A 76-year-old male was admitted to our hospital because of melena. However, no remarkable findings of rupture were shown by enhanced CT scan and angiography. On the 9th day of admission, he fell into a state of shock because of sudden massive bloody intestinal discharge. Colonofiberscopic findings revealed a primary arterio-enteric fistula. Therefore, an emergency operation was undertaken. Following aneurysmectomy, colostomy was performed in the descending colon. Right axillo-femoral artery bypass was finally performed as an extra-anatomical bypass to secure the right leg blood flow.

Thoracic aorta injury caused by blunt chest trauma is often fatal. A 26-year-old male with bilateral pneumohemothorax and disruption of the thoracic descending aorta due to a traffic accident was referred to our hospital. The chest X-ray film and CT scanning showed neither mediastinal widening nor periaortic hematoma. Three weeks after admission, aortography revealed flap formation at the aortic isthmus. Two months after trauma, we replaced the injured aorta with a vascular prosthesis using a centrifugal pump. Pathological examination showed separation of a medial layer of the aorta. His postoperative course was uneventful.

A 55-year-old man was admitted with anterior chest pain. He had received aorto-renal bypass for left renal artery stenosis at the age of 24. His coronary angiography with ergotamine malate provocation showed 99% stenosis in the left anterior descending artery and circumflex artery and abdominal aortography revealed an aneurysm with a diameter of 4cm at the proximal site of the graft anastomosis. The patient was surgically treated with aneurysmectomy and PTFE grafting (7mm) between abdominal aorta and the already-implanted graft to the left renal artery. His postoperative course was uneventful and no major complication such as renal failure were observed. Anastomotic aneurysm is a fairly common complication associated with arterial reconstruction which is most common in the common femoral artery. This is the first reported case of anastomotic aneurysm complicated by aorto-renal bypass.

A 54-year-old man consulted our hospital because of nocturnal and mild exertional chest pain. Echocardiography demonstrated a mobile mass in the right atrium. There were no abnormal findings on the coronary angiogram. Because of the large size of the mass, surgical removal was carried out and a yellowish, globular tumor, sized 20×15×13mm, attached to the anterior tricuspid leaflet with a short stalk was excised. Postoperative recovery was uneventful. The patient was discharged from the hospital with no symptoms. The diagnosis of papillary fibroelastoma (PFE) was confirmed on histologic examination. PFE is a well-known tumor that usually arises on the heart valves. Although, historically, this tumor has incidentally been discovered at necropsy, clinical case reports have recently increased. However, the vast majority of clinically reported PFEs were the cases of the left side of the heart, for which the operative indication is quite definite because of serious complications such as cerebral or myocardial infarction caused by this tumor, irrespective of size. On the contrary, only a small number (17 cases) of the right heart PFEs have been reported in the literature and its operative indications are unclear. Review with regard to the operative indications for the right heart PFEs was made based on the total of 18 cases including our patient.

In this paper we report two incidents of ciguatera fish poisoning (CFP) that occurred in 2008 on Kakeroma Island in Kagoshima Prefecture, Japan. A family consisting of father (42 y.o.), mother (39 y.o.), daughter (11 y.o.) and son (6 y.o.), as well as a friend of the family (male, 78 y.o.) consumed sliced flesh (sashimi) and developed typical symptoms of CPF 4-5 h later: diarrhea, vomiting, and paresthesia of the extremities. Additionally, the two male adults (42 and 78 y.o.) developed mild hypotention (84/48 and 94/40 mmHg, respectively) and bradycardia (36 and 50 bpm, respectively) and were rushed to the ER of the nearest hospital, located on an adjacent island. The implicated fish were caught together off the west coast of the island and were identified as Variola louti and Lutjanus monostigma based on analysis of 16S rRNA gene coded on mtDNA. Remnants of the implicated fish and other fish caught on the same occasion were examined by the official mouse bioassay method (MBA), which defines the minimum amount of CFP toxin needed to kill a male mouse of ddY strain of 20 g body weight within 24 h as one mouse unit (MU). A significantly high toxicity was detected in the V. louti (0.2 MU/g) eaten by the family and the L. monostigma (0.8 MU/g) eaten by the elderly man. Other specimens of Lethrinus nebulosus, Variola albimarginata, Lutjanus gibbus (2 specimens), Aphareus rutilans, and Sphyraena forsteri (2 specimens) were found to be nontoxic (< 0.025 MU/g).
The medical records regarding island inhabitants (ca. 1,500) kept at Kakeroma Tokushukai Clinic, the only medical facility on the Island, and also at Setouchi Tokushukai Hospital, a nearest hospital on an adjacent island (Amami) revealed 6 CFP outbreaks involving 13 cases between 2005 and 2008. The estimated frequency of CFP was 10.0 incidents/10,000 persons/year and the morbidity rate was 21.7 cases/10,000 persons/year. The symptoms and signs observed in the patients and the implicated fish species, L. monostigma and V. louti, were typical of CFP in this region.

Undergraduate medical students in their 5th year were given integrated lectures on two topics, “ The cerebellum ” and “Patient -centered medical care”. The results of a questionaire survey indicated that students had hoped for continuation and expansion of the lectures to include many other topics. A series of discussions among faculty however, disclosed two problems with regard to continuation and expansion, i. e., a lack of experts for integration and lack of adequate means to assess educational impact. Teaching personnel in integrated lectures need not necessarily be experts or professors, but persons who can be in close contact with one another for the purpose of integration. Setting aside rigid discussions on validity, small achievement tests may be useful in assessing the degree of student comprehension.

Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.
Bone Neoplasms ; Chondroblastoma ; Chondrosarcoma ; Durapatite* ; Epiphyses ; Femur ; Giant Cell Tumors ; Humans ; Hydroxyapatites ; Methods ; Osteosarcoma ; Reconstructive Surgical Procedures ; Recurrence ; Tibia

The engaging>30 minutes of physical activity (PA) at 4-6 METs has been recommended for the prevention of cardiovascular disease. We determined whether relatively low intensity (i. e., 3-5 METs) PA inhibits the age-related central arterial stiffening, a risk of cardiovascular disease. In the cross-sectional study, the association between carotid arterial properties (via ultrasound system) and daily PA (via electric accelerometer) were studied in 172 normotensive people (41-82 yrs). People engaging>30 min/day of PA corresponding to 3-5 METs had a significantly lower beta-stiffness index than sedentary peers after adjusting for covariates (i. e., age and PA time at more than 6 METs). In the interventional study, beta-stiffness index of nine normotensive postmenopausal women was significantly decreased after the 12-week aerobic training (cycling at 80% of ventiratory threshold, ≈4 METs, 30 min/day, 5 days/week). These results suggest that the increase in daily PA at 3-5 METs inhibits the age-related carotid arterial stiffening.

A 43-year-old woman underwent aortic valve replacement for aortic regurgitation causing aortitis syndrome. The postoperative course had been uneventful and inflammation was controlled by steroid therapy. She developed a moderate degree of dyspnea with cardiomegaly. Two years after the first aorta valve replacement (AVR), severe aortic regurgitation was observed on both echocardiography and aortography. Dehiscence of the prosthetic valve was suspected and an emergency operation was performed. To secure the reimplanted prosthetic valve, we applied the technique of passing felt-pledgeted sutures through the aortic wall in the vicinity to the right coronary cusp and the noncoronary cusp and others through the left coronary cusp with everting mattress sutures. The postoperative course of the second AVR has been uneventful for two months. Since prosthetic valve detachment can occur even if inflammation of aortitis is well controlled, strict management of inflammation is recommended for a prolonged period to prevent reccurence of aortitis and subsequent valve dehiscence.

Resistance exercise in the elderly and patients with a cardiovascular disorder has been thought to have a high cardiovascular risk, because it has the tendency to cause an excessive rise in blood pressure and induce serious arrhythmia. But recently, resistance exercise has been introduced into physical therapy because the safety of such exercise has been confirmed in subjects without a cardiovascular disorder.
The purpose of this study was to investigate the safety of lower extremity resistance exercise in middle-aged or elderly subjects with hypertension and receiving medical treatment (n=24), and those without hypertension (n=40), by measuring cardiovascular response during resistance exercise of different loads (40% and 60% 1 RM), and usefulness of respiratory guidance during such exercise.
As a result, there was no difference in diastolic blood pressure between those with and without hypertension ; but systolic blood pressure and rate pressure product both at rest and during exercise were significantly greater in patients with hypertension. However, neither group showed symptoms of angina, ischemic signs in ECG, or serious arrhythmia ; and there was no difference in the frequency of excessive rise in blood pressure between the groups (2 subjects with hypertension and 1 subject without hypertension) . Blood pressure during exercise was significantly lowered by respiratory guidance.
These results show that it is important to measure blood pressure during exercise before resistance exercise training regardless of the presence of hypertension, although an excessive rise in blood pressure occurred in only a few subjects. Furthermore, it is important to exhale slowly and not hold one's breath during exercise.