To investigate the effect of teeth clenching on isokinetic knee extension at various velocities, isokinetic muscle strength during knee extension was measured in association with teeth clenching at 30, 60, 150, 300 and 450 degrees per second (deg/s) using the Cybex 6000 isokinetic dynamometer. The volunteer subjects were 9 healthy males (26.2±0.97 years) . The peak torque per body weight and average power per body weight were statistically analyzed. Our results demonstrated that the peak torque per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 7.0%, 7.4% and 4.9%, respectively (p<0.05), but no significant differences were found at 300 and 450 deg/s. While the average power per body weight with teeth clenching at 30, 60 and 150 deg/s significantly increased by 6.5%, 6.1% and 6.9%, respectively (p<0.05), no sig-nificant differences were found at 300 and 450 deg/s. A significant negative correlation was shown between the isokinetic angular velocity and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.699; p<0.05) . These findings suggested that the effect of teeth clenching on isokinetic muscle strength of knee extension was dependent on the angular velocity, and at lower angular velocities teeth clenching had the effect of increasing the isokinetic muscle strength during knee extension.

Eight cases of isolated iliac artery aneurysms treated between January 1991 and December 1997 were reviewed. All patients were men and their ages ranged from 51 to 85 years (mean 69.6 years). The incidence rate relative to abdominal aortic aneurysm during the same period was 9.3%. The location of the iliac artery aneurysms was the common iliac artery in 6 patients and common and internal iliac artery in 2 patients. Rupture occurred in 3 patients (37.5%). Aneurysms ranged in size from 25mm to 55mm (mean 39.1mm) in 5 non-ruptured cases and from 50mm to 90mm (mean 71.7mm) in 3 ruptured cases (p<0.05). The operative procedures for common iliac artery aneurysms were aneurysmorrhaphy with prosthetic graft replacement in 7 patients and with common iliac-external iliac artery anastomosis in 1 patient. For internal iliac artery aneurysms, obliterative endoaneurysmorraphy was performed in 2 patients. Hartmann's operation with sigmoid colostomy was concomitantly performed in 1 case of rupture. Seven patients had good postoperative courses, however, one case of rupture that underwent Hartmann's operation died of multiple organ failure on the 13th postoperative day. Early diagnosis and elective surgery before rupture are recommended.

A 37-year-old woman had a permanent transvenous cardiac pacemaker inserted previously in the left subclavian region to treat complete atrioventricular heart block. As infection occurred in the left subclavian subcutaneous pacemaker pocket after generator replacement, the generator was removed and a new permanent transvenous cardiac pacemaker was inserted in the right subclavian region. After two months, she developed fever and productive cough, and was admitted to our hospital. Echocardiography showed vegetation on the pacemaker electrodes and the tricuspid valve. Chest-computed tomography showed scattered bilateral peripheral nodules with various degrees of cavitation. We diagnosed right-sided infective endocarditis (IE) with septic pulmonary emboli (SPE) and performed cardiac surgery. We observed vegetation on the pacemaker electrodes and the tricuspid valve. The vegetation, the electrodes, and the generator were all removed and a permanent epicardial pacemaker was inserted subcutaneously in the left subcostal region. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from cultures of vegetation. Postoperative antibiotic therapy was performed and SPE was completely cured. We removed the pacemaker and the electrodes, and performed postoperative antibiotic therapy.

The purpose of this study was to investigate the effect of teeth clenching on isokinetic knee extension force during repeated voluntary contractions. We assessed isokinetic muscle strength in association with teeth clenching during 100 consecutive knee extensions at 60 degrees per second (deg/s) using a Cybex 6000 isokinetic dynamometer. In this study, 8 healthy male volunteers (28.4 ± 3.89 years) were asked to perform isokinetic contractions in an extended cycle of five contractions without teeth clenching followed by five contractions with the teeth clenching. The peak torque per body weight was statistically analyzed. In our results, the peak torque per body weight with teeth clenching were significantly greater than those without teeth clenching in the first 70 cycles; however, no significant differences were shown at 71-100 cycles. There was a significant negative correlation between the number of knee extensions and the difference in peak torque per body weight derived from with and without teeth clenching (r=-0.475, p<0.0001) . Our findings reveal that the effect of teeth clenching on the isokinetic muscle strength of knee extension is dependent on muscular fatigue, and that the improving effect of teeth clenching on isokinetic muscle strength declines with increasing muscular fatigue.

Previous research has demonstrated that the concentric muscle strength of knee extension exerted at slow to medium angular velocities is increased by teeth clenching. This study evaluated the isokinetic eccentric strength of knee extensors at 4 angular velocities (60, 120, 180 and 240 degrees per second) with and without teeth clenching on the Cybex 6000 Extremity Testing and Rehabilitation System. Twelve healthy adult male (26.8±1.8 years) volunteered for the study. Peak torque per body weight and average power per body weight were analyzed. The results demonstrated that peak torque per body weight accompanied by teeth clenching was significantly increased at 60, 120, 180 and 240 deg/s by 9.5%, 8.2%, 8.2% and 9.8%, respectively (p<0.01) . Similarly average power per body weight during teeth clenching was significantly higher at 60, 120, 180 and 240 deg/s by 9.1%, 9.5%, 9.4% and 7.7%, respectively (p<0.05) . These findings suggest that teeth clenching is a factor that leads to augmented eccentric strength of knee extensors. Its effect appears to be independent of angular velocity.

A 68-year-old woman with a diagnosis of atrial septal defect (ASD) presented with dyspnea. Chest radiography demonstrated cardiomegaly and infiltration in both lungs, suggestive of cardiac decompensation due to ASD. Detailed evaluation with transthoracic echocardiography revealed a mobile tumor on the aortic valve. Intraoperatively, tumors were identified on all aortic cusps. Preservation of the aortic valve was difficult. We therefore performed aortic valve replacement and patch closure of the ASD. The existing literature suggests that mobile papillary fibroelastoma should be excised irrespective of size, to prevent the risk of embolism. Excision of the tumor alone is usually sufficient. However, the present case showed clustered tumors on the aortic valve, so preservation of the cusps could not be achieved in this case.

Type II endoleak after stent graft for abdominal aortic aneurysm generally permits a wait-and-see approach, however, additional second therapy is necessary if the aneurysm increases. A 78-year-old woman had undergone endovascular treatment with a stent-graft for abdominal aortic aneurysm. Computed tomography (CT) 3 months after the operation showed type II endoleak, and enlargement of the aneurysm was noted at 1 year. She underwent transarterial embolization for third and fourth lumbar arteries, but endoleak from the fourth lumbar artery remained, and the aneurysm was further enlarged. Surgical conversion was performed 2 years after the first operation. We applied a ligature to the forth lumbar artery by a laparotomy. Postoperative CT revealed disappearance of the endoleak. As endovascular treatment for abdominal aortic aneurysm is increasing and the number of cases necessitating additional therapy appears to be rising, we need to develop processes and strategies for coping with endoleaks.

Herein, we report a rare case of a pseudoaneurysm at the anastomotic site of the bicarotid trunk after thoracic aortic graft replacement. A 53-year-old man with Marfan syndrome underwent a three-stage operation involving aortic root reimplantation and ascending aortic replacement ; aortic valve replacement and total arch replacement ; and descending aortic replacement performed for type A dissection combined with an aberrant right subclavian artery. Two years after total arch replacement, the patient presented with hoarseness and a computed tomography scan revealed an anastomotic pseudoaneurysm of the common trunk of the left and right carotid arteries. A right axillary artery-common carotid artery bypass was performed, with simultaneous insertion of a vascular stent graft from the left common carotid artery to the anastomotic site. Cervical bypass and stent implantation were both performed without shunting. He was discharged home without any neurological complications.

Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001). Conclusions Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.