Unruptured sinus of Valsalva aneurysm is a rare anomaly which may be acquired or congenital. We describe a case of a 64 year old man with aneurysms (left : 31 mm, non : 21 mm) of the coronary sinus. The Bentall operation was successfully performed and his postoperative course was uneventful. The histopathology of the aortic wall showed Takayasu's arteritis. Bentall surgery is a good choice for multiple aneurysms of the Valsalva sinus with aortitis.

We used near-infrared spectroscopy (NIRS) to study noninvasively the effects of aging on changes in muscle oxygenation during steady bicycle exercise. For the study, 6 healthy young males and 13 healthy elderly male volunteers were recruited. To evaluate the physical fitness level and to determine exercise intensity, the ventilatory threshold (VT) was first measured. As a result, elderly subjects were divided into two groups according to O₂ uptake at VT (Elderly-H ; 936.0±26.4, Elderly-L ; 695.3±29.9, Young ; 790.0±51.19 ml) . Secondly we measured muscle oxygenation by NIRS at rest and during exercise at relative work intensities of VT ; 20%, 40%, 60%, 80% and 100%. In all cases muscle oxygenation at rest and during exercise was expressed as a relative value from 100% oxygenation (oxygen capacity) established by thigh occlusion (ischemia) . All subjects showed progressive deoxygenation with increasing intensity. There were no differences between the three groups in muscle oxygenation during exercise at relative work intensity of VT. These data suggest that aging and physical fitness level have no effect on muscle oxygenation below relative work intensity of VT.

This study was designed to clarify the causes of throwing injuries of the elbow and shoulder joints in baseball. Five varsity-skilled baseball players without pain in the elbow and shoulder joints were subjects for this study. They were fixed to a chair and asked to throw a baseball using three different throwing arm movements (T₀, T₄₅, and T₉₀) . These movements were filmed using three-dimensional DLT videography. Linked rigid-body segment inverse dynamics were then employed to determine resultant joint force and torque at the elbow and shoulder joints. Peak varus torque at the elbow joint for T₉₀ was less than for the other movements during the acceleration phase. In the follow-through phase, however, a large anterior shear force (70 N) at the elbow, for elbow extension, was present for T₉₀. These results indicate that T₉₀ was a high risk movement which leads to extension injuries rather than medial tension injuries. After the ball release, a large superior shear force (118 N) at the shoulder joint was present in all movements. This superior force may result from the subacromial impingement syndrome, except for critical zones of impingement caused by the different throwing arm movements. These findings suggest that the mechanisms of throwing arm injuries are closely related to differences in throwing arm movements.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

Cardiac surgery associated with idiopathic thrombocytopenic purpura (ITP) is rare, and only 10 cases have been reported in the literature. In this report, we described the successful surgical management of a patient with ITP, diabetes mellitus and malfunction of mitral bioprosthetic valve. A 62-year-old male, who underwent mitral valve replacement (MVR) by means of a Carpentier-Edwards valve prosthesis and CABG ten years ago, developed malfunction of mitral prosthetic valve. The preoperative platelet count was 52, 000/mm³ and PA-IgG elevated markedly. The diagnosis of ITP was based on findings of bone marrow examinations. Thrombocytopenia was treated by steroids for 4 weeks and large dose γ-globulin (20g/day) for 5 days preoperatively, but platelet count did not increase. Platelet rich plasma (PRP) was transfused prior to cardiopulmonary bypass (CPB) and fresh blood was added to the priming material of CPB. Re-MVR was performed by means of mechanical valve prosthesis. After operation, large doses of γ-globulin and transfusion of PRP were performed for 3 days, and the postoperative course was uneventful. Other reports in addition to this study reveal that cases of cardiac surgery associated with ITP should be initially controlled preoperatively with steroids or high-dose γ-globulin, and if these treatments are harmful or ineffective, splenectomy should be considered.

Destructive aortic valve endocarditis or poor controlled aortitis cause the development of left ventricular-aortic discontinuity. We reported our experience with aortic root replacement for cases of severe aortic annular destruction. Between 1999 and 2006, 9 patients with severe aortic annular destruction underwent aortic root replacement at our institute. There were 8 men and one women with a mean age of 55 years. Seven patients were in New York Heart Association functional class III. Four of 9 patients had native valve endocarditis, 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2, aortic root replacements in 2) and one had active aortitis with a detached mechanical valve. Radical debridement of the infected cavity and necrotic tissue was performed in all cases, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 3 cases. Antibiotic-saturated fibrin glue was applied to the cavity. Aortic root replacement was achieved with a pulmonary autograft (Ross procedure) in 4 and stentless aortic root xenograft in 4. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary implantation method. No mortality was observed during hospitalization and follow-up. Reoperation within 5 years was not necessary in 66.7% of the patients. Excellent outcome can be achieved by radical exclusion of the abscess cavity and viable pulmonary autograft or stentless aortic root xenograft in patients with severe aortic annular destruction.

A 67-year-old man with ascending aortic aneurysm was referred to our hospital. Transthoracic echocardiography showed severe aortic regurgitation with annuloaortic ectasia and transesophageal echocardiography revealed a quadricuspid aortic valve. This patient underwent aortic root replacement with a valve sparing technique. Under deep hypothermic circulatory arrest with retrograde cerebral perfusion, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful. This patient is doing well 6 months after surgery without recurrence of aortic regurgitation.

We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6:1. The most frequent age group was 21-25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.

BACKGROUND/AIMS: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. METHODS: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. RESULTS: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). CONCLUSIONS: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.
Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Multivariate Analysis ; Needles ; Prospective Studies ; Punctures ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

BACKGROUND/AIMS: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. METHODS: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information. RESULTS: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively). CONCLUSIONS: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.
Biopsy, Fine-Needle ; Cross-Over Studies ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Epithelium ; Glass ; Humans ; Needles ; Pancreatic Ducts ; Pancreatic Neoplasms ; Prospective Studies ; Random Allocation