Acute aortic occlusion is an infrequently observed but frequently fatal event requiring prompt surgical treatment. We encountered 4 cases of acute non-aneurysmal abdominal aortic occlusion caused by different mechanisms and reviewed the literature concerning surgical management. The patients consisted of 2 men and 2 women with a mean age of 68.7±5.7 years (range, 63 to 75 years). Three of the 4 patients had a history of atrial fibrillation. Clinical presentations included acute limb ischemia and neurological deficit in all 4 cases. The mechanisms of acute aortic occlusion were mainly divided into embolisms and thrombosis related to aortoiliac occlusive disease. Operation was done at mean intervals of 8.6h (range, 5 to 11h). Two patients underwent transfemoral thrombectomy under local anesthesia, one thromboendarterectomy under laparotomy on hemodialysis, and one axillobifemoral bypass procedure. One patient had to undergo fasciotomy immediately because of compartment syndrome, 2 other patients needed additional procedures (one had femoro-popliteal bypass and the other had mitral valve replacement). The perioperative mortality rate was 25%, related to massive cerebral infarction. The outcomes of these patients depend on prompt diagnosis, systemic heparinization and early revascularization by appropriate operation; initial attempt of transfemoral thrombectomy, and axillobifemoral bypass in high risk patients. After revascularization, patients must be carefully monitored for reperfusion syndrome, myonephropathic metabolic syndrome, acute renal failure and compartment syndrome.

A 71-year-old woman was diagnosed with antiphospholipid antibody syndrome following an acute myocardial infarction and had been taking anticoagulants ever since. Three years later, she was hospitalized with high fever and substantial fatigue. She was diagnosed with infective endocarditis because the blood culture was positive, and scattered cerebral infarction was seen on magnetic resonance imaging, along with an iliopsoas muscle abscess and purulent discitis. She was treated with antibiotics, and her blood culture became negative; however, she was referred to our hospital for surgical treatment because of severe mitral regurgitation due to the progressive valve destruction. She also had aortic regurgitation and underwent mitral and aortic valve replacement. The mitral valve exhibited strong thickening of both leaflets, including the subvalvular tissue, and perforation was observed in the posterior leaflet, P2. The operation time was 4 h and 2 min, and the aortic clamp time was 92 min. The culture of the mitral valve leaflet was negative. She had antiphospholipid antibody syndrome and intraoperative activated clotting time (ACT) management was difficult; therefore, her heparin blood levels were measured and managed using HMS PLUS. The target heparin blood concentration during cardiopulmonary bypass was set at 3 mg/kg and controlled; no thrombotic tendency or increase in circuit pressure was observed during the operation, and the procedure was completed without any problem. She resumed heparin administration 6 h after the operation and continued oral anticoagulant therapy. She recovered without problems and was discharged 12 days after the operation. Management using HMS PLUS may be useful in patients with antiphospholipid syndrome undergoing cardiovascular surgery.

Methods: We retrospectively reviewed the medical records of 404 patients who underwent corrective fusion surgery for ASD with a minimum 2-year follow-up. We studied cases of reoperation for postoperative rod fractures and investigated surgical procedure, intraoperative findings, clinical course, and rod refracture following revision surgery. Results: Rod fracture was observed in 88 patients (21.8%). Fifty-three patients (average age, 68.3 years; average blood loss, 502.2 mL [% estimated blood volume=16.4%]; and operation time, 203.3 minutes) who suffered from a rod fracture at an average of 28.3 months after the primary operation underwent reoperation. Surgical invasiveness had no significant differences in total or partial rod replacement; however, the procedures with and without an anterior bone graft significantly differed. The replaced rod refractured at an average of 35.3 months after the revision surgery of five patients. The rod also refractured at a level outside multiple rods in two patients and with traumatic episodes in three patients. Three patients had bone grafts in the anterior column. Conclusions Revision surgery involving a multirod with a posterior-only approach for a rod fracture that occurred after ASD was performed successfully. Bone grafting in the anterior column is unnecessary for patients without massive bone defects.

Objectives: Locomotive syndrome stage 3 (LS3), which has been established recently, may imply a greater need for care than LS stage 0 (LS0), LS stage 1 (LS1), and LS stage 2 (LS2). The relationship between LS3 and long-term care in Japan is unclear. Therefore, this study aimed to examine this relationship. Methods: A total of 531 patients (314 women and 217 men; mean age, 75 years) who were not classified as requiring long-term care and underwent musculoskeletal examinations in 2012 were grouped according to their LS stage. Group L comprised patients with LS3 and Group N comprised those with LS0, LS1, and LS2. We compared these groups according to their epidemiology results and long-term care requirements from 2013 to 2018. Results: Fifty-nine patients (11.1%) were diagnosed with LS3. Group L comprised more patients (50.8%) who required long-term care than Group N (17.8%) (P < 0.001). Group L also comprised more patients with vertebral fractures and knee osteoarthritis than Group N (33.9% vs 19.5% [P = 0.011] and 78% vs 56.4% [P < 0.001], respectively). A Cox proportional hazards model and Kaplan–Meier analysis revealed a significant difference in the need for nursing care between Groups L and N (log-rank test, P < 0.001; hazard ratio, 2.236; 95% confidence interval, 1.451–3.447). Conclusions Between 2012 and 2018, 50% of patients with LS3 required nursing care. Therefore, LS3 is a highrisk condition that necessitates interventions. Approaches to vertebral fractures and osteoarthritis of the knee could be key.