We reported a case of a 41-year-old woman with a ruptured inferior vena cava (IVC): this was revealed by a swelling in the lower extremities and bursting pain. This condition was diagnosed on laparotomy. The operation involved repair of the IVC tear and thrombectomy. In this patient, a permanent IVC filter had been placed previously due to deep vein thrombosis. The head of the IVC filter had been covered by a fibrous membrane. Entrapment of the thrombus in the IVC filter might have resulted in high venous pressure in the IVC and a subsequent predisposition of the IVC to rupture. The swelling in the legs diminished slowly, and the patient was discharged with oral anticoagulation and elastic stockings. Despite clinical features and computed tomography findings, the physician's awareness of this disease remains the most important factor for early treatment.

A 67-year-old man was admitted with heart failure. He had a past history of closed chest trauma due to a traffic accident at the age of 24. He had been complaining of a gradual increase of fatigue since a few years after the accident and received medical treatment. At approximately 40 years of age, he underwent cardiac catheterization and was given a diagnosis of Ebstein malformation. However surgery was not recommended. An echocardiogram showed a laceration at the tricuspid valve, enlargement of the tricuspid valve annulus and severe tricuspid regurgitation. The displacement of tricuspid valve was not present. His case was complicated with severe liver dysfunction of Child-Pugh class B and Model for End-Stage Liver Disease score 15. We performed tricuspid valve replacement with a Mosaic 31 mm tissue valve. The patient required pleurodesis for refractory severe pleural effusion at 2-months and was discharged 6 months after the operation.

Objective : In Europe, carbon dioxide therapy has been used for treating cardiac disease and skin problems for a long time. Previously, we demonstrated that transcutaneous carbon dioxide (CO₂) application facilitated dioxygen (O₂) dissociation from hemoglobin (Hb) in the human body. Additionally, we proved that transcutaneous CO₂ application to the lower limbs of rats increased the expression of peroxisome proliferator-activated receptor (PPAR) gamma coactivator-1α (PGC-1α), vascular endothelial growth factor (VEGF) and silent mating type information regulation 2 homologs 1 (SIRT1). It also increased the number of mitochondria, and changed IIB fiber to IIA fiber in similar manner to the change that occurs after exercise. The transcutaneous CO₂ application caused a similar effect to that of exercise training in skeletal muscle and indicated the possibility of improved endurance strength. However, the effect of transcutaneous CO₂ application on endurance exercise and the recovery of muscle fatigue has not been studied. Methods : In this study, we investigated the performance of endurance exercise in rats with/without transcutaneous CO₂ application and analyzed the muscle fiber changes, capillary density and mitochondrial DNA number of the skeletal muscles after training, using activity wheels. Results： Training with CO₂ application resulted in a higher percentage of TA muscle transformed to IIA and/or IID than training alone, suggesting that transcutaneous CO₂ application may increase the production of ATP, mitochondria number, and capillary density. Therefore, transcutaneous CO₂ application might lead to muscle damage recovery. Conclusion : We suggest that transcutaneous CO₂ application has a therapeutic potential for recovery of damaged muscle after excessive exercise and rehabilitation.

Coronary artery obstruction, pulmonary stenosis, aortic valve regurgitation, and enlargement of the neo-aortic root are major complications of arterial switch operation (ASO) for transposition of the great arteries (TGA). Supravalvular aortic stenosis following ASO is rarely reported, and technical factors should be considered as causes in such cases. We report a case of supravalvular aortic stenosis following ASO, in which we speculated that the cause of the stenosis was tissue overgrowth caused by the surgical suture. The patient was a 4-month-old girl with TGA (II) who had undergone ASO on the 12th day after birth. Neo-aortic anastomosis was performed with 7-0 polydioxanone absorbable suture (PDS^®, Ethicon, Somerville, NJ, USA). Transthoracic echocardiography performed 1 month after the surgery showed severe stenosis at the aortic anastomosis which worsened progressively. Therefore, the patient was reoperated 4 months after the previous surgery. The concentrically stenosed aortic wall at the anastomotic site was resected and aortic reanastomosis was performed using an interrupted suture pattern with 7-0 polypropylene (Prolene^®, Ethicon). The histological findings showed proliferation of collagenous fibers around the PDS^® suture. Because of the worsening stenosis over time and the histological findings, we speculated that the tissue overgrowth in reaction to the PDS^® suture was the main cause of the stenosis. Absorbable sutures are useful because they do not leave a foreign substance in the body ; however, the possibility of tissue overgrowth leading to anastomotic stenosis cannot be denied. When using absorbable suture, careful observation is mandatory until the material is completely absorbed.