An aberrant right subclavian artery (ARSA) is a relatively rare congenital anomaly of arch branches, occurring in 0.5-2.0% of the population. Stanford type A acute aortic dissection involving an ARSA is rare, and is associated with difficult surgical planning in an emergency situation. We report a case of Stanford type A acute aortic dissection originating from an ARSA in a 50-year-old man. He was referred to our hospital with a chief complaint of chest and back pain. Contrast enhanced CT scan revealed type A aortic dissection involving an ARSA, with the entry located near the ARSA. Given the possible difficulty of performing distal anastomosis over the ARSA and ARSA reconstruction, total arch replacement was performed using the open stent-grafting technique. The postoperative course was uneventful, and a CT scan revealed a thrombosed false lumen and ARSA. The false lumen of the aorta next to the stent graft eventually disappeared at 1 year postoperatively. The open stent-grafting technique might be an effective alternative in the management of Stanford type A acute aortic dissection with ARSA.

General practitioners frequently encounter uncertainties, making it an urgent issue to address. Recently, there has been growing attention to the concept of negative capability, which is the ability to remain in a state of uncertainty, mystery, and doubt without feeling a need to search for facts or apply reason. The Negative Capability Conference aims to encourage general practioner to recognize and accept uncertainty, acknowledging the various emotions involved in the process.

Ischemic colitis following cardiac surgery is a rare but critical complication. We report two cases of ischemic colitis following cardiac surgery successfully treated with stenting of the stenotic celiac trunk. Case 1 was a 65-year-old man who developed perioperative myocardial infarction during off-pump coronary artery bypass grafting. He experienced abdominal pain and bloody stool on postoperative day 19. Severe ischemic changes in the sigmoid colon and descending colon were seen on colonoscopy, and CT scan revealed significant stenosis of the celiac trunk and occlusion of the inferior mesenteric artery and bilateral internal iliac arteries. Revascularization of the celiac trunk via stenting resulted in dramatic improvement in colonic ischemic changes. Case 2 was a 60-year-old woman who underwent a restoration procedure for a left ventricular aneurysm. She experienced gradual onset of postprandial pain beginning 9 days after surgery and massive bloody stool on postoperative day 33. Imaging revealed severe ischemic changes in the descending colon on colonoscopy and stenoses of the celiac trunk, superior mesenteric artery, inferior mesenteric artery, and bilateral common iliac arteries on CT angiogram. Stenting was performed to the celiac trunk on postoperative day 52. Her abdominal pain and bloody stool were completely resolved after treatment. Prior to the introduction of endovascular treatment of mesenteric ischemia in 1980, the standard treatment had been open surgical repair. Since then, endovascular repair has become widely accepted. In our experience, endovascular treatment of the mesenteric vessels may be an effective and less invasive approach to treating mesenteric ischemia in unstable patients after cardiac surgery.

Thirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.

Transcatheter embolization of 25 aortopulmonary collateral arteries (7 bronchial arteries and 18 intercostal arteries) was attempted prior to intracardiac repair in 7 patients. The underlying disease was tetralogy of Fallot in 3 patients, pulmonary atresia with ventricular septal defect in 2, double-outlet right ventricle with ventricular septal defect and pulmonary stenosis in 1 and tricuspid stenosis with pulmonary atresia in 1. The intervals between embolization and intracardiac repair ranged from 0 to 17 days (mean 4.5 days). Embolization resulted in total occlusion in 7 bronchial arteries and 17 intercostal arteries, with an overall success rate of 96%. Complications included a coil dislodgement from a collateral artery into the aorta in one patient, necessitating surgical removal of the dislodged coil from the femoral artery, an exacerbation of cyanosis and dyspnea on exercise in 5, and slight fever in 2. In one patient with tetralogy of Fallot, who had 5 collateral vessels, transcatheter embolization caused hypoxemia, bradycardia and hypotension and therefore intracardiac repair was performed immediately after embolization. Aortopulmonary collateral arteries in patients with congenital heart disease can be effectively treated by transcatheter embolization. Embolization should be performed just before intracardiac repair because an excessive decrease in arterial oxygen saturation after embolization may require an emergency operation.

An educational video describing the acupunctural stimulation of the pudendal nerve for treatment of urinary disturbances was produced. Treatment points on the meridian were selected within the limits of the top 1/2 to 3/5 of the line that connects the superior posterior iliac spine and the inner lower edge of the ischiatic tuberosity. Since the pudendal nerve is situated between the sacrospinous ligament in this region, it could be readily stimulated from the body surface. A 90mm (#24) acupuncture needle was used for the treatments. When the needle was inserted to a depth of 50-80mm from the body surface, the pudendal nerve was reached. Echo sensation in the penis indicated that the acupuncture needle had contacted the pudendal nerve.
Either the sparrow-pecking, needle-twisting, or the low frequency acupunctural techniques were used to delver stimulation to the pudendal nerve. In conclusion, acupunctural stimulation of the pudendal nerve was clinically useful for treatment of urinary disturbances, such as uncoordination of the detrusor muscles in neurogenic bladder and urinary incontinence.

Temporomandibular arthrosis, whose major symptoms are trismus, pain of the temporomandibular joint and articular noise, has recently been increasing, primarily in younger people. This condition is often accompanied by unexplained complaints (e. g., headache and stiffness of the neck and/or shoulder) which are indications for the application of acupuncture therapy. To deepen the recognition of temporomandibular arthrosis by clinicians, we recently prepared a video tape showing detailed procedures of acupuncture therapy for this disease. The first half of this video tape consists of an explanation of the anatomical features of the temporomandibular joint, the pathophysiology and classification of temporomandibular arthrosis, and magnetic resonance images of the temporomandibular joint. The latter half consists of the diagnostic and therapeutic procedures for this disease, including the acupoints often stimulated for its treatment and the techniques of acupuncture therapy.

Purpose: Promoter DNA methylation of various genes has been associated with metachronous gastric cancer (MGC). The cancer-specific methylation gene, cysteine dioxygenase type 1 (CDO1), has been implicated in the occurrence of residual gastric cancer. We evaluated whether DNA methylation of CDO1 could be a predictive biomarker of MGC using specimens of MGC developing on scars after endoscopic submucosal dissection (ESD). Materials and Methods: CDO1 methylation values (TaqMeth values) were compared between 33 patients with early gastric cancer (EGC) with no confirmed metachronous lesions at >3 years after ESD (non-MGC: nMGC group) and 11 patients with MGC developing on scars after ESD (MGCSE groups: EGC at the first ESD [MGCSE-1 group], EGC at the second ESD for treating MGC developing on scars after ESD [MGCSE-2 group]). Each EGC specimen was measured at five locations (at tumor [T] and the 4-point tumor-adjacent noncancerous mucosa [TAM]). Results: In the nMGC group, the TaqMeth values for T were significantly higher than that for TAM (P=0.0006). In the MGCSE groups, TAM (MGCSE-1) exhibited significantly higher TaqMeth values than TAM (nMGC) (P<0.0001) and TAM (MGCSE-2) (P=0.0041), suggesting that TAM (MGCSE-1) exhibited CDO1 hypermethylation similar to T (P=0.3638). The area under the curve for discriminating the highest TaqMeth value of TAM (MGCSE-1) from that of TAM (nMGC) was 0.81, and using the cut-off value of 43.4, CDO1 hypermethylation effectively enriched the MGCSE groups (P<0.0001). Conclusions CDO1 hypermethylation has been implicated in the occurrence of MGC, suggesting its potential as a promising MGC predictor.

Purpose: Thyroid transcription factor 1 (TTF-1) expression is a useful predictor of treatment efficacy in advanced non-squamous non–small cell lung cancer (NSCLC). This study aimed to evaluate whether TTF-1 could predict the effectiveness of chemotherapy versus chemoimmunotherapy in patients with non-squamous NSCLC with programmed death ligand-1 (PD-L1) expression between 1% and 49%. Materials and Methods: We conducted a retrospective study of patients with NSCLC who were treated with chemotherapy or chemoimmunotherapy between March 2016 and May 2023. The patients had histologically confirmed NSCLC, stage III-IV or postoperative recurrence, TTF-1 measurements, and PD-L1 expression levels between 1% and 49%. Clinical data were analyzed to evaluate the effect of TTF-1 expression on treatment efficacy. Results: This study included 283 of 624 patients. TTF-1–positive patients showed longer progression-free survival (PFS) and overall survival (OS) (PFS: 6.4 months [95% confidence interval (CI), 5.0 to 9.4] vs. 4.1 months [95% CI, 2.7 to 6.1], p=0.03; OS: 17.9 months [95% CI, 15.2 to 28.1] vs. 9.4 months [95% CI, 6.3 to 17.0], p < 0.01) in the chemotherapy cohorts (n=93). In the chemoimmunotherapy cohort (n=190), there was no significant difference in PFS and OS between TTF-1–positive and –negative groups (PFS: 7.6 months [95% CI, 6.4 to 11.0] vs. 6.0 months [95% CI, 3.6 to 12.6], p=0.59; OS: 25.0 months [95% CI, 18.0 to 49.2] vs. 21.3 months [95% CI, 9.8 to 28.8], p=0.09). Conclusion In patients with NSCLC with PD-L1 expression between 1% and 49%, TTF-1 expression was a predictor of chemotherapeutic, but not chemoimmunotherapeutic, efficacy.