The surface-coated vascular stent of shape memory alloy was made for use of occlusion of pseudo-lumen of the dissecting aneurysm of the aorta, as the usage of shape memory alloy in angioplasty, and the metal flexible delivery catheter was also made for the introduction of the stent. In the present study, antithrombogenicity of the vascular stent was much improved by surface-coating with EPTFE and segmented polyurethane. The long-term usage of the stent was confirmed by radiological, macroscopic, and electron microscopic examinations. Moreover, the metal flexible delivery catheter was demonstrated to be of much benefit for the introduction of the surface-coated vascular stent of shape memory alloy.

In order to reduce the blood transfusion volume in open heart surgery, the new blood autotransfusion technique using cardiotomy reservoir unit BCR 3538, which was configured to serve also as a receptacle for postoperative mediastrinal drainage, was introduced. To investigate the utility and the problem in this system, every clotting factor, platelets' function and the extent of the hemolysis were measured serially both in patients' arterial blood and the shed mediastinal blood. The bank blood transfusion was significantly reduced to 250ml±330ml by this system compared to the 1080ml±820ml in the cases of usual system (p<0.01). Every clotting factor recovered well in patients' arterial blood after cardiopulmonary bypass (CPB). In the reservoir blood, the clotting factor IX, XI, XII were extremely suppressed at 1h CPB, and 3h after the CPB, every clotting factor except fibrinogen (42±28mg/dl) showed the quite higher activity, such as factor VIII 400%, IX 365%, XI 72%, XII 267%. Namely, the anticoagulability of the reservoir blood was maintained due to the effect of the residual heparin at 1h after the CPB, and due to the contact defibrinogation of the shed mediastinal blood at 3h after CPB. The free hemoglobin level was extremely high on the reservoir blood at 3h after CPB. In 6 cases, the autologous blood retransfusion was abandoned by clott formation in the unit because of the contamination of the intraoperatively used fibrin glue. From this study, the autologous blood transfusion using cardiotomy reservoir BCR 3538 was useful not only for saving the transfusion of the bank blood but also the hemostasis after CPB. But to reduce the hemolysis in this system, and to establish the safety against the other clotting material such as fibrin glue were the problems which should be resolved in future. I appreciate the kind support of Alexander von Humboldt Foundation for this study.

The purpose of this study was to investigate the effects of combined resistance training and aerobic training with protein intake after resistance training on body composition in obese middle-aged women. The subjects were 42 middle-aged women (age : 56.5±4.3 years, BMI : 26.6±2.3 kg/m²), who were classified into three supplementation groups: Protein group (PG), Isocalorie placebo group (IG), and Noncalorie placebo group (CG) by Double Blind Randomized Trial. The training program consisted of combined resistance training and aerobic training for 10 weeks, 5 times per week: twice a week in a university training room and 3 times per week at home. The subjects took the nutrient supplement immediately after each resistance training session. We measured body weight (Bw), body fat volume (Bf) by bioelectrical impedance analysis (BIA), and cross-sectional area (CSA) of muscle of the thigh extensor group (Te), flexor group (Tf), and psoas major (Pm) by magnetic resonance imaging (MRI) before and after the 10-week training period. Irrespective of group, Bw and Bf showed a significant decrease after the training period compared to before (p<0.001), and the CSA of Te muscle showed a significant increase after the training period (p<0.01). Moreover, the interaction of time×group was accepted in the CSA of Pm muscle (p<0.05), and the increase in muscle volume for PG was the highest increase among the three supplementation groups (p<0.05)(PG : 2.1±0.8 cm², IG : 1.3±1.0 cm², CG : 1.3±0.9 cm²). These results suggest that combined training in middle-aged obese women improves body composition, and resistance training with protein intake may increase the CSA of muscle of psoas major.

A 69-year-old man, who had undergone coronary artery bypass grafting using the right gastroepiploic artery 2 years previously, was hospitalized with acute epigastralgia. Gastroscopy showed an early gastric cancer in the greater curvature of the corpus and ultrasonography of the abdomen revealed acute cholecystitis due to a stone impacted in the cystic duct. The subtotal gastrectomy and the cholecystectomy with preservation of the right gastroepiploic artery graft were performed. The surgical margin of the resected specimen was negative for cancer. The postoperative course was uneventful. After coronary artery bypass grafting using the right gastroepiploic artery, annual gastroscopy is recommended.

Ischemic heart disease (IHD) poses a major complicating factor for abdominal aortic aneurysm (AAA) repair. To identify patients with IHD, we evaluated patients scheduled to undergo AAA repair with dipyridamole-thallium scintigraphy (DTS) and coronary angiography (CAG). If indicated, coronary revascularization was performed. Finally, an assessment of the effectiveness of these preventive measures was made. One hundred and ten patients scheduled to undergo AAA repair were identified and treated accordingly over a 20-year period. As the pre-operative evaluation and prophylactic surgical revascularization strategies were instituted in 1983, the patients were divided into 2 groups: 25 patients between 1973-1982 (group A) and 85 patients between 1983-1992 (group B). The mean age of patients in group A was 65.3 years. The male/female ratio within this group was 21:4. One patient in the group had a history of IHD and 9 had hypertention. The mean age of patients in group B was 67.7 years. The male/female ratio within this group was 77:8. Fourteen patients in this group had a history of IHD and 27 had hypertension. Screening and treatment of IHD in group B was as follows. All patients with a history of IHD underwent CAG. Of the 32 patients with cardiac risk factors, including hypertension and hyperlipidemia, or ECG abnormalities who underwent DTS, 8 were referred for CAG. Thirty-nine patients with no risk factors and a normal ECG proceeded to AAA repair without further workup. Perioperative myocardial infarction occurred in 2 patients in grouzp A, leading to death in 1 patient. Coronary revascularization was performed in 5 patients in group B. No perioperative myocardial infarction occurred in this group. Pre-operative identification of high-risk cases with DTS, CAG, and coronary revascularization in patients with IHD may prevent cardiovascular complications in patients undergoing AAA repair.

Background/Aims: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods: This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results: The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.

No abstract available.
Crohn Disease ; Humans

Objectives: The warm-water foot bathing is widely used as a clinical method for hemiplegic limb. Recent research have reported that the artificial high concentration carbon-dioxide (CO2) water foot bathing have a potent vasodilative action. However, the definite effects of the artificial high concentration CO2 water foot bath for hemiplegic limbs remain uncertain. We examined that the effects of the artificial high concentration CO2 water foot bath for patients after stroke. Patients: Three inpatients after stroke were recruited for this study. The age and duration after onset were 58.3 ± 21.4 years and 63.0 ± 38.9 months, respectively. Of the three patients (two males and one female), two were diagnosed with cerebral hemorrhage, one with cerebral infarction. Methods: The artificial high concentration CO2 water foot bath and tap water foot bath were prepared. The concentration of CO2 water foot bath was approximately 1000-1,200 ppm, and both lower limbs (under the knee joint) were immersed in 38 °C water for 20 minutes. Foot bathing in tap water was also carried out under the same conditions in the another day. The following physiological data were measured before foot bathing and after the end of foot bathing. Not only the deep body temperature at axillary, the surface skin temperature at the front of femur, the calf of the leg and the dorsal foot, but also the muscle stiffness at triceps muscle of calf were evaluated. Results: None of the subjects experienced discomfort before and after both the high concentration CO2 water and the tap water foot bath. The physiological examination was completed safely in all subjects. The results were as follows: The deep body temperature and the surface skin temperature had increased, and the muscle stiffness had been relieved in the high concentration CO2 water foot bath compared with the tap water bathing. The deep body temperature of the high concentration CO2 water foot bath have risen from 36.4 °C to 36.9 °C, the surface-skin temperature of the front of femur (from 26.7 °C to 28.1 °C), the calf of the leg (from 29.5 °C to 31.9 °C) and the dorsal foot (from 29.9 °C to 32.3 °C) have risen, respectively. The muscle stiffness have been relieved from 55.3 to 51.8 before and after. There was no change that the tap water had increased in the deep body temperature and the surface-skin temperature, and the muscle stiffness had been relieved before and after. Conclusion: These results suggested that the use of the high concentration CO2 water foot bath was more effective in hyperthermia compared with the tap water. Furthermore, we considered that carbon dioxide had promoted to increase the skin and the muscle blood flow by vasodilative action to the arteriole, and use of the high concentration CO2 water foot bath contribute to improve the circulatory dynamics for the hemiplegic limb. These findings may suggest that the use of the high concentration CO2 water foot bath is an effective physiotherapy for circulatory dynamics treatment that might facilitate stroke rehabilitation

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

Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.