Objectives : Mediastinitis results in significant morbidity in pediatric patients after cardiac surgery. The management of mediastinitis is not well established in the pediatric population. Our strategy for pediatric mediastinitis after cardiac surgery consists of rapid introduction of simple vacuum-assisted drainage system and sternal closure without plombage under aseptic conditions. The efficacy of our strategy was examined. Methods : The records of 7 pediatric patients with mediastinitis after cardiac surgery managed with this drainage system from May 2006 to May 2013 were retrospectively reviewed. The median age of the patients was 20.5 months and median body weight was 9.7 kg. Mediastinitis occurred 1-3 weeks after surgery. The mediastinum was re-explored immediately under general anesthesia after the diagnosis was made, and continuous drainage was used after extensive debridement was performed. We developed a simple vacuum-assisted drainage system consisting of conventional polyurethane foam, surgical drape containing povidone-iodine, and 1 to 3 silicone drainage tubes connected to a drain aspirator (-99 cmH₂O). Patients were allowed oral intake and resumption of daily activity after extubation. The components of the drainage system were exchanged every 2-3 days. The sternum was closed without the use of the omentum or muscle for plombage of the mediastinum after two negative topical swab cultures were obtained. Results : Negative topical swab cultures were obtained in all cases (3-12 days after the drainage commencement) and the sternum was closed 7-19 days after the drainage commencement. The median duration of hospital stay was 31 days (range, 14-47). Although one patient with prenatal infection died of aortic rupture, the remaining six children survived and did not experience recurrence after hospital discharge. Conclusion : The simple vacuum-assisted drainage system enabled rapid control of wound bacterial infection and sternal closure in postoperative pediatric mediastinitis without the need for special, and expensive devices.

There are many studies on physical effects of hot spring bathing, but few studies have been made on effects of hot spring bathing on coagulation and fibrinolytic systems. Therefore we studied the effects of hot spring bathing blood coagulation and fibrinolytic systems by measuring levels of tissue plasminogen activator (t-PA), euglobulin lysis time (ELT), plasminogen (PLG), alpha plasmin inhibitor (alpha 2 PI), fibrinogen (FBG), antithrombin III (AT III), thrombin antithrombin III complex (T-AT), and von Willebrand factor (vWF) in plasma before and after hot bathing.
Methods: The above measurements were made on 20 patients with chronic thrombotic stroke (65±12 years old (mean±2SD), comprising 18 cases of deep branch artery occlusion including four cases of multiple infarction and two cases of main trunk artery occlusion.
Collection and assay methods: Blood was collected from antecubital veins before and after a five-minute hot bath (at 40°C) and dissolved into 3.8% sodium citrate at the volume ratio of 1:10. T-PA and T-AT were measured by specific enzyme-linked immunoadsorbent assay. ELT by the fibrin plate method. and vWF by immunoelectrophoresis. Activities of P1G, alpha 2 PI, and AT III were measured by S 2251 and S 2238.
Results: The basal level of t-PA was 5.4±.8ng/ml (±2SD) and rose to 7.2±1.8ng/ml (±2SD) after a five-minute hot bath (p<0.005). ELT decreased from 6.5±1.5 hours (±2SD) to 4.9±1.8 hours (±2SD) (0.1Conclusion: The above results show that fibrinolysis is induced during hot bathing by the release of tissue plasminogen activator from vessel walls without causing significant coagulative activities, suggesting the clinical significance of hot bath in patients with thrombotic stroke.

We report two cases of pseudoaneurysms occurring at the anastomotic sites that had to be repaired several times after the original Bentall and Cabrol procedure. Case 1. A 62-year-old man had surgery to repair pseudoaneurysms at the anastomotic sites of the distal ascending aorta and right coronary artery 22 years after undergoing the original Bentall procedure. The anastomosis of the left coronary artery was normal at the time of the operation ; however, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the left coronary artery 2 years after the operation. Case 2. A 61-year-old man with Marfan syndrome underwent surgery twice to repair pseudoaneurysms at the anastomotic sites of the aortic annulus and the left coronary artery 2 and 11 years, respectively, after the original Cabrol procedure. In addition, 23 years after the Cabrol procedure, he was given a diagnosis of a pseudoaneurysm at the anastomotic site of the distal ascending aorta. Their pseudoaneurysms were successfully treated by the reanastomosis of new grafts. Computed tomography detected no recurrence of the pseudoaneurysm in the follow-up period. However, continual close observation for the recurrence of a pseudoaneurysm in the remaining anastomotic sites is necessary.

This case report describes a 20-year-old man, who was a drug abuser, and was treated surgically for tricuspid valve endocarditis. He presented with fever, caused by tricuspid valve endocarditis with a lung abscess. Blood culture detected Staphylococcus aureus and cardiac ultrasonography showed tricuspid insufficiency and tricuspid valve vegetation. He was treated with intravenous antibacterial agents, but the inflammation signs did not improve. He had a large number of puncture scars, as a consequence of self-injection of drugs in his lower arm. He underwent tricuspid valve plasty, and recovered successfully. He was discharged 2 weeks after surgery, and we instructed him to return for follow-up examination in our hospital. However, he did not return to our hospital because he was arrested for drug possession. In such cases, it is necessary to consider the operative method relative to reuse of drugs in the postoperative management of medication.

A 48-year-old man underwent an non-anatomical bypass surgery for aortic coarctation when he was 38 years old, when a bypass laid between the left subclavian artery and the descending aorta with a prosthesis (10 mm, internal diameter). Four years after the first surgery, aortic aneurysms at the proximal and distal sites of the coarctation were detected. Six years from then, we decided to perform another surgery when the maximum diameters of the proximal and distal sites exceeded 60 and 47 mm, respectively. We performed the aortic replacement from the proximal left subclavian artery to the descending aorta at eighth thoracic vertebra. The approach to the aortic aneurysm was through the extended left thoracotomy with the transection of the sternum. The cardiopulmonary bypass was established with an antegrade aortic perfusion (from the ascending aorta) and drainage from the right atrium. The circulatory arrest was obtained under deep hypothermia at 20°C measured by deep body temperature. After the surgery, the pressure differences between upper and lower extremities decreased to 10 mmHg, which had been 40 mmHg before surgery. Macroscopic observation showed the coarctation site was completely obstructed by an old thrombus. From this observation, we surmise that one of the reasons for the aneurysmal formation at the proximal site of coarctation might be an insufficient depressurization by the non-anatomical bypass grafting from the left subclavian artery to the descending aorta at the first surgery. We consider that a severe coarctation might become thrombotic sooner or later after a non-anatomical bypass surgery due to a change of blood flow, and a radical anatomical surgery would be recommended for adult coarctation cases.

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.
Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Cardia ; Deglutition Disorders ; Drug Therapy, Combination ; Esophagectomy ; Follow-Up Studies ; Gastrectomy ; Humans ; Japan* ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Pancreatectomy ; Splenectomy ; Stomach Neoplasms ; Stomach* ; Thoracotomy

BACKGROUND/OBJECTIVES: Osteoarthritis (OA) is a major public health issue in Japan and other countries, and foods that prevent or treat OA are in strong demand. Proteins and peptides in chicken meat and bones are known for being rich in functional and nutritional ingredients for the improvement of osteoporosis. We speculated that chicken legs, a food consumed in many regions of the world, may also contain such ingredients. In this study, we aim to (i) evaluate the effect of chicken leg extract (CLE) on the promotion of cartilage matrix production and (ii) identify the active ingredient in CLE that contributes to this function. MATERIALS/METHODS: Artificial CLE digest was prepared, and the acid mucopolysaccharide production-promoting activity of the CLE digest was evaluated by alcian blue staining of ATDC5 cells. CLE was orally administered to rabbits with burr holes in the knee joint of the femur, and the degree of regeneration of cartilage matrix was evaluated. Furthermore, we investigated orally administered CLE-derived peptides in human plasma using LC-MS. From measuring the acid mucopolysaccharide production-promotion activity of these peptides, a molecule considered to be an active ingredient in the CLE digest was identified. RESULTS: CLE digest promoted acid mucopolysaccharide production and facilitated regeneration of cartilage matrix in in vitro and in vivo experiments. Four peptides including phenylalanyl-hydroxyproline (Phe-Hyp) were detected as CLE-derived peptides in human plasma. The effect of CLE was inferred to be due to Phe-Hyp, which was confirmed to be present in the CLE digest. CONCLUSIONS: It was shown that CLE stimulated the production of articular cartilage matrix both in vitro and in vivo, and that CLE could be an effective food for preventing or treating OA. Furthermore, only Phe-Hyp was confirmed as the active compound in the CLE digest, suggesting that the activity of CLE was due to Phe-Hyp.
Alcian Blue ; Cartilage ; Cartilage, Articular ; Chickens ; Femur ; Humans ; In Vitro Techniques ; Japan ; Knee Joint ; Leg ; Meat ; Osteoarthritis ; Osteoporosis ; Peptides ; Plasma ; Public Health ; Rabbits ; Regeneration

Ultraviolet (UV) irradiation is a relevant environment factor to induce cellular senescence and photoaging. Both autophagy- and silent information regulator T1 (SIRT1)-dependent pathways are critical cellular processes of not only maintaining normal cellular functions, but also protecting cellular senescence in skin exposed to UV irradiation. In the present studies, we investigated whether modulation of autophagy induction using a novel synthetic SIRT1 activator, heptasodium hexacarboxymethyl dipeptide-12 (named as Aquatide), suppresses the UVB irradiation-induced skin aging. Treatment with Aquatide directly activates SIRT1 and stimulates autophagy induction in cultured human dermal fibroblasts. Next, we found that Aquatide-mediated activation of SIRT1 increases autophagy induction via deacetylation of forkhead box class O (FOXO) 1. Finally, UVB irradiation-induced cellular senescence measured by SA-β-gal staining was significantly decreased in cells treated with Aquatide in parallel to occurring SIRT1 activation-dependent autophagy. Together, Aquatide modulates autophagy through SIRT1 activation, contributing to suppression of skin aging caused by UV irradiation.
Autophagy ; Cell Aging* ; Fibroblasts ; Humans ; Skin ; Skin Aging

BACKGROUND/AIMS: Tacrolimus is effective for refractory ulcerative colitis in adults, while data for children is sparse. We aimed to evaluate the effectiveness and safety of tacrolimus for induction and maintenance therapy in Japanese children with ulcerative colitis.METHODS: We retrospectively reviewed the multicenter survey data of 67 patients with ulcerative colitis aged < 17 years treated with tacrolimus between 2000 and 2012. Patients’ characteristics, disease activity, Pediatric Ulcerative Colitis Activity Index (PUCAI) score, initial oral tacrolimus dose, short-term (2-week) and long-term (1-year) outcomes, steroid-sparing effects, and adverse events were evaluated. Clinical remission was defined as a PUCAI score < 10; treatment response was defined as a PUCAI score reduction of ≥ 20 points compared with baseline.RESULTS: Patients included 35 boys and 32 girls (median [interquartile range] at admission: 13 [11–15] years). Thirty-nine patients were steroid-dependent and 26 were steroidrefractory; 20 had severe colitis and 43 had moderate colitis. The initial tacrolimus dose was 0.09 mg/kg/day (range, 0.05–0.12 mg/kg/day). The short-term clinical remission rate was 47.8%, and the clinical response rate was 37.3%. The mean prednisolone dose was reduced from 19.2 mg/day at tacrolimus initiation to 5.7 mg/day at week 8 (P< 0.001). The adverse event rate was 53.7%; 6 patients required discontinuation of tacrolimus therapy.CONCLUSIONS: Tacrolimus was a safe and effective second-line induction therapy for steroid-dependent and steroid-refractory ulcerative colitis in Japanese children.
Adult ; Asian Continental Ancestry Group ; Biological Factors ; Child ; Colectomy ; Colitis ; Colitis, Ulcerative ; Female ; Humans ; Immunologic Factors ; Japan ; Prednisolone ; Remission Induction ; Retrospective Studies ; Tacrolimus ; Ulcer