A 71-year-old man with double vessel disease (left anterior descending artery and right coronary artery) was surgically treated by off-pump coronary artery bypass grafting. He had undergone pre-sternal subcutaneous gastric tube reconstruction and mediastinal radiation therapy 19 years previously due to esophageal cancer. The gastric tube prevented the median sternotomy that is commonly necessary for cardiac surgery. In cases with difficulties of median sternotomy, left anterolateral thoracotomy and the use of the subclavian artery as inflow root for bypass grafting are available. Both radial arteries were harvested as graft conduit, because of prospective severe adhesion of left internal thoracic artery due to previous radiation. The radial artery was anastomosed on the back side of the left subclavian artery with side-to-end fashion. Y-shaped composite graft was made with the other arterial graft. Both ends were anastomosed to the left anterior descending artery and the right posterior descending branch on the beating heart status without cardiopulmonary bypass. Intra-operative SPY images showed good patency of both bypass grafts. The post-operative course was eventful. The catheter angiography revealed all graft patency 5 years after the surgery.

The Fukushima Daiichi Nuclear Power Plant (FDNPP) Accident happened in Fukushima prefecture in March, 2011 and various efforts have been carried out to prevent health damage, including thyroid cancer, caused by radioactive-iodide. In this present report, we tried to discover whether stable-iodide for the prevention against the development of thyroid cancer was properly administered to radioactive-iodide-exposed persons or not. Since pharmacists play an important role in the treatment of stable-iodide, we investigated how the pharmacists in Fukushima contributed to the treatment of stable iodide in the FDNPP accident. In addition, we introduce a new revised method for the treatment of stable iodide published by the Nuclear Regulation Authority, discuss the important role of pharmacists in the Nuclear Power Plant Accident, and propose possible ways of preparation to protect the health of citizens.

A 69 year old man who was admitted with hoarseness and diagnosed as aneurysm of the diverticulum of the ductus arteriosus was reported. Operation was performed through a median sternotomy under partial cardiopulmonary bypass. Saccular form aneurysm, had a stalk attaching to left pulmonary artery, was repaired using Dacron patch prosthesis. His postoperative course was uneventful except transient left pleural effusion. Because of fragirity of aneurysm in the adult, early surgical intervention is recommended. To our knowledge, this is 11th surgically treated case to be reported in the literature in Japan.

Thromboexclusion method for thoracic aortic aneurysm was studied in 10 patients who had dissecting aneurysm in 7 and atherosclerotic aneurysm in 3. The aortic aneurysms extended from the left subclavian artery to the diaphragma or more widely. The operations were extraanatomic bypass and permanent aortic clamp proximal to the aneurysm in 9, and proximal and distal to the aneuysm in one. The follow up periods were 14 days to 80 months. Eight patients survived more than 3 months and 5 of them had thromboexclusion of aneurysm to the diaphragma. One with the aneurysms of incomplete thromboexclusion resulted in aneurysmal rupture 28 months after operation, and recovered by additional clamp distal to the aneurysm. Another had aneurysmal rupture, and died 63 months after operation. A patient had the penetration of the clamp to the pulmonary artery, and died 12 months after operation. Temporary paraplegia occurred in a patient 15 months after operation. Two patients developed constipation without ileus. Any difference of blood pressure between upper and lower extremities was not recognized, and no patient had deterioration of renal function. Indication of this method should be strictly selected, and careful follow up study is mandatory.

A recent study evaluated the effect of pleurotomy for harvesting internal thoracic arteries (ITAs) on pulmonary complications after coronary artery bypass grafting (CABG). Fifty consecutive patients with pleurotomy (group I) were studied retrospectively and compared with a control group of fifty patients undergoing CABG without pleurotomy during ITA harvest (group II). Group I was divided into two groups; forty patients using left ITAs with left open pleurotomy (group Ia), and ten patients using bilateral ITAs with bilateral open pleurotomy (group Ib). On the other hand, group II includes 22 patients without pleurotomy (group IIa) and 28 patients with closed pleurotomy (group IIb). In group I, ITAs were dissected from the chest wall with mediastinal pleura and then isolated from the pleura by pleurotomy. Before sternal closure, an L-shaped pleural tube was inserted into the deep costophrenic sinus and the pleurotomy remained open. In group II, ITAs were simultaneously dissected from the chest wall and mediastinal pleura, and if the pleura was damaged, the pleurotomy was approximated before sternal closure. There was no significance in the number of bypass grafts, aortic crossclamp time, cardiopulmonary bypass time and temperature. ITA harvest time with open pleurotomy was shorter than that of closed pleura (15min versus 25min). Postoperatively, the ventilation time and duration of chest drainage also showed no significance, however group Ia and Ib showed significantly more fluid accumulation removed by chest drainage (Ia, 288±193ml; Ib, 285±198ml, versus IIb, 169±98ml). On postoperative day 30 no pleural effusion was observed in group I but it was seen in one case in group IIb which had diaphragm paralysis. In conclusion, open pleurotomy results in minimal pulmonary complications with optimal chest drainage and offers significant advantages for harvesting ITAs.

A 51-year-old woman, who had undergone mitral valve replacement with the Starr-Edwards ball valve 21 years ago, was hospitalized with cardiac failure. Preoperative cineangiograms showed delay of the ball movement during the early diastolic phase. Re-replacement of the mitral prosthetic valve with a CarboMedics prosthetic valve and tricuspid annuloplasty was successfully performed. The postoperative period after the initial implantation of the Starr-Edwards ball valve is the longest among patients reported in Japan. The cause of prosthetic valve insufficiency may have been granulomatous hyperplasia on the valve seat.

A 78-year-old man underwent successful removal of a contaminated pacemaker in a case of methicillin-resistant Staphylococcus aureus (MRSA) septicemia. Septicemia was due to a subcutaneous abscess at the site of old cut electrodes. Following debridement of the infected pacemaker pocket, residual leads and the pacemaker system were removed under cardiopulmonary bypass. Bacterial examination of arterial blood and vegetation attached to the leads showed septicemia caused by MRSA. After the operation, antibiotic therapy with vancomycin, arbekacin and minocycline was performed for several weeks. His postoperative course was uneventful without the recurrence of infection. In cases of pacemaker contamination, with septicemia, total removal of the pacemaker system and adequate antibiotic therapy are necessary.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.

STUDY DESIGN: Retrospective case-control study. PURPOSE: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. OVERVIEW OF LITERATURE: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. METHODS: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. RESULTS: Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. CONCLUSIONS: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.
Case-Control Studies ; Constriction, Pathologic ; Decompression ; Humans ; Intervertebral Disc Degeneration ; Logistic Models ; Magnetic Resonance Imaging ; Odds Ratio ; Postoperative Complications ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Risk Factors ; Sciatica* ; Scoliosis ; Spinal Canal ; Spine ; Weight-Bearing

STUDY DESIGN: Retrospective case series. PURPOSE: To elucidate the impact of postoperative occiput-C2 (O-C2) angle change on subaxial cervical alignment. OVERVIEW OF LITERATURE: In the case of occipito-upper cervical fixation surgery, it is recommended that the O-C2 angle should be set larger than the preoperative value postoperatively. METHODS: The present study included 17 patients who underwent occipito-upper cervical spine (above C4) posterior fixation surgery for atlantoaxial subluxation of various etiologies. Plain lateral cervical radiographs in a neutral position at standing were obtained and the O-C2 angle and subaxial lordosis angle (the angle between the endplates of the lowest instrumented vertebra (LIV) and C7 vertebrae) were measured preoperatively and postoperatively soon after surgery and ambulation and at the final follow-up visit. RESULTS: There was a significant negative correlation between the average postoperative alteration of O-C2 angle (DO-C2) and the average postoperative alteration of subaxial lordosis angle (Dsubaxial lordosis angle) (r=-0.47, p=0.03). CONCLUSIONS: There was a negative correlation between DO-C2 and Dsubaxial lordosis angles. This suggests that decrease of mid-to lower-cervical lordosis acts as a compensatory mechanism for lordotic correction between the occiput and C2. In occipito-cervical fusion surgery, care must be taken to avoid excessive O-C2 angle correction because it might induce mid-to-lower cervical compensatory decrease of lordosis.
Animals ; Follow-Up Studies ; Humans ; Lordosis* ; Occipital Bone ; Retrospective Studies ; Spinal Curvatures ; Spinal Fusion ; Spine ; Walking