No abstract available.
Humans ; Liver Cirrhosis* ; Liver* ; Sepsis* ; Vibrio cholerae* ; Vibrio*

A 6-year-old boy underwent one stage operation for atrial septal defect (ASD) and funnel chest. The procedure began with removal of cost-sterno complex (plastron) following median skin incision. Plastron was kept in cold saline with antibiotics during ASD closure, and sterno-costal elevation method was performed. Simultaneous operation for heart disease and funnel chest is profitable in preventing postoperative circulatory or respiratory complications, in avoiding problems of two stage operation such as adhesion and mental stress of the patients. In addition, wide exposure and easy approach to the heart is available with this one stage procedure. Although current refinement both of cardiac and thoracic surgery has encouraged the possibility of simultaneous corrections for heart disease and funnel chest, much precautions against bleeding and infection are necessary for the satisfactory surgical result.

This is a case report of a 57-year-old woman with high aortic occlusion (HAO) who had acute symptoms of severe ischemia of the lower extremities and the intrapelvic organs. Generally, HAO is a chronic ischemic disease of the lower extremities and the intrapelvic organs; therefore, acute HAO is relatively rare. Acute thrombotic occlusion of a major collateral artery might be the cause of acute HAO. Laser Doppler flowmetry of the sigmoid colon was useful to evaluate the ischemia of intrapelvic organs. Thrombectomy of the juxtarenal portion with the suprarenal aortic cross clamp was performed within four minutes, then the clamp was moved to the infrarenal portion. The remaining occluded aorta was replaced with a Y-shaped knitted Dacron graft. She had no symptoms after the surgery except renovascular hypertension. Seventy five percent stenosis of the right renal artery was exacerbated to 99%. Vascular clamping of the right renal artery might have been the cause of severe stenosis. Percutaneous transluminal renal angioplasty was successfully performed after the surgery. Aggressive renal artery reconstruction during surgery is recommended in cases with moderate or severe renal artery stenosis.

OBJECTIVETo identify factors closely associated with plasma B type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.

METHODSA total of 1983 people (mean 66 years-old and 694 male) underwent annual health check-up in 2006 in Okuizumo district were included in this study. Blood pressure, electrocardiogram, conventional blood examination, plasma BNP and NT-proBNP were measured.

RESULTSBNP is positively correlated with NT-proBNP (r = 0.89, P < 0.01). Multiple regression analysis showed that age, Hb, pulse rate, SBP, TC, gender, TG and creatinine were significantly related to BNP and age, creatinine, Hb, gender, TG, TC, SBP, pulse rate were significantly related to NT-proBNP. NT-proBNP was more easily affected by renal function changes and BNP was more easily affected by autonomic nervous system changes. Both BNP and NT-proBNP significantly increased in proportion to SBP and age. NT-proBNP and BNP were significantly higher in females compared with males (all P < 0.05). NT-proBNP and BNP were also negatively correlated with abdominal circumference (all P < 0.05).

CONCLUSIONIn this study population, NT-proBNP and BNP were closely associated with age, blood pressure, creatinine, pulse rate, lipid levels, gender and abdominal circumferences.

Age Factors ; Aged ; Blood Pressure ; Female ; Heart Rate ; Humans ; Japan ; Lipids ; blood ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Physical Examination ; statistics & numerical data ; ROC Curve ; Regression Analysis ; Sex Factors ; Waist Circumference

The septicemia caused by the Arizona group organism is rare and usually observed in adults with underlying diseases. In Korea, Salmonella infection is common, but a report of Arizona infection is unknown. We isolated S. entercia subsp. diarizonae from blood of a 6-month-old infant. The serovar was determined as 28:z10:-, a rare one in America. The isolate was susceptible to ampicillin, chloramphenicol, cotrimoxazole and others. The patient rapidly recovered with ampicillin and gentamicin therapy. Clinical laboratories should consider that the infection exists in Korea and should attempt to isolate and identify Arizona organism in certain patients.
Bacteremia/*microbiology ; Case Report ; Enteritis/*microbiology ; Human ; Infant ; Korea/epidemiology ; Male ; *Salmonella Infections ; *Salmonella arizonae

Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.
Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Hypertension ; Insulin Resistance ; Lipoproteins ; Metabolic Diseases ; Obesity ; Pravastatin ; Renin-Angiotensin System ; Risk Factors

The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract cancers (cholangiocarcinoma, gallbladder cancer, and ampullary cancer) in 2007, then published the 2nd version in 2014. In this 3rd version, clinical questions (CQs) were proposed on six topics. The recommendation, grade for recommendation, and statement for each CQ were discussed and finalized by an evidence-based approach. Recommendations were graded as grade 1 (strong) or grade 2 (weak) according to the concepts of the grading of recommendations assessment, development, and evaluation system. The 31 CQs covered the six topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, and (6) radiation therapy. In the 31 CQs, 14 recommendations were rated strong and 14 recommendations weak. The remaining three CQs had no recommendation. Each CQ includes a statement of how the recommendations were graded. This latest guideline provides recommendations for important clinical aspects based on evidence. Future collaboration with the cancer registry will be key for assessing the guidelines and establishing new evidence.