Aberrant right subclavian artery is a common congenital anomaly of the aortic arch, with a reported prevalence of approximately 0.5%. However aneurysms of this aberrant vessel are very rare. A 71-year-old man was admitted with cerebral hemorrhage. Chest X-ray revealed an abnormal upper mediastinal shadow. Angiography, computed tomography (CT) scan, and magnetic resonance (MR) imaging revealed an aberrant origin of the right subclavian artery arising as the fourth branch of the aortic arch and crossing the mediastinum from left to right indenting the esophagus posteriorly. The origin of the right subclavian artery was aneurysmal (maximum diameter was 5cm), and this aneurysm did not compress the esophagus. The patient was treated by Dacron patch graft aortoplasty and right subclavian artery reconstruction with the aid of cardiopulmonary bypass and hypothermic selective cerebral perfusion. The postoperative course was uneventful and there were no major complications. The surgical technique is detailed as well as a review of all the cases in the literature.

A total of 56 patients undergoing coronary artery bypass grafting were allocated to two groups: the Cold group (28 patients) with cold (4°C) crystalloid cardioplegia and topical ice slush, and the Tepid group (28 patients) with tepid (32°C) blood cardioplegia delivered intermittently antegrade. The two groups were comparable in terms of preoperative New York Heart Association classification, age, gender, and number of grafts. Intraoperatively, tepid blood cardioplegia was associated with a significantly shorter cardiopulmonary bypass time and nearly uniform return of normal sinus rhythm. Cardiac output after bypass was significantly higher than before bypass only in the Tepid group. The absolute peak levels in the myocardial-specific isoenzyme of creatine kinase were higher in the Cold group (70±8IU/l) than in the Tepid group (31±5IU/l). There was a trend toward reduced incidence of perioperative myocardial infarction (0% versus 7.1%) and need for intraaortic balloon pump support (0% versus 3.6%) associated with the use of tepid blood cardioplegia. Our results suggest that intermittent tepid blood cardioplegia is a safe and effective technique for coronary artery bypass grafting.

A 72-year-old woman had undergone resection and graft replacement of the proximal ascending aorta for a DeBakey type II aortic dissection. She presented again 7 years later with progressive dyspnea and a cough. Computed tomography confirmed an aortic arch aneurysm and Doppler echocardiography demonstrated aortopulmonary shunting. Cardiac catheterization revealed a fistula between the aorta and pulmonary artery with a 54.3% left-to-right shunt and a Qp/Qs of 2.19. Operative repair was performed under profound hypothermic circulatory arrest with selective cerebral perfusion. The aortopulmonary artery fistula was closed from within the aneurysm using an equine pericardial patch and the transverse aortic arch was resected and replaced with a graft. The patient recovered uneventfully and was discharged on postoperative day 43.

A 47-year-old male complaining of dyspnea and fever was admitted to our hospital and regurgitation of the aortic and mitral valves with mitral valve aneurysm due to infective endcarditis was diagnosed. The non-coronary and the right coronary cusps of the aortic valve had amount of vegetations, and also the anterior leaflet of the mitral valve had an aneurysm with vegetations. Both aortic and mitral valve replacement were performed. The postoperative clinical course was uneventful.

The effects of bathing with inorganic salts and carbon dioxide (ISCD) on body temperature, systemic circulation, food ingestion and absorption have been studied in healthy volunteers. The peripheral blood flow in the forearm was found to increase in and after immersion of the forearm into a 25l bathing receptacle containing ISCD, as compared with plain water. The peripheral blood flow tended to increase in a dose-dependent manner with ISCD bathing. The skin core temperature, the skin surface temperature and the peripheral blood flow were significantly higher after ISCD bathing than after plain water bathing. The influences of ISCD bathing on food ingestion and absorption were also studied in healthy volunteers. Blood glucose and insulin levels after food ingestion tended to be suppressed by ISCD bathing as compared with plain water bathing. There was no difference between ISCD and plain water bathing in total protein, total cholesterol, triglyceride, HDL cholesterol, and uric acid levels in the blood. These results suggest that ISCD bathing may contribute to the promotion of human health.

From April 1990 to August 1995, 44 consecutive patients (25 males and 19 females; mean age, 63 years) who underwent surgery for Stanford type A aortic dissection, were studied to examine surgical results and postoperative quality of life (QOL). Ascending aortic replacement was performed in 22 patients and simultaneous replacement of the ascending aorta and the aortic arch in 22. The postoperative 30-day survival rate was 84% (37/44). Univariate analysis revealed that operation time (p<0.01), postoperative cardiac failure (p<0.02), respiratory failure (p<0.01), severe brain damage (p<0.01), and intestinal ischemia (p<0.02) were significant factors in increased operative mortality risk. Additional operative procedure was also a significant factor (p<0.05) all 3 patients with coronary artery bypass grafting died, while all 5 patients with the Bentall or Cabrol procedure lived. The factors which influenced postoperative QOL were preoperative renal damage (p<0.05), history of cerebral vascular disease (p<0.02), shock (p<0.02), postoperative renal failure (p<0.02), paraplegia (p<0.02), and residual dissection (p<0.02). The operation method, which was replacement of the ascending aorta or simultaneous replacement of the ascending aorta and the aortic arch, had no influence on postoperative QOL. Five of 22 patients receiving ascending aorta replacement had dissection only in the ascending aorta (localized type). The other 17 patients receiving ascending aorta replacement had dissections extending to the arch or descending aorta. The incidence of complications due to residual dissection was 5/17 (29%) in cases of replacement of the ascending aorta for type A aortic dissection, while it was 1/22 (5%) in cases of replacement of the ascending aorta and the aortic arch (p=0.0684). Simultaneous replacement of the ascending aorta and the aortic arch did not negatively affect the surgical results and postoperative QOL more than replacement of the ascending aorta, and there was lower incidence of postoperative complications due to residual dissection. If Stanford type A aortic dissection extends to the arch, simultaneous replacement of the ascending aorta and the aortic arch is recommended.

OBJECTIVE: In patients with recurrent ovarian cancer (ROC) in whom surgery is likely to render them disease-free, it is unclear whether secondary cytoreductive surgery (SCS) combined with chemotherapy is superior to chemotherapy alone. The aim of this study was to evaluate the 2 treatment options in Tian-model low-risk patients. METHODS: We retrospectively reviewed 118 ROC cases treated in our hospital between 2004 and 2016. Of these, 52 platinum-sensitive cases were classified as low-risk (complete resection anticipated) using the Tian model. Prognostic factors were assessed with univariate and multivariate analysis using Cox's regression model. Progression-free survival (PFS) and overall survival (OS) were compared in patients treated with SCS plus chemotherapy (SCS group) and those treated with chemotherapy alone (chemotherapy group), using a propensity-score-based matching method. RESULTS: By multivariate analysis, the only factor associated with better OS was SCS. PFS and OS were significantly longer in the SCS group compared to the chemotherapy group in the matched cohort (median PFS: 21.7 vs. 15.1 months, p=0.027 and median OS: 91.4 vs. 33.4 months, p=0.008, respectively). In cases with multiple-site recurrence, the SCS group also showed significantly longer OS than the chemotherapy group (median 91.4 vs. 34.8 months, p=0.022). In almost all SCS cases, cooperation was required from other departments, and operation time was lengthy (median 323 minutes); however, no serious complications occurred. CONCLUSION: SCS combined with chemotherapy results in better PFS and OS than chemotherapy alone in first platinum-sensitive ROC patients categorized as low-risk by Tian's model.
Cohort Studies ; Cytoreduction Surgical Procedures ; Disease-Free Survival ; Drug Therapy ; Humans ; Methods ; Multivariate Analysis ; Ovarian Neoplasms ; Recurrence ; Retrospective Studies

A 69-year-old man was referred to our hospital because of a right upper mediastinal mass observed on chest roentgenogram. Computed tomography showed a dissecting aneurysm of the right subclavian artery and dissection of the ascending aorta. Furthermore, the ascending aorta was dilated. We subsequently reconstructed the right subclavian artery with a bypass graft and replaced the ascending aorta. Two-thirds of the aortic arch was placed in deep hypothermic circulatory arrest with retrograde cerebral perfusion. His postoperative course was uneventful with no neurological complications. While subclavian artery aneurysms are relatively rare in comparison to other peripheral artery aneurysms, subclavian artery aneurysms with aortic dissections are even rarer. The most important concerns during subclavian artery aneurysm repair are the method of surgical approach and the maintenance of sufficient cerebral flow. We suggested that deep hypothermic circulatory arrest with retrograde cerebral perfusion might prove useful in cases involving an intramural thrombus adherent to cerebral vessels. Therefore, patients with subclavian artery aneurysms must undergo extensive preoperative evaluation.

Welwalk WW-1000® (WW-1000®) is a gait exercise-assisted robot. Suitable assistance was provided to the patients with hemiplegic legs in both stance and swing phases. In addition，this robot offers various forms of feedback to patients during exercise. We present the case of a patient with multiple sclerosis and left hemiplegia who underwent WW-1000® gait exercise.The 73-year-old patient required maximum assistance with metal ankle foot orthotics (AFO) and a quadruped cane prior to robot-based rehabilitation. The aims of gait exercise with the WW-1000® were as follows；① maintain the verticality of the trunk during the entire gait cycle；②shifting the center of gravity during stance phase on the nonparalytic limb；③stabilizing the swing phase on the paralytic limb, and enhancing support during the stance phase on the paralytic limb. Each aim was modified depending on level of achievement. Assistance with the WW-1000® activated the trunk and Nonparalytic limb (visual feedback was utilized in exercises). On day 9, the patient could walk using a plastic AFO and T-cane supervised by a therapist.The multifunctional WW-1000® is useful for subdividing gait goals, exercise and set stepwise aims consistent with the patient's abilities. Gait exercises using the WW-1000® may efficiently improve gait and helps adapt to changes in conditions in the subacute phase.

Background: Bathing is an important behavior for keeping the body clean and is one of the habits of daily life. Among other things, bathing is regarded as a means of relieving fatigue, refreshing oneself, benefiting health, and improving sleep. As such it can be considered a health-maintaining activity. Apart from a previous study by the authors, there has been very little research on the relationship between home bathing habits and health. Objective: The aim of this study was, therefore, to clarify how physical and mental health relate to daily bathing in the home, particularly the habit of full bath immersion. Method: The participants were 198 employees of a quasi-drug manufacturing company and their family members who could and cooperated in the present study. The study was conducted as a self-report survey from October 1-30, 2010, with questionnaires being distributed to and collected from subjects before and after this period. Participants were asked about their sex, age, frequency of bathing per week, frequency of use of bath additives per week, temperature of bath water, bathing duration, and water level when in the bath, health, and sleep quality. Health was assessed using the Profile of Mood States (POMS) inventory, and self-rated health and quality of sleep were assessed using a Visual Analog Scale (VAS). Results: Among bathing habits, the group with a high bath frequency had significantly low scores for tension-anxiety and depression-dejection mood scales, and significantly high self-rated health. In the present study, self-rated health and quality of sleep were significantly better in the group who frequently used bath additives. In the full bath group, Fatigue score was significantly low and self-rated health and quality of sleep scores were significantly high. Discussion and Conclusion: Taking a full bath frequently and frequent use of bath additives are bathing habits that increase physical and psychological health in the middle-aged.