We report a case with successful surgical resection for a leiomyoma with an extension into the right atrium from the pelvic vein. The patient was a 54-year-old woman who presented with syncope in 1989. She had had a history of resection of a uterine leiomyoma 10 years previously. Preoperative angiograms showed a long tumor with an extension into the right atrium through the inferior vena cava originating from the right internal iliac vein. The diagnosis of intravenous leiomyomatosis was made. The operation was performed through a median sterno-laparotomy using cardiopulmonary bypass with successful results. Histologic sections showed a benign leiomyoma. To our knowledge, 20 cases of resection of intravenous leiomyomatosis with the use of extracorporeal circulation have been reported in the literature. This rare condition was discussed with the review of the literature.

We studied the incidence of associated ischemic heart disease (IHD) among 143 consecutive patients (male 118, female 25, mean age 68.5±6.9 years) operated upon for abdominal aortic aneurysm (AAA), excluding ruptured aneurysms. The screening of IHD was routinely performed by using dipyridamole thallium scintigraphy, and when it was positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged positive for IHD. Sixty-two patients (43%) with AAA were simultaneously afflicated with IHD. We also compared the 62 AAA patients with IHD with the remaining 81 AAA patients in this series. The patients with IHD had higher incidences of risk factors such as diabetes mellitus (p=0.0031) and hyperlipidemia (p=0.0029) than those without IHD. Five patients were operated on for AAA after coronary artery bypass grafting (CABG), 11 were operated on for AAA and IHD (CABG) simultaneously, 10 were operated on after PTCA, thirty-two patients underwent elective surgery for AAA and four had emergency procedures due to impending rupture of AAA with continuous infusion of nitroglycerin with or without diltiazem. There was no significant difference in surgical mortality between AAA patients with IHD and those without IHD (3%vs2%), and no cardiac death in this series. When both AAA and IHD are severe enough to warrant surgical treatments at the earliest opportunity, we recommend concomitant operations for AAA and IHD (CABG) since these have been performed quite successfully in our series.

Normal human development requires the precise functioning and coordination of many complex pathways. Abnormalities in these signaling cascades often result in developmental perturbations, giving rise to congenital anomalies and cancers. There are 21,787 genes in each human nucleus, different gene subsets are expressed in different cell types, and different gene networks make different signal cascades. Among a large number of genes, in this review, we describe signaling disorders of sonic hedgehog and its receptor, patched-1; Tie2; fibroblast growth factor receptor in craniofacial anomalies and oral cancers.

Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.

The sudden onset of anuria in a 71-year-old man was found to be caused by the non-inflammatory (atherosclerotic) large abdominal aortic aneurysm compressing the bilateral ureters. A computed tomography scan demonstrated the bilateral extrinsic ureteral obstructions due to the large aneurysm of 13cm in diameter, left hydronephrosis and no thick layer of perianeurysmal fibrotic tissue. On the 9th day from the onset of anuria, an emergency operation was performed. There was no fibrotic adhesions around the aneurysm and mobilization of the aorta was easy. A straight Dacron prosthesis was inserted between the infrarenal aorta and the bifurcation of the abdominal aorta following resection of the aneurysm of the atherosclerotic origin. Soon after the operation, the patient had very good urinary output with adequate recovery of renal function. This case seems to be very uncommon, but very important in the surgical management of abdominal aortic aneurysm complicated by oliguria or anuria.

We studied the incidence of associated ischemic heart disease (IHD) among 110 consecutive patients (males 99, females 11, mean age 66.0±8.8 years) operated upon for arteriosclerosis obliterans (ASO). The screening of IHD was routinely conducted by using dipyridamole thallium scintigraphy, and when results were positive, the lesion was further confirmed by selective coronary angiography. More than 50% luminal stenosis of the major coronary arteries was judged as positive for IHD. Forty-eight patients (44%) of ASO were simultaneously afflicted with IHD. Ten patients were operated on for ASO after coronary artery bypass grafting (CABG), five for ASO and IHD (CABG) simultaneously, eight for ASO after PTCA. Twenty-five patients underwent surgery for ASO only with infusion of nitroglycerin, with or without diltiazem. We also compared 15 patients with thrombotic obliteration at the end of the abdominal aorta o: Leriche's syndrome with the remaining 95 patients in this series. The patients with Leriche's syndrome were younger and had higher incidences of hyperlipidemia (p=0.0254) and IHD (p=0.0225) than those without Leriche's syndrome. In surgical treatment for ASO, particularly for Leriche's syndrome, meticulous attention to complications is needed due to the frequent association of IHD. When both ASO and IHD are severe enough to warrant surgical treatment at the earliest opportunity, we recommend concomitant operations for ASO and IHD (CABG).

Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery.
Emergencies ; Endoscopy ; Equipment and Supplies ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Hospitalization ; Humans ; Mortality ; Radiology, Interventional

Objective: Adequate periconceptional intake of folic acid decreases the risk of neural tube defects.  The present study aimed to investigate pharmacists’ awareness of the importance of folic acid intake for the prevention of neural tube defects and to identify factors associated with pharmacists’ awareness.
Design: Questionnaire survey.
Methods: A self-administered questionnaire regarding the importance of folic acid intake for the prevention of neural tube defects was distributed to pharmacists who attended educational seminars offered by the Sendai City Pharmaceutical Association in December 2010.
Results: Among the 166 respondents, 104 (62.7%) pharmacists were aware that folic acid intake decreases neural tube defects.  After stratification for age and sex including history of delivery, female gender and history of delivery were significantly associated with the awareness of the importance of folic acid intake only among pharmacists younger than 40 years old. Of 104 pharmacists who recognized the importance of folic acid intake for the prevention of neural tube defects, 51.0% and 27.9% recognized that women should begin intake of folic acid before conception and should take about 400 μg of folic acid per day during pregnancy, respectively.
Conclusion: Although about 60% of pharmacists recognized that folic acid intake decreases the risk of neural tube defects, many did not know the intake level required to effectively prevent neural tube defects.  Therefore, more aggressive promotion of the awareness of the importance of folic acid intake among pharmacists is warranted.

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.
Adult ; Carcinoid Tumor* ; Colonoscopy ; Germinal Center ; Humans ; Lymphoid Tissue ; Lymphoma, B-Cell, Marginal Zone* ; Palatine Tonsil* ; Rectum ; Twins*