The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass.
Angiography ; Arteries* ; Extremities ; Female ; Fingers ; Forearm ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Necrosis ; Saphenous Vein ; Subclavian Artery* ; Thrombectomy ; Transplants ; Upper Extremity

Horseshoe kidney is an unusual abnormality occurring in 0.25% of the population. In surgery for AAA with horseshoe kidney, reconstruction of aberrant renal and preservation of renal isthmus is important. We report 3 cases of AAA with horseshoe kidney treated successfully without division of the isthmus.

An 83-year-old man had acute type B aortic dissection combined with a large athelosclerotic abdominal aortic aneurysm (AAA) over 8cm in diameter. The dissection advanced into the wall of the AAA. The patient was treated with strict medical therapy for two months and successfully underwent an early elective abdominal aortic repair concomitant with off-pump aortocoronary bypass grafting. This strategy of meticulous medical management may improve clinical outcome for the acute phase in such rare cases.

  After 1985, the decrease in domestic nursing power progressed gradually. The care for the elderly shifted from domestic private nursing to public nursing-care services when the long-term nursing-care insurance law was enacted in 2000. Because many of the elderly receiving nursing care suffer from chronic ailments of hypertension or the consequences of cerebrovascular disease, etc., cooperation between hospitals and nursing homes is necessary and indispensable. We began exchanging information by E-mail on a trial basis with a special elderly nursing home in April 2009. We aimed to integrate medical care and nursing by sharing medical and nursing information. We concluded that the use of E-mail could serve our purpose. The reason why we reached this conclusion is as follows:The mechanism of the information transmission by E-mail, that also relates to semiotics and narratology, is related to the essence of the description. This mechanism functions as a tool for mutual understanding among hospitals, nursing homes, and families. This also functions as a device to make the medical and nursing experience join. As a result, this mechanism enables the elderly to escape death as dying of sickness in the hospital and to die a natural death in the course of nursing. It is an easy method that can be introduced at a low cost for the purpose of establishing cooperation in medical and nursing care among hospitals, clinics, nursing homes, and nursing support centers, etc. especially in medically underserved remote areas.

Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.

Persistent sciatic artery (PSA) is a rare congenital peripheral artery disorder that is usually detected incidentally on computed tomographic examination. PSA can also cause iliac aneurysm and acute thromboembolism, which are potentially associated with rest pain, claudication, and limb-threatening ischemia. Patients with PSA and leg ischemia should be treated with revascularization and appropriate management of PSA aneurysm. The authors often choose emergent bypass surgery or endovascular intervention for aneurysmal rupture and acute lower-extremity arterial occlusion. This report describes an emergency procedure using catheter-based thrombolysis for acute limb ischemia in a patient with PSA.

Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. We have presented a case of PAA in an 81-yearold woman complaining of tingling sensations in her leg. Computed tomography revealed a large 10-cm sized PAA. Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein.

Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. We have presented a case of PAA in an 81-yearold woman complaining of tingling sensations in her leg. Computed tomography revealed a large 10-cm sized PAA. Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein.

In the central part of Shizuoka Prefecture, tea growing is carried out on hillsides. From the posture taken by farmers while they are picking tea-leaves, it is assumed that a heavy load is laid on the cervical region and that they must have complaints in that region frequently.
On this assumption, we have conducted a survey covering a total of 228 persons working in tea plantations, with 42 persons living in plains as a control group.
Of the total, 172 persons filled out a questionnaire and the remaining 56 underwent a physical checkup.
Of those surveyed, 92.8% said that they feel fatigued from work. Complaints in the cervical region were filed by 69.5% of the males and 89.0% of the females.
X-ray pictures revealed abnormal signs in 69.5% of the males and 89.0% of the females. Radiographic observation suggested that 77.0% of the abnormalities have some bearing on their complaints. It was also found that the stiffness in the shoulders accounted for most of the complaints.
From these findings, we have keenly felt it is necessary for us to continue to engourage them into practicing calisthenics designed to prevent the stiffness in the shoulders.

Purpose: A report of effective occupational therapy for delirium patients with cancer is uncommon. We report a patient of carcinomatous meningitis, in whom her daily activity is improved by occupational therapy. Case: Firstly, we supported her meals and then started occupational therapy accepting her interest. Although degree of confusion and her performance status was not varied from beginning to end, she could concentrate our programmed works and change her way of feelings. Also occupational therapy promotes reminiscence about her life review and friendship among other patients even in delirium condition. Conclusion: Occupational therapy can reduce cancer patients' impatience, anxiety and solitary feelings and improve quality of life.