For lower limb amputees, good prosthetic fittings are important for wearing prostheses while ensuring gait stability, without skin breakdown. Poor prosthetic fittings tend to occur in the early stage after amputation because of significant changes in residual limb volume. We measured the extent of change in residual limb volume in three below-the-knee amputees by using computed tomography. The measurements were performed before and after inpatient rehabilitation for the first prosthesis. The measurement showed a remarkable change in residual limb volume in a highly active amputee without complications. In contrast, the change in residual limb volume was small in two less active below-the-knee amputees with serious complications, such as heart and renal failures. Generally, to maintain good prosthetic fittings, the first prostheses should be made during inpatient rehabilitation to facilitate maturation of the residual limbs. For the less active below-knee amputees, the prostheses could be made in the outpatient settings because the volume fluctuations of their residual limbs are small and the functional requirements for their daily living are modest.

Para-anastomotic aneurysms may have dangerous complications such as rupture and thrombosis, with consequent loss of life. As these complications are associated with high mortality rates, early detection and prompt surgical treatment are important. Repair of para-anastomotic aneurysms may be challenging and the surgical approach should be carefully planned. A 66-year-old man had undergone thoracoabdominal aortic aneurysm repair 18 years previously. The diameter of the distal aortic anastomosis was gradually increasing. We comprehensively discussed the surgical approach preoperatively, including consideration of spinal cord protection. Abdominal aortic graft replacement was performed through a midline abdominal incision, with cross-clamping on the proximal side of the aneurysm, continuous intravenous infusion of naloxone, and segmental aortic clamping with distal aortic perfusion and selective visceral perfusion. The left renal artery was reconstructed, and the inferior mesenteric artery and lumbar arteries were preserved.

A 62-year-old man had been given a diagnosis of atrial septal defect (ASD) 20 years previously, but the condition was left untreated. A heart murmur was detected on a routine health examination, so he visited our institution where a diagnosis of type II ASD and moderate tricuspid regurgitation was given. Cardiac catheterization revealed a pulmonary to systemic flow ratio (Qp/Qs) of 2.9, pulmonary vascular resistance of 3.1 units, and systolic pulmonary artery pressure of 90 mmHg. The patient underwent open surgery consisting of a patch closure of the ASD, and tricuspid annuloplasty. His pulmonary arterial pressure rose and his blood pressure dropped, and left cardiac failure developed on postoperative day (POD) 2. The administration of catecholamines and a phosphodiesterase (PDE) III inhibitor failed to correct the left cardiac failure. We performed intra-aortic balloon pumping (IABP) immediately, and his hemodynamic condition stabilized. The IABP catheter was removed on POD 10. The postoperative development of circulatory failure suggested that it was almost too late for surgery for ASD. It has been believed that surgery for ASD is relatively safe. However, it seems that, the considering the possible occurrence of postoperative cardiac failure in elderly patients with accompanying pulmonary hypertension, careful postoperative management is necessary.

A 51-year-old man admitted to our hospital because of an ECG abnormality pointed out by his local doctor. He had been hospitalized for scarlet fever at age 10. A coronary artery CT scan showed coronary artery aneurysm of the left main trunk (LMT), and coronary angiography showed 3-vessel disease including a chronic total occlusion of the right coronary artery (RCA). We performed conventional coronary artery bypass grafting (CABG) using an arterial graft and aneurysmectomy. The patency of the graft was confirmed by coronary angiography postoperatively. The pathological diagnosis of the coronary aneurysm was Kawasaki disease. CABG is a standard procedure for coronary artery aneurysms with Kawasaki disease. However, there are no established treatment guidelines on whether to perform aneurysmectomy. We chose CABG with aneurysmectomy because of the possibility of intra-aneurysmal thrombosis leading to peripheral occlusion, and the cause of the coronary artery aneurysm could not be determined. However, even if additional treatment by percutaneous coronary intervention (PCI) is not possible, it is important to avoid occlusion of the graft.

The purpose of this study was to investigate the accuracy of estimating human body composition changes using bioelectrical impedance (BI) methods during a weight-loss intervention. Subjects were forty-three obese men (age : 49.2±10.5 yr, BMI : 27.8±1.7 kg/m²) who completed a 14-week weight-loss intervention. In all subjects, fat mass (FM) and fat-free mass (FFM) were assessed by dual energy x-ray absorptiometry (DXA) as well as single- and multi-frequency BI methods (SBIM, MBIM) before and after the intervention. Resistance parameters were measured by SBIM and MBIM (SBIM : R₅₀ ; MBIM : R∞, R0, and Rfc). In nine subjects these variables were also measured at weeks 1 and 4. Weight decreased (P<0.05) by -8.0±3.2 kg during the intervention while FFM changes averaged -0.4±1.6 kg (DXA), -2.0±1.5 kg (SBIM), and -1.6±1.7 kg (MBIM). BI methods overestimated FFM before the intervention (before ; DXA : 54.4±4.8 kg, SBIM : 56.5±4.3 kg, MBIM : 55.9±4.5 kg). In nine subjects, FFM measured by SBIM (FFM_SBIM) and MBIM (FFM_MBIM) was similar to FFM measured by DXA(FFM_DXA)(after ; DXA : 54.6±5.4 kg, SBIM : 54.6±3.8 kg, MBIM : 54.6±4.1 kg), although BI methods overestimated the FFM before the intervention (before ; DXA : 54.9±5.1 kg, SBIM : 56.9±3.8 kg, MBIM : 56.3±4.4 kg). The ΔFM_SBIM and ΔFM_MBIM were highly correlated with the ΔFM_DXA(SBIM : r=0.87, MBIM : r=0.88). The ΔFFM_SBIM andΔFFM_MBIM were significantly correlated with the ΔFFM_DXA(SBIM : r=0.54, MBIM : r=0.49). The ΔR₅₀ and ΔRfc were also significantly correlated with the ΔFFM_DXA(R₅₀ : r=-0.63, Rfc : r=-0.48). These results suggest that during a weight-loss intervention, 1) BI methods and DXA provide similar estimates of human body composition change, although they overestimate FFM in obese men, and 2) changes of resistance parameters observed with BI methods may estimate human body composition change more accurately.

Cardiac papillary fibroelastoma (CPF) is a rare benign cardiac tumor. It commonly arises from the left side heart valve. We present two rare cases of CPF that originating from the right side of the heart confirmed by surgical resection. Case 1 : A 67-year-old man was admitted for surgical resection of a cardiac tumor located in the right atrium. Transesophageal echocardiography revealed a mobile mass attached on the anterior leaflet of the tricuspid valve. The tumor was resected by open heart surgery. Histopathologic examination confirmed the tumor to be a CPF. Case 2 : A 68-year-old man was admitted for surgical resection of a tumor occurred from the tricuspid valve. Transthoracic echocardiography revealed a tumor attached to the medial leaflet. The tumor was resected. Histopathologic examination confirmed it to be a calcified mass. However, the surface of tumor had many papillary projections macroscopically. We redo the histopathologic examination, and confirmed the tumor as a CPF finally. In both cases, postoperative courses were uneventful.

Knee rotationplasty is a surgery wherein the rotated ankle serves as the new knee joint after resecting the original knee joint and lesion. However, details of postoperative rehabilitation treatment in a convalescent rehabilitation ward are not well-known. Therefore, we reported the rehabilitation progress of a 36-year-old man who underwent knee rotationplasty in the convalescent rehabilitation ward. In the early postoperative period, the surgery required no weight bearing on the operated lower limb until bone healing. Even during this period, we conducted physical therapies such as joint range of motion training and muscle strength training as outpatient rehabilitation therapy. After being admitted to the convalescent rehabilitation ward, physical therapy was intensified and the patient's rotationplasty prosthesis was then fabricated and fitted by a prosthetist and orthotist. The patient was discharged 80 days after his hospitalization and could eventually walk stably with his prosthesis and returned to work. In Japan, the length of stay in a convalescent rehabilitation ward is limited. If patients are provided with enough physical therapy during the postoperative course and rotationplasty prosthesis by a skilled prosthetist and orthotist, rehabilitation treatment after knee rotationplasty can achieve good results in a convalescent rehabilitation ward.