Recently, ischemic preconditioning (IPC) for myocardial protection in heart surgery, has been used intensively. However, no data are available concerning the effect and influence of reperfusion temperature during IPC. To estimate the effectiveness of re-perfusion temperature during IPC, we performed an experiment using pigs. Twenty male pigs (40-50kg in body weight) were used. After establishing cardiopulmonary bypass (CPB), IPC was made, cross-clamping the ascending aorta twice for 3min and performing re-perfusion for 5min. According to the re-perfusion temperature, we divided this model into four groups as follows; 37°C of the re-perfusion temperature with IPC (warm IPC, n=5), 37°C without IPC (warm NIPC, n=5), 32°C with IPC (tepid IPC, n=5) and 32°C without IPC (tepid NIPC, n=5). After the IPC procedure, all the hearts underwent global ischemia by cross-clamping for 15min under ventricular fibrillation, and re-perfusion with 32°C blood temperature was done for half hour. We measured myocardial levels of adenosine triphosphate, troponin-T, serum nitrous oxide, and other myocardial enzymes. After sacrificing animals, biopsy of the left ventricular free wall was made, and its histological changes were evaluated by scanning electron microscopy (SEM). Blood sampling was made before CPB, at the end of IPC, end of global ischemia, 10 and 30min after re-perfusion. In warm IPC, adenosine significantly increased, and serum troponin-T was significantly lower than other groups. The myocardium of warm IPC showed a normal SEM image, while ischemic damage was revealed in other groups. These results suggested that warm IPC induced effective myocardial protection. however tepid IPC did not protect the myocardium.

In 13 patients who underwent left ventriculography both before and after operation, we investigated regional wall motion of the left ventricle (LV) with the centerline method in LV aneurysmectomy. There were no significant differences between preoperative predicted and postoperative ejection fraction. No significant differences were observed between preoperative predicted and postoperative regional wall motion of all segments in all cases and cases without significant stenosis who did not undergo revascularization of the right coronary artery. Postoperative regional wall motion of the inferior wall was significantly better than the preoperative predicted one in cases who underwent revascularization of the right coronary artery with significant stenosis. It is considered that revascularization of the right coronary artery with significant stenosis in LV aneurysmectomy was effective for the improvement of regional wall motion of the inferior wall.

We report a case of a 72-year-old woman, who had an anastomotic pseudoaneurysm in the ascending aorta, successfully treated by endovascular aortic repair with vascular embolic devise and stent-graft. It seemed to be high risk to achieve conventional surgery with extracorporeal circulation, therefore we selected endovascular treatment because she had a bleeding tendency which derived from disseminated intravascular coagulation. Then, we adopted stent-grafting with a vascular embolic device, because the distal side of pseudoaneurysm had too short a landing zone to cover the stent-graft only. The patient well tolerated this procedure and her postoperative course was uneventful. The pseudoaneurysm shrank at 6th months after operation.

A 66-year-old woman with aortic stenosis and idiopathic thrombocytopenic purpura (ITP) underwent concomitant splenectomy and aortic valve replacement (AVR). High-dose trans-venous gamma-globulin therapy (400mg/kg/day) was performed for five days before surgery. The number of platelet, which was 6.0×10⁴/mm³ on admission slighty increased to 7.0×10⁴/mm³ before surgery. The aortic valve was replaced by an ATS 19mm prosthesis using cardiopulmonary bypass. Platelets were transfused postoperatively. Perioperative hemorrhage was moderate, and the postoperative course was uneventful. This was the second case we treated by concomitant cardiac surgery and splenectomy. It was safely performed after high-dose trans-venous gamma-globulin therapy.

Purpose: To clarify the family-perceived usefulness of a pamphlet for families of imminently dying patients. Methods: Physicians and/or nurses provided medical and practical information about the dying process using a pamphlet for families of imminently dying patients. We surveyed family members 6 months after the death of the patient about the perceived usefulness. Results: We sent out a questionnaire to 325 bereaved, and obtained an answer from 260 (response rate: 85%). Overall, 81% reported the pamphlet to be “very useful” or “useful”. The experience reported by the bereaved included: “Helped me to understand the dying process” (84%); “Helped me to understand how symptoms and changes occur” (76%), “Useful in preparation for patient's death“ (75%), “Helped me to understand the physical conditions of the patient” (75%), “Helped me to know what I can do for the patient” (74%). Conclusion: “A pamphlet for families of imminently dying patients” may be useful for members of an imminently dying patient's family.

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.

BACKGROUND: The canonical Wnt/β-catenin signaling pathway is a fundamental regulatory system involved in various biological events. ICG-001 selectively blocks the interaction of β-catenin with its transcriptional co-activator cyclic AMP response element-binding protein (CBP). Recent studies have provided convincing evidence of the inhibitory effects of ICG-001 on Wnt-driven disease models, such as organ fibrosis, cancer, acute lymphoblastic leukemia, and asthma. However, the effects of ICG-001 in atopic dermatitis (AD) have not been investigated. OBJECTIVE: To investigate whether β-catenin/CBP-dependent signaling was contributed in the pathogenesis of AD and ICG-001 could be a therapeutic agent for AD. METHODS: We examined the effects of ICG-001 in an AD-like murine model generated by repeated topical application of the hapten, oxazolone (Ox). ICG-001 or vehicle alone was injected intraperitoneally every day during the development of AD-like dermatitis arising from once-daily Ox treatment. RESULTS: Ox-induced AD-like dermatitis characterized by increases in transepidermal water loss, epidermal thickness, dermal thickness accompanied by increased myofibroblast and mast cell counts, and serum levels of thymic stromal lymphopoietin and thymus and activation-regulated chemokine, and decreases in stratum corneum hydration, were virtually normalized by the treatment with ICG-001. Elevated serum levels of periostin tended to be downregulated, without statistical significance. CONCLUSION: These results suggest that β-catenin/CBP-dependent signaling might be involved in the pathogenesis of AD and could be a therapeutic target.
Animals ; Asthma ; Chemokine CCL17 ; Cyclic AMP Response Element-Binding Protein ; Cyclic AMP ; Dermatitis ; Dermatitis, Atopic ; Fibrosis ; Mast Cells ; Mice ; Myofibroblasts ; Oxazolone ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Water

Here, we report a rare case in which the inlet pressure of the oxygenator increased three times in two operations, even though two different types of oxygenators were used. A 45-year-old man underwent mitral valve repair owing to posterior cusp (P2) prolapse. Immediately after median sternotomy, the patient went into anaphylactic shock. We immediately started cardio-pulmonary bypass. The inlet pressure in company A's oxygenator increased, and the oxygenator was immediately replaced with the same type of oxygenator. However, the same occurred, and the oxygenator was exchanged for one made by company B. Thereafter, the operation was completed without further oxygenator problems.Fifty-five days after the initial surgery, a second operation was performed to repair a pseudoaneurysm at the root vent cannulation site. After induction of general anesthesia, the patient went into anaphylactic shock, as before, but circulation was maintained. Cardio-pulmonary bypass was started using company B's oxygenator, as it gave no problems at the previous surgery. However, it had to be exchanged owing to inlet pressure elevation. Thereafter, cardio-pulmonary bypass was maintained without pressure elevation, and the operation was completed. The reasons for the inlet pressure elevations are unclear.