophilic chronic rhinosinusitis (ECRS) has become a very common disease in Japan. ECRS differs from other types of sinusitis in terms of clinical features, such as high rate of recurrence, olfactory disorders, ineffective macrolide therapy, and severe paranasal sinus shadow on CT imaging. The diagnosis of ECRS requires a biopsy of nasal polyps. Therefore, we tried to predict ECRS by evaluating CT images using the Lund-Mackay CT Scoring system (LMS). This retrospective study involved 105 patients who had undergone surgical treatment (ESS) between July 2011 and November 2012. These patients were divided into three groups based on patterns of pathogenesis: ECRS, fungal sinusitis (FS), and chronic sinus infection (CSI). The pathological classification of nasal polyp was graded on a 3-point scale according to the degree of eosinophilic infiltration. Total LMS score for the ECRS was 9.4±0.6 (mean±SE), which was significantly higher than for the other LMS scores (FS: 4.6±1.0, CSI: 5.8±0.2). LMS scores for the maxillary sinus were high for all three patterns of pathogenesis (ECRS: 1.4± 0.1, FS: 1.7±0.2, CSI: 1.3±0.1). The scores for the frontal and sphenoid sinus forECRS were significantly higher than the scores for the FS and CSI (maxillary sinus, ECRS: 1.5±0.1, FS: 0.4±0.2, CSI: 0.6±0.1; sphenoid sinus, ECRS: 1.4±0.2, FS: 0.2±0.1, CSI: 0.6±0.3). We assessed for and found a positive correlation between the bilateral LMS score and eosinophilic infiltration (rs＝0.665). Therefore, ECRS can be predicted by LMS without biopsy and LMS helps determine the management of chronic rhinosinusitis.

A 54-year-old woman underwent abdominal aortic replacement for abdominal aortic aneurysm in March 2012. Approximately 6 months after surgery, she was taken by ambulance to hospital due to thoracodorsal pain, lower limb paralysis and pain. Emergency computed tomography indicated acute aortic dissection involving the ascending aorta, aortic arch, and descending aorta. The outline of the prosthesis implanted in the abdominal aorta was absent, and emergency surgery was performed immediately by median sternotomy to treat suspected complete obstruction. Following confirmation of brachiocephalic artery dissection, extracorporeal circulation was started with drainage of blood from the vena cava and the return via left axillary artery, plus perfusion in both lower limbs. However, the level of regional oxygen saturation declined as the flow of extracorporeal circulation increased. To solve this problem, an incision was made in the ascending aorta, and an aortic cannula was inserted directly into the true lumen. Aortic arch replacement was then performed, but this central repair failed to improve blood flow in both the left and right femoral artery. Proximal thrombectomy successfully removed a large amount of thrombi, but did not improve blood circulation. Left axillobifemoral bypass was subsequently performed, and improved lower limb blood circulation, but with residual motor impairment. Since the patient regained somatosensory sensation and was able to perform simple exercises, rehabilitation was started. Hemodialysis was required after abnormal increases in muscle enzyme levels and white blood cell count, but this was later discontinued following improvement of renal function. The patient was transferred to a rehabilitation clinic 54 days after surgery.

Objectives : Mediastinitis results in significant morbidity in pediatric patients after cardiac surgery. The management of mediastinitis is not well established in the pediatric population. Our strategy for pediatric mediastinitis after cardiac surgery consists of rapid introduction of simple vacuum-assisted drainage system and sternal closure without plombage under aseptic conditions. The efficacy of our strategy was examined. Methods : The records of 7 pediatric patients with mediastinitis after cardiac surgery managed with this drainage system from May 2006 to May 2013 were retrospectively reviewed. The median age of the patients was 20.5 months and median body weight was 9.7 kg. Mediastinitis occurred 1-3 weeks after surgery. The mediastinum was re-explored immediately under general anesthesia after the diagnosis was made, and continuous drainage was used after extensive debridement was performed. We developed a simple vacuum-assisted drainage system consisting of conventional polyurethane foam, surgical drape containing povidone-iodine, and 1 to 3 silicone drainage tubes connected to a drain aspirator (-99 cmH₂O). Patients were allowed oral intake and resumption of daily activity after extubation. The components of the drainage system were exchanged every 2-3 days. The sternum was closed without the use of the omentum or muscle for plombage of the mediastinum after two negative topical swab cultures were obtained. Results : Negative topical swab cultures were obtained in all cases (3-12 days after the drainage commencement) and the sternum was closed 7-19 days after the drainage commencement. The median duration of hospital stay was 31 days (range, 14-47). Although one patient with prenatal infection died of aortic rupture, the remaining six children survived and did not experience recurrence after hospital discharge. Conclusion : The simple vacuum-assisted drainage system enabled rapid control of wound bacterial infection and sternal closure in postoperative pediatric mediastinitis without the need for special, and expensive devices.

This case report describes a 20-year-old man, who was a drug abuser, and was treated surgically for tricuspid valve endocarditis. He presented with fever, caused by tricuspid valve endocarditis with a lung abscess. Blood culture detected Staphylococcus aureus and cardiac ultrasonography showed tricuspid insufficiency and tricuspid valve vegetation. He was treated with intravenous antibacterial agents, but the inflammation signs did not improve. He had a large number of puncture scars, as a consequence of self-injection of drugs in his lower arm. He underwent tricuspid valve plasty, and recovered successfully. He was discharged 2 weeks after surgery, and we instructed him to return for follow-up examination in our hospital. However, he did not return to our hospital because he was arrested for drug possession. In such cases, it is necessary to consider the operative method relative to reuse of drugs in the postoperative management of medication.

A 48-year-old man underwent an non-anatomical bypass surgery for aortic coarctation when he was 38 years old, when a bypass laid between the left subclavian artery and the descending aorta with a prosthesis (10 mm, internal diameter). Four years after the first surgery, aortic aneurysms at the proximal and distal sites of the coarctation were detected. Six years from then, we decided to perform another surgery when the maximum diameters of the proximal and distal sites exceeded 60 and 47 mm, respectively. We performed the aortic replacement from the proximal left subclavian artery to the descending aorta at eighth thoracic vertebra. The approach to the aortic aneurysm was through the extended left thoracotomy with the transection of the sternum. The cardiopulmonary bypass was established with an antegrade aortic perfusion (from the ascending aorta) and drainage from the right atrium. The circulatory arrest was obtained under deep hypothermia at 20°C measured by deep body temperature. After the surgery, the pressure differences between upper and lower extremities decreased to 10 mmHg, which had been 40 mmHg before surgery. Macroscopic observation showed the coarctation site was completely obstructed by an old thrombus. From this observation, we surmise that one of the reasons for the aneurysmal formation at the proximal site of coarctation might be an insufficient depressurization by the non-anatomical bypass grafting from the left subclavian artery to the descending aorta at the first surgery. We consider that a severe coarctation might become thrombotic sooner or later after a non-anatomical bypass surgery due to a change of blood flow, and a radical anatomical surgery would be recommended for adult coarctation cases.

We report two cases of pseudoaneurysms occurring at the anastomotic sites that had to be repaired several times after the original Bentall and Cabrol procedure. Case 1. A 62-year-old man had surgery to repair pseudoaneurysms at the anastomotic sites of the distal ascending aorta and right coronary artery 22 years after undergoing the original Bentall procedure. The anastomosis of the left coronary artery was normal at the time of the operation ; however, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the left coronary artery 2 years after the operation. Case 2. A 61-year-old man with Marfan syndrome underwent surgery twice to repair pseudoaneurysms at the anastomotic sites of the aortic annulus and the left coronary artery 2 and 11 years, respectively, after the original Cabrol procedure. In addition, 23 years after the Cabrol procedure, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the distal ascending aorta. Their pseudoaneurysms were successfully treated by the reanastomosis of new grafts. Computed tomography detected no recurrence of the pseudoaneurysm in the follow-up period. However, continual close observation for the recurrence of a pseudoaneurysm in the remaining anastomotic sites is necessary.

BACKGROUND/OBJECTIVES: Osteoarthritis (OA) is a major public health issue in Japan and other countries, and foods that prevent or treat OA are in strong demand. Proteins and peptides in chicken meat and bones are known for being rich in functional and nutritional ingredients for the improvement of osteoporosis. We speculated that chicken legs, a food consumed in many regions of the world, may also contain such ingredients. In this study, we aim to (i) evaluate the effect of chicken leg extract (CLE) on the promotion of cartilage matrix production and (ii) identify the active ingredient in CLE that contributes to this function. MATERIALS/METHODS: Artificial CLE digest was prepared, and the acid mucopolysaccharide production-promoting activity of the CLE digest was evaluated by alcian blue staining of ATDC5 cells. CLE was orally administered to rabbits with burr holes in the knee joint of the femur, and the degree of regeneration of cartilage matrix was evaluated. Furthermore, we investigated orally administered CLE-derived peptides in human plasma using LC-MS. From measuring the acid mucopolysaccharide production-promotion activity of these peptides, a molecule considered to be an active ingredient in the CLE digest was identified. RESULTS: CLE digest promoted acid mucopolysaccharide production and facilitated regeneration of cartilage matrix in in vitro and in vivo experiments. Four peptides including phenylalanyl-hydroxyproline (Phe-Hyp) were detected as CLE-derived peptides in human plasma. The effect of CLE was inferred to be due to Phe-Hyp, which was confirmed to be present in the CLE digest. CONCLUSIONS: It was shown that CLE stimulated the production of articular cartilage matrix both in vitro and in vivo, and that CLE could be an effective food for preventing or treating OA. Furthermore, only Phe-Hyp was confirmed as the active compound in the CLE digest, suggesting that the activity of CLE was due to Phe-Hyp.
Alcian Blue ; Cartilage ; Cartilage, Articular ; Chickens ; Femur ; Humans ; In Vitro Techniques ; Japan ; Knee Joint ; Leg ; Meat ; Osteoarthritis ; Osteoporosis ; Peptides ; Plasma ; Public Health ; Rabbits ; Regeneration