Ultraviolet (UV)-induced wrinkle and pigmentation are very common in clinical practice. In this report, we presented the case of a 58-year-old man who developed wrinkle and pigmentation around right hand, face and neck for ten years. Coix-seed Reactive Derivatives (CRD) was administrated orally 2.1g twice a day for 6 months. These lesions were improved in the third month, and a dramatic response was obtained at the end of 6 months of treatment. Further research is needed to define the optimal dose and duration of CRD intake.

Friction melanosis is a cutaneous entity characterized by a brownish pigmentation distributed on the skin over bony regions of various sites including a trunk or the limbs, after the use, for many years, of a nylon towel or scrub brush to clean the skin. Moreover, repeated trauma due to friction of clothes on the skin over bony prominences are another factors characterizing its pathogenesis. In this report, we presented the case of a 58-year-old man who developed severe friction melanosis around both knees and lower extremities for about 20 years. Coix-seed Reactive Derivatives (CRD) was administrated orally 2.1g twice a day for 6 months. The lesions of pigmentation diminished markedly within 3 months. Further research is needed to define the optimal dose and duration of CRD intake against friction melanosis.

A 40-year old man with chest pain was admitted to our hospital. A three-dimensional CT revealed an unruptured left coronary sinus of Valsalva aneurysm and mild stenosis of the left main trunk. An echocardiogram revealed severe aortic regurgitation. He was operated on with an aortic root replacement procedure. Though the procedure was itself uneventful, he could not be weaned from cardiopulmonary bypass because of unexpected coronary events ; relative stenosis of the RCA and stretched LMT due to a huge aneurysm of the sinus of Valsalva. Additional CABG with LITA to LAD and SVG to RCA led to weaning from cardiopulmonary bypass. Left coronary sinus of Valsalva aneurysm is rare, and it requires early surgical intervention for an increase in the diameter of the aneurysm together with myocardial ischemia due to compression of the coronary artery.

BACKGROUND: The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. OBJECTIVE: To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. METHODS: We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). RESULTS: The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. CONCLUSION: Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission.
Asthma ; Child ; Cytokines ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-5 ; Interleukins ; Mites ; Prognosis

A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.

Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, n=31) and an OPCAB group (off, n=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, p=0.01), respiratory failure (on=58.1% : off=29.3%, p=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, p=0.01), and necessary inotropic support (on=51.6% : off=17.1%, p=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.

The patient was a 68-year-old woman with chief complaints of severe lumbago, left lateral abdominal pain and high fever. Computer tomography (CT) at a local hospital showed a left psoas abscess and a low density area around the terminal aorta. Blood tests indicated a high inflammatory response and MSSA was detected in a blood culture. Control of the infection was first attempted with antibiotics, but CT showed a pseudoaneurysm at the terminal aorta, and therefore she was transferred to our hospital. We diagnosed infected abdominal aortic and left common iliac aneurysms complicated by an MSSA psoas abscess, and performed extra-anatomic reconstruction with axillo-bifemoral bypass, aneurysmectomy and omentopexy in the psoas abscess cavity. Because of massive intestinal edema and mesentery, we attempted temporary abdominal closure with the vacuum-assisted closure (VAC) technique, and finally succeeded in closing without abdominal infection in the 6th operation, 42 days after the first operation. Infected abdominal aortic aneurysm complicated by psoas abscess is extremely rare and life threatening. The VAC technique is very effective not only in avoiding abdominal compartment syndrome but also in avoiding abdominal infection.

A 62-year old man was referred to our hospital with endocarditis. Although the infection was improved by antibiotic therapy, he underwent surgery because of severe aortic and mitral valve regurgitation. Preoperative computed tomography revealed a pseudoaneurysm of 20 mm in diameter at the posterior wall of the ascending aorta. The non-coronary cusp was infected and there was a punched-out pseudoaneurysm at the ascending aorta adjacent to the sino-tubular junction. After resection of the aortic wall and the aortic valve, a modified Bentall operation with a composite graft and mitral valve plasty was performed. Postoperative whole body computed tomography revealed no other pseudoaneurysms. In case of endocarditis, we have to consider the possibility of aneurysm formation throughout the body.

A 71-year-old man had sudden onset of left lower limb swelling and consulted an orthopedic surgeon 14 days later. Venous echography demonstrated compression of the left iliac vein and the thrombus of the common iliac vein. After emergency admission, conservative therapy was given for 7 days, but the symptoms did not sufficiently diminish and a thrombus was also present. We therefore performed femoro-iliac cross-over vein bypass using a 10mm ringed ePTFE graft. Symptoms were completely improved and the graft was shown to be patent by echography after 3 months.

A 16-year-old high school boy experienced intermittent claudication of his left lower limb during boxing training. Physical examination revealed a cold left foot and diminished pulse. A 64-row multi-slice CT (MSCT) demonstrated lateral shift and severe stenosis of the left popliteal artery due to malposition of the medial head of the gastrocnemius muscle. A diagnosis of popliteal artery entrapment syndrome (Delaney type II) was established and a surgical correction was planned. During surgery, since the artery was found to be compressed but not occluded, we simply released the popliteal artery by division of the medial head of the gastrocnemius and abnormal flips of muscle. The postoperative ankle brachial pressure index rose from “not measurable” to 1.22. MSCT was useful to characterize this anomaly by expressing the precise anatomical relation of muscle, bone and artery, which was a good guide for an appropriate surgical intervention.