In patients with type I CD 36 deficiency, immunization with CD 36 antigen (Nak^a) through pregnancy or transfusion, could produce anti-CD 36 antibody (anti-Nak^a), and potentially lead to platelet transfusion refractoriness or posttransfusion purpura. We report a 72-year-old woman who had no history of pregnancy or previous blood transfusions. She had been treated medically for hypertension and heart failure since the age of 65 years. Type I CD 36 deficiency was also diagnosed based on the findings of ¹²³I-β-methyl-iodophenyl pentadecanoic acid cardiac scintigraphy. At 72 years of age, she suffered acute thromboembolism in the left external iliac artery. The thrombus was removed and a left external iliac artery to left superficial femoral artery bypass was performed without any blood transfusion. Echocardiography, left ventriculography and coronary angiography showed left ventricular aneurysm and coronary artery disease. Resection of the left ventricular aneurysm and coronary artery bypass grafting were performed without donor blood transfusion. Autotransfusion by autologous blood donation and intraoperative autologous blood transfusion was used to avoid sensitization by the CD 36 antigen through donor blood transfusion. Autotransfusion should be performed to avoid complications associated with donor blood transfusion particularly in patients with type I CD 36 deficiency.

The patient was a 75-year-old woman, who had been treated for tuberculosis by artificial right pneumothorax at the age of 25. Although a cardiac murmur had been pointed out in her infancy, no treatment had been recommended because she had no symptoms. Effort dyspnea augmented along with her aging by degrees. She began to need oxygen therapy at the age of 75. She had her calcified ductus arteriosus. The systemic to pulmonary blood flow ratio (Qp/Qs) was 1.89. We diagnosed that pulmonary dysfunction after artificial right pneumothorax and pulmonary hypertension caused by persistent ductus arteriosus were the cause of her symptoms. After median sternotomy we closed the persistent ductus arteriosus using a patch through the pulmonary artery under cardiopulmonary bypass. Although she needed respiratory management with a ventilator for 2 days and oxygen therapy for 4 weeks, she has been doing well afterwards. We think that we should close persistent ductus arteriosus even in the elderly.

The patient was an 86-year-old man, whose medical history included pulmonary tuberculosis, pulmonary emphysema, hypothyroidism, subtotal gastrectomy for gastric cancer and proctectomy for rectal cancer. Since he suffered sick sinus syndrome (bradycardia-tachycardia syndrome), a DDD pacemaker was implanted using the right subclavian vein approach. Three months later, he suffered from a pacemaker infection of Methicillin-resistant Staphylococcus aureus. We performed extraction of the infected pacemaker system and implanted a new pacemaker. Because he had thoracic deformity, colostomy, and was in poor condition in general, we implanted the myocardial electrode through a small thoracotomy at the 6th costal bed under local anesthesia. The postoperative course was uneventful and there was no relapse of infection. Although this method is conventionally performed under general anesthesia, it is also possible to perform it under local anesthesia in selected patients. This method could be an alternative when endocardial electrode insertion is very difficult.

Laparoscopy-assisted distal gastrectomy (LADG) has been advocated as a minimally invasive operation for early gastric cancer which needs regional lymph node resection. However, since it is technically too complicated and difficult to perform all laparoscopic procedures within the abdominal cavity, LADG has not become the standard surgical procedure for early gastric cancer. Moreover, a skin incision of approximately 5cm is required to allow the reconstruction of the digestive tract after gastrectomy. Therefore, we have developed an operative procedure which we call hand-assisted laparoscopic distal gastrectomy (HALDG). In this procedure we make a skin incision of 6cm, and the surgeon inserts his/her left hand into the abdomen to assist the laparoscopic procedure. The surgeon can move his/her left hand freely, to palpate and explore the organs, as in an open surgery. Therefore, the operation time can be shortened. Our results thus far obtained demonstrated that HALDG was as safe and effective as open distal gastrectomy. HALDG assures the patients a better quality of life, --less surgical trauma, less pain, speedy return to dialy life activities. Thus, it is beneficial to the patients with early gastric cancer. We, therefore, advocate the use of HALDG in such cases.
Gastrectomy ; Stomach Cancer ; Hand ; Procedures ; Pulmonary evaluation

Bacterial infection associated with the use of medical or dental devices is a serious concern. Although devices made of ethylene vinyl acetate (EVA) are often used in the oral cavity, there are no established standards for their storage. We investigated bacterial survival on EVA sheets under various storage conditions to establish a standard for hygienic storage of such dental devices. Bacterial counts were evaluated, which showed a significant decrease after washing with sterilized water, mechanical brushing and rinsing, and using Mouthguard Cleaner as compared to untreated samples. In addition, no bacteria were detected on samples stored 2 days or longer in a ventilated environment, whereas they were detected for up to 14 days on samples without any cleaning stored in a closed environment. Bacterial counts for the untreated samples gradually declined, while surviving bacteria on samples treated with sterilized water and mechanical brushing showed a rapid decrease. Additionally, bacterial identification using polymerase chain reaction (PCR) revealed that Streptococcus oralis was dominantly detected on salivary samples after 14 days of storage among both two subjects. For effective hygienic storage of dental devices made of EVA, washing with sterilized water is important to remove absorbed salivary compounds along with storage in a ventilated environment.
Adult ; Colony Count, Microbial ; Decontamination ; methods ; Dental Equipment ; microbiology ; Equipment Contamination ; Humans ; Microbial Viability ; Molecular Typing ; Polyvinyls ; Saliva ; microbiology ; Streptococcus ; physiology ; Time Factors ; Water ; Young Adult