The purpose of this study was to resolve the confusion existing in the terminology for describing foot motion, particularly the definitions of inversion and eversion. First, the definitions of foot motion used by the Japanese Association of Rehabilitation Medicine and the Japanese Orthopedic Association were compared with those used by the American Orthopaedic Foot and Ankle Society (AOFAS) and with those used by the International Society of Biomechanics (ISB), to identify agreements and differences. Next, the terminology utilized in the literature was explored by examining several major textbooks and related academic papers retrieved through a search of the PubMed medical literature database. In the definitions of AOFAS and ISB, inversion and eversion, which correspond to triplane motions in the definition used in Japan, were regarded as motions in the coronal plane. Terminology in the textbooks was very diverse. Of the 141 academic papers explored, 92 papers (66%) regarded inversion/eversion as coronal plane motion, and 4 papers (3%) regarded it as a triplane motion. In the remaining 43 papers (31%), the definition was unspecified. In academic articles addressing foot motions, to avoid confusion in terminology, the definitions of inversion and eversion need to be specified.

Left heart bypass was performed with Bio Medicus Co.-made Bio-pump, a representative centrifugal pump. A vinyl chloride tube for the usual cardio-pulmonary bypass not treated with antithrombogenic material. was used in the bypass circuit. In the experiment, the mongreal adult dogs were divided into the systemic heparinized group and non-heparinized group and the bypass was performed for 6 hours. As a result, coagulation and fibrinolysis were more activated in the non-heparinized group than the other group. So, when this method is used clinically, a small quantity of heparin should be administered. Clinically, this approach was used as an adjunct in operation for 7 cases of thoracic aortic aneurysm. During left heart bypass, a small quantity of heparin (0.5-1.0mg/kg) was administered. A rise in FPA and FDP considered attributable to autotransfusion during the operation was noted. Distal perfusion could be performed fully and the amount of bleeding during and after operation was small, but 1 case each of acute renal failure and paraplegia as postoperative complication was encountered. Neither was considered due to left heart bypass; and, changes in respiratory system and hepato-renal function were considered within the tolerable range. These results have led us to believe that left heart bypass using Bio-pump is safe and useful as an adjunct in operation for thoracic aortic aneurysm and should be used positively in the future.

Between December of 1989 and May of 1993, 7 of 338 patients (2.1%) who underwent median sternotomy for cardiac operations developed mediastinitis. All of these infections caused by Staphylococcus species. Six of seven patients with mediastinitis were successfully treated with debridement, irrigation and omental transposition into the mediastinum. Between December of 1989 and May of 1992, sterile bone wax was used as a hemostatic agent in 233 of these patients. Between June of 1992 and May of 1993 an argon beam coagulator was used in place of bone wax in 105 patients. The incidence of mediastinitis significantly differed in relation to whether patients received bone wax or not (7 of 233 patients who did (3.0%) versus none in 105 patients who did not (0%) p<0.01). We conclude from this study that bone wax may be a promoting agent in postoperative mediastinitis, so the routine use of bone wax should be reconsidered.

Bypass grafting from the ascending thoracic aorta to the common iliac artery was performed to manage proximal hypertension in a patient with atypical coarctation of the thoracic aorta. The patient's history was significant for an acute aortic thrombosis at the level of the diaphragm for which she underwent an axillo-bifemoral bypass grafting as an emergency operation. Although she was doing well following the initial bypass grafting, the second bypass grafting was required to treat proximal hypertension refractory to medical management. The axillo-femoral bypass graft had a smaller diameter and a longer subcutaneous distance, and the blood supply to the abdominal viscera may have been insufficient. The proximal hypertension was well controlled following ascending thoracic aorta to common iliac bypass, because the diameter (16mm) of the graft is larger than that of the axillo-bifemoral bypass graft (8mm).

Dacron prostheses are the most widely used grafts in replacement procedures for abdominal aortic aneurysms, but they are not perfect grafts. We encountered a rare case of late graft complication. A 66-year-old man was admitted to our hospital with a pulsatile mass in an abdominal operation scar. He had received placement of a Y-shaped Cooley double velour knitted Dacron graft 18 years previously. Computed tomography and angiography demonstrated graft dilatation and an aneurysm. After resection of the graft aneurysms, the operative findings showed a non-anastomotic aneurysm formation due to longitudinal division near the graft guideline. In this case, this graft failure may have been due to the deterioration of the filter of the Dacron prosthesis itself. Therefore it is important to perform careful long-term follow-up in patients with implanted Dacron arterial prostheses.

Abdominal aortic aneurysms (AAA) are frequently associated with clinically significant coexistent ischemic heart disease (IHD). Cardiac events are the most common cause of death after AAA repair. Preoperative coronary evaluation and revascularization have been recommended to reduce postoperative cardiac complications following AAA repair. In this study, we retrospectively reviewed all patients who underwent AAA repair and compared operative results in patients with and without IHD. Of 388 patients who underwent elective AAA repair, 382 (98.5%) had aortography and coronary angiography for preoperative evaluation. Significant coronary artery disease was seen in 124 patients (32.5%). As a result of the evaluation, 46 patients (12.0%) were considered candidates for medical therapy, 18 for percutaneous coronary intervention (PCI), and 60 for coronary artery bypass grafting (CABG). In 24 patients (6.3%) who needed CABG and had large sized AAAs (>60mm), simultaneous CABG and AAA repair were performed. In the remaining 36 patients (9.4%) who needed CABG and had medium sized AAAs (40mm<, <60mm), staged operation was performed. We performed retrospective review comparing postoperative cardiac events and operative mortality among these treatment groups. There were 5 operative deaths (5/388, 1.3%) in patients following AAA repair. There were 2 operative deaths (2/124, 1.6%) in patients with significant IHD and 3 deaths (3/258, 1.2%) without IHD. In patients with IHD, 1 patient who received medical therapy died of acute renal failure and another one who received PCI died of acute myocardial infarction. There were no operative deaths or cardiac-related events in patients who received CABG before or concomitant AAA repair. There was only 1 cardiac-related event in all patient groups following AAA repair. Coronary arteries were preoperatively evaluated in almost all patients with AAA. If IHD was significant, the treatment for the IHD preceded AAA repair. Our strategy succeeded in reducing operative mortality and cardiac-related events in patients with both AAA and IHD. If a patient with a large sized AAA (>60mm) needs CABG, one-stage operation is recommended.

Twenty six adult patients who underwent prosthetic heart valve replacement and treated anti-thrombogenic therapy, were divided into 2 groups. One was administered Warfarin alone, another was administered Warfarin plus Aspirin (162mg/day) as antiplatelet therapy. Trapidil (300mg/day) was administered to all of the patients. Platelet aggregation, plasma level of TXB₂ (stable metabolite of thromboxane A₂), and 6-keto-PGF₁ (stable metabolite of PGI₂) were measured before and 1, 3, 6 months after Trapidil therapy. Platelet aggregability suppressed in both 2 groups. Plasma TXB₂ level, and TXB₂/6-keto-PGF₁ ratio showed a tendensy to decrease (p<0.05) 6 months after administration. In the Aspirin plus Trapidil group, platelet aggregability, serum TXB₂ level, and TXB₂/6-keto-PGF₁ ratio are significantly lower than that in the Trapidil only. These results suggest that Trapidil is clinically useful for antiplatelet agent, but the combined Aspirin plus Trapidil therapy is more efficacious than the Aspirin or Trapidil single therapy.

We reviewed our experience with 19mm size aortic valve prostheses for cases with small aortic annulus. Forty-six patients operated on between 1990 and Septembr 2002 were enrolled in this study. Clinical late assessment was performed to evaluate the incidence of valverelated complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 years (mean 5.3±3.6). There was no hospital mortality (0%). Actuarial survival rates at 10 years were 81.4±1.5%. The late postoperative peak gradient was 25±11mmHg. LVMI was significantly reduced in late phase. NYHA functional class significantly improved in the late period. Although 19mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI significantly reduced and patient activity was satisfactory maintained in the late period.

Six 1-month-old piglets were intravenously injected with deoxynivalenol (DON) at the concentration of 1 mg/kg body weight, with three pigs each necropsied at 6 and 24 h post-injection (PI) for investigation of hepatotoxicity and immunotoxicity with special attention to apoptotic changes and cytokine mRNA expression. Histopathological examination of the DON-injected pigs revealed systemic apoptosis of lymphocytes in lymphoid tissues and hepatocytes. Apoptosis of lymphocytes and hepatocytes was confirmed by the TdT-mediated dUTP-biotin nick end-labeling (TUNEL) method and immunohistochemical staining against single-stranded DNA and cleaved caspase-3. The number of TUNEL-positive cells in the thymus and Peyer's patches of the ileum was increased at 24 h PI compared to 6 h PI, but the peak was at 6 h PI in the liver. The mRNA expression of interleukin (IL)-1beta, IL-6, IL-18, and tumor necrosis factor (TNF)-alpha in the spleen, thymus and mesenteric lymph nodes were determined by semi-quantitative RT-PCR, and elevated expression of IL-1beta mRNA at 6 h PI and a decrease of IL-18 mRNA at 24 h PI were observed in the spleen. IL-1beta and IL-6 mRNA expressions increased significantly at 6 h PI in the thymus, but TNF-alpha decreased at 6 h PI in the mesenteric lymph nodes. These results show the apoptosis of hepatocytes suggesting the hepatotoxic potential of DON, in addition to an immunotoxic effect on the modulation of proinflammatory cytokine genes in lymphoid organs with extensive apoptosis of lymphocytes induced by acute exposure to DON in pigs.
Animals ; Apoptosis/*drug effects/immunology ; Cytokines/*biosynthesis/genetics ; Gene Expression Regulation/drug effects ; Histocytochemistry/veterinary ; In Situ Nick-End Labeling/veterinary ; Liver/*drug effects/immunology ; Lymphoid Tissue/*drug effects/immunology ; RNA, Messenger/*biosynthesis/genetics/immunology ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; Specific Pathogen-Free Organisms ; Swine/*immunology ; Trichothecenes/*toxicity

To evaluate the association of serum BDNF concentration with high-intensity interval training, 12 healthy male volunteers, aged 28-48 years, completed 16-week high-intensity interval training (HIIT) using ergometer. Training program consisted of >90% VO₂ peak for 60 sec separated by 60 sec active rest period for 8-12 sets twice weekly for 16-week. Maximal exercise tolerance tests were performed before (0-week), 4-week, and 16-week after the intervention program. VO₂ peak as well as peak watt was linearly increased after 4-week (9% for both VO₂ peak and peak watt) and 16-week HIIT training (15% for VO₂ peak and 18% for peak watt, p<0.01). However, there was no change in serum BDNF concentration by HIIT. On the other hand, there was a positive association of serum BDNF concentration at baseline with % increase in peak watt after the intervention (ρ=0.60, p<0.05). The association between BDNF and exercise training is still unclear, and more studies are needed to clarify the above positive association.