A 72-year-old man presented with back pain and 3 days after admission, chest and abdominal CT scanning revealed the existence of infrarenal abdominal aortic aneurysm with Stanford type B acute aortic dissection and hemorrhage in the retroperitoneal space. The maximum diameter of the abdominal aortic aneurysm was 60mm. After treating with anti-hypertensive therapy under restrictive observation because of the patient's stable general condition, surgery was performed 45 days after admission. The dissection extended into the abdominal aortic aneurysm and all visceral arteries branched from the true lumen. The presence of thrombus in the preperitoneal space suggested a ruptured abdominal aortic aneurysm. Abdominal aortic aneurysm was replaced with a Y shaped graft and proximal anastomoses was performed with fenestration to prevent rupture of the proximal dissecting aorta. We report a rare case of ruptured abdominal aortic aneurysm following Stanford type B acute aortic dissection, which was operated on in the chronic stage. The patient is doing well.

We report the successful surgical treatment of severe Ebstein's anomaly in a female neonate with pulmonary atresia. Soon after birth, a heart murmur was audible and the baby became cyanotic. Echocardiography showed Ebstein's anomaly with pulmonary atresia. We started a LipoPGE 1 infusion for the open ductus arteriosus, but her uncontrollable heart failure necessitated surgery. Thus, when she was 8 days old, she was placed on cardiopulmonary bypass and we performed a triuspid valve orifice closure with right atrium plication and enlargement of the interatrial communication. She received a modified Blalock-Taussig shunt at the age of 60 days, but a prolonged mirulinone infusion was needed for her persistent heart failure. When she was 10 months old, we inserted a bidirectional Glenn shunt and she was discharged. Finally, when she was 30 months old, she had a total cavopulmonary connection. The patient is now asymptomatic, 18 months after her last operation.

It has been known that access recirculation is positively related to dialyzer blood flow and is negatively related to access blood flow in the vascular access in hemodialysis patients. The present study was designed to examine whether an increase in access recirculation generated by an increase in dialyzer blood flow is related to access blood flow. All patients had native end-to-side arteriovenous anastomoses at the radial site. We measured access recirculation at two different dialyzer blood flow rates (85 and 170 ml/min) using a three-needle technique. Access blood flow rates (mean 668 ml/min ranging from 493 to 1038 ml/min) were measured using Doppler ultrasound sonography. We confirmed that an increase in dialyzer blood flow rate led to an increase in access recirculation (5.4±1.1 vs. 9.9±1.9%, p<0.05), and that access recirculation was negatively related to the access blood flow rate (y=-30.78x+972.20, r=-0.79, p<0.05). We further found a negative correlation between the increase in access recirculation generated by the increase in dialyzer blood flow rate and access blood flow rate (y=-33.88x+821.57, r=-0.75, p<0.05). These results suggested that dialyzer blood flow less affects access recirculation when access blood flow is higher.

To determine the effect of material factors on Ca-P biomaterial-induced osteogenesis, six kinds of biphasic calcium phosphate (BCP) ceramics with different HA to TCP ratio (HA/TCP 2-8, 7-3) and different porous structure (micro-, macro- and micro/macro- porous structures) were implanted intramuscularly in rabbits. Different tissue response was detected histologically and microradiographically after the ceramic samples were implanted in the dorsal muscles of rabbits for 3 and 6 months. Obvious bone formation was found in two kinds of ceramics with the same micro/macro-porous structure at both 3 and 6 months. In contrast, no bone formation or host tissue invasion was detected in two other kinds of ceramics with only micro-porous structure, even after 6 months implantation. Some bone formation was found occasionally in two kinds of ceramics with only macro-porous structure at 6 months. Bone tissue was usually formed in direct contact with the pore surface and was only located in non-dissolved porous regions. Osteocyte lacunae were seen and no pathological calcifications were observed. These results indicate that micro- and macro-porous structure play an important role in the osteoinduction with Ca-P ceramics. Furthermore, the results showed that the osteoinductive capacity of BCP ceramics was influenced by the different dissolution rate through changing HA/TCP ratio.

Effects of single moxibustion on platelet aggregation and ATP-release in mice have been studied. Male ddY mice (6 weeks old) were used as experimental animals. 15mg and 5mg of moxa were divided into 6 cones and mice were treated by each 3 cones at right and left LV-14. The electronic aggregometer was used for measuring platelet aggregation and ATP-release using whole blood. Platelet aggregation and ATP-release activities were determined by collagen (final concentration; 2μg/ml) and ADP (final concentration; 20μM) as inducers.
No significant changes on platelet and red blood cell numbers were found after the moxibustion with 15mg of moxa. However, white blood cell numbers were decreased at 1hr and increased at 24hr after the moxibustion.
After the moxibustion with 15mg of moxa, platelet aggregation activity induced by collagen showed no change, but the mild shortness of lag time was observed from 1 to 5hr. While, the mild suppressive effect on platelet aggregation induced by collagen was observed at 1 and 5hr after the moxibustion with 5mg of moxa.
After the moxibustion with 15mg of moxa, mild increase in platelet aggregation activity at 24hr and in ATP-release activity from 1 to 5hr was found. After the moxibustion with 5mg of moxa, an apparent increase in ATP-release activity was observed at 1 and 3hr.
These results suggested that the mild changes in platelet functions were closely related with the response of the coagulation and the fibrinolytic activity in mice.

Objective: There are few reports of the long-term outcomes of elderlypatients with prostate cancer. We analyzed data from our institution from the past 12years, including the patient history, treatment methods, and prognosis of patients withprostate cancer aged 80 years or more.

Patients and Methods: A total of 179 cases of prostate cancer in patientsaged 80 years or more were retrospectively evaluated. We divided them chronologically intogroups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013.

Results: Sixty-one (30%) patients changed treatment course. Interestingly,no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%)cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 orlater.

Conclusion: In our study, over 50 patients who underwent treatment survivedfor 5 years or more. By treating prostate cancer in elderly patients when appropriate, wecan lower the mortality rate due to prostate cancer. Our results support the activetreatment of prostate cancer in elderly patients.

Celiac artery aneurysm (CAA) is very rare. We report a case of CAA with type IIIb aortic dissection (DA) which was treated surgically. A 60-year-old man who had an abnormal enlargement of the aorta on abdominal ultrasonography was admitted to our hospital. Angiography and CT scan revealed CAA with type IIIb DA. His general condition was stable and surgery was performed electively. The CAA was exposed through a median laparotomy. It was found to be about 3cm in diameter. As vascular reconstruction seemed difficult and the proper hepatic artery showed good pulsation after clamping the common hepatic artery, we decided to perform celiac artery aneurysmectomy without vascular reconstruction. Except for transient liver dysfunction, there was no other complication and he was discharged on the 24th postoperative day. During surgery for CAA, when collateral perfusion from the SMA to the liver is adequate, it seems that vascular reconstruction is not always necessary as shown by this case.

  One patient was intervened by our palliative care team (PCT) to relieve neuropathic pain due to postoperative recurrence of rectal cancer. The dosage controlled-release oxycodone was increased, analgesic adjuvant drugs were changed and the administration of betamethasone were started. Furthermore, the number of times the patient took controlled-release oxycodone increased two to three times a day. These changes in medication resulted in relief of symptoms. Cetuximab therapy was given twice during the course. The other patient was intervened by the PCT for right upper limb pain and dyspnea due to postoperative recurrence of breast cancer. Morphine sulfate hydrate and analgesic adjuvant were additionally given. As pain increased three days after the administeration of transdermal fentanyl patches, the patches were changed every other day, instead of every three days. FEC100 therapy was given twice during the course. In the present two cases, the PCT was intervened with great zeal and rapid relief of symptoms resulted. In the meantime chemotherapy proceeded uneventfully. We thought that trust of the chief doctor in the PCT was most important for effective intervention.

The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; n=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; n=35), and those who were 60 years or younger and received rHuEPO (group III; n=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (p<0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (p<0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.

A 57-year-old man suffered hemoptysis during an examination for gastric carcinoma. Enhanced computed tomography demonstrated rupture of a thoracic aortic aneurysm to the left pulmonary lower lobe. The lateral segment of the liver was atrophic due to intrahepatic cholelithiasis. Emergency operation was performed after he was transferred to our hospital. The thoracic aorta was reconstructed using a temporary bypass and the pulmonary left lower lobe was resected. The omentum was mobilized and used to cover the prosthesis and bronchial stump. The gastric carcinoma and intrahepatic cholelithiasis with biliary stones in the common bile duct were treated in the next procedure. The pathologic examination revealed lymph node metastasis; thus this operation was recognized to be absolutely noncurative. The treatment of cardiovascular disease concomitant with malignancy remains controversial. The strategy to treat such patients is discussed in this report.