Introduction: To elucidate the issues surrounding adolescents' Internet use in social minority groups, this study investigated the current situation of Internet addiction among Brazilian students who live in A city in Japan.Methods: The participants were 342 local Brazilian students attending international schools. A cross-sectional study using a self-administered questionnaire in Brazilian-Portuguese was conducted. As a primary outcome, we used Young's Internet Addiction Test (IAT) to evaluate the level of self-reported Internet addiction. Social demographics (i.e. age, sex, etc. ), lifestyle (i.e. the time for Internet use, sleeping hours, etc. ), and depressive tendency (Patient Health Questionnaire 2, PHQ2) were also assessed. The χ-square test and logistic regression analysis were used for analysis.Results: The response rate was 65% (222; 111 males and 111 females). Factors related to an IAT score of 50 or higher were sleeping hours (<7.5 hours) (OR: 0.38, 95%CI: 0.21-0.68), the time for Internet use (≥4 hours) (2.6, 1.4-4.8), and PHQ2 score (≥3) (6.2, 3.3-11.5). On logistic regression analysis, an IAT score ≥50 was positively associated with the time for Internet use and PHQ2 score ≥3.Conclusion: The self-report of high Internet addiction among Brazilian students in A city in Japan was significantly related to the time for Internet use and depressive tendency.

We have recently experienced a case of impending ruptured aneurysm of the common iliac artery associated with a gelatinous substance in the retroperitoneal space. A 69 year-old male had been diagnosed as a left common iliac aneurysm at another hospital by CTscan during the examination of lower abdominal pain. At the midnight of the day he admitted, the severity of pain gradually intensified. But there was no sign of anemia nor hypotension. Next morning CTscan showed low density left retroperitoneal mass. The patient underwent emergency laparotomy. The further inspection revealed about 600cm³ of gelatinous substance in left retroperitoneal space without the sign of aneurysmal rupture. A bifurcated graft replacement was performed. The low density mass was not recognized by CTscan done 42 days postoperatively. Electrolyte study of the gelatinous substance indicated its serous leakage through the impending ruptured aneurysm. Our present report constitutes a completely distinct variety of common iliac aneurysm, associated with a gelatinous substance in retroperitoneal space without a major rent of the aneurysmal wall.

We present a case of Marfan's syndrome with acute aortic dissection during the trimester of her pregnancy, who underwent a Bentall operation 2 days after emergency cesarean section. A 24-year-old woman during the 31st week of pregnancy visited our emergency room due to sudden onset of chest and back pain, though she had no abnormality until this event. Because of her tall height, spider fingers, positive wrist sign, visual disorder and scoliosis, she was given a diagnosis of Marfan's syndrome. Enhanced CT and cardiac ultrasonography revealed that she was suffering from acute aortic dissection with annulo-aortic ectasia. Since it was difficult for her to continue with her pregnancy, she underwent emergency cesarean section and gave birth to a male baby weighted 1, 706g. Although there was little likelifood of early thrombus formation in the false lumen or significant aortic regurgitation indicating an emergency operation, fear of massive bleeding from her uterus and the exfoliated surface of the placenta after cesarean section required an observation period of 2 days. We performed a Bentall operation successfully after careful sedation, ventilation and blood pressure control for 2 days.

Protein C (PC) deficiency is an inherited thrombotic disorder with a prevalence of 0.19% among the general population. PC deficiency is associated with an increased risk of thrombosis when other risk factors are present, such as trauma, surgery, or infection, and is an important cause of mechanical valve thrombosis. We performed tricuspid valve replacement with a 29mm Carpentier-Edwards Perimount valve in a 20-year-old man with PC deficiency. The patient had corrected transposition of the great vessels with severe tricuspid insufficiency, as well as a history of cerebral infarction. In the perioperative period, we used only heparin sodium as the anticoagulant. When we restarted administration of warfarin, changing over from heparin, transient increases of serum plasmin inhibitor-plasmin complex (PIC) and thrombin antithrombin complex (TAT) levels were observed. Despite an increased dose of heparin, an appropriate activated partial thromboplastin time (APTT) was not obtained. This suggested a hypercoagulatory state, but the postoperative course was uneventful. Management of perioperative anticoagulation, prevention of late thrombotic events, and prosthetic valve selection in this particular situation are discussed.

We have examined the role of readmission of oxygen in the initiation of reperfusion-induced arrhythmias by separating readmission flow from readmission of oxygen on a temporal basis. Isolated rat hearts (n=12/group) were subjected to 10 minutes of global ischemia and reperfusion. In controls reperfused with aerobic perfusion medium, 100% of hearts developed ventricular tachycardia 1.48±0.78 seconds after reperfusion, and ventricular fibrillation occurred 13.47±2.91 seconds after reperfusion. Also in hearts reperfused with anoxic perfusion medium, 100% of hearts developed ventricular tachycardia 1.98±0.96 seconds after reperfusion, and ventricular fibrillation occurred 27.01±18.52 seconds after reperfusion. But the duration of the time from reperfusion to the onset of ventricular fibrillation were statistically differrent in these two groups (p<0.05). In conclusion anoxic reperfusion delayed ventricular fibrillation but prevent neither ventricular fibrillation nor ventricular tachycardia. This implies that oxygen-derived free radicals may play an important role in the initiation of reperfusion-induced arrhythmias, but are unneccessary for arrhythmogenesis.

A 63-year-old woman underwent coronary artery bypass grafting and mitral annuloplasty 4 years previously. She was readmitted owing to heart failure. Cardiac catheterization revealed worsened mitral regurgitation, although the internal thoracic artery (ITA) graft had good patency. Reoperation was performed by median resternotomy and continuous retrograde cardioplegia without clamping the ITA graft. The mitral valve had a perforation in the anterior leaflet, and was replaced by a 29mm Carbo-Medicus valve. The patient was discharged with transient myocardial ischemia. Although median resternotomy and continuous retrograde cardioplegia at reoperation provided on excellent view and myocardial protection, myocardial ischemia in the region perfused by the ITA graft may occur when the ITA graft cannot be clamped during continuous retrograde cardioplegia.

A 24-year-old woman had been injured in an automobile accident. The chest X-ray showed widening of the mediastinum and computed tomography showed mediastinal hematoma around the aortic arch. Aortic rupture was suspected, so we performed aortography, which revealed pseudoaneurysm of the descending aorta. Moreover, she also had splenic rupture and pelvic fracture. She underwent an emergency operation 4 hours after the accident. Medial tear of the descending aorta was replaced with a graft under temporary bypass without heparin. Simultaneously, splenectomy was performed. Her postoperative course was uneventful. We consider that temporary bypass without heparin is a useful method during repair of the descending aortic rupture due to trauma.