A 77-year-old woman presented three months after an inferior myocardial infarction with congestive heart failure, a 7-mm posterior ventricular septal rupture (VSR), moderate functional mitral and tricuspid regurgitation, and critical stenoses of the right coronary and circumflex arteries. To avoid a ventriculotomy, we repaired the defect through a trans-tricuspid right-atrial approach using a double 25×25 mm bovine-pericardial patch secured with eight 4-0 polypropylene vertical mattress sutures. Two-vessel coronary artery bypass grafting was completed on the beating heart, followed by mitral and tricuspid annuloplasty. Cardiopulmonary bypass and aortic cross-clamp times were 231 and 113 min, respectively. The postoperative course was uneventful without mechanical circulatory support. Echocardiography confirmed complete closure of the VSR and elimination of both valvular regurgitations, and the patient was discharged home on postoperative day 30. This case illustrates that a trans-tricuspid double-patch technique can achieve secure closure of chronic posterior VSR while preserving ventricular function and permitting simultaneous valve repair and revascularization.

The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.

The inactivation efficiencies of microorganisms were found to be enhanced by using silver solution together with ultraviolet light (UV-A, 395 nm) irradiation. The inactivation efficiencies were improved remarkably especially in eukaryotic microorganism. To make clear the inactivation mechanism of microorganisms by the combination effect of silver and ultraviolet light irradiation, the resultant solution was characterized by ESR (Electron spin resonance, ESR). Scanning electron microscopy (SEM) and the methnd for measuring enzyme activity of mitochondria for eukarvotic cells were used to conjecture the mechanism, by analysis of the morphological and physiologic changes in eukaryotic cells. It is proposed that silver oxide (Ag20) can be activated by ultraviolet light irradiation and react with water molecules to produce hydroxyl radical (.OH). Hydroxyl radical could damage cell wall of eukaryotic microorganisms, and inactivate the enzyme activity of mitochondria of eukaryotic microorganism cells. Accordingly, eukaryotic microorganism cells would die. In the experiment, Staphylococcus aureus was employed as the representative of prokaryotic microorganisms, and Candida albicans and Trichophyton mentagrophytes as the representative of eukaryotic microorganisms, respectively. Moreover, the results of the technology applied to washing machine were presented and discussed.
Anti-Infective Agents ; pharmacology ; Candida albicans ; drug effects ; radiation effects ; Disinfection ; methods ; Household Articles ; Silver ; pharmacology ; Staphylococcus aureus ; drug effects ; radiation effects ; Trichophyton ; drug effects ; radiation effects ; Ultraviolet Rays

A 75-year-old man was referred to our hospital with dyspnea on effort, recurrent attacks of loss of consciousness and abnormal shadow on chest X-ray film. Computed tomographic scan confirmed a 1.5×2.0cm mass with slight spiculation in the right lower lobe (S6) and revealed an ovoid right atrial mass. Transthoracic echocardiography showed that the giant mass which filled most of the right atrium had no mobility. Coronary angiography revealed clusters of new vessels which originated from the atrial branches of the circumflex coronary artery. A T1-weighted MRI scan demonstrated that the mass was isointense relative to the adjacent myocardium. We considered that performing cardiac surgery prior to pulmonary resection, as in a staged procedure, would have advantages in morbidity. We first performed removal of the right atrial tumor which was a 6.8×5.5×4.5cm shiny mass attached to the interatrial septum. Histological examination of the mass confirmed the diagnosis of cardiac myxoma. Three months later, right S⁶ segmentectomy was carried out using thoracoscopy and the tumor was finally diagnosed as squamous cell carcinoma. We have followed the patient for about 10 months after the first operation and there is no evidence of tumor recurrence and no more syncopic attacks.

A 16-year-old schoolgirl had aortic valve insufficiency, detected incidentally on electrocardiogram taken for a physical checkup. She was noted to have hyperextensibility of joints, hyperelasticity of the skin and an atrophic scar over the knees on physical examination and type II Ehlers-Danlos syndrome (EDS) was diagnosed by skin biopsy after admission. A Carpentier-Edwards pericardial bioprosthesis was chosen for aortic valve replacement because she was of childbearing age and had EDS. Seven years after the replacement she became pregnant, resulting in spontaneous vaginal delivery of a healthy male infant at 39 weeks. However, a second aortic valve replacement was staged for structural failure of the bioprosthesis which was accelerated during the gestation. Aortic valve re-replacement was carried out using a 21-mm Sorin Bicarbon mechanical prosthesis 4 months after the delivery. She was discharged on the 10th postoperative day without any complications.

A 77-year-old man with diabetes mellitus and hypertension presented with acute onset of pain and swelling of the right thigh. Physical examination showed a pulsatile mass in the mid-portion of the right thigh. Computed tomography revealed the presence of a 7-cm diameter aneurysm at superficial femoral artery with gas shadow around the aneurysmal wall. A diagnosis of infected superficial femoral aneurysm was made and emergency surgery was undertaken. The total resection of the aneurysmal wall, debridement of necrotic tissues including part of sartorius and quadriceps muscles were done. Femoro-popliteal bypass through subcutaneous route using a 6-mm diameter Dacron prosthesis was used as the mean of vascular reconstruction procedure. Citrobacter koseri was cultured from the infected aneurysmal wall. The antibiotic treatment was continued for total of 2 weeks. Although additional debridement was required, the patient was amkulabony when discharged on the 37th postoperative day.

A 75-year-old woman presented with chest pain on exertion. Cardiac catheterization revealed double vessel coronary artery disease. Echocardiographic examination showed the presence of an abnormal mass in the interatrial septum without any flow velocity signal within the mass. She was scheduled for elective coronary artery bypass grafting. The lesion appeared as a homogeneous mass on CT scan, with an attenuation coefficient of -122 Hounsfield units, suggestive of lipoma. A T1-weighted MRI scan demonstrated that the signal intensity of the interatrial mass corresponded to that of fatty tissue. On surgery with cardiopulmonary bypass a large mass was found to involve the right atrial wall, the interatrial sulcus and the interatrial septum. The mass could not be resected completely, because it adhered strongly to the septal myocardium. On histological examination, the tumor was composed of mature fatty tissues, was not encapsulated and was diagnosed as infiltrating lipoma. The postoperative course was uneventful. CT, MR imaging and color Doppler ultrasonography were very useful in making a tissue-specific diagnosis.

Spa therapy has been performed at our medical center for last 20 years. The changes in number and frequency of patients with respiratory disease were analyzed every 5 year for last 20 years. The total number of patients with respiratory disease who were admitted at our medical center for last 20 years was 1934, of whom the number of patients with asthma was 1226 (63.4%), and the number of those with COPD was 415 (21.5%). The number of patients with asthma treated with spa therapy showed a tendency to increase form 57 for the first 5 years (first stage) to 465 for the last 5 years (forth stage). The number of patients with COPD also increased from 26 for the first 5 years to 227 for the last 5 years. The frequency of SDIA decreased from 68.4% for the first 5 years to 29.0% for the last 5 years. In contrast, the frequency of pulmonary emphysema increased 19.2% at the first stage to 76.7% at the forth stage. The number and frequency of elderly patients with asthma and COPD over the age of 60 tended to increase for last 20 years.

N-3 fatty acids are reportedly effective for asthma. In addition, spa therapy has been reported to be effective for patients with asthma. In the present study, the effects of spa therapy combined with perilla seed oil-rich diet (rich in n-3 fatty acid) were examined on asthma. A total of 14 asthmatic patients had a complex spa therapy and consumed a perilla seed oil-rich diet-rich in α-linolenic acid (α-LNA) for 8 weeks. Generation of leukotriene (LT) C4 by leucocytes, respiratory function were analyzed. The generation of LTC4 by leucocytes decreased significantly for 2, 4 and 8 weeks (P<0.05). Peak expiratory flow (PEF) values increased significantly for 2, 4, 6 and 8 weeks (P<0.05). The values of ventilatory parameters [forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), forced expiratory flow after 25% of expired FVC (FEF₂₅), forced expiratory flow after 75% of expired FVC (FEF₇₅), mean expiratory flow during the middle half of the FVC (FEF_25-75)] revealed a significant increase after 4 and 8 weeks of the modified diet (P<0.05). The results suggest that spa therapy combined with a perilla seed oil-rich diet are effective in the treatment of asthma in terms of its ability to suppress LTC4 generation by leucocytes, and in inducing an improvement of pulmonary function.

A semicomatose 53-year-old woman who had been injured in an automobile accident was admitted. Injury to the thoracic descending aorta was suspected because of widening of the upper mediastinum on a chest X-ray film and confirmed by chest contrast-enhanced computed tomography (CT). We postponed surgical treatment because brain CT showed traumatic intracerebral hemorrhage. She was maintained in an intensive care unit and had pharmacological treatment and medical support. Two days later, brain CT showed that the intracerebral hematoma was a stable and inactive lesion, so she underwent aortic repair 3 days after the accident. Left thoracotomy was performed and an artificial vascular prosthesis was interposed under hypothermic circulatory arrest (open proximal method). The postoperative course was uneventful and the patient was discharged 44 days after the operation. Hypothermic circulatory arrest may be a valuable adjunct for traumatic injury of the thoracic aorta at risk for impending rupture.