The present study was carried out to investigate differences in hormonal and metabolic responses to moderate exercise in the post-absorptive state and during a 33-hour fast. Secretory factors and the roles of regulatory hormones of carbohydrate and lipid metabolism during moderate exercise were assessed baesed on these data. Energy substrates in the blood (glucose, BG; lactate, LA; triglyceride, TG; free fatty acids, FFA; free glycerol, FG) and plasma hormones (ACTH; GH; Cortisol, Corti; glucagon, IRG; insulin, IRI) concentrations were measured from 12 h to 33 h during the fasting period (12: 00, 24: 00, 06: 00, 09: 00), and 3min, 10 min and 30min after moderate treadmill exercise (estimated 70-80% of VO₂max) for 20 min under fasting conditions between 09: 00 and 11: 00. These results (in the fasting experiment, Fast) were compared to the results on a normal diet (N-D) .
The results were as follows:
1. No differences in mean VO₂ and respiratory exchange ratio (RER) during exercise were observed between the Fast and N-D experiments. Mean heart rate during exercise in Fast was higher by 3.3±2.2 bpm (p<0.05) .
2. Serum FFA and FG concentrations were significantly higher as a results of 24-hour fasting than the values measured at the same time in N-D. No significant change in serum TG concentrations were observed in Fast. While BG and LA concentrations remained low, and in small changes occurred in then both during Fast.
3. Slightly higher levels of plasma ACTH, GH and IRG were found in Fast, but they were not significantly different from N-D. Plasma Corti concentrations gradually increased after 24 hours of fasting, and were 1.9 times higher at 09: 00 after 33 hours of fasting than on N-D. Plasma IRI levels, however, remained low, and the molecular ratio of IRG to IRI (IRG/IRI) was higher throughout Fast (1.8 to 10.6 times higher than on N-D ) .
4. Plasma ACTH, GH and Corti concentrations increased markedly after exercise, and remained high until 30 min on Fast. No significant change in IRG and depression of insulin secretion were demonstrated after exercise on both treatment.
5. Significant correlation between changes in plasma ACTH and Corti concentrations were observed throughout the experiments (Fast, r=0.562; N-D, r=0.528) .
6. All of the energy substrates except blood TG increased after exercise, and the net increases in LA and FG (Δ) on Fast were significantly higher than on N-D. Significant correlations between the changes in the concentrations of FFA and FG (Fast, r=0.745; N-D, r= 0, 696), LA and BG (Fast, r=0.689; N-D, r=0.623), and FFA and LA (Fast, r=0.579; N-D, r= 0.479) were detected throughout both experiments.
7. The coefficients of correlation between changes in plasma ACTH and FFA, and between BG and LA concentrations were higher on Fast than N-D. However, changes in plasma IRI and IRG concentrations were not directly correlated with any other changes in energy substrates in the blood in either treatment.
The results indicated that moderate exercise for 20 min after a 33-hour fast causes marked responses in ACTH, Corti and GH secretions. It appeared that Corti secretion de-pended on ACTH, and that Corti facilitated fatty metabolism during exercise on Fast. However, secretion factors and the role of GH during exercise remain a matter of conjecture.

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis.
Aged ; Diagnosis ; Mediastinal Neoplasms ; Mediastinum ; Myelolipoma* ; Recurrence ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy

Cross-sectional study.

Cross-sectional study.

Methods: LSS patients who underwent decompression surgery with or without fusion were included. Clinical outcomes were measured before surgery and 6 months postoperatively using the Zurich Claudication Questionnaire (ZCQ); Visual Analog Scale (VAS) of low back pain, leg pain, and leg numbness; Japanese Orthopaedic Association Back Pain Evaluation Questionnaire; and the Medical Outcomes Study 36-item Short-Form General Health Survey (SF-36). The Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale were used to evaluate psychological status before surgery. Patients were classified as satisfied or dissatisfied with surgery based on a ZCQ satisfaction subscale cutoff score of 2.5. Results: The satisfied and dissatisfied groups contained 128 and 29 patients, respectively. Six months postoperatively, outcome scores for the dissatisfied group were unchanged or worse than preoperative scores (p>0.05). Multivariate logistic regression analysis showed significant associations between dissatisfaction and preoperative low back pain VAS score ≥ median (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.10–0.74; p=0.01), preoperative mental health SF-36 score ≥ median (OR, 0.26; 95% CI, 0.08–0.89; p=0.03), and preoperative anxiety HADS score ≥ median (OR, 3.95; 95% CI, 1.16–13.46; p=0.03). Conclusions Preoperative less severe low back pain, lower mental health, and higher anxiety are associated with patient dissatisfaction with lumbar surgery, not depression, pain catastrophizing, or fear-avoidance beliefs. Pre- and postoperative psychological status should be assessed carefully and managed appropriately.

East Asian surgeons generally report lower morbidity and mortality rates for gastrectomy with D2 lymphadenectomy than do surgeons in Western countries; however, the disparity remains unexplained. The aim of this article was to determine the feasibility and safety regarding cases in which East Asian surgeons perform such procedures in Caucasian patients (CPs). Twelve CPs underwent gastrectomy with lymphadenectomy for gastric cancer at Yonsei University Severance Hospital, Seoul, Korea between June 2011 and April 2014. Procedures performed included total gastrectomy (7 of 12, 58%), distal gastrectomy (4 of 12, 33%), and completion total gastrectomy (1 of 12, 8%). Nine patients (75%) underwent D2 lymphadenectomy, and D1+ lymphadenectomy was performed in three others (25%). In four patients (33%), combined resections were carried out. The median values of surgical parameters were as follows: operative time, 266.5 min (range, 120-586 min); estimated blood loss, 90 mL (range, 37-350 mL); retrieved lymph node count, 37.5 (range, 22-63); and postoperative hospital stay, 13.7 days (range, 5-63 days). No mortality was encountered, although two patients (17%) experienced complications (both Clavien-Dindo classification grade IIIa anastomotic leakages), which were successfully managed by conservative treatment. In the hands of East Asian surgeons, mortality and short-term morbidity appears to be acceptably low in CPs subjected to gastrectomy with lymphadenectomy for gastric cancer.
Adult ; Aged ; *European Continental Ancestry Group ; Female ; *Gastrectomy/adverse effects ; Humans ; Length of Stay ; *Lymph Node Excision/adverse effects ; Male ; Middle Aged ; Operative Time ; *Patients ; Pilot Projects ; Republic of Korea ; Safety ; Stomach Neoplasms/pathology/*surgery ; *Surgeons

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.

Herein, we present a case of aortic root replacement 42 years after aortic valve replacement (AVR) with the Björk-Shiley Spherical (BSS) valve in a patient with an aortic root aneurysm. The patient was a 67-year-old man who had undergone AVR with BSS and aortic root enlargement for the treatment of infective endocarditis and aortic insufficiency at 25 years of age. He underwent aortic root replacement for an enlarged aortic root (73 mm). Under general anesthesia, median re-sternotomy was performed, and the BSS valve was removed. The valve functioned well with no pannus or thrombus. We performed an aortic root replacement using a composite graft consisting of a 24-mm mechanical valve and 30-mm artificial graft. We experienced a rare case of long-term durability of the BSS valve, which functioned well for 42 years.