A 69 year old man who was admitted with hoarseness and diagnosed as aneurysm of the diverticulum of the ductus arteriosus was reported. Operation was performed through a median sternotomy under partial cardiopulmonary bypass. Saccular form aneurysm, had a stalk attaching to left pulmonary artery, was repaired using Dacron patch prosthesis. His postoperative course was uneventful except transient left pleural effusion. Because of fragirity of aneurysm in the adult, early surgical intervention is recommended. To our knowledge, this is 11th surgically treated case to be reported in the literature in Japan.

We report the rare case of a 68-year-old man, who was admitted to our hospital with a diagnosis of aortic arch anastomotic pseudoaneurysm, with concomintant aortic root enlargement and coronary artery stenosis. Eleven years previously, at age 56, he underwent total arch replacement with island reconstruction for chronic aortic dissection. We performed redo total arch replacement, aortic root replacement and coronary artery bypass, making use of a cardiopulmonary bypass with cannulation through the right subclavian artery, femoral artery and femoral vein before resternotomy. We also used selective cerebral perfusion. Postoperatively, the patient temporarily required reintubation ; however, he was discharged in good condition on the 50th post-operative day. The case suggests that island reconstruction has the potential to cause an aortic arch pseudoaneurysm, particularly after a long postoperative period of time. Therefore, thorough postoperative care strategy is required. We also need to consider surgical reconstructive techniques which eliminate vascular lesions as much as possible at the time of the primary surgery, particularly in cases of chronic aortic dissection.

One hundred and thirty cases of closed mitral commissurotomy were followed for up to 25 years and 10 months. There was no operative death, but 31 cases died during the follow-up period. Eight cases died suddenly of unknown cause, 7 due to heart failure, 5 due to thromboembolism, 4 on reoperation, and 6 due to other reasons. In the 7 cases who died of heart failure late after commissurotomy, 3 cases refused reoperation. Each of the remaising 4 cases were not operated on because of associated severe liver dysfunction, left ventricular dysfunction plus pulmonary hypertension, respiratory failure due to bronchial asthma, and unknown reasons, respectively. The actuarial survival rate was 93.6% 10 years after surgery, and 72.2% 20 years after surgery. Forty-two cases had reoperation with a mean interval of 12 years and 6 months. Reoperation-free survival rate was 88.7% 10 years after the first operation and 42.8% 20 years after the first operation. Incidence of major thromboembolism was 1.25%/patient-year. Thromboembolism and sudden death of unknown cause constituted the leading cause of late death and played a key role in long term results. Cardiac event-free survival rate was 65.7% 10 years after surgery and 32.6% 20 years after surgery. From these results it was concluded that the clinical limitations of the effectiveness of closed mitral commissurotomy was around ten years after surgery. We believe that these findings provide useful information for percutaneous transvenous mitral ommissurotomy.

Left ventricular hypertrophy in patients with aortic valve disease has long been recognized as a significant risk factor for aortic valve replacement. Higher operative mortality in such patients has been attributed to poor myocardial preservation. In these patients improvement of left ventricular subendocardial blood flow during reperfusion seems to be mandatory to avoid subendocardial injury. Therefore, we attempted to increase subendocardial blood flow during reperfusion by terminal warm blood cardioplegia (TWBCP) followed by controlled aortic root reperfusion (CARR) in patients requiring isolated aortic valve replacement. The patients with TWBCP and CARR had a tendency towards severe left ventricular hypertrophy and more advanced NYHA function class compared to those with hypothermic cardioplegia alone. Nevertheless, the patients with TWBCP and CARR showed significantly better recovery of left ventricular function, i.e., spontaneous recovery of beating and higher cardiac index as well as left ventricular stroke work index, despite significantly less catecholamine support. These resuls suggest that TWBCP followed by CARR may offer significant benefits over unmodified reperfusion during aortic valve replacement for patients with severe left ventricular hypertrophy.

AIMTo characterize mouse capping protein alpha3 (CPalpha3) during spermatogenesis and sperm maturation.

METHODSWe produced rat anti-CPalpha3 antiserum and examined the expression of CPalpha3 in various mouse tissues using Western blot analysis and the localization of CPalpha3 in testicular and epididymal sperm using immunohistochemical analyses. We also examined how the localization of CPalpha3 and beta-actin (ACTB) in sperm changed after the acrosomal reaction by performing immunohistochemical analyses using anti-CPalpha3 antiserum and anti-actin antibody.

RESULTSWestern blot analysis using specific antiserum revealed that CPalpha3 was expressed specifically in testes. Interestingly, the molecular weight of CPalpha3 changed during sperm maturation in the epididymis. Furthermore, the subcellular localization of CPalpha3 in sperm changed dynamically from the flagellum to the post-acrosomal region of the head during epididymal maturation. The distribution of ACTB was in the post-acrosomal region of the head and the flagellum. After inducing the acrosomal reaction, the CPalpha3 and ACTB localization was virtually identical to the localization before the acrosomal reaction.

CONCLUSIONCPalpha3 might play an important role in sperm morphogenesis and/or sperm function.

Acrosome Reaction ; physiology ; Actins ; metabolism ; Animals ; Blotting, Western ; CapZ Actin Capping Protein ; metabolism ; Cells, Cultured ; Epididymis ; cytology ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Sperm Head ; metabolism ; Sperm Tail ; metabolism ; Spermatogenesis ; physiology ; Spermatozoa ; cytology ; metabolism ; Testis ; cytology ; metabolism

　At Showa University, which consists of the Schools of Medicine, Dentistry, Pharmacy, and Nursing and Rehabilitation Sciences, systematic interprofessional education for the purpose of training staff who can contribute to the medical team has been introduced with the cooperation of all 4 schools and through all undergraduate years. In the lower years, students study the basics of medical team care through a 4-school joint curriculum of experiential learning （such as early exposure） and problem-based learning inside and outside of the university. In the upper years, to acquire practical skills, students study the practice of medical team care through a joint curriculum of participatory learning in hospitals and the community. Through this curriculum, I expect that the medical staff to promote patient-centered team medical care in a variety of medical fields will grow in the future.

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature Xue-shi yi-an (薛氏医案) . Yokukansan was described in the Bao-ying jin-jing-lu (保嬰金鏡録) written by Xue ji (薛己) in 1550, the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551,the Bao-ying cuo-yao (保嬰撮要) by Xue kai (薛鎧) in 1556, and the Xiao-er dou-zhen fang-lun (小児痘疹方論) in 1550. The phrase “one's own work” was used in “Bao-ying jin-jing-lu (保嬰金鏡録)” and in the Xiao-er dou-zhen fang-lun (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the Xiao-er dou-zhen fang-lun (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).
Yokukansan was found only in the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.
Yokukansan was previously thought to have originated with the Bao-ying cuo-yao (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the Bao-ying jin-jing-lu (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.

Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.