A 53-year-old male with ankylosing spondylitis presented with worsening exertional dyspnea. Echocardiography revealed severe aortic regurgitation and an aortic valve replacement was performed using a mechanical valve (SJM Regent 21 mm) in consideration of his age. By the 5th postoperative week, the patient exhibited signs of worsening heart failure. On the 52nd postoperative day, intermittent prosthetic valve regurgitation was detected on echocardiography. Valve fluoroscopy revealed that the valve intermittently remained fixed in the open position, leading to a diagnosis of prosthetic valve dysfunction. Contrast-enhanced CT revealed no evidence of thrombus or tissue formation around the prosthetic valve. On the 56th postoperative day, a redo aortic valve replacement was performed with another mechanical valve (On-X 21 mm). Intraoperatively, no obvious structural abnormalities were identified. Compression of the pivot may have contributed to the dysfunction. We report a rare complication associated with a mechanical prosthetic valve.

OBJECTIVE: Donepezil is used to improve cognitive impairment of dementia with Lewy bodies (DLB). Visuo-spatial dysfunction is a well-known symptom of DLB. Non-verbal Raven’s Colored Progressive Matrices (RCPM) were used to assess both visual perception and reasoning ability in DLB subjects treated with donepezil. METHODS: Twenty-one DLB patients (mean age, 78.7±4.5 years) were enrolled. RCPM assessment was performed at the time of starting donepezil and within one year after starting donepezil. RESULTS: There were significant improvements of RCPM in the total scores between one year donepezil treatment (p=0.013), in both Set A score (p=0.002) and Set AB score (p=0.015), but trend in the Set B score (p=0.083). CONCLUSION: Donepezil is useful for improving visuo-spatial impairment in DLB, but not for problem-solving impairment.
Cholinesterase Inhibitors ; Cognition Disorders ; Dementia* ; Humans ; Lewy Bodies* ; Lewy Body Disease ; Spatial Processing ; Visual Perception

Aortic pseudoaneurysm is a rare but life-threatening complication after graft replacement. One of the main challenges of surgery is the appropriate and safe method of re-entering the chest cavity. Therefore, it is necessary to consider a strategy which includes cardiopulmonary bypass. The patient was a 64-year-old man who had undergone hemi-arch replacement for pseudoaneurysm of the native thoracic aorta 17 years previously. The exact surgical details of the previous operation were unknown. He experienced progressive chest pain for 1 month, and noticed a parasternal pulsatile mass. An enhanced computed tomographic scan revealed a pseudoaneurysm originating from the thoracic aortic artificial graft itself, which had eroded the left parasternum and which would possibly rupture out of the skin. Preoperative examinations suggested a high risk of bleeding if redo sternotomy was performed. Therefore, we decided to perform open surgical repair with a cardiopulmonary bypass with cannulation through the femoral artery and vein before resternotomy. In addition, we performed a transthoracic left ventricular venting and selective cerebral perfusion using bilateral axillary arteries, which enabled core cooling in case of uncontrollable hemorrhage. He successfully underwent redo graft replacement of the thoracic aorta, and his postoperative course was uneventful.

We evaluated risk factors for prolonged pleural effusion after surgery in 35 children who underwent total cavopulmonary connection (TCPC). Duration of their chest tube drainage was 5.4±7.0 days (1-41, median 3). In univariate analysis, significant risk factors for prolonged pleural drainage over 7 days were preoperative body weight (p=0.03), preoperative cardiothoracic ratio (p=0.03), cardiopulmonary bypass (CPB) time (p=0.02), homologous blood transfusion (p=0.03), serum protein concentration at CPB weaning (p=0.04), central venous pressure (CVP) averaged during 3 postoperative days (p=0.01) and body weight change during 3 postoperative days (p=0.01). However multivariate analysis showed only CVP averaged during 3 postoperative days was a significant risk factor for prolonged chest tube drainage (p=0.03, odd's ratio 3.3). In conclusion, to keep the central venous pressure as low as possible during the early postoperative period might decrease the duration of pleural drainage.

As part of the outreach program of the Welfare Federation of Agricultural Cooperatives in Kumamoto Prefecture, ultrasonographic examinations for abdominal diseases were carried out in rural communities from the beginning of April 1986 to the end of March 1994. A total of 119, 172 people went through the abdomen checkup during the period. In this study, we reviewed the results of the examinations with respect to the followings.
The percentage of those examinees who were found to have some impairment increased from a range of 40% to upwards 50% during the period under review. Those who were told to receive followup examinations accounted for as high as 10% of the total initially, but the percentage dropped to 2. 9%. The percentage of those actually underwent followup examinations once fell to a range of 70%, but later rose to 85%. The rate of detection of malignancies went up steadily from 0. 08 to 0. 12% year by year.
To decrease the percentage of the patients having to receive followup examinations and to increase the malignancy detection ratio, it was deemed necessary to improve echographers' skills, and establish a nost-examination care/guidance system.

From 1986 to 1991, 49 malignancies were found in sonographic examination of 53, 788 subjects carried out by the Kumamoto Prefectual Welfare Federation of Agricultural Cooperatives. The cases were composed of 12 hepatocellular carcinomas, 11 metastatic liver tumors, 11 renal cell carcinomas, 6 gall bladder carcinomas, 3 gastric carcinomas and 6 ether malignancies including metastatic pancreas tumors and ovarian tumors. A follow-up survey was made in 37 cases. All the case of renal cell carcinoma were found in an early stage and showed the best prognosis; the 2-year survival rate was 100%(n=7). In hepatocellular carcinomas 1-year and 2-year survival rates were 85% and 33%, respectively. Eight of 11 metastatic liver tumors were f rom gastrointestinal malignancies, and prognosis was poor; 1-and 2-year survival rates were 44% and 37%, respectively. Gastric carcinomas were found with lymphadenopathy or the thickening of the gastric wall, so prognosis was quite poor. Abdominal sonography has proved to be a very convenient and safe procedure to find out malignancies in the early stage. In detected (asymptomatic) cases of renal cell carcinoma, prognosis was excellent.