A 72-year-old man presented with back pain and 3 days after admission, chest and abdominal CT scanning revealed the existence of infrarenal abdominal aortic aneurysm with Stanford type B acute aortic dissection and hemorrhage in the retroperitoneal space. The maximum diameter of the abdominal aortic aneurysm was 60mm. After treating with anti-hypertensive therapy under restrictive observation because of the patient's stable general condition, surgery was performed 45 days after admission. The dissection extended into the abdominal aortic aneurysm and all visceral arteries branched from the true lumen. The presence of thrombus in the preperitoneal space suggested a ruptured abdominal aortic aneurysm. Abdominal aortic aneurysm was replaced with a Y shaped graft and proximal anastomoses was performed with fenestration to prevent rupture of the proximal dissecting aorta. We report a rare case of ruptured abdominal aortic aneurysm following Stanford type B acute aortic dissection, which was operated on in the chronic stage. The patient is doing well.

In atrioventricular (AV) discordance, a morphologic tricuspid valve functioning as a systemic AV valve often becomes incompetent and needs to be replaced. However, mitral valve replacement concomitant with tricuspid valve replacement is unusual in the disease. Here, we report a case of successful double AV valve replacement long after functional biventricular repair in AV discordance. A 32-year-old man with AV discordance was admitted with orthopnea. He had undergone the Rastelli procedure at age 10 and removal of the deteriorated conduit valve at age 24. Preoperative examinations revealed not only tricuspid but also mitral regurgitation. Both deteriorated valves were replaced with mechanical valves. In AV discordance after Rastelli procedure, a non-valved conduit may accelerate mitral deterioration because pulmonary hypertension from tricuspid regurgitation increases the afterload of the pulmonary ventricle.

We report the successful surgical treatment of severe Ebstein's anomaly in a female neonate with pulmonary atresia. Soon after birth, a heart murmur was audible and the baby became cyanotic. Echocardiography showed Ebstein's anomaly with pulmonary atresia. We started a LipoPGE 1 infusion for the open ductus arteriosus, but her uncontrollable heart failure necessitated surgery. Thus, when she was 8 days old, she was placed on cardiopulmonary bypass and we performed a triuspid valve orifice closure with right atrium plication and enlargement of the interatrial communication. She received a modified Blalock-Taussig shunt at the age of 60 days, but a prolonged mirulinone infusion was needed for her persistent heart failure. When she was 10 months old, we inserted a bidirectional Glenn shunt and she was discharged. Finally, when she was 30 months old, she had a total cavopulmonary connection. The patient is now asymptomatic, 18 months after her last operation.

More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.
After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.
1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.
2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).
3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.
4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.
5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.

Objective:It is very important that oxidative stress is estimated for us to understand a player's condition in the field of sports. The purpose of this study was to investigate whether electroacupuncture has an effect on exercise-induced oxidative stress.
Methods:Ten healthy male volunteers participated in both the electroacupuncture (EA) group and the control group in a crossover design. EA at a frequency of 2 Hz and optimum intensity was performed in the subjects for 10 minutes in both the medial vastus muscles. During ergometer exercise by ramp load, respiratory metabolism including the RC point was recorded as the indication of energy metabolism. Blood was collected from the fingertips of the subjects, and then their levels of oxidative stress (d-ROMs test) and antioxidative (BAP test) were determined by using a Free Radical Analytical System (FRAS4, Wismell Instruments). Six measurements were taken;at rest, immediately after EA and following exercise, and at 20, 40, and 60 minutes following exercise.
Results:The RC point was significantly prolonged in the EA group compared with the control group. The level of oxidative stress (d-ROMs test) in the control group increased significantly at 20 minutes following exercise compared with rest (before exercise) and this increase was sustained until 60 minutes after exercise. In contrast, it did not significantly change in the EA group. Whereas the antioxidative level (BAP test) in the EA group significantly increased immediately following exercise compared with rest (before exercise), it did not increase in the control group.
Conclusion:These results suggest that electroacupuncture might enhance the antioxidative level (BAP test) and inhibit the level of oxidative stress (d-ROMs test) by effecting a change in respiratory metabolism. We propose that electroacupuncture might be useful for sports conditioning.

Objective: Patients treated with vinorelbine(VNR)-containing chemotherapy often suffer from injection site reactions.  VNR is a moderate vesicant that is well known to cause local venous damage.  We conducted this study to identify clinical risk factors related to the incidence of injection site reactions caused by VNR, and whether applying a hot compress was effective for preventing such reactions.
Methods: Medical records were retrospectively investigated for 48 patients treated with chemotherapy regimens containing VNR.  Injection site reactions were evaluated for every course and were graded according to the National Cancer Institute Common Toxicity Criteria (version 4.0).  Gender, age, body mass index, chemotherapy regimen, dose of VNR, and volume of fluid for flushing the vein were assessed as clinical variables.  A hot compress was applied to the vein proximal to the injection site during VNR injection.
Results: The injection site reactions occurred in 29 (60%) among 48 patients received intravenous VNR injection.  According to multivariate analysis, use of gemcitabine (GEM) in combination with VNR showed a significant independent correlation with an increased risk of injection site reactions (p=0.019).  When hot compress was applied to 21 patients, who experienced phlebitis of VNR, the injection site reaction was occurred to only three patients (p<0.001).
Conclusion: In this study, the risk factor of the injection site reaction by VNR seems to be combination of GEM.  Application of hot compresses was effective for preventing injection site reactions by VNR.

Branching morphogenesis of the fetal mouse submandibular gland (SMG) is regulated by signaling through the ErbB and FGF families of tyrosine kinase receptors, whose members activate the ERK-1/2 pathway. The four Sprouty (Spry) proteins are inhibitory modulators of ERK-1/2. There is little information on their expression during pre- and postnatal development of the SMG. Qualitative RT-PCR detected mRNAs for Spry1, 2, and 4 from embryonic day 13 (E13) through postnatal day 7 (P7), but only trace amounts of Spry1 and 2 in adult SMGs. More sensitive quantitative RT-PCR revealed that transcripts for all four Spry isoforms are expressed, and each shows individual patterns of variation across fetal and early postnatal stages, and that there are very low levels of Spry1 and 2, but no Spry3 and 4, in adult glands. EGF, FGF7 and FGF10 upregulate expression of mRNA for Spry1, but only FGF7 upregulates Spry2 mRNA. EGF strongly induces an activating phosphorylation of all four Spry isoforms, but both FGFs do so only minimally. Quantitative RT-PCR of samples collected by laser capture microdissection showed that transcripts for Spry1 are confined to the epithelium of E13 SMG rudiments. The isoform-specific temporal variation in the patterns of expression of Spry1, 2, 3 and 4 suggests a potentially important role for these negative modulators of growth-factor driven ras/ERK-1/2 signaling at stages when the SMG is most actively undergoing branching morphogenesis.

[Objective]Daily repetitive exercise is known to be necessary for players in sports. In this study, to further explore the potential functions of acupuncture, we studied whether electroacupuncture (EA) stimulation has efficacy for repetitive exercise-induced oxidative stress.
[Methods]Six healthy male volunteers participated in both the non-treatment control group and the EA group in a crossover design. EA stimulation was applied to both the medial vastus muscles at 2 Hz and optimum intensity for each subject during ten min just before each exercise period. The subject performed ergometer exercise for 20 min with 75%of maximal oxygen uptake each day. This exercise period was performed once a day for three consecutive days. Blood lactate level (BLL) and plasma lipid peroxide (LP) concentration were measured as the markers for metabolism and oxidative stress, respectively. Visual Analogue Scale (VAS) was used to evaluate the individual level of fatigue due to exercise.
[Results]During and just after the exercise period, each value of BLL in the EA group was lower than the same points in the control group. Whereas LP concentrations before the exercise period on the first day in the control group was higher than the values in the same points on the second and third days. LP concentrations before the exercise period in the EA group were almost the same levels for three days. Furthermore, after the exercise period for the three consecutive days, LP concentrations and VAS in the EA group were lower than each value of the same points in the control group, and especially, the alteration of VAS showed a significant difference.
[Conclusion]The increased tendency of LP concentrations before the exercise period for three days in the control group indicated that repetitive exercise induced the accumulation of excess lipid peroxide. It might be suggested that EA stimulation suppressed subjective fatigue by an enhanced energy metabolic rate and decreased production of lipid peroxide. Hence the evidence strongly supported that EA stimulation might be useful for sports conditioning.

Case 1 presented congestive heart failure with atrial fibrillation. Echocardiography and cardiac catheterization demonstrated mitral regurgitation and communications between the right and left coronary arteries and pulmonary artery (PA). The fistula orifice was directly closed and mitral annuloplasty was done at the same time. Case 2 had a history of open mitral commissurotomy for mitral atenosis (MS), and was diagnosed as to be re-MS. Selective coronary angiography (CAG) newly documented an aberrant artery originating from the left coronary artery and draining into the distal right PA. At operation, the origin of the aberrant artery was successfully ligated, and mitral valve was replaced with a prosthetic one. This paper presented relatively rare types of coronary artery fistulae, focusing on the importance of routine CAG before open heart surgery and of consideration on the association of this anomaly in respect to perioperative myocardial protection.

A 53-year-old man underwent aortic and mitral valve replacement, but postoperative cardioangiograms unexpectedly demonstrated aneurysms that had developed right-anteriorly and exactly anteriorly to the ascending aorta. They were initially thought to be pseudoaneurysms formed at the sites of aortotomy for valve replacement and of the aortic hole made by the needle puncture for air-venting. Operative findings, however, strongly suggested that it was a DeBakey type II dissecting aneurysm with two entries at the same sites as described. It was found that almost all distal parts of the aneurysmal cavity, probably a pseudolumen, had been occluded with clots, leaving two round cavities at the entries, which were preoperatively observed as pseudoaneurysms. The entries were successfully closed with approximation of the aortic walls using cardiopulmonary bypass, and the patient survived the operation.