Eight cases of isolated iliac artery aneurysms treated between January 1991 and December 1997 were reviewed. All patients were men and their ages ranged from 51 to 85 years (mean 69.6 years). The incidence rate relative to abdominal aortic aneurysm during the same period was 9.3%. The location of the iliac artery aneurysms was the common iliac artery in 6 patients and common and internal iliac artery in 2 patients. Rupture occurred in 3 patients (37.5%). Aneurysms ranged in size from 25mm to 55mm (mean 39.1mm) in 5 non-ruptured cases and from 50mm to 90mm (mean 71.7mm) in 3 ruptured cases (p<0.05). The operative procedures for common iliac artery aneurysms were aneurysmorrhaphy with prosthetic graft replacement in 7 patients and with common iliac-external iliac artery anastomosis in 1 patient. For internal iliac artery aneurysms, obliterative endoaneurysmorraphy was performed in 2 patients. Hartmann's operation with sigmoid colostomy was concomitantly performed in 1 case of rupture. Seven patients had good postoperative courses, however, one case of rupture that underwent Hartmann's operation died of multiple organ failure on the 13th postoperative day. Early diagnosis and elective surgery before rupture are recommended.

A 37-year-old woman had a permanent transvenous cardiac pacemaker inserted previously in the left subclavian region to treat complete atrioventricular heart block. As infection occurred in the left subclavian subcutaneous pacemaker pocket after generator replacement, the generator was removed and a new permanent transvenous cardiac pacemaker was inserted in the right subclavian region. After two months, she developed fever and productive cough, and was admitted to our hospital. Echocardiography showed vegetation on the pacemaker electrodes and the tricuspid valve. Chest-computed tomography showed scattered bilateral peripheral nodules with various degrees of cavitation. We diagnosed right-sided infective endocarditis (IE) with septic pulmonary emboli (SPE) and performed cardiac surgery. We observed vegetation on the pacemaker electrodes and the tricuspid valve. The vegetation, the electrodes, and the generator were all removed and a permanent epicardial pacemaker was inserted subcutaneously in the left subcostal region. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from cultures of vegetation. Postoperative antibiotic therapy was performed and SPE was completely cured. We removed the pacemaker and the electrodes, and performed postoperative antibiotic therapy.

A 49-year-old woman with systemic lupus erythematosus (SLE) underwent grafting for abdominal aortic aneurysm. She had been receiving steroid therapy for 23 years. The abdominal aneurysm was a saccular type, 7cm in width. It had thick mural thrombi with focal calcification, however, no inflammatory findings were recognized around it. Replacement with 16mm Dacron tube graft was performed. The postoperative course was uneventful. Pathological examination showed only atherosclerotic change with no specific inflammation in the aneurysmal wall. It is rare that SLE patients have aortic aneurysm. However, SLE patients should be carefully followed because of their premature atherosclerotis.

We reviewed our experience with 4 cases of chronic dissecting aortic aneurysm (DeBakey IIIb) with the false lumen extending into the abdominal aorta and major branches being perfused from the false lumen. In such cases, resection of the intrathoracic portion of the aneurysm and closing of the distral false lumen may exclude visceral perfusion from the false lumen. In order to ensure continued perfusion of true and false lumens after repair, we performed “double barrel” anastomosis for distal anastomosis in graft replacement of the descending aorta. Follow-up periods ranged from 8 to 21 months, 17 months on average. Postoperatively, neither apparent expansion of the false lumen nor compression of the true lumen was found in these cases. The advantage of this procedure is the effective restoration of visceral perfusion. We emphasize that this procedure is one of the choices of procedures, as a two-staged approach for chronic aortic dissection presenting with visceral perfusion from the false lumen and without an enlarged abdominal aorta, though more patients and longer follow-up are required to fully evaluate this procedure.

Sources of research funding: We gratefully acknowledge the support of the 17th Congress of the Japanese Society for Emergency Medicine support of this program.
Ethical considerations: The program was conducted after receiving approval from the Institutional Animal Experiment Committee of the Jichi Medical University, and in accordance with the Institutional Regulation for Animal Experiments and Fundamental Guideline for Proper Conduction of Animal Experiment and Related Activities in Academic Research Institutions under the jurisdiction of the Ministry of Education, Culture, Sports, Science and Technology of Japan. It was approved on April 9th, 2014. The approval number is 14-225.
Disclosure of conflicts of interests: We gratefully acknowledge the contributions of personnel from Panasonic Corp. who enabled the interactive communication system.
Abstract
Introduction: Live surgery demonstrations have been widely used in surgical education. However, they cannot be used to demonstrate trauma surgery due to the emergency situation and lack of informed consent. The aim of this study was to conduct a live demonstration of trauma surgery with a porcine model to increase educational opportunities in trauma surgery.
Methods: Live demonstration was conducted at the Center for Development of Advanced Medical Technology (CDAMtec) , Jichi Medical University, Japan. An experienced trauma surgeon instructed three trainees during a live demonstration using pre-planned injuries in a porcine model. A six-point Likert Scale was used on a written survey to determine the value of the program to the viewers. Free-form written comments were also obtained from the participants. Live images of the surgical field were transmitted to a lecture room by a closed wireless LAN with interactive bidirectional audio capability.
Results: Eighty-three participants viewed this live demonstration and completed the questionnaire. Participants were highly satisfied with the live demonstration (mean survey scores: 4.6-5.1/6) , and gave very positive feedback concerning the educational value of this program. Nine free-form comments were submitted, which revealed that the participants felt they could acquire concrete skills for trauma surgery.
Discussion: Live demonstrations for trauma surgery using a porcine model are a feasible and effective educational tool to demonstrate technical procedures and non-technical skills, with possible added advantages regarding the ethical considerations of performing a live surgery demonstration.

PURPOSE: Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients. MATERIALS AND METHODS: We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared. RESULTS: The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings. CONCLUSION: We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.
Aged ; Atrial Natriuretic Factor/administration & dosage/*therapeutic use ; Cardiac Output/*drug effects/*physiology ; Female ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Monitoring, Physiologic/*instrumentation ; Pulmonary Edema/*drug therapy/*physiopathology

The frequencies of the urinary complaints oa the outpatients (male 188, female 339, average age 59.2+14.9) of the five acupuncture clinics were surveyed. The elder patients showed the higher frequencies of the urinary complaints. The frequencies of the complaints were as follows: nocturia (25.8%), urinary urgency (17.7%), stress incontinence (16.3%), sense of residual urine (15.2%), protracted micturition (12.0%), and retarded micturition (11.3%), respectively. The nocturia was accompanied with the majority of the other urinary complaints. These results suggest that the survey of the patient's complaint of nocturia is useful.

Objectives: Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for surgical site infections (SSIs). However, few studies have evaluated the rate of nasal carriage of MRSA and its effect on SSIs in patients undergoing general thoracic surgery. We investigated the importance of preoperative screening for nasal carriage of MRSA in patients undergoing general thoracic surgery.Patients and Methods: We retrospectively analyzed 238 patients with thoracic diseases who underwent thoracic surgery. We reviewed the rates of nasal carriage of MRSA and SSIs.Results: Results of MRSA screening were positive in 11 of 238 patients (4.6%), and 9 of these 11 patients received nasal mupirocin. SSIs occurred in 4 patients (1.8%). All 4 patients developed pneumonia; however, MRSA pneumonia occurred in only 1 of these 4 patients. No patient developed wound infection, empyema, and/or mediastinitis. SSIs did not occur in any of the 11 patients with positive results on MRSA screening.Conclusions: The rates of nasal carriage of MRSA and SSIs were low in this case series. Surveillance is important to determine the prevalence of MRSA carriage and infection in hospitals, particularly in the intensive care unit. However, routine preoperative screening for nasal carriage of MRSA is not recommended in patients undergoing general thoracic surgery.