We report a case of a 24-year-old woman who presented with orthopnea, in whom an echocardiographic exam showed a very large mass in the left atrium. We diagnosed this as cardiac failure due to the tumor occupying it. Although the tumor malignancy remained unclear, we had to perform emergency surgery to excise the tumor. The tumor was excised in its entirety, including the interatrial septum and a large segment of the left atrial wall. We reconstructed them with the autologous pericardium. The pathological diagnosis was undifferentiated pleomorphic sarcoma. Conventional adjuvant chemotherapy and radiotherapy was performed. Primary cardiac malignant tumor prognosis is very poor, but she has survived over 1 year without recurrent symptoms after complete excision and adjuvant therapy. In addition to reporting this case, we discussed the diagnosis and treatment of undifferentiated pleomorphic sarcoma.

We describe successful surgical treatment of a right coronary artery aneurysm associated with a fistula to the right atrium (RA). The patient was a 50-year-old man who complained of palpitations. ECG showed supraventricular extrasystole, and coronary CT revealed a remarkably dilated and undulating fistulous tract originating from the region corresponding to the orifice of the normal right coronary artery (RCA). The fistulous tract detoured to the posterior wall of the RA. An RCA of normal size originating from the midway of the fistulous tract was observed. The patient was operated on under cardio-pulmonary bypass. An aortocoronary bypass was performed, using a radial artery graft to section of the RCA that had a normal diameter. The RCA was subsequently ligated at the proximal side of the anastomosis. The orifice of the fistulous tract from the aorta was closed with a patch, and the entrance to the RA was also closed with mattress sutures. The postoperative recovery was uneventful, and he was discharged on the 19th postoperative day. Currently, the patient has been doing well without any complaints at 2 years postoperatively.

This study compared the hemodynamic performance of the Carpentier-Edwards PERIMOUNT Magna bioprosthesis (Magna) with the Carpentier-Edwards PERIMOUNT bioprosthesis (CEP) for aortic valve stenosis (AS). Between January 2005 and May 2010, 164 patients underwent aortic valve replacement for AS with either the Magna (n=68) or the CEP (n=96) at our institute. Patients undergoing a concomitant mitral valve procedure were excluded from this study. The 21-mm Magna and CEP prostheses were the most frequently used during this period. Transthoracic echocardiography was postoperatively performed within 2 weeks. The peak velocity (PV) of the Magna was significantly lower than that of the CEP (2.59±0.36 vs. 2.75±0.47 m/s ; p=0.022). The mean pressure gradient (PG) was not significantly different. For the 19-mm prostheses, the mean PG and PV of the Magna were significantly lower than those of the CEP [16.4±4.5 vs. 19.7±6.4 mmHg ; p=0.034 (PG) and 2.70±0.36 vs. 3.03±0.49 m/s ; p=0.008 (PV)]. The effective orifice area (EOA) of the Magna was larger than that of the CEP [19 mm : 1.29±0.18 vs. 1.11±0.24 cm² (p=0.007) ; 21 mm : 1.46±0.23 vs. 1.42±0.18 cm² (p=0.370) ; and 23 mm : 1.70±0.34 vs. 1.52±0.25 cm² (p=0.134)]. In this study, the EOA of the Magna was approximately 80% of that described in the manufacture's description. Patient-prosthesis mismatch (PPM ; EOA index≤0.85 cm²/m²) was seen in 26.8% of patients with the Magna and in 47.2% of patients with the CEP (p=0.018). Severe PPM (EOA index≤0.65 cm²/m²) was not seen in any patients with the Magna. The EOA of the 19-mm Magna was significantly larger and the mean PG was lower than those of the 19-mm CEP. Compared with the CEP, the Magna significantly reduced the incidence of PPM, and had superior hemodynamic performance.

Acute aortopulmonary artery fistula is a rare but potentially fatal disorder. We encountered a case in which this disorder was successfully treated by urgent total arch graft replacement and repair of the left pulmonary artery. A 74-year-old man was referred to Shizuoka City Hospital with a 2-day history of worsening dyspnea and thoracic aortic aneurysm. The patient had a history of hypertension and dyslipidemia. Physical examination showed diastolic hypotension, marked peripheral coldness, and systolic murmur. Arterial blood gas analysis showed severe metabolic acidosis with base excess of −16 mmol/l. Contrast-enhanced computed tomography (CT) revealed an aortic arch aneurysm on the lesser curvature, almost obstructing the left pulmonary artery. A Swan-Ganz catheter study confirmed severe low-output syndrome and uncompensated congestive heart failure. After amelioration of critically ill conditions with dopamine, milrinone, and carperitide, oxymetry revealed significant left-to-right shunt with Qp/Qs＝3.2 at the pulmonary artery level. Acute aortopulmonary artery fistula was diagnosed and urgent surgery was planned. Transesophageal echocardiography showed systolic shunt flow from the aneurysm into the left pulmonary artery. Surgery was performed through a median sternotomy. Aortic arch graft replacement with a 24-mm Dacron graft and repair of the left pulmonary artery with an equine pericardial patch were accomplished under hypothermic circulatory arrest and selective antegrade cerebral perfusion. Flooding of pulmonary circulation until circulatory arrest was prevented by manual control through the main pulmonary artery incision. Postoperative recovery was uneventful, and the patient is doing well at one year postoperatively.

Inflammasomes are cytosolic multiprotein complexes that sense microbial motifs or cellular stress and stimulate caspase-1-dependent cytokine secretion and cell death. Recently, it has become increasingly evident that both DNA and RNA viruses activate inflammasomes, which control innate and adaptive immune responses against viral infections. In addition, recent studies suggest that certain microbiota induce inflammasomes-dependent adaptive immunity against influenza virus infections. Here, we review recent advances in research into the role of inflammasomes in antiviral immunity.
Adaptive Immunity ; Cell Death ; Cytosol ; Dendritic Cells ; DNA ; Inflammasomes* ; Influenza Vaccines* ; Influenza, Human* ; Metagenome ; Microbiota ; Multiprotein Complexes ; Orthomyxoviridae ; RNA Viruses

Objectives: We investigated the relationship between the perioperative nutritional status and postoperative walking ability in patients with hip fractures. Methods: We included 246 surgically treated elderly patients with hip fractures who were ambulatory before the injury. Patients were divided into two groups: group A, who were able to walk at discharge, and group B, who were unable to walk at discharge. We pair-matched these two groups according to age, preoperative subdivided walking ability, and fracture site to form groups A′ and B’. The prognostic nutritional index (PNI; PNI = 10 × serum albumin (g/dL) + 0.005 × blood total lymphocyte count (/mm 3 )) before surgery and 1 day, 1 week, and 2 weeks after surgery and energy intake 1 and 2 weeks after surgery were compared. Results: After adjustments for age, preoperative subdivided walking ability, and fracture site, there were 51 patients in group A’ (mean age 84.6 years) and 51 patients in group B’ (mean age 84.7 years). In group A’/group B′, PNI was 43.38/42.60 (P = 0.19) before surgery, 33.87/33.31 (P = 0.44) 1 day after surgery, 34.99/32.35 (P = 0.01) 1 week after surgery, and 37.33/35.69 (P = 0.15) 2 weeks after surgery. Energy intake was 1380.8/ 1203.1 kcal (P = 0.01) 1 week after surgery and 1382.0/1335.6 kcal (P = 0.60) 2 weeks after surgery. Conclusions PNI and energy intake at 1 week postoperatively were associated with early postoperative nutrition and the recovery of walking ability.