The effects of an arm lifting movement (ALM) on maximum vertical jumps with all but the ankle joints fixed (propelled only by plantar flexion) were studied in five subjects. ALM increased flight time, but did not alter maximum angular velocity of the ankle before takeoff. Holding 4kg dumbbells in their hands enhanced the effect of ALM on flight time. ALM increased the maximum force and the force at the onset of plantar flexion. Elbow angle recordings showed that both arms were accelerated before or around plantar flexion onset, and decelerated mainly after takeoff. In another series of experiments, we measured the vertical component of head and hand acceleration with accelerometers. ALM produced positive acceleration of the head after takeoff, which was related to negative acceleration of the hand. The results suggest that ALM increased flight time by enhancing plantar flexion torque under suppression of ankle angular velocity before takeoff. We discussed the relationship between this suppression and different acceleration between the arms and the body except the arms.

A 51-year-old woman was referred to our hospital for investigation of an abnormal ECG. Transesophageal echocardiogram revealed a round mass which originated from the right coronary cusp of the aortic valve. The tumor was successfully excised from the aortic valve, and the postoperative echocardiogram showed normal aortic valve function. Pathological examination demonstrated papillary fibroelastoma.

A 44-year-old man underwent implantation of a DDD pacemaker for third degree heart block at age 20. The cutaneous pocket for the pulse generator was situated in the left pectoral region. He visited our hospital because of skin ulcer over the pacemaker without any other complaint such as fever or pain. The patient received a new DDD pacemaker system in the right pectoral region and old pacing leads were translocated under the pectoral muscle. However, right pectoral skin ulcer appeared 1 month later. Patch tests revealed a positive reaction to silicon. Wrapping of the pacemaker with a polytetrafluoroethylene (PTFE) sheet proved to be effective.

We report 4 cases of delayed hypersensitivity reaction to Vancomycin (VCM) after cardiac surgery. Case 1: A patient developed sepsis and mediastinitis after aortic valve replacement (AVR) for aortic valve insufficiency. Case 2: A patient developed mediastinitis after coronary artery bypass grafting (CABG) for effort angina pectoris. Case 3: A patient developed pneumonia after AVR for aortic valve infective endocarditis. Case 4: A patient developed sepsis after CABG for acute myocardial infarction. All of them received VCM intravenously and their infections improved. However, sudden high fever, skin rush and eosinophilia occurred 12 or 13 days after the initiation of therapy. These symptoms resolved after halting VCM administration. We need to take examine eosinophils when considering further administration of VCM.

A 62-year-old man suddenly felt severe back pain. An enhanced computed tomography (CT) demonstrated an acute Stanford type B dissection and the true lumen was severely compressed by the false lumen. We started conservative therapy because there was no sign of organ ischemia. A 23 days from onset, he developed bilateral limb ischemia and renal failure because the compression of the true lumen increased. After bilateral axillo-femoral bypass the organ ischemia disappeared. Four months later, CT showed the dilatation of the true lumen and occlusion of the bilateral grafts. In spite of graft occlusion, there was no sign of organ ischemia.

A 56-year-old man was admitted with fever of unknown origin and congestive heart failure. Blood cultures grew Streptococcus gordonii. An echocardiographic examination showed vegetation attached to the bicuspid aortic valve and severe aortic regurgitation. Despite the aggressive therapy, an emergency operation had to be performed because it was otherwise impossible to control heart failure. Vegetation was attached to the aortic valve leaflets. There was no noticeable lesion on the aortic annulus, but a myocardial abscess was noted in the left atrial wall. Aortic valve replacement was performed after the myocardial abscess was drained. It was assumed that the myocardial abscess was due to the septic state from Infective endocarditis because it was recognized at a distant zone from the active valvular infection.

Application of local flaps for releasing postburn scar contracture has been limited because of a problem of invisible loss, difficulty to obtain the satisfactory result against correction of limitation of motion and possibility of contour deformity. However, proper use of local flaps, accurate designs and complete wound compression for a long term after operation enable to obtain good results in correction of some cases of postburn scar contracture. It will be related to reduce unsightly scaring when contractures are released. For this purpose, we have used a modified planimetric Z-plasty, a subcutaneous pedicle flap, a new classification V-Y plasties which was proposed based on the new concept and their combination. Proper application of local flaps corresponding to the degree of contracture and shape of burn scar have enabled to increase the use of local flaps against correction of postburn scar contracture during our past 15 years, from 1982 to 1997, we treated 235 cases of postburn scar or scar contracture in various regions except for the face. Of these, 177 cases were applicated with local flaps and we could have a good results in both aspects of function and appearance. We report our operative methods, a criterion to application of local flaps and representative results.
Burns ; Cicatrix* ; Classification ; Congenital Abnormalities ; Contracture* ; Wounds and Injuries

A free radical gas, nitric oxide NO), has many useful functions when produced under physiological conditions by neurons and endothelial cells. However, excess NO has been reported to exert cytotoxic effects by direct toxicity or by reaction with superoxide. Nitric oxide can react with superoxide to generate peroxynitrite which is as reactive as the hydroxyl radical. This study was attempted to observe formation of peroxynitrite and change in amount of NO synthase(NOS) in reperfused skin flap of rats following ischemia. 3-nitro-L-tyrosine, as direct evidence of peroxynitritemediated tissue damage, as well as endothelial and inducible NO synthase(eNOS and iNOS) were studied in ischemic and reperfused skin using western blot analysis. In addition, HNE-modified proteins, as direct evidence of oxidative tissue damage by reactive oxygen species(ROS), was also evaluated. Skin specimens were obtained over time from island skin flaps(3x3 cm2) of rats under the following two conditions: 1) reperfusion following 5 hours of ischemia, and 2) reperfusion following 10 hours of ischemia. In reperfused skin after 5 hours of ischemia, formation of 3-nitro-L-tyrosine and HNE-modified proteins was decreased 1 hour after reperfusion. However, they were thereafter increased and reached a maximum (3-nitro-L-tyrosine: 142%,HNE-modified proteins:237%) 6 hours after reperfusion. In reperfused skin after 10 hours of ischemia, formation of 3-nitro-L-tyrosine and HNE-modified proteins was increased 3 hours post reperfusion, and reached a maximum (3-nitro-L-tyrosine:178%, HNE-modified proteins: 204%) 6 hours after reperfusion. eNOS and iNOS were decreased 1,3 and 6 hours reperfusion following both 5 and 10 hours of ischemia. These results indicate that peroxynitrite-mediated cytotoxicity is involved in ischemic reperfused skin despite the fact that the amounts of both iNOS and eNOS are decreased.
Animals ; Blotting, Western ; Endothelial Cells ; Hydroxyl Radical ; Ischemia ; Neurons ; Nitric Oxide* ; Oxygen ; Peroxynitrous Acid ; Rats* ; Reperfusion ; Skin* ; Superoxides

Quantitative histochemical analysis of the internal thoracic artery (ITA) and right gastroepiploic artery (GEA) was performed using microspectrophotometry. Arterial specimens from eight patients who underwent coronary bypass grafting using both ITA and GEA grafts were examined. There were seven men and one woman with a mean age of 60 years; ranging from 36 to 73 years. Concerning risk factors, 4 patients had hypertension, 3 had hypercholesterolemia and 2 had diabetes mellitus. The degree of intimal hyperplasia was calculated as follows; Intimal hyperplasia (%)=(I/I+M)×100 (I: area of intima, M: area of media). Quantitative histochemical analysis (smooth muscle cells, elastin, collagen and mucopolysaccaride) of arterial graft was measured by means of microspectrophotometry. Pieces of both the ITA and GEA grafts were obtained immediately before grafting. Each sample was stained with Azocarmin G, Weigert, van Gieson and Alcian Blue stains to identify smooth muscle cells, elastin, collagen and mucopolysaccaride, respectively. Intimal hyperplasia was significantly greater in GEA than ITA grafts (25.3 ±8.7% versus 6.8±3.5%, respectively; p<0.01). In quantitative histochemical analysis of the arterial grafts, the volume of smooth muscle cells was also significantly higher in GEA than ITA at both the intima (ITA; 38.8±7.9%E, GEA; 52.5±7.6%E, p<0.01) and media (ITA; 49.6±6. 5%E, GEA; 59.5±8.2%E, p<0.05). No significant differences in elastin, collagen or mucopolysaccaride content were observed. The greater amount of smooth muscle in GEA grafts may be one reason why the magnitude of intimal hyperplasia was greater in GEA than ITA grafts. Long-term follow-up is necessary to determine the course of atherosclerotic change in arterial grafts.

We used the Fogarty 2Fr IMAG Kit^® on 14 patients who underwent aorto-coronary bypass grafting. The free flow of the left internal thoracic artery (LITA) after dilatation using Fogarty balloon catheter was 7.4 times greater than before dilatation. There was no statistical differences in catecholamines used postoperatively and postoperative cardiac output in the groups of cases with and without dilatation. String sign was appeared in 4 patients with dilatation of LITA. Fogarty balloon catheter save effective dilatation of LITA in certain selected cases.