The patient was a 75-year-old man who was referred due to hematuria. CT revealed bladder carcinoma 8cm in length, a 5-cm aneurysm of the abdominal aorta and a 3-cm aneurysm of the left common iliac artery. He was referred to our hospital for the treatment of bladder carcinoma and aneurysms. We simultaneously performed Y graft replacement, radical cystectomy and bilateral cutaneous ureterostomy. His postoperative course was uneventful, without any prosthetic infection.

Left ventricular reconstruction methods (LVR) consisting of the Dor procedure or septal anterior ventricular exclusion (SAVE) have been advocated for left ventricular dysfunction due to ischemic cardiomyopathy (ICM). This study reports early results achieved with LVR in patients with ICM. Between April 2001 and August 2004, 9 patients with ICM underwent LVR and coronary artery bypass grafting (CABG). Their age was 62±11 years, and 7 were men. The Dor procedure was performed in 8 patients and 1 patient underwent SAVE. CABG was performed in all patients. Two patients with grade 3 mitral regurgitation (MR) preoperatively had mitral valve annuloplasty (MAP). The mean left ventricular ejection fraction (LVEF) improved from 31.6±7.2% to 47.8±9.4%. The mean left ventricular end diastolic volume index (LVEDVI) decreased from 166.7±50.4ml/m² to 102.6±23.0ml/m². The mean left ventricular end systolic volume index (LVESVI) decreased from 114.4±34.7ml/m² to 52.4±16.6ml/m². The mean coaptation depth decreased from 9.3±3.1mm to 4.5±1.4mm. The mean MR, with or without MAP, improved from grade 1.7±1.1 to grade 0.2±0.4. There were no hospital deaths. Seven of 9 patients were categorized as New York Heart Association functional class I at discharge. We conclude that LVR is an effective treatment for ICM with severe left ventricular dysfunction.

A 64-year-old man who underwent aortic valve replacement with a 25mm Bjork-Shiley valve in 1993 began to have severe anemia and required repeated transfusions by November 2003. Doppler echocardiography showed only mild aortic regurgitation, but revealed turbulent flow around the mechanical valve. Autoimmune hemolytic anemia (AIHA) was diagnosed and he was treated with prednisolone (PSL) starting May 2004. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent rereplacement of the aortic valve with a 25-mm Freestyle valve. His hemolysis and general condition immediately improved. This case suggests the possibility that mild regurgitant jet and turbulent jet stress can cause severe hemolysis when AIHA develops.

Primary cardiac malignant tumors are relatively rare, and their prognosis is poor. We report a patient with sarcoma causing severe mitral regurgitation and stenosis due to rapid and specific infiltration into the mitral valve.

The effects of high concentration mineral water bating (31.16g/kg, mainly composed of Na, Ca, Mg chloride and sulfate) were studied in 13 healthy men (44.9±16.3y.o.). The subjects took 41°C, 10min bathing and kept warmth by a blanket for 30min. Blood pressure (BP), Heart rate (HR), cardiac output (CO), total peripheral resistance (TPR) and sublingual temperature by electric thermista as deep body temperature were measured during and after bathing. Skin blood flow by LASER doppler flow meter and venous partial gas pressure and pH were also measured.
Sublingual and forehead temperature was increased significantly by +1.4°C after 10min bathing and +0.9°C increase continued even after 30min. Diastolic BP and TPR were significantly decreased, and HR and CO were significantly increased by +20bpm and +2.7l/min, respectively. Significant increase of skin blood flow was also demonstrated. Significant increase of venous pO₂ (+20 Torr) and decrease of pCO₂ (-8.0 Torr) suggested the improvement of peripheral oxidative metabolism due to increased CO.
High concentration mineral water bathing was highly effective than simple water bathing probably due to the thick coating effect by binding concentrated minerals with skin furface protein.

A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm²) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.

An 80-year-old woman presented with neck pain and paraparesis of Frankel C in her upper and lower extremities after falling. Imaging revealed an ankylosing cervical spine and a fracture line running obliquely from the anterior C3-4 to the posterior C4-5 level. Posterior fixation from the occi pit to T3 was performed using the RRS Loop Spine System and concomitant polyethylene tape fixation. This system is characterized by the uniqueness of how it screws to the occi pit and its use of a fixation rod with a larger diameter than in other instrumentation devices for use in the cervical region. Sublaminar banding using polyethylene tape was used to secure fixation. Her postoperative course was unremarkable, and her neck pain was relieved, although neurological improvement was minor. To our knowledge, this is the first report of an application of the RRS Loop Spine System to an ankylosing spondylitis patient with a cervical fracture.
Aged ; Aged, 80 and over ; Female ; Humans ; Lower Extremity ; Neck Pain ; Paraparesis ; Polyethylene ; Running ; Spine ; Spondylitis, Ankylosing

STUDY DESIGN: Prospective study. PURPOSE: The main purpose of this study was to clarify the range of magnification errors on digital plain radiographs and to determine if there is a correlation between the body mass index (BMI) of a patient and the magnification error. OVERVIEW OF LITERATURE: Most clinicians currently use digital plain radiography. This new method allows one to access images and measure lengths and angles more easily than with the past technologies. In addition, conventional plain radiography has magnification errors. Although few articles mention magnification errors in regards to digital radiographs, they are known to have the same errors. METHODS: We used plain digital radiography and magnetic resonance imaging (MRI) to acquire images of the cervical spine with the goal of evaluating magnification errors by measuring the anteroposterior vertebral body lengths of C2 and C5. The magnification error (ME) was then calculated: ME=(length on radiograph-length on MRI)/length on MRI x100 (%). The correlation coefficient between the magnification error and BMI was obtained using Pearson's correlation analysis. RESULTS: Average magnification errors in C2 and C5 were approximately 18.5%+/-5.4% (range, 0%-30%) and 20.7%+/-6.3% (range, 1%-32%). There was no positive correlation between BMI and the magnification error. CONCLUSIONS: There were magnification errors on the digital plain radiographs, and they were different in each case. Maximum magnification error differences were 30% (C2) and 31% (C5). Based on these finding, clinicians must pay attention to magnification errors when measuring lengths using digital plain radiography.
Body Mass Index ; Humans ; Magnetic Resonance Imaging* ; Prospective Studies ; Radiographic Image Enhancement ; Radiography ; Spine*

OBJECTIVE: To evaluate the applicability of carotid Doppler echography for the assessment of changes of peripheral hemodynamics in the hypertensives. SUBJECTS: 28 hypertensives (17 males, 11 females), mean age of 64 yrs and 40 normal controls (24 males, 16 females) mean age of 49 yrs. METHODS: We recorded the right common carotid arterial Doppler flow velocity (BFV) pattern and measured the peak velocities of the percussion wave (P) and late rising tidal wave (T), the ratio of the two (P/T), the time interval between the two peaks corrected by heart rate (P-Tc), systolic flow velocity integral (FVI) and carotid artery diameter (CAD) before and after 0.4 mg dose of subligual nitroglycerin (NTG). RESULTS: 1) In hypertensives, the P wave velocity showed lower and P-Tc interval shorter than those of the normal controls at baseline. 2) After NTG, the P-Tc and P/T increased, but the T and FVI decreased significantly in both groups of subjects. 3) The P/T ratio was less significantly increased after NTG in the hypertensives than in the controls. These results suggest that NTG might have been involved in concomitant reduction and delay of the wave reflection from the peripheral vessels, preferentially in the normal subjects than in hypertensives. CONCLUSIONS: The carotid Doppler echography can be useful for the evaluation of the changes of hemodynamics in the peripheral vessel such as carotid artery in hypertensive subjects.
Administration, Sublingual ; Blood Flow Velocity/drug effects ; Carotid Arteries/ultrasonography ; Carotid Arteries/drug effects ; Case-Control Studies ; Female ; Human ; Hypertension/ultrasonography ; Hypertension/physiopathology* ; Hypertension/drug therapy* ; Male ; Middle Age ; Nitroglycerin/administration & dosage* ; Ultrasonography, Doppler, Color ; Vasodilator Agents/administration & dosage*

We report a case of extracardiac rupture of the left Valsalva sinus aneurysm, which is an extremely rare and fatal lesion. The three drugs, clindamycin, ethambutol and rifampicin, had been administered for eleven years because of lung mycobacterium infection. An emergency surgery was performed because of cardiac tamponade. The left Valsalva sinus was entirely enlarged without an aneurysmal neck. The other Valsalva sinuses seemed to be almost normal. The aneurysmal wall adhered the pulmonary artery and the left atrium. The left descending and circumflex arteries independently originated from the aneurysmal wall. The left main trunk seemed to become a part of the aneurysmal wall. Additionally the intraoperative transesophageal echocardiography showed severe aortic regurgitation. The Bio-Bentall procedure was performed. The right coronary artery was reconstructed with the Carrel patch method and the saphenous vein grafts were anastomosed to the proximal portions of the left anterior descending and circumflex arteries, individually. On the thirty-third postoperative day, the patient was discharged uneventfully expect for the delayed sternal closure on the second postoperative day. Five and half years after surgy, the patient is living a normal life and rifampicin has been administered without any anticoagulation drugs.