We investigated muscle activities of the scapular muscles during low row procedure (LR) usually used 12 weeks after a rotator cuff repair, and evaluated its effective application period comparing with scapular retraction procedure (SR) used for early postoperative period. Twelve healthy adults (mean age, 26.8 years) were enrolled in the current study. %MVICs (maximal voluntary isometric muscle contractions) of middle trapezius, lower trapezius, serratus anterior, posterior deltoid, and infraspinatus were calculated from the surface electromyography during both LR and SR. The %MVIC of either the middle trapezius or lower trapezius was not significantly different between during the LR and the SR. The %MVIC of the serratus anterior, posterior deltoid and infraspinatus during the LR was significantly higher than those during the SR (p=0.018, p<0.001, p<0.001, respectively). Additionally, the %MVIC of the posterior deltoid and infraspinatus in the SR was less than 20%. In training phase after rotator cuff repair, LR was considered to be effective procedure for most of the scapular muscles 12 weeks after a surgical repair of the rotator cuff. However, LR earlier than 12 weeks after the surgery is considered to yield a risk of re-tear of the rotator cuff, and SR may be a preferred training procedure in this early phase.

Abstract
Objective : Laninamivir Octanoate (LO) is a novel anti-influenza drug administered by inhalation only once administration, and with a very simple dosage adjustment regimen. Conversely, inhalation might be expected to fail in some groups of patients, particularly the very young and very elderly because of poor inhalation technique. Therefore, we undertook a study to investigate the success and failure rates of the dry powder inhalation formulation of LO.
Methods : We observed 159 patients who were prescribed LO. Pharmacists observed the administration technique after explaining how to inhale the drug. Success was defined as patients who could inhale the drug without a problem. Failure was defined as those patients who were judged to have inhaled less than 75％ of the drug. We also examined the success rate between pharmacies and the success and failure rates according to age.
Results : A 4-years-old patient was the youngest to fail LO therapy whereas a 5-years-old patient was the youngest to succeeded with the therapy. The success rate did not differ significantly between pharmacies. The success rate was 88.9％ in patients under the age of 9 years, but which was significantly lower compared with 97.9％ in the group of patients over 10 years of age.
Conclusion : This survey revealed that many cases of inhalation failure of LO anti-influenza therapy occur below the age of 9 year.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

A case of idiopathic enlargement of the right atrium (IERA) is described. A 28-year-old woman was admitted to our hospital because of cardiomegaly and a mass in the right atrium. She had had cardiomegaly for at least 8 years. Echocardiography showed an enlarged right atrium and a large mass. Cardiac catheterization demonstrated normal hemodynamic data. Based on these findings, we diagnosed this case as IERA and the right atrial mass was suspected to be myxoma. At operation, a markedly enlarged right atrium was found. The right atrial wall was paper-thin. Through right atriotomy, a giant round thrombus (5×4×4cm) was found. The tricuspid valve showed a normal configuration. After extirpation of the thrombus, the right atrial wall was excised and plicated. The postoperative course was uneventful. IERA is extremely rare and heart failure and sudden death have been reported. Therefore, symptomatic or complicated cases should be treated surgically.

Bypass grafting from the ascending thoracic aorta to the common iliac artery was performed to manage proximal hypertension in a patient with atypical coarctation of the thoracic aorta. The patient's history was significant for an acute aortic thrombosis at the level of the diaphragm for which she underwent an axillo-bifemoral bypass grafting as an emergency operation. Although she was doing well following the initial bypass grafting, the second bypass grafting was required to treat proximal hypertension refractory to medical management. The axillo-femoral bypass graft had a smaller diameter and a longer subcutaneous distance, and the blood supply to the abdominal viscera may have been insufficient. The proximal hypertension was well controlled following ascending thoracic aorta to common iliac bypass, because the diameter (16mm) of the graft is larger than that of the axillo-bifemoral bypass graft (8mm).

Dacron prostheses are the most widely used grafts in replacement procedures for abdominal aortic aneurysms, but they are not perfect grafts. We encountered a rare case of late graft complication. A 66-year-old man was admitted to our hospital with a pulsatile mass in an abdominal operation scar. He had received placement of a Y-shaped Cooley double velour knitted Dacron graft 18 years previously. Computed tomography and angiography demonstrated graft dilatation and an aneurysm. After resection of the graft aneurysms, the operative findings showed a non-anastomotic aneurysm formation due to longitudinal division near the graft guideline. In this case, this graft failure may have been due to the deterioration of the filter of the Dacron prosthesis itself. Therefore it is important to perform careful long-term follow-up in patients with implanted Dacron arterial prostheses.

A 51-year-old man with osteogenesis imperfecta and who had aortic regurgitation was admitted to our hospital for aortic valve replacement. His height was 146cm and his weight was 49kg. The patient had suffered from bone fractures several times since childhood. Bone deformity, blue sclera and his status were clinically indicative of osteogenesis imperfecta. Aortic valve replacement with a 25mm SJM^® prosthetic valve was successfully performed for aortic valve insufficiency and slight annulo-aortic ectasia. Soft tissues and the sternum were fragile. Pathological examination (Elastica-Masson stain) of the aortic valve and left ventricular wall revealed a loss of fibrous tissues and remarkable thickening due to elastic fibers. The patient was discharged 31 days after surgery. Osteogenesis imperfecta is one of the collagen diseases caused by gene abnormality, in which fragile bones are easily fractured. Cardiovascular disease is rarely associated with it and the surgery-related mortality rate is reported to be approximately 30%, due to bleeding.

To test the hypothesis that neutrophils play a role in lung injury during cardiopulmonary bypass, granulocyte elastase and myeloperoxidase release from pulmonary circulation were measured, as well as the respiratory index, before and after cardiopulmonary bypass. The production of granulocyte elastase and myeloperoxidase in the pulmonary circulation, and the respiratory index also elevated significantly after cardiopulmonary bypass. Furthermore, the level of granulocyte elastase and myeloperoxidase released from pulmonary circulation correlated with the changes of the respiratory index and preoperative pulmonary artery pressure. These data indicate that neutrophils play a major role in pulmonary dysfunction occurring after cardiopulmonary bypass, which is accentuated in patients with pulmonary hypertension.

To test the hypothesis that neutrophils play a role in ischemia/reperfusion injury during heart surgery, granulocyte elastase and myeloperoxidase release from coronary circulation were measured before and after aortic cross-clamping. The production of granulocyte elastase and myeloperoxidase across the coronary circulation elevated significantly after release of aortic cross-clamp. Furthermore, the level of granulocyte elastase and myeloperoxidase released from coronary circulation demonstrated positive correlation with the duration of the aortic cross-clamp. These data indicate that neutrophils play a major role in ischemia/reperfusion injury occurring during heart surgery.

Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.
Abdominal Abscess ; Abscess ; Anastomotic Leak ; Drainage ; Gastrectomy ; Humans ; Needles ; Pancreatic Fistula ; Punctures ; Stomach Neoplasms ; Ultrasonography