We report a case of successfully treated mesenteric ischemia following emergency endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysm (r-AAA). A 79-year-old man, who had received hemodialysis for 5 years for diabetic nephropathy, presented with sudden onset abdominal pain. Contrast-enhanced computed tomography revealed an rAAA with a 60-mm diameter in the infrarenal abdominal aorta. Emergency EVAR was performed. After completion of stent graft placement, intraoperative angiogram revealed serious imaging delay of the superior mesenteric artery. An emergency saphenous vein bypass was performed from the right external iliac artery to the ileocolic artery. The postoperative course was uneventful, and there has been no evidence of endoleak or enlargement of aneurysm diameter during the follow-up period of 2 years.

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

The aim of this study was to develop a new method for the determination of NO2 levels encountered in clinical settings as well as in environmental studies, using a bi−component atmospheric pressure ionization mass spectrometry(APIMS). Hydrogen (1%) diluted in pure argon was ionized by corona discharge in the first ionization component. Fifty ml of the analyte diluted in 250ml of composite air or carbon dioxide (CO2) was introduced into the second ionization component and analyzed. When composite air was used as the sample carrier gas, NO in the analyte was oxygenated and there was an increase in the NO2 content from that in the original analyte. However, when CO2 was used as the sample carrier gas, the level of NO2 in the analyte could be determined because CO2 did not change the NO2 content from that in the original analyte. A calibration curve with good linearity was obtained using the UG−410 APIMS system, with a regression equation of Y(%)=5.513*10-2 X(ppb) and a detection limit of 0.9ppb. Since APIMS detects NO2 directly within its system, the concentration of NO does not need to be measured. This system may be of great help in the accurate detection and determination of the concentration of low levels of NO2 during inhaled NO therapy
Carbon Dioxide ; ionization ; Spectrum Analysis, Mass ; Direct type of resin cement ; Adjudication

The efficacy of Landiolol hydrochloride (Onoact^®) for the treatment of arrhythmia was studied in 10 adult patients who underwent cardiovascular surgery. Onoact was continuously infused at a mean rate of 0.018 mg/kg/min initially and followed by 0.01 mg/kg/min. After the initiation of Onoact infusion, supra-ventricular tachycardia was eliminated in 5 out of 6 patients, and ventricular tachycardia disappeared in all 4 patients. The decrease in systemic blood pressure was not significant. Low-dose continuous infusion of Onoact was safe and effective even in patients just after cardiovascular surgery.

The use of axillofemoral bypass grafts (AxFG) has became a widely accepted treatment for high-risk patients with aortoiliac occlusive disease. On the other hand, AxFG has been associated with a variety of complications in the upper extremity. A symptom of upper extremity thromboembolism after AxFG occlusion is reported as axillofemoral bypass graft stump syndrome (AxFSS). We report the case of a 55-year-old man with repeated AxFSS after an AxFG occlusion. He underwent brachial artery exploration and embolectomy. Angiograms showed an embolus floating in the axillary artery, which originated from the occluded graft stump. The stump was obliterated with a metallic stent introduced through the same arteriotomy made for the embolectomy. The endovascular treatment of AxFSS is minimally invasive and is an effective modality in this condition.

Objectives Left ventricular systolic dyssynchrony is the most important determinant of response to cardiac resynchronization therapy (CRT), playing a vital role to predict improvement of systolic function or LV reverse remodeling. CardioGRAF is a novel programmer based on the ECG gated single photon emission computed tomography (G-SPECT) imaging to detect LV systolic and diastolic dyssynchrony simultaneously. This study was to investigate the prevalence of systolic and diastolic left ventricular (LV) dyssynchrony in patients with heart failure. Methods We retrospectively studied 69 patients with heart disease, including 31 patients who had symptoms of heart failure (NYHA class Ⅱ-Ⅲ), and 38 patients who had no symptoms of heart failure (NYHA class Ⅰ). G-SPECT data were analyzed by cardiaGRAF, and measurements included the time to end systole (TES), the time to peak ejection (TPE), the time to peak filling (TPF), TES+TPF and maximal difference (MD) of each parameters were obtained, using the 95th percentile of the control group as a cutoffof 150 ms for MD-TES, 139 ms for MD-TPE, 345 ms for MD-TPF and 315 ms for MD-TES+TPF. Results The prevalence of LV systolic dyssynchrony was significantly higher in heart failure patients with reduced LV ejection fraction (LVEF)<45% (72% for MD-TES; 64% for MD-TPE) compared with heart failure patients with preserved LVEF=45% (14% for both MD-TES and MD-TPE; P=0.002, P=0.005, respectively); The prevalence of MD-TES<150 ms was higher in NYHA class Ⅲ patients (64%) compared with NYHA class Ⅱ patients (27%, P=0.049). However, the prevalence of the LV diastolic dyssynchrony were high but not difference between NYHA class Ⅲ(47% for both MD-TPF and MD-TES+TPF) and class Ⅲ(63% for MD-TPF; 69% for MD-TES+TPF; P=NS) patients as well as between patients with preserved LVEF (43% for both MD-TPF and MD-TES+TPF) and patients with reduced LVEF(64% for MD-TPF; 72% for MD-TES+TPF; P=NS). Conclusions The prevalence of LV systolic dyssynchrony was high in heart failure patients with reduced LVEF. Diastolic dyssynchrony was common in patients with heart failure. CardioGRAF maybe a useful method to detect LV dyssynchrony.

A 60-year-old man was admitted to our hospital due to cerebellum infarction. He had undergone replacement of the aortic valve and ascending aorta because of aortitis syndrome 2 years ago. Electrocardiogram showed complete atrioventricular block. Echocardiography showed aortic annular abscess and vegetation on the prosthetic aortic valve. A pulmonary autograft was transplanted of the aortic root (Ross operation) after complete resection of the infected sites. The postoperative course was uneventful. The ross operation was considered to be a treatment of choice for prosthetic aortic valve endocarditis.

Purpose: Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single por t at t he umbi licus and using t he abdomina l wa l l-lif ting met hod, w it hout establishing pneumoperitoneum. Methods: Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection. Results: The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m 2 . The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups. Conclusion The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.

Purpose: Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single por t at t he umbi licus and using t he abdomina l wa l l-lif ting met hod, w it hout establishing pneumoperitoneum. Methods: Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection. Results: The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m 2 . The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups. Conclusion The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.

BACKGROUNDSmall acoustic neuromas seldom result in typical vestibular symptoms, despite the tumor arising from the vestibular nerve. In this study, we have shown that abnormal gait in eleven patients with small acoustic neuroma could be detected in gait analysis by the use of tactile sensor. Patients displayed no oculomotor abnormality and had tumors less than 10 mm from the porus acoustics.

METHODSGait related parameters including the coefficients of variations (CV) of stance, swing, double support, area ratio of trajectories of center of force (TCOF), in addition to the foot pressure difference between both feet, were used for assessment of gait.

RESULTSThe CV of swing and the area ratio of TCOF were greater in patients than those in the control group (P < 0.05). The values of these two parameters became greater under an eyes closed condition compared to eyes open (P < 0.05) in the patient group.

CONCLUSIONThese results indicate that gait analysis may be helpful to assess vestibulospinal function of patients with small acoustic neuroma, the slight vestibular deficits of which can not be detected by visual observation.

Adult ; Aged ; Female ; Gait Disorders, Neurologic ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Neuroma, Acoustic ; physiopathology