The purpose of this study was to examine the recruitment state of synergistic muscles in the thigh muscles in leg press exercise with and without pre-fatigue method using transverse relaxation time (T2) on muscle functional magnetic resonance imaging (MRI). Nine healthy male subjects performed the following two types of exercise trials on separate days: 1) 5 sets of a leg press exercise with pre-fatigue method, which consisted of 3 sets of knee extension exercise (LP-pre), 2) 5 sets of a leg press exercise without pre-fatigue method (LP). Both exercises were performed at a load of 80% one-repetition maximum. Before and immediately after exercise, T2-weighted MR images of right-thigh were taken to calculate T2 values of twelve-thigh muscles. The T2 values for quadriceps femoris muscle and hamstrings in LP increased significantly after the exercise, except in the adductor magnus, adductor longus, gracilis, and sartorius. In contrast, the T2 values for all of the twelve-thigh muscles in LP-pre increased significantly after the exercise. Upon comparison between the two trials, the percentage changes in T2 value for the adductor magnus, adductor longus, and sartorius in LP-pre were found to be significantly greater than those in LP. These results suggest leg press exercise with pre-fatigue method may be effective to increase activity of synergistic muscles in thigh muscles during exercise.

A girl was given a diagnosis of Takayasu arteritis (TA) with thoracic aortic aneurysm (TAA) at 11 years old, and began receiving medical treatment using steroids. At age 19, her biological inflammation markers were within normal limit ; however, contrast-enhanced CT showed the enlargement of the TAA to 60 mm in diameter. The risks and benefits of traditional revascularization vs endovascular procedures were carefully considered. The presence of suitable anatomical conditions, including adequate 20-mm-long landing zones, led us to select an endovascular approach. We exposed the right common iliac artery via a retroperitoneal approach, then, original stent grafts, using Z stents covered with thin-wall polytetrafluoroethylene, were positioned in the descending aorta from the level of the left subclavian artery to the level of the celiac artery. Intraoperative arteriography showed a patent stent graft without endoleaks or enlargement of the TAA. The postoperative course was uneventful, and follow-up CT scan performed 4 years after the repair showed shrinkage of the aneurysm diameter, and no evidence of any endoleaks. We concluded that endovascular treatment for TA-related aneurysm can be useful and safe, but further follow-up is needed in this case.

Tricuspid valve regurgitation, which is a main complication of corrected transposition of the great arteries (C-TGA), greatly influences prognosis like atrioventricular block, but there are many differing openions concerning the treatment of this condition childhood. In 2 cases of C-TGA (S. L. L.) without other cardiac anomalies, we performed tricuspid valve replacement for severe valve dysfunction.

Objective: We investigated the incidence of side effects related to contrast medium employed in our hospital based on monitoring materials to improve the safety of contrast-enhanced examinations.  Furthermore, we compared the incidence of side effects between the original product and generic drugs to confirm the safety of each preparation.
Methods: The survey period was from April 2007 until March 2011.  Based on the number of patients who underwent contrast-enhanced examinations and that of patients with side effects, we calculated the incidence of side effects in our hospital, and confirmed its annual changes.  Subsequently, we again collected the incidence of side effects per each manufacturer’s preparation employed, and confirmed the state of side effects of individual preparations.  Furthermore, we evaluated the symptoms as side effects, interval until appearance, and treatment for side effects during the data collection period, as well as the subsequent state, symptoms as side effects, and interval until appearance.  The chi square independence test was employed to compare the results among groups.  p<0.05 was regarded as significant (paired test).
Results: There were no changes in the annual incidence of side effects.  There were also no significant differences in the annual incidence of side effects among the preparations.  Furthermore, there were no marked differences in the symptoms, interval until appearance, treatment for side effects, or subsequent state among the preparations.
Conclusion: We investigated the appearance of side effects regarding contrast-enhanced examinations for 4 years.  We confirmed that there were no differences in the incidence of side effects among the preparations.

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.

Photodynamic therapy, a curative local treatment for esophageal squamous cell carcinoma, involves a photosensitizing drug (photosensitizer) with affinity for tumors and a photodynamic reaction triggered by laser light. Previously, photodynamic therapy was used to treat superficial esophageal squamous cell carcinoma judged to be difficult to undergo endoscopic resection. Recently, photodynamic therapy has mainly been performed for local failure after chemoradiotherapy. Although surgery is the most promising treatment for local failure after chemoradiotherapy, its morbidity and mortality rates are high. Endoscopic resection is feasible for local failure after chemoradiotherapy but requires advanced skills, and its indication is limited to within the submucosal layer by depth. Photodynamic therapy is less invasive than surgery and has a wider indication than endoscopic resection. Porfimer sodium (a first-generation photosensitizer) causes a high frequency of side effects related to photosensitivity and requires the long-term sunshade period. Talaporfin (a second-generation photosensitizer) requires a much shorter sun-shade period than porfimer sodium. Photodynamic therapy will profoundly change treatment strategies for local failure after chemoradiotherapy.

Photodynamic therapy, a curative local treatment for esophageal squamous cell carcinoma, involves a photosensitizing drug (photosensitizer) with affinity for tumors and a photodynamic reaction triggered by laser light. Previously, photodynamic therapy was used to treat superficial esophageal squamous cell carcinoma judged to be difficult to undergo endoscopic resection. Recently, photodynamic therapy has mainly been performed for local failure after chemoradiotherapy. Although surgery is the most promising treatment for local failure after chemoradiotherapy, its morbidity and mortality rates are high. Endoscopic resection is feasible for local failure after chemoradiotherapy but requires advanced skills, and its indication is limited to within the submucosal layer by depth. Photodynamic therapy is less invasive than surgery and has a wider indication than endoscopic resection. Porfimer sodium (a first-generation photosensitizer) causes a high frequency of side effects related to photosensitivity and requires the long-term sunshade period. Talaporfin (a second-generation photosensitizer) requires a much shorter sun-shade period than porfimer sodium. Photodynamic therapy will profoundly change treatment strategies for local failure after chemoradiotherapy.

This study was designed to evaluate the late changes of coronary bypass grafts in 60 patients who had undergone coronary bypass surgery and postoperative angiography in the period from 1994 to 1999. Angiography was performed at mean intervals of 84 months and a total of 134 grafts and 162 anastomoses were visualized. The Left internal thoracic artery and saphenous vein had a patency of 85% and 82%, there was not statistically significant. In this series, late graft function did not relate to the site of implantation, that was mainly due to excellent results of saphenous vein grafts. With increasing proximal stenosis severity (under 75% versus over 90%), there was an increase in patency rates and this relationship was statistically significant (p=0.0005). That was why about 20% of the grafts to moderately stenotic target vessels had occluded within 1 month after surgery. Ten patients among these 60 had cardiac symptoms, 6 were due to graft failure and the other 4 were due to new lesions in the right coronary artery. In the other 12 patients new coronary artery lesions without cardiac symptoms had been detected. Periodic coronary examinations should be recommended for the patients after surgery, regardless of the absence of symptoms.