We report the use of endovascular stent-graft treatment for a case of traumatic thoracic aortic dissecting aneurysm complicated with multiple injuries. A 65-year-old man who had fallen from a 6m high roof was admitted to our hospital with severe circulatory failure and deep coma. Examination showed right hemopneumothorax, hematoma around the thoracic descending aorta and abdominal cavity, and bone fractures of all right ribs, skull, right clavicle, pelvis and lumbar vertebra. The patient recovered without major neurological deficit, but a dissecting aortic aneurysm approximately 6.5cm in diameter occurred at the proximal portion of the descending aorta. Since we considered that conventional aortic repair would be difficult with high operative risks based on the complicated thoracic and head injuries, we performed an endovascular stent-graft treatment. The postoperative course was uneventful and the aneurysmal diameter has been decreasing to date.

Adventitial cystic disease of the popliteal artery is a rare condition of uncertain etiology. A 32-year-old sportsman had sudden claudication in the left leg. Arteriography demonstrated smooth narrowing of the left popliteal artery. Treatment consisted of surgical removal of the cyst and patch angioplasty. He had no signs of recurrence at one year after treatment. Now, he enjoys sports again.

We report a rare case of brachiocephalic arterial aneurysm associated with rapid tracheal obstruction. A 68-year-old woman visited our hospital because of progressive dyspnea. She developed acute respiratory failure and emergency incubation was performed. CT revealed a large brachiocephalic arterial aneurysm causing severe tracheal stenosis by compression. Angiography revealed a saccular aneurysm behind the brachiocephalic artery. It also demonstrated a common trunk of the brachiocephalic and the left common carotid artery. Aneurysmectomy with arterial reconstruction using an 8-mm prosthetic graft was performed while monitoring of regional cerebral oxygen saturation without extracorporeal circulation. The postoperative course was uneventful and there was no postoperative neurological deficit.

Objective : To investigate the surgical outcomes of left ventricular free wall rupture (LVFWR) and ventricular septal perforation (VSP) in terms of mechanical complications following acute myocardial infarction (AMI). Methods : Subjects comprised 26 patients (male : 12, female : 14, mean age : 74 years) who underwent surgery between 2001 and 2012. The LVFWR type was blowout in 2 cases and oozing in 5 cases. Immediately after diagnosis, 4 cases underwent intra-aortic balloon pumping (IABP) and 2 cases received extracorporeal membrane oxygenation (ECMO). LVFWR was repaired by suture and patch closure in 5 patients and by TachoComb in 2 patients. VSP was caused by anterior infarction in 15 cases and inferior infarction in 5 cases. IABP was inserted in 16 cases. VSP was repaired by the infarct exclusion technique in 17 patients, while 2 patients underwent suture or patch closure. Results : The operative mortality rate was 14.3% for LVFWR and 15.8% for VSP. The cause of operative death in 1 patient with blowout type LVFWR who was in a state of cardiopulmonary arrest on arrival, was low cardiac output syndrome (LOS). The causes of operative death in VSP included 2 patients with LOS and 1 patient who died suddenly 8 days postoperatively due to ventricular fibrillation. Two VSP patients underwent repeat surgery for residual shunt. The five-year Kaplan-Meier survival rates were 85% for LVFWR and 62% for VSP. Of 20 patients who received IABP preoperatively, the time from confirming LVFWR or VSP diagnosis after admission to IABP initiation was 103±45 (48-120) min in the survival group (n=17) and 259±174 (122-455) min in the operative mortality group (n=3). A significant difference was observed between the two groups (p=0.04). Conclusion : Therapeutic strategies including rapid diagnosis after admission, early insertion of IABP, and prompt surgery could improve the prognosis for patients with LVFWR and VSP following AMI.

A 24-year-old woman, under the treatment for atypical depression, visited our emergency room on foot with a chief complaint that she stabbed herself in the chest with a sewing needle. Chest X-ray and plain CT showed the needle penetrating the chest into the heart. There was no sign of pneumothorax or cardiac tamponade. She was hemodynamically stable. Echocardiography revealed atrial septal defect (ASD) by chance. We performed urgent surgery for needle removal and ASD closure through median sternotomy. The needle was easily recognized near the right ventricle apex. The right atrium was opened, but the needle was not seen through the tricuspid valve because of trabecular formation. After the needle was removed, ASD was closed using the direct suture method. The needle was 35 mm long. She was transferred to the psychiatry department on postoperative day 4 and had a good postoperative course.

The purpose of this study was to investigate the relationship between low back pain (LBP) any physical characteristics in university wrestlers. We especially focused on radiological abnormalitie (RA) in their lumbar regions.
Physical characteristics and isokinetic trunk muscle strength of the 55 male university wrestlers were measured. MRI was used to evaluate the cross-sectional areas of trunk muscles between lumbar spine 3 and 4 (L3/4) . Evaluations of LBP were based on the diagnose of orthopedic surgeons and the questionnaire test. According to this evaluation, we assigned all wrestlers into two groups as the LOP group and the no LOP group. Furthermore, four groups were defined by having RA based on X-ray and MRI diagnose.
We obtained the following results. In comparison between the LOP group and the no LOP group, the trunk muscle extension flexion strength ratio of the LOP was significantly lower than that of the no LOP group. In addition, the LOP without RA group showed significant low strength of their trunk extensors in comparison with the no LOP without RA group.
We considered that the relative low strength of trunk extensors should have some effect on LBP in university wrestlers.

The purpose of this study was to investigate relationships between low back pain (LBP) and psychological conditions in university wrestlers.
We examined psychological conditions of seventy male university wrestlers using the Psycholo gical Condition Inventory (PCI) test and evaluated whether psychological conditions have some relationships with LBP. Evaluations of LBP were based on a questionnaire test and the diagnosis of orthopedic surgeons. Based on the LBP evaluation, we assigned all wrestlers into two groups as the LBP group and the non-LBP group.
We obtained the following results. There were twenty-eight university wrestlers (40%) in the LBP group and forty-two wrestlers (60%) in the non-LBP group. Wrestlers in the LBP group showed significantly high values in all factors relating to fatigue in comparison to the non-LBP group.
We conclud that the university wrestlers with LBP feel fatigue in their minds and bodies.

A 76-year-old woman with abdominal aortic aneurysm coexisting horseshoe kidney and pelvic arteriovenous malformation (AVM) is reported. Operation was performed by a transperitoneal approach via typical median laparotomy. The aneurysm was successfully replaced by a bifurcated prosthetic graft without division of the renal isthmus. Cold lactated Ringer solution was injected into an aberrant renal artery at the time of aortic cross-clamping. This was useful not only to protect the kidney against ischemic injury, but also to know the perfusion area of the vessel. The aberrant renal artery was attached to the prosthetic graft following the aortic proximal anastomosis. Though a part of the asymptomatic AVM, which involved the left ureter, ovary, and uterus, was located anterior to the left iliac arteries, distal anastomoses at the internal and external iliac arteries were done smoothly. No surgical intervention was applied to the AVM in the operation. The post-operative course was uneventful.

The purpose of this study was to clarify physical characteristics related to low back pain (LBP) in collegiate track and field athletes. We particularly focused on the nature of the track and field. The subjects were 21 male collegiate track and field athletes including only sprinters, hurdlers, long jumpers and triple jumpers. The examined parameters were physical characteristics, isokinetic flexor and extensor strength in the knee and trunk regions. The evaluation of LBP was estimated by a questionnaire test and orthopedic surgeons' diagnosis. According to these evaluations, we divided all track and field athletes into two groups ; LBP group (n＝11, 52.4%) and no LBP group (n＝10, 47.6%). As a result, a take-off leg of knee flexor/extensor strength ratio in the LBP group was significantly lower than that in the no LBP group (P＜0.05). The LBP group showed a significant difference between a take-off leg and a lead leg in knee flexor strength compared with the no LBP group (P＜0.05). The LBP group has been short engaged in the track and field than the no LBP group (P＜0.05). In the trunk flexor and extensor strength, there was no significant difference between the LBP and the no LBP group in this study. These results suggest that the imbalanced knee muscle strength may be one of some factors related to chronic low back pain in collegiate track and field athletes.

In Japan, few surveys have evaluated the structure and clinical process of cardiovascular surgery programs. We mailed a questionnaire to all 149 facilities participating in the Japan Adult Cardiovascular Database as of April 1st 2007. We received responses from 129 facilities (response rate 86.6%). For CABG surgery, many facilities regard “IMA use (95.3%) ” and “off-pump surgery” is the first choice as a facility and recommend “discharge antiplatelets (89.9%) ” and “discharge antilipid (47.3%) ”. On the other hand most facilities did not made any recommendation regarding “preoperative beta blockers (72.9%) ” and “discharge beta blockers (60.5%) ”. The usage rates of preoperative beta blockers and discharge beta blockers were very low in Japan though their usage rates were relatively high in the United States.