Thoracic graft infection is a serious complication and has high mortality. We report a case of successful treatment of graft infection after ascending thoracic aortic reconstruction. A 66-year-old woman underwent surgery for DeBakey type I aortic dissection in June 2007. The ascending aorta was replaced with a prosthetic graft. Although her postoperative course was complicated with Methicillin-resistant Staphylococcus aureus (MRSA) mediastinitis, the infection was conservatively controlled by mediastinal lavage and antibiotics. However, she was readmitted in April 2008 due to lumbar pain and high fever, and was diagnosed with infectious spondylitis. Lumbar plastic surgery was performed. During hospitalization, she underwent total systemic examination. The results indicated aneurysm of the ascending aorta. MRSA was detected from culture fluid of her blood. Taken together, the presence of an infected aortic aneurysm was considered possible. Consequently, reconstruction of the ascending aorta using two allografts was performed after removing the prosthetic graft. The postoperative course was uneventful, and she was discharged on the 71st postoperative day. The patient continues to thrive 9 months after the operation. This case of an infected aortic aneurysm repaired with the use of allografts will be reported together with references to the literature.

Although the trunk segment shows well-coordinated movements in concert with the arms and legs during bipedal walking, little is understood about the neural mechanisms controlling the trunk muscles in response to sudden tactile sensations in the foot during walking. This study examined the cutaneous reflexes (CR) to shed light on the neural mechanisms underlying the regulation of the trunk muscles during walking and standing. Eleven healthy men participated in the study. Electromyographic (EMG) activities were recorded in the trapezius (TRAP), erector spinae (ES), and rectus abdominis (RA) muscles. To elicit CR, non-noxious electrical stimulation of the sural nerve at the ipsilateral lateral malleolus was applied during treadmill walking and tonic contraction of the test muscles during standing. During walking, cutaneous nerve stimulation in the foot gave rise to facilitatory CR in all the muscles, and the amplitude of the CR was strongly modulated in a phase-dependent manner. The amplitude of the background EMG and the amplitude of the CR showed a highly significant correlation in all the muscle tested during standing. However, this was true only in the ES during walking. In the RA, the inhibitory CR during standing changed to a facilitatory one during walking. In addition, reflex ratios were significantly larger during walking than standing. These findings suggest that common neural mechanisms in limb muscles could function in the TRAP and RA, however, in the ES disparate neural mechanisms play a crucial role in modulating cutaneous reflexes during walking and standing.

A 53-year-old man who had angina pectoris and juxtarenal aortic abdominal aneurysm was referred to our department. Because the coronary angiography showed severe triple vessel disease, coronary bypass grafting was performed prior to aneurysmectomy. Contrast enhanced computed tomography revealed a retroaortic left renal vein located behind the posterior wall of the aneurysm. The postoperative course was uneventful. Because of its complicated embryological development, the anatomy of the renal veins shows extensive variability. The incidence of retroaortic left renal vein was 2%. Large lumbar and retroperitoneal veins often joined it to form a complex retroaortic venous system. These veins are particularly vulnerable to injury during circumferential dissection of the proximal parts of the aorta. Unawareness of this anomaly and vigorous attempts at encircling the aorta with clamps can result in laceration of the vein. Subsequent catastrophic hemorrhage may lead to unfavorable results, nephrectomy or death. Therefore, preoperative evaluation by a contrast enhanced CT scan and adequate intraoperative management based on a understanding of the potential anatomical variations are imperative. We recommend crossclamp of the aorta proximally with a vertical clamp to avoid circumferential dissection with possible injury to a retroaortic left renal vein. Injury may necessitate division of the aorta to obtain exposure for venous repair. In addition, this anomaly may be related to aorto-left renal vein fistula syndrome and left renal vein entrapment syndrome.

We describe a novel method for repeat median sternotomy. We have successfully used ‘finger’ lifting resternotomy technique and achieved zero major cardiovascular injury/catastrophic hemorrhage events at reoperation. After general anesthesia, all patients were placed in the supine position and two external defibrillator pads were placed on the chest wall. We perform a median skin and subcutaneous incision along the previous sternotomy incision extending 3 cm distal to the sternum. The sternal wires that had been used for the previous closure were left in place but untied. Using a long electric cautery, right thoracotomy was performed under the right costal arch approach. Then, the operator could approximate the sternal wires in the retro-sternal space. At the same time, the operator could confirm the retro-sternal adhesion status which by touching with a finger. Resternotomy was performed using an oscillating saw pointed toward the operator's finger, which allowed safe re-median sternotomy from the lower to the upper part of the sternum. This technique of finger-lifting resternotomy has been employed in 50 cardiovascular reoperations and resulted in 0 incident of major cardiac injury or catastrophic hemorrhage. The finger-lifting resternotomy technique is safe and simple in reoperation procedures and yield excellent early outcomes.

An investigation was performed about clinical histories before hospitalization in 1142 cases of gastric cancer during 16 years from 1969 to 1984.
The average term from onset of the disease to hospitalization was 4.53 months which tends to decrease becoming 3.49 months in the latest 5 years. The patients had visited 0.72 other doctor in average before coming to our hospital, 0.35 in early cancer cases and 0.83 in advanced cases. The sources of patients of our surgery were as follows ; 60.5% were introduced from medical department of our hospital, 20.2% were introduced from other clinics or hospitals, 10.6% visited our surgical department directly, and 8.7% came to us after visiting one or some other doctors. The rate of early cancer cases were high and unresectable cases were low relatively in cases from our medical department and direct visitors to our surgical department.
The causative factors of delay of hospitalization more than one month were considered from both sides of patient and doctor. The results were ; no delay 55.3%, delay due to patient's fault 28.2%, delay due to doctor's fault 19.9%. The delay of hospitalization due to either side's fault was one factor of decreasing early cancers and increasing advanced cases. Among those with no delay, however, 22.6% were unresectable cases. Gastric cancers are too malignant to be cured by visiting hospitals with complaints. Gastric mass survey among symptomeless people is the only reasonable way to come out of this difficult situation.

No abstract available.
Child* ; Humans ; Status Epilepticus* ; Tachycardia*

BACKGROUND: Management of postprandial hyperglycemia is a key aspect in diabetes treatment. We developed a novel system to measure glucose area under the curve (AUC) using minimally invasive interstitial fluid extraction technology (MIET) for simple monitoring of postprandial glucose excursions. In this study, we evaluated the relationship between our system and continuous glucose monitoring (CGM) by comparing glucose AUC obtained using MIET with that obtained using CGM for a long duration. METHODS: Twenty diabetic inpatients wearing a CGM system were enrolled. For MIET measurement, a plastic microneedle array was applied to the skin as pretreatment, and hydrogels were placed on the pretreated area to collect interstitial fluid. Hydrogels were replaced every 2 or 4 hours and AUC was predicted on the basis of glucose and sodium ion levels. RESULTS: AUC predicted by MIET correlated well with that measured by CGM (r=0.93). Good performances of both consecutive 2- and 4-hour measurements were observed (measurement error: 11.7%±10.2% for 2 hours and 11.1%±7.9% for 4 hours), indicating the possibility of repetitive measurements up to 8 hours. The influence of neither glucose fluctuation nor average glucose level over the measurement accuracy was observed through 8 hours. CONCLUSION: Our system showed good relationship with AUC values from CGM up to 8 hours, indicating that single pretreatment can cover a large portion of glucose excursion in a day. These results indicated possibility of our system to contribute to convenient monitoring of glucose excursions for a long duration.
Area Under Curve* ; Extracellular Fluid ; Glucose* ; Humans ; Hydrogel ; Hydrogels ; Hyperglycemia ; Inpatients ; Plastics ; Skin ; Sodium

BACKGROUND: Irisin is a myokine implicated in lipid and glucose metabolism. The objective of this study is to examine the effect of a body weight reduction on the serum irisin level and physical indicators in obese Japanese patients without diabetes. METHODS: The subjects were 22 patients (male/female, 5/17; age, 46.1±16.0 years; body mass index [BMI], 36.9±5.0 kg/m²) who completed a 6-month body weight reduction program at our clinic. The program included diet, exercise therapy and cognitive behavioral therapy. Blood parameters, body composition, exercise tolerance, homeostasis model assessment of insulin resistance (HOMA-IR), and serum irisin were determined before and after intervention, and relationships among changes in these data were examined. RESULTS: There were significant decreases in body weight and BMI after the intervention. Irisin before the intervention was significantly positively correlated with HOMA-IR (r=0.434, P<0.05). The mean irisin level showed no significant change after the intervention in all participants. However, improvements in % body fat, subcutaneous fat area, triglycerides, and fasting glucose were significantly greater in patients with an increase in irisin compared to those with a decrease in irisin after the intervention. Patients with an increase in irisin also had significantly lower fasting insulin (9.7±4.8 vs. 16.4±8.2, P<0.05) and HOMA-IR (2.2±1.1 vs. 3.7±1.6, P<0.05) after the intervention, compared to patients with a decrease in irisin. CONCLUSION: Body weight reduction did not alter irisin levels. However, irisin may play important roles in fat and glucose metabolism and insulin resistance, and the effects of body weight reduction on irisin kinetics may be a key for obesity treatment.
Adipose Tissue ; Asian Continental Ancestry Group ; Body Composition ; Body Mass Index ; Body Weight* ; Cognitive Therapy ; Diet ; Exercise Therapy ; Exercise Tolerance ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Resistance ; Kinetics ; Metabolism ; Obesity ; Subcutaneous Fat ; Triglycerides

Mycoplasma spp. are contagious bacteria, and mycoplasmal mastitis is a serious productivity problem on dairy farms. Bovine mammary epithelial cells (bMECs) have an important role in the elimination of pathogens, but the effect of Mycoplasma bovis on bMECs has not been fully described. To elucidate the immune response against intramammary infection by M. bovis, we undertook microarray analysis to examine and profile mRNA expression in bMECs after stimulation with M. bovis. We also compared the effects of M. bovis, Staphylococcus aureus, and Escherichia coli on immune-related mRNA expression in bMECs. Transcriptome analysis indicated a significant decrease in the level of mRNA-encoding lysine-specific demethylase 4D, suggesting that the immune response is suppressed by a decrease in histone demethylase activity. Interleukin (IL)-1β, IL-6, tumor necrosis factor alpha, toll-like receptor (TLR) 2, and TLR4 mRNA expression levels were significantly increased in bMECs stimulated with heat-killed M. bovis, but the expression levels were lower than those following stimulation by heat-killed S. aureus or E. coli. Our results suggest that M. bovis weakly affects mRNA expression in bMECs compared to the effects of E. coli or S. aureus. Moreover, live M. bovis may induce suppression of the immune response in bMECs.
Agriculture ; Bacteria ; Cytokines ; Efficiency ; Epithelial Cells ; Escherichia coli ; Female ; Gene Expression Profiling ; Histones ; Immunity, Innate ; Interleukin-6 ; Interleukins ; Mastitis ; Microarray Analysis ; Mycoplasma bovis ; Mycoplasma ; RNA, Messenger ; Staphylococcus aureus ; Toll-Like Receptors ; Tumor Necrosis Factor-alpha