Left ventricular noncompaction (LVNC) is believed to represent an arrest in the normal process of myocardial compaction, resulting in persistence of both hyper-trabeculation and intratrabecular recess within the left ventricle. High mortality is the important clinical feature of this disease. LVNC in adult cases has been rarely, but occasionally, reported, however, LVNC with insufficiency of both the aortic and mitral valves has not been reported to our knowledge. Herein, we describe a 62-year-old man with LVNC and the severe insufficiency of the aortic and mitral valves, who was successfully operated upon with aortic and mitral valve replacement using mechanical valves. Although the postoperative course was uneventful, careful attention is mandatory for the possible left ventricular dysfunction due to LVNC.

Primary cardiac malignant lymphoma (PCL), which is defined as an extra-nodal malignant lymphoma involving only the heart and/or pericardium, is extremely rare. Its prognosis is reported to be very poor because the PCL grows rapidly and frequently causes fatal heart failure or arrhythmias. We report a 65-year-old woman with PCL accompanied with superior vena cava (SVC) syndrome 6 weeks following a pacemaker implantation for complete atrio-ventricular block. She underwent a partial resection of the tumor to release the SVC syndrome and subsequent systemic chemotherapy. This combined therapy successfully induced complete remission, and improvement of the atrio-ventricular conduction disturbance was also observed.

A 76-year-old man received implantation of sirolimus-eluting stent for total occlusion of the left circumflex artery causing an acute myocardial infarction of posterolateral wall on May 21st, 2005. Off-pump coronary artery bypass grafting was performed on June 9th for a residual 90% stenosis on the proximal segment of his left anterior descending artery. Ticlopidine and aspirin were discontinued 7 days and 2 days before the operation, respectively. Continuous intravenous drip of heparin had been given for 5 days until just prior to the operation. Though the left internal thoracic artery was successfully grafted onto the left anterior descending artery, he developed an acute myocardial infarction after the operation. An emergency angiography, performed on the 1st postoperative day showed thrombotic occlusion of the sirolimus-eluting stent in the circumflex artery and patent internal thoracic artery to the left anterior descending artery. Percutaneous catheter intervention restored the stent patency. Antiplatelet therapy including ticlopidine or clopidogrel is mandatory to prevent subacute thrombosis in drug-eluting stent. Hemorrhagic complication or major surgery may hinder continuing antiplatelet regimens and trigger acute thrombosis. Alternative antiplatelet and/or anticoagulant therapy is essential to prevent acute stent occlusion in such clinical settings.

OBJECTIVE: The purpose of the present study was to clarify the relationship between white matter tracts and cognitive symptoms in children with high-functioning autism spectrum disorder (ASD). METHODS: We examined the cognitive functions of 17 children with high-functioning ASD and 18 typically developing (TD) controls and performed diffusion tensor imaging (DTI) tractography. We compared the results between the groups and investigated the correlations between the cognitive scores and DTI parameters within each group. RESULTS: The Comprehension scores in the ASD group exhibited a positive correlation with mean diffusivity (MD) in the forceps minor (F minor). In the TD group, the Comprehension scores were positively correlated with fractional anisotropy (FA) in the right inferior fronto-occipital fasciculus (IFO) and left anterior thalamic radiation (ATR), and negatively correlated with MD in the left ATR, radial diffusivity (RD) in the right IFO, and RD in the left ATR. Additionally, a positive correlation was observed between the Matching Numbers scores and MD in the left uncinate fasciculus and F minor, and RD in the F minor. Furthermore, the Sentence Questions scores exhibited a positive correlation with RD in the right inferior longitudinal fasciculus. Relative to TD controls, the specific tract showing a strong correlation with the cognitive scores was reduced in the ASD group. CONCLUSION: Our findings indicate that white matter tracts connecting specific brain areas may exhibit a weaker relationship with cognitive functions in children with ASD, resulting in less efficient cognitive pathways than those observed in TD children.
Anisotropy ; Autism Spectrum Disorder ; Autistic Disorder ; Brain ; Child ; Cognition ; Comprehension ; Diffusion Tensor Imaging ; Humans ; Neurobehavioral Manifestations ; Surgical Instruments ; White Matter

In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.