The relationships between physical activity and childhood body size, low physical fitness epidemic are still unclear. The purpose of this study was to examine the relationship between energy expenditure estimated by doubly labeled water (DLW) method and body fatness, physical fitness in children, and the relationship between physical activity levels and percent time spent in activities. 30 healthy Japanese children (20 boys and 10 girls) participated in this study. The total energy expenditure (TEE) and % body fat were measured by the DLW method over a 6-day period. The physical activity-related energy expenditure (PAEE) was calculated as (TEE × 0.90) – basal metabolic rate (BMR). The physical activity level (PAL) was also calculated as TEE/BMR. The physical fitness tests (8 items) were applied to evaluate fitness, and scores of each test were calculated as overall physical fitness score. The TEE was 2009.8 ± 272.6 kcal/day, the PAEE was 558.4 ± 206.1 kcal/day and the PAL was 1.61 ± 0.18. TEE per weight and PAEE per weight (PAEE/wt) was significantly negatively correlated with % body fat (r = - 0.626; r = - 0.400, respectively). These results suggest that increasing energy expenditure is important for achieving adequate body size. The PAEE/wt was most strongly correlated with physical fitness score (r = 0.680). The PAL was associated with percent time spent of inactivity ( r = -0.506), light-moderate activity ( r = 0.450) and vigorous activity ( r = 0.545). It was suggested that physically active lifestyle would be necessary for childhood health.

The purpose of this study was to examine the relationships between patterns of daily physical activities measured by accelerometer and physical activity level (PAL) in children. Firstly, activity intensities during incremental exercise were measured using a tri-axial accelerometer (HJA-350IT) in twenty one children aged 10.6 ± 0.9 years. As a result of receiver-operating characteristic curve analysis, the cut-off value for discrimination between walking and running activity was set at 7.2 METs of HJA-350IT. Secondly, total energy expenditure (TEE) in daily life was measured by doubly labeled water method, and durations of lifestyle, walking, and running activities were measured by the accelerometer in 6^th grade elementary school children (11 boys and 10 girls). TEE and physical activity level (PAL) were 2,021 ± 343 kcal/day and 1.56 ± 0.17, respectively. The average durations of lifestyle, walking and running activities were 188 ± 30 min/day (50.6 ± 6.0 %), 171±28 min/day (45.9 ± 5.0 %) and 13.3 ± 7.6 min/day (3.5 ± 1.8 %), respectively. The proportion of the duration of running activity was positively correlated with PAL (r = 0.615, p < 0.01), and the proportion of the duration of lifestyle activity was negatively correlated with PAL (r = -0.439, p < 0.05). There was no relationship between the proportion of the duration of walking activity and PAL (r = 0.300, n.s.). These results suggest that running activity is important to increase PAL more than ever in primary school children.

A 26-year-old man with Marfan's syndrome suffered aortic dissection repeatedly during hospitalization. He was admitted with a diagnosis of annuloaortic ectasia with severe aortic regurgitation. A type A aortic dissection occurred after diagnostic angiography. Three weeks after the onset of the dissection, an aortic root replacement in combination with a total arch replacement was performed. Eight months later, residual dissection in the descending thoracic aorta was replaced with distal perfusion by a temporary bypass from the left subclavian artery to the descending thoracic aorta. At the termination of the operation, abdominal aortic dissection occurred with acute bilateral limb ischemia, which was treated with abdominal aortic intimal fenestration. He recovered uneventfully and was discharged 3 weeks after operation. In light of our experience, because of vascular fragility, great care should be taken in treating patients with Marfan's syndrome to avoid iatrogenic aortic dissection.

A 69-year-old male complained of intermittent claudication of the right leg. Computed tomography revealed a right femoral artery stenosis with severe calcification and intimal thickening extending to the superficial and deep femoral arteries. Femoral endarterectomy and decalcification was carried out using the Cavitron Ultrasonic Surgical Aspirator (CUSA). All arteries were repaired by an ePTFE Y-shaped patch. Postoperative CT showed no stenosis and progressive calcification of the common, superficial and deep femoral arteries 2 years after surgery.

Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass graft (CABG) surgery requires an appropriate surgical procedure to preserve the functional graft. We present a case of hybrid procedure of thoracic endovascular aortic repair combined with a redo off-pump CABG via median sternotomy. The patient was a 76-year-old man with a history of CABG and abdominal aortic replacement in a different country. Chest computed tomography revealed a saccular-shaped aortic aneurysm in the distal aortic arch with diameter of 5.6 cm. Coronary angiography revealed theLIMA graft was patent but anastomosed to the diagonal branch and the left anterior descending artery (LAD) was totally occluded and was opacified through the right coronary artery. Significant ischemic change in the anteroseptal wall suggested a requirement of surgical revascularization of LAD. The chest was opened via re-midsternotomy. Then the 3 arch vessels were reconstructed with a trifurcated artificial graft attached to the ascending aorta and coronary artery bypass grafting was performed on the beating heart. Finally, the aneurysm was excluded by introducing a stent graft through the graft to zone 0. The patient's postoperative course was uneventful and he was discharged on postoperative day 16. A hybrid procedure via median sternotomy was useful in the surgery for TAA with the functional LIMA after CABG.

A 17-year-old male was admitted to our hospital because of strong abdominal pain. His symptoms gradually worsened even after hospitalization, and contrast computed tomography (CT) revealed hemorrhage in the abdominal cavity. Interventional radiology (IVR) was performed to identify the bleeding site. No obvious source of bleeding was identifiable on IVR, so we opted to perform laparoscopic examination and hemostasis. The intraperitoneal finding was hematoma in the omentum, and omentectomy was performed for idiopathic omental hemorrhage because there was no history of trauma. The postoperative course was good and the patient was discharged after postoperative day 4. Performing laparoscopic surgery for omental hemorrhage facilitated minimally invasive treatment with a short hospital stay.

In our hospital, we typically perform laparoscopic partial gastrectomy as surgical treatment for extragastric growth type of submucosal tumor (SMT), and laparoscopic intragastric surgery for intragastric growth type. In 2008, laparoscopic and endoscopic cooperative surgery (LECS) was reported for the first time by Hiki et al. Against the background of LECS as laparoscopic local gastric resection with endoscopic resection, we started LECS for gastric SMT from 2015. 　　We performed laparoscopic (LAP) surgery for 15 gastric SMT cases from 2009, and compared 5 cases for which LECS was performed and 10 cases for which LAP was performed. Tumor diameter was 15–21 mm (mean 19.2 mm) in the LECS group, and 20–53 mm (mean 35.5 mm) in the LAP group; the LECS group had a significantly smaller tumor diameter. Operative time was 299 ± 45 min in LECS and 222 ± 25 min in LAP. The volume of blood loss was 24 ± 13 mL in LECS and 33 ± 13 mL in LAP. Hospitalization days was 14.0 ± 3.0 days in LECS and 12.9 ±0.8 days in LAP. There was no significant difference between them.

Simultaneous creation of an enterostomy for enteral nutrition during esophagectomy has been useful in our experience, but bowel obstruction associated with intestinal fistula remains a problem. Therefore, in this study, we retrospectively reviewed 18 patients with esophageal cancer who underwent transdiaphragmatic transgastric tube enteral feeding catheter placement during gastric tube reconstruction via the mediastinal route after esophagectomy from November 2012 to March 2014. The catheter was guided from the gastric tube into the gastrointestinal tract, with the tip placed in the jejunum distal to the ligament of Treitz. From the gastric tube, the catheter was guided along the diaphragm to the anterior abdominal wall through the extraperitoneal route. No bowel obstruction associated with catheter placement has been observed in any of the patients from the time of surgery to this writing. Also, the procedure enabled jejunostomy use for more than 5 years, similar to conventional jejunostomy. We experienced 1 case of catheter deviation into the mediastinum. Overall, transgastric tube enteral feeding catheter placement for reconstruction of the posterior mediastinal gastric tube was useful for avoiding intestinal obstruction associated with jejunostomy. However, there may be a risk of catheter displacement into the mediastinum.