We describe a young adolescent patient with spontaneous abdominal aortic rupture who was treated successfully. A 14-year-old boy was admitted to our hospital with severe abdominal pain and hypovolemic shock, without any episode of trauma. Computed tomography (CT) revealed massive hematoma in the retroperitoneal space and extravasation of copious amounts of contrast medium in front of the terminal aorta. Neither aortic aneurysm nor dissection was observed in this CT. An emergency operation was carried out. At first, left thoracotomy and clamping of the thoracic descending aorta were performed in order to reduce the aortic bleeding. Midline laparotomy revealed an aortic perforation of approximately 8mm at the bifurcation of the abdominal aorta. The aortic wall surrounding the perforation was nearly normal without any aortic aneurysm or dissection. A segment of the terminal aorta (length, 3cm) including the perforated lesion was excised and reconstruction was performed with a woven Dacron tube graft (10mm in diameter). On microscopic examination, the marginal tissue near the perforation showed diminished elastic fibers and minimal dissection of the medial layer of the aortic wall; however, no cystic medial necrosis or inflammation was seen.

A 49-year-old man was admitted to another hospital because of exertional dyspnea. He had run an entire 20-km race 33 days before admission. Echocardiograms, MRI and CT scans, and cineangiograms showed a right ventricular tumor arising from the tricuspid valve, which occupied the area from the right ventricular outflow tract (RVOT) to the pulmonary trunk and extended to the bilateral pulmonary arteries. MRI scans suggested that the tumor had not invaded the normal cardiac structure. The patient was transferred to our hospital for surgery. An operation was performed on the same day, since the tumor could have caused pulmonary embolisms. Under cardiopulmonary bypass, a right atriotomy, pulmonary arteriotomy and incision in the RVOT were made. The tumor had adhered to the chordae of the tricuspid valve, myocardium of the RVOT, and pulmonary valve. It was completely resected macroscopically. The postoperative course was uneventful and the patient was discharged on the 18th postoperative day. The size of the tumor was 2.0×2.0×10.0cm and the histological diagnosis was angiosarcoma. The patient died 4 months after the operation due to brain metastasis and local recurrence. This appeared to be a case of rapidly progressive cardiac angiosarcoma with an unusual noninvasive growth pattern.

In 2019, a team composed of medical and health economics educators and a family medicine trainee from the Department of Community and Family Medicine, Fukushima Medical University, and the School of International and Public Policy, Hitotsubashi University, Japan, embarked on a study tour to Toronto, Canada, a leading country in family medicine education and training. During this tour, the team visited the Department of Family and Community Medicine at the University of Toronto and affiliated hospitals to observe family medicine training in practice, which included video review and feedback for trainee development. In addition, they visited a practice attached to a legal clinic, with subsequent learning about the medico-legal interface and responsibilities of Canadian family doctors. The team gained first-hand insight into family medicine training along with an understanding of a healthcare system that values primary care.

A 41-year-old woman with neurofibromatosis (NF) was admitted to our hospital for severe pain and right leg swelling of 5 days duration. Paralysis of the right leg due to compartment syndrome was also recognized. She had been diagnosed as von Recklinghausen's neurofibromatosis, previously. 3 D-computed tomography showed a ruptured anterior tibial artery aneurysm. There was a normal patent posterior tibial artery. Since her complaint of pain was severe, we performed an emergency operation. Under the pneumatic tourniquet technique, the aneurysm was resected, and both the proximal and distal sides of the anterior tibial artery were ligated. A massive hematoma was completely removed. Postoperatively, the dorsalis pedis and posterior tibial pulses remained palpable. The paralysis improved considerably and she was given an ambulatory discharge from our hospital 21 days after the operation. Histological examination revealed proliferating wavy spindle cells infiltrating between the adventitia and mesothelium of the aneurysmal wall and staining positively for S 100 immunoperoxidase.

An 80-year-old man was transferred to our hospital because of blunt traumatic aortic arch injury caused by a fall. Computed tomography (CT) revealed a pseudoaneurysm and mediastinal hematoma around the aortic arch, right hemothorax, left hemopneumothorax, lung contusion and spine fractures. His hemodynamic condition was stable but he required mechanical ventilation because of severe hypoxemia. Surgery was postponed until twelve days after the injury, when his lung function improved and active bleeding decreased. During surgery we found that the intimal disruption extended to half of the circumference of the aortic arch, and thus performed total arch replacement under deep hypothermic circulatory arrest and selective cerebral perfusion. The patient suffered respiratory failure and pneumonia postoperatively as well as multiple cerebral infarctions. He was referred to a rehabilitation center on postoperative day 130.

We report a case of reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation (AR) after an ascending aorta replacement for acute type A aortic dissection. The patient was a 69-year-old woman who had undergone ascending aorta replacement for acute type A aortic dissection six years previously. Subsequent development of pseudoaneurysms of the ascending aorta and aortic regurgitation were revealed by computed tomography and echocardiography respectively. We chose debranch Thoracic Endovascular Aortic Repair (TEVAR) with a staged approach. First, aortic valve replacement, patch closure of proximal pseudoaneurysmal formation, coronary artery bypass, and ascending aorta-axillary artery bypass were performed. Two weeks later, debranching and TEVAR were performed. Cardiac reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation after an ascending aorta replacement is known to be high risk. Nevertheless we performed the operation safely in two-stage surgery.

We have checked into the function of konjak, or the devil's-tongue (Hydrosme vivieri) to reduce cholesterol in order to cast light on its significance as a health food. We processed chipped glucomannan into crackers (hereinafter referred to as “mannan crackers”) and examined its impacts on lipid metabolism. Enrolled for this study were hospital staff members whose total cholesterol exceeded 200mg/dl and students boarding in the hospital's nursing college.
The findings attested to the fact that the intake of mannan crackers may serve to reduce the values of total cholesterol. The higher the value of total cholesterol before this study, the greater the drop. Since we could not detect any effect on either HDLcholesterol or triglyceride, the mannan crackers were considered capable of specifically reducing LDL-cholesterol. We observed no numerical changes in the complete blood cell count (CBCC) and blood chemistry, either. Some of the subjects had abdominal swelling, diarrhea and other digestive problems but theirs were not serious cases. Yet in another aspect, there was no difference in body weight between before and after this study, but the intake of energy and lipid dropped during the period, suggesting that the intake of mannan crackers would produce an effect on the dietary pattern. Having said that, konjak (mannan crackers) may be considered capable of directly or indirectly reducing cholesterol, particularly LDL-cholesterol, suggesting that mannan crackers are of significance as a health food.
The significance of this study for agriculture and rural community must not go unmarked. This study will contribute to the development of agriculture as an industry, while the farm product by the name of konjak has something to do for health, and will be instrumental in protecting the rural environment, not to mention the lives of farm workers engaged in its production. It is a task for us to grapple with by associating itself with farm work and rural villages with the close collaboration of those farm producers.

To estimate the blood compatibility during extracorporeal circulation, we designed mock circulation system consisted of a membrane oxygenator and vinyl circuit with roller pump. Primed with 200ml Ringer's acetate and 200ml of fresh whole human blood, mock circulation was worked at flow rate 0.5l/min for 6hr. Heparin was not primed, oxygenator did not fill any gases and circulation was keeping at 37°C. The thrombin-antthrombin complex and fibrinopeptide-A showed progressive increase and fibrinogen correspondingly decrease. Nevertheless, the plasmin α2 plasmin inhibitor complex and D-dimer showed minimal changes within normal range in spite of increasing fibrinopeptide B β 15-42. We can not find any signs of secondary fibrinolytic activity. On the other hand, the platelet was persistently activated as shown statistically significant increase in β-thrombogloblin and platelet factor IV. Significant elevations of complement 3a and 4a were seen with increase of complement 5a and activated oxygen productivity by neutrophilic leucocytes. In conclusion, moderate and limited blood alterations occurred in mock cardiopulmonary bypass circuit.

PURPOSE: Since oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO. MATERIALS AND METHODS: Data were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups. RESULTS: Among 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658). CONCLUSION: TCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.
Asian Continental Ancestry Group ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Emergencies ; Humans ; Propensity Score ; Retrospective Studies

The patient was a 48-year-old woman who had been taking oral steroids for dermatomyositis since age 39. The patient experienced an episode of sudden chest tightness at age 48, and acute myocardial infarction was suspected. Coronary angiography revealed a right coronary artery occlusion ; emboli (thrombi) were collected from the same site. Left cardiac ventriculography revealed the presence of a mobile thrombotic mass in the ascending aorta. Although heparin therapy was initiated considering the possibility of thrombosis, no shrinkage of the mass was observed, and surgery was planned as per treatment guidelines. The mass was a rod-shaped thrombus measuring 20 mm×7 mm×7 mm attached to the aortic wall, approximately 2.5 cm distal from the entrance to the right coronary artery. Since the aortic wall at the site of the tumor attachment was normal, surgery involved only removal of the mass. A histopathological assessment revealed that the mass was a mixed thrombus containing both white and red thrombotic components. The patient was started on postoperative oral antiplatelet and anticoagulant drug therapy to prevent additional thrombosis, and no recurrence has been noted at 1 year postoperative.