Papillary muscle rupture, a complication of acute myocardial infarction, causes acute mitral valve regurgitation. However, to date, only a few articles have reported PMR associated with coronary spasm. In this article, we report the case of a 64-year-old woman who suffered posteromedial papillary muscle rupture caused by coronary spasm or Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA), and was successfully treated with mitral valve repair.

Spinal tuberculosis usually occurs in a single vertebral body or two to three adjacent vertebrae; it rarely occurs in multiple vertebral bodies. Surgery is indicated in cases that do not improve with conservative therapy, or when paralysis is evident. Two cases regarding patients with spinal tuberculosis in multiple vertebral bodies on whom surgery was performed are reported. Case 1, the patient was a 77-year-old woman with spinal tuberculosis in four vertebral bodies from the lower thoracic to the lumbar spine. As she had pronounced lower back pain, posterolateral fusion with a pedicle screw was performed. Case 2, the patient was a 29-year-old Indonesian man with spinal tuberculosis in 17 vertebral bodies of the spine who was unable to stand due to paralysis of both legs, thus posterolateral fusion with a pedicle screw was performed. Good results were obtained from tuberculostatic drug therapy and surgical instrumentation.
Adult ; Aged ; Antitubercular Agents ; Female ; Humans ; Low Back Pain ; male ; Paraplegia ; Spine ; Surgical Instruments ; Tuberculosis ; Tuberculosis, Spinal

The aim of this study was to clarify the comorbidities of patients with Leriche syndrome and ischemic heart disease. We enrolled 26 patients with Leriche syndrome and who had undergone preoperative coronary angiography were enrolled. The comorbidities of diabetes, hypertension, and coronary artery disease developed in more than half of Leriche patients with Leriche syndrome. Marked coronary artery disease was diagnosed in 14 patients, 7 of whom underwent coronary artery bypass surgery. The Revascularization procedures performed in patients with Leriche syndrome were anatomical aortofemoral bypass in 15 and an extra-anatomical axillofemoral bypass in 9. In 2 cases of extra-anatomical bypass, occlusion developed in the long-term.

It has been demonstrated that atrial fibrillation (AF) frequently occurs after coronary artery bypass grafting (CABG) and may cause cerebral infarction. The purpose of this research is to clarify the risk factors of AF in patients who underwent off-pump CABG (OPCABG). In this study, 142 patients (111 men and 31 women) were enrolled with an average age of 67 years old (range, 33-83). According to multivariate analysis, age and the preoperative peak early (E)/late (A) diastolic velocities ratio (E/A) were the independent predictors of postoperative AF. Patients who suffered from postoperative AF required a significantly longer hospital stay.

A 75-year-old man received a diagnosis of an abdominal aneurysm and underwent abdominal aortic replacement. His left internal iliac artery was sacrificed because of the difficulty of reconstruction. Rhabdomyolysis of the left gluteus muscle resulted in acute renal failure (ARF) postoperatively. Continuous hemodiafiltration (CHDF) was performed from postoperative day (POD) 1 through POD 10 for the management of his ARF. During CHDF, the maximum value of serum creatinine was 5.10 mg/dl and it returned to the normal range of 1.10 mg/dl on POD 20. We conclude that the early deployment of CHDF was effective in rhabdomyolysis-induced ARF.

Purpose: In terminally ill patients with advanced cancer,it is recognized that delirium is reversible in 20-50% of the patients with it. Identification of its cause is vital to ensure the quality of life of the patients with delirium at the end of life. We would like to report a case of the advanced cervical cancer patient with delirium, successfully treated by intravenous administration of vitamin B1. Case: An 83-year-old woman, who was diagnosed the advanced cervical cancer with carcinomatous peritonitis, was admitted to Shizuoka Cancer Center Palliative Care Unit. Four days after the admission, she presented sleep-wake cycle disturbance, poor attention, poor concentration,and short-term memory loss, and these conditions were diagnosed with delirium. Vitamin B1 deficiency was suspected by normal examinations including laboratory results and head computed tomography except for the low level (19ng/ml) of vitamin B1. One week after starting intravenous administration of vitamin B1, the symptoms of delirium were improved. Conclusion: In this case, delirium by vitamin B1 deficiency developed even though having adequate oral intake (about 1,000kcal/day), indicating malabsorption of vitamin B1 due to hypoperistalsis and edema of the bowel. Advanced cancer patients can easily develop vitamin B1 deficiency due to inadequate oral intake, increased consumption of vitamin B1 and malabsorption of vitamin B1. Therefore,the examination of vitamin B1 deficiency is necessary for patients with delirium that cannot be specified. Palliat Care Res 2009; 4(2): 330-333

We reviewed our experience with 19mm size aortic valve prostheses for cases with small aortic annulus. Forty-six patients operated on between 1990 and Septembr 2002 were enrolled in this study. Clinical late assessment was performed to evaluate the incidence of valverelated complications, residual transprosthetic gradient, left ventricular mass index (LVMI), and NYHA functional class. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Follow up was 1 to 12.7 years (mean 5.3±3.6). There was no hospital mortality (0%). Actuarial survival rates at 10 years were 81.4±1.5%. The late postoperative peak gradient was 25±11mmHg. LVMI was significantly reduced in late phase. NYHA functional class significantly improved in the late period. Although 19mm size aortic valve prosthesis remains small transprosthetic pressure gradient, LVMI significantly reduced and patient activity was satisfactory maintained in the late period.

Abdominal aortic aneurysms (AAA) are frequently associated with clinically significant coexistent ischemic heart disease (IHD). Cardiac events are the most common cause of death after AAA repair. Preoperative coronary evaluation and revascularization have been recommended to reduce postoperative cardiac complications following AAA repair. In this study, we retrospectively reviewed all patients who underwent AAA repair and compared operative results in patients with and without IHD. Of 388 patients who underwent elective AAA repair, 382 (98.5%) had aortography and coronary angiography for preoperative evaluation. Significant coronary artery disease was seen in 124 patients (32.5%). As a result of the evaluation, 46 patients (12.0%) were considered candidates for medical therapy, 18 for percutaneous coronary intervention (PCI), and 60 for coronary artery bypass grafting (CABG). In 24 patients (6.3%) who needed CABG and had large sized AAAs (>60mm), simultaneous CABG and AAA repair were performed. In the remaining 36 patients (9.4%) who needed CABG and had medium sized AAAs (40mm<, <60mm), staged operation was performed. We performed retrospective review comparing postoperative cardiac events and operative mortality among these treatment groups. There were 5 operative deaths (5/388, 1.3%) in patients following AAA repair. There were 2 operative deaths (2/124, 1.6%) in patients with significant IHD and 3 deaths (3/258, 1.2%) without IHD. In patients with IHD, 1 patient who received medical therapy died of acute renal failure and another one who received PCI died of acute myocardial infarction. There were no operative deaths or cardiac-related events in patients who received CABG before or concomitant AAA repair. There was only 1 cardiac-related event in all patient groups following AAA repair. Coronary arteries were preoperatively evaluated in almost all patients with AAA. If IHD was significant, the treatment for the IHD preceded AAA repair. Our strategy succeeded in reducing operative mortality and cardiac-related events in patients with both AAA and IHD. If a patient with a large sized AAA (>60mm) needs CABG, one-stage operation is recommended.

Dacron prostheses are the most widely used grafts in replacement procedures for abdominal aortic aneurysms, but they are not perfect grafts. We encountered a rare case of late graft complication. A 66-year-old man was admitted to our hospital with a pulsatile mass in an abdominal operation scar. He had received placement of a Y-shaped Cooley double velour knitted Dacron graft 18 years previously. Computed tomography and angiography demonstrated graft dilatation and an aneurysm. After resection of the graft aneurysms, the operative findings showed a non-anastomotic aneurysm formation due to longitudinal division near the graft guideline. In this case, this graft failure may have been due to the deterioration of the filter of the Dacron prosthesis itself. Therefore it is important to perform careful long-term follow-up in patients with implanted Dacron arterial prostheses.

Bypass grafting from the ascending thoracic aorta to the common iliac artery was performed to manage proximal hypertension in a patient with atypical coarctation of the thoracic aorta. The patient's history was significant for an acute aortic thrombosis at the level of the diaphragm for which she underwent an axillo-bifemoral bypass grafting as an emergency operation. Although she was doing well following the initial bypass grafting, the second bypass grafting was required to treat proximal hypertension refractory to medical management. The axillo-femoral bypass graft had a smaller diameter and a longer subcutaneous distance, and the blood supply to the abdominal viscera may have been insufficient. The proximal hypertension was well controlled following ascending thoracic aorta to common iliac bypass, because the diameter (16mm) of the graft is larger than that of the axillo-bifemoral bypass graft (8mm).