Prosthetic graft replacement for thoraco-abdominal aneurysm was performed in a 69-year-old man. Fever and CRP elevation developed 8 days after the operation. A subcutaneous abscess was found in the wound. The culture of pus and thoracic discharge revealed methicillin-resistant staphylococcus aureus (MRSA). Infected tissues were debrided and an omentopexy was performed without removing the prosthetic graft to avoid spinal cord ischemia. The thoracic cavity was irrigated continuously with 1% Povidone-iodine for three days. The infection subsided gradually and the patient was discharged. Graft infection due to MRSA has recently increased and we experienced such a case which we treated successfully by complete debridement, omentopexy and continuous irrigation.

Symmetrical lipomatosis is characterized by symmetrical infiltration of adipose tissue into the head, neck, or upper trunk. By contrast, oral involvement is extremely rare. The present report describes a case of symmetrical lipomatosis of the tongue (SLT) presenting as macroglossia. The patient was a 63-year-old Japanese male who developed progressive dysarthria secondary to enlargement of the tongue. The patient's medical history was notable for alcoholic hepatitis and hyperlipidemia. Marginal glossectomy was performed on both sides of the tongue to achieve volume reduction and restore normal speech. Histopathologic examination of the resected tissue revealed diffuse infiltration with adipose tissue lacking a fibrous capsule. The patient's postoperative course was uneventful, and he remained free of recurrence or regrowth and functional deficits at the 6-year follow-up time point.

To assess coronary artery disease in arteriosclerosis obliterans (ASO), the efficacy of a dipyridamole-loaded ECG was evaluated. Subjects consisted of 35 patients who underwent surgery for ASO between November 1988 and December 1989. A dose of 0.568mg/kg of dipyridamole was intravenously infused for over 4min. Changes of systemic blood pressure, heart rate and standard 12-lead ECG were accumulated. In eleven cases loaded ECG was considered to be positive and coronary arteriographies were performed. Stenotic lesions of 75% or over were observed in 10 cases, among them CABG was performed in one symptomatic case. In another positive but asymptomatic cases, only the existing ASO lesions were surgically treated. No intraoperative or postoperative ECG abnormality was observed and postoperative courses were uneventful. Negative cases (24 cases) underwent complete revascularization. These findings indicate that a dipyridamole-loaded ECG is a non-invasive preoperative means detecting coronary artery disease preoperatively is useful to decide operative procedure.

A patient with mutiple aneurysms of the thoracic aorta in Behçet's disease was treated with transluminally placed endovascular stent grafts. Stent graft devices composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron were inserted through 18 Fr sheaths via the femoral arteries. The stent grafts were deployed successfully and blood flow into the aneurysms was reduced immediately and no blood endoleak was found on aortography. However minor endoleak due to migrations of the stent grafts was recognized in two distal descending aortic aneurysms twenty days after the operation. Extra stent grafts were inserted to interrupt the endoleak and finally all aneurysms were thrombosed without any endoleak. Former surgical replacement of the aorta due to aneurysms associated with vasculo-Behçet's disease often causes anastomotic leakage and pseudoaneurysms. The endoluminal stent graft treatment is a minimally invasive operation in comparison with former surgical operations, and is useful for aortic aeurysms especially for inflammatory aneurysms in Behçet's disease because it requires no anastomotis. However, improvement of the stent graft devices, including components of the delivery system such as the dilator, sheath and pushing rod, and the development of better devices, is required to reduce delivery failure and to make stent graft treatment more reliable.

Ten cases of pseudoaneurysms that developed after thoracic aortic surgery were treated with an endovascular technique using stent grafts for redo operations. All patients were treated under general anesthesia and the stent grafts were implanted through 18 Fr or 20 Fr sheath introducers via femoral arteries under fluoroscopic guidance. The stent graft was composed of several units of self-expanding stainless-steel Z stents covered with an ultra-thin polyester fabric. Stent graft deployment was technically successful in all patients and in 7 of 10 cases exclusion of the aneurysms with no endoleak was achieved within two weeks after the operation (initial success rate: 70%). Minor endoleak was found in 3 patients and one of those finally underwent conventional surgery because of stent graft migration 6 months after the stent graft repair. Two of ten patients died, 10 days and 18 weeks after the operation, due to hemoptysis, which had already been observed before the operation. Endovascular stent graft repair of pseudoaneurysms after thoracic aortic surgery is a minimally invasive operation in comparison with conventional redo surgery with extracorporeal circulation. These results and experiences suggest that stent graft repair can be a safe and useful redo treatment for pseudoaneurysms. However, careful long-term investigations are necessary to prove the value and effect of this endovascular treatment and a new strategy for cases with hemoptysis is required.

A 60-year-old woman with acute Stanford type A dissecting aneurysm underwent Dacron graft replacement of the total aortic arch combined with the modified elephant trunk technique. Follow-up CT and angiogram demonstrated blood flow into the false lumen from the distal anastomosis. In order to interrupt the blood flow, endovascular stent grafting was undertaken. She recovered uneventfully, and was discharged on the 14th postoperative day. Follow-up CT taken in the third postoperative month demonstrated exclusion of the blood flow into the false lumen of descending thoracic aorta. Aortic arch replacement followed by endovascular stent grafting of the descending thoracic component is a potential therapeutic option in patients with dissecting aneurysm.

A high-risk abdominal aortic aneurysm patient with multiple complications was treated by a transluminally placed endovascular stent-graft. A tapered stent-graft composed of 3 units of self-expandable Z stents covered with ultra-thin woven Dacron was inserted through an 18 Fr sheath via the femoral artery. The stent-graft was deployed successfully, and endovascular exclusion of the abdominal aortic aneurysm was achieved. The endoluminal stent-graft treatment is an option for minimally invasive operation in comparison with conventional open surgery, and appears to be effective for aortic aneurysms in certain selected cases.

A 71-year-old woman was admitted with sudden onset of abdominal pain. CT scan image and symptoms showed an impending ruptured suprarenal abdominal aortic aneurysm therefore we performed an emergency operation. The abdominal aorta was replaced with a trunk prosthetic graft with four branches for visceral and lumbar arteries. The post-operative course was uneventful. Pathological examination showed that the aorta had severe atherosclerotic changes. The fibrous tissues increased in the aneurysmal wall which was not consistent with the normal aorta. Intima and media of the aorta everted into the aneurysm. These findings suggested that aneurysm was caused by a penetrating atherosclerotic ulcer.

Androgen replacement therapy (ART) is a widely accepted form of treatment worldwide for aging men with late-onset hypogonadism (LOH) syndrome. Concurrent with the progressive decline in testosterone from middle age, there is a gradual increase in prostate volume, reflecting the development of benign prostatic hyperplasia (BPH). Prostate growth is dependent on the presence of androgens, and conversely, antiandrogen agents or orchidectomy can decrease prostate volume in patients with BPH. Thus, it is important to investigate whether ART could have any negative effects on prostatic disease or lower urinary tract symptoms (LUTS). Although only limited amounts of information on the correlations between androgen levels in aging men and clinical manifestations of LUTS are available, a few recent studies have suggested that testosterone levels may have some beneficial effects on various urinary functions in men. Androgen receptors are found in the urothelium, urinary bladder, prostate, and urethra, and testosterone could have an impact on the autonomic nervous system, bladder smooth muscle differentiation, nitric oxide synthase, phosphodiesterase-5 and Rho/Rho-kinase activities, and pelvic blood flow. In addition, some previous studies demonstrated that ART had little effect on LUTS or urinary function in aging men with LOH syndrome. Furthermore, some recent randomized controlled trials indicated that short-term ART may be effective in the improvement of LUTS in hypogonadal men with mild BPH. However, only limited information is available regarding the effects of longer-term ART or the safety of ART in men with severe BPH and LUTS, and further studies are required to reach more definitive conclusions.
Aging ; Androgens ; Autonomic Nervous System ; Cyclic Nucleotide Phosphodiesterases, Type 5 ; Humans ; Hypogonadism ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Muscle, Smooth ; Nitric Oxide Synthase ; Orchiectomy ; Prostate ; Prostatic Diseases ; Prostatic Hyperplasia ; Receptors, Androgen ; Testosterone ; Urethra ; Urinary Bladder ; Urination Disorders ; Urothelium

Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.
Anemia, Sickle Cell ; Compartment Syndromes ; Diagnosis ; Discrimination (Psychology) ; Emergencies ; Humans ; Male ; Penile Erection ; Priapism* ; Stuttering