A 54-year-old man, involved in a motor vehicle collision, was transferred to our hospital. He was hemodynamically stable. A CT scan of the chest demonstrated traumatic aortic dissection and a mediastinal hematoma with hemothorax of left side. Endovascular aortic repair using a homemade device was immediately performed, and a completion angiogram revealed complete exclusion of the aortic injury, with no extravasation. A postoperative CT scan revealed satisfactory placement of the endograft, with no extravasation. The patient was discharged on the 13th postoperative day. Endovascular aortic repair was useful and minimally invasive therapy in this case for the treatment of traumatic thoracic aortic rupture.

A 79-year-old man was transferred to our hospital because of massive hematemesis. Contrast-enhanced CT scan demonstrated extravasation of contrast medium into the jejunum. Therefore, we diagnosed primary aortoenteric fistula and performed an emergency operation. At surgical exploration, the jejunum was closely adherent to the normal-sized aorta. The fistula was present between the anterior wall of the aorta and the jejunum. Operative reconstruction was performed with in-situ grafting and a pedicled omentum flap was placed around the graft. The postoperative course was uneventful, and there has been no evidence of infection during the follow-up period of 1 year.

We here report two cases of successfully treated secondary aorto or iliac arterial-enteric fistula after graft replacement for abdominal aortic aneurysm. Case 1: A 80-year-old man who complained massive anal bleeding had undergone Y-shaped graft replacement for abdominal aortic aneurysm 22 years previously. Computed tomography demonstrated an aneurysm and hematoma formation at the anastomosis of the right graft limb and the right common iliac artery. Preoperative angiography showed no leak of contrast medium at the distal anastomosis of the right graft limb. A presumptive diagnosis of secondary iliac arterial enteric fistula was made, therefore, we performed an emergency operation. Extra-anatomic bypass preceded the removal of the right graft limb, partial resection and direct reconstruction of the ileum by the retroperitoneal approach. His postoperative course was uneventful and he was discharged on the 19th postoperative day. Case 2: A 77-year-old man who had received Y-shaped graft replacement of an abdominal aortic aneurysm 9 years previously was transferred to our hospital because of sudden onset epigastralgia and massive hematemesis. Gastroduodenoscopy revealed a fresh blood clot in the third portion of the duodenum where it was compressed by for surrounding pulsatile environment. An emergency computed tomography showed aneurysm formation without extravasation of contrast medium in the duodenum at the proximal anastomosis of the prosthetic graft. A secondary aortoenteric fistula was highly suspected and emergency operation was performed. Extra-anatomic bypass preceded the removal of the graft body, infrarenal aortic stump closure, duodenal closure and the greater omentum was used to fill defects. He underwent successful staged abdominal wall closure due to bowel edema making primary closure impossible. His postoperative course was uneventful and he was discharged on the 26th postoperative day.

Recoarctation, systemic hypertension, aortic aneurysm and intracranial aneurysm are generally observed within a certain period after the surgical procedure for aortic coarctation, which is known as a systemic diseases caused by not only morphological abnormalities but also arterial functional abnormalities of artery. Here, we report a case who showed complications of recoarctation, hypertension and subarachnoid hemorrhage after surgery for aortic coarctation. A 17-year-old boy originally presented to our hospital with upper extremity systemic hypertension. Recoarctation after surgery for aortic coarctation was diagnosed in his childhood, following which hypertension was followed while he received continuous treatment with anti-hypertensive drugs. He was hospitalized with sudden headache and loss of consciousness. Since subarachnoid hemorrhage was diagnosed by computed tomography, clipping of intracranial aneurysms was performed. After the clipping procedure, he underwent percutaneous intravascular stenting angioplasty. However, the pressure gradient remained and sufficient dilatation was not obtained because of the hypoplastic anatomical distal aortic arch (from the left internal carotid artery to the site of recoarctation) due to the development of collateral circulation with rib notch. At age 21, extra-anatomical bypass (from the ascending aorta to the descending aorta) was performed because of persistent upper extremity systemic hypertension. However, systemic hypertension continued to require antihypertensive medication.

Positron emission tomography (PET) is an established imaging tool in oncology that has also been used in infectious and inflammatory diseases. PET combined with computed tomography (PET/CT) can be used to visualize metabolic activity with precise localization. We report an infant with late presentation of poststernotomy mediastinitis, the diagnosis and localization of which was confirmed by PET/CT. An 8-month old infant, who had undergone the Jatene procedure and right ventricle outflow reconstruction 6 months prior, was admitted for inflammation surrounding the superior aspect of the healed scar. Cultures from the wound grew methicillin-resistant Staphylococcus aureus (MRSA). Although the only symptom was discharge from the wound, and there were no other signs or symptoms suggestive of severe general infection, substernal abscess was suspected by magnetic resonance imaging. Since PET/CT revealed high accumulation of 18-fluorodeoxyglucose at the substernal region, the diagnosis of MRSA mediastinitis was made, which was confirmed by subsequent surgical treatment.

We reporte the initial results of open stent-grafting (OSG) applied with a Matsui-Kitamura (MK) stent in the treatment of thoracic aortic aneurysm (TAA). From August 2005 to March 2011, OSG for TAA was applied in 35 cases (male/female, 29/6, 58∼86 years old, mean age 71). During deep hypothermic circulatory arrest with antegrade selective cerebral perfusion, the stent graft was delivered through the transected proximal aortic arch, followed by arch replacement with a 4-branched prosthesis. Concomitant procedures included 1 coronary artery bypass graft, 1 mitral valve replacement and 2 pacemaker implantations. Operative mortality within 30 days was 5.7% (respiratory failure in 1 and ischemic enteritis in 1). There was 1 in-hospital death due to brain stem infarction. Perioperative morbidity included 2 (5.7%) stroke, 5 (14.3%) spinal cord injuries (paraplegia in 1, paraparesis in 1 and transient paraparesis in 3) , and 1 (2.9%) temporary hemodialysis. Ten patients (28.6%) were intubated for more than 72 h. There was no complication with the graft-related incident. These initial results suggested the OSG method applied with a MK stent is a useful surgical procedure for the treatment of TAA.

There have been very few studies on the expression of Centromere proteins in human salivary gland carcinomas. The purpose of this study was to clarify the correlation between Centromere protein H (CENP-H) expression and clinicopathologic factors in salivary gland carcinomas. The expression of CENP-H mRNA was investigated in 28 human salivary gland tumors (7 pleomorphic adenomas, 3 Warthin tumors, 6 mucoepidermoid carcinomas, 6 adenoid cystic carcinomas, 5 acinic cell carcinomas and 1 malignant myoepithelioma) and 8 normal submandibular glands using real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The labeling index of PCNA and Ki-67 were also investigated immunohistochemically in 16 salivary gland carcinomas. The mean expression level of CENP-H mRNA was significantly higher in malignant tumors (0.55 ± 0.68) than normal submandibular glands (0.10 ± 0.029). A significant correlation between the PCNA labeling index and CENP-H mRNA expression was also found (Spearman's correlation coefficient by rank test, P=0.033). We also found a significant correlation between the Ki-67 labeling index and CENP-H mRNA expression in malignant tumors (Spearman's correlation coefficient by rank test, P=0.040). These results indicate that human CENP-H mRNA is closely linked to increased or abnormal cell proliferation in malignant salivary gland tumors.

OBJECTIVETo evaluate the effects of the application of tongue pressure sensor sheet on the signal waveform of laryngeal movement produced by the bend sensor during deglutition.

METHODSTwelve adult male subjects were recruited to perform a single swallow of 5 ml water when sitting on the dental chair with upright position. The data recorded by bend sensor was obtained with attaching tongue pressure sensor sheet simultaneously or not. Then the measured parameters by bend sensor with or without concurrent application of tongue pressure sensor sheet were compared.

RESULTSThere were no significant differences between the same time point on the signal waveform produced by bend sensor whether concurrently attaching tongue pressure sensor sheet or not (P > 0.05). Additionally, we found no statistical significances between matched phases on the signal waveform recorded by bend sensor with or without application of tongue pressure sensor sheet (P > 0.05).

CONCLUSIONThe findings in this study suggest us that the usage of tongue pressure sensor sheet exerted no influences on the waveform of the laryngeal movement produced by bend sensor during deglutition, facilitating us to further apply tongue pressure sensor sheet and bend sensor simultaneously to record tongue pressure production and hyoid activity during deglutition.

Adult ; Biosensing Techniques ; instrumentation ; Deglutition ; physiology ; Humans ; Hyoid Bone ; physiology ; Larynx ; physiology ; Male ; Middle Aged ; Pressure ; Tongue ; physiology

OBJECTIVETo investigate the tongue pressure (TP) produced by tongue-hard palate contact in the process of normally swallowing liquid in healthy adults.

METHODSThirteen adult male subjects were recruited to perform a single swallow of 5 ml water when sitting with upright position. The tongue pressure sensor sheet was used to monitor TP as a result of tongue-hard palate approximatation in the anteriomedian, midmedian, posteriomedian and circumferential parts, and the swallowing sound was recorded by microphone. The temporal sequence of TP at each measured part was obtained after setting the swallowing sound as the reference time. Also, the total duration, pre-peak duration, post-peak duration, maximum magnitude and integrated value of TP were recorded and compared among the measured parts.

RESULTSTP was produced from anterior to posterior along the midline of hard palate during normal swallowing of water [Ch1: (-0.40 ± 0.22) s, Ch2: (-0.36 ± 0.21) s, Ch3: (-0.24 ± 0.18) s], with the circumferential TP [Ch4: (-0.38 ± 0.23) s, Ch5: (-0.40 ± 0.23) s] occurring nearly to the anteriomedian one (P > 0.05). Before the swallowing sound (P < 0.05), TP at each part reached a peak synchronously [Ch1: (-0.12 ± 0.24) s, Ch2: (-0.16 ± 0.22) s, Ch3: (-0.13 ± 0.21) s, Ch4: (-0.16 ± 0.23) s, Ch5: (-0.17 ± 0.23) s] in a rapid manner (P > 0.05), then decreased gradually until disappeared simultaneously [Ch1: (0.32 ± 0.23) s, Ch2: (0.27 ± 0.21) s, Ch3: (0.23 ± 0.16) s, Ch4: (0.33 ± 0.31) s, Ch5: (0.33 ± 0.29) s] (P > 0.05) after the swallowing sound (P < 0.05). The TP related parameters (the total duration of TP:Ch1: (0.72 ± 0.20) s, Ch2: (0.63 ± 0.16) s, Ch3: (0.47 ± 0.17) s, Ch4: (0.70 ± 0.35) s, Ch5: (0.73 ± 0.29) s; the pre-peak duration of TP: Ch1: (0.28 ± 0.21) s, Ch2: (0.20 ± 0.16) s, Ch3: (0.12 ± 0.10) s, Ch4: (0.21 ± 0.22) s, Ch5: (0.23 ± 0.21) s; the post-peak duration of TP: Ch1: (0.44 ± 0.23) s, Ch2: (0.43 ± 0.18) s, Ch3: (0.36 ± 0.18) s, Ch4: (0.49 ± 0.25) s, Ch5: (0.50 ± 0.23) s; the maximum magnitude of TP: Ch1: (13.80 ± 7.73) kPa, Ch2: (12.40 ± 6.51) kPa, Ch3: (10.26 ± 7.15) kPa, Ch4: (12.16 ± 5.38) kPa, Ch5: (13.08 ± 5.05) kPa; the integrated value of TP: Ch1: (4.99 ± 3.69) kPa×s, Ch2: (4.25 ± 2.13) kPa×s, Ch3: (2.88 ± 1.87) kPa×s, Ch4: (4.32 ± 3.47) kPa×s, Ch5: (4.63 ± 2.49) kPa×s were significantly smaller in the posteriomedian part among all the five parts measured. No laterality was found in TP produced at the circumferential parts of the hard palate (P > 0.05).

CONCLUSIONSThe TP at each part coordinates precisely during swallowing. The effective measurement of TP by tongue pressure sensor sheet will facilitate the evaluation of oral swallowing and the diagnosis of dysphagia simply and non-invasively.

Adult ; Deglutition ; physiology ; Deglutition Disorders ; diagnosis ; Drinking ; physiology ; Drinking Water ; Humans ; Male ; Palate, Hard ; Pressure ; Time Factors ; Tongue ; physiology