Case 1 was a 48-year-old mother who was under observation for Marfan syndrome and thoracic aortic dilation. She was brought to the hospital with chest pain, and a CT scan revealed acute aortic dissection (Stanford A). Aortic incompetence was also observed, and an emergency Bentall procedure was performed. Case 2, her daughter, was a 26 years old and 39 weeks pregnant. She did not meet the diagnostic criteria for Marfan syndrome. She experienced severe back pain on the same day that her mother was admitted for aortic dissection. Because the patient did not agree to the use of a contrast agent due to concern about its effect on the fetus, emergency cesarean section was performed. Subsequently, a CT scan performed on the patient showed acute aortic dissection (Stanford B). Accordingly, antihypertensive therapy was commenced. In both cases, the patients were discharged after they recovered. Although case 2 did not meet criteria for Marfan syndrome, because of the hereditary disposition, we strongly suspect this was a Marfan syndrome pregnancy. This type of case is included in the case literature on cesarean and vigilant perinatal care is thought to be necessary.

In recent treatment of mitral regurgitation due to active infective endocarditis, significant attempts have been made to repair as much of the mitral valve as possible. In cases where the leaflet is damaged extensively because of infection, valve repair generally becomes difficult unless the defect is reinforced by glutaric aldehyde-preserved autologous pericardium. We report a case in which mitral valve plasty for mitral regurgitation was performed under these circumstances. A 27-year-old man was admitted to our hospital because of headache and persistent fever. Transthoracic echocardiography revealed a 13-mm friable vegetation attached to the anterior leaflet of the mitral valve with severe mitral regurgitation. Urgent surgery was performed based on a diagnosis of active infective endocartitis. After cardiopulmonary bypass was performed and the aorta was cross-clamped, a left atriotomy was carried out on the interatrial groove. Much vegetation was attached to the damaged mitral leaflet from A3 to P3, and prolapse of the commissural leaflet was observed. The vegetation and damaged leaflet were then removed. Removal of the superficial vegetations enabled preservation of more than half of the A3. The valve was repaired by the resection-suture technique without using the autologous pericardium, as glutaric aldehyde solution was not available. Mitral annuloplasty using a 28-mm physio ring was performed thereafter. The postoperative course was uneventful and without any residual regurgitation. Nine months after surgery, no recurrence of infection or mitral regurgitation was not observed.

A 73-year-old man was referred to our hospital for treatment of a sacral aneurysm of the distal aortic arch with a maximum dimension of 66 mm. He underwent total arch replacement (TAR) with cardiopulmonary bypass (CPB), moderate hypothermia, circulatory arrest (CA) of the lower body and antegrade selective cerebral perfusion (SCP) via a median sternotomy. Through the aneurysm, the descending aorta was divided and distal anastomosis was performed using the stepwise technique. After the inserted tube graft was extracted, a four-branched arch graft was anastomosed. The arch vessels and the proximal aorta were then anastomosed to the four-branched graft. The operation time was 515 min, CPB time was 305 min, aorta cross clamp (ACC) time was 213 min, SCP time was 143 min, and CA of the lower body was 97 min. On postoperative day (POD) 5, right-upper abdominal pain suddenly developed, with low grade fever. Acute cholecystitis was suspected and antibiotic therapy was started. On POD 6, his abdominal pain shifted to the lower-right region. His blood examination results were unchanged. Acute peritonitis was suggested by abdominal-enhanced computed tomography (CT), and emergency open cholecystectomy was then performed. There was no evidence of gall stones, and a bacterial culture of the ascites was negative. The pathological diagnosis was thromboendarteritis of the gallbladder artery, accompanied with thrombophlebitis and thrombosis, causing massive infarction at the neck of the gallbladder wall. His postoperative course was uneventful and he discharged in an ambulatory state on POD 16. In TAR, the risk of gastrointestinal ischemia is considerable because of prolonged circulatory arrest of the lower body and debris embolism. It is necessary to recognize possible gallbladder infarction, although it is rare, as a differential diagnosis of acute abdomen after TAR.

Postoperative quantitative evaluation of left internal thoracic artery (LITA) grafts is usually performed by angiography, scintigraphy and Doppler flowire. However it is difficult to observe the characteristics of the intima of the LITA graft. The purpose of this study was to evaluate the characteristics and quantity of plaque of intima of LITA grafts in 6 cases after coronary artery bypass surgery using an intra-vascular ultrasound device (IVUS). There was no stenosis or calcification of LITA grafts on angiography. However we found atherosclerotic plaque in all LITA grafts by IVUS. Characteristics of plaque were eccentric in all cases, and soft, hard and mixed plaque were found. The average minimal lumen diameter of LITA grafts was 2.6±0.2mm. The average lumen area of LITA grafts was 5.4±0.7mm². The rate of plaque area was 37.1±5.9%. The eccentric arteriosclerotic plaques were seen in all cases, contradicting the established theory that LITA do not form arteriosclerosis easily. We suggest that IVUS is an effective follow-up device for evaluating the morphological findings and quantitative evaluation of LITA graft in a timely manner.

We present here a rare case of coronary artery bypass grafting through a left thoracotomy after substernal gastric interposition for esophageal cancer. A 58-year-old man, who had undergone esophagectomy and substernal gastric interposition 11 years previously, was admitted for cerebral infarction from which he made a good recovery without any complication. At this time, the patient was diagnosed as having coronary artery disease on electrocardiogram. Cardiac catheterization revealed triple vessel disease. Coronary artery bypass grafting to the left anterior descending artery and obtuse marginal branch through a left thoracotomy was performed using a radial artery Y-graft under femorofemoral bypass. The aorta was cross-clamped and the heart was arrested with antegrade cold cardioplegic solution for the distal anastomosis of the left anterior descending artery and the obtuse marginal branch which was embedded within the myocardium. The postoperative angiography showed good coronary flow. Left thoracotomy approach provides a good exposure of the left coronary artery. This approach, therefore, is advocated as an alternative method for cases requiring coronary artery bypass but in which median sternotomy is difficult, such as the present case. The appropriate procedure for the site of thoracotomy, supporting methods, choice of graft, and the site of graft anastomosis should be selected in each patient.

We perfomed an aortic valve replacement and intraoperative plasma exchange with Cell Saver 4^® made by Haemonetics for removal of bilirubin. Diluted blood after cardiopulmonary bypass and suctioned blood (total volume 11, 300ml) was washed, concentrated and transfused. Plasma bilirubin level was decreased to 5.4mg/dl from 9.9mg/dl during operation. It was concluded that intraoperative plasma excange with Cell Saver 4^® was safe and effective technique for removal of bilirubin during open heart surgery.

The purpose of this case report was to report a rare case of pyogenic spondylodiscitis caused by Campylobacter fetus. A 37-year-old male presented with fever and low back pain. By lumbar magnetic resonance imaging (MRI), no abnormal finding was observed at the first presentation. However, low back pain was aggravated, and fever did not improve. Thus, lumbar MRI was repeated on the 26 day after the onset of symptoms, showing abnormal signals at vertebrae and disc spaces, and pyogenic spondylitis was diagnosed. The possibility of pyogenic spondylodiscitis should be taken into account if a patient presents with low back pain and fever, and areas of low signal intensity on a T1-weighted MRI should be carefully examined. When initial MRI does not reveal abnormal findings, repeated MRI after one or two weeks or, more favorably, immediate gadolinium enhancement MRI, are important for patients who have persistent low back pain and fever.
Adult ; Campylobacter ; Campylobacter fetus ; Discitis ; Early Diagnosis ; Fever ; Gadolinium ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Spine ; Spondylitis

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the surgical results of cervical pedicle screw (CPS) fixation combined with laminoplasty for treating cervical spondylotic myelopathy (CSM) with instability. OVERVIEW OF LITERATURE: Cervical fixation and spinal cord decompression are required for CSM patients with instability. However, only a few studies have reported on CPS fixation combined with posterior decompression for unstable CSM patients. METHODS: Thirteen patients that underwent CPS fixation combined with laminoplasty for CSM with instability were evaluated in this study. We assessed the clinical and radiological results of the surgical procedures. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the clinical results. The percentages of sli p, difference in sli p angle between maximum flexion and maximum extension of unstable intervertebrae, and perforation rate of CPS were evaluated. RESULTS: The mean JOA scores before surgery, immediately after surgery, and at final follow-up were 9.1, 13.3, and 12.6, respectively. The mean percentages of sli p before surgery, immediately after surgery, and at final follow-up were 9.1%, 3.2%, and 3.5%, respectively; there were significant improvements immediately after surgery and at final follow-up. The difference in sli p angle between the maximum flexion and maximum extension of the unstable intervertebrae changed from 9.0degrees before surgery to 1.6degrees at the final follow-up. The perforation rate of CPS was 10.9%. CONCLUSIONS: The results suggest that CPS fixation combined with laminoplasty is an effective surgical procedure for treating CSM with instability.
Asian Continental Ancestry Group ; Decompression ; Follow-Up Studies ; Humans ; Orthopedics ; Retrospective Studies ; Spinal Cord ; Spinal Cord Diseases ; Spondylosis