A 37-year-old man with protein-losing gastroenteropathy underwent surgery for mitral and tricuspid regurgitation. Serum protein level and serum albumin level were normalized after surgery. Gastrointestinal scintigraphy images using ^99mTc-labeled albumin also showed no collection of tracer in gastrointestinal tract.

The purpose of this study was to investigate sex differences in the muscle volume (MV) of the iliopsoas, psoas major, and iliacus muscles, normalized by fat free mass (FFM), in the elderly. The subjects were 15 males and 15 females 65 years of age or over. Serial transverse 1.5T magnetic images (10 mm slice) of each subject were taken between the 12^th thoracic vertebrae and the lesser trochanter. FFM was measured with a bioelectrical impedance analyzer. The mean MV of each muscle on the right and left sides were calculated and used for regression analysis of the relationship between MV and FFM.A significant correlation was observed between MV and FFM of the iliacus in both sexes (p<0.01), but not between the MV and FFM of the psoas major. MV normalized by FFM and cross-sectional area (CSA) normalized by FFM^2/3 showed significantly greater values for the psoas major in the males than in the females (p<0.001), but there was no sex difference in the MV or CSA normalized by FFM of the iliacus.These results suggest that elderly males tend to have a greater muscle volume and cross-sectional area of the iliopsoas than elderly females, and that these sex differences are attributable to differences in the psoas major.

To compare the effectiveness of five different muscle training movements on the biceps brachii, latissimus dorsi and trapezius muscles, eight weight-trained men (age, 20.4±0.5 years) were asked to perform three repetitions, at 70% one repetition maximum, of upright rowing (UR) and bent-over rowing (BR) exercises using a barbell ; and seated rowing (SR), front lat pull-down (LPf) and back lat pull-down (LPb) exercises using a Universal Machine. The activities of the biceps brachii, latissimus dorsi, and trapezius during the elbow flexsion and elbow extension phases of each exercise were analyzed using integrated electromyography (EMG) and normalized I-EMG. The results were as follows :1. The mean nrmsEMG values for the biceps brachii were larger during UR and LPf exercises than during BR, SR, and LPb exercises, suggesting that UR and LPf are more effective than the other movements for training the biceps brachii. The mean nrmsEMG values for the latissimus dorsi were larger during SR, LPf, and LPb exercises, followed by BR and UR exercises (in descending order), suggesting that SR, LPf, and LPb exercises are more effective than the other movements for training the latissimus dorsi.2. The mean nrmsEMG values for the upper trapezius were larger during UR and BR exercises than during SR, LPf, and LPb exercises, suggesting that UR and BR exercises are more effective than the other movements for training the upper trapezius. The mean nrmsEMG values for the middle trapezius were larger during BR and SR exercises than during UR, LPf, and LPb exercises, suggesting that BR and SR exercises are more effective than the other movements for training the middle trapezius. The mean nrmsEMG values for the lower trapezius were larger during BR exercise than during other movements, suggesting that BR exercise is more effective than the other movements for training the lower trapezius.3. In all the exercises, each muscle showed a higher nrmsEMG value during the elbow flexsion phase than during the elbow extension phase. This observation suggests that the training method examined in this study should emphasize the elbow flexsion movement.The present results suggest that UR exercise is the most effective movement for training the biceps brachii and upper trapezius, BR is most effective for training the upper trapezius, middle trapezius and lower trapezius, SR is most effective for training the latissimus dorsi and middle trapezius, LPf is most effective for training the biceps brachii and latissimus dorsi, and LPb is most effective for training the latissimus dorsi.

The left IMA graft to the LAD showed a string sign with no antegrade flow in an asymptomatic 67-year-old man 3 years after the operation. The LAD lesion had regressed from 95% stenosis to less than 50% during this period. Exercise electrocardiographic and thallium 201 myocardial scintigraphic examinations revealed no ischemia in the LAD region. When the LAD was temporarily occluded by a PICA balloon, the anterograde flow from the IMA to the LAD could be demonstrated by angiography. The IMA graft in no flow situation has maintained anatomical patency for 3 years after the operation.

We report a case with successful surgical resection for a leiomyoma with an extension into the right atrium from the pelvic vein. The patient was a 54-year-old woman who presented with syncope in 1989. She had had a history of resection of a uterine leiomyoma 10 years previously. Preoperative angiograms showed a long tumor with an extension into the right atrium through the inferior vena cava originating from the right internal iliac vein. The diagnosis of intravenous leiomyomatosis was made. The operation was performed through a median sterno-laparotomy using cardiopulmonary bypass with successful results. Histologic sections showed a benign leiomyoma. To our knowledge, 20 cases of resection of intravenous leiomyomatosis with the use of extracorporeal circulation have been reported in the literature. This rare condition was discussed with the review of the literature.

A 68-year-old man with a right common iliac artery aneurysm perforating the inferior vena cava showed cardiomegaly and pulmonary congestion with left leg edema and dyspnea on exertion. The patient demonstrated a hyperdynamic circulation characterized by increased filling pressure, low systemic resistance, and high cardiac output (9.81l/min/m²) before surgery with a pulmonary-to-systemic blood flow ratio of 1.36. At operation, the right iliac artery to the inferior vena cava fistula, 5×10mm across, was closed along with resection and replacement of the aneurysm with a woven dacron graft of 10mm in diameter. The procedure caused acute and dramatic changes both in pre- and after-loads associated with aortic clamping as well as with elimination of A-V shunt through the fistula. Diligent attention was required both by surgeons and anesthesiologists to cope with these rather dramatic hemodynamic shifts during and after surgery. The patient did well and was discharged with normal hemodynamic parameters.

Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.

Microvascular free flap transfers have become a preferred reconstructive technique; however, rare complications may still prove devastating. This study reviewed 213 consecutive free-tissue transfers in order to assess the incidence and causes of complications in patients undergoing microvascular free flap reconstruction in the oral and maxillofacial region. In most cases, reconstruction was undertaken after resection of a malignant tumor. The flap donor sites were the radial forearm (n=111), rectus abdominis (n=88), scapula (n=13), and latissimus dorsi (n=1). The superior thyroid artery and the external jugular vein were commonly used as recipient vessels for anastomosis. The overall flap success rate was 99%. There were 7 cases of postoperative vascular thrombosis (6 venous and 1 arterial), constituting 3.3% of the entire series. Five flaps were salvaged, representing a 71.4% successful salvage rate in cases of vascular complications. Most of the successful salvage attempts were made within 24 hours of the end of the initial operation, and the successful salvage rate for re-exploration was 100%. Finally, the total flap loss rate was 0.9% and the partial flap loss rate was 2.3%. We conclude that early re-exploration should be the first choice for management of vascular compromised flaps. Complications at the donor site occurred in 17 cases (8.0%), the most common complication of which was partial skin graft loss after harvesting a radial forearm flap (n=10; 9.0%). Recipient and donor site morbidity was limited and considered acceptable.

BACKGROUND: Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported. METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation. RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL;P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 μIU/mL) were higher than at admission (1.48±0.5 μIU/mL) in group C (P<0.05). CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.

Objective: The present study was done to examine the effect of dietary supplement containing Kurozu concentrate on human visceral fat accumulation. Material and Methods: Sixteen subjects(BMI≧25) were orally administrated Kurozu concentrate for 8 weeks(low dose group: 500 mg/day, high dose group 1000 mg/day). Before and at weeks 8, hematological analysis, urinalysis and CT-scan to estimate the visceral fat accumulation were conducted. Results: In high dose group, following results were obtained; visceral fat decreased significantly(p=0.033), HDL-cholesterol level elevated significantly (p=0.034) and systolic blood pressure decreased significantly(p=0.004). In addition, no serious symptoms or abnormal hematological values were observed in both group.Conclusions: The dietary supplement containing Kurozu concentrate may be useful to prevent a metabolic syndrome.