Successful thoracic endovascular repair for complicated Stanford type B acute aortic dissection in two patients is herein reported. The true lumen flow was immediately restored following stent graft deployment in the descending thoracic aorta with subsequent resolution of the distal malperfusion syndrome. One patient is doing well more than 15 months after surgery and another patient who was treated more recently is also doing well 7 months postoperatively.
Aorta, Thoracic ; Humans ; Stents ; Transplants

The causes of aortic dissection are usually hypertension, connective tissue disease such as Marfan syndrome, congenital valvular abnormality such as bicuspid aortic valve, iatrogenic injury, pregnancy and drugs. Previous studies have shown that 50% of all dissections in women less than 40 years age were associated with pregnancy. Almost all aortic dissections during pregnancy occur during the third trimester or during labor and delivery. Marfan's syndrome is a particularly important predisposing factor for aortic dissection during pregnancy. We report here on a case of surgical treatment for acute type II aortic dissection in a Marfan syndrome patient who was 24 weeks pregnant, and we include a review of literature.
Aortic Valve ; Bicuspid ; Causality ; Connective Tissue Diseases ; Female ; Humans ; Hypertension ; Marfan Syndrome* ; Pregnancy ; Pregnancy Trimester, Third

Objectives: The purpose of this study is to investigate the difference in the effects of eye-mask and light-off on sleep status according to a commercial fitness tracker and a sleep diary of psychiatric in-patients in correctional facilities where nocturnal light is compulsory. Methods: This study was conducted over 3 consecutive nights. In-patients of the National Forensic Psychiatric Hospital (n = 29) were assigned random subject numbers and slept as usual in the light-on condition on the first night. The subjects slept with eye-masks in the light-on condition on another night and without an eye-mask in the light-off condition on the other night. Subjects were asked to sleep wearing a commercial fitness tracker and to keep a sleep diary. The order of these changes in bedroom lighting condition on the second and third nights was assigned randomly to participants. Results: In comparison of the sleep variables between the light-on condition and the eye-mask condition, the Wakefullness After Sleep Onset (WASO) was shorter and sleep satisfaction was higher in the latter.(respectively, Z = 3.66, p < 0.017 ; Z = 2.69, p < 0.017) In comparison of the sleep variables between the light-on and light-off conditions, the WASO was shorter and sleep efficiency and sleep satisfaction were higher in the latter (respectively, Z = 2.40, p < 0.017 ; Z = 3.02, p < 0.017 ; Z = 3.88, p < 0.017). However, there were no differences in the sleep variables between the eye-mask condition and the light-off condition. Conclusion Subjective improvements in sleep variables were noted in sleep diaries of institutionalized psychiatric patients under either the ‘eye-mask’ or ‘light-off’ condition. However, there were no significant differences between the ‘eye-mask’ and ‘light-off’ conditions. Therefore, we suggest that psychiatric patients in correctional facilities use eye-masks when sleeping.

Objectives: The purpose of this study is to investigate the difference in the effects of eye-mask and light-off on sleep status according to a commercial fitness tracker and a sleep diary of psychiatric in-patients in correctional facilities where nocturnal light is compulsory. Methods: This study was conducted over 3 consecutive nights. In-patients of the National Forensic Psychiatric Hospital (n = 29) were assigned random subject numbers and slept as usual in the light-on condition on the first night. The subjects slept with eye-masks in the light-on condition on another night and without an eye-mask in the light-off condition on the other night. Subjects were asked to sleep wearing a commercial fitness tracker and to keep a sleep diary. The order of these changes in bedroom lighting condition on the second and third nights was assigned randomly to participants. Results: In comparison of the sleep variables between the light-on condition and the eye-mask condition, the Wakefullness After Sleep Onset (WASO) was shorter and sleep satisfaction was higher in the latter.(respectively, Z = 3.66, p < 0.017 ; Z = 2.69, p < 0.017) In comparison of the sleep variables between the light-on and light-off conditions, the WASO was shorter and sleep efficiency and sleep satisfaction were higher in the latter (respectively, Z = 2.40, p < 0.017 ; Z = 3.02, p < 0.017 ; Z = 3.88, p < 0.017). However, there were no differences in the sleep variables between the eye-mask condition and the light-off condition. Conclusion Subjective improvements in sleep variables were noted in sleep diaries of institutionalized psychiatric patients under either the ‘eye-mask’ or ‘light-off’ condition. However, there were no significant differences between the ‘eye-mask’ and ‘light-off’ conditions. Therefore, we suggest that psychiatric patients in correctional facilities use eye-masks when sleeping.

BACKGROUND: Fulminant myocarditis is a rare, but life threatening condition. Its prognosis is related with proper management in the acute phase. A cardiopulmonary support device can be very useful in this phase. We report on our experiences with managing acute fulminant myocarditis with a cardiopulmonary support (CPS) device. MATERIAL AND METHOD: We reviewed retrospectively 9 patients who had a CPS device used for their fulminant myocarditis between September, 2006 and October, 2008. A Capiox emergency bypass system (Terumo Inc, Tokyo, Japan) was percutaneously inserted in all the patients. Upon implantation, all the patients were in cardiogenic shock because of ventricular arrhythmia or severe left ventricular dysfunction. The mean left ventricular ejection fraction (EF) was 20+/-6% according to transthoracic echocardiography. RESULT: 3 patients died despite CPS. The CPS was bridged to a transplanted heart in one patient. The rest were successfully explanted after a mean time of 107+/-70 hours of running. The mean EF after discharge was 56+/-7% without dilated cardiomyopathy. CONCLUSION: Fulminant myocarditis can be fatal, but its prognosis is excellent if these patients receive proper, timely treatment. A cardiopulmonary support device can be very useful in this acute period. However, the implantation and management protocol of cardiopulmonary support are not yet settled. Further study is necessary to lower the complications of cardiopulmonary support for patients with fulminant myocarditis.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated ; Echocardiography ; Emergencies ; Heart ; Heart Transplantation ; Humans ; Myocarditis ; Prognosis ; Retrospective Studies ; Running ; Shock, Cardiogenic ; Stroke Volume ; Tokyo ; Transplants ; Ventricular Dysfunction, Left

Primary malignant neoplasm of the pericardium is very rare. Neoplastic involvement of the pericardium may result in rapidly developing hemorrhagic effusion. A 30-year-old male who occasionally suffered from chest tightness was referred to our hospital under the diagnosis of unstable angina. He presented with acute chest pain and severe dyspnea that had developed one day previously. The diagnostic investigations such as echocardiography, chest CT and magnetic resonance image suggested cardiac tamponade that was caused by rupture of the pericardial teratoma. An operation to remove the tumor and effusion was performed. The pericardial mass was completely excised, and the result of the frozen biopsy favored malignancy. The final pathologic report was malignant fibrosarcoma of the pericardium and no malignant cells were found on the cytology of the pericardial effusion. The patient had a smooth postoperative course and was referred to another hospital for additional radiation therapy. We report here on this case of cardiac tamponade that was caused by primary pericardial fibrosarcoma, and this required urgent diagnosis and surgical management.
Adult ; Angina, Unstable ; Biopsy ; Cardiac Tamponade* ; Chest Pain ; Diagnosis ; Dyspnea ; Echocardiography ; Fibrosarcoma* ; Heart Neoplasms ; Humans ; Male ; Pericardial Effusion ; Pericardium ; Rupture ; Teratoma ; Thorax ; Tomography, X-Ray Computed