A 70-year-old man was given emergency admission with severe back pain. Computer tomography revealed type-B acute aortic dissection with a distal aortic arch aneurysm which was 69mm in diameter. The dissection extended from the distal portion of the aneurysm to right external iliac artery, and the false lumen was patent. The right renal artery arose from the false lumen. He was treated conservatively according to the guidelines of AHA, and later we performed total arch replacement electively for the aortic arch aneurysm. Distal anastomosis was applied using the elephant trunk method for reconstruction of only the true lumen. Postoperative computer tomography showed the false lumen was closed in the descending thoracic aorta, but patent below the level of the celiac artery. He was discharged without any complications. Cases of acute aortic dissection coexisting with atherosclerotic thoracic aortic aneurysm are rare. However, with the increase of the elderly population, vascular diseases will become more complicated. Strategy for therapy and operation should be considered carefully especially in such cases with multiple vascular diseases.

The purpose of this study was to examine statistical methods for assessing variance in students' learning attitudes over 2 months. The students' learning attitudes, measured by tutorial assessment sheets, were analyzed quantitatively by multidimensional scaling and cluster analysis. Items on the tutorial assessment sheets were divided throughout the practice period into two axes of speculation (behavior and partnership). At the initial and medium-term stages of this practice, the dispersion of student's consciousness for given assessments was able to determine the quantity. We could then determine the quantity of recognizing the importance of topics to learn, and consciousness for learning was a feature often found at the end of this practice.

We studied the effects of exercise on the blood fluidity. The subjects were 18 healthy males (21.6±0.8 yr, control : 5, soccer : 9, gymnastics : 4) . We measured the filtration time of whole blood by the Nuclepore filtration method as an index of blood fluidity. The filtration time at rest in the control group, soccer group, and gymnastics group was 59.8±11.9s, 42.5±15.1 s, 28.6±6.7s, respec tively. The filtration time at rest in the soccer group was significantly shorter than that in the control group (p<0.001) . There were no significant differences in filtration time at rest between the control and gymnastics groups, and between the soccer and gymnastics groups. The filtration time after single aerobic exercise was significantly prolonged compared with that before (p<0.001) . The filtration time before and after anaerobic exercise and muscular exercise was not significantly changed. The degree of filtration time prolongation was significantly lower in groups who drank water compared to groups who did not (p<0.001) . The effect of taking a sauna on filtration time was not significant. These results indicates the effect of aerobic exercise on blood fluidity, and the importance of water intake during exercise.

A 22-year-old man with dilated cardiomyopathy (DCM), who was a practicing Jehovah's Witness, was transferred to our hospital for surgical treatment of medically uncontrollable mitral regurgitation (MR). Our original mitral complex reconstruction procedure and permanent pacemaker implantation for biventricular pacing were successfully performed without transfusion of blood products. Blood conservation strategy included: 1) preoperative treatment with erythropoietin, 2) utilization of a shortened extracorporeal circuit and assisted venous drainage system, 3) the use of ultrafiltration to save the residual autoblood in the extracorporeal circuit. The preoperative hemoglobin level was 17.1g/dl and the postoperative lowest level was 9.5g/dl. MR decreased from grade III to none, and NYHA functional class improved from class II to class I postoperatively. He was moved to a cardiology ward on the 13th postoperative day without complications. Transfusion-free surgery for DCM should be performed before DCM advances and requires left ventriculoplasty at risk for major blood loss. A careful follow-up is needed to examine the long-term results of the operative procedure during his expected long survival.

No abstract available.
Carcinosarcoma*

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.
Asian Continental Ancestry Group ; Azoospermia ; Epididymis ; Genetic Counseling ; Humans ; Infertility ; Infertility, Male ; Male ; Middle Aged ; Semen Analysis ; Seminiferous Tubules ; Spermatogenesis* ; Spermatozoa ; Vas Deferens* ; Y Chromosome*

Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.
Adult ; Azoospermia* ; Fertility ; Fertility Preservation ; Humans ; Infertility, Male ; Male ; Methods ; Microscopy ; Orchiectomy ; Scrotum ; Semen Analysis ; Seminiferous Tubules ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatozoa* ; Testicular Neoplasms* ; Testis* ; Ultrasonography